[On the epidemiology of recurrent and chronic bronchopulmonary diseases -- an examination of about 18,000 children. 6th report: summary of the investigation in the four districts (author's transl)].

In 3 districts of the county of Halle and in the cities of Halle and Halle-Neustadt about 18,000 children of different groups of age were examined wether they were suffering from recurrent or chronic nonspecific lung diseases (CNSLD). Among the 18,000 children we found 4.3% with lung diseases. The morbidity rate was the lowest in the city of Halle and in the district of Quedlinburg, while in Bitterfeld, the district with the highest air pollution, about two times more children had fallen ill. In all districts the prevalence of CNSLD in young children was much higher than in elder ones. In the district with the highest air pollution with increasing age of the children the rate of prevalence lowered more slowly than in the other districts.


Studies on smoking, chronic nonspecific respiratory diseases, and lung cancer in selected territories of Czechoslovakia.

Results of epidemiological studies in selected territories of Czechoslovakia confirmed the important role of cigarette smoking as a risk factor of chronic bronchitis and lung cancer. Surveys in Kolin-District, in Prague, and Zatec revealed that the prevalence of chronic bronchitis for adult male smokers was 3--4 times, for adult female smokers twice higher than for the nonsmokers of the respective age and sex. The risk of developing lung cancer in male smokers aged 40--64 years who had smoked a total amount of 200,000 cigarettes and over was approximately 50 times higher than for nonsmokers. The smoking related respiratory diseases represent a serious medical, social, and economic problem. Their prevention carried out by various approaches, including effective smoking control measures, is an important task.


[The clinical value of unspecific humoral immune parameters. Attempt at an immunogram. 1. Quantitative determination of IgG, IgM, IgA and IgD and demonstration of antibodies against cell and tissue bound antigens in patients with chronic pyelonephritis].

In the serum of patients with chronic pyelonephritis IgG, IgM, IgA, IgD and autoantibodies against organ- and species-specific renal antigens were determined. Clinical questions concerned relations to the activity of the disease and the renal function. The Ig-mean-values lying within the biological norm could be precised by taking into consideration individual biological boundary titres and relative ratio values. Pictures of tendency led to the estimation that increases of IgG and IgD appear in severely restricted renal function in normal or decreased IgM. Increases may be a criterion of activity in diseases with normal or slightly restricted renal function. IgA determinations remained without any evidence.-- Autoantibodies were found in 32,5%, increased titres were a sign of deteriorated renal function. The apparently given possibility of a humoral immunogramme for the chronic pyelonephritis is discussed, in which case a combination with other test parameters seems to be necessary.


[Complications during long-term control of the pressure in the pulmonary artery].

It is reported on two rare complications occurring in the pulmonary catheterisation with long-term control of the pressure of the pulmonary artery. In case 1 in confluenting bronchopneumonias the formation of an abscess in the region of the point of the catheter developed, in which case by the infusion therapy with very peripheral position of the catheter local lesions are very probable. In case 2 the catheter via an atrial septum defect passed into a pulmonary vein in PCA-position. A haemorrhagic infarction of the lung developed. In the two cases after removal of the catheter and adequate therapy the pulmonary complications healed.


[Bronchial carcinoma in multiple bilateral amyloid tumors of the lung].

It is reported on an up to now not described combination of bronchial carcinoma and multiple amyloid tumours of the lung as autopic side findings in a 68-year-old patient.


[Respiratory tract diseases, their health-political importance and trends].

The diseases of the respiratory organs are defined and classified according to the 8th revision of the international classification of the diseases. The acute forms are above all represented by the infections of the respiratory tract. They are the problem No. 1 in health politics, since the most frequent exemptions from work are given on their account. A transition into chronic diseases of the respiratory tract is not infrequent. Among the causes of death the diseases of the respiratory system occupy the 3rd place, the chronic forms are an essential cause of early invalidity. Among the chronic diseases of the respiratory organs considerable shifts to the unspecific side took place. The tuberculosis is vastly reduced. The methods practised in its combat and the graduated, well functioning system of specialised outpatient institutions and hospitals proved as a very suitable instrumentarium also for the combat against the unspecific diseases of the respiratory organs. Three main groups increasingly demand our attention: bronchial carcinoma, chronic obstructive lung disease and the professionally conditioned diseases of the respiratory organs. Their combat demands a broad partnership with the physicians of the "first line", the factory health service and the internists. For this purpose the description of the own possibilities is necessary.


[Chronic diseases of the respiratory tract (proceedings)].

On account of their increasing social-medical importance chronic diseases of the respiratory tract demand systematic measures for prevention and combat. The size of the problem is described on the basis of the results of epidemiologic investigations. Issuing from the risk degrees of the cardio-respiratory insufficiency (obstruction, hypoxaemia, pulmonary hypertension) care groups are proposed. The combat against tobacco smoking (primary prevention) and long-term treatment of the chronic obstructive bronchitis (tertiary prevention) stand in the foreground of the measures. The solution of this task demands a close cooperation with the basic medical care.


[The bronchial carcinoma].

It is referred to the importance of the nicotine abuse as the evoking factor for the origination of bronchial carcinoma and to the necessity of an activation of the combat against the addiction to cigarettes, when the numbers of diseases shall be decreased. The at present still only possibility of therapy with curative character is the surgical intervention. For this a well-timed ascertainment of the diagnosis is necessary. This is successful in the peripheral circular focus carcinoma by the mass X-ray examinations. However, the to-day's 2-year mode of performance shows a decrease of the resection rate in comparison with former years. Also the carcinoma which develops in the central bronchial parts is to be found in good time, when the necessary critical attention is paid to the first of all unspecific symptomatology induced by this. With the help of instances references are given to the practicing internist.


[Therapy of tuberculosis].

The accomplishment of the principles for the prevention of a germ resistance and the development of new principles of treatment and highly effective antituberculotics has led to the fact that nowadays actually each case of tuberculosis may be treated and cured purely internally. This progress in the individual treatment were achieved by recommendations of therapy which are actualized from time to time. The modern treatment consists of a daily application of three effective antituberculotics for two to three months, fellowed by an intermittent application twice a week. The duration of the initial intensive period and the whole time of therapy is determined by the clinical and social state before the beginning and by the combination of drugs. INH, rifampizine, streptomycin and ethambutol form the components of the therapy combinations which at present are to be used no longer than twelve months. The redetection of the special microbiological qualities of the pyrazineamide and their importance for the prevention of relapses introduces the last phase of the development of the therapy of tuberculosis. By its means it is possible to shorten the duration of the treatment to 9 months and less and thus to increase the acceptability and cooperation, to decrease the toxicity and costs.


[Case contribution to the question of side effects in the dipyridamol test].

Report on a case with disturbance of the cardiac rhythm (atrioventricular dissociation with ventricular extrasystoles) in connection with a dipyridamol test which regressed under therapy with euphyllin. This observation supports the demand of a continuous control of the ECG when the test is performed.


[Results of experimental studies of 51chromium-albumin kinetics following intravenous administration of Hylase "Dessau"].

Experiments on the effect of Hylase on albumin kinetics were carried out by means of 51chromium-labelled albumin on 52 wistar rats. Most of the examined tissues showed a faster exchange between blood and extravascular space by help of Hylase. That was recognized from advanced peaks of activity, their higher absolute values, and partly from the faster decrease of activity in organs and tissues. This effect did not depend on the structure of capillaries, it was observed also in bradytrophic tissues (cartilage).


[Experimental animal studies of spring osteosynthesis].

Clinical experiences from spring osteosynthesis suggest that more stability and possibly earlier neogenesis of the bone in the fracture area can be achieved by suitable springs for osteosynthesis. This stronger stability of fixation could be proved in experiments on cadaveric bones. In 13 experiments on dogs the biologic occurrences at spring osteosynthesis were compared to those at inflexible osteosynthesis. Observation was carried out by means of x-ray films, Tc-scintigraphy, and histologic examination; used were the methods of applying an autologous graft and of transverse osteotomy of the femora of the dogs. The question initially asked could not be answered definitely. Basing on the reported experiences, however, an experimental procedure is proposed which might yield results with clinical relevance.


[Therapeutic endoscopy of an Abrikosov-tumor of the esophagus].

The rare and almost benign granular cell tumour has been described at first by Abrikossoff in 1925. The occurrence of this tumour in the esophagus is a rarity.--On occasion of gastroesophagoscopy of a 33-years old man we found an almost pea-sized polypous esophageal granular cell tumour, wich was completely removed with the diathermic electrosurgical snare. The endoscopic-therapeutic possibilities and limits concerning polypous lesions of the esophagus will be discussed.


[Frequency and pathogenesis of epitheloid cell granuloma in Crohn's disease (author's transl)].

12% of the rectal biopsies (19% of the patients) showed epitheloid cell granulomas in clinically definite Crohn's disease. In colonic biopsies such granulomata were visible in 14% (22% of the patients). Granulomata were scarcely seen in normal or slightly inflamed mucosa. They were mostly found together with crypt abscesses and/or erosions and ulcers. The combination of local inflammation around crypts and crypt abscesses is rather characteristic for Crohn's disease. The inflammatory colonic alterations, visible in crohon's disease, may have the following pathogenetic sequence: Local colitis-crypt abscess--destruction of the crypt with proliferation of enlarged histiocytes--transformation histiocytes to epitheloid cells and Langhans cells--epitheloid cell granuloma.


[Occurrence of HBs-antigen and anti-HBs in patients with porphyria cutanea tarda (author's transl)].

Serum 63 patients with porphyria cutanea tarda (PCT) was examined for the presence of HBs-antigen and anti-HBs by the CombRIA-Au method. HBs-antigen was not detected in any of the examined blood samples. In contrast to these findings in 12 of the 63 PCT-patients (= 28 per cent), anti HBs was detected in the serum. The results showed that a high percentage of our PCT patients had been afflicted with an inapparent hepatitis B and were producing HBs-antibodies.


[Exocrine pancreatic secretion, gastrin and insulin in men by intraduodenal bolus injection of calcium (author's transl)].

