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Nd:YAG, argon and diode lasers have been used in neurosurgical procedures including neuroendoscopy. However, many neurosurgeons are reluctant to use these lasers because of their inappropriate wavelength and uncontrollable tissue interaction, which has the potential to cause serious complications. Recently, a 2.0-microm near infrared laser with adequate wavelength and minimal tissue penetration became available. This laser was developed for endoscopic neurosurgical procedures. It is the aim of the study to report the initial experiences with this laser in neuroendoscopic procedures. We have performed 43 laser-assisted neuroendoscopic procedures [multicompartmental congenital, posthaemorrhagic or postinfectious hydrocephalus (n = 17), tumour biopsies (n = 6), rescue of fixed and allocated ventricular catheters (n = 2), endoscopic third ventriculostomy (ETV, n = 17) and aqueductoplasty (n = 1)] in 41 patients aged between 3 months and 80 years. The laser beam was delivered through a 365-microm bare silica fibre introduced through the working channel of a rigid endoscope. It was used for the opening of cysts, perforating the third ventricular floor, and for coagulation prior to and after biopsy. The therapeutic goals [creating unhindered cerebrospinal fluid (CSF) flow between cysts, ventricles and cisterns, sufficient tissue samples for histopathological diagnosis and catheter rescue] were achieved in 40 patients by the first and in 2 patients by a second neuroendoscopic operation. In one child, a CSF shunt was later required despite patency of the created stoma proven by magnetic resonance imaging (MRI). In another patient ETV was abandoned due to a tiny third ventricle. There was neither mortality nor transient or permanent morbidity. The authors conclude that the use of the 2.0-microm near infrared laser enables safe and effective procedures in neuroendoscopy.

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The principal subject of the Rehabilitation Research Network of Berlin, Brandenburg and Saxony (BBS) is "the theoretical and practical bases of the organisation and economics of rehabilitation". What is involved is a nation-wide analysis of the rehabilitation system, i.e. obtaining empirical information on the question as to what organisational forms are currently used to carry out rehabilitation and what results are achieved. This empirical stocktaking also includes economic aspects as far as possible. This study is to serve as a basis for developing, testing and implementing steps to rationalise steering mechanisms in the rehabilitation system. The first aspect to be studied is "national steering problems in institutionalised forms of rehabilitation". The focus is on projects on information management and performance and quality management in rehabilitation sciences as well as on the actual work of a number of bodies paying for rehabilitation (Bundesversicherungsanstalt für Angestellte, Landesversicherungsanstalten) as well as rehabilitation facilities (clinics etc.). The two other focuses of the study will examine "rehabilitative adjustment to remedies and technical aids/prostheses" and problems facing "family members in the context of rehabilitation". In studying these two areas, we are particularly interested in examining the interaction between institutionalised aspect of rehabilitation and informal factors both inside and outside the system. The BBS approach is supported by close co-operation with the regional pension insurance institutes (BfA, LVAs) with regard to both the data model and steps being taken. The principal instrument of co-operation is the "Gesellschaft für Rehabilitationswissenschaften e.V." (Society for Rehabilitation Sciences). In Berlin the BBS co-operates with Free University, the Technical University and the Robert Koch Institute and in Saxony with the universities in Dresden and Leipzig. Responsibility for scientific questions in the BBS lies with the Institute for Rehabilitation Sciences of Berlin's Humboldt University.

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Since more than 20 years CO2 and Nd:YAG lasers are established in the microsurgery of the nervous system. CO2 lasers can be used handheld, but may be focused on the target area by mirror optics and sideports of the operating microscope's micromanipulator. Nd:YAG lasers have the disadvantage of deep penetration into the brain and provocation of a large collateral damage. The need is for a fibre conducted solid system for surgery in delicate areas as for brain stem surgery. Fibre conduction of near infrared lasers allows better exposure of the target area compared to hollow wave guides or mirror equipment. Fibres can be tapered and modified according to the purpose. The holmium:YAG (Ho:YAG) laser has acquired interest by introducing the system into microsurgery of parenchymal tissue. They have not been proven yet sufficiently for neurosurgical tasks. The effort to minimalize the collateral tissue damage has to be maximalized in the surgery of nervous tissue and functional low redundant brain stem or spinal cord tissue. Volumetric data may be more precise in comparison to depth and width data of the laser lesion even when the different levels of the tissue interaction have to be analyzed for estimation of the real side effects in nervous tissue. We have used 50-800 ml delivered Ho:YAG single pulses in cortical areas of Sprague-Dawley rats and investigated the different lesion zones by volumetric data. The functional lesion zone was detected and measured by immunohistological staining of the heat shock protein HSP 72. For further reduction of the focus area, we have used tapered 400 to 200 microns fibres.

