[The molecular biology of aging -- 14: Structure and function of the genetic apparatus in aging. I. Changes in the genome]. In the last years there is agreement over the fact that genetic properties have an essential influence on the ageing process. Therefore many scientists choose the genom and its properties as object of the gerontological investigation. This review shows that changes are possible on all of structure levels of the genom down to the lowest molecular stage with increasing age. This concerns as well postmitotic as intermitotic, proliferating cells and tissues, too. Actually repair processes of defective DNA find an increasing consideration. Until now it is not possible to establish if the observed changes are the cause or the result of ageing processes.


Space gerontology.

Space gerontology. The initiation of the shuttle program, with the possibility of flying older persons and persons other than trained astronauts, makes it necessary to examine the effects of the weightless environment throughout the life cycle. The model of a hypothalamic clock as the timing mechanism for lifespan suggests that weightlessness and hypergravity may prove useful tools in the investigation of aging processes. For these reasons geriatrics and gerontology enter into the field of aerospace biology, both practically in crew selection and in the development of clinically useful data on the nature of human age changes and their control.


Age-dependent change of the protein-bound phosphorus in rat liver cell nuclei. Some aspects of the metabolism of the protein-bound phosphorus were examined on isolated rat liver cell nuclei in function of age. The protein complement of the nuclei was separated into 5 non-histone and one histone fractions by means of salt and acid extraction. The phosphorus content of the fractions was determined and the rate of phosphorylation and dephosphorylation was measured after 32P labelling. The supernatant of the in vitro phosphorylation system contained a lower amount phosphorus but showed high phosphorylation rate. For several parameters such as the relative amounts of the non-histone proteins, the net phosphorus contents, the newly incorporated phosphorus/unit protein and the phosphatase activity in the nuclei a common pattern was found in function of age; intermediate, maximum and low or intermediate values for the age-groups of 4--6 months, 16--18 months and 24--28 months respectively. The possible implication of the nuclear non-histone proteins in the process of ageing is discussed.


[On cyclic rejuvenation of life in change of generations (author's transl)]. Various cellular processes are discussed which might be able to reduce in protozoa as well as in higher organisms the accumulation of "errors" in protein synthesis by the interplay of error accumulation and cell division frequency or by katabolic effects after a generative process of one kind or another. Some of these processes also may be regarded as decisive for the time dependence of mass growth of higher organisms.


Effect of dimethylaminomethylendiphosphonate on the immobilisation osteoporosis in rats. The influence of the immobilization on the bone by the resection of the N. ischiadicus has been examined in rats, 130--150 g and 400 g of weight. The simultaneous administration of dimethylaminomethylendiphosphonate uses to lower the differences in respect to osteodissimilation between the immobilized and not immobilized extremity, caused by immobilization.


[The formation of lipofuscin (author's transl)]. The article deals with the present knowledge of the lipofuscin-formation. Lipofuscin is regarded as a lysosomal residue body and as a product of peroxidation and polymerisation of unsaturated fatty acids. Starting from this aspects conditions are derived, which favour the lipofuscin-formation. These factors are divided into three groups according to their effects.


[Problems of photographic documentation of color patterns in connection with the use of thermography with liquid crystals (author's transl)]. Cholesteric liquid crystals show different colors dependent on their temperature. The "thermography with liquid crystals" makes use of this property for the determination of temperature distributions of human skin. The correct photographic documentation of the color patterns is difficult, because the colors depend on the angle of incidence of light and the direction of observation. Further, the quality of the photos is reduced by the direct reflection of light at the surface. Possible geometrical conditions of taking photos are discussed. An optimum arrangement for producing photos without reflections and color changes is proposed.


[Diagnosis of malignant lymphomas].

[Diagnosis of malignant lymphomas]. In the diagnostics of the malignant lymphomas is to be differed between the proper diagnosing, i. e. the morphological confirmation of the disease and the enlarged diagnostics which, after ascertainment of the histologicopathological findings and prior to the beginning of a therapy is necessary for the statement of the size of the spreading of the disease (classification of stages) as well as for the inclusion in group A or B and for the registration of the most different signs of activity. Swellings of the lumph nodes in adults should be clarified morphologically after three weeks, since only on this way an early diagnostics is guaranteed. In an unclear fever an abdominal lymphogranulomatosis is to be excluded. The explorative laparotomy and splenectomy is - if possible - to be performed before the beginning of a treatment. When pronounced signs of activity are present, however, a cytostatic treatment should precede this operation in order to decrease the risik of the operation. The classification in stages with exclusively clinical examination methods at present comprises a vast number, which in all stages must always be performed as an interdisciplinary task in a haematologico-oncological centre under control of an internist. The classification after Kiel of the non-Hodgkin-lymphomas does not only demand the knowledge of the nomenclature, but also the evaluation by the internist in order to perform the optimum therapy in these patients.


[Therapy of lymphogranulomatosis].

[Therapy of lymphogranulomatosis]. A survey is given on the therapy of lymphogranulomatosis. Keystones of the treatment are radiotherapy, antineoplastic chemotherapy and supportive measures of treatment. A therapy referred to diagnosis and stages including a clinical and pathological staging proves to be necessary in every case. The initial treatment consists in a radiotherapy in the stages I, II and III A, in a polychemotherapy according to the scheme MOPP and COPP, respectively, or CVPP in the stages III B and IV as well as possibly in a combined treatment in histomorphologically unfavourable forms also already in the early stages. The problems of the MOPP alternative programmes in primary failures, of the programmes of the post-MOPP-therapy in secondary failures and recidivations as well as of the remission-keeping long-term therapy need a further clarification. It is referred to the dangers and side-effects of an aggressive radio- and chemotherapy.


[Various forms of drug-induced pulmonary eosinophilia]. On the basis of 3 casuistics the in most cases medicamentous allergic etiology of chronic eosinophilic lung infiltrates, their diagnosis and differential diagnosis is discussed. Practical conclusions to the possibly early recognition of eosinophilic infiltrates, the prevention of therapeutic errors and the severe courses of disease resulting from this are reported.


[Hepatologic dispensaire for blood donors]. By means of hepatological examinations of 119 blood donors who became conspicuous by liver screenings in 57 cases we could prove an adipose degeneration without, in 16 cases a fatty degeneration of the liver without, in 9 cases an adipose degeneration with and in 15 cases a fatty degeneration of the liver with mesenchymal reaction. Only 9 blood donors had normal liver findings. 90% of the punctured blood donors had an overweight up to a maximum of 35 kg in comparison to the ideal weight. 30% of the punctured patients admitted a clearly increased daily consumption of alcoholic beverages. By means of repeated punctures on 24 blood donors after 8 to 32 months after an adequate consultation in three cases a normalisation and in eight cases an improvement of the liver findings could be proved. In 13 cases the findings remained unchanged, also the anamnestic and clinical findings corresponded to this. In 2 blood donors by means of a threefold liver puncture in the observation period of 48 months also a clear retrogression of the liver findings was proved. With this was also connected the reduction of overweight and the avoiding of alcohol. Thus our investigations confirmed that overweight and abuse of alcohol are essential factors for the development of a fatty degeneration of the liver. Of an infectious hepatitis reported in the anamnesis in 10 blood donors histologically in no case residues were established. Thus the liver dispensary is of great importance for the care of blood donors who become conspicuous by screening tests. On the one hand the importance is referred to the blood donor himself, on the other hand to the group of donors. Blood donors taken out of the group could again be included in the special group, when after the exclusion of known noxae the retrogression of unspecific liver changes took place.


[Post-cholecystectomy condition: duodeno-gastric reflux and bile acid concentration in the gastric juice]. In cholecystectomized patients highly significantly more frequently a duodenogastric reflux was found than in a group of patients with a healthy abdomen and a group of patients with cholelithiasis. The average concentration of bile acid in the gastric juice was after the removal of the gall-bladder manifoldly higher than in the control groups. The number of patients with concentrated reflux was also highly significantly larger than in patients with cholelithiasis not operated on and in patients with a healthy abdomen. Despite the high reflux rate and the high concentration of the bile acids influencing on the mucous membrane of the stomach the number of patients with ulcera ventriculi was not significantly larger than in a group of not cholecystectomized persons. These observations plead for the fact that the bile acids in the duodenogastric reflux alone are not to be regarded as an ulcerogenic agent, but that perhaps other components of the duodenal juice have to be considered as causes of lesions of the gastric mucous membrane.


[Prevention of hepatitis in dialysis centers. A catalog of recommendations and suggestions. 3]. This last of three reports on the prevention of hepatitis in dialysis centres deals with the kind and frequency of desinfection measures in the dialysis area, contains advices to the mode of transfer of patients between dialysis centres and makes demands to the tests of hepatitis-B-antigen and antibodies. Finally proposals concerning the frequency of controls for HBs-antigen and anti-HBs and for the passive immunisation with anti-HBs-enriched immunoglobulin are rendered.


[Frequency of bone fractures in chronic fluoride exposure]. In order to establish the frequency of bone fractures in 2 population groups with increased and decreased fluor exposition, respectively, the case histories of a surgical ward for men were evaluated. Of 10 age groups ten times a lower percental frequency of fractures in combination with an increased presence of fluor was found. Fluorides have got an increasing significance for the prophylaxis of fractures in the treatment of osteoporosis.


[Diagnostic value of the detection of antibody-bound bacteria in the urine]. By means of the immunofluorescence technique 107 patients with chronic pyelonephritis and 43 patients with an infection of the lower urinary tract were examined for the presence of antibody-containing bacteria in the urine. Here in 84 out of 107 patients (78.5%) with a chronic pyelonephritis the positive proof could be made, whereas in 39 out of 43 patients (90.6%) with an infection of the lower urinary tract no antibody-containing bacteria were found. The test may be recommended as a relatively simple, riskless and evident method for the diagnostics of pyelonephritis.


