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BACKGROUND: Between June 1998 and January 2005 64 patients of the department of oto-rhino-laryngology, head and neck surgery in Kassel with primary resectable squamous cell carcinoma of the oropharynx underwent neoadjuvant induction therapy. Carboplatin and Paclitaxel were given 6 times once weekly. This combination has proofed to be successful in downstaging and extend survival in patients suffering from head and neck cancer. Afterwards tumor resection was performed in the initial extension of the carcinoma. Dependent on histological findings radiation therapy or radiochemotherapy was carried out. METHOD: Retrospective data were collected to analyse the effect on the tumor site and cervical lymph node metatasis based on post-chemotherapy clinical and postoperative histological results. In addition correlation between clinical findings and histological outcome and a possible survival advantage in patients with under induction chemotherapy remitted carcinomas was performed. RESULTS: The data showed no improvement in disease free survival in patients with complete remission of the primary tumor site but a significant prolonged survival time for patients with complete remission of the cervical lymph node metastasis.

Suprascapular neuropathy may present with chronic shoulder pain and weakness of abduction and external rotation of the arm. Therefore, it should always be included in the differential diagnosis of shoulder pain. Usually, the nerve is compressed at the suprascapular notch or the spinoglenoid notch. Here, the nerve is relatively fixed. In the etiology, repeated and forceful movements around the shoulder joint, especially in athletes such as volleyball players, are considered to be frequent causes of suprascapular nerve damage, whereas ligament hypertrophy and ganglia are uncommon. If conservative therapy fails, surgical decompression of the nerve is required for relief of pain and resolution of weakness.

Among a group of seven skeletons from the southern part of Lower Saxony, dating to the Single Grave Culture (ca. 2500BC), was a double inhumation, which showed an unusual burial position for one of the individuals interred. Deviating from the typical squatted position, this male was supine. Having been badly injured by an arrow shot into the back, he suffered from post-traumatic paraplegia and, most probably died from bacterial meningitis caused by the flint tip that penetrated the spinal cord. This infection was also responsible for the burial position, clearly pointing to an opisthotonus, which is indicative of the final stage of bacterial meningitis. The other individual, also male, had an arrow wound and died from the complications of a severe wound to the intestines.

The significance and possible extent of structural damage to the central nervous system (CNS) due to boxing are investigated. Bleeding, especially microhematomas, is considered to be one probable cause of the chronic encephalopathy in boxers. In a prospective study, 13 amateur boxers were investigated with the help of MRI several times before and after their fights. The MRI investigations were accompanied by neurologic examinations before and after the fights. Among the 13 boxes, 5 demonstrated focal neurological signs following the fights, without evidence of small hematoma or other structural alterations. The number of head punches did not correlate with the occurrence of neurologic signs. These results indicate that up to now imaging methods cannot clarify the development of chronic encephalopathy.

Between June 1998 and January 2005 64 patients of the department of oto-rhino-laryngology, head and neck surgery in Kassel with primary resectable squamous cell carcinoma of the oropharynx underwent neoadjuvant induction therapy. Carboplatin and Paclitaxel were given 6 times once weekly. This combination has proofed to be successful in downstaging and extend survival in patients suffering from head and neck cancer. Afterwards tumor resection was performed in the initial extension of the carcinoma. Dependent on histological findings radiation therapy or radiochemotherapy was carried out.Retrospective data were collected to analyse the effect on the tumor site and cervical lymph node metatasis based on post-chemotherapy clinical and postoperative histological results. In addition correlation between clinical findings and histological outcome and a possible survival advantage in patients with under induction chemotherapy remitted carcinomas was performed.The data showed no improvement in disease free survival in patients with complete remission of the primary tumor site but a significant prolonged survival time for patients with complete remission of the cervical lymph node metastasis.

