[Panel discussion: problems of the specialist's duty to inform the patient (author's transl)].

The obligation of the physician to inform the patient -- which he has to prove in a case of a suit -- is based on the patient's right of self-determination. This self-decision information was subject of the panel discussion. Not discussed in detail were the information concerning diagnosis and prognosis, and the instruction of the patient regarding his conduct postoperatively and during medical treatment. Not considered was the so-called malpractice and negligence respectively. Medical liability suits are increasing for various reasons and are frequently directed at a failure to inform the patient because the patient is often unable to prove a negligence of the physician ("surrogate liability"). The dimension of the duty of disclosure (complete information -- no information at all) is discussed in general and with special regard to the Ear-Nose- and Throat field. Special questions are answered regarding otoplasty, middle ear surgery, transplantations, extension of laryngeal surgery without prior informed consent, paranasal sinus and rhinobasis operations as well as surgery in minors and foreigners. In cases of non-vital indication and particularly in plastic-cosmetic procedures and outsider methods the requirements for informed consent are particularly important. The so-called rate of complications has perhaps a relative, but never an absolute meaning, and even this only in connection with the other circumstances of an individual case. The evidence of an adequate informed consent which must be included in a physician -- patient-dialogue is most convincing by means of a written consent and the additional signature of a witness, perhaps also of the patient. The value, the problems and even the risks of an information based only on forms or brochures is discussed in detail. The panel discussion from the four points of view of the organizers should by no means confuse the otorhinolaryngologist. It should inform him about the medicolegal aspects of his activity and protect him from avoidable burdens.


[Surgery on the ethmoid and sphenoid sinuses -- a critical appraisal (author's transl)].

The surgical management of various diseases of the ethmoid-sphenoid region is absolutely indicated in many cases because of the direct neighbourhood and the intimate relationship between a pathological process of these sinuses and a spreading of an infection or a tumor to the adjacent organs such as the orbit, the base of the skull, the dura, the optic nerve and the internal carotid artery. The optic nerve and the carotid artery are intimately related to the lateral wall of the sphenoid sinus and may even bulge into the cavity. In cases of an atypical posterior ethmoid cell we must expect an anomaly of the course of the optic canal with the increased danger of an injury to the optic nerve. The various possibilities of pneumatisation of the ethmoid-sphenoid region are described and illustrated. The diverse methods of the ethmoid-sphenoid operations are demonstrated and compared regarding their effectiveness and operative risk. Details of several iatrogenic injuries of the orbit, the dura or the optic nerve and the management of these lesions are mentioned. The medico-legal situation and the importance of the preoperative informed consent of the patient are discussed.


[Immunological examination methods for the diagnosis of allergic rhinitis (author's transl)].

Only a great number of well-established test methods helps to prove for sure the occurrence of allergic rhinitis. In addition to skin and provocative tests immunological laboratory tests are indicated for reliable diagnosis purposes. According to the immunological tissue reaction underlying the allergic rhinitis the following methods are suitable: the proof of histamine release of leucocytes, the determination of the immune serum globulin E-level and the differentiation of the specific IgE. Precipitation reactions prove the occurrence of antibodies of the type IgG. Hemaglutinating antibodies generally demonstrate the patient's inclination toward allergic reactions. On the basis of these investigations the specificity of the anti-allergic therapy can be essentially increased.


[Noise level measurements of the air noise during drilling and grinding on the fresh isolated temporal bone (author's transl)].

Aerial sound measurements with different drilling instruments were performed during dry running and preparations of the bone. Registered were the values of the small drilling instruments Sirona, Dentatus-Air, and Electro-Torque-Ritter. Also tested were the KaVo-Technique-machine, the Hall-machine, the Air-Orbit-turbine, and the Sirona-turbine. During dry running most of them already reached the allowed marginal value of noise nuisance for the ear of 85 dB (A) at a distance of 35 cm. Only the Air-Orbit-machine showed a slightly lower value of 80 dB (A). The level increases with the used handpieces. Normal handpieces 1:1 exert only a minimal influence, gear handpieces 2:1, however, markedly increase the level. The verticity is of no importance in the range of normal rotations between 10,000 r/min. and 80,000 r/min. Only rotations in the lower frequency range of 2,000 r/min. markedly decrease the noise level. During bone drilling, the kind and size of the drilling bit have an influence on the intensity of the noise level. Quadruple wing milling cutters create a very high noise level (at a distance of 15 cm still above 110 dB [A!]), big rose cutters (R 16) create noise levels of 95 dB (A) and above, and only diamond round bits create less noise (approximately 88 db [A]). Small drilling bits make such a faint noise, that it is overroared by the drilling instrument. The turbines create only slightly higher levels than during dry running. Larger drilling bits cannot be employed here on principle. Wing milling cutters can lead to persistent damages of the inner ear. The frequent use of dental drilling instruments for bone preparations can also lead to a hearing loss of the operator in the long run.


[Investigations on the shape and size of bone-chips produced during boring and grinding (author's transl)].

Examinations of the shape and size of chips produced during boring and grinding of dry macerated and fresh temporal bone by various drills and grinders at different revolutions show that rose trepans mainly scrape fresh bone, producing large rolled-up chips, but knock off dry macerated bone, producing more compact chips of bizarre shape. In either case the chip waste also contains plenty of fine and finest compact chips which are broken off and splinter during the removal or knocking-off of the chips from solid bone. The size of the chip depends on the size of the drill head. Diamond cutting heads produce fine and finest compact bone chips. Bone milling produces plenty of scrapes even from dry macerated temporal bone. The rate of revolutions (10,000-80,000 per min) had no influence on the shape and size of chips. Clinically the scraped chip seems to be the most favourable in the drilling of bone because it causes least damage. The use of a drill head with sharp-edged, intact cutting surfaces seems important for this, with continuous rinsing during the boring process to prevent soiling of the interspaces between the cutters and to ensure full performance in accordance with their construction.


[Physiological spontaneous and positional nystagmus. electronystagmographic examinations concerning type, frequency and intensity (author's transl)].

120 subjects were selected from a large number of healthy persons on the grounds of their medical history and preexaminations including audiogram, which excluded the possibility of previous cochelo-vestibular illness. These 120 healthy persons were examined by means of electronystagmography. We were searching for spontaneous and positional nystagmus in 5 positions with open eyes in darkness and with closed eyes. 50% proved to have a horizontal and 82% a vertical spontaneous nystagmus in at least 1 position. The sex had no influence on the frequency and there was no difference in results under smokers and non-smokers. There was the same frequency of nystagmus directed to right and left. We conclude that there is a physiological horizontal spontaneous nystagmus of low intensity if fixation is completedly excluded. In our opinion it is not possible to determine a certain level of intensity above which a spontaneous nystagmus is pathological as the intensity of nystagmus is essentially dependent upon non-vestibular elements.


[Binocular dissociated acquired nystagmus of unknown origin (author's transl)].

A case of noncongenital rare pendular nystagmus is reported in witch on the contrary to similar published cases no neurological disorder is present.


[On a neurophysiological interpretation of acupunctural analgesia in tonsillectomy and in extensive operations (author's transl)].

A multiple stimulus (secondary or repetitive stimulus) to the sensory nerve endings in the skin and in the connective subcutaneous tissue is exerted by acupuncture. Because of the tight interlacing of nerve endings, this stimulus affects simultaneously the sensory fibres of both the cerebrospinal nerve, the Sympathicus and the Parasympathicus. The slow conducting pain fibres (C-fibres) are inhibited in their function by the fast conducting Abeta-fibres and Adelta-fibres, which transmit pressure, vibration and electric currents (Foerster, Zottermann). In addition a secondary stimulus inhibits or modulates a peripheral pain stimulus (pain of operation) in various synapses on the sensory pathway to the cortex, especially in the substantia gelatinosa of the spinal cord. According to Keidel, Raich and Albrecht pain stimuli are masked up to 50% by vibration and other "rivaling" stimuli. Furthermore, acupuncture releases a higher level of Noradrenaline and Serotonine in the liquor of ventricles. These two biogenic amines effect also an analgesia such as demonstrated in animals by artificial injection in the ventricles. The author gives also a detailed review about the importance of the transmitters noradrenaline, serotonine and acteylcholine for the acupuntural analgesia.


[On mucoepidermoid tumors with rare locations in laryngological areas (author's transl)].

Report of three cases of mucoepidermoid tumors with rare locations in laryngological areas (fundus of the tongue, retromolar trigonum, nasopharynx and sinuses). In two cases the tumors could be removed radically, the third case resulted in an extensive tumorous destruction of the right half of the face after a protracted course of the disease, as the consequence of which the patient died. With the aid of the literature on the subject, the location, clinical features, pathological anatomy and histology, origin, biological valence and the prognosis of mucoepidermoid tumors are discussed. It is generally agreed that they are optionally malignant tumors which can induce a locally infiltrating or destructive growth, show a tendency to recurrence and may lead to distant metastases. The recommended therapy is the radical exstirpation of the tumor.


[Therapeutic progress in treatment of childhood lymphosarcoma (author's transl)].

In treating childhood lymphosarcoma, high-dose combination chemotherapy is most effective, when given as long-term therapy. The most important advances of the therapeutic regimen described here are not only obtaining complete remissions but to have them maintained; the side-effects of the intensive therapy are well to be kept under control. Besides, some of the drugs are effective against the severe complications, leucemic transformation and sacromatous meningiosis. The median time of complete remission in our own patients with head and neck primaries is already 63 weeks; in comparison, that of a former group of children was 11 weeks.


[Adenocarcinoma of the paranasal sinuses in woodworkers, an occupational disease? (author's transl)].

A 59-year-old carpenter, 44 years in his profession had an adenocarcinoma of the ethmoids. Similar cases have been described previously in foreign literature. This disease has been accepted as an occupational disease in England. The question is whether this disease, provoked by fine wood-dust may be observed in Germany too; whether the chemical wood ingredients and those being produced during fine-sanding may be carcinogenic. In gaschromatograms the wood ingredients have been demonstrated using oak and beech wood. It is proposed that comparable cases be collected in Germany in order to have a sufficient number of cases for a statistic base. This would make it possible to add this disease to the German list of occupational diseases.


