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Monitoring is a prerequisite for evidence-based wildlife management and conservation planning, yet conventional monitoring approaches are often ineffective for species occurring at low densities. However, some species such as large mammals are often observed by lay people and this information can be leveraged through citizen science monitoring schemes. To ensure that such wildlife monitoring efforts provide robust inferences, assessing the quantity, quality, and potential biases of citizen science data is crucial. For Eurasian moose ( Alces alces ), a species currently recolonizing north-eastern Germany and occurring in very low numbers, we applied three citizen science tools: a mail/email report system, a smartphone application, and a webpage. Among these monitoring tools, the mail/email report system yielded the greatest number of moose reports in absolute and in standardized (corrected for time effort) terms. The reported moose were predominantly identified as single, adult, male individuals, and reports occurred mostly during late summer. Overlaying citizen science data with independently generated habitat suitability and connectivity maps showed that members of the public detected moose in suitable habitats but not necessarily in movement corridors. Also, moose detections were often recorded near roads, suggestive of spatial bias in the sampling effort. Our results suggest that citizen science-based data collection can be facilitated by brief, intuitive digital reporting systems. However, inference from the resulting data can be limited due to unquantified and possibly biased sampling effort. To overcome these challenges, we offer specific recommendations such as more structured monitoring efforts involving the public in areas likely to be roamed by moose for improving quantity, quality, and analysis of citizen science-based data for making robust inferences., Competing Interests: There are no competing interests to be declared for this publication and its research., (© 2023 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Extensive pastoral livestock systems in Central Europe provide multiple ecosystem services and support biodiversity in agricultural landscapes but their viability is challenged by livestock depredation (LD) associated with the recovery of wolf populations. Variation in the spatial distribution of LD depends on a suite of factors, most of which are unavailable at the appropriate scales. To assess if LD patterns can be predicted sufficiently with land use data alone at the scale of one federal state in Germany, we employed a machine-learning-supported resource selection approach. The model used LD monitoring data, and publicly available land use data to describe the landscape configuration at LD and control sites (resolution 4 km * 4 km). We used SHapley Additive exPlanations to assess the importance and effects of landscape configuration and cross-validation to evaluate the model performance. Our model predicted the spatial distribution of LD events with a mean accuracy of 74%. The most influential land use features included grassland, farmland and forest. The risk of livestock depredation was high if these three landscape features co-occurred with a specific proportion. A high share of grassland, combined with a moderate proportion of forest and farmland, increased LD risk. We then used the model to predict the LD risk in five regions; the resulting risk maps showed high congruence with observed LD events. While of correlative nature and lacking specific information on wolf and livestock distribution and husbandry practices, our pragmatic modelling approach can guide spatial prioritisation of damage prevention or mitigation practices to improve livestock-wolf coexistence in agricultural landscapes., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Sustainable landscape management of protected areas in UNESCO-biosphere reserves (BR) has become an increasingly important topic for academics and environmental practitioners, yet it remains unclear how this can be operationalized in actual regional circumstances. To achieve positive and measurable sustainability impacts, effective BR management on the ground requires supplementary methods to conceive the unique territorial, political, economic and social characteristics of each case while also considering the needs and visions of different stakeholder groups. In this study, we used the Framework for Participatory Impact Assessment (FoPIA) to assess future projections of current land management strategies and possible alternatives in five BR in Germany. The FoPIA method helped identify major differences in the regional BR contexts, including defining the sustainability problem and sustainability challenges. It also proved suitable for fostering stakeholder dialog with regard to current and future sustainable land use management, particularly for the BR transition zones. Our results predict multiple negative impacts resulting from of a continuation of current practices, which are compared against the assessed outcomes of alternative multifunctional pathways. We use these findings to discuss recommendations and challenges for sustainable management of biosphere reserves, the potential of implementing the FoPIA in BR, and perspectives for further research needs., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Understanding the spatio-temporal distribution of ungulates is important for effective wildlife management, particularly for economically and ecologically important species such as wild boar ( Sus scrofa ). Wild boars are generally considered to exhibit substantial behavioral flexibility, but it is unclear how their behavior varies across different conservation management regimes and levels of human pressure. To analyze if and how wild boars adjust their space use or their temporal niche, we surveyed wild boars across the core and buffer zones (collectively referred to as the conservation zone) and the transition zone of a biosphere reserve. These zones represent low and high levels of human pressure, respectively. Specifically, we employed a network of 53 camera traps distributed in the Schaalsee UNESCO Biosphere Reserve over a 14-month period (19,062 trap nights) and estimated circadian activity patterns, diel activity levels, and occupancy of wild boars in both zones. To account for differences in environmental conditions and day length, we estimated these parameters separately for seven 2-month periods. Our results showed that the wild boars were primarily nocturnal, with diurnal activity occurring dominantly during the summer months. The diel activity patterns in the two zones were very similar overall, although the wild boars were slightly less active in the transition zone than in the conservation zone. Diel activity levels also varied seasonally, ranging from 7.5 to 11.0 h day -1 , and scaled positively with the length of the night ( R 2  = 0.66-0.67). Seasonal occupancy estimates were exceptionally high (point estimates ranged from 0.65 to 0.99) and similar across zones, suggesting that the wild boars used most of the biosphere reserve. Overall, this result suggests that different conservation management regimes (in this case, the zoning of a biosphere reserve) have little impact on wild boar behavior. This finding is relevant for wildlife management in protected areas where possibly high wild boar densities could interfere with conservation goals within these areas and those of agricultural land use in their vicinity., Competing Interests: None declared., (© 2021 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Human-wildlife conflict (HWC) is a key topic in conservation and agricultural research. Decision makers need evidence-based information to design sustainable management plans and policy instruments. However, providing objective decision support can be challenging because realities and perceptions of human-wildlife interactions vary widely between and within rural, urban, and peri-urban areas. Land users who incur costs through wildlife argue that wildlife-related losses should be compensated and that prevention should be subsidized. Supporters of human-wildlife coexistence policies, such as urban-dwelling people, may not face threats to their livelihoods from wildlife. Such spatial heterogeneity in the cost and benefits of living with wildlife is germane in most contemporary societies. This Special Section features contributions on wildlife-induced damages that range from human perspectives (land use, psychology, governance, local attitudes and perceptions, costs and benefits, and HWC and coexistence theory) to ecological perspectives (animal behavior). Building on current literature and articles in this section, we developed a conceptual model to help frame HWC and coexistence dimensions. The framework can be used to determine damage prevention implementation levels and approaches to HWC resolution. Our synthesis revealed that inter- and transdisciplinary approaches and multilevel governance approaches can help stakeholders and institutions implement sustainable management strategies that promote human-wildlife coexistence., (© 2020 The Authors. Conservation Biology published by Wiley Periodicals, Inc. on behalf of Society for Conservation Biology.)

