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A new multichannel system is presented which records and analyzes polysomnographic data. The reasonably priced hardware and software makes the diagnosis and therapy of sleep apnea syndrome possible even in smaller internal departments. By using this system, adjustments to the nCPAP therapy can be undertaken. A newly developed analog-digital converter and software functions record simultaneously up to 24 channels. It performs the functions of commercially available instruments for induction plethysmography. The system has a modular setup. It is also possible to record special parameters, such as transcranial Doppler signals. Without any difficulty, instruments already used in the sleep laboratory can be included into this multichannel system. For instance, the screening device for the sleep apnea syndrome MESAM IV can be easily integrated. With this combination, it is possible to adjust sleep apnea patients to the nCPAP therapy by using the MESAM IV device. The software also enables analysis of breathing parameters and algorithmic revision of channels. In this way, filters can be integrated and amplitude calculations can be conducted.

A case of rare segmental neurofibromatosis is presented. Multiple neurofibromas along the right sciatic nerve were found. Other typical manifestations of neurofibromatosis were absent. By microsurgical dissection, it was possible to remove the neurofibromas from the nerve trunks and to preserve all motor and sensory functions. Classification of the different neurofibromatosis types is briefly reviewed. The problems of resection of benign major nerve trunk tumors in neurofibromatosis are discussed.

A family with central nervous system tumors in five individuals in two generations is reported. Of five sisters, two had an isolated meningioma and one an ependymoma. Amongst the four children of those affected there was a son with two cerebral meningiomas and a daughter with a spinal meningioma. Signs typical of von Recklinghausen neurofibromatosis (NF1) or bilateral acoustic neurofibromatosis (NF2) were not present. The pattern is consistent with autosomal dominant inheritance with relatively high penetrance.

Three cases of non-paraneoplastic Lambert-Eaton syndrome are presented. There remains no indication of neoplasm after illnesses of nine years, 36 months and 20 months respectively. In one case, the syndrome became manifest during chloroquine medication. The cause of the proximal lower limb weakness had not been recognized during previous hospital stays, although in retrospect indications of a Lambert-Eaton syndrome were found in the electrophysiological tracings. The conclusive diagnosis was made electrophysiologically. The leading sign was an abnormally low compound muscle action potential evoked by supramaximal nerve stimulation. Furthermore, the characteristic increase of amplitude of the compound muscle potential after maximal voluntary contraction or at high frequency stimulation (20 Hz) could be demonstrated. It is concluded that the non-paraneoplastic Lambert-Eaton myasthenic syndrome may frequently remain unrecognized.

The following is an outline of one typical case of chronic eosinophilia-myalgia syndrome (EMS). In 1987 a 62-year-old woman began taking L-tryptophan, 1.5 g nightly, due to sleeping difficulty. During the months preceding the appearance of EMS she continued to take L-tryptophan, derived from the biosynthetic production of the Japanese manufacturer "Showa Denko". She has suffered increasingly from severe myalgia and a proximal muscle weakness since July of 1989. In November, 1989 her white blood cell count measured 12.1 X 10(9)/l with 3.6 X 10(9) eosinophil cells/l. The bone marrow exhibited an increased granulopoesis and an extreme increase in the amount of eosinophil cells. The muscle biopsy specimen indicated an inflammation with perivascular distribution. The eosinophil cell count of the blood was quickly normalized via the introduction of prednisone over a short period. In the absence of further immunosuppressive therapy a slow improvement can be seen in the myalgia and in her general condition. Since the beginning of 1990 there has been a slow development of hyperpigmented scleroderma-like skin changes with distal distribution.

A cardiac pacemaker was implanted because of nocturnal sinus arrhythmia into a 53-year-old man with hypersomnia. After other patients had reported loud snoring and breathing pauses, which appeared to be dangerously long, polysomnography was performed. It indicated a marked obstructive sleep apnoea syndrome with an apnoea index of 55 and an average apnoea duration of 35 seconds. The nocturnal cardiac arrhythmias disappeared under continuous nasal raised pressure ventilation.

An acute spinal epidural abscess is a rare cause of paraplegia, seen in seven patients over a period of ten years. All patients had fever and severe localized back-pain. Unless treated, within hours or a few days, there will be root defects and rapidly progressive paraplegia. Staphylococcus is the most frequent causative organism and clinically manifest septicaemia is common. Rapid diagnosis and treatment are essential in deciding the patient's fate. Myelography is an important additional examination as it demonstrates the abscess in 96% of cases. Non-contrast radiology is of little value. High-dosage antibiotics and surgical spinal decompression are the cardinal treatment procedures. Antibiotics alone are justified only so long as there are no neurological deficits and neurosurgical intervention, if needed, is immediately available.

Ten patients with a nontraumatic spinal extramedullary hematoma are reported, nine of the hematomas localized in the epidural space. Seven of the patients were taking anticoagulant drugs and five showed signs of liver disease, mostly due to alcoholism. The invariable first symptom was an intense local pain in the spine, followed in all but one case by radicular irradiation and in all by bladder disturbances and sensory and motor deficits of the spinal cord or cauda equina. All the patients had myelography to verify the spinal mass and were operated on as fast as possible. The outcome depended mainly on the preoperative neurologic status. If there was only an incomplete sensory and motor lesion before the operation, the patients recovered fairly well or completely. The patients who did not become capable of walking again were completely paralytic preoperatively.