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BACKGROUND: The habenular complex is composed of important relay nuclei linking the limbic forebrain to the midbrain and brain stem nuclei. Based on clinical observations, experiments with animals and theoretical considerations, it has been speculated that this brain area might be involved in psychiatric diseases (i.e. schizophrenia and depression). However, evidence in favour of this hypothesis is still lacking because the human habenular complex has rarely been studied with regard to mental illness. METHOD: We examined habenular volumes in post-mortem brains of 17 schizophrenia patients, 14 patients with depression (six patients with major depression and eight patients with bipolar depression) and 13 matched controls. We further determined the neuronal density, cell number and cell area of the medial habenular nuclei of the same cohorts using a counting box and a computer-assisted instrument. RESULTS: Significantly reduced habenular volumes of the medial and lateral habenula were estimated in depressive patients in comparison to normal controls and schizophrenia patients. We also found a reduction in neuronal cell number and cell area in depressive patients for the right side compared to controls and schizophrenia patients. No such changes were seen in schizophrenia. CONCLUSIONS: Our anatomical data argue against prominent structural alterations of the habenular nuclei in schizophrenia but demonstrate robust alterations in depressive patients. We are currently applying immunohistochemical markers to better characterize neuronal subpopulations of this brain region in schizophrenia and depression.

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AIM: Of this study was to define the significance of approximate ultrasound explorations of the thyroid gland for the clinical screening for thyroid diseases. METHOD: 918 patients in the medical service of a general hospital were screened for thyroid diseases by means of clinical, functional and sonomorphological methods. A sonographic screening scan with a 5 MHz probe provided data concerning structure and dimension of thyroid gland. Maximal sagittal diameter (SDm, normal range < 18 mm) was taken as a measure for thyroid size. RESULTS: Echogenicity has no essential meaning for thyroid dysfunction screening, but is indispensable for the detection of circumscript or general echo deficiency. SDm has proved to be a simple and well reproducible measure for thyroid size. Among 41 patients with thyrotoxicosis 40 had enlarged SDm, which means a sensitivity of 97.6%. However, a high rate of false positives makes TSH-screening of all enlarged thyroid glands obligatory. Moreover, SDm allows the estimation of a lack of thyroid mass as the most common cause of hypothyroidism. CONCLUSION: We recommend that an approximate ultrasound exploration of the thyroid gland including measuring of SDm should be part of every diagnostic procedure for thyroid disease, as it is precise and not time consuming.

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A 27-year-old woman with multiple bilobal liver metastases of a carcinoid tumour and carcinoid syndrome was treated with the somatostatin analogue Octreotide, 450-600 micrograms daily subcutaneously. This improved previous attacks of marked epigastric pain, while endocrine activity and tumour mass remained unchanged. Shortly after treatment had begun, soft fatty stools and oxaluria were noted. After six months severe renal colics were found to be due to non-opaque caliceal calculi, and a contracted non-functioning gallbladder was discovered. The calculi consisted of oxalate. The enteric hyperoxalosis, oxaluria and urolithiasis were presumably side effects of the Octreotide treatment.

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A 70-year-old woman with PAS-positive acute lymphatic leukaemia was treated with vincristine, vindesine and prednisone. After three-month peripheral remission there developed mature-cell chronic myeloid leukaemia with positive Ph1 chromosome. After 12 days on busulphan (Myleran) treatment peripheral remission occurred for three months. After this there was again a lymphoid blast crisis with progressive development of a peripheral aplastic syndrome, of which the patient died 14 months after diagnosis of the first blast crisis. In retrospect, basophilia, spleen size and platelet count provided a pointer to the existence of a myeloproliferative syndrome even prior to the first blast crisis. Cytogenetic studies are recommended before treatment is started in every case of blast leukemia in order to assess any morphological change in the further course of the disease.

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Ingestion of 5 g guar gum (Glucotard) led to complete obstruction of the distal oesophagus in a 63-year-old diabetic. A daily intake of 5 g guar gum t.i.d. with 250 ml of water had been tolerated without problems for half a year. Intake of a sufficient amount of water, as well as an undisturbed oesophageal function, are absolutely essential for the ingestion of guar gum. Since alcohol can influence the process of swelling and the consistency of the bolus, simultaneous intake of alcohol and guar gum should be strictly avoided.

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Despite histologically limited malignancy blastic leukaemia developed in two patients with centroblastic-centrocytic malignant lymphoma. Blastic cells were peroxidase- and PAS-negative, whereas alpha-naphthylacetate-esterase was predominantly positive. In one case blastic acid phosphatase showed a positive reaction. Despite multiple therapeutic attempts remission of acute leukaemia could not be achieved. Centroblastic-centrocytic malignant lymphoma is thus not only endangered by the histologic transformation to higher malignancy but also by the development of blastic leukaemia. Among our 18 patients with centroblastic-centrocytic lymphomas these two patients were the only to develop terminal blastic leukaemia. There was no leukaemic course in ten primarily centroblastic malignant lymphomas. The association of haematologic acute blastic leukaemia and simultaneous diffuse lymphnode swelling and enlargement of the spleen must lead to consideration of blastic leukaemia originating from a centroblastic-centrocytic lymphoma.

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The principles of modern diagnosis and therapy of lymphogranulomatosis are largely standardized today. Whereas the 50% probability survival rate in a group of patients diagnosed before 1970 was about 2 years, 23 out of 30 with standardized diagnosis and therapy have survived until now. Full remission was obtained in 21 of 30 patients. In spite of these encouraging results, the synopsis of the course of the disease shows that relapses and complications must be reckoned with in lymphogranulomatosis. Side effects of therapy may also acquire considerable clinical importance in the individual case.

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The orienting investigation should be a compulsory component of every internist echographic status with the rapid B picture. Besides its diagnostic aspects, thoracic echography with the rapid B picture in the region of the pericardium is also of therapeutic importance for the reliable specific ultrasonic pericardial puncture for the relief a tamponading pericardial effusion. All radiological shadows which are not completely clear must be subjected to echographic assessment before proceeding to more expensive diagnostic measures. This permits the sonographic differentiation between a collection of fluid and a solid structure as far as the shadows are confined to the wall.

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Eight patients with polycythemia whose main complaints resulted from vascular complications were prophylactically treated with ASS. 4 patients tolerated the treatment without any side effects, 4 patients had an acute upper gastrointestinal hemorrhage, which was fatal in 2 cases. Correlations between the thrombohemorrhagical syndrome in polycythemia on one hand and the side effects of ASS on the other hand are discussed. As a result of this antithrombotic prophylaxis with ASS is not indicated in polycythemia even in predominance of vascular complications and absence of bleeding tendency. In life-threatening situations antithrombotic therapy with heparine should be preferred.

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