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Very marked nausea and vomiting are the most frequently observed side effects of modern cytostatic agents, and make it necessary to include powerful anti-emetic drugs in any oncological chemotherapeutic concept. The selection of suitable anti-emetics, however, often proves difficult. The reasons for this are discussed. A number of important basic rules that should be observed with any anti-emetic treatment are proposed. Finally, a standardised stepwise anti-emetic plan is suggested for discussion.

A new alcoholic prolamine solution is now available (ETHIBLOC, supplied by Ethicon, Norderstedt) which can be used in neurosurgery for a variety of purposes. This material hardens quickly in an aqueous medium. Animal experiments have not shown any damaging action on the brain, meninges, or bone. The excellent tolerance of the material was seen in a total of 22 patients operated on with the help of Ethibloc. It is particularly well suited for closing frontal CSF fistulas, incised frontal sinuses, and for rearranging or shunting in case of cerebral vascular deformities. It can also be used as a carrier of antibiotics in osteomyelitis, for covering up minor defects of the dura mater, for dura sealing, and for closing the bone after trephination. The preparation is transformed completely to connective tissue within a period of 40 to 90 days. New techniques of surgery are described which have become possible by the use of Ethibloc.

The increase in serum uric acid induced by cytostatic drugs may be treated by a combined low-dose uricostatic and uricosuric regimen. The results obtained in an intraindividual cross-over study demonstrate the significant influence on serum uric acid and its renal excretion.

Even today lead intoxication may occasionally occur. As shown in this case report, careful history including that of the occupational environment may cause suspicion, when complaints such as abdominal pain and constipation are associated with erythrogenic disturbances due to inhibition of certain enzymes of hem synthesis. Although changes in peripheral blood and bone marrow may be typical, lead intoxication can definitely be diagnosed only by determination of lead in blood and urine, of accumulated porphyrins in the red blood cells and of the typical pattern of hem precursors in the urine. Finally, this report deals with the therapy of lead intoxication.

Among 78 000 patients hospitalized over a period of 11 years there were 12 with agranulocytosis drug- or allergy-induced. It is often difficult to be certain of the aetiology, because drug combinations or several drugs simultaneously are often prescribed. A definite relationship could not be proven, although it seemed possible, between six cases of agranulocytosis and the intake of metamizole. Taking into account two deaths and four relatively mild cases assumed to be the result of metamizole treatment, this incidence is similar to that reported in the literature. Alternative drugs have not been proven to cause fewer side-effects. These results suggest that there is no reason at present to stop the use of metamizole.

The development of neuroma after peripheral nerve surgery is still an unsolved problem. Such lesions are not yet controllable by conventional methods. Reports of results achieved using various types of laser surgery appear contradictory. In this experimental study on rats, the Neodym Yag laser was found to be superior the conventional methods. After severance and reanastomosis of the sciatic nerve using this type of laser, no development of neuroma was observed in any of the animals during the first three months of observation.

Clinical experiences on intracerebral hematomas with intraventricular involvement are recorded, and cases from 1976 to 1982 are surveyed. Important criteria for conservative and operative procedure are concluded. Localization of hematoma and follow-up clinical condition of the individual cases are the most reliable indicators in the choice of treatment. Good prognosis of hemorrhages caused by angioma is emphasized, if these are operated upon.

In 29 patients (48 courses of chemotherapy), a randomized double-blind crossover study was undertaken to establish the antiemetic effectiveness of a combination of metoclopramide at a moderately high dose (5 mg/kg body weight) with 1 g methylprednisolone (treatment A) as compared with metoclopramide monotherapy (5 mg/kg body weight; treatment B). With cisplatin doses of 60 mg/m2, a good antiemetic effect (0-1 vomiting episodes in 24 h) was observed in 9 out of 10 patients under treatment A as well as under treatment B. With a cisplatin dose of 120 mg/m2, treatment A produced a good antiemetic effect in 9 out of 11 patients (82%), while treatment B produced such an effect in only 3 out of 11 patients (27%; p less than 0.5). The results obtained permit the following conclusions to be made: At doses of cisplatin of up to 60 mg/m2, the antiemetic effect produced by metoclopramide (5 mg/kg body weight) given alone is adequate. At doses of cisplatin of 120 mg/m2 and more, high-dose methylprednisolone has a good additive antiemetic effect vis-à-vis metoclopramide (5 mg/kg body weight). The antiemetic effect of this combination corresponds approximately to the antiemetic effect produced with high-dose metoclopramide (10 mg/kg body weight) administered alone.

Thirty-seven patients with advanced, histologically confirmed non-small-cell lung cancer received combination chemotherapy with high-dose (120 mg/m2, day 1 and 29, thereafter every 6 weeks) cisplatin and vindesine (3 mg/m2, day 1, 8, 15, 22, and 29, thereafter every two weeks). All patients had measurable disease and had not previously received chemotherapy. 20 out of 37 patients responded to therapy. Two patients with adenocarcinoma, and one patient with squamous carcinoma of the lung experienced complete remission, 11 out of 37 patients partial remission, three patients a minor response, while in three patients the tumour neither remitted nor progressed. Despite chemotherapy cancer progressed in 17 out of 37 patients. Under supportive care including prehydratation, diuresis, administration of high-dose metoclopramide this aggressive chemotherapy was well tolerated. The response rate was similar to that of other chemotherapeutic regimens. The remission duration (9.5 months) and the survival time (16.5 months) are, however, somewhat better.