Objective: To evaluate the effect of repetitive locomotor training on an electromechanical gait trainer plus physiotherapy in subacute stroke patients. Design: Randomized controlled trial. Setting: Four German neurological rehabilitation centres. Subjects: One hundred and fifty-five non-ambulatory patients (first-time stroke Intervention: Group A received 20 min locomotor training and 25 min physiotherapy; group B had 45 min physiotherapy every week day for four weeks. Main outcome measures: Primary variables were gait ability (Functional Ambulation Category, 0-5) and the Barthel Index (0-100), blindly assessed at study onset, end, and six months later for follow-up. Responders to the therapy had to become ambulatory (Functional Ambulation Category 4 or 5) or reach a Barthel Index of ≥ 75. Secondary variables were walking velocity, endurance, mobility and leg power. Results: The intention-to-treat analysis revealed that significantly greater number of patients in group A could walk independently: 41 of 77 versus 17 of 78 in group B (P B < 0.0001) at treatment end. Also, significantly more group A patients had reached a Barthel Index ≥ 75: 44 of 77 versus 21 of 78 (P B < 0.0001). At six-month follow-up, the superior gait ability in group A persisted (54 of 77 versus 28 of 78, P B < 0.0001), while the Barthel Index responder rate did not differ. For all secondary variables, group A patients had improved significantly more (P B < 0.0001) during the treatment period, but not during follow-up. Conclusions: Intensive locomotor training plus physiotherapy resulted in a significantly better gait ability and daily living competence in subacute stroke patients compared with physiotherapy alone.

A case of essential tremor since early adultness is presented, which has been treated successfully with the acetylcholine precursor 2-dimethylaminoethanol (deanol) for 10 years. Development of a marked dyskinesia syndrome affecting predominantly orofacial and respiratory musculature has been noticed with this medication. Partial remission after discontinuation and a favorable response to anticholinergics are suggestive of an adverse drug effect.

The aim of the present study was to evaluate the prevalence of latent and manifest suprascapular neuropathy in high-level male volleyball players. Thirty subjects were examined clinically and electrophysiologically. Suprascapular neuropathy, most probably at the level of the suprascapular notch, was demonstrated in 12 subjects, being latent in eight. Taking into account our clinical findings in a further 36 international-level players, a remarkably high overall prevalence of suprascapular nerve lesion of 33% (22 of 66 subjects) was found. All cases involved the side of the body with the player's smashing arm. These findings suggest that careful monitoring of suprascapular nerve function may be useful in high-performance volleyball players, as early diagnosis is essential to prevent more severe damage.

Individual observations during the course of the medical care of the German men's national volleyball team in international tournaments gave cause to investigate more thoroughly the increasing occurrence of an atrophy of the infraspinatus m. in volleyball players at international level. An examination of three men's national teams specially slanted to throw light on this problem revealed that 28% (10 out of 36 players) had an atrophy of the infraspinatus m. On the basis of these findings, a prospective study was carried out, with the object of clarifying to what extent a developing or manifest compression neuropathy of the suprascapularis n. was present in a defined population of high-level volleyball players (1st National League, men). 32 players were examined as to the extent to which a functional impairment of the suprascapularis n. occurred in the pursuit of the competitive sport of volleyball. The study revealed a functional impairment of the suprascapular n. in 45% of the both clinically and neurophysiologically examined sportsmen. It follows in consequence that a control examination is advisable in the case of a latent disorder, so as to detect any continuation or possible deterioration. In the event of a developing or manifest atrophy of the infraspinatus m. the operative relief of the suprascapular n. in the region of the scapular incisure may be considered in addition to conservative therapy.

Suprascapular neuropathy may present with chronic shoulder pain and weakness of abduction and external rotation of the arm. Therefore, it should always be included in the differential diagnosis of shoulder pain. Usually, the nerve is compressed at the suprascapular notch or the spinoglenoid notch. Here, the nerve is relatively fixed. In the etiology, repeated and forceful movements around the shoulder joint, especially in athletes such as volleyball players, are considered to be frequent causes of suprascapular nerve damage, whereas ligament hypertrophy and ganglia are uncommon. If conservative therapy fails, surgical decompression of the nerve is required for relief of pain and resolution of weakness.

The significance and possible extent of structural damage to the central nervous system (CNS) due to boxing are investigated. Bleeding, especially microhematomas, is considered to be one probable cause of the chronic encephalopathy in boxers. In a prospective study, 13 amateur boxers were investigated with the help of MRI several times before and after their fights. The MRI investigations were accompanied by neurologic examinations before and after the fights. Among the 13 boxes, 5 demonstrated focal neurological signs following the fights, without evidence of small hematoma or other structural alterations. The number of head punches did not correlate with the occurrence of neurologic signs. These results indicate that up to now imaging methods cannot clarify the development of chronic encephalopathy.