The possible role of calcium in human bile during the biliary stimulated exocrine pancreatic secretion was investigated in 15 healthy volunteers. Total outputs of trypsin, bicarbonate, bilirubin and volume in the duodenal juice and serum gastrin were measured during a continuous intravenous infusion of secretion (0.5 CHR U/kg/h) for 40 min. The same parameters were determined after a single intraduodenal dose of Ca++ (20 ml 13,5, 135 or 270 mval/l, n = 5 for each dose) and compared with aequivalent intraduodenal dose of Na+ and an intravenous dose of secretion/cholecystokinin (1 CHR and IDU U/kg). Low calcium (13,5 mval/l) had no effect on the output of pancreatic enzymes and bile. However the higher doses led to a significant increases of the outputs of trypsin and bilirubin, which was about 75% of the enhancement seen with secretin/cholecystokinin in the dose used. Serumgastrin secretion was significantly increased only after the higher calcium doses.--Serum insulin in peripheral venous blood venous blood was unchanged after duodenal application of 20 ml 270 mval/l calcium (n = 5). From these data one has to conclude that the Ca++-content of bile has no stimulatory effect on the exocrine pancreas and on serum gastrin and insulin.


[The clinical picture of "circumscribed granuloma diseases"].

Characteristic findings, differential diagnosis and clinical course of the so-called "circumscript granulomas" (Granuloma anulare, necrobiosis lipoidica, Miescher's granulomatosis, disciformis, necrobiosis maculosa, granuloma multiforme, actinic granuloma, granuloma faciale and lethal midline granuloma etc.) are represented in a condensed clinical survey.


[Congenital, self-healing reticulohistiocytosis].

The described skin condition is characterized by multiple congenital skin tumours and disseminated papules on the trunk, which regressed without therapy during the first two months of life. Apart from the skin, no other organs were involved. The histological examination showed a histiocytic infiltrate composed of cells with large, irregularly formed nuclei and partly opaque, foamy cytoplasm. Extravasation of erythrocytes was frequent. The skin disorder is similar to the congenital self-healing reticulohistocytosis of Hashimoto and Pritzker.


Zinc metabolism in normal, lectin-stimulated and leukemic lymphocytes.

Gel filtration of the cytoplasmic fraction of homogenate from human peripheral lymphocytes incubated with 65Zn gave five separate peaks with molecular weights of greater than 150,000, 90,000, 65,000, 20,000, and less than 1000 daltons. Peaks I--IV consisted of proteins. The low molecular weight (peak V) may consist of nucleotides, polyamines and amino acids. After gel filtration 75-80% of the 65Zn activity was found in peak V. Lectin-induced stimulation of normal lymphocytes revealed a distribution pattern of 65Zn binding similar to that of unstimulated cells. There was only a slightly enhanced incorporation into the protein peaks I--IV. When peripheral lymphocytes of B lymphocyte origin from patients with chronic lymphocytic leukemia were incubated with 65Zn the same peaks were seen as with supernatants obtained from normal lymphocytes. Lectin-induced stimulation of leukemic lymphocytes had no significant effect on the 65Zn distribution pattern.


75Se-release: a short and long term assay system for cellular cytoxicity.

The gamma-emitting aminoacid 75Se-selenomethionine (75SeM) was examined as a target cell label in cytotoxic assays. It was efficiently taken up by activated, intensively metabolizing cells of various types but hardly at all by resting or low-metabolizing cells. Culturing activated cells in methionine-deficient medium with 3--5 mu Ci75SeM/ml for 18--22 h usually resulted in an uptake of 3--20 cpm/cell which was 3--200 times that of 51Cr marked cells. 75SeM-labelled cells kept in medium at ambient temperature or at 37 degrees C, maintained a high radioactivity per cell and a viability above 85% for at least 72 h without significant increase in spontaneous isotope release or loss in sensitivity in subsequent cytotoxic tests. 75Se-labelled material released from target cells was not reutilized by unlabelled lymphoid cells. Provided the cells were carefully washed after labelling and kept in optimal culture conditions, the reasonably low baseline release (usually 0.6--1.8% of input/h) in the medium control allowed performance of long-term assays of up to 54 h. However, strong cytotoxic reactions (e.g. ADCC) could cause over 50% specific 75Se-release within 5 h. With constant amounts of effector cells (3.6 x 10(3) up to 3 x 10(5)/well) identical or even higher, specific releases were obtained on 6 x 10(2) targets as compared to 1 x 10(4) targets/well. Thus, the 75Se-release assay offers a single monitoring system suitable for short (3--6 h) and long term (usually up to 44 h) cytotoxic reactions on a microscale, using 1 x 10(3) or less targets/well. Its sensitivity permits evaluation of strong and weak reactions as well as early and delayed onset cytotoxicity. In addition, with a gamma-spectrometer the radioactivity of 75Se can easily be distinguished from that of 51Cr. Due to this, and an improved method for 51Cr labelling of cells (10 mu Ci 51Cr/ml medium for 18--22 h), a double gamma-labelling of cellular proteins is available which provides new possibilities for monitoring cellular interactions in short and long term tests.


Erythrocyte adherence to the marginal zone of mouse spleen follicle mediated by receptor(s) for neuraminic acid.

Erythrocytes of different species (chicken, sheep, man, mouse, rat, guinea pig) except rabbit erythrocytes strongly adhere to the marginal zone of mouse spleen follicles in frozen sections. This adherence reaction (AR) is not restricted to red blood cells but is also observed with human lymphocytes. Pretreatment of the tissue sections with trypsin, mercaptoethanol, periodate, chloroform/methanol, acetone, and heating the sections abolishes AR whereas neuraminidase (VCN) treatment of the sections has an amplifying effect. AR is inhibited by preincubation of the neuraminidase- or untreated sections with neuraminic acid (NA). Treatment of the erythrocytes with VCN completely abolishes AR whereas treatment with other enzymes (hyaluronidase, collagenase) is ineffective in this respect. Determination of NA in the erythrocyte membrane before and after VCN treatment reveals a positive correlation between the amount of NA and AR. Rabbit red blood cells have the lowest NA content in their membranes and, in addition, there is little effect of VCN treatment in further reducing it. It is possible that a lectin-like substance is responsible for AR. The biologic significance of AR is hypothetical, but since AR occurs in an area of the spleen playing a role in antigen trapping it is conceivable that this trapping may be mediated by interaction of NA and NA receptor(s).


[Preliminary experience with the catheter dilatation of coronary artery stenoses (author's transl)].

The method of percutaneous transluminal coronary angioplasty (PTCA) may in selected cases dramatically improve myocardial blood supply. Seven attempts were made between September and December 1978 at the Gollwitzer-Meier Institute of Cardiology; three dilatations were unsuccessful, two were moderately successful and two highly successful. The problems as to methodology and selection of patients submitted to this procedure are discussed.


[Is hemoperfusion effective in the treatment of digoxin intoxication? (author's transl)].

Digitalis therapy is frequently accompanied by adverse drug reactions. Severe digitalis intoxications are still a problem. Therapeutical methods, which could be used in the case of a life threatening digoxin intoxication, are known, but not yet generally available. Hemodialysis has only a minor effect on digoxin excretion. This study was planned to test the hypothesis that hemoperfusion across dextran-cocoated charcoal or the resin Amberlite XAD 4 could be more effective in the therapy of digoxin intoxications. The ability of hemoperfusion to eliminate digoxin was tested in a patient who had to undergo treatment beacuse of a severe bromcarbamide intoxication. Additionally we compared the effect of several modifications on this method in 12 dogs, which had received 0.05 mg/kg body weight per day for three days prior to the experiment. Although hemoperfusion across Amberlite XAD 4 may eliminate as much digoxin as normal human kidneys during the few hours of treatment, the amount of digoxin removed after all is only a small percentage of the total body pool. Thus compared to the risks of hemoperfusion as an invasive treatment its effect is small. According to our results, hemoperfusion cannot be recommended as a standard therapy of severe digoxin intoxications.


[Electrophysiological mapping during open-heart surgery (author's transl)].

Intraoperative electrophysiological mapping provides a method to identify the specialized atrioventricular conduction system and to localize the morphological origin of different tachycardiac rhythm disorders at time of surgery. The basic technical aspects and methodical implications are presented with respect to its clinical applications.


[Ventricular and myocardial function in aortic regurgitation (author's transl)].

The influence of chronic volume load on ventricular function and myocardial load and shortening was investigated in 10 patients with chronic aortic regurgitation by means of biplane ventriculography and simultaneous pressure measurements. The regurgitant fraction was 63 +/- 15 per cent. Enddiastolic volume (EDVI 227 +/- 37 ml/m2), systolic (161 +/- 18 mm Hg) and enddiastolic ventricular pressure (30 +/- 12 mm Hg) were elevated, ejection fraction was reduced (54 +/- 7 per cent). Myocardial mass related to EDV was normal (1.2 +/- 0.2 g/ml). Contractility as measured from dp/dt max (1736 +/- 492 mm Hg s-1) and dp/dtmax/PI (22.2 +/- 4.3 s-1) was slightly reduced. Mean velocity of equatorial midwall fiber shortening VMW 0.45 +/- 0.13 cir X s-1) was significantly diminished, equatorial midwall fiber stress during ejection (sigma tej 267 +/- 44.5 X 10(3) dyn X cm-2) was elevated. In spite of a very high enddiastolic stress (sigma ED 96 +/- 36 X 10(3) dyn X cm-2) mean systolic power (sigma tej X VMX 123 +/- 43.2 X 10(3) dyn X cm-2 X s-1) was normal. Compensation of chronic volume load in aortic regurgitation is not compensated by an increased contractility but by ventricular enlargement and a pronouned increase in preload. Myocardial load and shortening in chronic aortic regurgitation are altered in the same way (increased stress and reduced shortening) as in chronic pressure overload.


[Coronary risk factors and extent of angiographically proven coronary artery stenoses (author's transl)].

In 196 patients with angina pectoris selective coronary angiography was performed, and the extent of angiographically proven coronary artery stenoses was described by means of a coronary score. A significant correlation between the degree of atherosclerotic lesions on the one hand and hypertriglyceridemia, hypercholesterolemia as well as smoking habits on the other hand was detected. No correlation between other risk factors, such as hypertension, diabetes mellitus, hyperuricemia and obesity, and the coronary score was observed.


