Retroperitoneal fibrosis secondary to metastatic neoplasm. Retroperitoneal fibrosis may occur secondary to metastatic neoplasm and may simulate the features of the idiopathic variety. A case of retroperitoneal fibrosis due to gastric carcinoma is presented and the historical, physical, cystoscopic, urographic, operative, and pathologic similarities to the idiopathic form discussed. Generous biopsy of retroperitoneal plaques and careful pathologic examination are stressed to avoid missing malignant disease.


Spectrum of ultrastructural patterns of renal cell adenocarcinoma. The ultrastructure of renal cell carcinoma was studied in 6 patients. This study demonstrated a spectrum of ultrastructural patterns ranging from the classic electron microscopic features of granular cell carcinoma at one extreme, to those of clear cell carcinoma at the other extreme. Other tumors demonstrated intermediate features. There was reasonably good correlation between the light microscopy and electron microscopy. Unusual findings of connective tissue banded structures and basement membrane branching were demonstrated.


Double contrast polycystography: new radiologic procedure. To plan the treatment of carcinoma of the bladder correctly accurate knowledge of the morphology and degree of infiltration of the tumor is essential. Double contrast cystography and polycystography are radiologic techniques that can provide such information. Hitherto, these two procedures have been performed separately. Herein is described a new method combining these two investigations. Thus maximum information necessary to plan the treatment of bladder tumors is obtained from a single radiograph. The advantages of this procedure are discussed.


Idiopathic pelviureteric varices.

Idiopathic pelviureteric varices. Pelviureteric varices are well-documented sequelae of renal vein thrombosis, but there have been only 10 prior reports of idiopathic renal vein varicosities. Herein we report 3 more cases and review the literature. Two thirds of the patients presented with hematuria; one-fourth had flank pain, and one-third had saphenous vein varicosities. Pyelographic findings include scalloped deformities of the upper ureter and pelvis with displacement and intraluminal filling defects. The diagnosis may be suspected from the excretory urogram, but venography is definitive. Excision and ligation of the varicose veins were curative in all but 3 patients who required nephrectomy for life-threatening hemorrhage.


Avascular renal adenocarcinoma: variations and characteristics. Six cases (men ranging in ages from thirty-seven to seventy-seven years) illustrate the varied characteristics of avascular renal adenocarcinoma. These tumors frequently stimulat benign lesions. All modalities including intravenous pyelography, nephrotomography, ultrasonography, cyst puncture with cystic fluid assessment, angiography, and operation with tissue specimens submitted for pathologic examination may be required before diagnosis is established. An orderly approach to the evaluation of lesions will allow accurate diagnosis approaching 100% with minimum morbidity. Attention to the finer details of vascular patterns on angiography has proved to be a most helpful diagnostic aid. Cyst puncture with histochemical, cytologic, and radiographic examinations appears to offer additional help in diagnosing these elusive lesions.


Accuracy of bipedal lymphangiography in testicular tumors. The accuracy of bipedal lymphangiography to evaluate nodal metastases in patients with testicular malignancies is discussed. A total of 108 patients were evaluated. Histologic correlation was available in 45 cases. The over-all accuracy was 89% which compares favorably with other large series.


Renal sinus angiomyolipoma.

Renal sinus angiomyolipoma. The first case of an angiomyolipoma limited to the renal sinus is presented. The radiographic findings were a relatively lucent mass within the renal sinus (extrarenal); neovascularity that did not respond to epinephrine; lack of arteriovenous shunting; a "whorled" venous pattern; and displacement and compression of the renal vein without evidence of invasion. Infusion nephrotomography and renal venography were crucial in the localization and preoperative suggestion of this benign renal sinus lesion. The renal sinus angiomyolipoma was removed by blunt dissection and the kidney preserved.


Seeding mechanism of urothelium over nonepithelialized surfaces. To study urothelial spreading over nonepithelialized tissue surfaces, bladder defects in rabbits were patched with pedicled prevesical fat. Using serial sections and scanning electron microscopic studies, it was concluded that urothelium in the process of covering nonepithelialized surfaces is able to seed at a distance from the periphery of the defect as one means of epithelializing a defect.


Minimal mortality of renal surgery.

Minimal mortality of renal surgery. Eight hundred fourteen renal operative procedures were reviewed to determine overall mortality and to identify patients at risk. The over-all mortality was 1.35%, but as high as 30% in patients with uremia and spesis. Carcinomatosis contributed to higher mortality in other groups. In the absence of these three factors renal surgery was associated with very low or no postoperative (thirty day) mortality.


Nonobstructive anuria in children: hemolytic uremic syndrome. The hemolytic uremic syndrome (HUS) must be considered as a cause of oligo-anuria in a previously healthy young child. This syndrome consists of a viral-like prodromal illness, followed by acute renal failure, thrombocytopenia, and an abnormal blood smear with fragmented erythrocytes. Awareness of this syndrome will permit earlier diagnosis and management and will minimize unneccessary investigation in the anuric child.


Prevention of venous thromboembolism with low doses of heparin in urologic patients. The effectiveness of low doses of heparin was investigated for the prevention of clinically manifested thromboembolic disease. In the group of 125 patients, who received 5,000 units of subcutaneous heparin two hours before the operation, and postoperatively 15,000 units per day for seven to ten days, deep vein thrombosis was not observed, and in only 1 patient (0.8%) pulmonary embolism was suspected. Of 216 patients from the control group, pulmonary embolism was clinically diagnosed in 4 (1.9%), deep vein thrombosis in 7 (3.4%), and in 2 patients (0.9%) fatal pulmonary embolism was found at autopsy. The difference between total thromboembolic disease of the control group (6.2%) and heparinized group was highly significant (p less than 0.02). Postoperative bleeding was seen two times more often in the heparin group, but bleeding was not severe and was easily controlled.


Tactile litholapaxy--safe and efficient. Tactile litholapaxy is a safe procedure and is not difficult to learn. It can be used for stones up to 5 cm. in diameter unless the stone is very hard. The bladder is distended with irrigating fluid, the lithotrite passed, the jaws opened, and the lower jaw depressed against the floor of the bladder and vibrated to allow the stone to roll on to it. The upper jaw is depressed against the stone, the threads at the handle are meshed, and the stone is crushed. Fragments are crushed in like manner and are then washed out through a resectoscope sheath. It is easier to do and more efficient in both length of operating time, absence of complications, and shorter hospital stay when compared with visual litholapaxy and cystolithotomy.


Vascular obstruction of ureter after transureteroureterostomy. Transureteroureterostomy in 6 dogs with the ureter transposed to cross the arterial notch between the caudal (inferior) mesenteric artery and aorta did not result in vascular induced ureteral obstruction.


Reversible systemic abnormalities associated with renal cell carcinoma. A sixty-eight-year-old male was found to have renal carcinoma after seven months of constitutional symptoms. Initial study of the patient showed a puzzling array of laboratory abnormalities. These led initially to a search for gastrointestinal malignancy and then later to consideration of multiple myeloma. This case serves as a reminder of the propensity of early renal carcinoma to produce striking constitutional symptoms and marked hematologic and serum protein abnormalities. These may occur in the absence of metastases and are frequently reversible as shown in this case with resection of the primary lesion.


Pelvic lymphadenectomy in stage A prostatic cancer. Pelvic lymphadenectomy as a staging procedure in clinically apparent prostatic adenocarcinoma has long been recognized and its value appreciated. Twenty-three recent cases from the University of Colorado of clinically unapparent carcinoma of the prostate were studied with this modality, 5 Stage A1 and 18 Stage A2 tumors. Four of the 18 Stage A2 tumors but none of the A1 lesions after negative staging procedures revealed metastatic disease to the pelvic lymph nodes. Our experience indicated this modality should be employed in selected cases of incidental adenocarcinoma of the prostate.


Pasteurella multocida infection of urinary tract in patient with ileal loop. Pasteurella multocida infection in the ileal loop and in the pelvis of a hydronephrotic kidney of a patient whose other kidney had been removed at age six months was documented by the repeated isolation of this patthogen. Two episodes occurred, the first terminated after a dose of gentamicin and the other without chemotherapy. Since the patient prior to infection was in severe renal failure necessitating hemodialysis, the effect of this infection on renal function could not be ascertained. The probable source was a cat present in the household.


Correction of renal hypertension by ligation of stenotic segmental renal artery. Hypertension secondary to segmental renal ischemia caused by segmental renal artery stenosis has been relieved by nephrectomy, partial nephrectomy, excision of atrophic segments, or repair of the segmental vessels. This is a report of hypertension caused by stenosis of a segmental renal artery and cured by simple ligation of the stenotic artery.


Aortic aneurysm with retroperitoneal fibrosis and ureteral obstruction. Arteriosclerotic aneurysms of the abdominal aorta constitute a common clinical entity. Rarely are they associated with retroperitoneal fibrosis and ureteral obstruction requiring ureterolysis. Fifteen such cases have been reported, with resection successful in 5 of 7. A sixteenth case is presented complicated by the presence of a persistent left cardinal vein. It is the third aneurysm resected with such an anomaly, and to our knowledge the first to be associated with retroperitoneal fibrosis and ureteral obstruction. Ureterolysis with resection of the aneurysm was performed. The difficulties presented by these pathologic entities, as well as the anomalous venous pattern, are reviewed. Complete preoperative evaluation, including intravenous pyelogram, retrograde pyelography, aortography, and venacavography, for the definition of anatomic relationships and planning of the surgical approach is stressed.


Renal plasmacytoma.

Renal plasmacytoma. Plasmacytoma, a localized extramedullary mass of plasma cells, is one manifestation of multiple myeloma. Renal plasmacytomas are rare lesions with neovascularity on arteriogram. This may cause confusion with the much more common renal cell carcinoma unless the clinician is aware of this entity. A case is presented, the literature reviewed, and problems in management discussed.


Congenital megalourethra associated with hypospadias. Megalourethra is an extremely rare congenital anomaly. Association with hypospadias has not been previously noted. It is essential that this condition be recognized so that circumcision is not performed. More importantly, other congenital anomalies must be suspected. One-stage surgical repair of the condition is not difficult and generally offers good results.


