Importance of intensive therapy in the treatment of purulent meningitis (author's transl)

In recent years the lethality of purulent meningitis has not fallen significantly in spite of antibiotic therapy. Aspects are indicated which complicate the successful treatment of purulent meningitis, and in addition the problems of artificial respiration, the provocation of cerebro-organic paroxysms by high dose penicillin therapy, the not uncommonly observed hemorrhagic diatheses, disturbances of acid-base balance and the results of neuropathologic and echoencephalographic investigations are discussed. In addition to beginning treatment early and selective antibiotic therapy, intensive medical measures can contribute to an improvement in the prognosis of purulent meningitis.     

Therapy of meningitis (author's transl)

For the specific and unspecific treatment of purulent meningitis, penicillin, ampicillin and chloramphenicol are usually sufficient. Only resistant pathogens (Klebsiella, Pseudomonas among others) and meningitis in infants require other treatment. Cephalosporins and aminoglycosides only come into consideration for the treatment of very rare exceptional cases. The still relatively poor prognosis of purulent meningitis is largely independent of the efficacy of the treatment. Delay in beginning therapy, lack of intensive care, primary diseases and complications are principally responsible for this. Medicamentous prophylaxis is only possible for meningococcal meningitis. The distribution of antibiotics in the CSF is irregular. Also the antibacterial activity in the CSF is different from culture media.     

The management of traumatic hemothorax (author's transl)

We reviewed 395 patients with isolated hemo- or hemopneumothorax from stab or bullet wounds. Of these, 45 were in shock on admission. All patients were initially treated by closed thoracostomy and infusions or transfusions. Of the 45 patients in shock, 24 responded to this treatment and remained stable. The other 21, after an initial response, showed a renewed drop in blood pressure and rise in pulse rate and had to be explored. All were found to be bleeding from either a systemic artery or a major lung laceration extending into the hilus. All other patients were continued on tube drainage, supplemented, if necessary, by needle aspiration and instillation of fibrinolytic enzymes until the lung was fully expanded, thus avoiding empyemas and the need for decortications. We found the clinical course after initial tube thoracostomy to be a reliable indicator for thoracotomy or for continued non-operative management, thus avoiding unnecessary thoracotomies.     

The new features of meningococcal meningitis (author's transl)

According to a previous pattern epidemics of meningococcal meningitis (MM) were localized in North tropical Africa, caused by A serotype, easily treated with sulfanilamides and prevented by a polyosidic vaccine, A type. Changes have occured : epidemics in Finland and Brazil, with an African A type germ, in place of the American, sulfa-resistant, C type; outburst of epidemics in South tropical Africa; presence of C type in Tchad, Niger and Nigeria. In the same time dramatic evolutions due to endotoxinic processes and drug-resistances are more frequently observed.     

Traumatic lesions of the optic chiasma (author's transl)

Traumatic lesions of the chiasma are few when one considers its anatomical position. They happen after severe direct or indirect traumas with or without skull fractures, and with or without macroscopic lesions. Microscopic lesions are characterised by contusion. Clinically the visual loss goes together with bitemporal defects and with bilateral hemorrhagic papillar oedema. Early complications are hematoma of the optochiasmatic space and perichiasmatic meningitis: among delayed complications optochiasmatic arachnoiditis prevails.     

Unusual course of traumatic intracranial bleedings (author's transl)

Intracranial bleedings occurred in three patients as complications of h-ad trauma, without any initial acute disturbance of consciousness. Only careful observation, which revealed slow deterioration in consciousness, made it possible to establish the diagnosis of intracranial haemorrhage, confirmed angiographically in all three instances.     

Symptomatology of dyscalculia in the presence of cortical lesions (author's transl)

The authors examine the function of calculation in 26 patients presenting lateral local cortical lesions. They analyse the symptomatology of acalculia in relation to the location and lateral position of the lesion, and define the influence of concomitant constructive apraxia or aphasia before proposing a method for the classification of calculating disorders.     

Ultrasonic diagnosis of space-occupying lesions of the kidney (author's transl)

In 140 patients who were suspected of having space-occupying lesions of the kidney the ultrasound findings were analysed. There were no false negative results. Out of 4 false positives two could be explained by nontumourous focal renal disease. In a further 10 cases a space-occupying lesion could not be excluded with certainty on the grounds of the ultrasound investigation alone. Out of a total of 96 space-occupying lesions (48 solid tumours, 48 cystic processes) 83 were correctly diagnosed sonographically.     

Treatment of a traumatic intestinal prolaps in a lizard (author's transl)

A serious intestinal prolaps in a lizard (Lacerta pityusensis pityusensis) that was sent by parcel post package, was replaced and the wound sutured. Anaesthesia, surgery and post-operative course are described.     

Rehabilitation into employability after traumatic loss of an eye (author's transl)

After the loss of an eye re-education can become either imperative according to present law or because of medical reasons. The insurer's attention should be drawn to these facts very early, perhaps already by the accident report, to avoid unnecessary long times of incapacity for work.