[Non-invasive effects of cigarette smoking on left ventricular function at rest and with exercise in normal individuals (author's transl)].

The effect of cigarette smoking on systolic time intervals at rest, with volume overload and with dynamic exercise was studied in nine healthy cigarette smokers. For heart rate, PEP, LVET and blood pressure, reactions to smoking demonstrated considerable interindividual variations with comparable work loads and volume loads. More than half of the subjects developed significant left ventricular dysfunction by these parameters after smoking ten cigarettes. The negative inotropic effect was felt to be caused in these subjects by carbon monoxide. The remaining subjects did not show left ventricular dysfunction with smoking. In these subjects the stimulating effect of nicotine on the nervous system was covering the negative inotropic effect of carboxy hemoglobin.


[Arrhythmias in patients with mitral valve prolapse syndrome. An echo- and electrocardiographic study - (author's transl)].

The echocardiograms and electrocardiograms of 76 patients with mitral valve prolapse syndrome (MVP) were examined and compared with those of 20 normal subjects. 30 patients had a late systolic, 32 a holosystolic MVP, 14 patients had a mixed motion pattern of the MVP. Eighty percent of them had arrhythmias, which were detected in 44% only by 24-hours ECG, in 32% by 24-hours ECG and exercise ECG and in 4% only by exercise ECG. 16% of the patients had only atrial premature contractions (APC), 22% only ventricular premature contractions (VPC), 39% had both ventricular and atrial premature contractions. Multifocal VPC'S WERE MORE COMMON IN PATIENTS WITH LATE SYSTOLIC MVP, salvos of VPC however were detected in 3 patients with holosystolic and in one patient with late systolic MVP. Only less severe arrhythmias, in general isolated, univorm VPCs were found in 40% of the normal subjects.


["Words" in orthopaedics (author's transl)].

The interpretation of the words in the detailed and prolix terminology by Andry conveys some of the essential contents of modern orthopaedics, but completely ignores another branch of orthopaedics in adults, particularly its most important source, namely, traumatology of the locomotor organs.


[Problems and risks of functional treatment of hip joint dysplasia in early infancy (author's transl)].

Initial difficulties arise already in diagnostic stage. We cannot say whether a hip will spontaneously develop into a normal one. Hence, we must treat all children showing signs of dysplasia, and we must be willing to accept being accused of polypragmasis. There is also a certain, albeit slight, risk of disturbing the development of the femoral head. The must be strictly avoided by exercising greater possible care with regard to surgical technique and follow-up control. It is precisely the apparent simplicity of the method which presents a major difficulty. The article goes into the details of the method. Prevention in early infancy is the only possibility of checking the disease in all its stages.


[Planning of a complex intertrochanteric osteotomy (author's transl)].

The article describes in detail the preoperative planning on a complex intertrochenteric osteotomy with eight corrections. Attention is drawn to two main complication risks and how to avoid them, namely, necrosis of the head of the femur and tilting of the proximal fragment when inserting the blade of the rectangular plate.


[Comments on the double-cup hip endoprosthesis according to Freeman (author's transl)].

Histological examinations (including tetracycline labelling) of preparations of the neck of the femur which had to be removed 1 1/2, 3 and 14 1/2 months subsequent to double-cup arthroplasty according to Freeman, prove that the bone tissue can remain vital under the solidly cemented metal cup. A thick layer of connective tissue with bundles of collagenous fibres running parallel to the surface, is temporarily formed between the cement layer and the prepared spongiosa of the neck of the femur. It is possible that this layer of connective tissue is replaced within about a years' time by a thin, lamellar cortex layer, which is then covered only by a thin layer of connective tissue which is rich in fibres. Below this layer, the spongiosa spaces are definitely widened and filled with fibrotic fat marrow; vascularisation decreases, whereas osteoporosis increases.


[Discussion on the substitution of anterior crucial ligament in knee capsule instabilities (author's transl)].

The conventional methods of rehabilitation plasty of the insufficient anterior crucial ligament will usually display elasticity in course of time. Accurate reconstructions of all capsular ligament lesions and the reinforcement by threads of the requisite connective tissue transplants, show good stability and a good overall result four years after the operation in a relatively small number of patients.


[Narrowness of the recessus lateralis in the lumbar region of the spine as cause of the nerve-root compression in narrowing of the intervertebral discs (author's transl)].

The intense radicular pain of sciatica may result from nerve root entrapment in a narrowed lateral vertebral recess without discal herniation. In such cases relief of pain is achieved by unroofing the lateral recess and excising the overhanging portion of the superior articular facet, without removing the disc. The narrowing of the lateral recess is congenital, but the compression of the root occurs first in adult life. The thinning of the disc causes backward displacement of the vertebral body above and forward displacement of the cranial articular facet of the vertebral body below the thinned disc. In a large lateral recess such subluxation does not cause any entrapment of the root. If the lateral recess is congenitally narrowed the root is tightly wedged laterally and sometimes can be decompressed only by a complete arthrotomy. The same entrapment can occur as a consequence of removing of a disc (pseudorecurrence).


[Anterior interbody fusion with neurological symptoms of a spondylolisthesis (author's transl)].

28 patients with spondylolisthesis who underwent anterior interbody fusion at the Orthopaedic Department of the University of Basle between 1968 and 1976, have been follow-up. In 90% satisfactory or good clinical results were achieved. In 82% the neurological symptoms - without laminectomy - were markedly improved or eliminated. According to the authors anterior interbody fusion (with reduction and enlargement of the intervetebral space) is indicated even when neurological symptoms are present.


[The operative therapy of the acquired pes plano-valgus and pes planus of the child (author's transl)].

The author shows the importance of the development of the leg axis for the diagnosis and the indication for the treatment of the acquired infantile pes plano-valgus and pes planus. Only when this development is finished an operative therapy can be indicated. The experience gained on a very treat number ofpatients shows that it is evident that the best method is the transposition of the tendons M. fib. III or IV. The author also discusses the reasons for indication and the limitation of this operation. (The author prefers the modified techniques of K. Niederecker (1959) based on the idea of E. Müller (1903).


[Indication and assessment of the surgical treatment of fractures of the os calcis (author's transl)].

The instable fractures of os calcis are usually treated by conservative methods with early functional mobilization. In a few cases we think that in the Tongue Type and especially in the Joint Depression Type of Essex-Lopresti a surgical treatment may be useful to reestablish the congruence and the gometry of the joint surfaces. Some typical cases are described. Even if this active treatment of fractures of the os calcis may be generally regarded as hazardous, we think that especially in young selected individuals an operative anatomical reduction and stable fixation may be appropriate.


[Dwyer's calcaneal osteotomy for varus deformity of the foot. (A follow-up study including gait analysis) (author's transl)].

A follow-up study on 20 patients one to 9 years after lateral wedge resection of the calcaneus according to Dwyer is reported. In 18 feet with neurogenic varus deformity of the hind foot, the angle between the axis of the lower leg and the heel was altered from 11.4 degrees +/- 1.4 degrees SD varus to a normal value of 5.9 degrees +/- 0.9 degrees SD valgus. The position of the calcaneal tuberosity was changed from 6.7 degrees +/- 1.1 degree SD varus to 0.1 degree +/- SD varus in 7 congenital club feet. The osteotomy reduced accompanying deformities of pes cavus and pes adductus in the operated children.


[Tenosynovectomy in rheumatoid arthritis (author's transl)].

Tenosynovitis is much more frequent in RA than supposed. A comparative statistic of joint- and tenosynovectomy of the Clinic Wilhelm Schulthess is presented. It also proves the importance of flexor tendon involvement. From the patient's point of view the result is good in more than 95% 6 years in average after synovectomy. Recurrent synovitis is very rare in the extensor tendon. It may occur in the extensor carpi ulnaris. In the flexor compartement the symptoms disappear also in most instance. The reasons are discussed and figures given of our statistic.


[Temporary plugging of cystic bone tumors by bone cement (author's transl)].

Methylmethacrylate bone cement was used to refill bony defects following excisional biopsy of supposed benign or semimalign bone tumors. This procedure offers several advantages: the anatomical situation at the site of the lesion will not be altered, that means the functions of the joint and the continuity and stability of the bone will be preserved; the histological examination of the tissue is possible without a hurry; the follow up of the lesion is easily possible by X-ray-examination; further therapeutic procedures can follow without restriction, for example if the histology discovered an unsuspected malignant tumor or if the follow-up revealed a recurrency. In addition a favorable effect is the necrosis of tumor cells, eventually left behind in the bone, by the action of zytotoxic monomer and heat, originated during the polymerisation of the methylmethacrylate. In benign or semimalignant bone tumors the cement has to be removed after an adequate observation period; at this occasion the cavity again is curetted and then filled with autologous bone grafts. Since 1972 we treated 13 bone lesions by this method of "temporary bone cement plugging". The lesions were 5 giant cell tumors, 2 aneurysmal bone cysts, 2 simple bone cysts, 1 osteosarcoma, 1 malignant lymphoma, and 2 metastases of hypernephroid carcinoma. In the case of osteosarcoma an amputation was performed just after the diagnosis was made. In the other cases no local recurrances up to now were seen.


[Progresses in the orthopedic-reconstructive surgery by microsurgery (author's transl)].

After a short description of the microsurgical technique for operations of periphere nerves and small vessels, the possibilities for reconstructive operations in orthopedic surgery are demonstrated. The actual experiences allow a critical but also cautious prospective statement.


[Differential diagnosis of osteoporosis (author's transl)].

This is a review of the diagnostic procedures used in patients with osteoporosis. The differential diagnosis of various forms with recognized etiology is used as a background for the study of postmenopausal osteoporosis with largely unknown pathogenesis.


[Standing and walking with walking aids - an electromyokinesigraphic examination (author's transl)].

Study of the variations of the automatic electrical activity of the shoulder, trunk and lower extremities muscles with different types of walking aids (Cane, elbow-crutches, shoulder-crutches, tricycle). Electromyocinesigraphic recordings have been made in 10 normal men and women age 24 to 35. The variations of their posture and walking pattern according to the weightbearing with different types of aids have been studied and are discussed.