Epilepsy is a frequent disease. The question of possible sport activities and epilepsy is important because of the prominent role of sport in the population. The present paper deals with problem if epileptic patients can freely participate in sport or whether they are restricted to a certain extend by their disorder. The aim of this review is to determine the factors which may or may not interfere with sport for the epileptic patient.

Subacute necrotizing encephalopathy (Leigh syndrome) is characterized by lactacidosis, seizures, ataxia, multiple cerebral hypervascularized lesions and mitochondrial oxidation defects. This is a report on a 21-year-old patient with proven Leigh syndrome, mild central and provokable peripheral lactacidosis, an extra-erythrocyte complex II defect, functionally reduced myokinase adenylate deaminase activity, but no ultrastructural mitochondrial changes. Determination of lactate, pyruvate and ammonia under ischemic conditions plus a pyruvate loading test were particularly useful. Oral flunarizine (Sibelium 30 mg/d) proved to be therapeutically effective.

✓ The present study evaluates the interdependence of clinical stage, cerebral vasospasm, intracranial pressure (ICP), and transcranial Doppler ultrasonographic parameters. The mean flow velocity of blood in the middle cerebral artery and the index of cerebral circulatory resistance as a measure of the peripheral vascular flow resistance were determined in 76 patients with spontaneous subarachnoid hemorrhage. The ICP was measured using an epidural transducer in 41 patients. There was no case in which both high ICP and a high mean flow velocity were observed simultaneously. The investigations led to the following conclusions. 1) In patients with a resistance index of less than 0.5, changes in the mean flow velocity seem to reflect sufficiently the actual severity and time course of vasospasm. 2) During the time course of vasospasm, an increase in the resistance index above values of 0.6 with a simultaneously decreased mean flow velocity indicates a rise in ICP rather than a reduction in vasospasm. 3) With a pronounced increase in ICP, evaluation of the severity and time course of vasospasm by transcranial Doppler ultrasonography based solely upon the mean flow velocity can lead to false-negative results.

5576 Background: The five-year survival for patients with recurrent disease has not been significantly increased in the last years. Despite aggressive initial management of the primary tumor, patients suffer from locoregional recurrence in up to 50% and distant metastasis is seen in about 25% of cases. Materials and Methods: 96 patients with recurrent or metastatic carcinoma of the head and neck received therapy as follows. From August 1996 to May 2000, 52 patients received chemotherapy with paclitaxel 100 mg/m2 in combination with carboplatin AUC2. Between May 2000 and October 2004, 44 patients with recurrent or metastatic disease were treated with docetaxel 35 mg/m2 in combination with carboplatin AUC2. Both chemotherapy regimens were administered weekly for a maximum of six cycles. Results: Most of the patients underwent a combination first line therapy with CT/Surg/RT (48%/47.7%) or CT/RT (36%/23%) before suffering from rec. disease. After recurrence local, regional or distant, we observed 9.6% complete response for the combination-therapy with paclitaxel/carboplatin and 25% with docetaxel/carboplatin, partial response in 38.5% and 34.1% of the patients, yielding an overall response rate of 48.1% with weekly paclitaxel/carboplatin and 59.1% with weekly docetaxel/carboplatin. Stable disease was documented for 25% of the patients treated with paclitaxel/carboplatin and 18.2% after treatment with docetaxel/carboplatin. Median survival was measured after first diagnosis of recurrence or metastatic disease. We observed a median survival of 10.9 month for the group treated with paclitaxel/carboplatin and 37 month for patients treated with docetaxel/carboplatin. Therapy with both treatment-options was well tolerated, all 96 patients received six cycles. Most frequent toxicity was leucopenia (Grade I/II/III: paclitaxel 12%/27%/15%; docetaxel 25%/23%/16%). Conclusions: Chemotherapy for recurrent carcinoma of the head and neck with weekly docetaxel/carboplatin is well tolerated and effective. The toxicitiy profile makes this combination favourable for an outpatient setting. No significant financial relationships to disclose.

