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The workshop of scientific medical faculties (Arbeitsgemeinschaft wissenschaftlicher medizinischer Fakultäten [AWMF]) of Germany has asked societies of specific medical disciplines to jointly publish guidelines on the treatment of diseases and injuries. On behalf of the Deutsche Gesellschaft für Neurochirurgie, its commission on guidelines initiated an interdisciplinary approach to publish guidelines on the treatment of head injury in adults. These guidelines were published in German by the AWMF in late 2015. Because these guidelines have received widespread attention in Germany and became fundamental for research in head injuries, we have translated the German version into English to make it accessible to the international scientific community.

The plastic deformation of a 165 × 165 mm2 tube mould during casting was measured. It was found that the internal bulge in the meniscus region of about 0.2 mm developed at the very beginning of mould life during the first three heats and afterwards stayed practically unchanged till the end of mould life of 512 heats

In 2005 and 2013, the "Deutsche Gesellschaft für Neurowissenschaftliche Begutachtung" (German Society for Neuroscientific Evaluation) together with other societies developed and consented guidelines fort the legal evaluation of patients with closed head injuries and published them trough the National Working Group of Scientific Medical Societies and in this journal. Five years later, a revision was necessary, this was developed on the higher S2 k level of consent through a Delphi conference.2005 und 2013 hat die Deutsche Gesellschaft für Neurowissenschaftliche Begutachtung gemeinsam mit anderen Fachgesellschaften und Verbänden „Leitlinien zur Begutachtung nach gedecktem Schädel-Hirntrauma“ erarbeitet und über die Arbeitsgemeinschaft wissenschaftlicher medizinischer Fachgesellschaften (AWMF) sowie in den Fortschritten der Neurologie und Psychiatrie publiziert. Nach 5 Jahren war eine Revision der Leitlinie erforderlich, diese erfolgte erstmals auf der höheren Entwicklungsstufe S 2 k (Expertenkonsens via Delphi-Konferenz).

The cells-of-origin and the mode and site of termination of the interhemispheric connections passing through the anterior and posterior pallial commissures in the telencephalon of two lizards (Podarcis hispanica and Gallotia stehlinii) were investigated by studying the anterograde and retrograde transport of unilaterally injected horseradish peroxidase. The commissural projections arise mainly from pyramidal cells in the medial, dorsomedial, and dorsal cortices (medial subfield). Additionally some non-pyramidal neurons in the medial and dorsal cortices contribute to the commissural system. Medial cortex neurons project to the contralateral anterior septum through the anterior pallial commissure. The dorsomedial cortex projects contralaterally via the anterior pallial commissure to the dorsolateral septum and to the medial, dorsomedial, and dorsal cortices. The projection to the medial cortex terminates in two bands at the inner and outer border, respectively, of the cell layer; the projection to the dorsomedial and dorsal cortex ends in a zone in layer 1 which previously has been described to be Timm-negative, and in a diffuse band in the inner half of layer 3. The medial subfield of the dorsal cortex projects through the anterior pallial commissure to the dorsomedial and dorsal cortices with a similar pattern of termination to that found for the dorsomedial cortex. The posterior pallial commissure contains only the projections from the ventral cortex to its contralateral counterpart and to the ventral part of the caudal medial cortex. The similarities found between this commissural system and the mammalian hippocampal interhemispheric connections are discussed.

The cubital tunnel syndrome is one of the most widespread compression syndromes of a peripheral nerve. In German-speaking countries it is known as the sulcus ulnaris syndrome (retrocondylar groove syndrome), which is anatomically incorrect. The cubital tunnel consists of the retrocondylar groove, the cubital tunnel retinaculum (Lig. arcuatum or Osborne band), the humeroulnar arcade and the deep flexor/pronator aponeurosis. According to Sunderland it can be divided into a primary form (including the ulnar luxation and the epitrocheoanconaeus muscle) and a secondary form caused by deformation or other processes of the elbow joint. The diagnosis has to be confirmed by a thorough clinical examination and nerve conduction studies. Neurosonography and MRI are becoming more and more important with improving resolution and enable the direct identification of morphological changes. Differential diagnosis is essential in atypical cases, especially C8 syndrome and pressure palsy. Double crush (double compression syndrome) may occur. Operative treatment is more effective than conservative treatment, which consists primarily of the prevention of exposure to external noxes. According to actual randomised controlled studies the therapy of choice of the primary form in most cases is the simple in situ decompression of the ulnar nerve in the cubital tunnel. This has to be extended at least up to 5-6 cm distally of the medial epicondyle and can be performed in the open or endoscopic technique, both under local anesthesia. Simple decompression is also the therapy of choice in uncomplicated ulnar luxation and in most post-traumatic cases and other secondary forms. In cases of severe bony or tissue changes of the elbow (especially cubitus valgus) the volar transposition of the ulnar nerve may be indicated. This can be performed in a subcutaneous or submuscular technique. Risks of transposition are impairment of perfusion and, above all, kinking caused by insufficient proximal or distal mobilisation of the nerve has to be avoided. In these cases revision surgery is necessary. The epicondylectomy is not common in our country. Recurrences may occur.