[The Erlangen hip brace, a principle of rehabilitative treatment (author's transl)].

Painful, loosened total hip prostheses and instability following their removal require up to now occasionally support by means of a brace. The paper deals with design, way of action and indication of a new, light-weight, dynamic brace to controle the motion of hip joint. It is evident that this brace can be used not only to manage the loosening of a total hip prosthesis or conditions following the resection of the head of femur, but also in osteoarthrosis of hip joint.


[The use of carbon as manufacturing material of endoprotheses (author's transl)].

According to the present stage of technology, arthroplasties have a change of only short-term to medium-term success quotas despite good initial successes. Permanent healing is restricted because of possible loosening of the prostheses. Even clinically silent loosenings will ultimately lead to failures, either by progressive degeneration of the bones at the supporting points of the prosthesis or through breakage of the stem of the prostheses. Attempts to overcome such difficulties by changing the shape of the prostheses, remain unsuccessful. The material employed in the construction of the prosthesis is certainly of some importance in this connection. Carbon has been known for a long time as a well-tolerated material in implant surgery. Carbon is indeed distinguished by high biocompatibility. The development of new carbons based on graphite which considerably improve its physical properties, has enabled the manufacture of endoprostheses made from carbon. Studies have proved that this substance is nontoxic. There are also no immunological reactions. Abrasion is low, and the abraded particles do not produce any severe inflammatory reactions. Hence, prostheses made from carbon can be employed as combination constructions, using suitable types of carbon in accordance with the required functions.


[A contribution to the differential indication of endoprosthetic knee-joint substitution (author's transl)].

The article describes a few guiding points for indicating the need for a knee-joint endoprosthesis, basing on experience with 253 cases, followed up for 2--48 months. Following the application of prostheses according to Walldius-Debeyre and Guepar, several complications were seen which we tried to reduce by introducing four prostheses of different sizes, since the choice of the implantates could be adapted to the prevailing anatomical conditions. A hinged-joint prosthesis of the St. George type is indicated in cases of most severe axial deviation, severe flexion contraction, extensive loss of bone substance, and instability of the ligaments. Sheeban's prosthesis is indicated in severe damage involving both compartments, limited frontal axial deviation, and flexion contraction of not more than 25 degrees with intact lateral ligaments. In younger patients with rheumatoid arthritis we implant the Geomedic prosthesis. If only one knee-joint compartment is involved, and after the possibility of readjustment osteotomy has been excluded, we consider a sliding prosthesis to be the prosthesis of choice.


[Histological and morphometric investigations of knee joint synovial membrane concerning diabetic arthropathy (author's transl)].

Joint capsular tissue from both knee joints have been investigated light microscopically and morphometrically in 40 cases with maturity onset of diabetes. The tissue specimen were taken from autopsy cases (27 female, 13 male). The following alterations of synovial tissue can be regarded as typically in diabetes mellitus: 1. An increased formation of synovial villi without proliferation of synoviocytes and without inflammatory reaction. 2. Increased hyalinosis and fibrosis of the synovial villi as well as fibrosis of the flat synovial membrane. The alterations were far developed in more than 50% of all cases with diabetes.


[Observation of the so-called "anti-Chiari effect" subsequent to osteotomy of the pelvis in children (author's transl)].

Osteotomy of the pelvis according to Chiari is performed in the immediate vicinity of the acetabulum and the craniolateral corner of the acetabulum. In children, it will almost always involve damaging the important growth zones of the acetabulum. Depending on the site and extent of the osteotomy performed, the pathological growth kinetics will lead to varying defects. This pathology of the kinetics of growth is known as "Anti-Chiari effect".


[Osteochondrosis dissecans of the elbow joint and the therapy depending on stage of development (author's transl)].

Of 46 cases of Osteochondrosis dissecans (OD) of the elbow joint between 1949 and 1976 in 35 patients we could control 31 patients with totally 42 diseases. According to clinical symptoms and roentgenological signs we classified the OD in an early, medium and late stage of development. The success of the therapy was discussed depending on the method of therapy, on the stage of the disease and on the age of the patients.


[Ultrastructural investigations of the palmarfascia in M. Dupuytren (author's transl)].

The palmarfascia of 30 patients with Dupuytrens disease was investigated light- and electron microscopically. As typical changes there exist an increase in cells which form noduli. Many cells contain contractile filaments in their cytoplasma are therefore described as myofibroblasts. Beside these cells active fibroblasts could be observed. Close to their cell membranes there occur filaments with a diameter of 100--300 A. In a greater distance fibrils and fibers with a diameter of 400--600 A were observed. The regular order of the connective tissue is disturbed, one often can observe "vortex" like structures. The lumina of many capillaries are collapsed. The pericytes are increased. The nerve fibers are morphologically unchanged - they are often closely surrounded by collagen fibers. Respecting the morphological findings the pathogenesis of Dupuytrens disease is discussed.


[The lengths' difference of legs in view of the general physician (author's transl)].

The present paper treats the problem of the lengths' difference of legs in view of the general physician. After a five years' research a survey has been established and a classification in four groups has been made. Moreover the question of diagnosis and therapy has been treated. The requirement has been raised to diagnose as early as possible and to apply the corresponding therapy even in case of a lengths' difference below 20 mm in order to avoid any inevitable secondary consequences. Only by acting this way arising complaints, long working incapabilities and last but not least considerable expenses can be prevented.


[Investigations on hips and extremities by ultrasonics (author's transl)].

Using a Picker Echoview System 80 L, an Ultrasound Compound scanning instrument from Picker Roentgen GmbH, Espelkamp, Germany, some investigations on bones and joints were performed. In comparison with needle probe diameter measuring of muscles it could be shown that ultrasound tomography gives identical results without pain. Figuring of hip and knee joints outlines was possible. Alterations of muscles and tendon tissue were to be seen. Special meridians on the hip joint, along with the ultrasound probe had to be moved, were defined by anatomical marking points. So it became possible to reproduce some angles which usually had to be measured at X-ray pictures.


[Late results of the operated patients with femoral neck fractures. results of the a-o technique and the endoprosthesis from 3 to 5 years after operation (author's transl)].

The late results of 133 operatively treated patients with femoral neck and trochanteric fractures were evaluated. The series consisted of 86 women and 47 men, 72 femoral neck fractures and 61 trochanteric fractures. 99 patients were treated by A-O osteosynthesis and 34 by endoprosthesis. The average age of the group with osteosynthesis was 71 and of the group with endoprosthesis 76 years. From 3 to 5 years after the operation the nailing results of the patients with femoral neck fractures were poor in 7.1 and with trochanteric fractures in 15.4 per cent. During the same observation period the results of the patients treated with endoprosthesis were poor in 14.3 per cent. There were no statistically significant difference between the A-O group and the endoprosthesis group with femoral neck fractures. Between the mortality of the nailed patients with femoral neck fractures and the endoprosthesis group there was no statistically significant difference.


[Intraosseous osteotomy in arthrosis of the knee joint (author's transl)].

The article describes a surgical method in which removal of the spongiosa is effected in the region of the upper tibia and the lower femur after fenestration of the cortex. Results are reported on the surgical treatment of 24 knee joints with painful arthrosis without any deformation worth mentioning. Worthwhile pain relief was achieved in 22 cases. In these cases, no osteotomy with correction was indicated.


[A contribution to pigmented villonodular synovitis of the shoulder joint (author's transl)].

Pigmented villonodular synovitis of the shoulder joint, particularly with osseous invasion, is a rare disease. Typical clinical, roentgenological and histological criteria are pointed out on the basis of the case report of one of the authors' own patients. Aetiology and pathogenesis of the changes are discussed. This disease must be included in differential diagnostic deliberations in the shoulder joint region as well, where it may be superficially confused with malignant tumours of the joint.


[Functional adaptation in transnaviculolunate resectionarthroplasty (Steinhäuser operation) (author's transl)].

The functional status of the new wrist joint after transnaviculo-lunate resectionarthroplasty is examined with a 12 year follow-up. The biomechanical and functional changes induced by total os lunatum and partial os navicularis resection are demonstrated. The resulting degenerative changes remain within tolerably acceptable limits after this long period. Clinically, we find a stable, almost completely pain free joint with good motion and good stress tolerance.


[Recessus and ganglia (author's transl)].

Preparated, communicating Recessus - Bursa suprapatellaris, Recessus popliteus and Bursa musculi gastrocnemii medialis - will be compared with ganglia. The surfaces document conformity. The REM-controls show a further proof of the gangliagenesis from recessus.


[Angioma like dysplasia of synovial membrane with phlebectasia causing palindromic joint swelling in childhood (author's transl)].

In a five year old boy who had intermittent knee joint swelling, angioma like venous dysplasia of synovial membrane was diagnosed by arthroscopic examination. The arthroscopic diagnosis was the indication for arthrotomy. The suprapatella pouch of the knee joint contained a blue grape like tumor. Angiomalike venous dysplasia of the synovialmembrane can histologically be separated from other angiomas of the inner joint capsule and angiomalike alterations in other joint diseases. Arthroscopy should be performed if within half a year monarticular intermittent joint swelling in childhood can not be diagnosed.


[Experimental investigations on the pathogenesis of achillis tendon rupture (author's transl)].

The histological changes following ischemic alteration of achillis tendon in rabbits are similar to those found in ruptured human achillis tendons. The healing of the experimentally damaged tendons is equal to that found in humans. Those results suggest that at least in a part of cases ischemic causes achillis tendon rupture.


Renal osteodystrophy in children with end-stage kidney failure.

The discovery that the kidney is the site of production of calcitriol clarifies our understanding of calcium metabolic disorders in chronic renal failure and carries with it clinical implications in the treatment of renal rickets. The author presents data on the action of calcium and reviews the therapeutic effects on uremic osteodystrophy in children of calcitriol and its analogue.


Family planning in Virginia: the role of public health.

Under the aegis of many medical organizations, family planning in Virginia has grown remarkably in recent years. Today the State Department of Health administers a statewide program to foster family planning and has recently created a voluntary sterilization fund, the first of its kind in the nation.