Human-carnivore conflicts and retaliatory killings contribute to carnivore populations' declines around the world. Strategies to mitigate conflicts have been developed, but their efficacy is rarely assessed in a randomized case-control design. Further, the economic costs prevent the adoption and wide use of conflict mitigation strategies by pastoralists in rural Africa. We examined carnivore (African lion [ Panthera leo ], leopard [ Panthera pardus ], spotted hyena [ Crocuta crocuta ], jackal [ Canis mesomelas ], and cheetah [ Acinonyx jubatus ]) raids on fortified ( n  = 45, total 631 monthly visits) and unfortified (traditional, n  = 45, total 521 monthly visits) livestock enclosures (" bomas ") in northern Tanzania. The study aimed to (a) assess the extent of retaliatory killings of major carnivore species due to livestock depredation, (b) describe the spatiotemporal characteristics of carnivore raids on livestock enclosures, (c) analyze whether spatial covariates influenced livestock depredation risk in livestock enclosures, and (d) examine the cost-effectiveness of livestock enclosure fortification. Results suggest that (a) majority of boma raids by carnivores were caused by spotted hyenas (nearly 90% of all raids), but retaliatory killings mainly targeted lions, (b) carnivore raid attempts were rare at individual households (0.081 raid attempts/month in fortified enclosures and 0.102 raid attempts/month in unfortified enclosures), and (c) spotted hyena raid attempts increased in the wet season compared with the dry season, and owners of fortified bomas reported less hyena raid attempts than owners of unfortified bomas. Landscape and habitat variables tested, did not strongly drive the spatial patterns of spotted hyena raids in livestock bomas. Carnivore raids varied randomly both spatially (village to village) and temporally (year to year). The cost-benefit analysis suggest that investing in boma fortification yielded positive net present values after two to three years. Thus, enclosure fortification is a cost-effective strategy to promote coexistence of carnivores and humans., Competing Interests: None declared., (© 2019 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

