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Unlabelled: As the number of patients treated with stereotactic radiosurgery increases, it becomes particularly important to define with precision adverse effects on distinct structures of the nervous system., Object: This study was designed to assess the dose-response tolerance of the visual pathways and cranial nerves after exposure of the cavernous sinus to radiation., Methods: A total of 66 sites in the visual system and 210 cranial nerves of the middle cranial fossa were investigated in 50 patients who had undergone gamma knife treatment for benign skull base tumors. The mean follow-up period was 40 months (range 24-60 months). Follow-up examinations consisted of neurological, neuroradiological, and neuroophthalmological evaluations. The actuarial incidence of optic neuropathy was zero for patients who received a radiation dose of less than 10 Gy, 26.7% for patients receiving a dose in the range of 10 to less than 15 Gy, and 77.8% for those who received doses of 15 Gy or more (p < 0.0001). Previously impaired vision improved in 25.8% and was unchanged in 51.5% of patients. No sign of neuropathy was seen in patients whose cranial nerves of the cavernous sinus received radiation doses of between 5 and 30 Gy. Because tumor control appeared to have been achieved in 98% of the patients, the deterioration in visual function cannot be attributed to tumor progression., Conclusions: The structures of the visual pathways (the optic nerve, chiasm, and tract) exhibit a much higher sensitivity to single-fraction radiation than other cranial nerves, and their particular dose-response characteristics can be defined. In contrast, the oculomotor and trigeminal nerves have a much higher dose tolerance.

Background: Heparin-induced extracorporeal LDL/fibrinogen precipitation (HELP) eliminates selectively fibrinogen, LDL, cholesterol, triglycerides and LP(a) from blood plasma using extracorporeal circulation. The reduction of fibrinogen and LDL by about 50% after only one procedure immediately improves the hemorheological situation., Method: In a prospective, randomized, controlled study over a period of 3 months, 40 patients with nonarteritic ischemic optic neuropathy (NAION) were randomly assigned to either HELP or hemodilution therapy to determine the efficacy of these two treatments on visual acuity and fields., Results: After transformation of the Snellen acuity into logMAR units the statistical analysis did not show a significant difference between the two groups (P = 0.48). An increase of the visual acuity by two or more lines was obtained in 9 patients (47.4%) of the HELP group, 10 (52.6%) remained stable and none got worse. In the hemodilution group, visual acuity increased in patients (33.4%), 9 (42.8%) remained stable and 5 (23.8%) experienced a decrease. The calculated mean sensitivity of visual fields at baseline improved statistically significantly (P < 0.01) in the HELP group from 6.83 +/- 4.52 dB to 8.27 +/- 4.89 dB, but did not change significantly in the hemodilution group (6.25 +/- 4.12 dB to 6.12 +/- 3.92 dB)., Conclusion: The HELP system seems to be safe and more effective than hemodilution in improving the hemorheological and the functional situation in NAION and could be a promising regimen in the treatment of NAION.

We present four cases of verified late Lyme borreliosis with persistent symptoms and positive serology despite repeated courses of high-dose intravenous penicillin G and/or cephalosporins (including cefoperazone). The patients were now treated with cefoperazone 2 g plus sulbactam 1 g bid iv for 14 days. At the end of treatment, patients were symptom free and have remained so for the following 12 months. By then, IgG against Borrelia burgdorferi had decreased. It is concluded that the addition of beta-lactamase inhibitors to intravenous treatment could be beneficial in Lyme disease refractory to conventional treatment.

Heparin-induced extracorporeal LDL precipitation (HELP) eliminates selectively fibrinogen, LDL cholesterol, cholesterol, triglycerides and LP(a) from the blood plasma using extracorporeal circulation. The reduction of fibrinogen and LDL about 50% after only one procedure immediately improves the hemorrheological situation, which has so far not been achieved by any hemorrheologically active substance. Five patients (1 central retinal vein occlusion, 3 branch vein occlusions, 1 central arterial occlusion) ranging from 59-76 years underwent HELP treatment six times over a 5-week period. After the first HELP procedure the fibrinogen was lowered from 278 +/- 57.8 to 157 +/- 22.2 mg/dl and LDL from 162.2 +/- 58 to 82.4 +/- 32.5 mg/dl. Plasma viscosity decreased from 1.3 +/- 0.07 to 1.1 +/- 0.05 mPa/s. At the end of the treatment an increase in visual acuity of 3 or more lines and an improvement in the visual field was seen in all patients. Measurements of the arteriovenous passage time with laser scan video fluorescein angiography before and at the end of the therapy showed a significant decrease from 3.5 +/- 1.59 to 2.88 +/- 1.54 s (P < 0.05) without influencing the arm-retina time. This first clinical and hemorrheological data on the HELP procedure in retinal vessel occlusion demonstrate a promising regimen in the treatment of acute retinal microcirculatory diseases.