Responsiveness of lymphocytes to soluble extracts of prostatic tumors and abrogation by serum-blocking factor(s). Preliminary evidence is presented suggestive of antitumor immunity, cross reactive with allogeneic extracts from tumors of the same type, and serum-blocking factor(s), which appear to be specific to autologous tumor only, in patients with prostatic cancer employing the method of leukocyte adherence inhibition.


Squamous metaplasia and invasive epidermoid carcinoma of bladder. Invasive epidermoid carcinoma of the urinary bladder is described in a young woman with a long history of bladder infections and extensive squamous metaplasia without atypia. The literature on squamous metaplasia and leukoplakia progressing to epidermoid carcinoma of the chronic dysuria, bladder infections, and long histories of squamous metaplasia of the bladder should be followed up very closely. If epidermoid carcinoma of the bladder develops, they should undergo radical surgery.


Renins and prostaglandins in segmental renal artery aneurysm associated with accelerated hypertension. A patient with hypertension of sudden onset and with segmental renal ischemia due to an aneurysm in a renal artery branch underwent a nephrectomy which apparently cured his arterial hypertension. The nephrectomy specimen was studied to determine the activity of the juxtaglomerular cells and the concentration of prostaglandins in both ischemic and normal renal tissue. As compared with the normal tissue, the ischemic cortex had an increased number of heavily granulated juxtaglomerular cells. Interstitial fibrosis in the ischemic segment was associated with considerably lower tissue concentration of both prostaglandins A2 and E2 when compared with surrounding normal medulla. These findings appear to correlate well with present theories that consider renal ischemia to be associated with decreased production or response of prostaglandins that normally would counteract the effects of angiotensin.


Prostatic mycosis: nonsurgical diagnosis and management. Mycotic prostatitis is usually found incidentally at autopsy or in surgically removed prostates. A seventy-nine-year-old man with mycotic prostatitis presented with prostatism. A non-operative diagnosis was established by needle biopsy of the prostate. Symptoms of prostatism improved with medical management. A review of prostatic mycosis is presented.


When is biopsy necessary in pelvic lipomatosis? Pelvic lipomatosis has a classic roentgen triad which includes (1) pelvic radiolucency, (2) elevation of an intact rectosigmoid, and (3) elevation of the urinary bladder. This triad, in the absence of other abnormal clinical and roentgen findings, is pathognomonic of pelvic lipomatosis, and surgical biopsy is not necessary to confirm the diagnosis.


Computed tomography of gas-filled bladder: method of staging bladder neoplasms. Current methods of staging bladder carcinoma have many disadvantages. A new method of staging bladder tumors employing computed tomography (CT) of the gas-filled bladder is presented. Representative cases are demonstrated. Direct visualization of the extent of the tumor and adjacent soft tissue structures is possible. CT scanning of the gas-filled bladder is a promising new method for staging bladder tumors and following their response to therapy.


Source of diagnostic pitfalls in renal sonography. In the evaluation of 116 renal masses 91 (80%) were interpreted as cystic and 25 (20%) as solid. Additional evaluation by arteriography and finally surgery showed that 3 of the 25 initially believed to be solid proved to be cystic. These three renal masses with internal echoes on ultrasound were found at surgery to be either collections of contiguous cysts or loculated cysts with calcification. These conditions are believed to represent a source of diagnostic pitfalls in renal sonography.


Fluorosis in dairy cattle.

Fluorosis in dairy cattle. The investigation of a high incidence of arthritis in 21 dairy herds disclosed elevated fluorine levels in bone samples. In every herd except one, where herbage and water was contaminated by industrial fall-out, the main source of the fluorine was from mineral supplements; In a few herds, purchased cake or grain balancers contributed to the abnormal levels. Over 100 cows with arthritis had fluroine levels in the bone of between 2000 and 8000 ppm, or were in herds whose diet contained excess fluorine. Characteristic tooth lesions often confirmed the link between arthritis and fluorosis. Sixteen out of 31 samples of mineral supplement contained dangerous levels of fluorine (3000 to 13000 ppm). Grain balancers contained up to 400 ppm F, and dairy cake had levels as high as 140 ppm F. There was a statistical correlation between a high incidence of damage to peri-articular structures, resulting in debility and loss of production, and elevated bone fluorine.


Reduction of uterine prolapse in a sow by laparotomy. In the past, total uterine prolapse in the sow has been regarded as a grave condition because manipulative reposition through the vulva and vagina is extremely difficult, if not impossible, and amputation is merely a salvage procedure with a mortality rate approaching 100 percent. Laparotomy as a means of facilitating reduction of the prolapse in the sow appears to have been overlooked although it is a standard procedure in dogs and cats. This report describes a case of uterine prolapse in a sow successfully treated by laparotomy.


Globidium leuckarti infection in a horse with diarrhoea. The history, clinical signs and post mortem findings in a case of Globidium leuckarti infection in a horse with chronic diarrhoea are described. The limited literature concerning this infection is reviewed, with particular reference to pathogenicity.


Degenerative myopathy in housed yearling bulls. In an outbreak of a degenerative myopathy six animals from a group of 20 intensively reared yearling bulls were affected. With one exception there was no history of stress or unaccustomed exercise. The diet was found to be deficient in vitamin E and selenium and it is thought that the rapid growth rate of the bulls concurrent with a continuing myodegeneration was sufficient to precipitate clinical disease.


A Canadian commercial ovum transfer unit. Mr. Bloxham received support from the Harry Steele-Bodger Memorial Fund towards the expenses of working at the Medical School of the University of Calgary, Alberta, Canada, where he was able to continue his researches on early implantation of mammalian blastocysts. He also took the opportunity to visit the commercial ovum transfer unit near the University of Calgary and has provided the following impressions of that part of his stay in Canada.


Proficiency testing in agriculture.

Proficiency testing in agriculture. The development and organisation of proficiency testing in agriculture in England and Wales is described. The National Proficiency Tests Council, which was established as an independent examining body in 1971, is responsible for administering the proficiency testing scheme at a national level. On passing a category based proficiency test an agricultural worker may apply for a craftsman's certificate and is then entitled to a wages premium under the Agricultural Wages Board's Wages Structure Scheme. The development and format of a series of new category based tests for livestock production, which were introduced in January 1976, is outlined.


Slaughterhouse condemnations for hind leg disease in cattle. Hindlimb condemnations occurred in 0-11 per cent (194/173,580) of all cattle at a large Scottish slaughterhouse over a 22-month period. Cows and bulls were more frequently involved than steers or heifers. Gross pathology, studied in 42 cattle (21 per cent of the total condemned), revealed osteoarthritis of the stifle and hip respectively in 19 and 16 cases. The traumatic lesions included meniscal damage, anterior and other ligamentous rupture. The UK loss from such condemnation is estimated at over pounds200,000 in January 1977.


A field study of mortality in pheasant chicks. A survey of the causes of mortality in four pheasant rearing units in Norfolk showed that although specific pathogens were found in some birds they were not associated with a significant number of losses.


The fate of type 7 adenovirions in lysosomes of HeLa cells. Properties of type 7 adenovirions in lysosomes of HeLa cells were studied 12 hr postinfection. Viral particles were transferred to the lysosomes very quickly after initiation of penetration, i.e., after 10 min of incubation at 37 degrees. No morphological modification of the virion was detected for 6 hr postinfection. However, by 12 hr postinfection, the virion was no longer recognizable. Most of the virus remained infectious for 2 hr, whereas after 12 hr the infectivity was abolished. Soon after the adsorption of the virus on the cell membrane at 4 degrees, the viral DNA in the virion became sensitive to pancreatic DNase, and this sensitivity increased during the first 2 hr of incubation at 37 degrees. This result suggests that some modification in the architecture of the virion occurred before transfer to the lysosomes. The adenovirus 7 (Ad 7) DNA extracted from the lysosomes appeared intact for 6 hr postinfection and was found to cosediment at 34 S with the Ad 2 DNA marker. Comparable activities of free acid phosphatase were found in lysosomes isolated from uninfected control cells and from infected cells. In in vitro experiments, lysosomal acid DNase and pancreatic DNase were shown to degrade Ad 7 DNA at similar rates; however, in vivo, intralysosomal Ad 7 DNA was only partially sensitive to lysosomal DNase.


A comparison of different methods of screening blood donations for HBsAg. In a retrospective comparison between countermigration immunoelectrophoresis (CIEP) and reverse passive haemagglutination (RPHA) for screening 260,500 blood donations, the latter's 10-fold increase in sensitivity resulted in 36% more HBsAg detections. In a prospective comparison between RPHA and radioimmunoassay (RIA) the latter's 40-fold increase in sensitivity over RPHA resulted in 11% more detections than RPHA in 27,094 new donors. One in 500 new donors was HBsAg-positive by RPHA, compared with 1 in 11,000 established donors who had donated and been tested previously. Acute hepatitis B infections, though uncommon, accounted for a greater proportion of the HBsAg-positive found in "established" rather than new donors. Reported post-transfusion hepatitis cases have declined following the introduction of screening tests in 1971. The feasibility of RIA testing at a transfusion centre supplied simply with the two basic RIA reagents has been demonstrated.


Genetic control of immune responsiveness in man. Interest in immunogenetics originated from two streams: (a) histocompatibility in mouse and man, and (b) inheritance of specific immune responses in the guinea pig and mouse. In the mouse, there are genes associated with the major histocompatibility complex (MHC) which (i) code for antigens determining allograft responses and mixed lymphocyte reactions, (ii) control responses to certain antigens (Ir genes), and (iii) code for cell-surface antigens which elicit specific antisera (anti-Ia). In man, there is genetic control, in part X-linked, over levels of immunoglobulins and immunoglobulin classes. Evidence for MHC-linked genetic control is derived from immune responses to (i) micro-organisms, (ii) pollen antigens, (iii) food antigens, (iv) vaccines, (v) inocuous test antigens, and (vi) autoantigens. Some evidence exists for allotype-linked genetic control. Practical aspects concern influences of the MHC on susceptibility to disease, within individuals and populations.