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Using an experimental animal model, the thermal single-pulse lesion derived from a mid-infrared 1.0 Joule 300 microns fibre-conducted Holmium: Yttrium-Aluminum-Garnet (Ho:YAG) laser was examined, with special emphasis on the orientation and depth of the tissue reaction. Performing biparietal craniotomy in Sprague-Dawley rats weighing 250-300 g, both hemispheres were targeted by different radiant exposures from 20 to 140 J/cm2 derived from a 600-800 microsecond single pulse. After survival periods of one to 30 days, the animals were sacrificed and both hemispheres were processed for light- and electronmicroscopic investigations. To resolve the depth and orientation of the tissue reaction regarding the localization of reactive astrocytes, we looked for the expression of glial proteins like glial fibrillary acidic protein (GFAP), Vimentin and S 100 with a three-step biotin-avidin immunoperoxidase method. Neuronal and secondary axonal damage was investigated by labelling Neurofilament and Synaptophysin. The tissue reaction beneath the ablated material, consisting of a vacuolation and coagulation zone resulting from heat diffusion, was further elucidated by localization of the heat shock protein (HSP 72 kilo Dalton). Revealing the extension of reactive astrocytes and the degree of the electronmicroscopically depicted glial oedema, the depth of the tissue damage was estimated to reach about 700 microns beneath laser excision. Since McKenzie predicted the depth of tissue damage beneath CO2 and YAG laser excisions in a theoretical mathematical model, the authors were able to develop a sensitive model for testing new laser systems and as a promising instrument for neurosurgery.

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The results are focussed on the three most important wishes and fears of 247 adolescents aged 14 years whose development is being followed from birth in the framework of the Rostock Longitudinal Study. The peace/war problem occupies a central position in the thinking of adolescents today. However there are no indications that the individual perception of and reflection on the nuclear threat impair psychic development nor is there any relation between political fears and the anxiety trait. The extension of personal wishes and fears to broader fields of significance and the facing up to world problems constitute signs of a maturing personality and a widened consciousness of reality. Psychic coping of such global fears will be facilitated the more the individual gains personal experience of the effectiveness of peace policies and activities--not least by making his/her own contribution.

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The phenotypic and functional characteristics of the leukaemic cells from one patient with T suppressor ALL were studied at the time of diagnosis and in relapse. At the time of diagnosis, the phenotype corresponded to the intermediate stage between the cortical and medullary phases of normal thymocyte differentiation with a high proportion of T8+ cells (E-R+, TdT+, C3bR-, T3-, T4-, T6+, T8++, T10+). Functionally, the cells did not respond to mitogens but mediated strong suppressor activity to allogeneic B-cells, as measured in a reversely haemolytic plaque test. Clinically, the patient exhibited the uncommon feature of hypogammaglobulinaemia. Induction therapy led to complete remission, which continued for 12 months. In the relapse, the phenotype remained essentially stable except for a dramatic decrease of the T8+ cell fraction and an increase of the T10+ cell fraction. Functionally, the suppressor activity was completely lost, indicating a close correlation between phenotype and functional activity in this leukaemic cell population.

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Age-dependent changes in EEG activity were assessed in a comparison of EEG recordings taken from 102 children at the ages of 6 and 10 years. Of the 2-to-13-cycle-a-second activity recorded from the left occipital region, the fast alpha frequencies (10 to 13 cycles a second) showed a significant increase at the expense of all slower frequencies. The children were divided into two groups according to whether they had been exposed to a small or large number of biological risks; in the latter group the extent of the increase in fast alpha activity was negatively related to the number of additional psychosocial risks. This effect was even more pronounced in the group of brain-damaged children, where the smallest age-dependent shift in the EEG frequencies was seen in the group with both minimal brain damage and a high psychosocial risk factor. These data suggest that the exposure of children with minimal brain damage to multiple psychosocial risks may lead to a delay in the maturation of the brain that can be detected by neurophysiological methods.

