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We report the case of a 63-year-old patient with sudden onset of an acute syndrome of auditory hallucinations and delusions. Considering the anamnesis, course of the illness, and organopathologic results, we assumed an organic schizophreniform disorder within the scope of pre-existing autoimmune thyroiditis. Under treatment with high-potency neuroleptics, we observed partial regression and, after strumectomy, complete regression of the psychotic symptoms. Apparently, the acute organic schizophreniform disorder was caused by a changed metabolic situation with a transition to hyperthyroidism coinciding with beginning a small dose of antithyroid drugs.

Two patients with paranoid schizophrenia had delusions involving the internet. Additionally, one of them experienced computer databases as being distributed to other people in a phenomenologically similar way to that encountered in thought broadcasting. The presented cases illustrate the historical association of the contents of delusions in schizophrenia.

Subperiostal hematomas (SPOH) of the orbit are mostly of traumatic origin, but may occur spontaneously. In patients with frontal and temporal extradural hematomas, concomitant SPOH of the ipsilateral orbit have sporadically been observed. We report clinical and radiological findings of a patient and a review of the literature and discuss the development of SPOH.

CT- or MRI-guided stereotactic procedures should be a standard in a modern neurosurgical unit. Analysing 71 cases the indications and results of stereotactic neurosurgery are presented. In 53 patients stereotactic serial biopsies of different intraaxial lesions were performed, in 5 patients a spontaneous haemorrhage of the basal ganglia was removed by lysis with r-tPA. In 3 patients suffering from hydrocephalus due to diencephalic cysts a cystventricular shunt device was implanted. In 3 patients an intracerebral abscess was aspirated and drained. A stereotactic guided craniotomy and excision of small deep-seated lesions was performed in 6 cases. The accuracy of stereotactic tumour biopsies was 88.7% in our series, in accordance to other authors. The stereotactic aspiration and drainage of an intracerebral abscess provides accurate localization and minimal cortical damage and offers the possibility of intracavitary application of antibiotics. The stereotactic internal shunt implantation seems to be an alternative approach in the treatment of diencephalic cysts due to its minimal invasiveness and low operative risk. The aspiration of basal ganglia haematomas with insertion of an external drainage allows the lysis of the haematoma with r-tPA or urokinase. With stereotactic guidance small, deep-seated intraaxial lesions can be well localized and removed.

The development of severe tardive dystonia after short-term use of low-dose Fluspirilen is described. A 39-year-old woman was treated with Fluspirilen IM by her family doctor for reactive depression. She did received no other neuroleptic agents and no risk factors for the development of tardive dyskinesia (e.g. old age or organic brain damage) were present. For the first time a relation between short-term monotherapy with Fluspirilen and tardive dyskinesia appears highly probable. The use of Fluspirilen for the treatment of psychogenic disturbances should therefore be considered carefully.

The therapeutic concept of local administration of opioids into the perimedullar and cerebrospinal fluid is the result of fundamental studies concerning the discovery and localization of specific binding sites. These studies provoked considerable clinical interest, because they suggested a non-destructive and fully reversible method. In our department we have been gathering experience with an implantable pump system for various indications of chronic pain on a sample of 25 patients. The first implantation was performed in February 1987 and the latest included in this study in February 1991. The sample of patients consisted of two groups: (A) Chronic non-malignant pain (13 cases), (B) Chronic pain due to cancer (12 cases). We used two different pump devices: the gas-filled continuous infusion pump (Infusaid, Mod. 400) in 10 cases and the manually tractable micro pump (Cordis) in 15 cases. In 23 cases we decided in favour of an intraventricular drug administration, mainly because of the site of the pain; in each of these a ventricular catheter was placed in the frontal horn of the lateral ventricle. In the remaining two cases, the catheter was placed intraspinally, the catheter tip terminating at thoracic segments. Nine of the patients with cancer-related pain experienced from excellent to acceptable pain relief, as did also 10 patients with chronic non-malignant pain. Side effects were rare. Our findings also indicate that, in carefully selected patients, both malignant and non-malignant pain may be managed satisfactorily with this technique.

We delineate the case history of a 74-year-old female patient. On the occasion of acute physically established psychoses in this case, we were able to detect a primary hyperparathyroidism due to adenoids of the epithelial body. This critical psychopathological condition developed from a psychosyndrome, most likely seeming as senile schizophrenia, and which had previously existed for four years. It will be discussed whether these chronic schizophrenia-like symptoms and signs can be explained by hyperparathyroidism.

A case is reported of an organic auditory hallucinosis and depressive episode in a man aged 52. A new finding is the correlation of the musical hallucinosis to a central nervous disorder as shown by pathological sphenoidal EEG and 18FDG-PET-examination and not to acquired peripheral hearing deficit as often reported before.

We set up a laser nephelometric assay for the quantitation of serum amyloid A (SAA) in human plasma. Therefore monospecific antibodies were raised in sheep and used in parallel to measure SAA concentrations by nephelometry and also by radial immunodiffusion, an assay usually applied for determination of SAA. The nephelometric method is precise, simple and unlike radial immunodiffusion results are obtained within an hour. The antigen concentrations determined both by laser nephelometry and radial immunodiffusion correlated highly (r = 0.98). As plasma SAA concentrations were reported to be a possible marker of kidney allograft rejection, the assay was applied to measure SAA concentrations in patients after kidney transplantation. Data were compared with clinical and other biochemical parameters. The period after kidney transplantation is reported for two cases, where SAA plasma concentrations were helpful in diagnosing allograft rejection. The rapid availability of the SAA plasma concentrations by nephelometry makes them a possible additional tool to decide quickly upon antirejection therapy.

17 patients (40 +/- 9 years) with essential hypertension were included in the study. A monotherapy of 120, 160 or 240 mg propranolol per day was administered orally according to the antihypertensive effect. Four weeks after treatment, blood pressure and heart rate showed a statistically significant decrease and remained unchanged over a period of six months. Plasma renin activity decreased significantly from 5.7 +/- 6.3 ng/ml/h at the beginning of the study to 1.8 +/- 1.3 ng/ml/h after 4 weeks. 5 months later however plasma renin activity increased again to 5.0 +/- 0.9 ng/ml/h. The difference was statistically significant. From 17 patients 7 (41%) had lower levels of plasma renin activity after 6 months treatment when compared with pretreatment values. In only 3 patients (18%) was plasma renin activity lower after 6 months than after four weeks. We conclude that the increase in plasma renin activity is a reactive mechanism to the reduced blood pressure under long-term conditions. The decrease of plasma renin activity in short-term treatment of essential hypertension is not a mechanism responsible for the antihypertensive effect of propranolol during long-term treatment.