[Chronic bismuth poisoning with encephalopathy and dementia]. / Chronische Wismutintoxikation mit Enzephalopathie und Demenz.

A 58-year-old woman developed severe progressive dementia. Markedly impaired memory, apraxia and abnormal behaviour with psychotic components suggested Alzheimer's syndrome. But there were atypical signs, namely abnormal coordination, occasional tremors and dysarthria. A search for a possible toxic cause was at first unsuccessful, but by chance a "gastric power" containing 0.1 g of bismuth gallate per gram of powder, was found in her night-table. The patient had taken it regularly over years, at a dosage of up to 1.5 g daily, to combat gastric acidity. Six days after stopping the drug the blood bismuth level was 70 micrograms/l, which within 1-2 months fell to 9 micrograms/l. After 4 1/2 months in hospital the patient was discharged in a good general condition and with normal intellectual function.

[Oligofascicular median nerve compression syndrome]. / Oligofaszikuläres Medianus-Kompressionssyndrom.

The anterior interosseous nerve syndrome is described as a compression of this nerve by a fibrous band in the region of the pronator teres or the flexor digitorum superficialis muscle. We report a case which appeared clinically as an anterior interosseous nerve syndrome but on exploration no fibrous band was present. The compression involved exclusively the fascicles in the main trunk of the median merve which form more distally the anterior interosseous nerve. The damage fascicles were resected and interfascicular nerve grafting was performed. After 16 months motor function has recovered well. Recently a similar case was observed.

Temperature and endocrine activity during sleep in man. Activation of cortisol and thyroid-stimulating hormone, inhibition of human growth hormone secretion by raised or decreased ambient and body temperatures.

1. Polygraphic night sleep recordings in eight healthy male volunteers with simultaneous measurement of rectal temperature, plasma growth hormone (HGH), cortisol, and TSH concentrations were performed during normal, raised, and lowered ambient and body temperature. 2. There was a statistically significant increase in plasma cortisol and TSH levels during cold nights with a smaller rise during high temperatures. 3. Growth hormone levels, measured as the mean highest plasma concentration in the first two NREM-REM sleep cycles, were slightly lower during hot and cold nights than corresponding baseline values. It is suggested that there may be an inverse relation between ACTH and HGH secretion by the anterior pituitary gland. 4. During the nights of high ambient temperature, decreased total duration of sleep and particularly low values of paradoxical sleep were observed. Night sleep in low ambient temperature with a significant decrease of body temperature is not different from baseline conditions. 5. The results suggest that a pronounced increase in stress hormone secretion may occur without changes in polygraphic EEG criteria.

[Diagnosis of internal carotid artery obstructions (author's transl)]. / Die diagnostik von stenosen oder Verschlüssen der A. carotis interna mit der direktionellen Ultraschall-Doppler-Sonographie der A. supratrochlearis

The diagnostic value of directional ultrasound Doppler-sonography (UDS) of the supratrochlear (medial frontal) artery was evaluated by examination of 191 angiographically controlled cases in whom a carotid obstruction was suspected. A systematic compression of the facial and temporal arteries of both sides was performed. In 108 cases the UDS findings were normal, 6% of these were false negative and actually had a stenosis (n = 6) or occlusion (n = 2) of the internal carotid artery. In 88% of the pathological findings a stenosis (n = 39) or occlusion (n = 34) of the internal carotid artery was revealed by angiography. 79% of the stenoses were of severe degree (more than 50%). These results show that UDS is a useful diagnostic tool for the detection of severe stenoses or occlusions of the internal carotid artery. A distinction between stenosis and occlusion by UDS of the supratrochlear artery is, however, not possible, unless additional examination of the carotid arteries is performed. The method is not suitable for the detection of low grade stenoses.

[Liberation of growth hormone and melanocyte-stimulating hormone in natural and melatonin-induced human sleep (author's transl)]. / Freisetzung von Wachstumshormon und von Melanozyten stimulierendem Hormon im durch Melatonin gebhnten Schlaf beim Menschen

As in the early period of night sleep, plasma levels of human growth (HGH) are markedly elevated in afternoon sleep in healthy young males. Melatonin (50 mg i.v.) induces marked secretion of HGH when sleep is prevented. It decreases latencies for sleep onset and deep sleep significantly, and markedly enhances peak secretion of HGH during slow-wave sleep. Plasma melanocyte-stimulating hormone (betal-MSH) levels were influenced neither by melatonin nor by sleep.

[Two-dimensional ultrasonic diagnosis of brain tumors and subdural hematomas by electronic sector scanning (author's transl)]. / Zweidimensionale Ultraschall-Diagnostik von Hirntumoren und Subduralhämatomen mit dem elektroinischen Sektor-Scan

Electronic sector scanning (ESS) is a new two-dimensional ultrasonic technique which provides continuous and instantaneous cross-sections of intracranial structures through the intact skull, including the ventricles and large cerebral arteries, by means of a stationary probe. 2. The efficiency of the ESS in the diagnosis of brain tumors and extracerebral hematomas in 295 neuroradiologically controlled cases out of an unselected number of patients during 1972-1974 is described. 3. Supratentorial brain tumors can be detected directly with the ESS by abnoramal reflections of the tumors as well as indirectly by displacement of intracranial reference structures, mainly the ventricular borders. In 239 cases of suspected brain tumor, 126 were neurodiologically confirmed as supratentorial brain tumors. Among these 126 brain tumors the correct localization was determined by the ESS in 86.5%. 4. The highest reliability of the ESS proved to be the direct demonstration of frontal tumors (93%), whereas space-occupying lesions near the midline could be shown only in 79%. Up to now there have been difficulties in the diagnosis of tumors situated near bony structures, e.g., calvarian meningiomas. 5. Subdural hematomas (56 patients) could be lateralized correctly in 93%. Hwever, direct demonstration of the border of the hematomas could be achieved only in 48,2%. Chronic subdural hematomas in children are easier to recognize and the border could be demonstrated in 18 out of 19 cases. 6. The clinical applicability and diagnostic values of the ESS as a nontraumatic investigation procedure are discussed in comparison to cerebral angiography, pneumoencephalography, brain scintigraphy, and CAT scan. scintigraphy, and CAT scan.