The impact of land use changes on sustainable development is of increasing interest in many regions of the world. This study aimed to test the transferability of the Framework for Participatory Impact Assessment (FoPIA), which was originally developed in the European context, to developing countries, in which lack of data often prevents the use of data-driven impact assessment methods. The core aspect of FoPIA is the stakeholder-based assessment of alternative land use scenarios. Scenario impacts on regional sustainability are assessed by using a set of nine regional land use functions (LUFs), which equally cover the economic, social and environmental dimensions of sustainability. The cases analysed in this study include (1) the alternative spatial planning policies around the Merapi volcano and surrounding areas of Yogyakarta City, Indonesia; (2) the large-scale afforestation of agricultural areas to reduce soil erosion in Guyuan, China; (3) the expansion of soil and water conservation measures in the Oum Zessar watershed, Tunisia; (4) the agricultural intensification and the potential for organic agriculture in Bijapur, India; and (5) the land degradation and land conflicts resulting from land division and privatisation in Narok, Kenya. All five regions are characterised by population growth, partially combined with considerable economic development, environmental degradation problems and social conflicts. Implications of the regional scenario impacts as well as methodological aspects are discussed. Overall, FoPIA proved to be a useful tool for diagnosing regional human-environment interactions and for supporting the communication and social learning process among different stakeholder groups., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Environmental threats and progressive degradation of natural resources are considered critical impediments to sustainable development. This paper reports on a participatory impact assessment of alternative soil and water conservation (SWC) scenarios in the Oum Zessar watershed, Tunisia. The first objective was to assess the impact of three SWC scenarios on key social, economic and environmental land use functions. The second objective was to test and evaluate the applicability of the 'Framework for Participatory Impact Assessment (FoPIA)' for assessing scenario impacts in the context of a developing country, in this case Tunisia. The assessed scenarios included: the originally planned SWC policy implementation at 85 % coverage of arable land of the watershed, the current implementation (70 %), and a hypothetical expansion of SWC measures to the entire watershed (100 %). Our results suggest that implementation of the SWC policy at 100 % coverage of arable land achieves the maximum socioeconomic benefit. However, if stakeholders' preferences regarding land use functions are taken into account, and considering the fact that the implementation of SWC measures also implies some negative changes to traditional landscapes and the natural system, SWC implementation at 85 % coverage of arable land might be preferable. The FoPIA approved to be a useful tool for conducting a holistic sustainability impact assessment of SWC scenarios and for studying the most intriguing sustainability problems while providing possible recommendations towards sustainable development. We conclude that participatory impact assessment contributes to an enhanced regional understanding of key linkages between policy effects and sustainable development, which provides the foundation for improved policy decision making.

Background: We retrospectively analyzed a series of patients harboring a FT meningioma with regard to clinical presentation, surgical technique, and follow-up results., Methods: Clinical data in a consecutive series of 13 patients treated for a meningioma of the FT junction were retrospectively reviewed. Tumors were classified into 4 types according to their dural origin and tumor extent as depicted from preoperative MRI., Results: Main presenting symptom in 9 women and 4 men (mean age, 56 years) was headache (69%) and gait disturbance (54%). Clinical examination revealed gait ataxia in 62% of the patients. The tumor displaced the vein of Galen inferiorly in 6 patients, superiorly in 2, and medially in 5 cases. The main surgical approach to the meningioma was via an occipital interhemispheric route (10 patients). Additional resection of the falx and/or incision of the tentorium was performed in 6 cases each. A complete resection (Simpson grade 1 and 2) was achieved in 85% of patients. Permanent surgical morbidity was 23%. One tumor recurrence in an atypical meningioma was observed after the mean follow-up period of 6.2 years (range, 1-14 years) with clinical and MRI examination and had to be reoperated. Eighty-five percent of the patients regained full daily activity on follow-up., Conclusions: The surgical approach should be tailored to the dural origin and extent of the tumor as depicted from preoperative MRI. Preservation of the straight sinus and Galenic venous system is recommended.