[The importance of the vertebral venous plexus for the occurrence of haematogenous metastases in malignant diseases of the head and neck (author's transl)].

The analysis of observation about the progress of 1136 malignant diseases of the epi- and mesopharynx and of the nasal cavity and sinuses from the ENT-Clinic of Jena showed in 16 to 18 per cent of the cases haematogenous metastases observed only in a third to a half in the lung. If the lung had been spared especially the axial skeleton and the liver had metastases. This finding was especially significant in cases of epipharyngeal carcinomas. The discussion about the causes of the frequent occurence of metastases in the axial skeleton led to the supposition, that an independent way of the spreading of haematogenous metastases via the vertebral venous system and the azygos veins could be possible.


[The cryoeffect on the growing bone (morphological findings on the kneejoints of rabbits as an example) (author's transl)].

The cryoeffect on growing long bones is studied. The kneejoints including the bordering surrounding epiphyseal disks of the femur, tibia and fibula of 35 young (4-6 weeks old) and 6 adult rabbits were frozen by dipping the knee joints totally or partially into liquid nitrogen (-196 degrees C). The freezing time varies 3-5 min. After different times of survival maximally up to 397 days the animals are sacrified. The length of the cryosurgical treated and untreated extremities are measured and the kneejoints, especially the epiphyseal disks, are studied lightmicroscopically. Totally or partially frozen joints show after a complete necrosis in the phase of regeneration and reparation an uncoordinated overgrowth of cartilage-and bone cells and a proliferation of connective tissue with deformation of the epiphysis. The above mentioned facts and the disturbance of growth in length in young animals is mainly caused by the irregular function of the epiphysical disks after being treated cryosurgically. Also the epiphysical disks being only partially treated cryosurgically show growth disturbances and deformities. Deducing from the animal experiments clinical cryosurgery, has to be applied with extreme caution in the surrounding area of growing bone in children so that the centers of growing bone are not be frozen. Treating bones of adult rabbits cryosurgically there are only time limited reversible morphological findings so that clinically cryosurgery can be used in the surroundings areas of adult bones, especially joints, without any remarkable morphological long term findings.


[Histological examinations on the hemostatic effect of freezing during surgical procedures in the head and neck (author's transl)].

In the course of surgical interventions 28 tissue blocks of muscle, subcutis, submaxillary gland and tumors were frozen in situ, using liquid nitrogen and a closed cryoprobe. Specimens were taken before freezing, immediately after thawing, 5 minutes and 30 to 60 minutes later. They were fixed in formaline, embedded in paraffine and stained with hematotoxylineosin and after Ladewig, for better diagnosis of a possible microthrombosis. Comparing the specimens taken before and after freezing we found: no reactive vasoconstriction but dilatation, no remarkable changes of vascular wall, a moderate edema of the connective tissue, abundant bleeding, only in two of 84 sections singular microthrombi. That means no reliable criteria of an hemostatic effect of CRYOSURGery could be found histologically within the first postoperative hour, at least in case of freezing during conventional surgery.


[A new magnifying laryngoscope (epipharyngoscope) (author's transl)].

A new developed laryngoscope (epipharyngoscope) is demonstrated, which comes now to production stage after three years of experimental work. The endoscope-a high capacity optical system with an angled direction of view-allows a thorough inspection and easy fotodocumentation of the larynx and epipharynx without molesting the patient. Even under difficult conditions regarding the anatomy the findings can be inspected as a survey or under magnification, which is done-technically an innovation-by moving an integrated lens system of the endoscope.


[Diseases of the trachea and bronchi by special consideration of x-ray diagnostic (author's transl)].

Important aspects for the diagnosis and therapy of diseases of the trachea and bronchi are the surgical anatomy, physiology and histopathology. For the evaluation of these diseases x-ray studies can make a major contribution.


[Radiogenic disorder in sense of smell (author's transl)].

The influence of radiotherapy on the sense of smell was investigated in 24 patient (age 28-80 years) with Elsberg's method. Out of 19 patients, who were measured 1-15 years after radiotherapy, the thresholds exceeded the normal range in no case, i.e. no permanent disturbance of smell after radiotherapy. In 5 patients, tested before, during and after irradiation, the thresholds rised continuously to the upper margin of the normal limit between 1,000 and 6,000 rads and, after the end of therapy returned to initial levels within 6-8 weeks.


[Excision in the epipharynx anterior or posterior to the ostium tubae with stenosis of the cartilaginous eustachian tube (author's transl)].

A large excision anterior to the ostium tubae in the epipharynx is advised in cases with stenosis of the cartilagenes eustachian tube. The operations performed by transpalatimal approach under general anesthesia were in 11 cases without complications so far. Excision and scar retraction yielded good functioning results over the longest observation period of 18 month. -A resection of the tensor tympani muscle out of its bony canal is advised in bony tubal obstruction. Ventilation may be improved by use of our conic and oval shaped steel probe which helps to combine the bony tensor typani canal with the eustachian tube.


[Contribution to the epithetical supply of the extended face-defects (author's transl)].

As an example it will be shown how the advantages of the soft-staying and the stiffstaying epithesis-material can be put together. Also it will be a simple fastening method of the epithesis shown.


[Experimental investigation concerning the substitution of the orbital floor of the cat (author's transl)].

In 12 cats the floor of the orbit including the infraorbital margin had been totally resected on both sides. The 24 orbital defects were substituted by complete homologous floors of the orbit which had been preserved in thiomersalate, autologous bone from the tegmen of the sinus frontalis of cats, autologous and homologous cartilage and lyophilizised human dura. All implants healed well. It was found that both autologous and homologous bone implants gave the most stable mechanical connection to the orbital wall. Histological new bone formation was present at 6 months in the homologous bone transplant. This work raises the probability of the use of homograft orbital floor in surgical management of trauma to the orbit.


[Principles of the burden of proof in medical liability proceedings (author's transl)].

The application of different ways of thinking - that is to say the juridical, human scientific evaluating and the medical, natural scientific establishing - next to each other can direct to difficultics and divergencies in the reply of expert questions in medical liability proceedings, although each way of thinking attains to correct and practicable results. Relative to the medical expert this presums on the one hand a distinct degree of juridical mentality and necessitates on the other hand a medical mind and scrutiny of the factual situation coordinated to the juridical train of thoughts and terms. A particular importance is due herein to the knowledge of the principles and directions of the burden of proof within the rules of criminal and civil procedure. Starting from the legal handling the forms observing are explained in detail and illustrated by means of competent laws and court findings. Therewith an estimation of the medical state of affairs should be rendered possible for the medical expert adequate coordinated to the juridical terms.


[On a biochemical model of neurogenic sialosis: studies in rats (author's transl)].

By studying the influence on rat-parotid glands of the antihypertensive drug, guanoxane (Envacar), we attempted to establish a biochemical model of a neurogenic sialosis. Protein content and alpha-amylase activity were determined in gland extracts and in polyacrylamide gel slabs after electrophoretic separation of equal amounts of parotid-gland protein. The values for both parameters showed a marked increase during the first week of treatment as compared with the controls, but decreased subsequently. After electrophoretic separation into 4 isoamylases, the activity per unit protein decreased with time in one group of isoenzymes and increased in another. We interpret these findings as a gradual shift in the isoamylase distribution pattern of the rats' parotid glands with increasing duration of a neurogenic sialosis of the peripheralvegetative type.


[The albumin content of parotid saliva in regard to age (author's transl)].

In seventy nine persons of age between twenty and eighty the albumin content of parotid saliva were estimated by means of electroimmunodiffusion. The albumin content is independent of age. The problem of permeability of salivary glands for serum proteins is discussed.


[Simultaneous determination of lysozyme and IgA-content in human parotid saliva, compared with flow-rate and totalprotein-secretion during rest and stimulation (author's transl)].

Parotid saliva was collected in 10-minutes-fractions during rest and stimulation from 66 healthy individuals. The time of collection was 80 minutes, in every sample flow-rate, total-protein-concentration, IgA- and Lysozyme-content were determined. According to sex and age of the individuals, the results obtained were classified in four groups. Stimulation produced characteristic changes in the flow-rates, which seemed to be correlated with the age of the persons. The total-protein-concentration of the single samples showed great differences; yet, regarding flow-rate and proteinconcentration together, the so calculated secretion of protein of every gland was almost the same. Secretion of IgA was dependent on age and sex: the secretion-rate was greater in females than in males. Besides, younger people had lower IgA-concentrations than older ones. On the other hand, lysozyme-secretion was reciprocal to IgA-secretion. The concentration of lysozyme was much higher in young persons compared with the older group. The clinical importance of this findings is discussed.


[A case of industrial origin of laryngeal carcinoma (author's transl)].

The Growing importance of industrial noxae for carcinogenesis will, in the course of further progressive mechanization and industrialization, suggest an increasing confrontation with this problem. The above mentioned case, a patient working with insulating materials on industrial heating systems, impressevely demonstrates the transformation of chronic laryngitis into a carcinoma in the course of years, brought about by industrial influences and thus proving the exogenous origin of this genesis. Dust as well as strong effects of heat under conditions of variable atmospheric humidily are concerned to be principal damaging factors.


[Hemilaryngectomy with reconstruction of the pyriform recessus (author's transl)].

A new plastic method for closed hemilaryngectomy with reconstruction of the recessus piriformis by means of prelaryngeal musculature is reported. The functional advantages compared with the hochnaht method are demonstrated. A review of the indication and its limits looked upon at today's standard is given.


[One stage reconstruction of hypopharynx following total laryngopharyngectomy (author's transl)].

The author reports upon his own experience with a one stage, total reconstruction following total laryngopharyngectomy first described by Loré jr. 1973. For the rebuilding of the anterior and lateral walls of hypopharynx a posterior tongue flap after Sisson (1956) and Hiranandani (1967) is used. The reconstruction of the posterior wall of hypopharynx is done using a free dermal graft from the thigh. This method seems to have certain merits: A radical procedure is possible; one stage operation; a good functional result concerning deglutition after a short time, which in the own two cases was not essentially injured after x-ray treatment with a full tumordosis.


