[Prognosis and life expectancy in multiple sclerosis]. / Zur Prognose und zur Lebenserwartung bei Multipler Sklerose.

Prognosis and life expectancy of patients with multiple sclerosis can be judged according to disability state, to duration and course of the disease on the basis of regular examinations. Assuming that life expectancy is reduced--collectively--by 10 to 15 years, it should be possible to find some form of life insurance for patients with multiple sclerosis also.

[Brain death--a certain sign of death]. / Der Hirntod--ein sicheres Todeszeichen.

Brain death means a complete and irreversible loss of all brain activity during intensive care with mechanical ventilation. On autopsy is seen an ischemic infarct of the whole brain following the stopped blood flow in the intracranial cavity after the elevation of the pressure. With brain death a human being loses two characteristics of its earthly life, the physical base needed for his spirit and his soul in this world, and the integration, the unity as the independent and self-contained organism.

[Cervical transverse spinal cord injury caused by knife stab injury]. / Zervikaler Querschnitt durch Messerstichverletzung.

This clinical report refers to a case of quadriplegia caused by a knife stab wound in the cervical spine. Open removal of the knife made it possible to avoid such complications as bleeding and infection. Nevertheless, the tetraplegic signs and symptoms were the result of complete severance of the cervical spinal cord and therefore persisted.

[Heart transplantation: successful treatment of postoperative complications. Case report with 19 months' follow-up]. / Herztransplantation: erfolgreiche Behandlung postoperativer Komplikationen. Fallbeschreibung mit 19monatiger Verlaufskontrolle.

In March, 1981, a 37-year old patient underwent cardiac transplantation, the first to be performed in Germany since 1969. Subsequent to the successful procedure, the patient has now been followed for more than 19 months. The indication for the intervention was established on the basis of endstage coronary artery disease. The operation was performed according to the technique of Lower and Shumway. Immunosuppression, in the early postoperative phase, was carried out with antithymocyte globulin, azathioprine and corticosteroids with administration oriented on the T-lymphocyte and total leukocyte counts as well as analysis of myocardial biopsies. In the late postoperative course, dosage of immunosuppressive agents was based almost exclusively on biopsy findings. Within the course of immunosuppressive therapy for cardiac transplantation, in particular, initial experience was gained with the use of antithymocyte globulin which was given in dosages of up to 12 mg/kg daily. The antithymocyte globulin proved effective for more than six weeks postoperatively. The alterations in immunosuppressive treatment necessitated by two gastrointestinal complications (perforated gastric ulcer, perforation of the small intestine) enabled a comparative analysis of the results of therapy with cyclosporin A given orally, intravascularly and intravenously. The Patient continues to be maintained on a regimen of cyclosporin A and corticosteroids and his general condition is good. For future cardiac transplantations, in the early postoperative course, alternating treatment with antithymocyte globulin, azathioprine and corticosteroids, on the one hand, with cyclosporin A and corticosteroids, on the other hand, would seem meaningful both to minimize adverse reactions as well as to provide effective immunosuppression. The experience rendered would promise to facilitate management of patients after cardiac transplantation.

[Medical aspects of cerebral death determination of the time of death (author's transl)]. / Arztliche Aspekte des Hirntodes und Feststellung des Todeszeitpunktes.

As a result of the development of intensive-care medicine and organ transplantation, an increasing number of neurologists and other physicians are being confronted with problems of cerebral death and relevant diagnostics. Subsequent to a survey of the, after all, rather uniform pathogenesis, and of the anatomic findings, the clinical syndrome is described in detail with the object of helping to avoid a diagnostic misinterpretation of individual neurologic findings. The diagnostic aids or methods which can be applied at present, are judged with regard to the problems involved and their diagnostic value (experiences with the computer-tomogram have been omitted, since too few observations have been made to date). The paper concludes with a few pointers as to how these guidelines can be utilized when dealing with the concrete everyday situation of diagnosing cerebral death.

[Immunosuppressive treatment of multiple sclerosis. 4. Results of treatment with azathioprine and antilymphocyte globulin (author's transl)]. / Immunsuppressive Therapie der multiplen Sklerose. 4. Mitteilung: Behandlungsergebnisse mit Azathioprin und Antilymphozytgenglobulin.

During the long-term treatment with azathioprine of 79 patients suffering from MS there was a significant reduction in the relapse rate; the course of the disease was also favorabley influenced. In about one third of the patiens afflicted with the chronic progressive form of MS, there was no further progression. After conclusion of the treatment its favorable effect lasted for 1 to 2 years; then the disease worsened, and the relapse rate increased again. Treatment with antilymphocyte globulin and/or thoracic duct drainage in 18 patients led to impressive improvement or a stabilization of the neurological signs in those with a relapsing course. The chronic progressive course of MS was arrested in about two thirds of the patients. The effect of the treatment lasted from one to several years.

[The EEG in hypercalcemia (author's transl)]. / Zur Bedeutung elektroenzephalographischer Veränderungen beim Hyperkalzämie-Syndrom.

The EEG of 20 patients with hypercalcemia of different aetiology were investigated. (Hyperparthyreodism n = 14; Carcinomas with metastases n = 5; plasmocytom n = 1). General abnormalities were observed in most cases in different severity with a decrease of frequencies (n = 13) and an abnormal periodicity (n = 9). Beside one case there was a positive correlation between serum-calcium-level and EEG-abnormalities. Abnormal EEG-findings were observed mostly above serum calcium levels of 6,5 mval/1 = 13 mg%. There was a marked normalisation of EEG with decreasing serum-cacium-level. Different factors dealing with these abnormal EEG findings in hypercalcaemia were discussed.

[Damage to the spinal marrow in kyphoscoliosis (author's transl)]. / Rückenmarksschäden bei Kyphoskoliose

Damage to the spinal marrow by kyphoscoliosis shows a characteristic clinical syndrome: severe curvature of the vertebral column, first manifestation in the second decade or in the second half of life, at this time frequently associated with cardiac and circulatory failure, spinal symptoms often accentuated on the convex side of the scoliosis. Mechanical alteration of the spinal marrow and cardiovascular failure are considered to be pathogenetic factors. Kyphoscoliotic lesions of the bone marrow are rare and ought only to be diagnosed by exclusion. Conservative treatment consists of orthopedic measures and treatment of the heart and circulation. Operative decompression of the spine may be successful, but deterioration is possible after some years.

[Chromosomal aberrations in peripheral lymphocytes of patients with multiple sclerosis (author's transl)]. / Chromosomenuntersuchungen an peripheren Lymphozyten bei Patienten mit multipler Sklerose

In chromosomes of peripheral lymphocytes of 35 patients with multiple sclerosis treated with azathioprine, antilymphocytic globulin or thoracic-duct drainage structural aberrations (breaks and gaps) were found at a significantly high rate. The aberration rates were increased in another ten untreated patients as well, but less so. Patients previously treated had a high aberration rate, too. The B- and C-chromosomes of patients treated with azathioprine were more frequently involved than those of control subjects. The terminal segment of the long arm of chromosome 1 was mostly affected in these patients, while in all groups there was an increase of aberrations in the centre of the long arm of the C-chromosome. The clinical significance of these chromosomal aberrations is not yet clear.