Objective: The purpose of this study was to analyse a series of patients harbouring an intracranial hemangiopericytoma (HPC) with respect to clinical presentation, treatment results and long-term follow-up outcomes., Patients and Methods: Clinical data were retrospectively obtained in a series of 12 patients who underwent microsurgical resection for HPC at two neurosurgical institutions between 1987 and 2004., Results: The main presenting symptoms in the seven men and five women (mean age 38 years) were headache in 50% and epileptic seizures in 33% of the patients. A Simpson grade I resection was achieved in seven patients (58%) and none of these patients developed local tumour recurrence after a mean follow-up period of 127 months (10.6 yrs). Only one of these patients received adjuvant radiotherapy. A recurrence of the HPC was observed in all patients (42%) who underwent subtotal tumour resection at first surgery (Simpson grade II or higher). Recurrences occurred after a mean period of 39 months (3.2 yrs) after primary surgery and were effectively controlled by surgical excision, radiotherapy and gamma knife radiosurgery. Two patients (17%) developed extraneural metastases which were treated by surgical excision, radiotherapy and salvage chemotherapy. Poly-chemotherapy was ineffective with respect to tumour control in this study., Conclusions: The study emphasises the importance of total resection of HPC, defined as a Simpson grade I removal, at first surgery. Adjuvant radiotherapy is recommended after subtotal tumour resections. A life-long vigilant follow-up of these patients is mandatory.

Object: The authors retrospectively analyzed a consecutive series of patients with cranial vault primary extradural meningioma (PEM), with particular regard to the tumor's dural involvement. The pertinent literature was reviewed., Methods: Clinical data were retrospectively obtained in a consecutive series of 16 patients treated for a PEM at two institutions between 1992 and 2004. The authors created a classification system based on dural involvement of the tumors. Nine women and six men (mean age 55 years) presented with a painless, slowly progressive swelling. Preoperative magnetic resonance (MR) imaging revealed dural enhancement at the site of tumor in 11 patients. On surgical inspection, the tumor infiltrated the dura in all but three patients. Histological examination of tissue samples demonstrated tumor infiltration of the dura in all 14 patients in whom the dura had been resected. Three recurrent tumors were observed on follow-up examination during a mean period of 5.8 years (range 1.5-13 years) and required extirpation. In addition to one patient in whom there was histological evidence of malignancy, the other two cases involved two patients in whom no apparent dural involvement was observed during the first surgery. In a review of the literature, the authors found that histological examination showed dural involvement in 22%; the dura was not histologically evaluated in the remaining patients (78%). Postoperative follow-up data exceeding 2 years were only provided in two of the reported cases., Conclusions: Tumor infiltration of the dura should be assumed in PEMs of the cranial vault, and resection of the dura at the site of craniotomy is recommended to prevent tumor recurrence.

Objective: Intradural nonneoplastic cysts compressing the spinal cord are rare lesions. We retrospectively analyzed a series of patients harboring this entity with regard to clinical and radiological features, surgical management, and follow-up results., Methods: In a retrospective study, we reviewed the medical charts, radiological investigations, and follow-up data of 11 women and 10 men (mean age, 43.6 yr) with intradural juxtamedullary spinal cysts, which were consecutively treated microsurgically at our institutions between January 1995 and January 2003. All lesions were approached via a laminectomy, hemilaminectomy, or laminoplasty at the corresponding vertebral levels and histopathologically verified. The patients were routinely scheduled for clinical follow-up 2 and 6 months after surgery. Baseline postoperative magnetic resonance imaging (MRI) was ordered 6 months after surgery. Thereafter, follow-up was performed at 1-year intervals, with neurological examination and MRI., Results: According to presenting symptomatology, two main patient groups could be differentiated: one group with a myelopathic syndrome (10 patients) and another group with a predominant radicular pain syndrome (8 patients). Histopathological examination revealed 16 arachnoid cysts, 4 neuroepithelial cysts, and 1 cervical nerve root cyst. Most arachnoid cysts (12 cases) were located on the dorsal aspect of the thoracic spinal cord. The mean craniocaudal extension of these cysts was 3.7 vertebral levels, and complete resection was performed. In four patients, the arachnoid cyst was situated ventral to the spinal cord and involved up to 17 vertebral levels. These patients had a history of major spinal trauma, and the cyst was generously fenestrated at its greatest circumference as depicted on preoperative MRI scans. The four neuroepithelial cysts and the cervical nerve root cyst were located on the ventral or ventrolateral aspect of the spinal cord, and their maximum sagittal extension was two spinal vertebral levels. Symptoms in all but two patients demonstrated major improvement; in particular, radiating pain disappeared immediately after surgery. There was no cyst recurrence on MRI after a mean follow-up period of 3.2 years., Conclusion: Intradural cysts should be considered in the differential diagnosis of lesions causing myelopathy and/or a radicular pain syndrome. Microsurgical resection or generous fenestration in cysts with large craniocaudal extensions effectively ameliorated patients' symptomatology. A description of the first documented case of a surgically treated intradural cervical nerve root cyst is provided.