Haemostasis disorders in open heart surgery with extracorporeal circulation. Importance of the platelet function and the heparin neutralization. The main haemostasis changes observed in a screening study performed in 40 patients who underwent an open heart surgery with extracorporeal circulation (ECC) are: a significant drop in platelet count from the onset of the ECC to the third postoperative day, a decrease of platelet retention and aggregation during ECC with an 8-day persistently increased heparin-neutralizing activity in plasma but not in serum, a moderate decrease of plasma factors I, II, VII-X, X and XIII and a more important drop in factor V which disappears 24 h after ECC, a transitory increase of fibrinolysis during ECC and the lack of FDP elevation in the serum. These disorders require a very good neutralization of the heparin used during ECC. The ratio protamine/heparin can be established by a titration clotting time test. Protamine chloride seems to be more efficacious and to act more quickly than protamine sulfate for the neutralization. An overload in protamine can enhance the hemostatic, biological and clinical disorders. The preventive administration of platelet concentrate immediately after the heparin neutralization contributes to reduce the bleeding disorders related to the quantitative and qualitative platelet defects.


Properdin factor B (Bf) polymorphism in Norway. Bf phenotype distribution and Bf allele frequencies in samples of the Norwegian population and the Lappish minority of Norway are presented. Bfs in Norwegians was found to be 0.817, while it was 0.888 in Lapps. The difference is statistically significant. Possible explanations of this difference are discussed. It is noted that Bf allele frequencies of Norwegians are similar to those of Germans, while differing from frequencies found in US whites.


Two Japanese families with Pk members.

Two Japanese families with Pk members. Two individuals with the blood group Pk found in the Japanese population are reported, as well as the results of family studies. A second Pk sibling was found in the second family. Red cells from four members of the first family, who presumably were heterozygous for the gene responsible for Pk, showed no evidence of having a weaker P antigen. One of the two propositi gave birth to a baby, whose red cells gave a doubtful reaction in the direct antiglobulin test, but who showed neither clinical nor hematological signs of hemolytic disease of the newborn.


[The laboratory diagnosis of amoebic infections in man (author's transl)]. The rapid progress made in both theoretical and practical fields in laboratory medicine, in general, and in microbiological diagnostic procedures, in particular, have also led to a significant enlargement of, and improvement in laboratory diagnosis of amoebic infections in man. In all intestinal infections with Entamoeba histolytica the demonstration of the parasite is absolutely essential, but is facilitated nowadays by the great improvement in technical conditions. Immunodiagnostic methods have become of great importance in all cases of extraintestinal manifestation of parasite. By the combined application of several serological tests (latex test + indirect haemagglutination test or latex test + indirect immunofluorescence test) practically 100% of cases of extraintestinal amoebiasis can be detected. When using all available optimum methods of laboratory diagnosis today, it is neither possible to overlook an infection with Entamoeba histolytica nor to make a flase positive diagnosis. Great difficulties are still encountered in the laboratory diagnosis of primary meningoencephalitis caused by free-living amoebae of the Limax group owing to the dramatic course of the disease. Present and possible future methods are discussed.


[The clinical features of brucellosis in an endemic area (author's transl)]. Brucellosis remains a problem in many rural areas of Greece. A case report is given of 50 patients with brucellosis treated at the regional hospital of an endemic area. Various forms of fever were observed; a raised temperature was universal. Sweating and joint pains were prominent general symptoms. The most common local findings were arthritis, orcheoepididymitis and osteomyelitis. More rarely, rashes, bronchitis, difficulty in micturition and paraesthesiae were found. Routine laboratory investigations were of no diagnostic help, but the serum agglutination reaction according to Wright is diagnostic of brucellosis at high titres. An equally successful therapeutic result was achieved with streptomycin in conjunction with tetracyclines or with the combined preparation of sulphamethoxiazole and trimethoprim.


[Disseminated intravascular coagulation in Reye's syndrome (author's transl)]. A five-month-old infant with Reye's syndrome developed disseminated intravascular coagulation, which was successfully controlled by heparin. A fatal outcome could not, however, be averted. The pathogenetic role of disseminated intravascular coagulation in Reye's syndrome is discussed.


[Studies on mortality in diabetics in a circumscribed region: age and death,  length of diabetes and causes of death]. Studies were carried out in regard to the age at death, duration of diabetes mellitus at the time of death and cause of death in an unselected evaluation of the findings in all 1694 diabetics who died in Erfurt and environs over an 11-year period. The The mean age of the patients at the time of death was 70.6 years, with virtually no difference between the sexes. Only six patients died prior to the age of 40. In accordance with the age structure of diabetics in a circumscribed area, the average survival time was 6.5 years. The interval between the first manifestation of the disease and death was 0 to 4 years in 45% of the patients; only every fifth patient survided for 10 or more years. These results are interpreted as being a reflexion of the frequent incidence of preceding or simultaneously-occuring atherosclerosis in these diabetics. Cardiovascular incidents affecting, above all, the coronary and cerebral vessels, account for about 60% of the deaths. Differences between these results and other statistical analyses can be explained on the basis of the unselective nature of the case material in the present study which was, moreover, collected in a defined region over a definite period of time.


[Myocardial performance during therapeutic starvation in obese subjects]. The effect was studied of therapeutic total starvation of two weeks' duration on myocardial performance in 12 obeses patients. Half of these subjects were trained for 10 minutes daily on a bicycle ergometer, whilst the other half had no training. After two weeks of total fasting no significant changes were observed either inter- or intracollectively with regard to systolic time intervals, ejection fraction and the index of myocardial contractility, nor in respect to serum electrolytes. Physical training had no influence on the systolic time intervals and the other noninvasive parameters of left ventricular performance. The inclusion of previous data obtained in a similar investigation enabled the establishment of a correlation between the serum potassium level and the ejection franction.


[The value of the blood xylose test in children with the malabsorption syndrome (author's transl)]. Blood xylose levels were studied 30, 60 and 90 minutes after oral administration of D-xylose in 121 patients aged 2 months to 12 years with symptoms of malabsorption. The results show that the 60-minute test aline is sufficiently accurate and the dose of 15g xylose/m2 surface area seems perferable to a uniform dosage of 5g xylose. Reference values of blood xylose were determined in children with normal intestinal mucosa and prove a significant difference between babies and elder children. Comparison between the results of the xylose test in normal children and in different conditions of intestinal mucosa showed that the one-hour blood xylose test is of little value in the selection of cases requiring primary diagnostic intestinal biopsy in children with malabsorption. This test, however, might be valuable in the control of patients with diagnosed coeliac disease and as a screening test for other members of those families.


[The extent to which ethanol absorption is influenced by an alteration of gastric emptying (author's transl)]. Gastric emptying of a 500ml liquid test meal containing 6.2% ethanol and phenol red was studied on two consecutive days in a group of persons without gastroduodenal disease. On the first day an aqueous ethanol solution was administered, whilst on the second day a solution of ethanol in 10% glucose was given in order to delay gastric emptying. Twenty minutes after introduction of the test meal by tube, the gastric contents  were recovered by aspiration and a gastroscopic examination was performed. Simultaneously, the amount of ethanol absorbed by the stomach, as well as the ethanol level in the peripheral venous blood was determined over a period of 10 to 90 minutes. Considerable individual variations were observed both in respect to the gastric emptying rate and the level of blood ethanol during the absorptive phase. The absorption rate and blood ethanol curvetion rate and blood ethanol during the absorptive phase. The absorption rate and blood ethanol curve were markedly reduced as a result of a delay in gastric emptying. The tolerance to alcohol may be greatly influenced by the rate of gastric emptying and, consequently, by the composition of alcholic beverages, drinking habits, and food intake.


[A comparative study of patients following myocardial infarction assessed by the freiburger personality inventory (author's transl)]. The relationship between coronary disease and psychological factors is generally accepted. Numerous psychiatric studies have shown that there are typical basic personality features which predispose to heart disease. A personality inventory - the Freiburger Persönlichkeitsinventar (FPI) - was applied to a group of patients attending the Cardiology Clinic of the University of Vienna for a follow-up control examination after a heart attack. The results were compared with those of a control group (taken from the control population of the FPI). With respect to one personality dimension of the FPI, the so-called,,Nervositätsskala" (nervousness scale), significant differences were observed between the two groups. This scale includes so-called ,,psychosomatic" distrubances and disorders. According to these results,patients with coronary disease were more likely to experience such ,,psychosomatic distrubances" (as far as could be measured by this dimension of the FPI) than members of the control group. A comparison of patients graded according to the physical stamina level showed that those with a greatly-reduced work capacity as a consequence of myocardial infarction had a significantly higher score than patients whose work capacity was impaired to a lesser extent. This study introduces a new aspect in the relationship between coronary disease and personality dimensions.


[Relationship between the skin test and the specific IgE (radio-allergo-sorbens test) in the diagnosis of inhalative allergies]. Immediate-type reactions such as asthma, pollinosis and several forms of urticaria can be regarded as type I reactions according to Coombs and Gell. Primary these diseases are caused by the immune globulin E. As skin testing is accompanied by numerous failors, there is a real possibility in increasing the diagnostic relevance by measurement of the specific IgE in serum (Radio-Allergo-Sorbens-Test = RAST; Phadebas-RAST -- Pharmacia Uppsala). There are often found divergent results and therefore this investigation was started. 1357 RAST-results (530 patients) were compared with skin tests in order to investigate the concordance of the two test-methods. The statistical analysis is performed wit "4-square-Chi2". Very good correspondence could be calculated for the pollens of Festuca elatior, Poa pratensis, horse-epithelium and housedustmite (1 0/00O significancy). 1 0/0 significancy was found for catepithelium and 5 0/0 for Birch-pollen. The advantages and the disadventages of RAST are discussed.


[The Rothmund syndrome. A contribution on congenital poikilodermas]. The death of the last patient of the original cases of Rothmund is reported who died in the age of 92 years. The Rothmund-Syndrome is discussed as a clinically discernible entity in the group of congenital poikilodermias. A review of the literature is given.


Circulating IgE levels in a normal human population. Circulating IgE levels were measured in a non-selected normal population using a solid phase radioimmunoassay (Phadebas Radioimmunosorbenttest "RIST"). The population was divided according to age into 6 subpopulations. Both the main and the subpopulation showed multimodal distributions with 3 maxima of their IgE levels and not a Gaussian distribution. According to the maxima, the multimodal distribution was divided into 3 groups designated AA, Aa and aa. The IgE geometric mean in each group differs statistically significant (p less than 0.01). The proportions of individuals in each group agreed with the theoretical frequencies derived from the Hardy-Weinberg law and with frequencies for atopic (a) and non-atopic (A) alleles (0.152 and 0.846, respectively), as calculated from clinical studies by WIENER et al. (1). After exclusion of Aa and aa individuals from the population the distribution was shown to be normal. The IgE geometric mean in the "net" main population was found to be 33 U/ml. This value is slightly higher than those of recent studies on IgE levels. The mean level of IgE in the different age-groups did not vary significantly from that of the main population although a tendency for a decrease of IgE levels with increasing age was noticeable.