[Prognosis of lymphogranulomatosis (stage III B-IV) treated with drugs--results of a retrospective 10 year study]. With the help of survival curves of 91 patients with histologically ascertained lymphogranulomatosis a report on experiences concerning the prognostic importance of different factors is given. The examination is based on a retrospective analysis of a well documented number of patients who were chemotherapeutically treated from 1967--1976 in the medical outpatient department and the medical clinic of the Erfurt Academy of Medicine. We found on the basis of the retrospective study that the following factors deteriorate the prognosis: Clinical stage IV, presence of general symptoms, type poor in lymphocytes. Older age at making the diagnosis as well as male sex also reveal a worse prognosis as to the 3-year-survival rate than the comparative groups. Furthermore it was shown that the quality of remission after initial chemotherapy is of decisive prognostic valency. When cytostatic combination schemata were used for the induction of the remission the survival rates could be improved. The problems of the remission-keeping chemotherapy are entered.


[Liver involvement in lymphogranulomatosis]. Of 146 patients with lymphogranulomatosis biochemical parameters were tested for their diagnostic valency concerning the recognition of a liver infiltration. In patients with histologically proved affection of the liver the AP, GGTP, AAP, LAP and LDH show a significant increase in comparison to the enzyme values of the patients without any hepatic manifestation. In an increased result of 4 enzyme values with a probability of 85% muste be reckoned with a participation of the liver. The enzyme SGOT, SGPT, GDH, LDH-isoenzymes, choline esterase, beta-GC, the De Ritis quotient and the quotient (Formula: see text), on the other hand, do not give any additional differential-diagnostic information.


[Bone changes in hemoblastoses and malignant lymphomas]. In haematological systemic diseases such as acute and chronic leukoses, malignant lymphomas, lymphogranulomatoses, osteomyelofibroses, polycythaemias and aplastic anaemias with a different proportion changes of the bones in form of osteoporoses, osteolytic processes and deformations of the vertebral bodies are to be found. The proof may be performed radiologically and histologically. In 461 patients with different haematological diseases absorption measurings of monoenergetic rays of a J-125-source were performed at the distal third of radius and ulna. It was shown that the bone mineral content of patients with proved bone destructions did not significantly differ from the normal group. The too peripherally located place of the measuring and also the late inclusion of the compacta into the changes is regarded as cause for the negative result.


[Experiences with primary and secondary laparotomy with splenectomy in Hodgkin's disease]. The explorative laparotomy with splenectomy belongs under adequately strong indication to the standard techniques of the dilated diagnostics and stage subdivision of lymphogranulomatosis. 61 patients of the Medical Academy Magdeburg were exploratively laparotomised from 1974--1978, of them 38 patients primarily before the beginning of the therapy and 23 patients secondarily 1--8 years after therapy. Changes of the stages before and after laparotomy, relations between affection of the spleen and histological type and primary histology, respectively, as well as weight of the spleen are discussed, postoperative complications are explained and adequate conclusions rendered.


[Value of total nodal radiotherapy in the treatment of lymphogranulomatosis]. From 1968 to 1976 in the Radiological Clinic of the Karl-Marx-University of Leipzig 199 patients with Hodgkin's disease were irradiated, 24 patients totally nodal. As this form of treatment has been used in our institution only since 1976, on account of the small time interval not the survival rate, but only the quota of recidivation could be used for the judgment of the effectiveness of the total nodal irradiation. Compared with the local irradiation the result was a decrease of the distribution recidivations from 82.3% to 20.8%. Also in comparison to the systemic X-ray treatment above or below the diaphragm (= 34% of recidivations) a clear progress was shown.


[The passage of dyes through the retinal vessels]. Examinations of the retinal haemodynamics after injection of fluorescein sodium were performed on three groups of test persons, in normal persons, patients with diseases of the retina as well as patients with organic heart defects. In the group of heart diseases statistically significant disturbances of the retinal haemodynamics could be proved, which the retina tolerates without any lesion. In comparison to this retinopathies with severe changes of the fundus show only slight disturbances of the haemodynamics. These do not give the possibility of the explanation of the changes of the fundus.


[Behavior of the erythrocyte glucose-6-phosphate dehydrogenase in patients with functional thyroid disorders and in hyperthyroxinemic rats]. This paper deals with the activity of glucose-6-phosphate dehydrogenase in patients with hyper- and hypothyroidism as well as in hyperthyroxinaemic rats. The activity of glucose-6-phosphate dehydrogenase is enhanced in red blood cells of hyperthyreotic patients and hyperthyroxinaemic animals. The activity will be decreased to normal range in patients by administration of antithyreotic drugs, such as thiamazole. Patients with hypothyroidism exhibit decreased enzymatic activity. It is suggested that thyroid hormones stimulate the HMP-shunt in red blood cells as a defence mechanism against additional oxidative stress.


[Experiences in fiber-endoscopic removal of foreign bodies from the intestinal tract]. It is reported on the complication-free fiber-endoscopic extraction of foreign bodies in 8 cases, of these 7 times from the upper intestinal tract and then, taking into consideration literature, the indication spectre to the endoscopic approach is mentioned. An immediate attempt to extraction should be performed above all in all sharp and pointed things on account of increased danger of perforation. An additional waiting for longer than 8 days after incorporation we consider little reasonable, since a spontaneous passage at this moment is unlikely. Small-calibrated perforating lesions of the stomach, the possible poverty of symptoms is emphasized apparantly heal without any sequels after extraction. Finally is referred to the prevention of an unnecessary laparotomy, when the therapeutic fiber endoscopy is reasonably used.


[Serum activity of leucine aminopeptidase in lymphotropic infections and in malignant lymphomas]. Increases of the leucine aminopeptidase according to data of literature are regarded as a sensitive parameter of lesions in liver diseases. In patients with active generalised lymphadenitis (viral infections, toxoplasmosis) as a typical enzyme constellation a relatively strong leucine aminopeptidase increase in the serum with missing or relatively slight enzyme deviation of the transaminases could be found. The quotient of the activities of LAP/ALAT was clearly above that of inflammatory liver diseases. In chronic lymphatic leukosis, plasmocytoma and malignant lymphomas the leucine aminopeptidase serum activities were within the normal. Increases of leucine aminopeptidase in lymphotropic infections are probably partly of extrahepatic origin.


[Therapeutic endoscopy in the gastrointestinal tract]. In selected chapters of the therapeutic endoscopy we tried to represent secure knowledge, actual tendencies and partly future prognoses. Hereby completeness cannot be expected. However, it became clear that numerous physical principles became useful for the therapy with the endoscope. Chemical techniques, such as the litholysis of gall-stones are only at present used in our field. With all scepticism against the own field of interest one may say that the operative therapeutic endoscopy, as it is seen at the instance of the classification of polyps, has led to an improvement of the diagnostics, Its advantages in the therapeutic field are based on the fact that it substitutes larger operations. In the polypectomy- the intervention, avoiding laparotomy and colotomy, is reduced on the minimum given by the size of the polyp. The risk of endoscopic operations is small, compared with the alternative surgical interventions. Shortening of the duration of the disease and hospitalisation leads to lower expenses. Methods, such as the endoscopic haemostypsis or the obliteration of the pancreatic duct, need further detailed examinations. There is no doubt that the modern endoscopy has a strong technical fascination for many young physicians. It gets the greatest value in the hands of a clinically experienced physician.


[Indications and value of gastrointestinal biopsy]. Concerning the stomach biopsy without optical control has only historical importance, concerning the small intestine it serves for the recognition of diffuse changes--particularly for the the differential diagnosis of the malabsorption and in the large intestine for the diagnosis and course control of inflammation. The aimed biopsy is a constituent of every endoscopy investigation, with the exception of completely normal or fully clear pathological findings. Without an aimed biopsy the diagnosis of the early cancer in ulcers, "polyps" and "ulcer scars" is not possible. Its gain depends on the number of biopsy particles; only the positive findings are proving.


[Risk and ethical problems in endoscopy]. The explosive growth of natural-scientific knowledge and its utilization in medicine has enlarged the diagnostic and therapeutic possibilities. A change of the physician's work is connected with the laboratory and apparative-technical medicine. The simple methods of the anamnestic, at the same time psychoanalytic talk and the immediate examination of the patient are no more used according to their value. The immediate meeting between physician and patient is being forgotten. At the instance of the gastroenterological endoscopy the importance and methodology of the permanent collective judgment of examination techniques under management of a subspecialised team as well as the definition and control of risk and ratio expenses-use are described. For the testing of techniques as well as their use in routine work an informing talk with the patient is necessary as well his agreement, according to the directives of the WHO. Work and responsibility of the physician in Socialist Public Health is characterized by inclusion of state and society and the conscious participation of the citizens.


[Serology of toxoplasmosis in patients with lymphogranulomatosis]. The technical progress in the development of the fiber coloscopy gives the possibility to inspect the whole large intestine including the terminal ileum. The essential contribution of the coloscopy consists in the early diagnosis of the carcinoma of the large intestine. The malignant change of the polyp may be proved or excluded only after total polypectomy. In our clinical material consisting of 250 patients in 44% of the cases the total coloscopy confirmed the radiological suspicion. In 38% of the cases the pathological changes of the large intestine could be excluded, and a laparotomy was unnecessary. In 18% another severe finding of the large intestine was established. In haemorrhage of the large intestine of unclear genesis the coloscopy made possible the final recognition of the source of haemorrhage in 92% of the cases. In patients with colitis we established coloscopically larger changes than could be assumed on the basis of the barium enema. The total coloscopy given a highest possible certainty in the diagnostics of the large intestine.


[Outpatient care in uric acid disorders]. In 35 patients with uricopathy (arthritis urica, essential hyperuricaemia) the serum uric acid values, consumption of alcohol, overweight, hypertension and liver enzyma under dietary and medicamentous therapy (allopurinol) were investigated. Here during an observation lasting 12--48 months allopurinol proved as a well tolerable uricostatic drug which was sufficiently effective also with a considerable exogenic purine application. We only insufficiently succeeded in influencing overweight and alcohol consumption as well as hypertension by rheumatic dispensary care and family doctor.