Continuously cast ball and roller bearing steel 100Cr6 exhibits comparatively strong segregation which poses a quality handicap. In the present work which was carried out in the time between 1992 and 1996 the void formation which is related to the centre segregation and the centre segregation were measured on 2 m long segments of 240 × 200 mm2 blooms cast at the steel plant of Georgsmarienhutte GmbH. It was found that the segregation of carbon expressed with the ratio of C max/C o increases with casting speed and superheat. Many experiments were carried out to elucidate the effect of electromagnetic stirring along the lower part of the metallurgical length (F-EMS). But, unfortunately, a decrease in segregation could not be achieved by F-EMS. The only method to decrease the centre segregation in continuously cast blooms of 100Cr6 seems to be casting at low speeds with low superheat.

Background: Official guideline “indications and methods of hysterectomy” to assign indications for the different methods published and coordinated by the German Society of Gynecology and Obstetrics (DGGG), the Austrian Society of Gynecology and Obstetrics (OEGGG) and the Swiss Society of Gynecology and Obstetrics (SGGG). Besides vaginal and abdominal hysterectomy, three additional techniques have been implemented due to the introduction of laparoscopy. Organ-sparing alternatives were also integrated. Methods: The guideline group consisted of 26 experts from Germany, Austria and Switzerland. Recommendations were developed using a structured consensus process and independent moderation. A systematic literature search and quality appraisal of benefits and harms of the therapeutic alternatives for symptomatic fibroids, dysfunctional bleeding and adenomyosis was done through MEDLINE up to 6/2014 focusing on systematic reviews and meta-analysis. Results: All types of hysterectomy led in studies to high rates of patient satisfaction. If possible, vaginal instead of abdominal hysterectomy should preferably be done. If a vaginal hysterectomy is not feasible, the possibility of a laparoscopic hysterectomy should be considered. An abdominal hysterectomy should only be done with a special indication. Organ-sparing interventions also led to high patient satisfaction rates, but contain the risk of symptom recurrence. Conclusion: As an aim, patients should be enabled to choose that therapeutic intervention for their benign disease of the uterus that convenes best to them and their personal life situation.

Receptor-activity-modifying protein (RAMP) 1 is an accessory protein of the G protein-coupled calcitonin receptor-like receptor (CLR). The CLR/RAMP1 heterodimer defines a receptor for the potent vasodilatory calcitonin gene-related peptide. A wider tissue distribution of RAMP1, as compared to that of the CLR, is consistent with additional biological functions. Here, glutathione S-transferase (GST) pull-down, coimmunoprecipitation and yeast two-hybrid experiments identified beta-tubulin as a novel RAMP1-interacting protein. GST pull-down experiments indicated interactions between the N- and C-terminal domains of RAMP1 and beta-tubulin. Yeast two-hybrid experiments confirmed the interaction between the N-terminal region of RAMP1 and beta-tubulin. Interestingly, alpha-tubulin was co-extracted with beta-tubulin in pull-down experiments and immunoprecipitation of RAMP1 coprecipitated alpha- and beta-tubulin. Confocal microscopy indicated colocalization of RAMP1 and tubulin predominantly in axon-like processes of neuronal differentiated human SH-SY5Y neuroblastoma cells. In conclusion, the findings point to biological roles of RAMP1 beyond its established interaction with G protein-coupled receptors.

In the period from July 2005 through November 2006, the evidence-based guidelines were developed by a steering committee consisting of three members from each of the societies involved (German Society for Hand Surgery, German Society of Neurosurgery, German Society of Neurology and German Society of Orthopaedics), coordinated by one member each from the DGH and the DGNC, under the methodological guidance of Prof. Selbmann of the German Association of the Scientific Medical Societies (AWMF). Six all-day working sessions and one proceeding to build a consensus (modified Delphi process) were held within the seven specialised societies involved. Degrees of recommendation, based upon the degree of evidence of the underlying literature studies, modified, if necessary, by the expert opinion of the steering committee's members and the external evaluators of the Delphi round, were established for the most important diagnostic and therapeutic methods. In addition to the long version, a short version and a patient information bulletin were prepared as well, and the ways, means, and considerations surrounding their realisation and implementation, and other potential developments were also pursued.

In the past few years, the essential role of the homeobox gene Pax6for eye development has been demonstrated unambiguously in a variety of species including humans. In humans, Pax6mutations lead to a variety of ocular malformations of the anterior and posterior segment. However, little is known about PAX6 expression in the adult human retina. We have therefore investigated PAX6 levels and localization in the human retina at various ages. Adult human eyes of various ages (17–79 years) were obtained from the Zurich Eye Bank. PAX6 expression levels and patterns were analysed by Western blot analysis of total retinal protein and by immunohistochemistry on paraffin sections, respectively. PAX6 expression in the retina was detected up to 79 years of donor age and was predominantly localized to the ganglion cell layer and the inner part of the inner nuclear layer. PAX6 remains distinctly expressed throughout the lifespan of the human retina suggesting a role for PAX6 in the retina after completion of eye morphogenesis.