Cranial rat bone was irradiated by 2.1 microns Holmium Yag laser radiation. Quantitative edge rates were calculated. Histologic sections were investigated by light and electron microscopy. Eighteen cases of hard fibrous or calcified spinal and cranial meningiomas and neurinomas were operated upon using pulsed laser beam. In rat cranial bone ablation rate ranged between 0.3-0.5 mm per pulse. Perifocal thermal damage was observed in a zone of 20-90 microns around the lesion. In all human cases tumors could be removed totally without additional neurological deficit. In vivo heat development was measured by an i.r.-camera.

Knowledge of conditions associated with an increased prevalence of obstructive sleep apnoea (OSA) may help to identify patients with OSA and might give some insight into the pathogenesis of OSA and its sequelae. A number of earlier, smaller studies hinted at an association between diabetic cardiovascular autonomic neuropathy (AN) and OSA. The present study was, therefore, conducted with the aim of establishing the prevalence of OSA in diabetics with AN and of determining whether OSA is more prevalent in diabetics with AN, than in those without. We studied two groups of diabetic patients: 23 with and 25 without AN. All patients were evaluated for possible OSA (apnoea/hypopnoea index > or = 10) using initial ambulatory screening followed by polysomnography. Six patients with AN (26%) were found to have OSA, but none of the patients without AN met the diagnostic criteria (p<0.01). When the patients with OSA were compared to those without, no differences were found in terms of age, sex, body mass index or diabetes type or duration. In conclusion, about one in four diabetic patients with autonomic neuropathy suffers from OSA. Thus, obstructive sleep apnoea is more prevalent in diabetic patients with autonomic neuropathy, than in those without.

A pilot study was undertaken to test whether combining the polymerase chain reaction with restriction fragment length polymorphism is suitable for the routine diagnosis of carcinoma of the pancreas. The method makes it possible to recognize point mutations in codon 12 of the Ki-ras oncogene. 60 cytological specimens from the pancreatobiliary tract, the bronchopulmonary system (by bronchoalveolar lavage or from pleural effusion) and ascites were tested. Results from nine pancreas carcinoma cell lines served as control. A PCR product was successfully amplified in all cell lines and 47 of the clinical specimens. In all eight samples in which a mutated Ki-ras oncogene was demonstrated, there was at least a suspicion of malignancy by cytological examination. A mutation was also found in four of five pancreas carcinomas. But no mutation was found in one, clinically certain, case of pancreas carcinoma. The described method is an elegant and, most of all, rapid means to complement and optimize any cytological diagnosis.

The suitability of Excimer laser beam for microneurosurgery was investigated in an animal experimental study. Cranial bones, cortex and the nervus ischiadicus of the rat were irradiated with 193 nm argon fluoride, 248 nm krypton fluoride, 308 nm xenon chloride and 351 nm xenon fluoride. After survival times of up to 30 days microscopic and electron optic findings of laser lesions at the tissues mentioned above, were studied. By means of the Excimer laser beam high precision tissue effects without or with only low thermal damage to the surrounding tissue were produced with any desired depth of penetration or extension. In analogy with the experiences gathered from animal experiments, a possible use is discussed for the removal of bone tissue around cranial nerves or vascular structures, of epileptogenic foci, or for cutting off pathways in pain surgery (e.g. the zone of entry of the dorsal root of spinal nerves).

Although lumbar disc surgery (discectomy) definitely improves the overall situation of the patient in most cases, it does create problems of a hitherto absent kund in about 6% of the patients. Expertising of uncomplicated cases should not be too difficult. However, modulated by individual disposition, a syndrome may develop known as "failed back surgery syndrome" caused by intersegmental loosening, crumbling or fusing and scarification. The pain it causes is decisive for its assessment, not so much any motor or other neurological deficits. In mild cases the loss in capacity for gainful employment may be assessed at between 20% to at the most 30%, but the severely handicapped are unable to cope with their daily life without assistance, their incapacitation amounting to as much as 100%. If the patient concerned is on a job that places stress on this spine, he may be unfit for work even if the affliction is relatively mild.