[Inability to work in gastrointestinal diseases]. 11.7% of all cases with inability to work, 11.3% of all days with inability to work, and 13.6% of all dismissals from hospital of working people concern diseases of the digestive system. Gastroenterological diseases occupy an anterior place in inability to work. The inability to work is essentially determined by 7 diagnoses--gastritis and duodenitis, cholelithiasis, gastroenteritis and colitis, cholecystitis and cholangitis, ulcus ventriculi and duodeni, acute appendicitis. They comprise 78% of the days of inability to work. The endoscopic diagnostics is further to be developed with the further improvement of the organisation of treatment, particularly the cooperation between outpatient department and hospital and the interdisciplinary work.


[Classification of stomach and duodenal ulcers]. The working classification of the ulcerous disease after Melikova is suitable for the differentiated demonstration of the gastric and duodenal ulcers. In connection with this principle of subdivision essential features of the disease, such as localisation of the ulcer, clinical course, morphological characteristics of the ulcer and the ulcer-carrying organ, gastro-intestinal functional parameters and complications of the ulcer are demonstrated.


[Functional behavior patterns of the pylorus in duodeno-gastric reflux]. There are relations between function of the pylorus and the appearance of duodeno-gastric reflux. However, much speaks for the fact that the pylorus alone is not able to prevent duodeno-gastric reflux. In the problem of the causes of reflux also the motoric behaviour of the upper duodenum must be taken into consideration.


[Comparison of the value of ERCP, angiography and scintigraphy in pancreatic diseases]. The endoscopic retrograde cholangiopancreaticography, angiography and scintigraphy have a different value in the diagnostics of chronic pancreatitis and carcinoma of the pancreas. The scintigraphy of pancreas has the lowest value. It should not alone be the basis for making the diagnosis or planning the treatment. In chronic pancreatitis the endoscopic retrograde cholangiopancreaticography has precedence of angiography. The chronic pancreatitis may angiographically be recognised only in the late phase. However, the angiography can give valuable references to the planning of the operation. At a suspicion of the pancreas malignoma the endoscopic retrograde cholangiopancreaticography and the angiography have nearly the same value in the plan of diagnostics and they both should be performed.


[Comparative study on the diagnostic value of direct and indirect cholangiography]. The examinations contain the findings of the endoscopic retrograde cholangiopancreaticography in 600 patients, the date of a controlled comparative study intravenous cholangiotomography versus endoscopic retrograde cholangiography in 45 patients undergoing endoscopic retrograde cholangiopancreaticography and the results of the percutaneous transhepatic cholangiography in 54 patients. In anicteric patients and after subsidence of the clinical symptoms the optimum use of the intravenous cholegraphy with tomography is to be demanded. It is able multiply to clarify the diagnosis. The terminal part of the choledochus deserves particular consideration. In obstructive jaundice the percutaneous transhepatic cholangiography is essentially more successful and simpler than the endoscopic retrograde cholangiography.


[Therapy of primary glomerulonephritis. Comparative study on the effect of cytostatics-prednisone and cytostatics-anticoagulant-aggregation inhibitor combination]. The result of the treatment with chlorambucil, dipyridamol, heparin/warfarin and prednisone on 50 patients as well as with imuran and prednisone on 32 patients is compared. Basis for this is a detailed morphological and clinical subdivision. With the help of therapy results is tried to derive regions of indication: the therapy with cytostatics, anticoagulants and aggregation inhibitors is above all suitable for patients with a short duration of the disease and with sign of activity, also in renal insufficiency. On the other hand the therapy with cytostatics and prednisone is also successful in patients with longer duration of the disease and missing signs of activity.


[Incidence and mortality of malignant lymphomas in the GDR]. Based on data from the cancer register of the German Democratic Republic established in 1952 and on the official mortality statistics, incidence of and mortality from malignant lymphomas (ICD 200-203) in the GDR are analysed. Age-specific incidence and mortality of Hodgkin's disease show a peak in the age group of 25-30 years and rise steadily from 45 years on up to the highest age. Lymphosarcoma and reticulosarcoma increase slowly from infancy to old age, whereas multiple myeloma is a disease of the elderly and extremely rare before the age of 40. The apparent increase of malignant lymphoma may be due to underregistration at the beginning of the cancer register. In the past years mortality from Hodgkin's disease is slowly decreasing, thus reflecting progress in methods of treatment and results.


[Paracardial round foci, case contribution to the radiologic differential diagnosis of mediastinal and pulmonary tumors]. The paper deals with the differential diagnosis of coin lesions lying in close contact to the heart. Six own cases of different origin are described. The radiographic difficulties with regard to localisation and separation from adjacent tissues are discussed. The radiodiagnostic possibilities are demonstrated.


[Hyperuricaemia--a parameter in the prognosis of gestosis (author's transl)]. The level of uric acid is considered to be of prognostic value regarding gestosis and condition of the fetus. Serum concentration of uric acid is influenced by sex, age and, during pregnancy, by gestational age. In order to get a sound basis for correlations in gestosis we collected data of normal gravidae in different weeks of gestation: in the mean values there was an increase of uric acid concentration from 2,03 mg/100 ml up to 3,54 mg/100 ml (from the first week of gestation up to the end of gestation). In gravidae with gestosis (according to Gestosis Index recommended by Geocke) the mean values were found to be between 2,71 mg/100 ml and 7,54 mg/100 ml. In gravidae with gestosis and intrauterine fetal death during II. and III. trimenon the mean values of uric acid were found between 5,05 mg/100 ml and 9,91 mg/100 ml. In clinical routine we proofed the estimation of uric acid concentration as a prognostic aspect in gestosis and especially by serial estimations and furthermore there is a possibility to study therapeutical effects. In a pilot study we try to use the estimation of uric acid concentration as an early symptom of gestosis.


[Studies on renal function in H-gestosis using renal sequence scintigraphy and 131-J-hippurate clearance (author's transl)]. The article comments on the results of a study conducted in 23 women with H-gestosis, in 43 gravidae of the corresponding period of gestation with healthy kidneys, as well as in a control group of 13 women with healthy kidneys, in order to determine, by means of renal sequence scintigraphy and 131-J-hippurate clearance, the change in renal function caused by H-gestosis. The clearance data are shown both globally and broken down according to the individual kidneys. Typical activity-time curves of the relevant groups under examination are also demonstrated. The results show that with mild to moderate H-gestosis, the clearance equivalents are just below the values found in pregnancy without complications, the difference not being statistically significant. In the 28th-34th week of pregnancy, the elimination phase above the right renal parenchyma "regions of interest" is enhanced in a partly statistically significant manner, compared with the corresponding control group.


[Intrapartum fetal heart rate patterns and fetal outcome: prediction of newborn depression (author's transl)]. A statistically significant correlation exists between patterns of fetal heart rate (FHR) and neonatal state. However, the prognostic value of alterations of FHR for the individual has not been established. In 812 deliveries, we analyzed FHR tracings of the 30 minutes preceding delivery and correlated 6 characteristics of baseline, 10 of floating line and 6 of oscillation type with the incidence of severe acidosis (pH of umbilical cord artery less than or equal to 7.10) and low Apgar scores (one minute Apgar score less than or equal to 6). The exact risk for neonatal depression was calculated for each pattern of FHR. A high rate of depressed infants could be expected when the following alterations of FHR were seen during the last 30 minutes before delivery:--mild tachycardia, severe bradycardia,--severe variable decelerations, uniform late decelerations,--oscillation frequency less than 2 per minute independent of oscillation amplitude.


[Studies on placental transfer of 16-methylene prednisolone (decortilen) (author's transl)]. The placental transfer of 16-methylene prednisolone is demonstrated via thin layer chromatography. Concentrations of 100-500 ng/ml plasma result in the umbilical cord blood on intravenous application of 60 mg methylene prednisolone administered to the mother 5-30 minutes ante partum.


[Influencing the maternal energy metabolism via infusion of xylite during childbirth (author's transl)]. During parturition, there is an increase in the glucose, pyruvate and lactate levels in the maternal venous blood, as well as an increase in the concentrations of free fatty acids, d-(-)-3-hydroxybutyrate and acetoacetate. Peripartal acetonaemia in the mother can be reduced by infusing solutions which contain xylite. No essential increase in blood lactate levels was seen following in fusion of 0.4 g xylite/kg body weight. The acetone bodies reach the foetal blood via the placenta. It remains to be clarified as to how far they are an important source of energy during the newborn period.


[The uptake of tritiated thymidine in human fetal membranes during the last third of pregnancy (author's transl)]. Eighty-four fetal membranes--amnion, chorion and adhaerent decidua--were investigated with the in vitro uptake of tritiated thymidine in the last trimester of pregnancy. Labelling patterns were observed in each component of fetal membranes and decidua. The proliferation activity of the cells was determined by the 3H-thymidine labelling index. Significant correlation was found between labelling activity of chorion and decidua. The cells of the chorion layer and decidua showed linear decreasing uptake of tritiated thymidine from 200th to 300th day of pregnancy. The cellular growth of the chorion epithelium seems to be directed from the pseudobasement membrane to the decidua layer. There was also a significantly increased DNA-synthesis in decidua cells when labelled endothelium-cells of decidua vessels were observed. In the same cases we found significant correlation to mean placental weight. When fibrinoid deposits between the chorion and decidua layer were found the mean tritium index of the chorion layer was significantly lower than when fibrinoid material was missing.


[Daytime rooming-in--a contribution to family-oriented obstetrics (author's transl)]. Rooming-in of mother and child during the puerperium is an essential step towards family-oriented obstetrics. However, the setting-up of full rooming-in wards is often prevented by problems of organisation, personnel, cost and space. It is here where the reorganisation of conventional maternity wards to daytime rooming-in wards can be regarded as a feasible alternative, since it requires low investment cost and moderate expenditure of effort required for satisfactory working. At the Freiburg University Gynaecological Hospital, 1028 women were asked to choose between a conventional ward and a daytime rooming-in ward. The article reports on experience collected during the reorganisation of this ward as well as on the behaviour, reactions and requests on the part of the mothers. The high degree of positive acceptance as well as the easy adaptability of this maternity ward system to existing conditions, favour widespread introduction of the daytime rooming-in system.