[Problems of intracranial extension of malignant disease of the nose and sinuses (author's transl)].

Out of 424 cancers of the nasal cavities or sinuses seen at the University E.N.T. Clinic Jena, 120 had penetrated into the anterior or middle cranial fossa. The commonest of these were tumours of the upper sinuses but a fifth of all antral tumours were also involved. The favourite site of intracranial breakthrough was studied in relation to the origin of the tumour and a particular liability of antral cancers to extend to the middle cranial fossa was noted. Critical analysis of the preoperative diagnostic features showed that the extent of the tumour relative to the base of the skull was often only demonstrated by a wide external surgical exposure. Operative and electrosurgical exenteration after Zange followed by radium application to the infiltrated dura resulted in over 17% of the operated patients surviving 5 years or more without recurrences. Irradiation alone was unsuccessful in all cases. In recent years resection of the tumour has been followed by excision of the infiltrated segment of the dura and the defect covered with fascia lata. First impressions and several examples are given.


[Considerations on stellate ganglion blockage (author's transl].

It has been considered why it is possible to inject the local anaesthetic into a vessel even though the previous aspiration-test for blood had a negative result. To avoid an intravasal injection it is to be recommended to interrupt the injection with 15-20 further aspiration tests.


[Contribution to the diagnosis, therapy and prognosis of head and neck tumors in childhood and adolescence: experience with 94 own cases (author's transl)].

The head and neck region is - among the body regions - one of the most frequently affected one by malignant primaries in childhood and adolescence. The diagnosis of malignant lymphomas (Hodgkin's and non-Hodgkin's type) predominanted (55 cases) in the own case material of 94 patients. Besides, there were 21 tumors of mesenchymal origin, 11 neuroepithelial tumors and 5 cases of histiocytosis X. The first symptoms are often discret (painless swelling) and they represent one of the major problems in handling childhood tumors. An optimal therapy, which resulted in longterm cures in the majority of the own patients, is based on an intensive team-work of pediatricians and ENT-doctors. One of the important points for successful treatment is individualizing the intensity of each of the effectful modern therapeutic modalities.


[Metabolic enzymes in human nasal mucus under physiological and pathophysiological conditions of the mucous membrane (author's transl)].

In the human nasal mucus several enzymes of the intermediary metabolism are present. Due to secreted albumin the enzyme-levels are determined in different diseases of the upper respiratory tract. It is possible to differentiate viral rhinitis from bacterial or allergic or atrophic rhinitis by a significant increase of the activities of GOT, LDH and CPK.


[Detection of split products of the immunoglobulins IgG, IgA and IgM during chronic otitis media (author's transl)].

Proteolytic enzymes such as pepsine or papaine are able to split IgG antibodies into large fragments in vitro. These immunoglobulin fragments (IgG, IgA, IgM) were now detected in vivo from the purulent secretions of cholesteatoma, chronic otitis media and radical mastoid cavities. During chronic otitis media the intact immunoglobulins are split due to the proteolytic activity of neutral proteinases. These fragments were qualitatively and quantitatively investigated by means of various immunological procedures. After the immunoelectrophoretic separation of the purulent middle-ear-secretions and after diffusion against anti-IgG-, anti-IgA- and anti-IgM- serum double precipitate lines could be observed especially in middle-ear-secretion with a bacterial flora of pseudomonas aeruginosa (pyocyanea) and of the proteus-providencia-group. This was the first proof of the presence of split products of the immunoglobulins. The exact demonstration of these split products could be carried out by gel-filtration and fractionation of the intact and split immunoglobulins. During chronic otitis media intact immunoglobulins are split by leucocytic and extracellular bacterial proteinases into fragments of different molecular weight. The most malignant extracellular proteinases with the greatest proteolytic activity against intact immunoglobulins are the bacterial proteinases of pseudomonas aeruginosa. These proteinases can not be inhibited by the other serum proteinaseinhibitors except for alpha-2-macroglobulin of the human blood serum. This inhibitor has a very high molecular weight so that we can not find it in a higher concentration in the middle-ear-secretion. We can liberate this inhibitor by injuring the blood vessels during a tympanoplasty. In this way we get an inhibitory effect against these proteinases and combined with an appropriate antibiotic therapy we can cure a chronic otitis media.


[The effect of the argon laser on the vessels, the macro- and microcirculation of the mucosa of the hamster cheek-pouch. An intravitalmicroscopic study (author's transl)].

The mucosa of the cheek-pouch of five golden Syrian Hamsters was irradiated with the beam of an argonionlaser (diameter 0.5 mm and 200 mW). The effect on the micro- and macro-vessels and the bloodstream, especially of the microcirculation, is studied intravitalmicroscopically. In the microcirculation and also in the small and large venous and arterial vessels a restriction of bloodstream, praestasis, pendulumstream, stream reversal and some white microthrombi, -- emboli and agglutination of erythrocytes are visible. The bloodless welding of the vessels takes place even before the evaporation and coagulation necrosis of the surrounding epithelium of the mucosa as a result of the relatively selective effect of the Argon Laser on the reddish vessel-system by a continuous narrowing of the vessels-walls to the complete loss of their lumen rather than by a thrombosis. Firstly the capillaries, the venoles and the arterioles are obliterated, then those of middle size and at last the large venae and arteries in which case large vessels function for a moment as smaller ones. A continuously growing imbibition with increasing duration of the laser irradiation can be observed. Three clinically important phenomenon, depending on the laserdose can be observed: 1. a partial, 2. a subtotal and total obliteration of the network of the vessels, and 3. a total destruction of the blood-vessels and also of the tissue. Therefore clinically a subtotal or total network obliteration of the blood-vessels of strongly vascularised tissues, haemangiomas, teleangiectasias in case of morbus Rendu-Weber-Osler and livid enlarged nasal conchae might be obtained. Further a total tissue-destruction with a break in the continuity of the tissue for example with strongly vascularised carcinoma or its metastases might be effected.


[The effect of various aerosols on nasal ventilation (rhinomanometric investigations (author's transl)].

Rhinomanometry is useful for estimating the reactions of nasal mucosa to saline aerosol inhalations. The resistance of the whole nose provides insufficient evidence. Reactions on one side of the nose clearly show that--it is possible to differentiate qualitatively and quantitatively between the first and the second stage after inhalation. The reaction on one side of the nose may be opposite in character to the other side. The same person may respond in a contrary manner on different days both qualitatively and quantitatively. Patients with rhinitis and allergy react particularly briskly. The problems of nasal dynamics are indicated.


[A dangerous perforating injury of the soft palate in childhood (author's transl)].

Perforating injuries of the soft palate in childhood are generally uncomplicated. Such simple injuries may however be accompanied by far reaching consequences. A resulting thrombosis of the A. carotis interna in a child after a perforating injury of the soft palate showed how difficult diagnosis may be. Perforating injuries of this type are relatively common, complications are relatively rare. Furthermore the injury may be followed by a lengthy symptom-free interval. No further diagnostic procedure seems necessary during this interval than clinical examination. The belated appearance of central symptoms comes at a time where all to often diagnosis and therapy can not influence the final outcome.


[The puncture treatment in frontal sinusitis (author's transl)].

Patients suffering from acute or chronic frontal sinusitis should be treated by a drill-puncture of the anterior wall. A chronic cannula or a plastic tube is inserted and the sinusitis by this way influenced directly. In more than 60% of the cases the sinusitis can be cured and an operation is prevented. The procedure should be combined with a control of the nasal septum and the medial turbinate. Recidives of chronic frontal sinusitis after previous puncture should not a second time be treated using this method.


[Acute unilateral peripheral vestibular upset in herpes simplex infection (author's transl)].

Report on a sudden peripheral vestibular upset 8 days after a serologically evidenced herpes simplex infection. Reference to the significance of virological-serological examinations in any cases of acute vestibular upset, sudden deafness and peripheral facial palsy. Discussion of etiology, pathology and probable localization of this affection, about which medical literature does not contain any relevant observations made in connection with herpes simplex infection. Electronystagmographic control of the course of the disease, demonstrating the complete restitution of the vestibular organ. Thus, justified assumption of rather a peripheral vestibular lesion.


[Neurootological findings in zoster oticus (author's transl)].

Zoster oticus is an important disorder in neurootological routine diagnostics. However, the neurotoxic zoster virus is not being confined to the nerval periphery. Therefore as well typical peripheral as well as typical central as well as combined reactional patterns are to be found by neurootological functions tests. By selection and adaptation of tests optimal diagnostics can be completed in the vestibular-ocular, the vestibular-spinal and retinal-ocular sensory motory systems. Thus disorders as such can be identified and additionally localised. The peripheral zoster oticus can be differentiated from the central zoster encephalitis. These findings are demonstrated by typical case reports.


[Rate of transudation of the mucous membranes by testing the enzymes of the intermediary metabolism in the secretion of patients with different internal diseases (author's transl)].

In patients with increased levels of GOT, GPT, CPK, LDH, SP and AP in serum, the activities of these enzymes in nasal mucus are determined. Even in cases with extreme increase of activity in serum, the enzyme-activities in nasal mucus are normal. From this we concluded first, that the enzymes in nasal mucus are specific products of the intermediary metabolism of the mucous membranes and secondly, that the rate of transsudation of serum proteins by the nasal mucous membrane therefore is very low in physiological state.


[Experimental study on compatibility of endotracheal prostheses (author's transl)].

On 34 rabbits we supported the trachea with endotracheal tubes of PVC or PTFE (Teflon). Results are discussed. To obtain satisfying results, it is necessary to use short, soft and inert tubes without sharp edges at the ends. The prostheses should be fixed in the trachea. Immobilisation of head and neck with a plaster-collar minimizes mechanical irritation.


[Automatic evaluation of ERA based on stochastic-ergodic conversion (SEC) (author's transl)].

Averaging of stimulus-locked EEG-samples often leads to unreliable results in patients for which ERA is indispensable for diagnostics, namely in the case of uncooperative children with hearing disorders. SEC converts the EEG into a binary random sequence which after averaging results directly in a probability measure for the response. Clinical experiences with an automatic evaluation procedure based on SEC are reported.


[Electrocochleographic potential pattern, recorded by different pick-ups (author's transl)].