During the last two years oral contraceptives containing gestodene were suspected to cause cerebrovascular disorders. 52 cases with adverse neurological side effects were registered up to October 31, 1990. Anonymous protocols received from the Companies Schering AG and Wyeth Pharma were analyzed from a clinical point of view. There are different arterial and venous, thrombotic and embolic disorders caused by different pathogenetic principles. Only one third of the cases was documented by neuro-imaging to render possible actual diagnostic reliability. Suspected cases represent a great number of different cerebrovascular disorders usually observed in neurological and neurosurgical series, concerning both men and women, OC-users and non users.

We report a retrospective account of 200 patients who have been surveyed after having undergone neurosurgical intervention. They received as perioperative antibiotic prophylaxis a combination of Mezlocillin and Oxacillin in a ratio of 2:1 (Optocillin) in their management. The clinical and bacteriological efficacy including the side effects was examined with standardisation of sterility measures in the operating theatre, careful standardised operative procedures and ward after care. No problems in wound healing were found. There was no certain evidence of side effects.

Among 29 evaluable patients with progressive metastatic renal cell cancer treated by interferon alpha 2b in combination with vindesine and ifosfamide, we have observed an objective (complete and partial) response rate of 24.1% and an overall (complete and partial response and stable disease) response rate of 58.6%. The median duration of remission has not yet been reached, but the survival of responding patients is considerably longer than that of non-responders. Because we could not find any differences (sex, age, WHO performance status, prior therapy, site of metastatic disease) between responding and non-responding patients, we believe that the treatment might modify intrinsic characteristics of the tumour growth and/or host-tumour relationship in the long term. Although the toxicity recorded is high, the results are sufficiently positive to justify further investigation of this approach.

During a period of 32 months (August 1986 until April 1989) 108 patients (74 women, 34 men; mean age 53 years) with neoplastic diseases (59 patients with solid tumors, 45 patients with lymphomas, two patients with acute leukaemias, one patient with chronic myelogenous leukaemia, one patient with aplastic anaemia) were studied in the Department of Internal Medicine of the University Erlangen-Nuremberg. Most were treated with a cytostatic chemotherapy. In order to prevent a mycotic infection in these immunocompromised patients, itraconazole, a new broad-spectrum antimycotic drug of the azole group, was given in an oral dosage of 100 mg day-1 (mean duration of prophylactic treatment 24 months). Localized Candida infections involving the oropharynx and the female genital organs were diagnosed in 16 patients (14.8%). Candida endophthalmitis occurred in one patient (0.9%). The serum concentration of Candida antibodies was significantly elevated in one patient (0.9%) without evidence of fungemia. Itraconazole had to be discontinued in four cases (3.7%) due to minor side effects of the drug (nausea, stomach complaints). Itraconazole appears to be a safe and effective antimycotic drug in long-term use in neutropenic patients.

Sixteen heavily pretreated patients (pts) (4 surgery + chemotherapie + radiotherapy; 4 chemotherapy + radiotherapy: 6 surgery + radiotherapy; 2 chemotherapy) and one previously untreated patient, who refused surgery and or radiotherapy, all with progressive disease, with advanced squamous cell carcinoma of the head and neck were included in a phase II study with pirarubicin 60 mg/m2 i.v. day 1 every 3-4 weeks (CT). All pts received at least one course of CT. 15 pts were evaluable for response, all 17 pts were evaluable for toxicity. Female (male ratio 1/16; mean age 56 (42-68) yrs, mean performance status 70% (50-70). Seventeen pts received a mean of 3 (1-8) courses, 2 pts had received only one course of CT. Response and toxicity were assessed according to WHO classification. Results after 1-8 courses of CT: 1 (7%) complete remission; 1 (7%) partial remission; 9 (60%) no change; 4 (26%) progressive disease. No toxicity of grade IV was observed. Mean duration of remission 16 weeks. Median survival time 7 (1-10) months. 9 pts died and 8 pts are alive; six of them had progressive disease.