The purpose of this prospective randomised study was to evaluate which operative technique for treatment of cubital tunnel syndrome is preferable: subcutaneous anterior transposition or nerve decompression without transposition. This study included 66 patients suffering from pain and/or neurological deficits with clinically and electromyographically proven cubital tunnel syndrome. Thirty-two patients underwent nerve decompression without transposition and 34 underwent subcutaneous transposition of the nerve. Follow-up examinations evaluating pain, motor and sensory deficits as well as motor nerve conduction velocities, were performed 3 and 9 months postoperatively. There were no significant differences between the outcomes of the two groups at either postoperative follow-up examination. We recommend simple decompression of the nerve in cases without deformity of the elbow, as this is the less invasive operative procedure.

Ziel unserer Studie war es, den Einfluss des intraoperativen Monitorings auf die Funktionserhaltung des N. facialis nach Resektion des Akustikusneurinoms zu analysieren. Zur Beurteilung der Fazialisfunktion wurde das Gradingsystem nach Stennert verwendet. 130 Patienten wurden in 2 Gruppen unterteilt. Gruppe 1: Operation ohne, Gruppe 2: mit intraoperativem Monitoring. Trotz anatomischer Erhaltung des Nervens, kam es postoperativ zu deutlichen Verschlechterungen der Nervenfunktion, wobei es im Verlauf zur signifikanten Ruckbildung der Fazialisparese kam. Der Schweregrad der Fazialisparese verschlechterte sich am 1. Tag postoperativ in Gruppe 1 von 0,77±1,5 auf 4,4±3,0 und in Gruppe 2 von 0,4±1,2 auf 2,4±2,1. Sechs Monate nach der Operation besserte sich die Fazialisfunktion (Gruppe 1: 2,0±2,3, Gruppe 2: 4,1±3,2), der praoperative Zustand konnte jedoch nicht erreicht werden. Es konnte gezeigt werden, dass die Funktion des N. facialis bei Patienten, die mikrochirurgisch unter Verwendung des intraoperativen Fazialismonitorings an einem Akustikusneurinom operiert wurden, zu jedem postoperativ untersuchten Zeitpunkt signifikant bessere Ergebnisse aufwies als bei den Patienten, die ohne Monitoring behandelt wurden (p=0,001).

Every year, approximately 55,000 patients suffering from spinal trauma require hospital care in Germany. About 20% of these patients have symptoms of a spinal cord injury. It is important to know that vertebral column injury may be associated with spinal cord injury or not and that spinal cord injury may even occur without a lesion of the vertebral column. Pain and malposture are signs of vertebral column injury while a spinal cord lesion causes neuro-deficits, usually presenting as complete or incomplete transverse cord lesion. First aid calls for stabilization of blood pressure and pulmonary function. Additional damage to the cord should be avoided by immobilization. The application of steroids (methyl-prednisolone) is recommended according to the presently available evidence. The patient should be transferred to a center, in which all diagnostic and therapeutic facilities required for the management of spinal trauma are available. Currently, there are no evidence-based data favoring any treatment option. The outcome seems to be independent of surgical or non-surgical management. However, the advantage of surgical treatment is the early mobilization of the patient due to the immediate stabilization and a reduction of late complications.

Purpose: Additionally to the typical carpal tunnel symptoms, the patients of this study had atypical complaints. Other reasons for these symptoms than those caused by the compression of the median nerve could be excluded using medical examination or imaging techniques. Purpose of this study was to investigate whether decompression of the median nerve may reduce or even abolish the atypical complaints. Method: For this prospective study 378 patients with carpal tunnel syndrome were clinically and electroneurographically examined, which was performed before and after (3 months) they underwent surgical decompression of the median nerve. Results: 70 patients (19% of all patients) with carpal tunnel symptoms suffered from additional atypical symptoms such as cardiac pain, ipsilateral headache as well as neck and shoulder pain. The diagnosis of carpal tunnel syndrome was made using clinical and electroneurographical examination. Carpal tunnel symptoms of all patients disappeared completely after surgery. Respectively, 61 % of those patients with preoperative atypical complaints did also fully recover. Conclusion: This study shows that patients with carpal tunnel syndrome may also suffer from atypical complaints. These symptoms have been shown to be associated with the compression of the median nerve. They may be caused by spinal synaptic interaction between sensory and sympathetic/parasympathetic neuronal pathways by somatically-induced reflex responses.

Surgical aspiration and/or drainage of brain abscesses is considered to be the first-line treatment for abscesses larger than 25 mm. This is ususally performed with the aid of CT-guided stereotaxy. A method of ultrasound guidance is presented that allows a single burr hole approach with real-time imaging of the whole procedure. A bayonet-like shaped ultrasound probe with tip dimension of 8 x 8 mm only (EUP-NS 32, Hitachi/Ecoscan) with frequencies of 3.5 and 5 MHz is used. After placement of a burr hole the target is identified by transdural insonation, a guideline is adjusted and a mounted puncture-adapter guides the cannula towards the lesion under real-time imaging control. Up to now 12 abscesses in 10 patients were treated. Visualization was always excellent. A second aspiration had to be performed twice. One abscess did not contain enough pus to be cured by aspiration and was removed by open surgery, another could not be tapped by the blunt cannula and was aspirated under stereotactic control using a sharp trocar. Outcome was excellent in 6 patients and fair in 2 patients but this was due to the pre-existing disease. Two patients admitted in deep coma died despite an emergency operation. The presented method has proven to be a very powerful guiding tool in the surgical treatment of brain abscesses through a single burr hole approach.