At electrocochleography, the active electrode was placed on the earlobe, the mastoid, the nasopharynx, the hard palate and the external ear-canal respectively. It could be shown that the potential pattern, consisting of five components, during the first 8 msec after the click-onset could be obtained from all the above mentioned sites. In relation to the various electrode pick-ups we obtained different amplitude functions with nearly the same latency behaviour for all five potentials.


[Liquorrhea of the maxillary sinus, caused by an arachnoidal cyst of the ethmoid cell system (author's transl)].

Clinical case report of a liquorrhéa of the maxillary sinus, caused by an arachnoidal cyst of the ethmoidal cell system. The cerebrospinal fluid was drained by a canalis ethmoideo-maxillaris into the maxillary sinus. The clinical signification of the canalis ethmoideo-maxillaris, canalis fronto-(ethmoideo)-maxillaris and canalis sphenoideo-(ethmoideo)-maxillaris in cases of rhinobasal fractures and cases of meningitis have been discussed. 2 X-ray and 1 endoscopical photo.


[Neoplastic "acute mastoiditis" in childhood (author's transl].

Report of two cases with "acute mastoiditis" which was due to secondary malignant disease in the mastoid as shown postoperatively. One was the metastisis of an embryonic lung tumor previously diagnosed as histologically benign, the other one was the first sign of acute myeloid leukemia.


[Written information as a basis for the individual instructive talk before standard operations of the ENT (author's transl)].

Before any operation the patient is to be informed by his doctor thoroughly of the calculated risk between illness and operation so that he will be able to choose between the different methods of treatment. The information should not frighten the patient, but--on the other hand--should not diminish the realities of the situation. The patient's consent to the operation is only legal under the above mentioned conditions. Information-sheets have been presented to the patients before standard-operations of the ENT and have been in practice for 6 years. These sheets have been found helpful, as they are a basic source of information for the patient and a first step before a more thorough talk with his doctor which is then more informative and precise than it would be without the information recieved before hand.


[The objective sinumanometry (author's transl)].

Using a pressure chamber for differenatiation of naso-sinal and sino-nasal ventilatory ostial resistance, we examined 300 patients with pathology of the frontal and maxillary sinuses, stimulating physiological conditions. The analysis of the different obstructing factors--before and after washouts--hints to the presence of a surface--active substance in human sinus secretions.


[The stuffed nose in the morning--a symptom of house-dust allergy (author's transl)].

Not only the aetiology and the pathogenesis, but also the ecology of the house-dust system, determine the symptoms of house-dust allergy. In interpreting the symptoms, the altered elasticity of nasal blood vessels as a sign of allergic and non-allergic rhinitis must be taken into consideration.--Excerpts from a questionnaire are used to describe patients' complaints: They experienced stuffines of the nose for half an hour or longer in the morning with a lessening of symptoms in the evening--a condition which had existed for months or even years. These complaints are compared to the results of a scratch test in which the patients' own house-dust was used. With a statistical certainty of more than 99%, the described complaints differed from those of a perennial and constant rhinitis of a differing aetiology. The value of a special anamnesis in association with dermatological and intranasal tests is discussed.


[Lethal aspergillosis of the paranasal sinuses (author's transl)].

A 73-year-old farmer developed both blindness of his left eye and a 20 kg loss of weight within 3 months. A protrusion of his left eyebulb was observed, which suggested the retrobulbar growth of a tumor. Histologic examinations of several biopsies from the paranasal sinuses evidenced polypoid tissue with signs of chronic inflammation, ulceration, and fungus infection. The patient died in cerebral coma. The autopsy revealed a destruction of the cranial base by a chronic mycocenic osteomyelitis, a frontal lobe abscess, and a fungus invasion of the internal carotid artery with circumscribed thrombosis of this vessel and adjacent encephalomalazie. The fungus was identified morphologically as aspergillus, a rare differential diagnosis to paranasal malignancies.


[Hearing alterations in vertebro-basilar insufficiency (author's transl)].

The morphological facts are represented, to see hearing alterations as a possible consequence of vertebro-basilar insufficiency. The conception: "vertebro-basilar insufficiency" is defined. Compared to vestibular disturbances cochlear disturbances in vertebro-basilar insufficiency are extremely rare. Always we find sensorineural hearing loss or complete unilateral deafness, most combined with tinnitus. All publications we got reported, only 4 from otologists. The conception "sudden deafness" is defined by differential diagnosis. The vertebro-basilar insufficiency, secured by arteriographical or neurological examinations, is not the same as a syndrome of cervical spine with effects to the vertebro-basilar artery system, except the pathogenesis of this syndrom is evident. But this evidence is not given till now.


[Central hearing loss in patients with fronto-basal fractures of the skull (author's transl)].

23 persons were examined with regard to post-traumatic hearing damage after having had a frontobasal injury of the skull. The occurrence of central hearing damages was especially looked for. On the basis of preceding experiences with central hearing test methods gathered on persons with noise-induced hearing damage 21 victims of accidents had to undergo the following three special tests apart from the usual audiometrical procedures: Dichotic discrimination test, acoustic trigger action of the impedance jump and direction audiometry. The investigations had the following results: 1. Damages of the inner ear in the high frequency range originate for the most part also in frontobasal fractures of the skull--basocochlear type. 2. Damages of the inner ear are small and indicate a continuous increase towards higher frequencies. 3. The dichotic discrimination test is positive only in a few cases (4 out of 21). 4. Direction audiometry clearly indicates the existence of central  damages (increase of the lateral position angles). 5. With transanimated cases the deviations of central hearing damages equal the average. As a consequence of the studies under consideration a search for central hearing damages after frontobasal fractions of the skull is recommended. In these cases investigation methods of direction audiometry seem to be particularly convincing.


[Noise-induced hearing loss with chronic otitis media (author's transl)].

Two different otological noxes add up in their effect. In some cases, however, the first one may cause a reduction of the noxious effect of the second one. Opinions are divided as to whether the susceptibility to noise of an ear with chronic otitis media is increased or decreased. From 14,300 audiograms we selected those 131 cases with unilateral chronic otitis media and, at the same time, with a typical noise-induced recruitment-positive c5-dip on the other side. There were 86 cases with larger bone conduction hearing loss on the ear with chronic otitis media. In these cases, the bone conduction hearing loss, by all differential diagnostic criteria, could be judged to be caused by the chronic otitis media. On the other hand, in all those 45 cases which, on the side with chronic otitis media, had a bone conduction loss in form of a c5-dip, this was in each single case less pronounced than on the other ear. Regarding the susceptibility to noise, the reduction of sound intensity by the conductive deafness seems to be more important than noxious effects of the chronic otitis. Generally a substantial bone conduction hearing loss with chronic otitis media and noise exposure should be attributed to effects of the otitis.


[Dichotic hearing test in 750 German school-children (author's transl)].

Dichotic tests, according to Feldmann 1965, were carried out within a main highschool of Munich (W.-Germany). Over 750 school-children ranging from 6-17 years in age were tested in pure tone audiometry and dichotic Feldmann test. The result showed a poor reproduction of words in the dichotic test in age groups under 10 years. The conclusion seems to be that the single words of this dichotic test are 1. too difficult, 2. without real meaning, 3. hard to grasp or 4. without worthy motivation in these children. A new test for children is required to cope with the difficulties of speech assessment in young school-children.


[Meteorological observations concerning haemorrhages after tonsillectomy (author's transl)].

Based on the observation of 929 patients who had to be subjected to tonsillectomy within a period of twelve months, the authors concluded that the vast majority of post operative haemorrhages occurred during the beginning of a good weather period (clearing from the west), not quite so often during a "Föhn"-period (warm winds from the south). This contrasts somewhat with the observations of other authors who found a connection between haemorrhages and the beginning of a period of bad weather (close and stuffy, increasing humidity, high clouds). The dependence of postoperative haemorrhages on meteorological influences would perhaps give a reason for the hitherto medically unexplainable 40 per cent bleedings. Based on these observations it would be desirable for the meteorologic stations (or the media) to inform the doctors and hospitals about the weather phases.


[Primary sarcomas of the skull in children (author's transl)].

Most cases of primary malignant tumors of bone occur in children and adolescents. There are several types to be classified according to clinical and radiological findings and histologic diagnosis Ewing's sarcoma and osteogenic sarcoma; chondrosarcoma, malignant tumor of cartilage, is also classified in this group of tumors. Incidence, age-and-sex-distribution clinical presentation, and diagnostic procedures are reported for the different types of tumors, with special reference to primary localization in the skull. Different therapeutic modalities are discussed. Cure rates in these highly malignant tumors are still low, but evidently improving.


[Carcinosarcoma of the larynx (author's transl)].

Case report of a 53-year-old male patient with a carcinosarcoma of the vocal cord. The diagnostic problems of these rare tumors are discussed with a review of the available literature.


Quantitative aspects of the metabolic response to pancreatic islet transplantation in rats with severe ketotic diabetes.

Injection of 100-140 mg/Kg of streptozotocin produced severe, ketotic diabetes in 12 pairs of adult rats. Transplantation of intact islets of Langerhans from syngeneic adult donors into a muscle pocket or a pouch created from pancreatic tissue of one animal from each pair eliminated ketonemia in the immediate postoperative period, while ketonemia persisted in the sham-operated controls. Mean survival of transplanted animals was 145 days, versus 70 days for controls. Mean body weight increased and blood sugar decreased in transplanted animals compared with controls; the differences were greatest in those animals which received the largest number of islets per unit body weight. In one animal, all metabolic indices returned to normal for a period of 8 wk following transplantation of 650 islets. After gaining to 300% of initial body weight, diabetes reappeared in this transplanted animal and was again reversed by a second transplantation. The metabolic data indicate that: (1) islet tissue from adult donors survives and functions in severely diabetic, ketotic hosts; and (2) metabolic response to transplantation is a function of the ratio of islet tissue to body mass, a minimum ratio of about 2-3 islets/gm body weight being required to maintain normal homeostasis.


Biogenesis of mitochondria 36, The genetic and biochemical analysis of a mitochondrially determined cold sensitive oligomycin resistant mutant of Saccharomyces cerevisiae with affected mitochondrial ATPase assembly.