[Diagnostic problems in skin tumors].

[Diagnostic problems in skin tumors]. Several starting-points for improvement of diagnostic accuracy in skin tumors are illustrated by examples: Frequencies and direction of diagnostic errors, as well as the value of diagnostic criteria need further investigations. Frequent "customary" diseases need more attention in medical textbooks, compared with less frequent "interesting" syndromes. Erroneous denominations and historical false classifications which are handed down in the literature demand correction. The possibility continues, that apparently clearly defined entities may decay; they may be replaced by new entities in consequence of new perceptions.


[The purine salvage pathway in erythrocytes of psoriatic patients]. Investigations on the purine-salvage-pathway in erythrocytes of 3 patients with psoriasis and of 3 healthy control persons revealed equivocal differences. The transfer of 14C-adenine to adenosine-monophosphat as well as the uptake of 14C-guanine is markedly increased and the incorporation of 14C-hypoxanthine deviates in psoriatics from the controls. A correlation between these findings and the clinical course could not be observed. The paper presents first results of a study concerning the synthesis of nucleotides in the course of the reutilisation of purines within erythrocytes of psoriatic patients.


[Seasonal burning palate in allergy against grass pollen]. An immediate type I allergy elicited by IgE antibodies against pollen of grasses and cereals was demonstrated as the rare cause of palatinal stomatopyrosis (burning palate). The casual relationship was suggested through history and proven by skin, radioallergosorbent and exposition tests.


[Voice - speech - life satisfaction. Existential analysis in view of a medical discipline]. The author begins with a characterization of one of the fundamental problems of phenomenological existential analysis: how can results which have been arrived at by means of special scientific methods be applied to an understanding of the world we live in? Referring to the work of L. Binswanger, M. Boss, A. Jores and others, he demonstrates the possibility of a new understanding of the meaning of some voice and speech disorders, particularly hysterical aphonia, spastic dysphonia, stuttering and so-called functional development symptoms (which are found in the results of organic examinations in connection with speech disorders). He bases an adequate psychotherapy mainly on the interpretation of dreaming, of resistance and of the meaning of pathological symptoms in general.


[Speaking - understanding - interpreting - remembering. The hermeneutic discussion of psychoanalysis]. The situation of the therapeut-patient interview is taken as unifying point of reference for a discussion of the relation between psychoanalysis and hermeneutics. ""Speaking,'' ""Understanding'', ""Interpreting'', ""Remembering'' - these constituents are of central importance in psychoanalysis as well as in hermeneutics. The situation of the therapeut-patient interview permits of developing the respective ways of thinking in different schools of hermeneutics, in a relatively consistent field that is determined by the situation of the interview. Thus the possibilities and limits of a hermeneutical reception of psychoanalysis become apparent.


[Self control developing function of self verbalization in children in experimental situations]. 80 children received 5 different instructions which the children were supposed to repeat when exposed to classical tempting situations. As one result it could be shown that children of the middle class under the treatment conditions of verbalizing positive consequences were significantly better concerning the time of latency than those of other groups. In contrast to the expectations there were no differences according to factors like class, intelligence and latency. Results are discussed in terms of the development of self-control, relations between verbal and nonverbal behavior, cognitive behavior modification, and in the relation to a similar experiment by Hartig and Kanfer (1973).


[Development of the autonomy concept in psychoanalytic literature]. The development of an implicit concept of autonomy in Freud's work and the different explicit concepts of autonomy in neo-analysis and ego-psychology is delineated. The contradictory views of a strict psychic determinism and the utopia of freedom stand side by side in early psychoanalysis. They represent its scientific and romantic root. Neo-analysis puts a stress on the romantic tradition and elaborates a philosophical concept of autonomy, while modern ego-psychology follows rather the scientific tradition. All concepts of autonomy are based on a model of psychic health that is related to the idea of a harmonious personality, an ideal which has precursors in German classicism, the renaissance, and the antique.


[The interaction TAT - an auxiliary method in the diagnosis of marital crises]. Out of the need for an auxiliary method, that provides a comprehension representation of matrimonial relationships, the classical TAT procedure was modified to an interactional TAT. The question, whether this modified procedure is suitable as a diagnostic tool, was cause to analyse an extremely selected group of persons. The confirmation of hypotheses deducted from theoretical considerations, permits the statement, that the modified TAT procedure (Interactional-TAT) represents a superior instrument in matrimonial therapy. Its particular merit consists in the variability of tables and the various possibilities of adjustment to the special problem, the therapist is faced with.


[What is the meaning of ""general psychopathology''?]. There is no general consensus referring to this what ""Allgemeine Psychopathologie'' is - neither between psychiatrists nor psychologists. The following projects, which are shortly marked implicate indeed mostly the same notions, but make use of formal different definitions in the determination. The present article shows, how in the now discussed conceptions not different declarations about psychopathological facts are opposed, but controversial psychological and anthropological fundamental conceptions dispute together.


[Ultraviolet sensitivity in skin of the aged]. The sensitivity for ultraviolet rays of the skin on the back was determined in 340 men and women being more than 49 years of age. We used the "light staircase" applied by Wucherpfennig and Mathiesen. We found a great variation in the results. Neither age nor season showed a significant influence on the ultraviolet erythema threshold in older persons. Only sex seemed to have an influence.


[Cossio syndrome: above average life expectancy of a patient with congenital large atrial septal defect]. Cossio's syndrome is demonstrated in a patient with a congenital large atrial septal defect who died at the age of 72. The clinical and pathomorphological findings as well as the pathophysiological implications on pulmonary circulation are described. The probable genesis of this interauricular defect is discussed.


[EEG findings in 40-60 year old subjects]. Electroencephalographic standard examinations were performed in 170 selected healthy persons aged between 40 and 60 years (average age 49 years). "Ideal Normal Traces" with a regular background Alpha-Activity were registered with only 39 test persons (22.9%). They showed an average frequency of 9.9 c/s and extreme values of 8.6--11.2 c/s. In 35 persons (20.5%) the only outstanding feature was merely a marked discontinuity and a considerable frequency lability of background activity, mostly combined with low voltage and a noticeable beta-waves component. In 17 persons (10%) a diffused increase of the Theta activity was found; the average age of this group was slightly higher (52.9 years) than in the remaining groups. Strongly marked paroxysmal-dysrythmic sequences were noted in 21 Test Persons (12.4%); these were in none of the cases clear sharp waves. In 58 Persons (34.2%) the essentiel changes were observed in the temporal regions being of a slighter nature in 46 persons (27.1%), and in 12 persons (7.1%) of a stronger character, lefthand significantly more frequent than righthand.


Age and diseases: the hypothesis about two constitutional types of human aging. The paper is concerned with some evolutionary aspects of aging. Old age diseases are considered as a concrete mechanism of maintenance of the species' lifespan within limits intended by evolution. The relationship between reproduction, aging, and diseases based on the evolutionary conception proposed by Williams is discussed. According to the author's hypothesis, the human population consists of the two subpopulations which differ by the constitutional type of hormonal regulation and reproduction potential; the constitutional type of hormonal regulation exerts a considerable effect of the aging rate, morbidity, and longevity.


[Geriatric and gerontopsychiatric clinical institutions: results of an empirical study]. A research project was carried out to investigate 138 geriatric and geropsychiatric institutions. In the first instance the object of the study was a comprehensive survey of all clinical institutions in the Federal Republic of Germany specializing in the treatment of geriatric and geropsychiatric patients. The study was carried out since no comparable survey was available. A further aim was the analysis of the data obtained by questionnaire concerning different characteristic of the clinical institutions specializing in the care of the aged. This article presents a summary of the research methods and the most important results of the characteristics surveyed. The results presented inable us to make statements about the buildings and equipment of the institutions surveyed, about those groups of patients treated, the number and qualifications of staff, methods of treatment and about costs. Further information is given about supporting institutions and about planned future alterations.


[The geriatric day clinic: report on a stay in Glasgow]. In the United Kingdom Geriatric day hospitals perform an increasing part of the medical care of the elderly since the early 1950 s. This report is based on a stay in 1978 to study the 8 geriatric day hospitals working in Glasgow. An account is given of equipment, staff, program, and function within the medical care system. The special possibilities of clinic-related therapeutic teams can be used, whereas unevitable side effects of common clinic care like immobilisation, institutionalisation can be avoided. Day clinic care is in agreement with the main intention of modern geriatrics -- to maintain or recover the patient independent, its success reacts upon this intention in a confirming way. An international comparison in this respect is not complimentary for the situation in the GFR.


[Resources in old age].

[Resources in old age]. General results of the psychological research on aging lead to the hypothesis that demands during the life cycle are accomplished the better, the more general and the more specific resources the individual disposes of. The analysis of four surveys on elder people shows that health, income, social integration, knowledge about aging, plans for retirement, good ecological conditions, life satisfaction, and a low age seem to be general resources. In addition there are some specific resources. The relevance and the necessary differentiation of the resource-perspective in gerontology are discussed.


[Perceived immutability of health and economic stress: cognitive theory of adjustment to aging]. 94 women and 80 men with or without major economic and/or health problems (age 65--94 yrs.) were given a set of interviews and questionnaires, including a scale for measuring 'perceived definitiveness of the own negative situation' (PEDE). Persons socring high in this scale differed in a significant way regarding health, housing, family, and economic situation, intelligence, and life satisfaction. Major differences exist also regarding responses to economic and/or health problems. Hypotheses were derived from a cognitive theory of adjustment to aging emphasizing the impact of cognitive systems on the primary and secondly appriasal processes and the selection of response.