Viral hepatitis: prevention and prophylaxis.

Hepatitis A is spread by fecal-oral transmission and accounts for 25% of the cases of sporadic hepatitis in this country; fatal cases have been documented but are unusual, and chronic hepatitis A has not been documented. Hepatitis B is spread by varied routes of transmission, fecal-oral being the least important, and accounts for half the cases of sporadic hepatitis in this country; fatal cases are well documented and chronic hepatitis B is common. The only documented route of transmission of non-A, non-B hepatitis is parenteral; fatal and chronic cases have been documented, and a quarter of the cases of sporadic hepatitis are non-A, non-B. Diagnosis of the etiology of viral hepatitis cannot be determined on clinical grounds but must be made through serologic tests.


Colonoscopy in a small community hospital.

Colonoscopy is seldom performed in a small community hospital, due to the high cost of instruments and other factors but the author has accomplished 450 colonoscopies in that setting, with a small complication rate and no mortality.


Early control of a community measles outbreak.

Door-to-door immunizations and a community canvass for susceptibles were marshalled to quell a rubeola outbreak in Norfolk, one of 25 outbreaks reported in Virginia from January through August 1977.


Computed tomography of the pancreas: a preliminary experience.

CT appears to be an excellent non-invasive method for the evaluation of pancreatic disease, particularly when ultrasonography is inconclusive. The authors review their preliminary experience and analyze the results in 34 patients.


Microsurgical treatment of intracranial aneurysms.

An important advance in aneurysm surgery is the operating microscope, which allows the neurosurgeon access to previously inoperable lesions. The authors describe the technique and document their results in 19 aneurysms.


Nissen fundoplication.

A personal series of 16 patients treated with Nissen fundoplication for reflux peptic esophagitis with or without hiatal hernia between March 1975 and September 1977 is presented. The average length of followup was 18 months. The age range was 21 to 78. Very good to excellent results were achieved in 94% with a 12.5% morbidity, 6% operative complication rate and 0 mortality. This relatively simple procedure definitely reduces, if not cures, the symptomatology of the often "miserable" patient with intractable reflux peptic esophagitis. The encouraging reports in the recent literature concerning patients treated with this operation recommend its wider use in the future.


Toxic trace metals in food. II. A comparative study of the levels of toxic trace metals in wine by differential pulse anodic stripping voltammetry and electrothermal atomic absorption spectrometry.

A new high-performance analytical procedure for the determination of the toxic trace metals cadmium, lead and copper in wines by differential pulse anodic-stripping voltammetry (DPASV) subsequent to UV irradiation of the sample is compared with the hitherto more common application of electrothermal atomic absorption spectrometry (AAS). In this manner also mutually the accuracy attainable with both alternatives has been established. The particularly favourable potentialities of the new voltammetric approach for toxic metal control of wines are demonstrated by the investigation of a typical selection of 36 wines from recent vintages and common vine types of the German and some European wine cultivating regions.


[Health planning and management, instruments for technical cooperation].

Western models of health strategy are not applicable in developing countries. These need, for developing original and effective health services and systems, a planning method meeting their specific requirements. A WHO-sponsored collaborative development effort from 1970 to this day resulted in a set of programming, project formulation and management procedures broadly based on the systems approach. The 31st World Health Assembly commended this effort, which is on-going.


[Swiss cooperation in the development of public health in Tanzania].

With the financial support of the Basle Foundation for Aid to Developing Countries and in close collaboration with the St. Francis hospital, the Swiss Tropical Institute has set up and looked after a teaching centre at Ifakara, Tanzania, for the training of African medical, paramedical and auxiliary personnel. In the course of seventeen years, 770 young Africans have undergone training here. The centre has now been handed over in its final form as a Medical Assistants Training Centre to the Tanzanian Government, which has assumed full responsibility for its further direction and maintenance. The results obtained and the experience gained are discussed, as is the relationship of the centre to the public health policy of the Tanzanian Government. The writer considers that the whole undertaking has been of great mutual benefit and is looking forward to further collaboration between the Swiss Tropical Institute. Based on the Field Laboratory Ifakara, this will be mainly in applied epidemiological research, e.g. on schistosomiasis in and around Ifakara.


[Training of physicians at the Swiss Tropical Institute].

On account of the evolution of the concept of health care in developing countries, the author describes the new orientation of the medical training at the Swiss Tropical Institute. For this purpose, the miscellaneous problems met, as well as their solutions, are presented. The training of physicians in tropical medicine is more and more taking the shape of a preparation to "development medicine".


[An example of the application of factorial analysis of correspondences to infant mortality and its prevention in a rural area of West Africa].

A retrospective study through questionnaire was made among over 800 women of a Pre-Sahel region of Mali. It confirmed the very high infant and child mortality in this population: over 250% mortality under 1 year of age and over 400% under 6 years of age. The factorial analysis of correspondences proved adequate to determine the main characteristics of the local mortality pattern. In chronological order, the most important causes are obstetrical factors (1st day of life), umbilical tetanus (1 week to 1 month of age), malaria (1 month to 1 year of age), pneumopathies (including pertussis and lung complications of measles), toxicoses and nutritional syndromes (over 1 year of age).  Preventive measures at various levels are proposed on the basis of these findings. They belong to three broad groups: -Overall socioeconomic development with effective participation of the rural communities concerned. -Development of an appropriate primary health care structure, with a primary health care team in each village. -Strengthening of the programmes of control of the most important communicable diseases. Such simple and cheap actions should, given a clear political will of the national authorities and a modicum of trust in the future on the part of local leaders, be rapidly implementable even in the most underprivileged countries and bring a significant amount of progress in the rural areas.


[Integration of health development cooperation into the cultural and socioeconomic context of the operational area: work of the Putina medical team in Peru].

Contrasting with what happened with the indio traditional medicine and with the Western medical knowledge the Spaniards imported, industrialized nations' medicine, through its growing ability to fight infectious diseases, has sharpened in Peru in the 20th century the social disparity between the well-to-do upper classes and the poor masses. In order to alleviate this situation, efforts have been undertaken since the 1940's in the Department of Puno, the poorest of the country, in order to bring to the rural population the benefits of modern medicine. Since 1971, a team of Swiss physicians, integrated into the Peruvian Ministry of Health, works in the Putina area in several State health centers. There are presently five doctors for a 130,000 inhabitants population, collaborating in the setting up of basic health services. The most important pillars of the programme, which should be able to function without physicians, if need be, are voluntary health auxiliaries, chosen by their own community (1 per 500 people). State employed auxiliary nurses (1 per 5000 people), and Peruvian State Registered nurses, entrusted with training and supervisory tasks.  The progress of the programme, in terms of the growing independence of the basic health system, is described, as are potentialities and limits in bringing it closer to the indigenous traditional medicine. Through the example of the supply of basic drugs, it is pointed out how setbacks suffered in the last two years, are illustrative of the country political crisis and of its growing dependency on industrialized nations.


[The voluntary health auxiliary. Application to the Peruvian Altiplano of new concepts of primary health care in disadvantaged communities].

A group a Swiss physicians, who have been working for about eight years in rural health posts of the Peruvian highlands (Altiplano), engaged in training voluntary health auxiliaries, chosen by the indigenous communities. Experience has shown that, as in other countries, it is thus possible to markedly improve the health of populations which badly lack resources. The efficacy of using such auxiliaries was recognized by the Peruvian Ministry of Health, which has now set up a programme for their training and supervision. Within the concept of primary health care, based on the participation of people to the management of their health, the voluntary health auxiliary is placed in a strategic and decisive position for the success of an enterprise which is now spreading to many countries of the Third World.


[Preventive aspects and problems of a rural health project in Chad--the need for health motivation].

Some of the main difficulties encountered in health work in developing countries depend on the sociocultural conditions. Health animatiod until now) of rural health care. Its implementation requires the training and recycling of existing health personnel as well as of parts of the population. It includes the concept of "barefoot doctor", which corresponds well to the prevailing priority health needs. One should note potential difficulties, however, for example in regard to the way the barefoot doctor is to be remunerated (the author discusses some possibilities). It isn't easy either, in practice, to mobilize the community through health education and to obtain its participation in prevention and health promotion measures. The crucial element is to win its confidence. The author describes his practical experiences in Chad in this respect. Health animation stimulates the responsabilization and the development of a prospective outlook in people, and can thus make an important contribution to their overall development efforts. It is necessary to fight factors which slow down such an evolution, among which certain habits as well as obstacles of an administrative nature.


[Treatment of fractures by traditional healers in Morocco].

Traditional traumatologists, specialized in the treatment of fractures, practise throughout Morocco. Their original technique is described and its efficiency evaluated through twenty or so cases studied during three years of medical work in the Great South of the country. Theories are propounded to explain the population's preference for these treatments to the detriment of the medical methods, which have a bad reputation. In the present situation, the medical infrastructure is unable to replace the benefits of these bonesetters, neither in quality--with the exception of the main centres-nor, above all, in quantity. Their activities are decentralized, socially integrated and economical for both the population and the state. These considerations lead to the conclusion that their practice should be maintained, improving it if need be.


[Medical development cooperation in the Confederation. The international framework and the important place of public health in Swiss development cooperation].

The systematic organization of health services in the developing countries to benefit the majority of the population is seen as an important contribution toward the general economic and social development of these countries. This view is uncontested today, but was given less importance in the early years of Swiss development aid. The Swiss Development Cooperation's support of health services is now integrated into its overall program to satisfy the basic needs of the people of the developing countries.


[Swiss Confederation cooperation in health development: beginnings, experiences and present projects].

The types of medical and health activities in the first ten years of the Swiss Confederation's development aid program (1961-71) are examined in a critical light. In that period such aid was primarily in support of missionary hospitals in Africa and came to 3% of the total aid program of Switzerland. In the seventies guidelines for health programs were established and these have since been systematically applied. The principal aspects are: creation of basic health services, adaptation to local conditions, integration into the overall economic and social development efforts, training of health personnel. In conclusion, the article lists geographically those health projects, which are at present financed and/or staffed by DEH.


[Frères des Hommes--actions with grass roots participation aimed at satisfying priority needs: from theory to practice].

