[Alternative therapy concept for the treatment of psychosomatic disorders. Controlled double-blind evaluation of fluspirilene versus bromazepam]. / Alternatives Therapiekonzept zur Behandlung psychosomatischer Beschwerden. Kontrollierte Doppelblind-Prüfung von Fluspirilen versus Bromazepam.

Today, Fluspirilene 1.5 mg i.m. (Imap 1,5 mg), is used to treat psychosomatic conditions, anxiety states and psychogenic disorders. The present article reports on clinical studies involving these indications. The efficacy of Fluspirilene 1.5 mg i.m. was demonstrated in patients with functional organic complaints, autonomic emotional symptom complexes, patients with anxiety, patients with functional heart complaints, and patients with functional gynaecological disorders. The results of a controlled study of 1.5 mg Fluspirilene i.m. and 6 mg Bromazepam are discussed. Forty-five patients from a neurologist's practice participated, all of whom had been classified as treatment-requiring patients with neurotic anxiety, on the basis of the physician's diagnosis and psychometric examination. Treatment lasted 42 days. The clinical assessment by the physician revealed that 1.5 mg Fluspirilene i.m. is significantly more effective than Bromazepam. The psychometric findings showed that patients with marked somatic anxiety treated with Fluspirilene showed greater improvement as expressed in a reduction in anxiety, lightening of mood, and increased activity, as compared with Bromazepam.

[Symmetric cerebral calcification associated with disturbed parathyroid function (author's transl)]. / Symmetrische, intrakranielle Verkalkungen bei gestörter Nebenschilddrüsenfunktion.

Alteration of the metabolism of calcium and phosphate may be associated with symmetric cerebral calcification. Detailed investigations of the function of parathyroid glands including computer tomography of the brain are so far missing. In 6 patients with clinical and biochemical signs of altered function of the parathyroid glands symmetric cerebral calcification could be demonstrated by computer tomography. They are also visible by X-ray examination in one patient. Consequently, functional disturbances of the brain, cerebellum and of the extrapyramidal system may occur. Moreover, the combination of hypoparathyroidism and hypothyroidism also appears to result in the development of symmetric cerebral calcification. The pathogenesis of the calcification as well as therapeutic approaches will be discussed.

Morphometric studies of the neuropathological changes in choreatic diseases.

The striatum, pallidum and subthalamic nucleus were studied by combined morphometric methods in serial sections of 13 brains of normal adults and of 15 patients with choreatic diseases. In addition the volume of the hemispheres and of the cortex were measured. All data obtained were corrected by the shrinkage factor to represent fresh brain values. In Huntington's chorea the pallidum was more severely affected than is commonly appreciated. The average volume reduction was of the same degree (lateral-57%, medial-50%) as that of the striatum (-56%). The absolute number of nerve cells of the pallidum decreased in both segments by about 40%. The reduction of the volume and of the number of nerve cells was not reduced in the three subcortical nuclei studied. For the first time it has been shown that there is no increase in the absolute number of glial cells in the striatum. The increased numerical density of glial cells is caused by shrinkage. The loss of nerve cells of the pallidum and subthalamic nucleus is caused mainly by a primary process. Huntington's chorea is a multifocal process. Morphometric data do not suggest that subchorea is a variant of Huntington's chorea. Chorea minor is regarded as a multifocal process with varying affliction of the striatum, pallidum and subthalamic nucleus. An increase in the number of glial cells and, as a rule, a moderate loss of nerve cells were found in this disease.

[Morphometric-statistical structure analysis of human striatum, pallidum and nucleus su-thalamicus. III. Nucleus subthalamicus]. / Morphometrisch-statistische Strukturanalysen des Striatum, Pallidum und Nucleus subthalamicus beim Menschen III. Nucleus subthalamicus

1. A morphometric-statistical analysis of the subthalamic nucleus was carried out on 14 hemispheres of 12 normal human brains. 2. The values determined in paraffin embedded sections were corrected for shrinkage which showed considerable interindividual variation. 3. The mean fresh volume of the subthalamic nucleus amounted to 144 mm3 for males and 134 mm3 for females, the difference of 7% not being statistically significant. 4. In the medial part of the subthalamic nucleus the nerve cells were smaller and more closely grouped than in the lateral part which had larger nerve cells. The ratio of the volumes of the two parts was about 1:4 (medial: lateral). 5. The nucleus subthalamicus occupied 0,027% of the volume of the hemisphere. 6. The numerical nerve cell densities -- corrected for shrinkage -- were 1970 +/- 145 nerve cells/mm3 for the lateral part and 2910 +/- 310 nerve cells/mm3 for the medial part, this difference of 48 +/- 4% being highly significant. On the other hand, no difference between sexes could be shown. 7. The mean of the absolute number of nerve cells was 306000 for male and 286000 for females, the difference of 7% not being significant. 8. The volumetric nerve cell densities were found to be 1.58 +/- 0.15 vol% lateral and 1.99 +/- 0.16 vol% medial, the difference of 27% being significant. No differences between sexes were found. 9. The linear dimensions of the nerve cells of the medial part were about 10% smaller than those of the nerve cells of the lateral part. The mean fresh volume of a nerve cell was 8070 mum3 in the lateral portion and 6960 mum3 in the medial portion, the nerve cells of pars lateralis being just as large as the nerve cells of the lateral segment of the pallidum (8100 mum3). 10. The parameters determined showed good correlations with corresponding data of the pallidum. The fresh volume and the absolute numbers of nerve cells of the nucleus subthalamicus were better correlated with the pallidum laterale than with the pallidum mediale.