[Attitude toward and experience of finiteness of human life]. Consciousness of the finitude of human life is found to occur in childhood as well as in age and adulthood, but is turning up more intensively in subjects being terminally ill, and is aroused -- as an irritation to be repressed -- in persons who regularly contact patients confronted by death. Thinking of the end is embedded in a complexity of psychosocial correlates: this is shown to be true for two subgroups of the Bonn Longitudinal Study of Aging, who are discriminated by their contrasting manner of facing finitude.


[Lymphographic visualization of the rectal lymphatic channels and nodes]. Injection of Lipiodol U.F. was effected in the submucosa of the rectum. Injection was done exactly 1,6 mm into the wall. This created a wheal from which reflux of the contrast medium occured. Up to 5 ml Lipiodol U.F. were injected in this manner. Roentgenograms were made in two planes after 2,4,8,24 and 48 hours; occasionally, oblique or spotfilm exposures were taken. Accumulation of the contrast medium began after only 2 to 4 hours, usually reaching its maximum after 12 hours. Thereafter, no further lymph nodes became apparent, so that radiographs taken at this time are representative of final stage. This procedure was carried out on 12 patients suffering from rectum carcinoma and on one patient with a villous adenoma. All tumors were located at a depth of 4 to 6 cm. The results are demonstrated by pictures. The lymph was found to flow longetudinally in the wall of the rectum. The order of appearence of the nodes was arbitrary. Due to the small size of the lymph nodes, no preoperative conclusion could be drawn as to wether or not they had become metastatically infested. The postoperative radiographs provided a check in the radicality of the operative procedure, especially in those cases in which lymph nodes had been clearly visible. Because of the viscosity of the contrast medium and because of the quantity that remained in the submucosa and was resorbed by the lymph channels, the method was self-limiting.


A fine structural study of the tissue channels' numbers and dimensions in normal and lymphoedematous tissues. The numbers and effective radii were estimated for the tissue channels in the intersitial tissue of rats in the cerebral cortex and the facial subcutaneous tissue. Normal animals and some with acute (3 days) abd chronic (12 months) lymphoedema were used. It was found that the numbers and sizes of the channels corresponded well to those obtained by other techniques, however it  was possible that in the oedematous animals the largest channels may have been artefactually counted as a number of smaller ones, thus reducing the hydraulic conductivity calculated. It is unlikely that this error was important for the normal tissue. In acute lymphoedema the numbers of both the small and the larger channels increased markedly, as did the radii of the largest channels. In chronic lymphoedema the numbers of the smaller channels fell to some extent. It was noted that, especially in lymphoedema and especially in the brain, there were many extra channels in the basement membrane regions of the capillaries. It is concluded that this new technique will be of considerable use in investigating the tissue channels in human patients since it can be applied to biopsy specimens.


Response of white mice to inoculation of irradiated organisms of the Toxoplasma strain RH. Chemotherapeutic agents available for use against toxoplasmosis are usually not suitable for prophylactic purposes because of their toxicity. The observed increasing number of activated latent infections with Toxoplasma, especially in immune suppressed patients, requires that safe techniques are available for use during the patient's regression period. Pretreatment of mice with Toxoplasma killed by irradiation appeared to induce resistance to challenge with virulent organisms. Survival times of six months have been observed to date. Increasing effectiveness was seen after more than one administration. Further investigation into the duration of effective resistance is needed; the question of at which intervals subsequent inoculations should be performed in order to acquire a booster effect, if any, has still to be solved before application to man can be recommended.


Scanning and transmission electron microscopy of the oocyst wall of Isospora lacazei. The oocyst wall of Isospora lacazei from sparrows was studied with scanning (SEM) and transmission (TEM) electron microscopy. In TEM, the oocyst wall consisted of four distinct layers (L1-4). The innermost layer, L1, was moderately electron-lucent and 240--285 nm thick; L2 was electron-dense and 210--240 nm thick; L3 was moderately electron-lucent and 15--150 nm thick; L4, the outer most layer, was discontinuous and consisted of electron-dense discoid bodies which measured 180--220 nm x 320--840 nm. The discoid bodies of L4 as seen by TEM appeared spheroid in shape when observed by SEM. One or two membranes were situated on or between various layers of the oocyst wall. One such membrane occurred on the inner margin of L1, two closely applied membranes were interposed between L1 and L2, one membrane occurred between L2 and L3, and one membrane on the outer margin of L3.


Characterization of Eimeria species. I. Isolation and study of pathogenicity of a pure strain of Eimeria perforans (Leuckart, 1879; Sluiter and Swellengrebel, 1912). Eimeria perforans was isolated in pure strain by utilizing specific biological characters and specific-pathogen free rabbits. The purity of this strain was demonstrated by measurements of oocysts, derived from a line, started by infection from a single oocyst. The parasite, when inoculated in large numbers, causes a mild disease response for only about two days.


The detection of rickettsia-like microorganisms within the ovaries of female Ixodes ricinus ticks. An ultrastructural study of tick-borne fever (TBF)-infected Ixodes ricinus ticks revealed the presence of rickettsia-like microorganisms within the ooplasm and the mitochondria of developing oocytes. These microorganisms are similar in appearance to the TBF agent and it is possible that although transovarial transmission of the TBF agent apparently does not occur, the rickettsiae are at least able to establish themselves in the ovaries of infected ticks.


Accidental poisoning in children in Lusaka. An analysis of 378 cases of accidental poisoning by ingestion or inhalation in children admitted to the University Teaching Hospital, Lusaka, in 1978, is presented. The distribution was as follows: paraffin poisoning (57.1%), food poisoning (18.3%), other household poisons (11%) and "medicines" (10.8%). In 9 cases poison could not be identified. Two patients (0.5%) died.


The gall bladder in adult Zambians.

The gall bladder in adult Zambians. The morphology of the gall bladder, the length and mode of termination of the cystic duct, and the origin and distribution of the cystic artery were studied in 88 adult Zambians (61 men, 27 women). The origin of the cystic artery was the right hepatic artery (53%), and the common hepatic artery (41%). Hartmann's pouch was observed in 44% of gall bladders. The cystic duct usually opened into the common hepatic duct (91%); its average length was 2 cm.


The use of diflunisal in post-operative pain. A single-blind trial of diflunisal (Dolobid) against osyphenbutazone (Tanderil) was performed in a randomised series of 50 patients undergoing various orthopaedic operations. The patients were screened for the known contra-indications to both drugs. All those admitted to the trial had considerable pain on the first post-operative morning. Diflunisal was found significantly more efficacious in the relief of orthopaedic post-operative pain. No significant side-effects were recorded for either drug.


[Determination of carbamate pesticides in fruits and vegetables by means of high pressure liquid chromatography (author's transl)]. It is shown that carbamate pesticides can be determined at the ppm level in different kinds of fruits and vegetables using high pressure liquid chromatography. The lower detection limit corresponding to a signal to noise ratio of three is between 0,025 and 0,25 ppm depending on the type of carbamate and plant material. In all cases it is below the maximum permissible value for pesticide residues. Due to the high separating power of high pressure liquid chromatography a simple sample pretreatment procedure can be used. The carbamates are extracted from the biological sample by dichloromethane and injected directly into the liquid chromatograph after replacing the extraction solvent by the mobile phase. In many cases a definite identification and quantitation of the carbamate is possible with a single chromatographic column. Some plants with a more complex matrix require a two-column operation in which the effluent fraction of the first column containing the pesticide is transferred by column switching to a second column in order to achieve a complete separation. The improved resolution in the two-column operation is caused by the relative enrichment effect of the fractionation and the increased column length.


[Direct questioning of serially studied 8th grade students on their leisure time activities]. 8th degree students were asked by questionnaire on their leisure-time activities. Home work was shown to interfere with time spent in front of the television screen, whereas sports did not. Girls spent more time  at homework than boys, and less time at television. Also they were less active in sports, especially in the lower grade schools.


[Absences from school in Basle primary pupils]. In the lower income group children of full-time working mothers have the lowest average of school absences, whereas in the higher income group they have the highest average. School absences of children in the lower income group increase markedly with increasing learning problems which might point out class differences of our schools.


[Consumption of sweets and freedom from caries in Basle school children]. A sample of 1'838 school children of Basle, aged 8 to 14 years, who were examined by dentists of the school dental health service, attended at the same time a 24 hour recall interview on nutritional habits. The data show that absence of caries (among 448 or 24,4% of all) is more frequent within those children who prefer fruits instead of sugar containing sweets with and especially between the meals. Since school children are not able to distinguish well between sugar- and non-sugar containing sweets and drinks, health education on such subjects is emphasised.


[Breast feeding money in Switzerland].

[Breast feeding money in Switzerland]. A mailed questionnaire was sent to all sickness-insurances on the subject of breast-feeding premium. 52% of the insurances replied, representing 90% of all insured persons. In 1976 23% of the mothers received the premium, in 1977 27%. This figure increased, as the membership of the insurances decreased. It is therefore thought, that mothers are not properly informed on this subject.


[Development of cardiovascular risk factors during adolescence]. Results of a first phase of follow-up in the population of the "Basle Adolescents Study" indicate that average blood pressure increased more in boys than in girls, blood lipids remained at the same level. Boys cought up with girls as far as cigarette smoking is concerned.


[Visual disorders, functional defects and vitamin deficiencies]. The comparison between complaints, functional defects and vitamin deficiencies is reported for several professional groups characterized by different work conditions. Results suggest that complaints are an useful indicator of visual load and that retinal sensitivity to the light is especially tried. Longitudinal studies are required to verify whether some functional alterations on the aging process of the eye can be aggravated by a visual overload. Visual complaints, functional defects and vitamin deficiencies as indicators of visual load.


[Traffic noise: estimation of discomfort in Geneva and in Scandinavian countries]. Annoyance among persons exposed to traffic noise has been studied using an interview technique. Results show a better correlation between annoyance and the number of heavy vehicles between 5-10 p.m. than the LEq values. The same reactions were measured in Geneva and Scandinavia.


[Stomatologic health and orthodontic requirements of Geneva children (1979)]. The present paper reports on current pedodontic and orthodontic research jointly pursued by members of the School of dentistry and of the Institute of social and preventive medicine (both at University of Geneva).