Brothers of All Men (Frères des Hommes) is a group of the two objectives of which are concrete direct action in the Third World, where the underdevelopment situation is most crucial, and an information and sensitization action in Europe. The primary health-care concept is fashionable presently, and this is all well. In the light of Brothers of All Men's practical experience in the field, at the grass roots, and on several continents, the author, however, wants to call attention, among the current enthusiasm, to serious difficulties, and certain failures, encountered in primary health-care projects undertaken with the participation of the concerned communities. He does it in particular on the basis of efforts in Sahelian Africa and Bangladesh. He also recalls that it is not the Third World partner who is supposed to assist in pursuing the goals of a foreign cooperation agency, but the latter which proposes its collaboration to the former. Consquently, projects must be formulated by the local communities and controlled by them. The implementation of primary health-care programmes requires the conjunction of two flux, a real popular dynamics locally, at the periphery, and a clearly defined national political will. It appears that, for the time being, those conditions are more easily found in congress halls than in the field.


[Kinetics of the growth of Ca oxalate crystals from supersaturated solutions].

Several factors influencing the nucleation and growth of Ca-oxalate crystals from metastable and instable solutions were studied in some detail. Factors of interest were the absolute concentration of calcium respectively oxalate, the quotient oxalate/calcium, repeated additions of calcium and/or oxalate, the presence or absence of crystal seeds, the agitation respectively stagnation of the metastable Ca-oxalate solution, the duration of crystallization, etc. The striking findings are the eminent role of oxalate in the formation of big crystals and crystal aggregates, the distinct inhibition of crystal growth at higher and very high calcium concentrations, as well as the substantial crystal enlargement at the presistent oxalate load.


[Ionic calcium in blood and urine. Methods of determination and methodological difficulties].

The present paper reports about the individual fractions of the plasma and urine calcium, further about the analytical methods for the determination of the ionic Ca, as well as about the methodical difficulties of the described analytical techniques. Considerations about the real informative value of the Ca2+ -determination in the urine led us to the conclusion that only the additional knowledge of the actual concentration of the stone-forming anions, the oxalate resp. the phosphate may mediate a more complete picture about the calculogenetic "aggressivity" of the urine under investigation.


[Compliance and active cooperation of patients in preventing recurrence of urinary calculi].

An anonymous questioning of 200 patients with urinary calculi concerning the observation of the general and special measures of the metaphylaxis of urinary calculi resulted in the fact that in particular the measures of the general metaphylaxis (bodily movement, diet, dilution of the urine) are not or only parlty obeyed by a large part of the patients. The examinations show that for the improvement of the understanding of the disease and the behaviour of the patients concerning their health further on a great attension must be paid to the quality of the information by the physician and to the communication between physician and patient. An insufficient cooperation of the patients in the metaphylaxis of the urinary calculi would call in question the effectivity of all efforts and measures concerning the prevention of relapses.


[Neurogenic bladder dysfunction in childhood. I. Diagnosis].

The diagnostic demands of the neurogenic disturbances of the voiding of the bladder in patients with myelodysplasia are summarized in tabulated form. It is reported in detail on own experiences of the authors with urodynamic measuring methods and with the electromyography of the striated musculature of the floor of the pelvis. At present the two methods are not yet used everywhere and they are a considerable enrichment of the diagnostics.


[Evaluation of hydroxyproline excretion in the urine (UHP) in prostate carcinoma].

82% of the male patients with healthy urogenital tract showed an isoelectric line in the stimulataneous EMG-derivation of the sphincter of the bladder under conditions of rest; in 18% of the males a moderate activity was present. In voluntary innervation at once an intensive electric activity of a spinle-shaped discontinuous pattern of the action potential developed in 76% of the patients. In the pressing trial in 83% of the cases a slight to moderately strong activity appeared. In contrast to the examined patients with healthy outlet of the vesicle the patients in whom an adenoma of the prostate gland or a carcinoma of the prostate gland, respectively, was present exhibited deviations from the normal pattern of the action potential, in which cases carriers of adenoma and carcinoma differed. Whether and to what extent the electromyography on the m. sphincter vesicae allows the possibility of the differentiation between adenoma of the prostate gland and carcinomaof the prostate gland in the early clinical stage shall be reserved for further examination.


[Lymphogenic metastasis in prostate carcinoma and radiation therapy].

Our examinations allow the following conclusions: 1. Before the beginning of a curative radiotherapy of the carcinoma of the prostate gland in a negative and questionably positive lymphogramme the pelvic lymphadenectomy with histologic examination of the lymph nodes is indicated. 2. In the negative findings of the histologically examined lymph nodes an exclusive local tumour irradiation is justified. 3. If in regional and negative findings micrometastases appear in the area of juxtaregional lymph nodes the additional curative irradiation of the pelvic lymph nodes seems to be indicated for the comprehension of the regional lymph nodes. 4. When there are micrometastases in the area of the aa. iliacae communes or macroscopically extended metastases in the regional and juxtaregional lymph area, so we regard as a rule a radiotherapy of the carcinoma of the prostate gland no more indicated and recommend a contrasexual treatment. The necessary expansion of the radiotherapy is according to our hitherto existing experiences badly tolerated by the for the most part older patients. 5. The intraoperative labelling of the prostate gland and the determination of the size of the prostate gland facilitate the localisation of the tumour for the radiotherapist.


[Complications of urologic diseases in diabetes mellitus].

It is reported on complications of urological diseases in diabetes mellitus. Above all the diabetic late syndrome and its multiform and uncharacteristic symptomatology in the urogenital system are discussed in detail. The present form of diabetes control can not yet be regarded as optimum form. It should be striven for changes, since it is to be reckoned with an increase of diabetes mellitus all over the world.


[Adenomectomy in hemophilia A patients].

A patient with haemophilia A is described in whom a loading blood-loss after adenomectomy developed. The congenital haemorrhagical diathesis was diagnosed only after the surgical intervention, since there did not exist any clinical symptoms. Taking into consideration world literature the problem of adenomectomy in patients with haemophilic is discussed.


[Multicentricity of urothelial tumors of the efferent urinary tracts].

On the basis of 8 cases with primary urothelial tumours of the upper efferent urinary tract with simultaneously only partly preoperatively diagnosed secondary tumours of the urothelium the problems of diagnostics and therapy are discussed. A conservative surgery may be regarded as sufficiently radical only then when a multicentric genesis may be excluded with certainty. In our patients with tumours of the upper efferent urinary tract we found a multicentricity in 18.4%.


[Primary nodular amyloidosis of the lung (author's transl)].

A 69-year old woman deceased from a pericardial tamponade following a myocardial infarction. In the autopsy, approximately 30 cherry-sized or smaller nodules, were unexpectedly found in the subpleural tissue. These nodules produced no clinical manifestations, however histological and polarisation optical investigations showed that they correspond to an isolated primary pericollagenous amyloidosis of the lung.


[Two cases with vitium cordis congenitum and rare nodules in the epicard (author's transl)].

In one newborn and one infant with vitium cordis congenitum in the epicard in correlation with coronary arteries little nodules were found. By histological observation a direct communication of large intermyocardial sinusoids and the lumen of the ventricle was seen. It is suggested, that these are arterio-venous anastomoses.


[Peritoneal aluminosis after alugramin treatment of decubital ulcers (author's transl)].

The occurrence of unusual peritoneal and subserous deposits of metallic aluminum granules in a 34 years old man after local alugramin treatment of decubital ulcers lasting for about 10 weeks is described. He died of an apallic syndrome approximately 3 months after a head-brain-injury due to an accident and terminal bronchopneumonia. The peritoneal aluminosis was diagnosed at autopsy as a secondary finding. An inflammatory peritoneal reaction was not notified. The lymphatic ganglion system is assumed to be the route of transport.


[Contribution to the knowledge of the "periostitis ossificans interna" of the cranial vault (author's transl)].

An unusual observation of hyperostosis of the frontal bone exhibiting five alternating layers of compact and cancellous bone on cross section is demonstrated. The peculiar, hitherto not described hyperostosis occurred in an 18 year old female suffering from recurrent chronical pachy- and lepto-meningitis since birth. A second similar observation was made in a 15 year old male, trepanated because of an epidural abscess. Similar accessory layers of cancellous bone on the internal surface of temporal bone suggested that also the first observation had to be interpreted as an unusually extensive form of periostitis ossificans, only involving the frontal bone, due to the recurring inflammation processes of the meninges.


[Familial occurrence of onocytic carcinoma of the thyroid gland during pregnancy (author's transl)].

Two cases of oncocytic papillary carcinoma of the thyroid gland are reported, which occurred in two sisters during pregnancy. In both cases the follow-up is without complications (after strumectomy and postoperative radiation) and therefore it is in strong contrast to the aggressive biological behaviour during pregnancy. The oncocytic papillary carcinoma is a rare disease in the endemic-goitre area without iodine prophylaxis. Electron microscopic findings confirm the histological diagnosis and outline the oncocytic cell against light-microscopically similar cells.


[Indication for treatment of gastric and duodenal ulcers by resection (BI/II) (author's transl)].

After exposing the indications for resections according to Billroth, the results achieved are analysed, advantages and disadvantages of the method are discussed with regard to late results. A strict indication lowers the motality rate, postprandial disorders, anastomotic ulceration and carcinoma of the gastric stump. New operative methods like vagotomy and its modifications should complete the surgical armamentarium, but cannot replace the classic gastric resection.


[Topography of benign nonepithelial tumours of the stomach (author's transl)].

In a series of 500 unselected autopsy cases 23 myomas, 14 neurinomas and 5 lipomas of the stomach were met. Benign tumours are mainly localized in the corpus and fundus of the stomach.


[Chronic pancreatitis; surgical therapy (author's transl)].

41 patients suffering from chronic pancreatitis underwent surgery from 1965 to May 1978. Mortality rate was 4,8%. Drainage operations and resections are the methods of choice today.


[Surgery in combined aorto-iliac and femoro-popliteal occlusive lesions (author's transl)].