Ir gene control of carrier recognition II. Unexpected low immunogenicity of guinea pig insulin. The immune response of mice to guinea pig insulin (as well as to insulins from other species) is controlled by immune response genes. The immunogenicity of guinea pig insulin is generally much lower than that of bovine insulin, through there are 14 sequence differences between mouse insulin and guinea pig insulin as compared to 5 sequence differences between mouse insulin and bovine insulin, respectively. The low immunogenicity of guinea pig insulin is indicated by a low frequency of responder strains and the requirement for high antigen doses for immunisation. Guinea pig and bovine insulin do not cross-react at the antibody level, but there seems to be some cross-recognition at the carrier level, as indicated by the capability of guinea pig insulin primed spleen cells to provide help for the pig insulin carrier in cooperative cell transfer.


No direct activation of fluid phase C3 by lymphokines. Supernatants of stimulated (PPD or Con A) or unstimulated guinea pig lymph node cell cultures in serum-free medium were fractionated on Sephadex G 75. The fractions were tested for C3-consuming activities in a hemolytical assay. No C3 consumption could be detected in any fraction (MW range 80,000 to 10,000). The same result was obtained by extending the fractionation range using Sephadex G 200. A lytic activity with a molecular weight of appr. 225,000 which lysed EAC 14 cells in the presence of C2, 5, 6, 7, 8, 9 was attributed to serum C3 contaminating the cultures. It was determined that C3 is not produced in significant amounts by lymphocyte cultures.


[Exercise-induced tachyarrhythmic syncopes with sinus bradycardia and normal QT-interval at rest (author's transl)]. Two children with exercise-induced syncopes are described. There was no evidence for congenital or acquired cardiac defects, cardiomyopathy or myocarditis in either of them. Both had sinus bradycardia and a consistently normal QT-interval at rest. In both, exercise induced regularly a multiform ventricular tachycardia, additionally in one on occasion a bidirectional, in the other a supraventricular tachycardia. Beta receptor blocking agents prevented tachyarrhythmias in both. Under treatment with beta receptor blocking agents, one child remained without syncopes, the other died suddenly. These cases underline the possiblility that exercise-induced syncopes may be caused by tachyarrhythmias even if the QT-interval of the resting Ecg is normal. In suspicious cases an exercise-Ecg is indicated.


[The influence of antiarrhythmic drugs on the exercise-ecg (author's transl)]. The influence of five most common antiarrhythmic drugs on exercise-electrocadiogram was investigated: prajmaliumbitartrat, quinidinbisulfate, diphenylhydantoine, propranolol, and verapamil. All exercise-tests were performed in eight healthy males. During exercise and the subsequent resting period, the changes in the following parameters were analysed: blood pressure, heart rate, P-Q-time, Q-T-time, and the formal course of the Ecg as well as individual reactions. None of the drugs produced a pathological ECG. As for the analysed parameters, diphenylhydantoine was entirely neutral, whereas propranolol caused the most significant changes. Propranolol lowered heart rate by more than 20% and blood pressure by 10%. Verapamil had a less pronounced effect on diastolic blood pressure and heart rate. Prajmaliumbitartrat and quinidine had no definite effect during exercise and resting period.


[One year experiences with a new atrial lead (j-version) in 53 patients (author's transl)]. The new atrial leads (J-version) of type Medtronic 6991, of which we implanted endocardially a total of 53 between April 1975 and May 1976, are characterized by properties, as, up to now, were exclusively to be seen in the so-called flange electrodes of ventricular position. 1. The tined J-leads were easily to introduce and required only an average of 5 minutes to position into the right appendage. 2. Moreover, these atrial leads guaranteed an anatomic stable anchorage with a dislodgement ratio of less than 6% (3 of 53). 3. Additionally, the action voltages sensed the J-shaped electrodes showed themselves averaging 5.2 mV of very high amplitude. Up to this time comparable results could not be achieved neither by other atrial leads nor techniques of their emplacement. The intraatrial voltage thresholds exceeded, as described before, the intraventricular ones by two to three times. In spite of this, no exit block was seen in 34 cases with atrial pacing systems, not even during an observation time of maximal 13 months. Therefore, the tined J-leads fulfill all requirements of a suitable atrial electrode.


[Distribution of scattered X-ray around a U stand in cardiology (author's transl)]. To estimate the stray radiation exposure which will be delivered to the doctor during a coronary angiography we made phantom measurements. The dependence of the stray radiation from the projection angle as well as from the tube tension for fluoroscopy and cinematography was measured in the three space coordinates. Out of these results the exposure per examination can be estimated for each place and hight of the doctor. As an example a determination of exposure under practical condition as well as the means of radiation protection are discussed.


[Diagnosis and quantiation of left to right shunts using radioisotopes]. After intravenous injection of 99mTcO-4 into the femoral vein the count-rate vs. time curve of a lung field is recorded and analysed (Ohio Nuclear Camera ON 110, pdp 11 computer GAMMA 11, hp 5407 computer). Using a modified gamma function area-ratio technique, the size of the left to right shunts is calculated and compared with cardiac catheter results (128 patients). The localisation of the left to right shunt (ASD or VSD) is possible, if the shunt size rises over 30%. The method may be an alternative to oximetry and conventional dilution techniques.


[Correction of tetralogy of Fallot and its influence to oxygen transport and lung changes. Part I. Oxygen transport (author's transl)]. 30 patients with tetralogy of Fallot were examined before and after correction. 10 of whom had previous procedures including 13 Blalock-Taussig shunts, 1 Cooley anastomosis and 6 pulmonary valvulotomies (Brock) with a dilator. Hemoglobin and blood gases were measured in 22 patients pre- and postoperatively on the 7th respectively 14th day and finally after 12 months. In 8 children the concentration of 2,3-DPG was accessed (pre-, postoperatively, immediately in ICU, on the 1st, 7th, 14th day and after 21 months). Hypoxia of various degrees was found at any time of the investigation, verified by a low venous oxygen saturation, high 2,3-DPG concentration and an erythrocytosis. The 2,3-DPG concentration was always elevated (preoperatively 18.2 +/- 1.8 muMol/g Hb; postoperatively 1st till 14th day 19.0 +/- 2.2; after 21 months 16.3 +/- 1.2 muMol/g Hb). Preoperatively hypoxia was correlated to the degree of the heart disease expressed by the hight of the Hb-concentration. In contrary after the correction signs of hypoxia (decreased venous oxygen saturation, increased 2,3 DPG-concentration) appeared with a low Hb as found in patients with anemia. The long term check-ups are indicative for slight cardiac residual disorders as there are hypoxic myocardial damage, residual gradients over the right ventricular outlet, reopened VSD's, and ventriculotomy scar tissue. Though the elevated 2,3-DPG-concentration and the consecutive rightward shift of the oxygen saturation curve obviously compensate these cardiac handi-caps as the excellent physical condition of the children shows.


[Correction of tetralogy of Fallot and its influence to oxygen transport and lung changes. Part II: Lung changes (author's transl)]. 22 children got lung scans 3 weeks respectively 12 months after the correction of a tetralogy of Fallot. In 18 cases previous operations were done: 12 times a Blalock-Taussig shunt and 6 times a Brock procedure. For the scan 20-70 mu diameter albumin macrospheres were used, which were labeled with Technetium 99m. The following pathologicla lung changes were seen: 1. Loss of perfusion, typical after Blalock-Taussig shunt procedure; these findings were always on the left side, the site of the anastomosis. 2. Anomalous flow distrubution (=more spheres in the upper than in the lower lobe) in the left lung; these changes were also caused by the Blalock-Taussing shunts, but disappeared within the one year follow-up after the correction. 3. Intrapulmonary rigt-left shunts (according to the dilatation of the alveolar capillaries). These decreased within one year from 9.9+/-1.3 to 4.6+/-0.9%.


[Obstructive thrombosis of the pulmonary trunk: a rare but dangerous late complication of the banding procedure (author's transl)]. This paper presents three cases of obstructive thrombosis of the pulmonary trunk following banding procedure. The complication was lethal for all our patients as well as for the three others reported in the literature. Considering the typical course of the complication, the relatively late onset of cyanosis or its increase in heart diseases with primary right-to-left shunt, the X-ray pictures of the thorax depicting a drastic fall of pulmonary flow, and most of all the angio-cardiographic clues for the presence of an intravasal thrombus, it appears, that the correct diagnosis could be made early enough to permit life saving surgery. The anatomical-pathological findings and the results of histological examination are reported for all three patients.


[Dysplasia and pseudodysplasia of the infantile hip joint (author's transl)]. The natural course of "dysplasia" of the hip diagnosed between the age of two and ten months was followed in 47 children. If the dysplasia diagnosed by radiographs was not combined with a clinical instability of the hip dislocation never occurred although no therapy- except abduction exercise - was given. The radiological signs of dysplasia regularly disappear after the child has learned to walk. Three different kinds of dysplasia are described. Dysplasia may be a residual sign of neonatal instability which became stable with or without treatment. Pseudodysplasia is the effect of faulty X-ray technique or X-ray interpretation. In dysplasia with no known instability in the history it may be the residual sign of a neonatal instability which was not diagnosed or it may be a variation of development of the hip joint during the first year of life. Since dysplasia without clinical instability does not progress and will never end with a dislocation there is no indication for therapeutic measures in a stable hip with radiological signs of dysplasia during the first year of life. The treatment of unstable hips diagnosed between the third and the twelfth month of life may be dangerous due to epiphyseal damage by immobilisation.


[The effect of correction of the varus or valgus deformity of the knee (author's transl)]. The distribution of pressure force (load) on the tibia-plateau in a normal knee as well as varus or valgus deformity has been measured electronically and also studied by photoelastic experiments. The translocation of it by changing the knee axis has been demonstrated. The significance of the pressure force causing monocompartmental gonarthritis has been shown. The causal therapy is a correction of the valgus or varus deformity. The effect of this operation lies in the biomechanical discharge of the damaged compartment.