[Functional disability according to Guttman's scale and self-evaluation of health in the elderly]. The global score of disability according to Guttman and the assessment of one's own health are correlated. Whenever this assessment is compared by reference to other people's state of health, it often appears better and it corresponds then to a lower level of disability.


[An overview of health education in Switzerland]. The present research is an attempt to give an overall view of health education programmes in Switzerland. Three phases are planned: 1. Inventory of health education programmes, 2. evaluation of these programmes, 3. recommendations for the improvement of the present situation. The present paper gives the underlying concepts of the project. These concepts are: - personal responsibility and active participation, - coordination of existing structures. The inventory is meant to give an exhaustive view of the fields covered, the target groups, the channels of informations, and the organization.


[Standardization, a tool for the analysis of transversal data in epidemiology]. The direct method of standardization is mainly applied for eliminating undesirable effects of confounding variables in the comparison of several rates or means. This paper stresses the usefulness of standardization for detecting the statistical association between two variables. Under the assumption of a simple model implying two main effects and an interaction, it is discussed how the comparison between crude and standardized values measures altogether the main effect of the variable and the interaction. Furthermore, the variation in the population of the differences between crude and standardized values is shown to be an index of the effect of the variable for which it has been standardized.


[Decomposition of polycyclic aromatic hydrocarbons by means of radiation]. BaP decomposes rapidly after exposure to solar illuminations or in simulated atmosphere. The kinetics of degradation depend upon the nature of the support material, the radiant energy, the light wavelength and the presence of other components in the mixture on the same support.


[Pathology of shift work. Study of 4 state-owned factories]. Out of 131 workers whose 2/3 are shifted, 6 have to stop shift-work due to diseases probably bound to the irregular schedule: the frequency of sleeplessness and absenteism was increased, and a loss of weight was noticed. The "psychological" troubles (irritability, tiredness) are more frequent among the shift-workers.


[Results of analytical controls of the urine of drug addicts]. Chemical analyses provide a useful and necessary mean of information on progress of drug addicts in desintoxication program. Meanwhile, a systematic planning of analytical controls should be settled. Results observed on two groups of addicts in Switzerland are presented.


[The Institute for Social and Preventive Medicine at Zürich University]. The chair of Social and Preventive Medicine at the University of Zurich has been created in the year 1962. A description of the teaching activities is given. As regards research the main directions are: epidemiology and prevention of cardiovascular diseases, hygiene of sports, drug abuse, nutrition and health education. The services offered by the Institute include councelling in health matters and vaccinations for travellers.


[Pre-exposure rabies vaccination].

[Pre-exposure rabies vaccination]. Prophylactic vaccinations against rabies were given to 150 occupationally exposed persons. A new killed vaccine, grown on human diploid cells, was used. The first immunization resulted in a rapid development of neutralizing antibodies. Antibodies declined very quickly so that 50% of the probands failed to show adequate titres after 12 months. All probands reacted with a distinct rise in antibodies on re-vaccination. The vaccine was well tolerated and local or general reactions were observed only rarely.


[The incidence of coronary disease in Switzerland compared to the rest of Europe]. Switzerland ranks low in ischaemic heart disease mortality amongst the European countries. Evidence from field studies, however, would suggest that mortality is underestimated. Nevertheless, in Switzerland, like in France, the disease is probably rather less common than in some other comparable countries. The difference seems unexplained by the major, known risk factors, indicating a need for further research.


[Irtitation by smell in the neighborhood of a garbage burning plant]. Dilution threshold values were measured using sensory methods for an evaluation of odorous emissions of an incineration plant. The dispersion of odours was estimated based on recording of the local wind. The level of public annoyance in the neighbouring residential areas will be assessed by special questionnaires.


[Posture and muscular fatigue during work with a book-keeping machine]. A survey on localized fatigue was carried out in 119 accounting machine operators. In 51 cases the dimensions of the working places and different characteristics of the body postures were measured. The incidence of localized fatigue symptoms was found to be related to the degree of ulnar deviation of the hand, to the angle of the elbow as well as to the angle of the head inclination.


[Conclusions from traffic noise studies: suggestions for noise thresholds]. Based on 4 surveys, threshold limit values for noise are proposed; beside noise immissions, the quality of living has also been considered.


[Health-related effects of repetitive activities]. Two hundred workers of the Swiss watch industry were examined in a study of repetitive work effects on the well-being of workers. Repetitive work has shown to have two main influences on well-being: Relationships were found between subjective assessment of variety and autonomy, job satisfaction, psychosomatic complaints and headache. Repetitive work was always done under some positional constraint. This was shown to result in an increased rate of "arm, neck, shoulder syndrome" and visual problems.


[National Research Program 1: participation in the base examination, analysis by means of a logit-linear model]. In each of four swiss cities participation to baseline screening for the prevention of cardio-vascular diseases is analyzed within a stratified random sample using a logit-linear model. Stratification was chosen along sex, age and time of residence for persons living alone, and mean age of parents, number of children and time of residence for persons living as a family.


[Basle family study. Organization and 1st results]. The organisation of the Basle Family Study and preliminary results outlining the data analysis are presented. The study investigates in 500 families the familial influence on risk factors for cardiovascular diseases. In addition the distribution of hemostatic variables is studied. Analysis of the data according to age, sex and intrafamilial relations in 211 families demonstrate the influence of the mother on the development of the life style of the children.


[The perinatal neuroglia in hypoxia. An electron- and light microscopical study with addition Golgi's impregnation (author's transl)]. The light microscopical morphology of perinatal neuroglia caused by hypoxia was examined in 60 cases, in 5 of them corresponding structures were investigated electron microscopically. The astroglia was studied additional by using the silver impregnation technique Bubenaite in 20 cases of the group. The glial lipid accumulation is a perinatal pathological process and is not related to myelination. It was found in 71,5% of the cases in astroblasts and astrocytes but seldom in oligodendrocytes. At the ultrastructural level, the lipid-loaded neuroglial cells cannot be confused with macrophages. One third of the cases showed a proliferation of the macroglial. In 20% of the cases, a focal leukodystrophy was found. A hypoxical degeneration was revealed of astrocytes by the Golgi modification of Bubenaite. The study demonstrates pathological changes of myelin formation in connection with degeneration and immature myelination. These perinatal neuroglial reactions seem to be connected with diffuse leukodystrophies. The examination gives the impression that the oligodendroglial differentiation might be disturbed. In contrast to myelin degeneration, the glial cells lesions and myelination defects play a decisive role in postnatal CNS formation.


[Hairy cell leukemia. Light and microscopic and electron microscopic examinations (author's transl)]. Two cases of a typical hairy cell leukemia are presented. The light microscopic findings within the bone marrow, lymph nodes and spleen are documented. The hairy configuration of tumor cells can best be seen in semithin sections of white cells of the peripheral blood. Electron microscopically, the organelle composition of hairy cells (including the characteristic ribosome lamellae complex) is demonstrated. The significance of morphological observations for the diagnosis of hairy cell leukemia and the differential diagnosis of this tumor disease are discussed. From the electron microscopic observations of intercellular cross-banded structures it seems possible that the increase of intercellular material demonstrable light microscopically by silver impregnation is the consequence of synthesis of collagen type IV. The conclusion is drawn from findings in our cases and from reports in the literature that hairy cell leukemia is a clinically and structurally defined syndrome rather than a pathological entity.


Leiomyomas of the larynx.

Leiomyomas of the larynx. In a now 65 years old male patient a monochorditis of the left vocal cord was clinically observed over several years. Multiple exploratory excisions finally demonstrated a leiomyoma with atypically growing histological structures. The complaints of the patient permanently increased, and a hazel-nut-sized leiomyoma with atypically growing tissue structures, originating in the left vocal cord, was removed by laryngectomy. The exploratory specimen, which was diagnosed in our laboratory as proliferative pseudosarcomatous tissue 11 months before manifestation of the leiomyoma with atypical structures, is compared with analogous findings reported by Lane (1957) and Sherwin et al. (1963). Our observations, completing the results of these publications, allow the conclusion that pseudosarcomatous tissue structures do not only occur in the surroundings of carcinomas but also in the immediate neighbourhood of mesenchymal tumours. Choice of the adequate site for exploratory excision is decisive for correct histological diagnosis. A comparison with the literature concerned shows that leiomyomas and leiomyosarcomas rarely occur in the laryngeal region.


[The diagnostic value of the epidermal pigmentation in nevus-cell nevi (author's transl)]. The pigmentation of epidermis in areas of nevus-cell nevi is frequently not specially noted, but may be of considerable diagnostic value in particular cases. Two cases are demonstrated. Multiple tumors with the aspect of nevus Spitz in a 35-year old woman were histologically diagnosed by means of melanin impregnation methods as "amelanotic nevus-cell nevi with overlying vitiligo". A flat papillomatous nevus-cell nevus of the abdominal skin of a 38-year old man showed clinical signs of activity, but histologically only a total depigmentation of the epidermis and of the peripheral parts of the nevus was observed.


[Comparative, quantitative and morphological investigations (automatic image analysis--micromorphometric analysis) of myocardium of rat isoprenalin treatment (author's transl)]. The alterations of areas of myocardium of male rats (2, 4, and 6 months) are investigated after isoprenalin treatment (0.05 mg/kg body weight and day i.p. for 30 days). The investigations are carried out using automatic microscope picture analysis, morphometric point counting and resp. Both methods yield the same qualitative results: The effect of isoprenalin is dependent on age and yields for old rats (6 months) only very little morphometric alterations in the myocardium. The automatic microscope picture analysis is a very effective method of investigation (45 seconds/cross section).


[G. I. diagnostics; its ranking and interdisciplinary organisation (author's transl)]. The complicated and expensive diagnostic apparatus available today has to be applied in an orderly sequence. This order depends on certain prerequisites, e.g. on the disease, urgent complications, patient tolerance, apparatus potential, hospital structure and organisation etc. The more rational the indication is to use certain methods, the more efficient will be the results. The appropriate concepts and suggestions for certain general and specific examples, used by us at present are demonstrated. Complicated and expensive diagnostic procedures have to be decided primarily on an interdisciplinary level. The increased costs of these procedure are balanced by a decrease in hospital stay and fewer operative explorations too. At other places different actions will be taken for equally good reasons.