Hintergrund. Durale Karotis-Sinus-cavernosus-Fisteln machen ca. 12% aller intrakraniellen arteriovenosen Fisteln aus. Die klassische Therapie besteht in einer interventionellen Embolisation uber transarteriellen Zugang. Wir berichten uber die Vorgehensweise bei zwei Patientinnen, bei denen die ublichen therapeutischen Masnahmen nicht moglich oder ineffektiv waren. Patienten und Methode. Nachdem andere Therapieversuche erfolglos waren, wurde bei zwei Patientinnen ein endovaskularer Fistelverschluss durch Partikelembolisation uber eine Vene der Fissura Sylvii durchgefuhrt. Die Vene wurde hierzu neurochirurgisch uber eine osteoplastische pterionale Kraniotomie prapariert. Ergebnisse. Bei beiden Patientinnen zeigte sich angiographisch und klinisch ein suffizienter Fistelverschluss. Bei einer Patientin kam es als schwerwiegende Komplikation nach der postoperativen Kontrollangiographie zu einem thrombembolischen Insult. Schlussfolgerung. Die transvenose Embolisation uber eine superfiziale Vene der Sylvius-Fissur stellt bei sorgfaltiger Indikationsstellung, ausfuhrlicher praoperativer Diagnostik und interdisziplinarer Durchfuhrung ein effektives Verfahren zur Therapie duraler Karotis-Sinus-cavernosus-Fisteln dar. Das Verfahren sollte jedoch erst Anwendung finden, falls die klassischen Therapieformen nicht durchfuhrbar sind oder aufgrund besonderer Gegebenheiten keinen Erfolg versprechen.

In 2005, the "Deutsche Gesellschaft für Neurowissenschaftliche Begutachtung" (German Society for Neuroscientific Legal Evaluation) together with other Societies published a guideline for the legal evaluation of patients with closed head injuries. Meanwhile, not only scientific progress in imaging techniques but also in other fields such as neuropsychology has necessitated a revision, which is presented here. In the mean time, the handling of guidelines has been systematised in Germany so that a registration with the Cooperation of German Medical Learned Societies is applied for and publication in the German Guideline Registry is expected.

The available data on secondary creep in creep tests and on maximum stress in hot deformation tests obtained for δ and α ferrite have been reviewed and expressed in the form of the equation ϵ = K(σ/E)Pc sinh(Vσ/RT) exp(—Qc/RT) with pc = 2·5, V = 0·0013 m3 mol−1, and K = 2·6 × 1017 s−1, E and Qc being temperature dependent functions. The approximate range of validity is Z = ϵ exp (Qc/RT) ≈ 101—1011 s−1. Together with the corresponding equation for austenite the data can be used to predict the viscoplastic behaviour of austenite—ferrite mixtures.MST/1538

A modified Czochralski technique (EMS-CZ) has been developed to pull single crystals without mechanical rotation of the crystal and the crucible by bringing forth the controlled convection in the melt solely by a rotating electromagnetic field. Crystals of copper, germanium and silicon have been grown successfully with this technique.

Both coal combustion and coal gasification processes now require careful control of sulfur-bearing effluents. These needs have stimulated an extensive amount of research and development (R & D) on simple and complex sulfur sorbent materials. The application of thermodynamics in the study of the performance of these materials can and should be an effective approach. Examples are described to show its effectiveness as an analytical tool and to point out some misconceptions that have been created in the published literature.

The available data on minimum strain rate (‘secondary creep’) in creep tests and on maximum stress (first peak stress) in hot deformation tests obtained for γ iron and for γ Fe–C alloys have been reviewed and allocated in the form of an equation ɛ=4·6×1017 (σ/E)3·0 exp (α%C) sinh (60·137σ/T) exp (−32 714/T), where ɛ is the strain rate (s−1), σ is the stress (MN m−2), E is the elastic (Young's) modulus (MN m−2) according to E=230 950−99·04T, %C is the per cent carbon content, and T is the absolute temperature. The range of validity is from approximately Z′=ɛexp (32 714/T) exp (−α%C)=103 to 1014 s−1 (where Z′ is a modified Zener–Hollomon parameter), which covers the temperature range from 900 to 1400°C. The factor α describing the influence of carbon content is given by the expression α=2·3−2·1 log (60·137;amp;#x03C3;/T). Hence, the softening of austenite by carbon decreases with increasing stress and decreasing temperature. At very high σ/T ratios, the factor ;amp;#x03B1; may even become negative r...