In combined chronic occlusive lesions at the aorto-iliac and femoro-popliteal level the partial repair of the central vessel in combination with profundaplasty and lumbar sympathectomy ("triad procedure") represents a simpler and shorter procedure than the previously preferred total correction of both segments. In a retrospective study of 403 limbs (stage II-IV) the triad procedure shows a cumulative patency (life table analysis) of 77% vs. 39% in total repair. The amputation rate in triad procedure--for stage III/IV--was 8% vs. 36% and the frequency of reoperation 7% vs. 23% in total repair. Prerequisites for this type of repair are an optimal technique and a correct selection of patients presenting patient "receiving segment" of the popliteal artery and a sufficient run-off below the knee.


[Operative treatment of deep vein thrombosis (author's transl)].

From 1973 to 1977 a total of 63 patients with thrombosis of the deep veins in leg and pelvis and in the V. cava inferior was treated by operative thrombectomy. Prior to the operation all patients were submitted to phlebography. The mean age of all was 52 years. One patient died from pulmonary embolism during thrombectomy, there was no further hospital mortality. Because of low mortality incidence and rarely postthrombotic complications we prefer the operative treatment of deep vein thrombosis. The preoperative cavography helps to avoid pulmonary embolism during thrombectomy.


[Comparative histological and histochemical studies on the "spleen-ovary" in the rat (Lipschütz) following administration of FSH and spleen extract].

On the basis of the "Lipschuetz-ovary" model the rat ovary is cystically altered. -- In such an ovary the effect of a spleen extract (Solcosplen) and FSH (Anternon) were compared with histological and histochemical methods. -- With bothe the substances could be observed a diminution of the cystic degeneration.


[Examination of hormonal contraceptives by enzyme induction (author's transl)].

The influence of drug stimulated biotransformation on the biological effectiveness of two different contraceptives (Deposition and Gravistat) was observed.--Phenobarbital, a potent enzyme inducer, is known to increase the metabolism of steroid hormones, including estrogens and progrestogens. -- The clinical symptoms of drug mediated enzyme induction of hormonal steroid contraceptives are dysfunctional bleedings. This phenomenon is discussed.


[Investigation of hydroxyproline by hormonal contraception (author's transl)].

The effect of hormonal contraceptives administered for 24 months on the hydroxyproline content in urine was investigated. -- The results suggest an increase of hydroxyproline by application of sexual steroids. The reversibility is discussed.


[A prospective trial on osteoporosis following bilateral ovariectomy with and without oestrogen replacement (author's transl)].

During four years a prospective study was carried out on 59 women, who had ovariectomized bilaterally for non-malignant diseases. It was studied the loss of the body length, the loss of bone mineral content in a middle phalanx expressed as percentage and several x-ray criteria. By means of combined performance signs of a beginning osteoporosis were found in 59 per cent of women after 2 years and in 68 per cent after 4 years after ovariectomy. -- The authors recommend relative simple screening methods: observation of body length, the dual beam x-ray spectrophotometry (Krokowski) and the minimal combined cortex thickness of the proximal radius according Meema. Women undergoing ovariectomy before the menopause should be attended by medical teamwork. The results of oestrogen prophylaxis were not so convincing as other investigators described.


[Experiences using the suction curettage system of Hamann and Pockrand (author's transl)].

All curettages of a 8-week-period were done using the suction system of Hamann and Pockrandt. This test-collective includes 66 patients, their age was between 20 and 78 years; 6 of them had to be excluded: the surgical intervention was begun without general anaesthesia but continued with general anaesthesia is required by the patient. The test-collective was divided into 2 groups: in group A (30 patients) all suction-curettages were done in general anaesthesia, in the first 20 patients a conventional curettage with dilation of the cervix were performed additionally, in order to proof the effectiveness of the suction curettage. The histological findings of the materials of the conventional curettages had shown no more informations than that of the materials of the suction curettages. -- In group B (30 patients) the suction curettage were done in diazepampentazocin-analgesia; a third of them had specified no  sensations, the others had stated a feeling of pressure or spasms. -- In each group the histological examinations were possible without any problems. The advantages of the suction curettage system are the rare necessity of cervix dilatation (7 of 60 cases), the possibility of the operation without general anaesthesia and the possibility of a quick performance of the curettage.


[Extended prevention of uterine cervix cancer].

A transverse-oval os uteri or Emmet' tear are the result of a tear at the mouth of the womb during final cervical dilatation. Furthermore, they are the cause of a more or less developed ectopia and combined cervical and vaginal fluor with concomitant colpitis. These alterations also represent the foundation not the cause, of a development of cervical carcinoma. In the sense of prophylactic reasoning the elimination of the symptoms mentioned above should be considered. -- The use of the speculum and care of the suture of the nearly always torn os uteri after each delivery must be the first step to avoid the development of a collum carcinoma. -- In the second place, electrocoagulation or shallow conisation with subsequent coagulation and cryo-surgical treatment of the ectopia has to be carried out. -- Therefore the obstetrician decides whether the patient -- in view of developing a collum carcinoma -- becomes a risk patient. He has to ensure that an almost normal portio uteri returns without ectropion and Emmet'tear and also without cervical and vaginal fluor, which could trouble the patient considerably. -- After every delivery, therefore, the speculum should be used. At the same time a cervix tear haemorrhage, one of the most frequent exsanguinations, can be avoided.


[Various healing results in adenocarcinoma and squamous-cell carcinoma of the cervix uteri].

An account is given on the difference in prognosis between squamous cell carcinoma and adenocarcinoma of the cervix. -- The 5-year-healing reaches by adenocarcinoma up to 65.3%, by epithelial carcinoma up to 50.1%. -- Possible causes of carcinoma are referred to. Conclusions are pointed out.


[Lymphography in malignant vulvar and vaginal tumors. 1. Clinical significance].

The results of a retrograde analysis of lymphographic processes in 111 patients with malign vulvar and vaginal tumours are substantiating statements concerning the importance of lymphography in diagnosing metastastic processes in lymph-nodes of the inguinal and retroperitoneal region. -- Metastases could be proved lymphographically in 24 (34%) out of 70 carcinomas of the vulva and 8 (22%) out of 37 carcinomas of the vagina. In 24% of all patients with carcinomas of the vulva there were lymph-nodes involved, in two of these cases without a simultaneous involvement of the inguinal region. With carcinomas of the vagina a lumbar involvement was found in 50% of the cases. The accuracy of lymphographic diagnosis was 79% regarding the inguinal region and 89% in the iliac region. Despite of the lower accuracy with regard to inguinal lymph-nodes lymphography exceeds findings obtained by clinical palpation in this respect. As a result of the study, the use of lymphography in case of vulvar and vaginal carcinomas of all clinical stages is considered to be profitable for diagnosing and therapy planning.


[Rare cause of death in pulmonary recurrence of uterine cancer].

A brief report on endometrium carcinoma with lung metastases is given. The obturation of the main bronchus and trachea by lymphonodular metastases is a rare cause of death.


[Knowledge of uterine lipomas].

Report of a rare case of an uterine lipoma. Review of the literature with regard to frequency, site, size, age and clinical symptoms. Differential diagnosis and pathogenesis have been discussed.


[The microprobe excision as a search biopsy within the scope of cancer-trace detection on the cervix uteri].

Besides colposcopy and cytology microbiopsy as a detection method for early detection of malign cervical lesions was applied to 142 women patients of the UFK Halle. A precondition for the successfull application of this method is a carefull preliminary colposcopic examination and close co-operation with the histologist. The interim result of the microbiopsy corresponded to a high degree with the definitive result. In this way, it was possible to indicate 20% of the preclinical carcinoma for histological evidence despite of negative cytology. An individual combination of all 3 ways of research guarantee a maximum of certainty for the early finding of cervical carcinoma and their pre-stages.


[On the therapy of uterine cervix carcinoma in situ].

It is reported of 607 cases of uterine cervix carcinoma in situ from the years 1963 to 1977. During this period, the diagnostic and therapeutic procedures as well as the histological preparation technique have advanced. -- 75% of the cases were primarily conized. About half of these cases were surely radically excised. 323 patients (53,2%) were treated actively by simple hysterectomy, 242 patients (46,8%) were treated conservatively (190 conisations, 19 reconisations, 60 portioamputations, 12 ringbiopsies, 3 radiations). -- After 323 total exstirpations, 2 recurrences of carcinoma in situ in vaginal stump were observed (0,6%). After local treatment of 242 patients, 17 recurrences of the disease appeared (6%), among them 4 cases as invasive cervix carcinoma. 11 cases belong to the group of primarily nonexcised or uncertainly radically excised carcinoma in situ, and in 4 cases a possibility of recurrence has been discussed. -- It has been refered to the importance of the exact conisation technique and subtile histotechnical obtaining of slides in step sections. If the carcinoma in situ radically excised and followed by an attentive follow up in women below 40 years, a conservative procedure is adviced. For women above 40 years an active procedure is indicated, because it offers a high therapeutic reliability and a minimal risk. For cases of nonradically excised carcinoma in situ hysterectomy is indicated. The removal of the vaginal cuff is considered as unnecessary.


[Effectiveness of adjuvant chemotherapy in ovarian carcinoma].

A report is given about the efficiency of the so called adjuvant chemotherapy in 26 cases (26 patients suffering from ovarian cancer in the stage T1M0N0) in a time of 10 years (1968-1977).--After the primary operation-therapy, a part of the patients (9) got the cytostatic drugs Trenimon or Cyclophosphamid. The patients of the control group got nothing. The survival times of both groups showed no significant distinctions. -- The results show that the adjuvant chemotherapy in cases of ovarian cancers in stage T1M0N0 can not be recommended because there are too many side effects of the these cytostatic drugs.


[Glucose assimilation under high-dose norethisterone-acetate therapy in adenocarcinoma of the corpus uteri].

In 29 patients suffering from adenocarcinom of the corpus uteri, who had been treated with high doses of norethisterone acetate (NEA) alone or in combination with irradiation, we performed a study in order to find out whether NEA will produce a clinically measurable and noteworthy modification of glucose tolerance. -- For this purpose, the glucose assimilation coefficient (k value), apart from its first determination, will be determined 6 weeks later under current therapy. The comparison of both values shows a statistically significant decrease of the k value after 6 weeks in all patients whose first value was k less than or equal to 1. For the patients with a first value of k greater than 1 a significant development was not detectable. The alteration of the k value under NEA therapy in patients with a primarily decreased value (n = 11; in 5 of them diabetes known) was accompanied merely by 2 diabetics with changes in the day profile of such an extent that a correction of therapy was necessary.