[Morphometrical-statistical structure analysis of human striatum, pallidum and subthalamic nucleus]. / Morphometrisch-statistische Strukturanalysen des Striatum, Pallidum und Nucleus subthalamicus beim Menschen

1. A morphometric-statistical analysis was carried out of fifteen hemispheres of thirteen normal brains of human adults. 2. A comparison of the volumes and the cell densities studied in serial sections is only meaningful if the results are corrected for shrinkage, which varies interindividually to a great extent. 3. The mean of the fresh volume of the striatum of the male subjects (10.2 cm3) was 12% higher than that of the female subjects (9.0 cm3), the difference not being significant. The putamen was 13% bigger on the average than the caudate nucleus. The size of the two nuclei was strictly correlated (r = 0.81). 4. The relative volume of the striatum in percent of the hemisphere volume amounted to 1.87% in males and 1.97% in females, of the putamen 0.99% (male) and 1.05% (female), of the caudate nucleus 0.88% and 0.92%, respectively. 5. The mean of the numerical density of small striatal nerve cells (kl. Nz) -- corrected for shrinkage -- came to 1100 kl. Nz/mm3, without evidence of being dependent of sex or age. 6. The corrected numerical density of the large striatal nerve cells (gr. Nz) had a mean of 65 gr. Nz/mm3 with a wide range of 49 to 78 gr. Nz/mm3, without a significant influence of sex or age. 7. The relation of kl. Nz/gr. Nz was on an average of 171:1 with a range of 130:1 to 258:1. 8. The mean of the corrected numerical density of glial cells (Gz) was found to be 41000 Gz/mm3 with a range of 34500 to 49200. Neither a difference between sexes nor a dependency of age was found. 9. The glia index (Gz/Nz) showed a mean of 37:1 with a range of 3.2:1 to 4.7:1. 10. The total number of small striatal cells averaged 100 million for males and 105 Million for females; for the large striatal cells the means were 670 thousand (male) and 570 thousand (female). Differences due to sex failed to be significant. 11. The total number of glial cells decreases with age. The mean of 408 million for males exceeded the mean of 380 million for females by 7% but without significance. 12. The volumetric density of nerve cells of males (4.03 Vol.-%) and females (4.14 Vol.-%) differed very little. 13. The mean fresh volume of a single small nerve cell in the striatum was calculated to be about 3600 mum3, ranging from 2600 to 4600 mum3. 14. The striatal nerve cells reached a total volume of 423 mm3 in males and 374 mm3 in females. 15. The mean of the diameter of the nucleus of the small nerve cells was calculated to be 8.64 mum in males and 8.70 mum in females.

[Morphometrical-statistical structure analysis of human striatum, pallidus and subthalamic nucleus. II. Globus pallidus]. / Morphometrisch-statistische Strukturanalysen des Striatum, Pallidum und Nucleus Subthalamicus beim Menschen. II. Pallidum

1. The pallidum of 13 hemispheres of 11 human brains of normal adults was studied by morphometric-statistical methods. 2. The values obtained on paraffin-embedded frontal serial sections were corrected individually for shrinkage in order to get comparable fresh values. 3. The mean fresh volume of the pallidum laterale of males (1220 mm3) was 13% higher than that of females (1065 mm3). The corresponding mean values of the pallidum mediale were 520 mm3 (male) and 430 mm3 (female), the difference being 17%. The difference between sexes failed to be significant. The lateral segment accounted for about 70% of the total volume of the pallidum. 4. The pallidum occupied 0,32% or ca. 1 over 300 of the volume of the hemisphere. 5. The numeric cell densities showed no significant age or sex differences. The mean value of the lateral pallidum was 437 nerve cells/mm3 and of the medial part 327 nerve cells/mm3, the difference being highly significant (p less than 0,001). 6. The pallidum laterale showed a numerical density of 66000 glial cells/mm3, the medial segment had 62000 glial cells/mm3, the difference just reaching the 5% -- level of significance. 7. On the average the ratio of glial cells to nerve cells was 158:1 in the lateral pallidum, and 159:1 in the medial part. The difference was statistically significant (p less than 0,01). 8. The mean of the total number of nerve cells in the pallidum laterale amounted to 540000 for males and 465000 for females. The corresponding values of the medial part were 171000 (male) and 143000 (female). The total number of pallidal nerve cells is just about as high as the number of large striatal nerve cells (670000 (male) and 570000 (female). 9. In the pallidum laterale we calculated the total number of glial cells to be 82 million for males and 63 million for females. In the medial pallidum we found 32 million (male) and 26 million (female). 10. The total numbers of nerve and glial cells were well correlated in the lateral as well as in the medial segment (r = 0,636 and r = 0,734, respectively). 11. The volumetric nerve cell densities showed no significant differences between sexes. The values were 0,36 Vol.-% lateral and 0,31 Vol.-% medial. This difference failed to be significant. 12. The volumetric densities of the glial cell nuclei were equal in both segments, the value being 0,43 Vol.-%. They were strictly correlated (r = 0,830). 13. The mean volume of a nerve cell in the medial segment (9600 mum3) was 19% higher (p less than 0,05) than in the lateral segment (8100 mum). 14. The mean volume of a nucleus of a glial cell showed only insignificant differences, being lateral 65 mum3 and medial 70 mum3. 15. The various morphometric data indicated a closer correlation between striatum and pallidum laterale than between striatum and pallidum mediale. Within the striatum, the putamen showed a better correlation with the pallidum than the nucleus caudatus.