The cubital tunnel syndrome is one of the most widespread compression syndromes of a peripheral nerve. In German-speaking countries it is known as the sulcus ulnaris syndrome (retrocondylar groove syndrome), which is anatomically incorrect. The cubital tunnel consists of the retrocondylar groove, the cubital tunnel retinaculum (Lig. arcuatum or Osborne band), the humeroulnar arcade and the deep flexor/pronator aponeurosis. According to Sunderland it can be divided into a primary form (including the ulnar luxation and the epitrocheoanconaeus muscle) and a secondary form caused by deformation or other processes of the elbow joint. The diagnosis has to be confirmed by a thorough clinical examination and nerve conduction studies. Neurosonography and MRI are becoming more and more important with improving resolution and enable the direct identification of morphological changes. Differential diagnosis is essential in atypical cases, especially C8 syndrome and pressure palsy. Double crush (double compression syndrome) may occur. Operative treatment is more effective than conservative treatment, which consists primarily of the prevention of exposure to external noxes. According to actual randomised controlled studies the therapy of choice of the primary form in most cases is the simple in situ decompression of the ulnar nerve in the cubital tunnel. This has to be extended at least up to 5-6 cm distally of the medial epicondyle and can be performed in the open or endoscopic technique, both under local anesthesia. Simple decompression is also the therapy of choice in uncomplicated ulnar luxation and in most post-traumatic cases and other secondary forms. In cases of severe bony or tissue changes of the elbow (especially cubitus valgus) the volar transposition of the ulnar nerve may be indicated. This can be performed in a subcutaneous or submuscular technique. Risks of transposition are impairment of perfusion and, above all, kinking caused by insufficient proximal or distal mobilisation of the nerve has to be avoided. In these cases revision surgery is necessary. The epicondylectomy is not common in our country. Recurrences may occur.

Identified entorhino-hippocampal projection neurons were investigated for their ultrastructure. Spinous projection neurons (pyramidal and spiny stellate cells) display common features such as symmetric axosomatic terminals on their somata, asymmetric synapses on the spines, and both types of synapses on the dendritic shafts. Their axons descend towards the white matter, branching occasionally via collaterals which establish contact with local spines and rarely on dendritic shafts and somata. The sparsely spinous projection neurons (multipolar and horizontal-bipolar) typically show deep nuclear infolds and symmetric and asymmetric synapses on their somata and dendritic shafts. Axons also collateralize in the soma vicinity and form local synapses. It is concluded that the entorhino-hippocampal projection neurons (both spiny and sparsely spinous) act locally and distally thus performing simultaneously as local-circuit and as projection neurons. In accordance with other morphological and electrophysiological reports it appears likely that the generation, modulation, and suppression of entorhinal excitation waves is mediated by these neurons through direct excitation, feed-forward and feed-back inhibition, and disinhibition.

In the period from July 2005 through November 2006, the evidence-based guidelines were developed by a steering committee consisting of three members from each of the societies involved (German Society for Hand Surgery, German Society of Neurosurgery, German Society of Neurology and German Society of Orthopaedics), coordinated by one member each from the DGH and the DGNC, under the methodological guidance of Prof. Selbmann of the German Association of the Scientific Medical Societies (AWMF). Six all-day working sessions and one proceeding to build a consensus (modified Delphi process) were held within the seven specialised societies involved. Degrees of recommendation, based upon the degree of evidence of the underlying literature studies, modified, if necessary, by the expert opinion of the steering committee's members and the external evaluators of the Delphi round, were established for the most important diagnostic and therapeutic methods. In addition to the long version, a short version and a patient information bulletin were prepared as well, and the ways, means, and considerations surrounding their realisation and implementation, and other potential developments were also pursued.

Evidence-based supradisciplinary guideline that deals with the epidemiology, pathogenesis, symptoms, clinical and electrophysiological diagnosis, supplementary imaging investigations, differential diagnosis, conservative and surgical treatments, prognosis and course along with complications and revision surgery. The recommendations on investigation and treatment are based on a comprehensive literature search with critical evaluation and two consensus methods (expert group and Delphi technique) within the participating specialist societies. Besides this long version, a short version and a patient version can be viewed through the AWMF platform. The development of the guideline and the methodological foundations are documented in a method report. MAIN STATEMENTS: Apart from an accurate history and clinical neurological examination (including clinical tests), electrophysiological investigations (distal motor latency and sensory neurography) are particularly important. Radiography, MRI, high-resolution ultrasonography can be regarded as optional supplementary investigations. Among conservative treatment methods, treatment with a nocturnal splint and local infiltration of a corticosteroid preparation are effective. Oral steroids, splinting and ultrasound showed only short-term benefit. Surgical treatment is clearly superior to all other methods. Open and endoscopic procedures (when the endoscopic surgeon has sufficient experience) are equivalent. A routine epineurotomy and interfascicular neurolysis cannot be recommended. Early functional treatment postoperatively is important.