[Complications after chemotherapy of solid malignant human tumours and their therapy (author's transl)]. The necessity of additional cancer therapy of human solid malignant tumours is emphasized. The general and specific complications after their treatment with cytostatic agents, hormones and BCG as well as their therapy are mentioned. Own complications after additional cancer therapy are demonstrated and compared with the results of polychemotherapy.


[Current therapeutical aspects in gastric carcinoma (author's transl)]. The poor prognosis of gastric carcinoma can be improved by intensification of early diagnostics and adequate surgical measures. To avoid local recurrent tumour growth at the resection lines total gastrectomy is necessary if the tumour is located in the upper and middle third of the stomach as well in the case of diffusely infiltrating tumours in the distal third. To prevent relapses in the regional lymphatics radical lymph node dissection should be performed. Remission rates in advanced gastric cancer are high after combination chemotherapy with 5-fluorouracil and nitrosourea. Postoperative adjuvant chemotherapy seems to be successful according to newer communications. Basic problems of adjuvant chemotherapy in gastric cancer are discussed.


[Abdominal radiation and mechanical ileus (author's transl)]. In 406 cases of mechanical ileus we observed 42 (10,3%) patients who previously underwent abdominal radiation following resection of an abdominal tumour. In 12 of these patients the intestinal obstruction was only caused by adhaesions, no presence of recurring tumour tissue. Because of the high percentage of benign stenoses laparotomy has to be performed in every case to differentiate the cause of obstruction.


[Acute normovolaemic haemodilution (author's transl)]. Report on 50 acute pre-operative normovolaemic haemodilutions. In 21 cases reactions of incompatibility after dilution were observed. Possible causes are discussed.


[Chromosome aberrations in oncobiogram - cytogenetic studies into aberration frequency following trenimon treatment in vitro (author's transl)]. Quantitative determination of qualitatively unequivocal signs for an individual oncobiogram is difficult. However, the use of a properly standardised analysis of chromosomes may offer a possible approach to the problem. Sixty-nine tissue cultures were prepared from 15 ovarian carcinomas, and 56 of them under went sufficient growth. A concentration of 2 . 10(-7) moles/l of trenimon was added to the tissue culture for one hour. Sixteen tissue cultures were used as controls. Chromosome preparation was achieved with good success after recovery periods between five and nine hours. A total of 2,890 mitoses was evaluated. Trenimon increased the amount of damaged mitoses from 1.2 per cent to eleven per cent, while the number of aberrations was aggravated even by the factor of 6.6. - The differences were statistically secured with high significance. Some of the cell cultures suffered rises in aberration frequency by 50 per cent and even 190 per cent. Such extreme values obviously suggest the presence of extraordinary sensitivity which be utilised for cytogenetic oncobiogram.


[Results of treatment of vaginal carcinoma, 1960 to 1969 (author's transl)]. Reported in this paper are 81 patients who received therapeutic irradiation by various modes for primary vaginal carcinoma, between 1960 and 1969. Severities were as follows: 23.4 per cent in Stage I, 42 per cent in Stage II, 27,2 per cent in Stage III, and 7.4 per cent in Stage IV. One single percutaneous irradiation was applied, between 1960 and 1966, while combined contact-percutaneous irradiation was used in the second half of the sixties. Five-year survival rates were 65.6 per cent for Stage I, 29 per cent for Stage II, 35.5 per cent for Stage III, and 37.6 per cent on average. The best results of combined contact-percutaneous treatment were recordable from the earlier stages. Therapies tailored to the individual concerned proved to be most effective in the context of vaginal carcinoma.


[Two-decade record of gynaecological department in municipal hospital of Berlin-Friedrichshain in graduated treatment of carcinoma in situ (author's transl)]. Reported in this paper is experience so far obtained from graduated or stepwise treatment of carcinoma in situ. The report is based on the author's own experience obtained from 716 cases as well as on another 342 carcinomas in situ which had been evaluated earlier and elsewhere by Mosler and co-workers. The five-year healing rate accounted for 99.87 per cent. The first and second periods of follow-up checks were compared for all 1,058 in situ carcinoma cases under review, and the following conclusion were drawn: 1. More women were involved in prophylactic gynaecological checks. - 2. The age peak of carcinoma in situ cases in the second follow-up period was two years below that observed in the first period. - 3. Decline in cases with carcinoma location in ectocervix only, but increase in cases with carcinomas in situ of endocervical or endocervical together with ectocervical locations. - The following advantages are likely to be obtainable from conisation over general use of simple hysterectomy and even more over radical surgery, provided observance of the conditions specified in this paper: 1 Mitigation of physical and psychic surgical trauma and its consequences; - 2. Less exposure to severe potential intra-operative and/or postoperative complications; - 3. Savings on cost of treatment resulting from shorter hospitalisation and reduced need for nursing, medicaments, and attention, using hardware.


[Action of progesterone on endometrial carcinoma (author's transl)]. The use of progestagenic hormones in the treatment of endometrial carcinoma is reported in this paper. Optical microscopy and ultrastructural techniques used in morphological investigation established extremely good response to treatment primarily by adenocarcinomas which are characterised by advanced histologic differentiation. Deceleration of tumour progression was a clinical result of the therapeutic approach taken, with shorter or longer periods of remission being recordable. The results are likely to support the assumption that "cytostatic" action of progestagenic substances can yield desirable complementary effects in cases when surgical or radiological treatment is abandoned for high risk.


[Subcutaneous mastectomy (author's transl)]. Subcutaneous mastectomy is a real precaution to third-order mastopathy, and it is urgently indicated for therapeutic action on carcinoma in situ, since the incidence of invasive carcinomas to accompany such diseases is between ten and 25 per cent. Proliferative forms of mastopathies were recorded from 768 in 2,563 surgically treated women, with atpical tissue being found in 164 cases. Carcinoma in situ was established from 28 women. Indications, limitations of the method, surgical technique, and complications are discussed against the background of results obtained from 31 subcutaneous mastectomies.


[Use of partusisten during labour for treatment of increased uterus tonus (author's transl)]. Partusisten slow-drop infusions were applied to twelve women in labour with spontaneous increase of the uterus tonus in rest. The preparation was found to lower the tonus in rest and to increase the amplitude of uterus contractions.


[Antepartal and intrapartal betamimetic long-time-therapy - effects on blood sugar in premature infants (author's transl)]. The glucose oxidase method was used to measure blood sugar concentrations of 61 newborns over their first 24 hours of life in an effort to study the effects of long-time antepartal and intrapartal application of betamimetics to the mothers upon the blood sugar levels of premature infants. Betamimetically affected premature infants, different from all expectation, exhibited a trend towards higher blood glucose values in the first hours from birth. However, no difference was any longer recordable between the treated group and the controls, after twelve hours had elapsed.


[Analysis of caesarian sections at county hospital (author's transl)]. Reported in this paper are 268 caesarian sections in 8,259 childbirths without electronic monitoring, between 1967 and 1976. Hence, caesarian sections were necessary in 3.34 per cent of the cases under review. The average rate of sections went up from 1.89 to 4.31 per cent over the last five years. Perinatal mortality accounted for 2.17 per cent, uncorrected. It was reduced from 2.88 to 1.13 per cent. Indications changed clearly from vital to prophylactic requirements for child-saving reasons, the shift towards the latter indication being from 16.7 to 62 per cent. Maternal section morbidity amounted to 15 per cent, while maternal mortality was zero.


[Radiological and ultrasonographic diagnosis of advanced abdominal pregnancy (author's transl)]. Radiological and ultrasonographic findings recorded from one case of abdominal pregnancy are reported in this paper and discussed, in the context of relevant literature data.


[Importance of early neurosurgical intervention in acute traumatic comatose and subcomatose states]. The authors report 91 cases of acute posttraumatic coma. The propose undertaking of promptly diagnostic, and consider that the most important is angiographic examination. Excluded the cases of clinical evident brain death of very dad generaly status of patient, they preopse prompt carotid angiography by every case of posttraumatic cerebral coma, in spite of eventual lack the neurological lateralisation. When they havenit time of possibility for angiographic examination, they undertook the diagnostic bur-hole. Early intracranial and intracerebral decompression in the first six hours is, if indication for operation is good line, nowadays unique method for treatment these patients in contemporary neurotraumatology.


[Diagnosis and surgical treatment of endocranial compressive hemorrhage]. Authors present results of diagnosis at surgical treatment of 122 patients with compressive intracranial haemorrhages, observed and treated in the course of last five years. All patients have been admitted and treated at the Department for intensive care of patients, and have been under care of one neurosurgeon and anestetists duty and radiologists. 18 patients had chronical subdural haematoma, and 104-patients had acute compressive intracranial haemorrhages: epidural, subdural and intracerebral, one more haemorrhages in the same patient, hygromas, and sclopetar wounds with fast evolution. Out of 104 patients, 25 died (mortality rate 24%), and 26 patients died out of 122 patients (mortality rate being 21,3%). Authors enphesize the value of eho-encefalography and CAT of brain in the manengement of compressive inte cranial haemorrhages in the state of peace and in the state of war.


[Thoracic injuries treated at the surgery clinic in Novi Sad from 1968-1977]. The authors analysed 516 injuries of the thorax. treated in a ten year period (1968-1977). These injuries were 2,2% of 23.300 injuries treated by this Clinic during this time period. The etiology shows that 63,9% of these cases were caused through traffic accidents. In 516 of this cases, there were 5% penetrating injuries. A big percent of polytrauma (42,6%), traumatic, haemorrhagic shock (21,5%) and the difficultes in mechanics of breathing or respiration function (61,2%), shows the difficulties and importance of the medical attitude in curing these injuries in peace time, and in war, or during massive injury. The authors have also stressed the necessity of education for professional medical staff, equipment for the staff and its organization during peace time. This also serves the goals for national defence.