[Clinical experience with the copper T-200 intrauterine device].

It is reported on experiences with 138 Cooper-T-200 IUDs, resulting in 1868 months of use. Both the Pearl-Index with 1,3 and the expulsion rate with 1,44% are no significant lower, than in a compared DANA-Super-IUD collective. In both groups the rate of all events like pains, spottings and hypermenorrhea is almost identically. Hypermeorrhea is of significant frequenter occur in the Copper-T-IUDs.


[Gynecologic geriatric surgery at the University Gynecological Clinic Rostock during 1960--1974].

There is reported about 2279 gynaecological operations at women, aged 60 years and more, in a period from 1960 to 1974, divided into three 5-years-groups. The part of geriatric operations increased from 5,3% to 7,0% of all operations. The division into high risk-groups took place after points given by Loskant. 41,1% of all patients where classified into group III. Group IV has the highest postoperative mortality rate (5,3%). The postoperative mortality rate altogether was 2,2%. In the years from 1960 to 1974 it decreased from 2,6% to 1,9%. 25,1% of the surgical operations where carried out abdominaly. The high part of vaginal operations comes off by placing curettages into the analysis. Under that aspect must be seen the postoperative mortality rate 7,1% at abdominal and 0,7% at vaginal operations. In the main point indications for operation were malignant tumours (37,3%), haemorrhages (25,4%), benign tumours (17,6%), and position variations of the genitals (10,6%).


[The reverse effect of sexualsteroids on the serum-lysozyme (author's transl)].

75 women received different preparates of contraceptives (Non-Ovlon, Ovosiston, Gravistat, Deposistion--VEB Jenapharm Jena, GDR) for two years. In the last month of the application of the sexual steroids and one month later the lysozyme titer in the sera was tested to determine a reverse or stop-effect. An elevation of the muramidase could be shown in all cases. This findings are interpreted in relation to a non manifest influence of sexualsteroids on the lysozyme.


[Radioimmunological LH and FSH determination from urine collected within 24 hours].

Sensitive radioimmunoassays for measurement of urinary human LH and FSH by using either pituitary or urinary LH and FSH standard preparations are described. In healthy subjects mean LH and FSH values in 24-h-urine specimens were determined which are similar to those reported by others: LH: 22.6 IU/24-h (males), 17.8 IU/24-h (females), 49.1 IU/24-h (postmenopausal females); FSH: 6.0 IU/24-h (males), 15.0 IU/24 h (females), 48.5 IU/24-h (postmenopausal females). Because of the high sensitivity and practibility we believe that these radioimmunoassays are clinically useful approaches in assessment of pituitary and gonadal disorders.


[Cell-mediated immunity in myoma uteri measured by the leukocyte migration inhibition test (author's transl)].

The leukocyte migration inhibition test was performed on 56 patients hysterectomized on account of myoma. -- Despite low antigenicity of autologous myoma tissue significant differences in inhibitions of migration were observed depending on the extent of surgical radicality in the adnexal region. -- Non-inhibition of leukocyte migration in patients whose myomatous uterus alone was exstirpated is explained by the oestrogens produced in the remaining ovaries.


[Clinical value of various parameters in antenatal diagnosis of fetal hypotrophia (intrauterine retardation) (author's transl)].

Retrospective evaluation of percental frequency of pathological data gained by prepartual monitoring in pregnancies at risk of 180 small for gestational age infants and 130 eutrophic ones at term (postnatal classification). Parameters of interest were continuous maternal gain of weight, monthly progress of the size of the uterus, continuous ultrasomic cephalometria, maternal urinary estriol and serum heat stable alkaline phosphatase as well as amnioscopia and cardiotokographia with and without oxytocin challenge test. -- It seems that there is a significant better prediction of fetal retardation with the help of common clinical methods as well as with ultrasonic and that they are superior to the examined biochemical, cardiotocographical and amnioscopical parameters. With regard to possible additional disturbances of the fetoplacental unit--especially of respiratory placental function--in suspected intrauterine retardation the complete monitoring program should be taken.


[Mode of delivery, postnatal condition and neonatal outcome in preterm infants].

There were under examination 578 preterm infants of two groups--28. up to 31. and 32. up to 36. week of gestation--after birth of vertex as well as breech prevention. Postnatal condition and neonatal outcome were put into relation to the mode of delivery. We compared Apgar-Score (one and five minute value), morbidity on respiratory distress syndrom as well as rate of survival and neonatal mortality in spontaneous delivery with and without episiotomia, with specula delivery, Shute-forceps and vacuum extraction of vertex presentation as well as with breech presentation after vaginal delivery and primary Caesarean section. In respect of the management of the second stage of labour it is our opinion that prophylactic additional measures in preterm delivery of vertex presentation after 32 weeks of gestation are not necessary and that this question should be examined in a larger study of much more cases. But we were able to demonstrate that up to 32. week of gestation well-timed episiotomia of optimal size is necessary. Our good experiences in breech presentation between 31. and 35. week of gestation treated by obligate Caesarean section have to prove true in future.


[Desoxycytydil-deaminase activity in obstetrics].

The Deoxycytidyl-Deaminase activity in the plasma of 75 woman with a normal or complicated pregnancy was estimated. The control group consisted of 20 healthy, non-pregnant woman. Only in the cases of pregnancies with trisymptomic toxaemia and chronic kidney diseases high enzyme activities were estimated. There are no timedependent changes in the enzym activity during a normal pregnancy. The estimation of the enzyme activity of DCMP-Deaminase in the plasma seems to be a valuable method for the registration of pregnant woman with classical EPH-Gestosis and chronic kidney diseases.


[The conduction of labor and postlabor periods following cesarean section].

Out of 11315 childbirths under review, 109 women (0.96%) with state after secio caesarea were delivered of a child in the period from 1970 to 1978. In 63.3% of the cases it was possible to achieve a vaginal birth. With 450 caesarean sections, 2 cases of the mother mortality occurred. -- A comparison between the sectio and the re-sectio indications does not show any difference. -- Uterus rupture was noticed in 2 cases. -- In a comparative study, general palpating of the uterus is contrasted with a conservative behaviour involving haemorrhage, blood-pressure, and pulse controls. -- As a result, manual re-palpating is again recommended, however, should not be forced. In certain individual cases a conservative behaviour is also justified.


[Reinfection in brucellosis].

The results of clinical observation on 68 recurrent cases of brucellosis, occurring a long time (3 to 30 years) after the primary disease, are presented. As the recurrent disease developed against an unfavorable premorbid background, a considerable severity in the clinical manifestations of brucellosis was observed.


[Characteristics of the precipitation reaction at the stage of antigen-antibody complex aggregate formation studied by a spectroturbidimetric method].

The possibility of using the spectroturbidimetric method, one of the variants of the light scattering method, for the determination of the characteristics of the second phase of the antigen-antibody reaction was shown examplified by the interaction between rabbit antiserum and bovine serum albumin. The parameters of the aggregates formed in the process (their average size, their concentration by weight and number) were calculated for the whole period of the reaction and with its components taken in different proportions. The precipitation curve plotted by the above method correlated well with the result of an independent determination at an extinction coefficient of E278. A conclusion was drawn, based on special evaluation, that hydrophobic interactions have a predominant influence on the formation of antigen-antibody aggregates. A quantitative approach was proposed for studying the mechanism of the antigen-antibody aggregate formation and for the analytical determination of various classes of immunoglobulins.


[Comparative analysis of the interaction of protein A from Staphylococcus aureus with native, reduced and aggregated IgG].

In a comparative study the affinity of rabbit and human IgG, native, reduced and aggregated by various methods, to protein A obtained from the cell wall of Staphylococcus aureus was determined. For this purpose the method of the passive hemagglutination inhibition test was developed. The affinity to protein A was found to grow considerably after specific or non-specific IgG aggregation and to decrease by 60% after local damage affecting the structure of the IgG molecule waist as a result of the dissolution of the disulfide bond between its heavy chains. The problem of similarity between such effector properties of IgG as its ability to activate the complement system and to combine with protein A is considered, as well as the problem of the pathogenetic role of immune complexes bound with protein A.


[Quantitative indices of the activity and the electrophoretic characteristics of staphylococcal catalase].

The average levels of activity of intracellular and extracellular catalase were determined. The activity of intracellular catalase was shown to be significantly higher than that of extracellular catalase, the average level of activity of extracellular catalase being higher in S. aureus than in S. epidermidis. In most of the strains one zone of extracellular catalase and two molecular forms of intracellular catalase were revealed by means of polyacrylamide gel electrophoresis.


[Depression and stimulation of immunologic memory by typhoid lipopolysaccharide and polysaccharide].

The effect of typhoid lipopolysaccharide (LPS) and polysaccharide (PS) on immunological memory in the system of IgM and IgG synthesis and rosette-forming cells was studied. When introduced into animals previously immunized with SRBC, PS stimulated, under certain conditions, immunological memory in the system of IgM synthesis and rosette-forming cells, while the injection of LPS induced only an insignificant stimulation of immunological memory. No stimulation in the system of IgG synthesis was observed after the injection of both LPS and PS. The suppression of immunological memory was noted in the animals receiving LPS as well as in those receiving PS the immunosuppressing effect produced by LPS was more pronounced.


[Morphology of the bifidobacteria by light and electron microscopy and their biological properties].

The morphology and the acid-producing, antagonistic and enzymatic activity of the strains of bifidobacteria isolated from the intestine of adults and children were studied. Bifidobacteria showed a considerable polymorphism, all the strains were antagonistically active. The strains isolated from adults were found to have greater acid-producing activity; the predominant species were B. longum and B. adolescentis, and in children B. bifidum were also isolated. The characteristic feature of B. longum strains was the presence of a slime-like layer and formations resembling bubbles around bacterial cells. The stains with greater physiological activity were found to have an extensive mesosomal complex, as well as a great number of volutin granules.