[Skin-thermography with fluid crystals in orthopedics and sport-medicine (author's transl)]. Thermography with fluid crystals is an effective diagnostic aid for the differentiation between bacterial and non-bacterial inflammation i.e. for the differential diagnosis between joint damage due to overloading and irritative arthrosis. Thermography enables us to assess severity and extent of the condition and to prove the success of treatment.


[Investigations of the final settling of implanted hip-joints by use of 85Sr (author's transl)]. Up to 8 years after replacement of hip-joints in 26 patients the strontium-85-uptake over both thighs was followed scintimetrically. In contrary to normal healing of fractures, this uptake became normal on the side of the operation not earlier than the end of the 2nd year after operation. One cause of this delay could be the continuing liberation of monomeres of polymethyl-methacrylates at the bed of the implant. It is important to consider the clinical signs on the opposite side, since there a raised strontium-85-uptake could produce a "pseudo"-diminished ratio between the two sides.


[Dupuytren's contracture (author's transl)]. The previous treatment, and the open palm and finger technique as described by MacCash and Borden were reviewed. The experience of the author with a case of bilateral recurrent Dupuytren's contracture with severe shrinkage of the skin and an almost total lack of cooperation on the patient's side is added. It is felt that in spite of a crust formation, which seemed at first to interfere with as excellent a result as reported by Borden, the open skin technique encourages further trials, especially in cases with severe shrinkage of the skin combined with psychic disorders, making the cooperation of the patient poor or impossible.


[Neonatal paresis of the radial nerve due to benign angioleiomyoma (author's transl)]. Report on a newborn with left-sided radial paresis due to a solitary angioleiomyoma in the lateral distal third of the upper arm. The literature does not disclose that this rare benign tumor can produce radial palsy. A palpable soft-part tumor in the new born suggests malignancy. The tumor including the atrophic radial nerve was radically excised. When histology proved it to be benign, a nerve graft with the sural nerve was carried out. After 6 months of electrical and physiotherapeutic treatment partial radial function had returned. In differential diagnosis of radial palsy of the neonate, birthtrauma is a likely cause. Tumors as a cause are rare and are found almost exclusively in adults, due to lipoma, neuroma or ganglia. In the neonate the socalled "idiopathic" radial paresis does not occur and in adults is usually due to the "supinator syndrome".


[To discharge one compartment of the knee without a varisation or valgisation osteotomy in the knee region (author's transl)]. The correction of a varus or valgus deformity around the knee joint as prophylaxis or as a therapy of monocompartmental osteoarthritis of the knee is limited in its indication and of the amount of correction. The experiments have shown a possibility of discharging one compartment by a translocation of the knee to lateral or medial side after a supracondylar osteotomy. The method and its indication have been discussed.


[Diagnostic and therapeutic value of rachitomy (author's transl)]. Between October 1968-1973, 16 rachitomies were carried out in 14 patients at the Univ. of Orthop. Hospital Balgrist in Zurich. The casuistic indicates the necessity for diagnostic surgery, particularly because tuberculous spondylitis cannot be differentiated radiologically from other nonspecific processes. Rachitomy together with histologic and bacteriologic examinations of precisely removed specimens makes a dependable diagnosis possible and permits therapeutic accommodation of the procedures to the individual case as 15 out of 16 of our cases indicate. The direct therapeutic possibilities and the diagnostic accuracy document, in our opinion, the superiority of rachitomy over exploratory puncture. Following-up control examinations up to four years following the operation confirm the success of surgery as evaluated by the subjective freedom of complaints and satisfactory results.


[Hyperlipoproteinemia, a possible cause of osteochondrosis dissecans? (author's transl)]. Report on 5 cases of osteochondrosis dissecans of the knee joint in patients with various types of disturbance of fat-metabolism. The literature, diagnosis and medical reporting on such cases are discussed.


[Radiological diagnosis of the narrow lumbar spinal canal syndrome (author's transl)]. 31 myelograms of patients with the syndrome of lumbar spinal canal constriction were analysed. Two forms can be distinguished - a primary form with hypoplasia of the lumbar section of the spinal canal, and a secondary form with circumscribed constriction through olisthy or spondylosis deformans. The characteristics symptoms of the primary form (n = 21) are: difficult lumbar puncture, the ascent of the contrast medium in the thoracic section of the vertebral canal, multiple protrusions of the intervertebral discs, reduced sagittal diameter of the dural area which is marked by additional signs of spondylosis. In this connection, the alterations were so characteristic that it was possible to diagnose the condition even before the operation. The myelogram with water-soluble contrast-medium is considered to be markedly superior to other methods of radiological examination.


[Clinical signs of the narrow lumbar spinal canal (author's transl)]. The syndrom of the narrow spinal canal is today to be separated from other lumbar diseases by its nosological entity. It starts slowly and becomes manifest in middle and advanced age. Claudicatio intermittens is the characteristic symptom of this disease the aetiology of which is multifactory. Most patients show in the myelogram konstitutionell alterations combined with localized or generalized degenerative narrowing of the spinal canal. The clinical findings correspond to the lumbar segments affected. With localized narrowing the differential diagnosis of disc herniation is generally possible by myelography. This is of therapeutic consequence because in this cases a removal of the disc is unnecessary.


Intraosseous ganglion (author's transl). The intraosseous ganglion must be always included in the differential diagnosis of cystic epiphysial bone lesions, which are localised in the vicinity of a joint, especially since this bone disease can be succesfully operated on. The preoperative diagnosis can be established with the help of conventional and tomographic x-rays examination. A communicating chanel, which is recognizable in tomographic cuts as a lucent line between the ganglion and a joint, is a pathognomic finding. The interpretation of the radiological symptoms can be difficult in those cases in which the lesions are not yet well developed or in which concomitant degenerative joint changes are present.


[The oto-palato-digital syndrome (Taybi) (author's transl)]. Two girls with typical clinical and radiological signs of the oto-palato-digital (OPD) syndrome are described. The grade of severity attained that usually seen only in boys. The patients are thought to be homozygotes for an autosomal recessive gene, not heterozygote carriers.


[Sawing and welding with ultrasonics. Experimental investigation to test the applicability of an apparatus for sawing and welding bone tissue with ultrasonics in orthopedics (author's transl)]. An experimental investigation of a procedure for sawing and welding of bone tissue with ultrasonics in the area of orthopedics was reported. The welding of bone with ultrasonic waves, bone meal and a plastic adhesive did not product satisfactory results in terms of stability and tissue reaction. The applicability of the ultrasonic saw is limited by the thickness of the bone on which the osteotomy is to be performed. We saw no advantages over against the oscillating saws which were available to us. In our opinion, an indication for the application of the ultrasonic apparatus could be the removal of inflammatory, tumerous or necrotic bone processes.


[Critical observations and the loads on femoral head replacement and the femoral bone calculated for a support in 3 points (author's transl)]. In their attempts at calculation of forces acting on a femoral head implant and the forces transmitted to the bone, some authors have assumed support of the implant in a few distinct points. It can be shown, however, that forces thus calculated very much depend on the direction and point of action of the supporting forces assumed arbitrarrily. The suggestion to implant a prosthesis in a "valgus" position cannot be justified by results obtained by the method in question. The change in the resultant force at the hip joint due to positioning in "varus" or "valgus" has not been taken into account by previous authors. In the valgus position of the femoral head prosthesis the resultant hip force is up to 33% greater than that in a "varus" position.


[Clinical and radiological aspects of dysplasia of the hip. 4th report: Radiation exposure in the early diagnosis during the first three months (Volume-dose) (author's transl)]. Calculations of the relative volume-dose for 1 and 4-month-old infants yielded a ratio of 1:2. Measurements in the phantom and newborns yielded a surface incidence dose for newborns of 1/400 of the annual environmental radiation surface incidence dose (with optimal radiographic technique). The radiation risk of the pelviogram for newborns and during the first three month period can be justified. Indicated radiographic examination for diagnostic clarification of dysplasia of the hip should not be omitted during the first three months period.


[Analysis of the metaplastic disturbances in dislocated hip joints in the orthopedic hospital of the Medical Academy in Magdeburg (author's transl)]. One of the most frequent and prognostically unfavorable complications occurring with therapy for dislocated hip joints is a metaplastic disturbance at the coxal end of the femur. We undertook a differentiation between metaplastic disturbances in necrosis of the center of the femur head and restorative disturbances. In the evaluated period between 1964 and 1974, 1298 children (2236 treated hips) were examined. Between 1965 and 1968 when the old, classical therapy for dislocation was employed, we established a metaplastic disturbances rate of 20%. The rate for necrosis of the femur head was 9% and the restorative disturbance rate was 11%. The metaplastic disturbance rate was lowered to 5.65% as a result of the modern, functional, early therapy instituted between 1969 to 1974. Here we established a rate of necrosis for the femur head of 0.45% and a restorative disturbance rate of 5.2%. This falls within the range established by Huber (5.5%) and Unger (6.06%). The possibility of an endochondral dysostosis must always be considered when bilateral restorative disturbances are present. We observed that restorative disturbances always occurred more frequently in connection with dysplasias. We fell that the cause is the endogenous tendency toward restorative disturbances of the center of the femur head. With early therapy, the possibility of a dislocation can, however, be avoided. In contrast to Kiltz, our later results and follow-up examinations indicate a poorer prognosis for necroses of the center of the femur head.


Renal serendipity in whole body scintiscan. The importance in nuclear medicine procedures of critical examination of all of the data, beyond the problem in question, is emphasized. These case reports exemplify such situations. Renal pathology was diagnosed serendipitously while performing skeletal screening in patients in whom renal diseases had not been thought of.


Utilization of Virginia's hospital emergency departments. When compared with the results of a statewide study conducted in 1968, these data indicate that the utilization of Virginia's emergency departments has increased substantially both in absolute numbers and on a per capita basis. Consistent with the national pattern, the results of this study suggest that a large proportion of patients who utilize the hospital emergency department are actually seeking care for non-acute conditions. Thus the hospital emergency department and its staff are confronted with the complex and often contradictory task of responding appropriately to growing demands for primary medical care while, concurrently, trying to improve the level of care for patients with acute illness or injuries. The development of workable ways to resolve this dilemma and still ensure that the public has ready access to appropriate medical care at a reasonable cost is one of the major challenges in the health industry today.