The isolation and characterisation of a mutant affecting the assembly of mitochondrial ATPase is reported. The mutation confers resistance to oligomycin and venturicidin and sensitivity of growth on nonfermentable substrates to low temperature (19degrees). Genetic analysis indicates that the phenotype is due to a single mutation located on the mitochondrial DNA which is probably allelic with the independently isolated oligomycin resistance mutation [oli1-r]. Growth of the mutant at the non-restrictive temperature (28degrees) yields mitochondria in which the ATPase appears more sensitive to oligomycin than that of the sensitive parental strain. However, when the enzyme is isolated free from the influence of the membrane strong resistance to oligomycin is evident. These data suggest that the component responsible for the oligomycin resistance of the ATPase is part of or subject to interaction with the mitochondrial inner membrane. Measurements of the ATPase content of mitochondria indicate that ATPase production is impaired during growth at 19degreesC. In addition, studies of the maximum inhibition of mitochondrial ATPase activity by high concentrations of oligomycin suggest a selective lesion in ATPase assembly at low temperature. The nett result is that during growth at 19degrees only about 10% of the normal level of ATPase is produced of which less than half is membrane integrated and thus capable of oxidative energy production. We propose that the mutation affects a mitochondrially synthesised membrane sector peptide of the ATPase which defines the interaction of F1ATPase with specific environments on the mitochondrial inner membrane.


Genetic position and amino acid replacements of several mutations in ribosomal protein S5 from Escherichia coli.

The relative genetic position of the following four mutations of ribosomal protein S5 has been determined: spc-13, a mutation to spectinomycin resistance; stri N421 and strid1023, mutations suppressing dependence on streptomycin and sup0-1, a mutation suppressing partially the temperature-sensitive phenotype of an alanyl-tRNA synthetase mutation. The transduction experiments performed indicate that the spc-13 site is located in the S5 cistron proximal to the strA locus, that sup0-1 maps proximal to the aroE gene and that the striN421 and strid1023 loci are located between these two mutational sites. Proteinchemical analysis of the amino acid replacement in protein S5 of strain N421 (carrying the striN421 allele) has shown that an arginine residue is replaced by leucine which results in the appearance of a trypsin intensitive bond between the tryptic peptides T2 and T16. The same alteration has been previously found by Itoh and Wittmann (1973) in the S5 protein of strain d1023. Determination of the alteration of ribosomal protein S5 of strain 0-1 (sup0-1 allele) revealed that the C-terminal tryptic peptide is altered. It differs from that of the wild-type protein by the lack of five amino acids and the appearance of a C-terminal glycine residue instead of a lysine residue. This change can be explained by the deletion of eleven nucleotides in the S5 cistron of strain 0-1. The recent determination of the primary structure of ribosomal protein S5 (Wittmann-Liebold and Greuer, 1975) allows the ordering of the S5 alterations employed: The order is spc-13-strid1023 (striN421)-sup0-1 with the spc-13 amino acid replacement being located at the NH2-terminal portion of the S5 sequence and the alteration of strain 0-1 at the COOH-terminal end. The proteinchemical results are therefore in full agreement with the genetic data and unambiguously allow the conclusion that the S5 cistron is transcribed counterclock-wise on the Escherichia coli chromosome.


Problems of ocular immunopathological inflammations.

The following facts are emphasized. Release of histamine, immune complexes with complement activity or immunocyte interference provide the principle methods by which immunopathological inflammation of the eye are induced. Both antibody-mediated and cell-mediated hypersensitivity have been found capable of injuring ocular structures. Microbe-induced cellular hypersensitivity can be considered the etiological basis of some ocular inflammations, but this has not yet been irrefutably demonstrated in the majority of cases. Ocular autoimmune responses in man are still rather an idea than an established fact.


Anatomy of passive arthus reaction in the cornea. A preliminary communication.

Corneal changes in passive Arthus reaction are essentially the same as that reported to occur in active Arthus reaction and consist of accumulation of polymorphonuclear leucocytes around the deposits of immune complexes, release of lysosomes and fragmentation and dissolution of collagen fibrils. In addition, degenerative changes were found in the corneal endothelium and Descemet's membrane.


Standardization of an experimental immune uveitis in the rabbit for topical testing of drugs.

An egg albumin uveitis of the Arthus active type was developed in the rabbit. The experimental conditions were investigated in detail with regard to the following factors: influence of the number of sensitizing injections on serum antibody production, length of the recovery period which elapsed between sensitization and challenge, and influence of the size of the challenging dose on the severity of the inflammatory response. To develop the procedure optimally, emphasis was given to criteria of evaluation. Refractive index, protein and immunoglobulin assays in the aqueous humor of inflamed eyes were significantly correlated. These objective measures were considered more reliable than arbitrary grading systems. In addition, supportive histopathologic observations have been made in rabbit eyes. The above studies led to a reproducible model of uveitis in which drugs were tested topically. Dexamethasone phosphate in solution and indomethacin in suspension were effective in a dose-related manner. 6-Mercaptopurine did not demonstrate a useful anti-inflammatory effect.


Histopathologic observations on thyroid carcinoma with amyloid stroma.

The authors describe histopathologic aspects in ten cases of thyroid carcinoma with amyloid stroma. This form of cancer represents 3.4% of all the thyroid cancer cases in the last five years in the Institute of Endocrinology. Microscopic examination reveals a polymorphous picture alongside with amyloid deposits. The authors attribute to the tumor cells an important role in producing thyroid amyloidosis.


Morphological study of rat thymus after tumoral, non-tumoral antigens and thiamine pyrophosphate administration.

The study was performed on 60 Wistar white rats sacrificed 24 hours and 7 days after administration of glycoprotein 8 (extracted from Jensen rat tumors), glycoprotein 5 (from normal rat blood), bovine albumin, tuberculin (PPD), and a complex of strychnine, picrotoxin and TPP administered alone or together with the above-mentioned antigens. In order to study thymus morphological changes, methods of quantitative morphology and current histological techniques were used. The thymus responds morphologically to the antigenic administration - (glycoprotein 8, bovine albumin and PPD) - by cortico-medullary ratio modification, expressed by decrease of cortical surface and increase of medullary one, thymocytes agglomeration in the perivascular sheaths and their deliverance in the blood flow. Under other conditions (strychnine, picrotoxin and TPP administration) thymus responds only by thymocytes agglomeration in the perivascular sheaths. Glycoprotein 5 does not induce any modifications in thymus structure.


Kinetics of mucous cells in bronchial and bronchiolar epithelia during aerogenic elicitation with aspergillary proteins. A quantitative cytologic study.

During a prolonged exposure of rabbits to aerosols with asperigillary antigens, the content of bronchial and bronchiolar epithelia in mucus-secreting cells was quantified. In normals, the mucous cells do not exceed 3.2 per cent in bronchial epithelium and 0.44 per cent in bronchiolar one. After exposure, these proportions rapidly increase, after a primary discharge of goblet cells. The mucous cells become a majority after 7 exposures in bronchi and after 21 in bronchiolar epithelium. The maturation is more rapid in bronchioli than in bronchi. The secretion of neutral and acid mucopolysaccharides is early, concomitant in the same bronchus, and predominantly located in the impingement zones, especially the bifurcations of bronchial tree. The mitoses are extremely rare in exposed bronchi, but the epithelial and mesenchymal alveolar cells present a high mitotic index (1.14%) 24 hours after the second exposure to antigens.


Relationships between specialized cells, capillaries, and intermediary cyto-fibrillar elements. Vth note. Organizational steps or levels of these relationships during their biological development.

The developmental analysis of the interrelations between specialized cells, capillaries, and intermediary cyto-fibrillar elements points out the existence of four organizational steps reflecting the gradual increase in complexity and diversity of animal structures and functions. The development of secretory and defence functions produces a dissociation of steps between the increase of the organizational level of the whole animal organism and the autonomy of organizational steps or organs. The steps are not immovable, but under some conditions the possibility of a mutation exists between the IInd and the IIIrd steps.


Cholinergic innervation of the human stomach.

A histochemical method for the acetylcholinesterase activity was used to establish the parasympathetic components of the gastric coats in man. The four gastric layers contain a rich cholinergic innervation. In the mucosa the positive nerve fibers are located around the gastric glands and between the muscles of the muscularis mucosae. In the submucosa rich interconnected nerve fibers, rare large nerve trunks, and scarce ganglia cells show a strong cholinergic reaction. The muscular layer contains the highest density of cholinergic nerve fibers, isolated or in large bundles. Auerbach's plexus has a strong acetylcholinesterase activity in the nerve cell bodies. The subserous layer is very rich in cholinergic nerve fibers, rarely isolated, but interconnected. The vessels of each gastric layer exhibit a rich cholinergic innervation in the adventitia and the outside part of media.


Electrocardiographical investigations of normal and malformed embryo and foetus hearts in humans, mammals, and avians. Electrocardiographical investigations of the experimentally malformed heart of the chick foetus.

The experimental technique was based on the injection of a 0.5 % Janus green B solution into the embryonic pharynx through a branchial slit, at the age of three days. This method of chemical endocauterization of the pharynx was elaborated by B. Menkes. Our experimental method produces a necrotizing intoxication of an extracardiac region (the region of the branchial arches) and cardiovascular malformations similar to those observed in human pathology have been obtained. This experimental group consisted of chick foetuses of 9 -- 11 days; their interventricular septation is normally fulfilled at the end of the 8th day of incubation. 342 foetuses with or without cardiovascular malformations have been examined by electrocardiography and 678 electrocardiographs have been recorded. Normal electrocardiographs of chick embryos were similar to those recorded in mammal and human embryos. The probability of a cardiovascular malformation could be assumed by direct electrocardiography in a proportion of 80 -- 85% while indirect electrocardiography could allow the diagnosis in a proportion of only 60 %. There are no pathognomonic electrocardiographs for a certain type of malformation, but the grouping of certain alteration of the electrical recording can suggest the existence of a cardiovascular malformation. Electrocardiographs recorded with experimentally malformed hearts recall the patterns of human foetal pathology.


Dynamic aspects of the liver ATP-ase and its functional involvement in propranolol treated rat.

