A new alcoholic prolamine solution is now available (ETHIBLOC, supplied by Ethicon, Norderstedt) which can be used in neurosurgery for a variety of purposes. This material hardens quickly in an aqueous medium. Animal experiments have not shown any damaging action on the brain, meninges, or bone. The excellent tolerance of the material was seen in a total of 22 patients operated on with the help of Ethibloc. It is particularly well suited for closing frontal CSF fistulas, incised frontal sinuses, and for rearranging or shunting in case of cerebral vascular deformities. It can also be used as a carrier of antibiotics in osteomyelitis, for covering up minor defects of the dura mater, for dura sealing, and for closing the bone after trephination. The preparation is transformed completely to connective tissue within a period of 40 to 90 days. New techniques of surgery are described which have become possible by the use of Ethibloc.

Production of hydrocephalus in animal experiment has been difficult and not uniformly successful so far. The preparation Ethibloc (supplied by Ethicon, Hamburg-Norderstedt), which is a protein solution in alcohol, and which has been in use in abdominal surgery for occluding the pancreatic duct system, enables production of an obstructive hydrocephalus easily and with reproducible results. The authors report on 24 cases of development of an obstructive hydrocephalus in rabbits after Ethibloc had been introduced into the ventricular system.

Sixteen heavily pretreated patients (pts) (4 surgery + chemotherapie + radiotherapy; 4 chemotherapy + radiotherapy: 6 surgery + radiotherapy; 2 chemotherapy) and one previously untreated patient, who refused surgery and or radiotherapy, all with progressive disease, with advanced squamous cell carcinoma of the head and neck were included in a phase II study with pirarubicin 60 mg/m2 i.v. day 1 every 3-4 weeks (CT). All pts received at least one course of CT. 15 pts were evaluable for response, all 17 pts were evaluable for toxicity. Female (male ratio 1/16; mean age 56 (42-68) yrs, mean performance status 70% (50-70). Seventeen pts received a mean of 3 (1-8) courses, 2 pts had received only one course of CT. Response and toxicity were assessed according to WHO classification. Results after 1-8 courses of CT: 1 (7%) complete remission; 1 (7%) partial remission; 9 (60%) no change; 4 (26%) progressive disease. No toxicity of grade IV was observed. Mean duration of remission 16 weeks. Median survival time 7 (1-10) months. 9 pts died and 8 pts are alive; six of them had progressive disease.

Clinical experiences on intracerebral hematomas with intraventricular involvement are recorded, and cases from 1976 to 1982 are surveyed. Important criteria for conservative and operative procedure are concluded. Localization of hematoma and follow-up clinical condition of the individual cases are the most reliable indicators in the choice of treatment. Good prognosis of hemorrhages caused by angioma is emphasized, if these are operated upon.

As result of a poll, the opinion of 50 Neurosurgical Departments in the Federal Republic of Germany relating to the importance of hypophysectomy in the therapy of metastatic carcinoma of the breast was obtained. Four of 32 replies prefer a regular hypophysectomy and 11 departments do the hypophysectomy only in exceptional cases. In 17 clinics this operation is not used. It should be emphasized, that a quarter of those neurosurgeons, who took part in our inquiry, had already given up hypophysectomy some years ago. About 50% of the surgeons talk about positive effects on metastatic carcinomas. The hormonal dependence of disseminated cancers is the only condition, which has to be presumed. Implantation of radioisotopes and trans-sphenoidal hypophysectomy are mentioned as the main operative techniques. The indications for hypophysectomy for metastatic carcinoma of the breast are discussed in the light of the recent literature. If one considers the possibilities of radiotherapy and chemotherapy, hypophysectomy can still be of considerable value as a palliative measure in hormone-dependent tumours with bone metastases, provided that the cases are carefully selected.