Summary: A 49-year-old man presented with temperature up to 39.5"C, a sudden peroneal nerve lesion, and a cardiac murmur. The peroneal nerve lesion was likely caused by an embolic occlusion of an artery supplying the nerve. Until now, six cases of embolic mononeuropathy in endocarditis have been reported in the literature. Embolic mononeuropathy is a very rare manifestation of subacute bacterial endocarditis and quite often complicates, as do other more common embolic manifestations, the correct diagnosis.

The most well known brain tumour models will be discussed. It is a series of animal experiments with an induced tumour and with heterologous and homologous transplantation. This work will deal especially with technical problems, which have not so far been satisfactorily resolved. With the aid of a stereotaxic operation method, the exactness of the technique of transplantation could be improved. The tumour contamination problem of the injection pathway as well as of the cerebral spinal fluid compartment is satisfactorily resolved. The authors have at their disposal a standardized cerebral glioma model in the rat in order to study the interstitial chemotherapy of brain tumours.

The incidence of sports accidents is on the increase. The authors examined the question whether this is also true of craniocerebral injuries during sports activities. For this purpose they studied and assessed all grade I and II craniocerebral injuries treated during 1982 at the departments of Surgery and Neurosurgery at the University of Gottingen. The craniocerebral injuries had a share of 13.5% in the total incidence of Sports accidents. This figure is markedly above the comparative figures quoted so far. The incidence of craniocerebral trauma varies from one sports discipline to another, depending on the popularity of the particular sport. However, a comparison with data published in the literature shows that craniocerebral trauma is the most frequent sports injury in all disciplines in which the head is particularly exposed.

The skulls of 55 mice (strain C 57 Black) were studied radiologically at various ages. In the mouse, craniocaudal growth of the skull takes place exclusively within two synchondroses. Longitudinal growth is completed at 50 to 60 days of life and it is dependent on the pressure developed by the growing brain. In strain C 57 Black congenital hydrocephalus occurs with an incidence of approximately 8%, causing a characteristic deformity of the skull. Hydrocephalus developing after 30 days of age causes deformity restricted to the calvarium. The base of the skull remains unchanged and may not be distinguished from that of normal individuals of the same age. Abnormal lateral growth of the base of the skull may be observed if hydrocephalus develops in the young mouse: At 25 days pp. the syndesmosis between os petrosum and the adjacent bones is not yet solidified. Consequently, the ossa petrosa may yield to the increased intracranial pressure. The result is a measurable widening of the distance between the tips of the ossa petrosa. A radiological method is described, permitting high resolution of minute details of the skull of small experimental animals.

A simple illumination system is described that can be easily adapted to a laboratory stereomicroscope allowing for low power high contrast dark field surveying. The system uses commercially available fibre optic lamps, standard bright field objectives and produces a large, evenly illuminated field suitable for photography.

A case is presented in which the initial CT scan failed to demonstrate subdural suppuration over both convexities. Definitive CT finding of subdural empyema (SDE) was only positive at an advanced stage, when a bilateral subgaleal empyema also spread out. Because of the fulminant development of the subdural empyema and the delayed diagnosis, the outcome was fatal in spite of neurosurgical operation. Subdural empyema is a neurological and neurosurgical emergency. Early diagnosis is imperative, because the mortality is about 25-40% and the outcome depends upon the promptness of diagnosis and the appropriate operation. In the recent literature the value of computerised tomography for early detection of subdural empyema is controversial. Some reports failed to demonstrate any evidence of purulent subdural collection in CT scans while others were able to make an early diagnosis. This report presents a case which demonstrates the difficulties in making an early diagnosis of a subdural empyema by CT.

Traumatic damage in the posterior fossa is a relatively rare event. A case of a 52-year-old alcoholic is reported who had two severe head traumas during a fight. The subsequent complaints consisted in vertigo and ataxia and were related to a post-commotional syndrome or damage due to chronic alcoholism. The neurological work-up, which was performed a few months later showed typical signs of traumatic damage of the cerebellum. This was confirmed by axial CT-scan.