[Serum immunoglobulin patterns in rheumatoid arthritis]. Immunoglobulins were estimated quantitatively in sera from patients with rheumatoid arthritis. According to the significantly increased immunoglobulin class(es), in RA patients as compared to normals the following immunoglobulin patterns were registered: IgG pattern, IgM pattern, IgA pattern, IgG-IgM-IgA pattern, IgG-IgM pattern and IgG-IgA pattern. The IgG-, IgA- and IgG-IgM-IgA patterns were predominantly found in sera from patients with seropositive RA. A positive correlation was found between other inflammatory parameters and high titered rheumatoid factor of the IgG-IgM-IgA-, IgG-IgA- and IgM patterns. C-reactive proteins were increased more frequently in seropositive cases and correlated quantitatively with the IgG-IgA-, IgG-IgM-, IgG-IgM-IgA and IgA patterns. Maximal erythrocyte sedimentation rates were accompanied with the IgG-IgA-, IgG-IgM-IgA- and IgG-IgM pattern. The serum complement components C 3 and C 4 were not decreased in neither seropositive nor seronegative RA. The formation of antiglobulins in hypergammaglobulinemic patients with RA induced by an increased immunoglobulin catabolism is suggested as a possible pathogenetic mechanism.


[Calcium, phosphorus, hydroxyproline and nitrogen in inflammatory joint diseases]. The elimination of calcium, phosphorus, hydroxyproline and nitrogen was studied in 127 patients with inflammatory joint diseases and )6 healthy controls for 4 days. On the third day, 186 mg of calcium was administered intravenously. Provoked hypercalciuria tests were made in 35 males, 116 females with rheumatiod arthritis (RA), 18 males with ankylosing spondylitis (ASp), 8 postinfectious arthritis (PA) and 18 healthy controls (C). In 120 patients comparison was made between the ratios of eliminated P/hydroxyproline, Ca/hydroxyproline and P/Ca with regards to the results obtained in healthy controls. The kinetics of 47Ca were studied in 7 males with ASp and 4 C. The ratios Ca/P in serum and P/Ca in urine were studied in the same patients and compared with 21 C. The results show that the bone symptomatology of PA manifests itself by elimination of elevated amounts of all of the indicators studied, especially phosphorus. In RA there may be considerable oscillations of flow of urine due to the perspiration of patients. RA differs from decompensated coxarthrosis and gonarthrosis in that the patients eliminate significantly less calcium and phosphorus. Corticosteroids stimulate the elimination of hydroxyproline. Younger patients with RA (25-44) show changes compatible with osteoporosis, older females (45-64) display changes similar to those seen in osteomalacia, the oldest female patient (65-84) appear to have insufficient binding capacity for calcium. The hyposthesis is proposed that at the disease onset RA is characterized by an extremely marked syndrome of osteopathy. ASp is characterized by significantly reduced elimination of hydraxyproline, higher metabolic pool of calcium, lower elimination of calcium in urine and faeces and lower accretion to bone.


[Lung function disorders in Sjögren's syndrome]. Pulmonary function tests were performed in 15 patients with Sjögren's Syndrome (SS). All patients presented with rheumatoid arthritis (RA) as well as with sicca syndrome. The mean values of residual volume, compliance and diffusion capacity were found to be abnormal. Vital capacity was abnormal in 40 percent of patients with SS, residual volume in 46 percent, compliance in 60 percent, and diffusion capacity in 66 percent respectively. The lung function was apparently affected more severely in SS than in rheumatoid arthritis. Thus in addition to the well known changes of lung function occuring in rheumatoid arthritis, progressing fibrosis might also contribute to a more extensive impairment of the lung function in SS. Although symptoms of chronic bronchitis and coughs were prevalent in our patients, obstruction was only observed in a comparatively small number.


[Analytical psychosomatics and medicine--self concept and self comprehension]. Psychoanalytic Psychosomatics derive their selfassessement from the fact that they have turned into a recognized speciality in medical science. High rates of epidemiological occurrance of psychogenetic diseases as well as the proofed efficiency of psychoanalytic methods of treatment encourage psychosomati specialists to take care of a great number of diseased, chronically disabled or high-risk persons. The differences to traditional organic medicine are shown up by ennumerating some of the common but rarely considered facts where supply with psychoanalytic-psychosomatic treatment of patients is concerned: All the therapeutic work is here done by the therapist himself. This is the cause for an exceptionally high Doctors'-time-expenditure for each patient. In spite of his psychotherapy is not expensive compared with average costs of other forms of medical treatment. Further topics are: The question of postgraduate training in psychoanalytic psychosomatics, the special patient-doctor reltionship and other special problems arising during psychotherapy in hospital and outpatient work. These problems are discussed in regard to cooperative collegues from other medical disciplines; dealing c.i. with their transference problems to patients they send to psychotherapy.


[Methods and transference in short term psychoanalytic therapy]. The therapist's emotional reactions and attitudes in time-limited short-term therapy are presented. Limitations of time and scope this kind of therapy must be dealt with emotionally by the therapist; emotional reactions and attitudes can be expected to vary according to the therapist's personality structure; schizoid, depressive, compulsive or hysterical. Transference in time-limited short term therapy can be very intense but is easier to indendify. This has implications for countertransference reactions caused by the patient's transference.


[Psychosomatic resort clinic patients].

[Psychosomatic resort clinic patients]. The structure of patients' specific expectations as to their "rehabilitation cure" in a psychosomatic rehabilitation clinic is demonstrated by means of a statistical study over 100 patients. Thereafter a collective of 500 patients of such a clinic is discribed in detail as to symptoms complained, duration of symptoms, prognosis, and psychotherapeutic results. At last, a review is given following up the further development of 247 rehabilitation patients; this review is prooving the effectiveness of group psychotherapy in the treatment of these patients.


[Spontaneous pneumothorax treated with continuous suction drainage (author's transl)]. In a 5-year period 90 patients were treated. In case of a total collapse of the lung we made use of continuous aspiration. 2/3 of all patients with spontaneous pneumothorax recovered. Only in 5 cases a surgical intervention became necessary.


[Gottschalk-Gleser method: verbal content analysis to measure aggressive and anxious affects]. In this article the Gottschalk-Gleser-Method, a content analysis of speech, developed in the United States, is presented for German conditions. The theoretical assumptions, on which the method is based, are entered, the three hostility-scales and the anxiety-scale in the German translation and also the technique how to use th scales are described. For demonstration there are given two scored samples. Besides it is pointed out by testing the interraterreliability between Gottschalk and two German raters, that the method is adaptable to the German language. It could also be shown, that values of American normal population are similar to the values of a German normal population.


[Blood traumatization after heart valve replacement (author's transl)]. Blood traumatization after heart valve reconstruction or replacement was checked in 47 patients. Among the types of prostheses tested the Beall-valve caused the highest subclinical hemolysis, the Björk-Shiley-valve the lowest. In the aortic position the values for the Björk-valve were better than those for the Starr-valve. In cases with double valve replacement (Starr in aortic, Beall in mitral position) hemolysis was not much higher than in cases with single Beall mitral valve replacement. Clinical hemolytic anemia was only observed in 3 patients, 2 of them being affected with paravalvular leakage. In cases of paravalvular leakage parameters of hemolysis was very high and became normalized after successful repair in 2 patients.


[Performance of av--fistula for dialysis (author's transl)]. From 1971 to 1975 104 a.v. fistulas were performed. The rate of thrombosis of the shunts came up to 24%. The best results were obtained with end to end anastomosis between the radial artery and the cephalic vein of the forearm.


[Operative treatment of acute ileofemoral phlebothrombosis (author's transl)]. Preoperative, operative and postoperative measures in treating acute deep phlebothrombosis are described, as they are performed at the angiological centre of the district hospital "Heinrich Braum" at Zwickau. Clinical, phlebographic and phlebodynamometric results after thrombectomy are demonstrated.


[Myxoma of the heart (author's transl)]. In every valvular defect of the heart and in particular of the mitral valve the existence of a tumour should be taken into consideration if diagnostic criteria are not evident. In this case the operation should not be delayed and performed in extracorporeal circulation.


[Plastic surgery of the female breast (author's transl)]. A brief presentation of the plastic surgery of the female breast is made. Emphasis has been placed on clearly defined indications of operation as well as the selection of the most appropriate methods.


[Value of the knowledge of the mechanical-traumatic component in the course of delivery under the aspect of electronic birth monitoring]. Three cases were detailed pointed out. They demonstrate the opinion of the author about the relations between mechanical cerebral pressure on the fetus, fetal CTG, fetal pH and neurological findings during neonatal period. It is possible, that a cerebral damadge resulting from mechanical birth trauma occours without the findings of variable decelerations and Dip II in the fetal CTG or without fetal acidosis. Our conclusions are: terminate the delivery after 2 hours severe Dip I under normal fetal pH or after 12 hours of efficient labour.


[Amnioscopy as a routine method--results of 9 years experience]. In the 9-years period (1967 to 1975) we are using the amnioscopy increasing generously. Nevertheless the percentage on pathological findings of the amniotic fluid altogether and in the seperate groups of indication is nearly has been always the same. It is'nt exact correlation between the severity of the symptoms of risk and the occurrence of the pathological findings in the amniotic fluid. The grand reliability of the amnioscopy also follows from the material of ourselves: The perinatal mortality in the group of supervised pregnant women by amnioscopy is clear less than in the group of nonsupervised. That comes true to all three parts of perinatal mortality. Our own experiences speak in generous use of the optical evaluation of amniotic fuuid by was of screening.


[Caudal regression, constrained position of the fetus in utero, maternal prediabetes]. This report concerns a new-born infant with the syndrome of caudal regression. His mother, an epileptic, shows borderline values in the glucose tolerance test in childbed. The pathogenesis of fetal position of discomfort in the uterus as well as etiological factors of this malformation are discussed.