Thirty patients with metastasing hypernephroid renal carcinoma were treated with sequential cytostatic combinations of vincristine and ifosfamide (Holoxan¿). Two complete and two partial remissions and arrest of tumour growth in two cases were achieved. These results justify use of at least time-limited chemotherapy so as not to miss a chance of long-term remission in tumour patients.

Two weeks after removal of a peridural catheter a transverse lesion of the cord with paraplegia developed. At operation a paravertebral abscess, osteomyelitis of the lamina L2 and L3, and epidural abscess, a phlegmonous duritis and myelitis of the conus-cauda region by transmigration was found. The catheter had been in position for four days. The infection was caused by staphylococcus epidermidis. After laminectomy L2 and L3 as well as local and systemic application of antibiotics, according to the results of sensitivity tests, neurological deficits disappeared nearly completely.

Metastatic tumors within the pituitary gland are rare. The incidence--reported by series of autopsies--differs from 1.8-12% of metastatic tumors. Most of the primary tumors are breast cancers, followed by cancers of the gastro-intestinal system. Only 20% of these metastases are clinically diagnosed. Diabetes insipidus is the main symptom, correlating with the greater incidence of metastatic lesions in the posterior lobe. The unusual features of a reported case are discussed. In this case the dysfunction of cranial nerves passing the sella turcica led to the diagnosis. Therapy with Flutamid initiated a remission. Survival of 18 months is remarkably long.

The influence of Laser radiation on neuroma formation was investigated in rat sciatic nerves. Peripheral nerve trunks were divided by focused Neodym Yag Laser and compared with those transected by microscissors. The nerves were re-exposed at different time intervals up to 240 days after initial operation. True neuroma formation could not be observed after laser transection. Sharp division resulted in widespread amputation neuromas consisting of regenerating axons and connective tissue. Neodym Yag laser radiation by its scattering effect may cause deep coagulation necrosis and thrombosis of vasa nervorum thus sealing the dome of the divided nerve trunk. The formation of amputation neuromas may be suppressed by laser application.

A prospective study of 60 patients with head injuries who received both primary care and an assessment at our Department, the influence of various parameters on the assessment was investigated. Catamnestically, the insurance-relevant results actually achieved are shown. It can be seen that at a 40 per cent incapacitation, reintegration into the work-a-day world is hardly possible.

As result of a poll, the opinion of 50 Neurosurgical Departments in the Federal Republic of Germany relating to the importance of hypophysectomy in the therapy of metastatic carcinoma of the breast was obtained. Four of 32 replies prefer a regular hypophysectomy and 11 departments do the hypophysectomy only in exceptional cases. In 17 clinics this operation is not used. It should be emphasized, that a quarter of those neurosurgeons, who took part in our inquiry, had already given up hypophysectomy some years ago. About 50% of the surgeons talk about positive effects on metastatic carcinomas. The hormonal dependence of disseminated cancers is the only condition, which has to be presumed. Implantation of radioisotopes and trans-sphenoidal hypophysectomy are mentioned as the main operative techniques. The indications for hypophysectomy for metastatic carcinoma of the breast are discussed in the light of the recent literature. If one considers the possibilities of radiotherapy and chemotherapy, hypophysectomy can still be of considerable value as a palliative measure in hormone-dependent tumours with bone metastases, provided that the cases are carefully selected.

Multiple myeloma is the most frequent type of hemoblastic disorders including paraproteinemia. Most cases show a disseminated involvement; few patients have solitary lesions of the bones or connective tissues. Different localizations are the reason for the multiform clinical picture of the disease. The main symptoms result from neurological and dermatological involvement, less usual are gastrointestinal complaints. Fractures, neurological deficiencies, lack of antibodies and failure of the kidneys determine the course of plasmocytoma. Our case reports are demonstrating examples of the different clinical expressions.

Pseudomeningoceles have been observed several times after closed traumatic injuries of the cervical plexus resulting in avulsion of the nerve roots. Following lumbar puncture or lumbar disc operation meningoceles are seldom occurring events. The first report of perineural cysts causing sciatic pain was made by Bancroft (1) in 1941. Since that time about 50 cases have been reviewed by the literature (10, 11). In this paper we report another case of an iatrogenic pseudomeningocele developed following surgical treatment for herniated lumbar disc attempting to outline their clinical and radiological findings.

The development of neuroma after surgery of peripheral nerves is an unsolved problem. Conventional methods like suture after cutting by seizure or bipolar coagulation cannot control it until today. Contradict results are reported since different types of laser were introduced in surgery. In an animal experimental study on rats the Neodym Yag laser is superior to conventional methods described above. After severance and reanastomosis of the sciatic nerve by laser in none of these cases a development of neuroma could be observed until three months of surviving.

Production of hydrocephalus in animal experiment has been difficult and not uniformly successful so far. The preparation Ethibloc (supplied by Ethicon, Hamburg-Norderstedt), which is a protein solution in alcohol, and which has been in use in abdominal surgery for occluding the pancreatic duct system, enables production of an obstructive hydrocephalus easily and with reproducible results. The authors report on 24 cases of development of an obstructive hydrocephalus in rabbits after Ethibloc had been introduced into the ventricular system.

Three patients had as a side effect of cytostatic treatment severe intestinal atonia which in two cases led to paralytic ileus. With ceruletid (Takus) rapid normalisation of intestinal peristalsis was achieved in all three patients.