The clinical picture of Morvan's fibrillary chorea includes a. spontaneous muscular activity resulting from repetitive motor unit action potentials of peripheral origin (multiplets), b. autonomic dysregulation with profuse hyperhidrosis, and c. central nervous system involvement as shown by severe insomnia and hallucinosis. A case featuring all these symptoms is presented. Whereas known causative factors range from gold or mercury poisoning to autoimmune disorders, the presented case is the first one in which chronic manganese intoxication (occupational exposure) seems to be implicated. Manganese has been found to inhibit acetylcholine esterase, and, as a consequence, may produce peripheral and central cholinergic hyperactivity.

The incidence of sports accidents is on the increase. The authors examined the question whether this is also true of craniocerebral injuries during sports activities. For this purpose they studied and assessed all grade I and II craniocerebral injuries treated during 1982 at the departments of Surgery and Neurosurgery at the University of Göttingen. The craniocerebral injuries had a share of 13.5% in the total incidence of Sports accidents. This figure is markedly above the comparative figures quoted so far. The incidence of craniocerebral trauma varies from one sports discipline to another, depending on the popularity of the particular sport. However, a comparison with data published in the literature shows that craniocerebral trauma is the most frequent sports injury in all disciplines in which the head is particularly exposed.

The clinical and electrophysiological examination of 36 top-level volleyball players showed a suprascapular neuropathy in 28% of the subjects. The most commonly observed clinical symptom was a focal severe atrophy of the m. infraspinatus, combined with loss of strength of the arm in abduction and external rotation. In contrast to previous reports on suprascapular neuropathies in volleyball players, the present investigation demonstrates an additional milder affection also of the nerve fibres supplying the m. supraspinatus.

Within the C57 black murine strain, a repeated appearance of hydrocephalus was observed during genetic experimentation (6). This strain belongs to 1 of the 14 known murine strains which have congenital hydrocephalus (1). It has been proposed (5) that the cause of hydrocephalus is a premature ossification of the skull base. Within the mouse family “ch,” it has been proved (3, 4) that ossification of the base of the skull during embryonic development caused the formation of hydrocephalus. This observation contrasts sharply to the case of the C57 variety. Within the framework of a more extensive project, we would like to clarify to what degree a disorder in the development of the skull can be considered to be the cause of hydrocephalus in the C57 black murine strain. In addition to the radiologic technique, the histologic and elucidation technique proved especially useful in the hydrocephalic skull.

The Kearns-Sayre syndrome is identified by the triad of progressive external ophthalmoplegia, atypical pigmentary retinopathy, and conduction disturbances. In addition, clinical manifestations may include mental retardation, sensorineural deafness, cerebellar ataxia, and facial and peripheral muscle weakness. Morphologic alterations in skeletal muscle may be characterized by ragged-red fibers. Two patients with Kearns-Sayre syndrome underwent electrophysiological examination. The first patient had a first and second degree AV block (Mobitz type II), right bundle branch block, and left axis deviation. The His-bundle electrogram showed a prolonged HV interval as a hint at an intraventricular conduction delay. The signal-averaging technique and endocardial mapping revealed ventricular after-depolarizations. The second patient had an unsuspicious ECG, recurrent atrial tachycardias, normal atrial and ventricular conduction, and after-depolarizations in endocardial mapping. Two months later he showed a second degree AV block combined with clinical symptoms. Pacemakers were implanted in both patients. Beside disturbances of the conduction system in both patients signs of electrical instability of the myocardium were found. In this way the Kearns-Sayre syndrome may be seen as a form of cardiomyopathy.

Die Diagnose des Alkoholismus (Alkoholabusus und -abhangigkeit) ist in der Regel mit Hilfe von Anamnese, Fremdanamnese, korperlicher Untersuchung und Fragebogentests mit relativ groser Sicherheit zu stellen. In einigen Situationen jedoch versagen diese Methoden, und zwar bei 1) Verheimlichungs- oder Verleugnungstendenz des Patienten, 2) fehlendem Alkoholismusverdacht, 3) unvollstandiger Untersuchung, 4) Bewustlosen, 5) der Untersuchung von Verstorbenen.