[Significance of model studies for explanation of the pathogenesis of the mechanically induced birth trauma (author's transl)]. We have studied the propotions of displacements from fetal cerebral parts during simulated intrauterine pressure. Stillborn children from the death to the experiments last only some hours, were put in cephalic position in our birth model. The cavum uteri was simulated by a metal cylinder, in which we gave compressed air for simulating the labor. The pressure was held about 100 mm Hg. A rubber cuff was fixed on the metal cylinder and let an opening of 8 cm, simulating the cervix uteri. The model with the death infant in it was frozen and than the fetal head sectioned in slides of 1,5 cm in the right of the birth pressure axis. We found, that the gyri occipital were widened, opposite the gyri frontal were compressed. Parieto-occipital we found a venous blood congestion. The brain stem was kinked and displaced dorsal. In one case we carried out in the meantime an aniogram. The cerebral vessels became under the pressure elongated. This was reversible by decrease of the pressure. The limitation of such model studies are give in some facts. We do not know, how much the loosening of the skull, following the fetal death, leads to a more than normal shifting. We further do not know, which proportions of the displacements of the cerebral substance during labor from the fetus could be compensated. Our findings suggest, that it is possible, that cerebral blood flow will be altered by displacements of the cerebral masses during intrauterine pressure. But we have not exact informations about it.


[Comparison of media for the isolation of Ureaplasma urealyticum (author's transl)]. Two liquid media and two agar media were compared for their sensitivity in the isolation of Ureaplasma urealyticum. 22 of the 144 urine specimens examined were positive. The U9-medium with low serum content showed a higher isolation rate and earlier results than a medium with 20% serum (Table 1). However some cultures grew sometimes better in the serum rich medium, suggesting a growth enhancing effect of urine in the U9-cultures. On agar more positive cases were detected with the A6-differential agar which showed urease-activity by brown color (MnO2), and less specimens were positive on A5C-agar without manganese sulfate (19 vs. 16). The number of colonies was only slightly lower on A5C-agar (Fig. 3). The darkbrown colonies on A6 (Fig. 1) were easy to detect and to count. Filtration of the urine specimens through a polycarbonate filter (0.4mum) reduced the number of bacterial contaminations, but resulted also in a lower isolation rate of ureaplasmas (13 of 22). This is probably caused by the tendency of ureaplasmas to attach to other structures e.g. epithelial cells (Fig. 2). For isolation of U. urealyticum from clinical specimens a combination of a liquid medium and a differential agar-medium is recommended.


Experimental Toxigenicity of NAG Vibrios. Some strains of NAG vibrios isolated from the stool of patients with diarrhoeal disease as well as from surface water caused an accumulation of fluid in the ligated rabbit gut loop. 5-fold concentrated sterile culture filtrates of some strains were found positive in this test as well. The volume of the accumulated fluid in gut loops injected with live cultures as well as with concentrated culture filtrates was apparently smaller than the volume accumulated after injection of non-concentrated V.cholerae culture filtrates. This points to the fact that the NAG vibrio strains belong to weaker producers of enterotoxin than the cholera vibrios. The culture filtrates of all investigated strains contained the skin toxin which was of increased vascular permeability in the skin of rabbits. Besides this, a hemorrhagic effect was found in the filtrates. The skin toxin of NAG vibrios appears to be more heat resistant than the toxin of cholera vibrios. The presence of the skin toxin in culture filtrates, however, does not correlate with the enteropathogenicity of NAG vibrio strains.


[The occurrence of neuraminidase and N-acylneuraminate pyruvate lyase in Haemophilus paragallinarum and Haemophilus paravium n.sp (author's transl)]. 14 strains of H. paragallinarum, isolated from fowls suffering from infectious coryza or received from other investigators for comparison, and a collective consisting of 9 strains of the new species H. paravium nova species, also isolated from fowls, were shown to possess both enzymes, neuraminidase (EC 3.2.1.18) and N-Acylneuraminate-pyruvate lyase (EC 4.1.3.3). The detection of the enzymes was made initially by paper chromatography using N-acetyl-neuraminyllactose as substrate and secondly by the colorimetric assay of Warren's thiobarbituric acid method using N-acetylneuraminyllactose, colomic acid, Na salt, bovine submaxillary mucin, human serum and furthermore N-acetyl-neuraminate as substrates for neuraminidase and N-acylneuraminate pyruvate lyase respectively. The enzyme activities of the strains of H. paravium are stronger than those of H. paragallinarum.


[The course of Jones-mote reaction in guinea pigs after the sensitization with mycobacteria (author's transl)]. Mycobacterial antigens induce of JONES-MOTE reaction, which is well stated in 7 to 9 days after being intracutaneously sensitized (Tab. 1). The reaction is adjuvant independent; Al(OH)3 as an adjuvant stabilizes and enlarges the reaction in the interval between 7 and 9 days after the sensitization (Tab 2). The erythema size, read 6, 24 and 48 hours after the intradermal testing shows no significant differences (Tab. 3). The maximal intensity of the JONES-MOTE reaction was found after 24 hours (Tab. 4). The sensitization with 0.2 mg of bacterial mass is sufficient (Tab. 5, Fig. 1). The size of erythema increases when 0.5 mug to 10 mug of homologous sensitin are used (Tab. 6, Fig. 2). An oral application of M. fortuitum increased the total count of basophilic leukocytes and caused cross reactions (Fig. 3).


[Differentiation of mycobacteria by the Jones-Mote reaction (author's transl)]. The specificity of the Jones-Mote reaction to the mycobacterial species was investigated in mycobacteria-free guinea pigs. To the sensitization and the sensitine production the following type strains (Trudeau Institute Saranac Lake) were used: M. avium, M. borstelense, M.chelonei, M. flavescens, M. fortuitum, M. gastri, M. gordonae, M.kansaii, M. marinum, M nonchromogenicum, M. phlei, M. scrofulaceum, M. smegmatis, M. terrae, M. triviale and M. bovis strain Vallee as well as M. intracellulare serotyp Davis ATCC 23435. Eight days after intracutaneous sensitization with 0,2 mg of bacterial mass (wett weight) in Al(OH)3 as adjuvans the groups of 10 animals for each species were tested intracutaneously with all 18 sensitins in a concentration of 5 mug. The animals reacted positive with the homologous sensitin only; (tab. 1) a cross-reaction was stated between M. avium and M. intracellulare (closely related) and between M. borstelense and M. chelonei (the same species). The homogeneity of the Jones-Mote reaction in some rapidly growing Mycobacteria was investigated with 11 strains of M. diernhoferi, 10 strains of M. smegmatis, M. phlei, M. fortuitum and 3 strains of M. borstelense. The positive reaction was stated with species-specific sensitin only. It should be possible to identify the primocultures using mycobacteria-free guinea pigs and suitable sensitins.


[Vibrio parahaemolyticus in mussels and in silt in the southern central baltic sea (author's transl)]. Because the previous studies of 541 fish of the Southern Central Baltic Sea area gave negative results for the presence of Vibrio parahaemolyticus, 150 shellfish and 40 mud samples of the same origin were tested this time. In none of them presence of Vibrio parahaemolyticus nor Vibrio alginolyticus has been stated, though.


[A simple climatic chamber for testing air filters 2. Communication: adjustment of relative humidity (author's transl)]. A climatic chamber for laboratory use is constructed using unexpensive materials. The relative humidity is to be adjusted between 20% and nearly 100% by regulation of the water temperature in the humidifier. The temperature range is 20-40 degrees C. As there are to be done experiments with air filter samples under practical conditions the system is enabled to work up 75 m3 of fresh air per hour. In comparison to commercially available apparatus the system described may be easily modified to fit the geometrical and experimental conditions.


[Transmission of staphylococci from the nose to hands and eye-glasses as a nosocomial problem (author's transl)]. The isolation of Staphylococcus aureus from the pharynx, the nasal vestibule, as well as the eye-glasses and palms of both clinical personnel and of healthy subjects of the general population, resp., is reported. In either group, the findings were largely identical. About half of the subjects (46%) proved to be carriers of staphylococci, with the bacteria being mostly localized in the nasal vestibule (91%) rather than in the pharynx. The majority of those harbouring staphylococci in their nasal vesibule carried the same strains on their eye-glasses (67%) and on their hands (62%). The reason for the occurrence of pathogenic staphylococci, in most cases, in the nasal vestibule may be seen in the anatomical and physiological peculiarities of the pharynx and nasal vestibule, resp. While there is a highly efficient anti-bacterial defence system on the basis of both cellular and humoral mechanisms in the pharynx and oral cavity, the keratinizing stratified epithelium lining the nasal vestibule offers a milieu favourable for bacterial growth with regard to nutrients, temperature, and humidity, humoral and cellular defence mechanisms being virtually absent. With respect to nosocomial problems, the important conclusions to been drawn from the present data are the following: 1. surgical masks barring the penetration of bacteria should be used frequently, not only during surgical operations but also in emergency wards, infant care and premature baby wards, and in similar clinical areas requiring critical attention.  2. persons dependent on wearing eye-glasses should wear sterilized glasses when performing surgery, or subject their glasses to an efficient disinfection procedure. The latter also applies to all personnel wearing glasses in the clinical area. 3. The very frequent association between the occurrence of staphylococci in the nasal vestibule and the contamination of hands makes it imperative to observe a strict rountine of disinfection of hands in all critical areas (emergency ward, premature baby care etc.). In food hygiene, too, proper attention should be paid to the chain of staphylococcal contamination from nose to food. Therefore, to minimize the hazard in such high-risk situations as public canteens and in the manufacture of ice cream, a well-planned routine of hand disinfection should be adhered to.