High doses of propranolol give rise to a liver disenzymic injury by depression of its clearance and colloidopexic functions, but without any histological change. The molecular target responsible for this disturbance seems to lie at the level of ATP-ase, because propranolol stimulates the membrane activity and supresses the citochondrial one. There are described some effects of this drug and its pharmocological opposite, isopropylenorepinephrine, on the liver cell enzymes, which may serve as a morphological proof of the antagonism between the mitochondrial and plasmalemal ATP-ase activity, on the one hand, and of the membrane ATP-ase and AMP-cyclase, on the other hand.


The role of capillary wall in the histogenesis of glomerular diseases.

The glomerular capillary is the most solicited renal component of the local and general systems of integration both under normal and pathological conditions. The alterative and reactive modifications of the glomerular capillary may be the expression of a systematic capillary disease of the initial involvement of ths structure of glomerular corpuscles. The sum of certain kind of lesions of the complex glomerular structure realizes diverse morphofunctional entities of proliferative, membranous, and sclerocicatricial glomerular diseases. The glomerular diseases, irrespective of their nature, induce changes in the balance of the intra-and internephronal relationships, realizing new vicious circles which amplify and maintain the tissular destructions.


An approach to a histogenetic nomenclature and classification of lung carcinomas based on the study of 2500 cases.

The recent data concerning the action of carcinogens and cocarcinogens, as well as the role of host factors in the development of lung carcinomas are discussed in relation to 2500 studied cases. The role of basal cell hyperplasia and of metaplastic factors is emphasized. Two developmental patterns could be observed: one characterized by the persistent action of carcinogens on a substrate similar or less different as to the normal one, giving rise to the microcellular, pleomorphous and epidermoid carcinomas, and the other related to the pre-existence of fibrous lesions in the lung which enhance the accumulation of carcinogens and provide for the cylindrocubic, bronchioloalveolar carcinomas and for the pseudoglandular zones of pleomorphous ones. In these views a histogenetic nomenclature and classification of lung carcinomas is proposed.


Aminoacetonitrile (AAN)prevents connective proliferation in rat liver induced by tetrachlorcarbon. Continuous concomitant administration of AAN.

A total dose of 10 g/kg body weight of aminoacetonitrile distributed almost evenly over 35 days prevents formation of connective bands and damage of hepatocytes in the liver of rats submitted to CCl4 inhalations at a partial pressure of 1/6 atm, eight times within the same interaval. Control animals exhibited the usual pattern of CCl4 injury.


Data regarding the restorative effects of the partial removal of the liver in advanced stages of toxic cirrhosis.

The effects of subtotal hepatectomy of albino rats liver cirrhois at 6 and 9 months after the start of CCl4 administration were studied. The results were assessed through self-control and comparison with similar groups in which the spontaneous reversibility of cirrhotic lesions was followed. In the group of 6 months, the liver exeresis results in normalization of morphological and biochemical liver aspects within a period of one month from the intervention. In the group of 9 months, one may also note a stimulation of the regenerative capacity of parenchyma and marked collagenolytic effects without the complete restoration of the stroma/parenchyma ratio. It seems that the major exereses are also effective in the advanced stages of liver cirrosis once the threshold of spontaneous reversibility has been exceeded.


The effect of cancer chemotherapy on lysosomal enzymic activities (acid phosphatase) of Ehrlich ascites carcinoma cells.

The distribution of acid phosphatase in Ehrlich ascites carcinoma cells was studied by histochemical techniques in mice treated with antitumoral agents (Tio-Tepa, Cosmegen). The results proved the accuracy of the histoenzymatic demonstration of APh activity for the study of early changes induced in Ehrlich ascites tumor by antitumoral drugs : these changes precede those revealed by routine histological methods and are related to the degree of sensitivity of the tumor to the drugs.


Morphogenesis and pathogenesis of chronic lung diseases. IX. Development of reticulinic fibrillogenesis during the evolution of an associated experimental silicosis and tuberculosis.

Well developed silicotic nodules of rabbit lungs were infected with tuberculosis and treated with tuberculostatics. The spatial evolution of lesions, as well as the density of intralesional and perilesional reticulinic fibrils were quantitatively analysed, measured by planimetric and target methods, and statistically analysed. Under tuberculostatics, the size of lesions, expressed in the dynamics of the SL/ST % ratio, rapidly diminished to half after three months. In the some period, the density of reticulinic fibrils expressed by the PA of the target method, increased, with significant differences between treated silicotuberculotic lesions and tuberculotic ones. The correlation analysis between these two divergent changes showed the interfering with other factors.


[Diagnosis and differential diagnosis of chronic pancreatitis (author's transl)].

The large number of pancreas tests recommended today shows that no single method is satisfactory. In general, the rule holds that invasive methods are relatively conclusive and non-invasive are unreliable. In this report it is shown that by a rational combination of simple tests, a reliable procedure for pancreatic diagnosis in about 75% of cases is possible for the general practitioner. The methods described in recent years, such as scintigraphy, ultrasonography, angiography and retrograde pancreaticography are complicated and require great experience. In combination, they raise the accuracy to about 95%. Individual investigators can specialize in only one or a few of these methods. Diagnosis of pancreatic conditions which exceed the facilities of the doctor in practice is only possible in large centers or through co-operation of several specialists.


[Local treatment of common acne with vitamin A acid (Eudyna) (author's transl)].

A report is made on 80 male patients aged 19-25 and suffering from common acne, who were treated with vitamin A acid (Eudyna) partly as inpatients and partly as outpatients. All stages were present from acne comedonica to acne conglobata. The preparation was available in the form of cream and jelly, each containing 0.05% tretinoin. As a rule, the drug was applied once daily. At the end of the tretinoin treatment lasting for a maximum of 9 weeks, a decrease in comedones of more than 90% is reported. The tolerance of Eudyna was seen to be good to very good in more than two thirds of the patients.


Dehydroepiandrosterone sulfate loading test in the diagnosis of complicated pregnancies.

To assess placental and fetoplacental function, 50 mg of dehydroepiandrosterone sulfate was administered intravenously to 11 normal obstetric patients at 35 to 40 weeks and to 36 high-risk patients at 35 to 43 weeks of pregnancy. Plasma estradiol converted from dehydroepiandrosterone sulfate by the placenta increased in all patients after infusion, with maximal concentrations of 28 to 65 ng per milliliter 30 to 60 minutes after infusion (P less than 0.01). Plasma estetrol, produced by the fetus from estradiol, increased in all patients with maximal concentrations of 0.8 to 3.2 ng per milliliter four hours after infusion (P less than 0.01). In complicated pregnancies a subnormal rise of estradiol and estetrol was highly suggestive of fetal distress whereas a normal rise was associated with no fetal distress. The simultaneous determination of estradiol and estetrol after dehydroepiandrosterone sulfate infusion may reflect placental and fetoplacental function, and may be used as an adjunct to other methods of assessing fetal well-being.


Cellular immunity in myasthenia gravis. Response to purified acetylcholine receptor and autologous thymocytes.

To determine the potential importance of an immune response directed against the acetylcholine receptor in myasthenia gravis, we studied cell-mediated immunity to receptor as measured by lymphocyte stimulation in 21 myasthenic patients and 21 controls, including five with amyotrophic lateral sclerosis. The mean (+/- S.E.M.) stimulation index was 5.3 +/- 1.3 for patients and 1.2 +/- 0.3 for controls (P less than 0.005). Fourteen patients had indexes greater than 2.0 (nine of 11 males, five of 10 females, 10 of 11 elderly patients, and five of six with thymoma). Stimulation index correlated with disease activity (rs = 0.71, P less than 0.01). Peripheral blood lymphocytes from one of three young female myasthenic patients responded to autologous thymocytes but not to receptor; peripheral blood lymphocytes from the other two responded to receptor but not to autologous thymocytes. Our findings are further evidence that autoimmunity to the acetylcholine receptor plays a central part in myasthenia gravis.


Differential function of major histocompatibility complex antigens in T-lymphocyte activation.

We have emphasised the functional dichotomy of MHC LD and LD antigens as well as the differences in cellular responses to these antigens. Perhaps in so doing we have failed to stress adequately the similarities that exist. But while the similarities (for example skin graft rejection associated with both K and I region differences) are so very clear, the differences have best allowed our progressive understanding of MHC induced cellular responses from the perspective stressed in this article. Of greatest importance to our understanding of these transplantation antigens are the potentially differential roles for the LD and SD antigens in the complex series of events that are collectively referred to as the "allograft reaction". It has been suggested that these differences may be "merely quantitative". This possibility has been discussed repeatedly in our previous reports on the distinction of LD and SD. In fact, the great bulk of biological phenomena can be reduced to quantitative differences. It would seem to us that sufficient evidence for such differential activity exists to make the LD-SD dichotomy model an heuristically valuable one for purposes of designing future experiments. We have discussed the clinical relevance of this model elsewhere. Many authors have speculated and evidence has been gathered to suggest, that cell surface antigens associated with the MHC are important in developmental and other cell interactions. Some studies have directly addressed the question of the need for MHC compatibility to allow cell interaction to proceed optimally. It thus seems most appropriate that the genetic complex with which we are dealing has been termed the major histocompatibility complex; allowing for the literal interpretation of this term this may be the genetic region that by its influence on "tissue compatibility" may control critical cellular interactions in addition to those observed in allograft reactions. It is the simple good fortune for those whose attention was focused on this complex by transplantation problems to find themselves with a panorama of biological phenomena that require extensive experimental probing and integration, hopefully ultimately leading to an understanding of the MHC in a broader context than has to date been possible.


Plasma estrogen response to dehydroepiandrosterone sulphate injection in normal and complicated late pregnancy.