[Diagnosis and treatment of thoracic injuries]. Injuries of the chest isolated or joined with injuries of other organs are distinctly increasing. There are almost no polytraumatic people without thorax injuries. Traffic traumas have a dominant role in causing these injuries. We had most injuries in sammer months. The isolated chest injurie we had 60% and the accompanying injurie 40%. Of the accompanying injuries, the head injurie have the most autstanding place, which especially make difficult the diagnostics, and curing. In heavy injuries of the thorax with paradoxical breathing and on both sides of the leasions, establishing the internal pneumatic stabilisation at the beginning by pulmomatic and then ostheosyntesis of ribs are the most effective therapy. In order to prevent the infections, atracheobronchial dressing with antibiotics is performed as well as the regular X-ray check. As a general rule than 200 ml. per 3 hour requires operative control of the hemorrhage. We had 5,6% thoracothomy after continuous drainage by persstend hemorrhage. The obstructive pneumonia, particularly the eldery are to avoid obstructis, aspiration by catheter with bronchoscopy.


[Splenic rupture].

[Splenic rupture]. Rupture of spleen occurs more and more frequently in peactime conditions and resemble to wartime injuries. Authors describe own experiences of treating such traumas.


[Injuries of the extrahepatic biliary tract]. We represented two injuries of extrahepatic bile ducts upon our clinics materijal within last ten years. With the first case we had isolated rupture calculus gallbladder by closed abdominal injury. Secend case had opend abdominal injury and rupture of gallbladder and common bile duct. We faund gallbladder teard off in Douglas spece. We solved both cases succesfully with cholecystectomy and in secend case we also aplied suture of common bile duct with T tube drainage.


[Tactics of surgical care of closed abdominal injuries under conditions of defensive war]. The authors are analizing the mechanism of initiation, frequency, surgical characteristics, the way of treatment and the factors affecting the prognosis of close injuries of abdomen in peace and war conditions. The discussion is about the problems of uniform surgical war-doctrine (army sanitary service, public-health service) in conditions of general civil-war defence. Own experiences are presented in surgical treatment of 179 patients with close injuries of abdomen in 10-year research on the Regional Surgical Department of Banja Luka's Medical Center.


[Comparative analysis of changes in cerebrospinal fluid pressure and ocular fundus findings in traumatic subarachnoidal hemorrhage]. In this paper we gave the analysis of the height of CNS fluid pressure at patients with traumatologic subarachnoidal hemorrhagy and changes in fundus shown as preretinal hemorragies. By analysing 15 patients we could some to the conclusion that CNS fluid pressure, measured in lumbal did not follow the appearance of preretinal hemorragies. Or in other words, the appearance of preretinal hemorragies was not in direct dependance of the CNS fluid pressure. The measuring of the CNS fluid pressure was usual performed each second and third day after the patient had entered the hospital.


Effect of suture materials on bacterial survival in infected wounds. An experimental study. A non-capilllary and a capillary suture material were compared as regards the course of Staphylococcus areus infection at the site of implantation. The materials were implanted in the muscle of the rat, and bacterial counts were made at intervals over 41 days. The number of bacteria recovered at the implantation site during the test period decreased steadily and was significantly lower for the non-capillary than for the capillary materials. In the latter case the bacterial counts did not fall far below the initial value at inoculation. The number of bacteria isolated from the suture thread in relation to the total number from the thread and the surrounding muscle was significantly greater for the capillary material. The difference in the results for the two types of suture materials might be ascribed to differences in the extent to which the bacteria are exposed to the body's defence mechanism; in the case of the capillary suture material the bacteria would tend to be protected through their enclosure in the interstices of the material.


Surgical classification of abdominal aortic aneurysms. A new surgical classification of abdominal aortic aneurysms is proposed. The classification is based upon the clinical features immediately prior to surgery and the findings during operation. Group I consists of elective cases without symptoms, group II elective cases with symptoms, group III suspected rupture, group IV rupture without clinical shock and group V rupture with clinical shock. The mortality in a material of 129 cases was 0 in group I and progressed to 74% in group V. The mortality distribution was confirmed by a collective review of the literature. The proposed classification sheds light upon the natural history of the disease, prognosis and indication for operation.


Peroperative estimation of the size of the thyroid remnant. A new method for estimation of the size of the remaining tissue after thyroid resection is described. The method has been tested on cadavers and during lobectomy in a series of patients. It is shown that intraoperative quantification of the thyroid remnant can be performed mostly with +/- 0.5 g for an individual thyroid lobe with a coefficient of variation of +/- 7.6%. In patients with toxic nodular goiter and calcifications, however, the error might be larger due to the varying homogeneity of the thyroid tissue. In 73 patients with negative antibody titers operated on for hyperthyroidism it was shown that the size of the thyroid remnant was negatively correlated to the delta TSH, determined 6 weeks after the operation.


Halothane hepatitis after jejunoileal bypass. A case of halothane hepatitis occurring 14 months after jejunoileal bypass for morbid obesity in a 49-year-old woman is described. Hepatic dysfunction after bypass procedures is especially seen in the weight losing phase, and has been ascribed to protein malnutrition. Halothane is considered immunogenic and it is possible that the hepatitis was provoked by repeated halothane administrations due to the patient's altered immunological competence.


Liver circulation and oxygen metabolism during short time ligation and the hepatic artery in the dog. The changes of liver circulation and liver oxygen metabolism during and after one hour hepatic artery ligation (HAL) were studied in eight mongrel dogs. At the end of the HAL period total hepatic blood flow (THBF) was reduced from 115.6 +/- 5.5 ml/min . 100 g liver tissue to 68.0 +/- 3.7 ml/min . 100 g or 59% of the initial value. The portal venous blood flow was reduced from 83.1 +/- 3.4 to 58.8 +/- 3.7 ml/min . 100 or 82% of the initial value and the liver oxygen consumption was reduced from 4.1 +/- 0.2 ml/min . 100 g to 3.1 +/- 0.3 ml/min . 100 g or 76% of the initial value. The changes in portal venous blood flow and liver oxygen consumption were reversible following reopening of the hepatic artery. The clinical importance of a reduced portal venous blood flow and liver oxygen consumption following HAL and the possibilities to increase the portal venous blood flow are discussed.


Palpatory estimation of liver size. Within- and between-observer variation. A study based upon 23 patients revealed substantial within- and between-observer variation, when 14 senior and junior surgeons under blindfold conditions were requested to measure the distance from the thoracic cage to the lower border of the liver in the midclavicular and midsternal lines. Clinical decisions should accordingly not rely heavily upon a palpatory estimate of liver size.


Low anterior resection using stapling instrument. Twenty-one patients, eighteen with carcinoma of the rectum and three with diverticulosis of the colon, have been treated with anterior resection. The anastomoses were made with the stapling instrument, EEA, allowing very low anastomoses. All patients had temporary colostomy. Seventeen patients had a postoperative uneventful course. In three patients, major but tractable complications were seen. One patient died of pulmonary embolism. All survivors were completely continent for air and faeces, even with anastomoses only 4 cm above the anus. Two cases of recurrency have been noticed, one after two months and one after thirteen months. The result of making low anterior resection with the aid of the stapling machine EEA are so far promising.


Nonrotation anomaly of the bowel causing acute intestinal obstruction in adults. A report of two cases. Two cases of acute intestinal obstruction in adults caused by a nonrotation anomaly of the bowel are presented. Both of the patients had suffered since chilhood from chronic, recurrent but rather mild abdominal symptoms which subsided spontaneously. In both cases volvulus of the cecum caused the acute abdominal condition, necessitating emergency operation. The nonrotation anomaly was an unsuspected discovery at laparotomy. The possibility of this type of congenital anomaly should be kept in mind whenever a patient has chronic recurrent abdominal symptoms or an acute abdominal condition.


Renal vein thrombosis in the newborn.

Renal vein thrombosis in the newborn. Abdominal masses localized to the region of the kidney in the newborn require different diagnostic procedures. Taking advantage of cystourethrography, retrograde and intravenous pyelography and angiography, it should be possible to make the right diagnosis as in our two cases demonstrating renal vein thrombosis.


Serum activity of ornithine carbamoyl transferase in patients operated with jejunoileal bypass for extreme obesity after pretreatment with aminoacids. Increased blood level of the liver specific enzyme ornithine carbamoyl transferase (OCT) is known to be a sensitive indicator of liver cell damage. The effect of preoperative aminoacid infusion to obese patients before jejunoileal bypass due to obesity was studied in 7 patients. They had a significantly lower rise on OCT than eight patients receiving only 5.5% glucose. The result seems to indicate that the liver in an obese patient undergoing abdominal surgery is protected against damage by an infusion of aminoacids.


Achilles tendon injury. 3. Structure of rabbit soleus muscles after immobilization at different positions. This investigation was designed to study the short and long term effects of inactivity on the fine structure of skeletal muscle tissue. Ankles of rabbits were unilaterally immobilized for one of three weeks. The knees were semiflexed and the feet were either in plantar or in dorsal flexed positions. The soleus muscles were examined immediately after removal of the plaster or after six months of observation. The muscle fibres, when immobilized in the slackened state, showed serious degenerative changes and Type 1 fibres, i.e. fibres lightly stained for myofibrillar ATPase at pH 9.4, were often necrotic. The fibre type ratio was changed when examined immediately after removal of the casts so that the relative number of Type 2 fibres was increased. If stretched, essentially normal morphology was seen. The contralateral soleus muscles, which were excessively weight-bearing during the plaster period, were characterized by small, sometimes necrotic, Type 2 fibres and splitting of Type 1 fibres. Whatever the reason for the structural changes it seems correct to point out to the surgeon that too much emphasis on tendon aspects implies certain risks. Overeagerness to obtain a safe way of unloading the tendon during the necessary period of immobilization after suture may result in longstanding damage to the muscle structure and, as a sequel, decreased strength.