[About problems of carriers of Salmonella typhi and paratyphi B under hygienic, epidemiologic and sociologic view (authors transl)]. The carriers of salmonella typhi and paratyphi B are the central figures of the epidemiology of typhoid illnesses. The files available at the medical authorities' office of the Hansestadt Lübeck, with regards to all 543 carriers registered up to 1972, have been analysed, and 102 of 108 carriers who were inhabitants of Lübeck on 31.10.72, have been interviewed in their lodgings.--Following results are mentionable: 1. 55 carriers have been traced during a hospital stay, 22 of them were under hospital treatment because of cholecystectomy. 2. The circle of persons to be obligated for medical examination as per $ 17 of the Federal Republic of Germany's law of epidemics has proved as too small. For instance two female carriers--known since years--did their job without any hindering as plates washer or waitress in restaurants. 3. 21 persons=4% of the patients excreted salmonellae in urine only. 4. 10% of the carriers of salmonella typhi and 16% of the carriers of salmonella paratypi B had in their faeces as least 5-years intervals of non-excretion. 5. The precentage of carriers with at least 5-years intervals of non-excretion in urine was significantly larger than the corresponding percentage in faeces. 6. Falling ill of 280 persons out of the environs of the carriers have been lead back to the latters. 73% of these infections were placed by the carriers before their detection through the medical authorities' office. 7. For 10 patients whose health was recreated excretion did not cease promptly after the cholecystecystectomy. Salmonellae had been found in the faeces for several months more, at two persons even two years after the operation. 8. For 8 carriers a final decision with regards to the success of cholecystectomy is impossible because they denied a duodenal soundation. 9. 123 persons of 23% of total 543 carriers had--before their ascertation--professions not allowed for those persons. Efforts for a successful job arrangement, possibly combined with a change in profession, always met to obstacles. 10. More than 80% of the carriers who were interviewed ignored the directions about personal hygiene. 11. Difficulties arose during a stay in sanatories, hospitals and old age homes. 12. While 60 of the carriers contemplate their situation with indifference other 42 patients are psychically influenced. 5 of them suffer from a psychical trauma. 13. The environment often tends to overrate the danger resulting from carriers. 14. Information of the carriers must be improved.


[The determination of resort and stress-areas by air pollution 1. Communication: health effects, methods, emission inventories (author's transl)]. The Alps and other mountainous areas are air-hygene problem zones: By distadvantageous geographical and  meteorological conditions relativ small emissions can be the reason of high concentration of air pollutants in the ambient air. Therefore the separation of different stress zones by the air quality is an important data for land use planning with regards on health. Different methods which are internationally usual can not be used in mountainous areas (e.g., dispersion models, calculation according to the TAL). A method is introduced for determination and separation of the level of SO2 and particulate matter in a spreadout area which can be used also in complex terrain. This method was proved in air pollution studies in areas with more than 30000 km2 over four years. The investigations were based on a combination of emissions studies, measurements of immissions by continous working SO2 monitoring instruments, lead dioxide candles and Bergerhoff-instruments, and--if possible--meteorological investigations. Report 1 describes the health effects of SO2 and particulate matter, the used tentative methods (analysis for dustfall, the sulfation rate by lead dioxide candles, analysis for sulfur dioxide content by conductimetric and coulometric methods), the emission inventories and the net works.


[The determination of resort and stress-areas by air pollution 2. communication: the evaluation of air pollution in spreadout areas, classification into stress-categories (authors transl)]. To qualify the air pollution by SO2 and particulate matter in wide spreaded areas a method for complex terrain was used in the Austrian Alps. The working model which was chosen is described in report 1. It is possible to classify the investigated area according to stress-categories by adjusting the data. For the qualification of results of measurements for dust fall the criterias were used according to KOFLER and BENGER. Two different situations were considered for the separation of limits for the stress-categories for SO2: areas which are polluted in first line by area sources, and areas which are polluted in first line by point sources.--The limits which were used in the study of Salzburg are introduced and discussed.--According to the method which is described above all municipalities of Tyrol and Salzburg were classified in stress-categories during to their air quality. The results are introduced.


[Virucidal efficacy of a chemical instrument surface disinfectant ("Gigasept") against coxsackie virus type B3. II. Investigation in the instrumental surface test (author's transl)]. The virucidal efficacy of the chemical disinfectant "Gigasept" on the basis of succine dialdehyde and formaldehyde was tested with an instrumental surface test which was elaborated for the control of instrument-surface disinfectants. These must be able to inactivate viruses on plastics, rubber and metal. Therefore, PVC tubes, PVC dental suction tubes, red rubber catheter and aluminium surfaces were included in this investigation. Coxsackie virus type B3 served as test virus. The surfaces were coated with liquid virus suspensions with the exemption of the aluminium surface which was contaminated with a gelatinous virus suspension. The instrumental surface test procedure enabled not only the analysis of the specific virucidal effect but also the evaluation of the unspecific virus adsorption onto the surface as well as the unspecific virus resuspension from the surface. Parameter for the disinfectant activity was the virus inactivation kinetic, i.e. the interdependence of the titer reduction vs. disinfectant contact time of a 5% solution of "Gigasept". An optimal disinfection must gain absence of virus, a titer reduction of larger than or equal to 103ID 50 and a significant titer decrease of p less than 0.0001. According to these criteria an optimal disinfection was achieved with a 5% Gigasept concentration after 4 hours. The different surfaces did not influence the virucidal activity of the disinfectant. The results of the instrumental surface tests confirmed those of the suspension test.


[Toxicity of lead chloride influenced by zinc iones in cultures of mouse macrophages (authors transl)]. We analysed the toxic effect of lead chloride employing peritoneal macrophages of the mouse. Toxic effects were determined using the following parameters: viability by dye exclusion test, membrane permeability estimating release of lactate dehydrogenase and carbohydrate metabolism measuring lactate production. Our results demonstrate that Zinc iones in a concentration of 1 X 10(-5) M reduce the toxic effect of lead chloride of 2-4 X 10(-4) M.


[The relationships between blood lead, erythrocyte count, blood hemoglobin concentration and age in children (author's transl)]. With increasing age of the children and increasing hemoglobin, hematocrit and serum protein levels, the lead concentrations of the blood in the children dropped. By contrast, high lead concentrations in blood correlate with low MCV and high erythrocyte values. The possible causes are discussed.


[Specific immune response and immunoglobulin production in intestinal infections. III. Intestinal antibodies and immunoglobulins in the dynamics of dysentery infection]. Coproimmunoglobulins and specific coproantibodies were studied in 98 adult patients and 32 children in the course of infection caused by Sh. sonnei, and in 102 healthy individuals of various age. The concentrations of IgA, and, to a lesser extent, of the IgG and IgM proved to be significantly higher in the patients than in the healthy persons. Locally synthesized secretory IgA made up the main part of the total amount of the IgA in feces. The titres of specific coproantibodies were significantly higher in patients than in healthy persons; these antibodies, as identified by Coombs test with monospecific antiglobulin sera, mainly belonged to the secretory IgA. The local immune response to Sh. sonnei was more intensive in adults than in children. In adults the increase in the secretory IgA was revealed at the earlier stages of the disease, and specific antibodies were found more frequently and in higher titres than in children. The lesser intensity of local immune response in children apparently depends on a lesser maturity of the IgA system providing the local defence.


[Subclasses of immunoglobulin G. I. Determination of subclasses of G-paraproteins by the method of tryptic splitting]. Subclasses of the G-paraproteins were examined by the method of tryptic splitting of the sera. The fragments were identified in the immunoelectrophoresis with the antisera detecting the IgG, Fab-, Fc- and Fc1-fragments. It was revealed that for the IgGI most typical was formation of the Fc1-fragment continuously detected along with the Fab- and Fc-fragments; for the IgG1--retention of a considerable amount of unsplit protein; for the IgG3--formation of the Fab- and Fc-fragments, for the IgG4-- of the Fab-fragment alone. Analysis of 96 sera of the patients suffering from G-myeloma showed that 69 were referred to the IgGl, 19 - to the IgG2, 5 - to the IgG3, and 3 - to the IgG4. The method tested permitted successful identification of subclasses of the G-paraproteins, this serving as the necessary prerequisite for the choice of antigens and sorbents in the preparation of the subclass-specific antisera.


[Pathogenic and antigenic properties of NAG-vibrios isolated from man and environmental objects]. A study was made of the pathogenic properties of NAG-vibrios on various experimental animals (917 guinea pigs, 609 nursling rabbits, and 203 rabbits aged from 20 to 24 days). The results obtained were compared with the reference to definite serological groups. Pathogenic NAG vibrios proved to be encountered in all the serological groups studied. The presence of pathogenic NAG-vibrios was mostly noted among the cultures belonging to the 2nd, 5th, 8th and 18th serological groups. The majority of serological groups isolated from man were also revealed among the cultures obtained from water.


[Course of attack-like schizophrenia inlight of late catmnesis]. On the basis of remote follow-up checkings the author studied the development of attack-like schizophrenia with an onset before 40 years of age and proceeding in the form of clear-cut psychotic attacks up to senescence. Such forms of development seen in 86 patients permitted to conventionally eliminate 3 variants in attack-like schizophrenia (depending upon the prevalence of different tendencies); a) development of the "cliche type", b) with a simplified clinical picture and c) a clinical development with a complication of the repeated attacks. The study demonstrates that these changes in the development of the disease are mainly seen in certain periods of old age (involution, senescence).


[Late catamnesis of recurrent schizophrenia with prolonged remissions (according to an unselective study)]. The author studied the entire population of schizophrenic patients with recurrent forms where the disease proceeded for more than 20 years. Among 115 patients, 97 had long-term (8--40 years) remissions. Two types of development in recurrent schizophrenia with long-term remissions differing in progressiveness are described with rare attacks and with a tendency to series. The data give ground to eliminate the prognostic criteria of the probability of long-term remissions.


[Clinical typology of dysomorphophobic states in juvenile schizophrenia]. On the basis of a clinico-catanmestical study of 104 patients with adolescent schizophrenia and dysmorphobic disorders the author distinguished 3 types of such conditions. The first type was characterized by the formation of ideas of a physical defect accompanied by psychasthenia-like disturbances. Its development corresponds to the regularities typical for slowly progressive schizophrenia. The second type was characterized by conditions similar to pubertal crises, but with a certain dysharmony the third type of dysmorphophobic ideas was included into the delusional system. A complication of the dysmorphophobic state was in a direct correlation with the stage of the continuous development of the process and to a lesser extent with affective disorders as it is the case with the first two types.


[Changes in cardiac activity in the acute period of subarachnoid hemorrhage]. In the acute phase of subarachnoidal hemorrhages which was seen in 32 patients the author studied changes in the cardiac activity and phasic structures of cardiac contraction. The studies were supplemented by electrocardiographic and polycardiographic methods permitting to determined separate phases of cardiac contraction and quantitatively characterize the contracting function of the myocardium. In 21 patients according to the EGC data there were changes in the cardiac activity. It is assumed that the main role in the development of such changes during subarachnoidal hemorrhages belongs to diencephalic brain structures, the changed function of which lead to distrubances of central regulation of the heart activity.