In a randomized prospective study of 206 children aged between one and 14, the influence of oral praemedication on the psychic condition and with regard to anaesthesiologic measures was investigated. Heart rate, inhibition of salivation and the kind and frequency of side-effects were also examined. The praemedication was carried out using diazepam (0.3 mg/kg), promazin (1.0 mg/kg), promethazin (1.0 mg/kg) and chlorphenaethazin (1.0 mg/kg). It was not possible to determine statistically relevant differences between the various drugs concerning the fixed criteria. In general, however, diazepam seems to achieve the best results. In the younger children (1 to 6 years) a frequent and insufficient effect of praemedication was noted immediately. Oral praemedication proved to be a valuable and practicable method which was well tolerated by the great majority of the children.

The practical importance of BSR and blood cell changes for the early recognition should not be overestimated. But every symptomless person with raised BSR should be examined very carefully, especially for occult hepatic diseases (active hepatitis, liver cirrhosis), for anaemias, leukaemias, malignant lymphomas and other malignant diseases. The practical use of the diagnosis of blood cell changes is the possible recognition of anaemias, leukaemias and malignant lymphomas.

In a 46-year-old female patient suffering from renal hypertension due to polycystic kidney degeneration with creatinine values between 3 and 5 mg/dl leucopenia developed 3 weeks after beginning antihypertensive therapy with the angiotensin-converting-enzyme inhibitor captopril. On continuation of treatment signs of haemorrhagic diathesis appeared 7 months later. Cytology and histology led to the diagnosis of panmyelopathy which, from the clinical findings and the close patient follow-up, was to be regarded as captopril-induced. Bone-marrow regeneration could be shown 6 months after discontinuing the drug. In renal insufficiency, captopril treatment should be monitored using regular haematological tests and the drug withdrawn when leuco- or thrombocytopenia occurs.

Rheumatic symptoms in patients with leukemia are not uncommon. Often they delay correct diagnosis and therapy. We describe a patient presenting with oligoarticular joint disease in whom immunological analysis of synovial fluid (SF) led to the detection of leukemic cells in the joint. Moreover, analysis with a variety of monoclonal antibodies established the diagnosis of acute lymphoblastic leukemia of null cell type with phenotypically identical malignant cells present in the bone marrow, peripheral blood and SF. Our investigations demonstrate that analysis with monoclonal antibodies is helpful in characterizing joint involvement in patients with leukemia.

Increasing incidence of gout and its importance as a risk factor for arteriosclerosis stimulate the practitioner to improve his knowledge about therapeutic possibilities. Therapy of gout includes (1) treatment of acute attack with colchicine and indometacin, (2) decrease of uric acid blood concentration in tophaceous gout using uricosurica, alkalinization of urin, increased diuresis, and blockade of de-novo synthesis of uric acid, and (3) maintenance therapy with allopurinol or uricosurica to avoid recurrent arthritis as well as tophi. In addition, surgical removal of larger tophi may be of benefit.

Fractures of the frontal base of the skull are often accompanied by rhinoliquorrhea. To prevent infections of the brain they must always be closed surgically. We report on a new method of closing the dura mater defect using an alcoholic prolamine solution, which hardens within a few minutes. After 40 to 90 days the mass has been replaced by connective tissue. We describe our experience with 24 patients who were successfully operated on using this method and followed up for two years.

The pharmacokinetics of high-dose metoclopramide (10 mg/kg body wt. in five infusions of 2 mg/kg body wt. each) was studied in 11 patients (5 females, 6 males) in two groups: group A with and group B (consisting of five patients) without forced diuresis. When the drug was infused, forced diuresis had no influence on the pharmacokinetics of metoclopramide (serum level after the 1st infusion was 851 +/- 361 ng/ml in group A versus 840 +/- 348 ng/ml in group B; after the 5th infusion it was 2,005 +/- 588 ng/ml in group A versus 2,463 +/- 1,350 ng/ml in group B). There were significant differences in the 24-h serum levels (582 +/- 308 ng/ml in group A versus 379 +/- 170 ng/ml in group B; P less than 0.05) and in the elimination half life (8.5 +/- 2.6 h in group A versus 6.1 +/- 1.1 h in group B; P less than 0.05). The results demonstrate that the dosage regimen originally suggested by Gralla for cytostatic drugs, with forced diuresis for high-dose metoclopramide therapy, may also be applied, with no dosage reduction, with to other cytostatic drugs which do not require forced diuresis.