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We have studied B-lymphocyte function in 39 patients with Crohn's disease and 35 normal individuals using a reverse haemolytic plaque assay as the effector system. Ten patients had active Crohn's disease, the others being in an inactive state of the disease. Compared with normal individuals, the Crohn's disease patients - especially those in the active state of the disease - had markedly raised numbers of spontaneous immunoglobulin secreting cells and severely decreased responses to the polyclonal activator pokeweed mitogen. The differences between the reactivity of patients with active disease and those with inactive disease were statistically significant. These findings indicate an in vivo polyclonal B-cell activation in Crohn's disease patients, possibly due to antigen(s) or infectious agent(s). In vitro experiments were performed with separated lymphocytes in order to characterise the mechanism responsible for the altered immune reactivity in Crohn's disease. These revealed an intrinsic B-cell defect as well as an impaired T-helper cell capacity in patients with Crohn's disease. Findings supporting the hypothesis of an increased suppressor activity in Crohn's disease patients could not be observed, and marker analyses revealed normal proportions with the exception of raised Leu 7 positive cells that mediate 'natural killer' and 'killer' cytolysis. We conclude that immune dysfunction in peripheral blood lymphocytes of Crohn's disease patients involves B-cells as well as T-helper cells.

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Leukaemic cells from a patient in the blast crisis of chronic myeloid leukaemia were subjected to a surface marker analysis using a panel of monoclonal antibodies recognizing differentiation antigens of myeloid (MY7, MY906, VIM D5, M phi P9), erythroid (VIE G4), megakaryocyte (AN51), T-lymphoid (WT1, 10.2, OKT3, OKT4, OKT6, OKT8, OKT11A) and B-lymphoid cells (B1, B2, Y29/55), common ALL-antigen (VILA1), non-lineage-restricted antigens (OKT9, OKT10), monomorphic HLA-DR determinants (7.2) as well as TdT. When the patient entered his first blast crisis, his blasts expressed a phenotype corresponding to an immature myeloid cell (7.2+, MY7+, My906+, VIM D5-). Ph1-chromosome-positive blasts from this patient's first relapse had completely changed their surface marker characteristics: they had become TdT-positive and exhibited surface features characteristic of early T blasts (WT1+, 10.2+, OKT9+, OKT10+, 7.2-, OKT6-). Together, these features provide evidence that myeloid cells may share a common precursor with T cells.

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In some cases it is possible to enter the ureter and inspect its lower part up to 4 inches using a 13,5 charr. sized childrens cystoscop. By use of a 5 charr. foreign body forceps small stones can be extracted and larger ones removed by lithotripsy. Own cases are reported.

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The data given in the literature about frequency and relative importance of diagnostic criteria for children with cerebral lesions show considerable differences and so do, as a consequence, diagnosing practice and epidemiological statements. This study aims at weighting the determing factors of a diagnosis and ascretining their interrelations and the associated influence on the psychic-mental development. In a total of 279 six-year-old risk and control children eight criteria regarding brain damage were recorded. The conclusive results give evidence of the influence exerted by organic conditions on the child's development and of the possibility of objectification by common methods. There is no justifiable alternative to a primarily organic basis of the diagnosis of infantile brain damage.

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An immunoregulatory circuit is described in which B cell blasts activate syngeneic Ly-1+2-3- T cells to (a) start a reaction which is indistinguishable from a graft-vs.-host reaction (syngeneic GvH) and (b) induce suppressor cell activity which abrogates the syngeneic GvH. Since capping the surface immunoglobulin (Ig) on B cell blasts blocks their ability to activate the circuit, it is likely that the relevant cell surface structure "seen" on the B cell by the Ly-1 T cell is either Ig itself or another molecule in association with Ig.

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The authors present a factor analysis of 49 psychic and physical peculiarities found in 294 children in creches, most of them high-risk children; these were perinatologically classified at the time of birth, and an examination was performed by neuropsychiatrists and a follow-up clinical and psychological examination made, at the age of 2.0-2.3 years. The following two problems were of interest: 1. Can psychosyndromes be detected in creche children and, if so; 2. Does the psychosyndrome obtained through factor analysis contain vegetative symptoms? Results - The peculiarities can be grouped as follows: (table; see text) This is the first time that the existence of a pre-school chronic psychosyndrome has been detected using a multivariate method. Its basic structure is as described by Göllnitz. A discussion follows of its position within the symptom variability in damaged and disturbed children, and of rough brain localization analogies.

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Using the questionnaire that has been specifically developed to obtain data on parental educational behavior, 294 mothers of 2-year-old children were studied and their attitudes towards corporal punishment correlated with characteristics and symptoms of children as well as with psychosocial factors. Low level of education and lack of domestic happiness proved to be essential conditions for acceptance of corporal punishment. Children with developmental disorders are especially endangered only because of their particular liability to disorders, but on account of the fact that they do not receive the same amount of clemency as do children who are liable to infections. Problems of maleducation should receive greater attention in the elimination of environmental dangers to healthy development of children as well as in counseling.

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