Glaucoma, frequently associated with high IOP (intra-ocular pressure), is a leading cause of blindness, characterized by a loss of retinal ganglion cells and the corresponding optic nerve fibres. In the present study, acutely and transiently elevated IOP, characteristic of acute angle-closure glaucoma in humans, was observed in CLR (calcitonin receptor-like receptor) transgenic mice between 1 and 3 months of age. Expression of CLR under the control of a smooth muscle α-actin promoter in these mice augmented signalling of the smooth-muscle-relaxing peptide adrenomedullin in the pupillary sphincter muscle and resulted in pupillary palsy. Elevated IOP was prevented in CLR transgenic mice when mated with hemizygote adrenomedullin-deficient mice with up to 50% lower plasma and organ adrenomedullin concentrations. This indicates that endogenous adrenomedullin of iris ciliary body origin causes pupillary palsy and angle closure in CLR transgenic mice overexpressing adrenomedullin receptors in the pupillary sphincter muscle. In human eyes, immunoreactive adrenomedullin has also been detected in the ciliary body. Furthermore, the CLR and RAMP2 (receptor-activity-modifying protein 2), constituting adrenomedullin receptor heterodimers, were identified in the human pupillary sphincter muscle. Thus, in humans, defective regulation of adrenomedullin action in the pupillary sphincter muscle, provoked in the present study in CLR transgenic mice, may cause acute and chronic atony and, thereby, contribute to the development of angle-closure glaucoma. The CLR transgenic mice used in the present study provide a model for acute angle-closure glaucoma.

In Germany, Directive 2001/20/EC is implemented by articles 40 to 42a of the Federal Drug Act and by the Decree on Good Clinical Practice. Pivotal provisions have been included into the Federal Drug Act, such as those aiming at the clinical trial subject's protection and defining responsibilities for the evaluation of applications as well as for pharmacovigilance and surveillance. The Decree comprises: relevant definitions; requirements for manufacturing, importation and labelling of investigational medicinal products; the procedures to obtain the ethics committee's opinion and the authorization from the competent authority on the trial application and on amendments thereof; documentation and information tasks of the investigator, sponsor and competent authority; rules for inspection to verify compliance with good clinical and manufacturing practice. Finally, the decree lists infringements within the meaning of article 97, paragraph 2, no. 31 of the Federal Drug Act, and lays down the necessary provisions for a transitional period and the entering into force of the new provisions.

The aim of this study was to evaluate the influence of intraoperative monitoring on the function of the facial nerve after surgical treatment of acoustic neurinomas, classified according to the grading system of Stennert. One hundred thirty patients were divided into two groups. The first group underwent surgery without intraoperative facial monitoring; the second group included intraoperative facial monitoring. Concerning degree of paresis, preoperatively there was no statistically significant difference between the two groups (group 1: 0.77+/-1.5; group 2: 0.4+/-1.2). Despite structural preservation of the facial nerve, postoperative deterioration of its function was observed which consecutively improved postoperatively. Postoperatively, the mean degree of paresis increased to 4.4+/-3.0 in group 1 and 2.4+/-2.3 in group 2. For better understanding of the role of intraoperative monitoring, we investigated the outcome of patients with acoustic neurinomas who underwent surgery over the following 6 months postoperatively. At that time, function improved by 4.1+/-3.2 (group 1) and 2.0+/-2.3 (group 2). We could show that intraoperative monitoring of the facial nerve was a significant factor for better postoperative function in patients undergoing microsurgical excision of neurinomas (P=0.001) .

Clinical practice guidelines (CPGs) are suited tools for controlling and improving the effectiveness and efficiency of medical care. With the upcoming internet, the numbers of CPGs have increased rapidly, however, only few offer the attributes of good guidelines such as reliability/reproducibility, applicability, flexibility, clarity, multidisciplinary process, scheduled review and documentation of clinical and scientific evidence. Nearly identical criteria for appraisal of CPGs have been developed in many countries consisting of a checklist with questions concerning the quality of development, the content and format, and the applicability of the guideline. In the United States, guidelines which successfully passed the appraisal (or clearing) process, were stored in the National Guideline Clearinghouse, an internet-based database. A German counterpart is under construction, which will comprise clearing reports reviewing and appraising all existent guidelines covering a medical topic. Developing high-quality CPGs is a time consuming and expensive process. A widely accepted guideline for guideline development was published by the Scottish Intercollegiate Guideline Network. CPGs touching neurosurgical topics are rare and often developed without neurosurgical participation. Due to the potential medico-economic impact of CPGs in the future, national neurosurgical societies and their international associations should play a more active role in the development and implementation of CPGs.

Additionally to the typical carpal tunnel symptoms, the patients of this study had atypical complaints. Other reasons for these symptoms than those caused by the compression of the median nerve could be excluded using medical examination or imaging techniques. Purpose of this study was to investigate whether decompression of the median nerve may reduce or even abolish the atypical complaints.For this prospective study 378 patients with carpal tunnel syndrome were clinically and electroneurographically examined, which was performed before and after (3 months) they underwent surgical decompression of the median nerve.70 patients (19 % of all patients) with carpal tunnel symptoms suffered from additional atypical symptoms such as cardiac pain, ipsilateral headache as well as neck and shoulder pain. The diagnosis of carpal tunnel syndrome was made using clinical and electroneurographical examination. Carpal tunnel symptoms of all patients disappeared completely after surgery. Respectively, 61 % of those patients with preoperative atypical complaints did also fully recover.This study shows that patients with carpal tunnel syndrome may also suffer from atypical complaints. These symptoms have been shown to be associated with the compression of the median nerve. They may be caused by spinal synaptic interaction between sensory and sympathetic/parasympathetic neuronal pathways by somatically-induced reflex responses.

