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Context: Alcoholic liver cirrhosis is a significant risk factor for the development of hepatocellular carcinoma (HCC). The importance of tumour-associated cirrhosis in the development or progression of HCC is not understood. MiRNAs are important regulators for HCC development, but their role in HCC due to alcoholic liver cirrhosis is unclear. Objective: The aim of this study is the detection of miRNA expression in alcoholic liver cirrhosis, tumour-associated cirrhosis, and HCC. Materials and methods: We analysed the differences in the miRNA profiles of HCC, tumour-associated cirrhosis, and cirrhosis without HCC samples from 30 patients who underwent liver transplantation because of alcoholic liver disease. Results: Microarray analyses revealed 40 significantly differentially expressed miRNAs between HCC tissue and tumour-associated cirrhosis tissue. Furthermore, the microarray analysis discovered 56 differentially expressed miRNAs in tumour-associated cirrhosis and cirrhosis without HCC. Discussion: The differences of miRNA profile in alcoholic liver cirrhosis with and without HCC could improve understanding of HCC development, as well as lead to a new diagnostic tool in HCC screening. Conclusion: We were able to show for the first time, the differences of miRNA profile as promising biomarker in HCC, tumour-associated cirrhosis, and cirrhosis without HCC in context of alcoholic liver disease.

We conducted a semi-standardized enquiry concerning diagnostic, immunotherapeutic and supportive care strategies for multiple sclerosis (MS). A questionnaire was sent to all German neurological departments in December 1996, with 63% (n = 244) responding before May 1997. As might be expected, MS therapy in Germany is not very standardized. Most clinics use intravenous steroids for treating relapses, although with different dosing regimens. Nevertheless, oral steroids are also used. Interferon-beta and azathioprine are both used for the treatment of relapsing-remitting MS at the same frequency. Only 33% of German neurological departments said that they used an immunomodulating agent for chronic-progressive cases, indicating it in about 50% of cases. Azathioprine is the drug of first choice, followed by methotrexate. Regarding supportive care measures, the technique of intermittent self-catheterization is widely under-represented. Despite the lack of conclusive evidence from prospective studies for the value of azathioprine, it is still one of the most commonly used drugs for the treatment of relapsing-remitting and chronic-progressive MS. There was no evidence of a consensus on treatment standards for chronic-progressive disease courses., (Copyright 1999 Lippincott Williams & Wilkins)

Analyses of stroke morbidity or mortality are usually based on official statistics. A reduction in stroke mortality rates has been shown for many countries. It is not clear, however, whether this is due to declining morbidity or case fatality (or both). For this purposes population-based register data are required. Using the standardized methodology of the WHO-MONICA Project, stroke cases were also registered in Germany from 1984 to 1993 (7,435 first-ever and recurrent stroke cases). The data collection was almost restricted to East Germany. The age-specific stroke rates in males/females showed an increase from 9/11 per 100,000 population in the youngest age group (25-34) to 1,005/779 cases per year in the oldest group under study (65-74). If one tries to classify stroke types, which is not always possible in a population-based register, the best estimate for men (women) would be: 63(62%) thromboembolic stroke, 25(22)% intracerebral hemorrhage, and 12(17)% subarachnoid hemorrhage. The 28-day case fatality of the 25-74 year old stroke patients was found to be about 40%. Neither for stroke attacks nor for case fatality was a convincing time trend over the 10-year period found. The very small changes observed over 10 years time should lead to increased attention to strokes, particularly primary and secondary prevention, and this not only in East Germany. This applies also for treatment in the acute phase, because the case fatality before admission in the hospital and during the first few days is still very high. Population-based studies of the long-term prognosis of stroke patients in Germany are also missing, i.e., including the effectiveness of various forms of treatment and rehabilitation. Systematic monitoring of the development in this field is an important part of the assessment of the quality and effectiveness of the health care service.

In 1993 and 1994 an official inquiry was carried out by the Deutsche Gesellschaft für Neurologie into the existence of neurochemical laboratories in departments of neurology throughout Germany. The following results were obtained. Neurochemical laboratories are more often seen in neurology departments involved in routine or emergency diagnosis than in departments engaged only in rehabilitation. Nearly all departments with an intensive care unit in a university hospital (91%) and nearly half of those outside the university (46%) have their own neurochemical laboratory. Departments with their own neurochemical laboratories are characterized by the use of specialized immunological diagnosis, especially of the cerebrospinal fluid (e.g., immunoglobulins, isoelectric focusing), in contrast to departments that are not working in the field of emergency medicine and are not equipped with their own neurochemical laboratories. The latter mostly carry out screening tests (e.g., antiepileptic drug monitoring, tumor markers). The existence of a neurochemical laboratory in a neurology department does not lead to an undifferentiated increase in the number of laboratory tests, but reflects the need for specialized diagnosis in CSF and neuroimmunology.