Dehydroepiandrosterone sulphate (DHAS) was administered intravenously to 70 women in the third trimester of pregnancy. By measuring the increase in the concentrations of estrogens in maternal plasma, it was hoped to assess the reserve capacity of the placenta. In normal pregnancies, unconjugated estradiol invariably showed a marked increase within 60 minutes of the injection of DHAS, reaching 174 to 478% above basal levels. Changes in unconjugated estrone were more variable, but significant increases usually occurred 2 to 3 hours after the peak concentration of estradiol. The concentrations of unconjugated estriol showed no significant change. Patients with preeclampsia, essential hypertension, retarded intrauterine growth, diabetes, and twin pregnancies did not show any major differences in response compared to the normal pregnancies. Two patients with intrauterine deaths had low basal concentrations of estrogens but responded to the DHAS injection by having significantly increased concentrations of unconjugated estradiol after 60 minutes. The only patient who did not show any increase in unconjugated estradiol levels after DHAS was thought to have a placental sulphatase deficiency. This test does not appear to have any advantage over existing methods of assessing the endocrine function of the placenta except in confirmation of placental sulphatase deficiency.


Modified Gilliam uterine suspension using laparoscopic visualization.

In recent years, uterine suspension has become in infrequent operation on most gynecologic services. While numerous types of suspensions have been described, the round ligament fixation to the rectus sheath described by Gilliam is commonly employed because of its ease, effectiveness, and low complication rate. Laparoscopic visualization of the pelvic organs can allow this type of suspension, requiring only superficial incisions down to the rectus fascia, and thereby markedly reducing the procedure's morbidity and the patient's hospitalization.


Metabolic clearance rate of dehydroisoandrosterone sulfate. V. Studies of essential hypertension complicating pregnancy.

The metabolic clearance rate of dehydroisoandrosterone sulfate (MCRDS) was determined prospectively in gravidas with and without chronic essential hypertension. In normotensive patients, the MCRDS increased in linear fashion throughout pregnancy. In patients with chronic essential hypertension the MCRDS also increased progressively, but at higher values than in normotensive subjects. In normotensive gravidas who ultimately developed pregnancy-induced hypertension, the MCRDS increased progressively at a higher level than in gravidas who remained normotensive until approximately 4 weeks prior to the onset of clinical symptoms, at which time the MCRDS slowly decreased. Similarly, in gravidas with chronic hypertension who developed superimposed pregnancy-induced hypertension, the MCRDS increased progressively at higher levels than all groups studied until approximately 4 weeks prior to onset of hypertension, when a progressive decline in the MCRDS began.


Metabolic clearance rate of dehydroisoandrosterone sulfate. VI. Studies of eclampsia.

The metabolic clearance rate of dehydroisoandrosterone sulfate (MCRDS) was measured in 11 women during an eclamptic episode, and the subjects were then followed for at least 5 years. The MCRDS was usually decreased in primigravid women with eclampsia. However, in eclamptic primigravid women who later developed essential hypertension and/or recurrent hypertension in subsequent pregnancies the MCRDS was elevated. Also, in multiparous women with chronic essential hypertension plus superimposed eclampsia, the MCRDS was increased to above normal values.


Ovarian and peripheral venous steroids in XY gonadal dysgenesis and gonadoblastoma.

Determinations of multiple steroids were made on ovarian and peripheral blood in a 46,XY patient with bilateral gonadoblastoma. The right gonadoblastoma had undergone complete calcific ablation. The principal viable cellular elements in the left gonadoblastoma were Leydig cells. Except for a borderline increase over peripheral levels of estradiol, the degenerated right tumor mass showed no evidence of endocrine activity. Venous blood emanating from the left cellular gonadoblastoma exhibited significant elevations of testosterone, progesterone, and estradiol as compared to peripheral blood. Viable sex cord elements were present in the left tumor mass but did not exhibit sufficient steroid activity to have demonstrable clinical manifestations.


[Hypospadias in infancy I) pathophysiologic considerations II) hormonal balance studies (author's transl)].

Animal studies (Goldman, Jost) and test results in patients with hypospadias (Bongiovanni, Zachmann, Knorr) put up the question, whether all forms of hypospadias could be caused by a disturbance or peculiarity of the adrenal or gonadal androgen metabolism. Healthy volunteers and boys with glandal, penile and scrotal hypospadias were examined for their basal hormon status and response to stimulation. The following test-results are uniform, however due to the small number of cases, we would like to use these data more as a suggestion for peculiarities of the androgen metabolism, these are: 1. signs of quantitatively decreased testosteron production. 2. signs of qualitatively deranged testosteron-biosynthesis in patients with hypospadias due to a) decrease in certain enzymes in the testosteron-biosyntheticpathway (3-beta-hydroxysteroid-dehydrogenase, 17,20-desmolase, 17-beta-hydroxysteroid oxidoreductase) b) increased peripheral conversion of androgen metabolites 3. signs of a suggested "saving" of androgens in the catabolism of those compounds and, last not least 4. signs of gonadal transformation of the adrenals, seen by increased adrenal androgen production and an adrenal transformation of the gonads, which can ultimately be considered as faulty differentiation of these 2 organ systems.


[Structural change of special education in rural districts (author's transl)].

Using statistical material on the care of handicapped persons administrated at a Special Care Centre, the author demonstrates development of special education service in Carinthia. A considerable increase in the number of persons treated causes more efforts on special education of preschool children. This early training prevents a further increase in special schooling and facilitates the integration of the handicapped in the normal community. Institutions for vocational training are necessary. There is a tendency not only to create more institutions but to specialize their programmes so that their wide variety provides for different therapeutic plans.


[The social integration of disorded children and juveniles. Aspects of the medical, socialpsychiatric and therapeutic pedagogies (author's transl)].

The general principles in the treatment of the disordered, is the change from segregation to social integration. The allocation of financial resources is necessary for the needed conditions, that means, that instead of the traditional institutions but mostly the ambulatory institutions, an early apprehension therapy should be financed. The seriousness in the treatment next to the specific facilities for the disordered, is the individual psychic help needed in regard to the secondary psychic problems, as a result of his disorder, also the socialization of the disordered should be advanced. Social organizations for disordered, as well as the parents of disordered children have a very important task, but the organizations can only fullfill the work in cooperation with a municiple care system.


[Congenital heart disease and down syndrome (author's transl)].

It is reported about 61 children and literature of congenital heart disease and Down syndrome. Even for the cardiologist the heart malformations has to be seen only as a part of the disturbance of the whole individuum. Therapeutic problems are discussed.


Chromosome damage in Down's syndrome induced by chickenpox infection.

Chromosomes were studied in 74-hr lymphocyte cultures from seven patients with Down's syndrome and from 12 hematologically and karyotypically normal control subjects. Six were studied before and six after chickenpox infection. In Down's syndrome, the number of breaks per cell was 0.083 +/- 0.036 immediately after chickenpox infection; this was significantly greater than the number of breaks before infection, 0.03 +/- 0.008, and also significantly greater than the number of breaks, 0.046 +/- 0.023, observed in control children with chickenpox. Therefore, chromosomes from patients with Down's syndrome were significantly more sensitive to breakage after chickenpox infection than those from control subjects. The incidence of chromosome breaks in Down's syndrome 1 month after chickenpox infection fell to the level observed in the preinfection range. The present results showed that the difference between the observed and the expected values for breakage in special regions of chromosome was not significant, but that chromosome breakage was random.


The effect of anabolic hormone 19-nortestosterone propionate on the metabolism of striated muscle during experimental ischaemia.

The effect of the anabolic hormone 19-nortestosterone propionate (Superanabolon Spofa) on the metabolism of chronically ischaemic striated muscle (anterior tibial m.) was studied in a described model in the rat. Metabolic changes were estimated in terms of the activities of a number of enzymes in muscle fibres. Enzyme activities (AcP, ATPase, CE, LDH, MDH) were determined both biochemically and histochemically excepting SDH, which was determined only by the histochemical way. Morphological changes were investigated by routine histology. Administration of 19-nortestosterone propionate prevented enzymatic changes which are typical for chronic ischaemia, primarily the decrease in the activities of dehydrogenases of Krebs' cycle tricarboxylic acides (MDH, SDH). In addition, the ratio of red to white muscle fibres increased. Administration of anabolic hormone has a similar favourable action on ischaemic muscle as training, studied previously.


Warm receptors in the dorsal abdominal wall of the rabbit.

Warm stimulation of a circumscribed region of the dorsal abdominal wall of the rabbit evoked discharges in splanchnic afferent single fibers. They showed positive temperature coefficients of their static activities and of their dynamic responses to temperature changes. They were not excited by mechanical stimuli. Cooling from static conditions caused a transient inhibition of impulse frequency. Two populations were found, one having a static and dynamic maximum at 46 degrees C, the other one at about 40 degrees C. Both types were found to be C-fibers, with a conduction velocity of 0.6 - 1.1 m/sec.


[Polyamides and esters of terephthalic acid used in the production of medical articles to be sterilized by accelerated electrons].

The paper concerns the study on the resistance of home-made polyamides and polyterephthalic acid esters used for manufacture of medical equipment to the effect of accelerated electron radiation. The studied polyamides were found to be unfit for medical articles manufacture without removal of soluble components of the plastics. Sterilization with accelerated electrons results in limited advantageous changes in polyamide properties. Medical articles made of polyethylene terephthalate can be successfully sterilized in electron accelerator with no changes in characteristics even upon prolonged storage.


Endotoxic activity of complexes of myristic acid and proteins.

Complexes of myristic acid and bovine serum albumin, myristic acid and concanavalin A, beta-hydroxymyristic acid and concanavalin A, or dimethyl myristamide and concanavalin A are lethal for male BALB/c mice treated with mithramycin. Prior treatment of mice with myristic acid-protein complexes renders the animals resistant to a dose of bacterial endotoxin that is lethal for untreated animals. Prior treatment of mice with bacterial endotoxin renders them resistant to a combination of mithramycin and a complex of myristic acid and bovine serum albumin or dimethyl myristamide and concanvalin A that is lethal for untreated animals. These data indicate that a fatty acid is an important functional component of the endotoxin toxophore.


Human pituitary growth hormone. 44. Effects of plasmin-modified hormone and its fragments on ornithine decarboxylase activity and lipolysis.