Mukozelen treten am haufigsten in der Stirnhohle und seltener im Siebbeinzellsystem und in der Kiefer- und Keilbeinhohle auf. Mukozelen der Stirnhohle konnen durch eine Infektion oder durch ihr expansives Wachstum zu intrakraniellen und orbitalen Komplikationen fuhren. Die chirurgische Intervention stellt die einzige therapeutische Option dar. Wahrend Mukozelen des Siebbeinzellsystems, der Kiefer- und der Keilbeinhohle uber einen endonasalen Zugang problemlos in die Nase marsupialisiert werden konnen, ist das Vorgehen bei Mukozelen der Stirnhohle von der Lokalisation und der Ausdehnung der Mukozele abhangig.

Dural carotid sinus cavernous fistulas account for about 12% of intracranial arteriovenous fistulas. These dynamic shunts are dilemmas not only for the clinical diagnosis but also for the management of ocular complications and in the application of diagnostic and therapeutic techniques. The traditional therapy is transarterial embolisation by an interventional neuroradiologist. We report on the management of two fistulas where the classical therapeutic methods were not possible or failed.Two patients underwent an osteoplastic pterional craniotomy with cannulation of a vein of the sylvian fissure and controlled embolisation of the fistula with polyvinyl alcohol particles.Successful closure of both arteriovenous shunts was achieved on angiography with normalisation of clinical symptoms. As a severe complication one patient suffered from a stroke after the postoperative angiography.Arteriovenous fistulas not approachable by traditional therapeutic methods, can be embolised effectively via a superficial vein of the sylvian fissure. This surgical route should only be considered if other therapeutic ways fail or seem impossible.

Due to the Hospital Statistics Regulations of the 10th April 1990, the German Hospital Diagnosis Statistics were introduced in 1993 with the intention to serve as a database of health care decisions. This purpose requires a high-quality collection of epidemiologically relevant data. From 1993 to 1996 we analysed the datasets obtainable for subarachnoid haemorrhage which is coded with ICD 430. A subset concerning the data of 1996 and the Saarland region was compared to the data of the Saarland medical school at Homburg/Saar. Cases treated in the neurosurgical department were critically reviewed. About 20% of the cases coded with ICD 430 showed no subarachnoid haemorrhage. On the other hand, again about 20% of subarachnoid haemorrhage cases were not coded with ICD 430. The statistics comprise duplicates due to transfers between hospitals. The calculation of incidence is not possible because new bleeding cases cannot be outlined. In the present form the German Hospital Diagnosis Statistics are not suitable as a reliable base of health care decisions. This is partly caused by the inadequacy of the ICD-classification but, also, by the criteria for collecting data. We propose several modifications which can improve data quality in order to meet the intended requirements.

In this study the fine structure and synaptic connections of mossy cells in the rat and monkey fascia dentata were analyzed. In order to study commissural connections of identified mossy cells in the rat, hilar neurons were retrogradely labeled by horseradish peroxidase (HRP) or Fast Blue (FB) injections into the contralateral hippocampus. Vibratome sections containing retrogradely HRP-labeled hilar neurons were Golgi-impregnated and gold-toned. Hilar commissural neurons identified by contralateral FB injection were intracellularly labeled with Lucifer Yellow (LY). Lucifer Yellow staining was made electron-dense by photoconversion thereby allowing for an electron microscopic analysis of the retrogradely labeled and intracellularly stained neurons. With these two different approaches, we succeeded in identifying rat mossy cells projecting to the contralateral hippocampus. Mossy cells in the fascia dentata of primates (Papio anubis, Macaca mulatto, Saimiri sciureus) were, like mossy cells of rats, either Golgi-impregnated and gold-toned or intracellularly injected with LY. No major differences were found between mossy cells of rats and monkeys. The mossy cell dendrites originated from the two sides of an ovoid cell body and were mainly oriented parallel to the granule cell layer. In contrast to the rat, dendrites of mossy cells in the primate did not respect the granule cell layer and penetrated frequently into the molecular layer. The occurrence of excrescences on proximal dendrites was a characteristic feature of all mossy cells. These large spines were more complex in the primate than in the rat. In both rats and primates they formed numerous asymmetric synapses with large boutons of mossy fibers. Peripheral dendrites were covered with small, simple spines. Interestingly, these peripheral dendrites lacking excrescences also established asymmetric synapses with mossy fiber boutons as well as asymmetric and symmetric contacts with smaller terminals of unknown origin. These findings indicate that in both rats and primates the thorny excrescences are not the only target of the mossy terminals. While the proximal portions of the mossy cell dendrites appear to be exclusively contacted by the granule cells, a larger number of neuron types may converge on the distal dendrites. The axons of mossy cells, in both rats and primates, although incompletely stained with the present methods, were seen to ramify in-the hilar region. Our results demonstrate that, despite minor species differences, the mossy cells of the fascia dentata represent a cell type that is preserved in phylogenetically distant species.