Adult albino rats received callosotomies or lesions in the paracingular cortex. Between 12 h and 3 months after injury the structure and topography of the degeneration products were studied by light- and electron-microscopy. The degeneration process was quantified by television-image analysis applied to sections prepared according to a new technique that stains reliably degenerating terminals and lysosomes (Gallyas et al. 1980). All types of cortico-cortical connections show a multiphasic degeneration process: During a precursor stage a small number of dense bodies and mitochondrial granules are stained. These and the few early degenerating axon terminals are much more diffusely distributed than the large number of terminals that degenerate during the following period. The terminal degeneration shows a biphasic time course. One maximum appears at 2–7 days post operation, which corresponds to the well known direct consequence of axotomy. The second peak at 10–20 days post operation could be caused by transneuronal reorganization of the cortical connectivity. Terminal degeneration always begins along the borders between cortical regions and areas, but it may change its laminar and columnar distribution pattern during the second phase. The degeneration products that are phagocytosed by astrocytes seem to be removed by intracellular transport to their perivascular endfeet. The degeneration process ends with fiber degeneration which, especially in laminae I and VI, may form a separate peak after 20 days or more.

Undercutting of the cortex destroys all subcortical afferents and efferents, leaving most cortico-cortical connections intact (Szentagothai 1965). The resulting terminal degeneration shows a laminar pattern similar to thalamo-cortical projections (Hubel and Wiesel 1972; Ogren and Hendrickson 1977; Gould et al. 1978), although the synaptic density is slightly reduced (Clark et al. 1939; Gruner et al. 1974). Chronic isolation results in the survival of the majority of neurons (Creutzfeldt and Struck 1962).

Publisher Summary This chapter presents a study that focuses on the modular organization of cortico-cortical connections and its relation to the surface growth and vascularization of the neocortex. The study is based on observations in the neocortex of adult rats and on the development of its parieto-occipital region between embryonic day 13 and adult. It was found from the study that depending on the position within the cortex, small cortical lesions produced various localized degeneration patterns. These patterns depended on differences in the intralaminar spread of terminal degeneration. At common borders between cortical regions, columnar units may form complexes of several columns or modules. In the cerebral cortex of man and rat, the angioarchitecture consists of four sets of radial vessels that branch in different levels of the cortex. Inspite of great differences in the cortical thickness between the species, the radial vessels form terminal branches in L.II/III, in L.IV/V, in L.V/VI, and in the subcortical white matter in both the species.

Jahrelanger massiver Alkoholmisbrauch fuhrt zur Hirnatrophie im CT (1, 5, 7, 8, 9). Dabei ist eine direkt toxische Wirkung des Alkohols (oder seines Metaboliten Acetaldehyd) als Ursache am wahrscheinlichsten; vorbestehende Schadigungen, Traumafolgen, Hepatopathiefolgen und Ernahrungsmangel sind weitgehend ausgeschlossen. Wasserverschiebungen konnten mittels Kernspintomographie als Storfaktor ausgeschlossen werden (2).

Mangan ist ein wichtiges Spurenelement mit Einbau in verschiedene Enzyme, insbesondere fur diejenigen, die Biotin als Koenzym haben, ferner fur die Arginase sowie Isocitrat-Dehydrogenase (10). Die normale Manganaufnahme mit der Nahrung betragt etwa 10 mg pro Tag, wovon aber nur ein kleiner Teil absorbiert wird. Die Ausscheidung erfolgt hauptsachlich durch den Darm, in geringem Mase durch den Urin. Die Toleranz ist gering, so das es bei exogener Belastung schnell zu einer Hyper- oder Dysmetallose kommen kann (8). Der groste Teil der Manganvergiftungen wird in den Berufen gefunden, bei denen es zu einer chronischen Inhalation kommt: Arbeiter in Braunsteinminen und Beschaftigte in manganverarbeitenden Betrieben (Trockenbatterien, Manganstahl sowie Manganlegierungen) (7, 8, 5). Bei einer chronischen inhalativen Manganvergiftung treten die klinischen Symptome meist nach einer Zeit von drei Monaten bis mehreren Jahren auf und zeigen vorwiegend einen Befall des extrapyramidalen Systems. Desweiteren werden psychische Veranderungen, Storungen der Libido sowie des vegetativen Nervensystems gefunden, ferner Manganpneumonien. Pathologisch-anatomisch finden sich Veranderungen in den Stammganglien, i.S. von Degeneration der Ganglienzellen im Putamen, Pallidum und Nucleus caudatus. Daneben werden aber auch analoge Schadigungen im Groshirn und Kleinhirn beschrieben (7).