The rat hepatic ornithine decarboxylase stimulating activity of plasmin-modified human growth hormone and its two peptide fragments has been investigated. The activity was completely retained after plasmin treatment. The NH2-terminal fragment [Cys (Cam)53-HGH-(1-134)] retained 10% of the activity, whereas the COOH-terminal fragment [Cys (Cam) 165, 182, 189-(141-191)] was not active. The lipolytic activity of human growth hormone was greatly reduced after plasmin treatment, as examined in isolated rabbit adipocytes. It is suggested that the structural requirements for the lipolytic activity of the hormone are different from those required for stimulation of ornithine decarboxylase activity.


The effects of DL-p-chlorophenylalanine and DL-alpha-methyl-p-tyrosine on the brain catecholamine, serotonin and free amino acid contents in rat.

The changes in the brain levels of catecholamines, serotonin and free amino acids have been considered as a factor in the development of the physical dependence on and tolerance to some drugs. In order to show the relationships among the brain levels of these substances, three groups of rats were given i.p. DL-alphaMpT alone, DL-pCPA alone, or DL-alphaMpT and DL-pCPA together, twice a day for three days. Another group was kept as control. The brain levels of catecholamines, serotonin and free amino acids were determined. Although DL-alphaMpT and DL-pCPA alone caused a decrease in the levels of catecholamines and serotonin respectively, the administration of DL-alphaMpT and DL-pCPA together did not. The changes in the levels of free amino acids which were found were related to the metabolism of catecholamines and serotonin.


[Effects of diazepam on six drug-induced locomotor hyperactivities in mice (author's transl)].

Experiments were carried out in mice to investigate the influence of diazepam (DZP) on dexamphetamine, parachloro-N-methylamphetamine (pCMA), cocaine, morphine, trihexyphenidyl or (in MAOIs pretreated) reserpine induced motor hyperactivity. The interaction of DZP with these hyperactivities in which probably different biochemical central mechanisms are involved allows to construct a profile of action of DZP and to approach its mechanism of action. The locomotor hyperactivities induced by dexamphetamine, pCMA, morphine, cocaine were not reduced by DZP even by doses which decrease spontaneous locomotor activity; low doses of DZP enhance the hyperactivity induced by these compounds. Those induced by trihexyphenidyle or by reserpine (after MAOI) were reduced by DZP at doses which produce no decrease in spontaneous motor activity. Inasmuch as DZP at low doses potentiates the effects of 4 different substances, the results can hardly be satisfactorily explained neither by an interference of the benzodiazepine on the metabolism of the drugs or by a depression of the anxiogenic action of dexamphetamine. Even though it may be difficult to relate the antagonism of DZP on trihexyphenidyl- or on reserpine- (after MAOI) induced motor hyperactivity to the suggested anticholinergic and dopaminergic actions of DZP, these effects may partly be involved in the increase in locomotor hyperactivity induced by dexamphetamine, morphine, or cocaine. The observed effect of DZP on pCMA induced locomotor hyperactivity does not support a possible antiserotonine action often suggested to explain the effects of benzodiazepines in conflict situations.


The right pulmonary artery-left atrial axis line. A method for measuring left atrial size on lateral chest radiographs.

Based on the relationships of the aorta, right pulmonary artery (RPA), and left atrium (LA), a method for directly measuring the LA diameter is described. A line drawn downward from the anterior wall of the RPA, parallel to the barium-filled esophagus, will approximate the anterior wall of the LA and enable a direct measurement of the anteroposterior LA diameter. This radiological measurement correlated well with the echocardiographic determination of LA size in 82 adult patients. In some patients, direct measurement of LA size made it possible to detect chamber enlargement before other signs appeared. The major disadvantage of this method is the inability to clearly see the RPA in infants and in approximately 10-15% of adults.


Skin reactions with iocetamic acid.

Four cases of severe skin reactions to the use of iocetamic acid as a contrast medium are reported. Although the incidence of this type of reaction was relatively small (1.8%), its severity induced the authors to discontinue the use of this medium.


Pulmonary edema and respiratory insufficiency in acute pancreatitis.

Pulmonary edema, cardiac enlargement, and respiratory insufficiency may occur in patients with acute pancreatitis. The mechanisms are complex and incompletely understood, but probable etiologic factors include fluid overload, left ventricular failure, impaired respiratory excursion and microatelectasis, and a nonspecific response of the lung to various types of pulmonary injury including hypotension, intravenous crystalloids, and the effects of circulating pancreatic enzymes. Recognition of the association of pulmonary edema and respiratory insufficiency with pancreatitis is importance because early treatment with positive pressure breathing, careful fluid management and diuretics, and corticosteroids may prevent the development of irreversible respiratory failure.


[Carcinoid tumors of the digestive tract].

With reference to 6 cases of carcinoid tumours of the digestive tract the authors discuss the clinical aspects, emphasizing the utility of the paraclinical tests and the benefit of an early diagnosis, in the premetastatic phase, when surgery gives the best results.


[Odontoid fractures].

The authors present some basic considerations on the fundamental problems raised by odontoid fractures. The necessity is stressed of a correct diagnosis as well as for careful evaluation of the evolution, this lesion being characteristically unstable and precariously consolidated. This is why the authors suggest an early surgical procedure in such cases.


[Clinical and therapeutic findings cardiotuberosity on cancer].

In a total number of 1,109 cases of gastric carcinomas (encountered between 1949 and 1973) the authors have noted 122 cases with oeso-gastric localization in which 29 total gastrectomies were performed and 50 superior polar resections with oeso-gastric anastomosis (the mortality in both groups of patients was of 20%).


[Gastric consequences of toxicoseptic agression].

This study is concerned with gastro-secretory and motor answers. It was carried out in two groups of patients and the results obtained were compared. The following aspects were noted: a. the control group was represented by 10 patients that had been exposed to anesthesic-surgical aggression; b. the second group was formed by 20 patients with toxico-septic syndrome of various etiologies and in different stages of evolution; - secretory and motor gastric disturbances take on an evolutive dynamic character, according to the clinico-biological phase of the syndrome; in the acute stage absolute hypersection is noted, as well as from the viewpoint of the rate, of hydrochloric acid, and gastric hypomotility; in the chronic stage there is acid hyposecretion both insulin- and histamine-resistant and in 30% of the cases there is anachlorhydria; to the general-metabolic phase of inversion corresponds, at the gastric level; a return to normal of the motility and of the acid gastric secretion.


[Aortocoronary bypass].

Two cases are discussed, of severe myocardial ischaemia determined by coronary obstruction. The cases were solved by surgical treatment that consisted in direct myocardial revascularization with the aid of aorto-coronary by-pass with a fragment of autologous saphene vein.


[Incomplete form of congenital megacolon].

The inapparent form is described, of a congenital megacolon. The surgical treatment consisted in an exeresis of more than 70 cm of volvular sigmoid, as well as of limitrophic areas supposed to be dystonic. Re-establishment of the continuity was achieved according to the technique of B. Duham 1, modified according to D. Vereanu and A. Pesamosca.


[Surgical operations in repeated occlusions caused by adhesions and perivisceritis].

Based on the experience accumulated in the treatment of 35 cases of iterative occlusions through adherences and perivisceritis the authors present the advantages and the disadvantages of the different operatory techniques employed (total or partial Noble procedure, Raymond technique, Child-Phillips method, C. Andreolu and I. Vintilă procedures). The various factors are stressed (such as local and general conditions of the patients) that preside over the selection of the operative procedure.


[Effect of pulmonary ventilation capacity on the postoperative course in thoraco-pulmonary surgery].

The authors made a statistical investigation of the postoperative evolution in thoraco-pulmonary surgery and found diffuse hemorrhage, alterations in the evolution of wound healing, failures, higher death-rate and longer hospitalization, higher incidences being noted, inverse relationship with the pulmonary ventilation. These phenomena are attributed to the respiration disturbances, without patient clinical manifestations. The utility of the global spyrogram is acknowledged, when there are no other dysfunctions. The authors consider as lower limits of the spyrographic data, under which the surgical indications are fraught with too high a risk, values between 50 and 60% of the theoretical ones.


[Study of the blastic response of human peripheral lymphocytes to phytohemagglutinin, before and after surgical and anesthetic stress].

The results obtained by the authors show that in the postsurgery period (the 4-th to the 7-th day after surgery) there occurs a lowering of the immunological capacity of the organism, a fact that explains, in part at least, the postoperative septic complications that are more frequent in this period.


[Surgical treatment of interatrial septal defect].

On the basis of the authors' experience acquired between 1956 and 1973 (a total of 401 cases with inter-atrial communications and 234 cases of ostium secundum that have been operated by them), data are presented concerning the diagnostic means, the indications and the contra-indications of the surgical treatment, as well as the attitude to be adopted towards the associated lesions.


[Our new methods in the treatment of pertrochanteric and basocervical fractures].

The authors have employed the Ender intervention in the pertrochanteral and basi-cervical fractures, an osteo-synthesis technique which is less traumatizing and of shorter duration, providing only a very limited access of pathogenic germs and allowing for an early mobilization. In 25 patients that have been operated on the results have been very satisfactory.


[Surgical treatment of empyema (with or without bronchial fistula) after pneumonectomy].

The therapeutical possibilities are discussed in the most severe of the complications of pneumectomy : empyema, with or without bronchial fistula. The value was demonstrated of the thoraco-mediastinal plicature in the solution of 21 cases of empyema (of which 6 had bronchial fistula) occuring after pneumectomies performed for bronchopulmonary cancers (10 patients), pulmonary tuberculosis (8 patients) and broncho-pulmonary suppurations (3 patients). The results obtained were very satisfactory in 19 cases while in the other two cases the cure of the empyema was achieved although the patients died as a result of the evolution of the basal disease (bronchopulmonary cancer).


[Transdiaphragmatic shunt with a Roux loop in non-resectable neoplastic processes of the cardia].

On the basis of 26 cases with non-operable primary or secondary neoplastic obstructions of the cardia the authors express the opinion that the best solution is the transdiaphragmatic pontage with a jejunal loop mounted in Y. Enlargement of this indication should not be made on behalf of radical or palleative resections, but on the contrary internal derivations should increase the range of surgical solutions in cancer of the cardia. Making an analysis of the major aspects (death-rate, indications and some technical details) in connection with the by-pass with a Roux loop the authors stress the benignity of this type of surgery and the chances it has to take the place of external derivations, compared with which it provides both nutritional and moral advantages.