The connections of the olfactory bulbs of Podarcis hispanica were studied by tract-tracing of injected horseradish peroxidase. Restricted injections into the main olfactory bulb (MOB) resulted in bilateral terminallike labeling in the medial part of the anterior olfactory nucleus (AON) and in the rostral septum, lateral cortex, nucleus of the lateral olfactory tract, and ventrolateral amygdaloid nucleus. Bilateral retrograde labeling was found in the rostral lateral cortex and in the medial and dorsolateral AON. Ipsilaterally the dorsal cortex, nucleus of the diagonal band, lateral preoptic area, and dorsolateral amygdala showed labeled cell bodies. Retrogradely labeled cells were also found in the midbrain raphe nucleus. Results from injections into the rostral lateral cortex and lateral olfactory tract indicate that the mitral cells are the origin of the centripetal projections of the MOB. Injections in the accessory olfactory bulb (AOB) produced ipsilateral terminallike labeling of the ventral AON, bed nucleus of the accessory olfactory tract, central and ventromedial amygdaloid nuclei, medial part of the bed nucleus of the stria terminalis, and nucleus sphericus. Retrograde labeling of neurons was observed ipsilaterally in the bed nucleus of the accessory olfactory tract and stria terminalis, in the central amygdaloid nucleus, dorsal cortex, and nucleus of the diagonal band. Bilateral labeling of somata was found in the ventral AON, the nucleus sphericus (hilus), and in the mesencephalic raphe nucleus and locus coeruleus. Injections into the dorsal amygdala showed that the mitral neurons are the cells of origin of the AOB centripetal projections. Reciprocal connections are present between AOB and MOB. To our knowledge, this is the first study to address the afferent connections of the olfactory bulbs in a reptile. On the basis of the available data, a discussion is provided of the similarities and differences between the reptilian and mammalian olfactory systems, as well as of the possible functional role of the main olfactory connections in reptiles.

Die Entnahme von Chorionzottengewebe im 1. Trimenon einer Schwangerschaft ermoglicht eine fruhzeitige pranatale Diagnostik von Chromosomenanomalien und erblichen Stoffwechselerkrankungen, stellt somit eine Erweiterung der invasiven pranatalen Diagnostik dar. Zwischen Oktober 1984 und August 1990 wurden an unserer Klinik 1 061 Chorionzottenentnahmen durchgefuhrt. Seit Anfang 1989 befassen wir uns zunehmend mit der transabdominalen Methode.

An almost fully automatized program for evaluation of somatosensory evoked potentials (SSEP) is described. It is suitable for intraoperative monitoring of SSEP as well as for continuous recording in the intensive care unit. The principles of peak detection, the reliability of peak amplitude and latency measurements, and possibilities to reduce the complex information of evoked potentials to a few parameters are shown. As yet, there has been little clinical experience; however, in practice, a good applicability of the softeware could be shown.

In 1680 cases of alveolitis ("dry socket") the national economic-loss is more than 339,693.-marks. Nearly 3 million teeth will be extracted in one year in the DDR. By a valuation of nearly 3% of the alveolitis 90,000 patients have this complication. That will be a economic-loss of 18.1 million marks in one year. The prophylaxis of this complication is therefore a most important problem.

During lumbar disc operation in the flexed prone position, a decrease in conjunctival pO2 can be observed although there is an increase in systemic blood flow after infusion of colloidal volume expanders. The regions of the body situated below the heart do not profit from the increase in systemic blood flow due to compression. The pO2 decreases more significantly after the infusion of a medium-molecular-weight solution with a more marked hemodynamic effect than after the infusion of low-molecular-weight hydroxyethyl starch. As the decrease in conjunctival pO2 is considerably less after low-molecular-weight hydroxyethyl starch, improved blood fluidity may be responsible for the increased tissue perfusion in the compressed area.

Electrophysiological and anatomical studies indicate functional relationships between the olfactory bulb and the hippocampus, mediated by the lateral olfactory tract and perforant path. Fibres from the lateral olfactory bulb terminate in the molecular layer of the lateral entorhinal cortex, which contains stellate and pyramidal cells that project to the hippocampus. Therefore this study was performed to analyze whether a trineuronal, disynaptic chain connects the olfactory bulb and the hippocampus. In adult rats, Fast Blue was unilaterally injected into the septal hippocampus to label cells of origin of the entorhinohippocampal pathway. Lesions of the ipsilateral olfactory bulb induced anterograde terminal degeneration in the entorhinal cortex of the same animals. Fast Blue labelled, and thus hippocampally projecting entorhinal neurones in fixed vibratome slices of the operated brains were injected with Lucifer Yellow. Most of these neurones were stellate layer II and pyramidal layer III cells; in addition there were some sparsely spinous multipolar cells in layers II and III and sparsely spinous horizontal cells at the layer I/II border. Injected cells were photoconverted and processed for electron microscopy. Olfactory bulb lesions resulted in electron-dense degeneration of abundant terminal boutons in the outer zone of entorhinal layer I. The relative frequency of degenerating boutons decreased towards deeper zones of the layer. In the outer zone, degenerated terminals predominantly contacted dendritic spines. These contacts could be seen on injected stellate cells but not on pyramidal cells. This study shows that the area dentata of the rat is reached by disynaptic afferent input from the olfactory bulb and thus is likely to process olfactory information. Oligosynaptic pathways might provide the hippocampus also with visual and auditory inputs; such fast transmitted polysensory information could be essential for the proposed participation of the hippocampus in attention-related mechanisms.