[Experimental studies on surgical therapy of acute infarct].

The authors examined the effects of reperfusion after temporary ischemia in 50 dogs. The morphologic alterations were documented by methods of electron microscopy, fluorescence microscopy, and histochemistry. Lactate and activity of glycogen phosphorylase were assessed. According to the results, the optimal ischemia interval is 30 to 60 minutes for rational application of reperfusion, while it is just possible after 120 minutes. After a 4-hours-period of ischemia reperfusion increase morphologic damage of myocardium and impairment of myocardial metabolism. Prolonged reperfusion of 7 days resulted in a reduced extent of infarction compared with controls. In non-ischemic myocardium the morphologic and metabolic alterations were less expressed. The effects of "no-reflow"-phenomenon and conclusions for clinical practice are discussed.


[Morphological studies on swine livers after extracorporeal perfusion].

Morphologic examination of 6 porcine livers after extracorporeal perfusion showed toxic damages of parenchyma with and without necrosis, dilatation and distension of sinusoids with and without hemorrhage and accumulation of inflammatory cells, activated stellate cells, different distributions and loss of glycogen. These findings in the liver could be caused as well by inflow of toxins and cells from the patient, as by increasing damage of the livers under the unphysiological conditions of extracorporeal circulation. The authors point at possible immunologic responses and give their opinion on the question of "vitality" of extracorporeally perfused porcine livers.


[Diagnostic accuracy of fiber endoscopy in esophageal and gastric carcinoma. Attempt at error analysis].

A retrospective analysis was performed in 332 cases with cancer of the upper gastrointestinal tract. A limit of one month was set for delayed and missed bioptically verified endoscopic diagnosis. Malignant cycle in ulcerated lesions and the size of elevated processes were the probable causes of delayed diagnosis in 7 out of 37 cases with early cancer. In advanced gastric cancer missed diagnosis was probably caused by the indication for endoscopy made too late in an unknown number of cases or patient's refusal to undergo controls. However, failure of the endoscopist to recognize a malignant process must be considered too. The percentage of endoscopist's mistakes was below 2% in our series.


[Functional scintigraphy in the diagnosis of gastroesophageal reflux (author's transl)].

The accepted diagnostical procedures to prove a gastroesophageal reflux by direct or indirect methods do not allow any quantification and are of limited sensitivity. A quantification is possible by use of a gamma-camera with a computer-system after application of a small amount of 99m Tc-DPTA (reflux scintiscan). The high accuracy of this method could be proven by evaluation of 51 patients with suspected gastroesophageal reflux esophagitis or after total gastrectomy. The results were compared with the histological findings. With this method we found after total gastrectomy the expected high incidence of relux. The long-term results after semifundoplication were not as good as after fundoplication. The reflux scintiscan is a less invasive, but reliable method to detect the gastroesophageal reflux.


[Behavior of histamine in gastric secretion and plasma in the normal and morphologically altered human gastric mucosa].

The existence of a relationship between the morphological state of oxynthic gland area of the stomach and the histamine content in the gastric juice was studied. In 86 patients (48 males and 38 females) four groups were formed due to a multiple biopsy pattern: individuals with normal gastric mucosa, with superficial gastritis, with beginning atrophy and with advanced atrophic gastritis. In the basal and maximal stimulated gastric juice the following parameters were used: volume, H+ concentration, acid output, histamine concentration and histamine output. The histamine content was additionally determined also in the plasma. The histamine output and the histamine content of the gastric juice was significantly diminished parallel to the degree of the atrophy of gastric mucosa and parallel to the decrease of the volume and acid output and the increase of the intragastral pH values. In the plasma an increase of the histamine content was observed under similar conditions. A possible relationship is discussed between increased plasma histamine content and increased serum gastrin concentration in cases of advanced atrophic gastric mucosa.


[Changes of alcohol resorption through apomorphine in subemetic dosage].

Apomorphine in sub-emetic doses inhibits gastric emptying without producing nausea or vomiting. This discovery was applied to 21 persons to find out correlation between gastric emptying rate and alcohol absorption. In the 60 minutes after a single oral ingestion the shape of the alcohol-tolerance curve is considerably flatter after administration of apromorphine as compared to controls. The peak blood alcohol concentration occurs later and is significantly lower. These findings suggest that absorption of ethyl alcohol after a single oral alcohol ingestion can be controlled to a considerable extent by the gastric emptying rate.


[Gastrin].

Gastrin antisera were raised by immunization of rabbits or guinea pigs with synthetic human gastrin I conjugated to bovine serum albumin by carbodiimide. Radioiodination of SHG: 2-17 was performed by the chloramine T-method and by an enzymatic procedure. AE-cellulose was used to get a monoiodinated tracer hormone. Antibody reactions with the different forms of gastrin and with CCK-PZ was characterized. Precision (VK = 6-8%) and reproducibility (VK less than 15%) of the gastrin values were comparable to the insulin assay. Gastrin stimulates the parietal cell and has trophic effects on gastric mucosa. Hypergastrinaemia in combination with hypersecretion exhibits clinical significance in patients suffering from Zollinger-Ellison-syndrome or excluded antrum-syndrome which are due to autonomous gastrin release. Some findings suggest a pathogenetic role of gastrin in duodenal ulcer disease. Those disease in which gastrin determinations are of clinical value are discussed.


[Secretion radioimmunoassay, physiology and pathophysiology in man].

Production of antibodies to secretin for radioimmunoassay is straightforward. Secretion is iodinated by weak oxydation with lactoperoxydase and subsequent purification by ionexchange chromatography (Sephadex C25). The specific activity of fresh label is between 650 and 900 mCi . mol-6. The label is highly purified and may be used in radioimmunoassay for several months. In order to eliminate plasma interference sepharose-beads with covalently coupled secretin antibodies are used to produce secretin-free standard plasma samples. Delay in the separation of plasma from fresh blood samples can lead to erronous results, even to falsely elevated secretin levels.--Duodental acidification only leads to physiological increases of secretin plasma levels. This may happen by intraduodenal instillation of acid, or by an acidic oral drink, or to a lesser extent after a meal. Secretin is distributed throughout the plasmavolume and has a short halflife of around 3 minutes. Impaired release of secretion is found in children with coeliac disease. The role of secretin in peptic ulcer however is not clear. Chronic pancreatitis and renal insufficiency are without effect on plasma secretin levels.


[Radioimmunoassay [RIA] of cholecystokinin-pancreozymin [33-CCK] (author's transl)].

A further specific, reproducible radioimmunoassay of cholecystokinin-pancreozymin was developed. 125J-labelled 39-CCK was used as tracer. The limit of detection for CCK in serum was 40 pg/ml. Basal levels for CCK have been found to be 222 pg/ml, being increased after food ingestin. No crossreactivity with gastronintestinal hormones could be observed. Somatostatin was inhibiting the stimulated CCK-release. Histochemical and radioimmunological determinations localized CCK-containing cells in duodenal tissue of humans. Physiological and pathological processes in which CCK is involved have to be studied to evaluate its role in the gastrointestinal tract.


[Gastric inhibitory polypeptide (GIP) (author's transl].

Gastric inhibitory polypeptide (GIP) is released from the duodenum and jejunum following the ingestion of glucose, fat and amino acids. This hormone potentiates the glucose-induced insulin release from the beta-cells of the pancreas. The role of GIP as "incretin" is discussed. The method of the radioimmunoassay for the determination of GIP in serum samples is described. The lower limit of sensitivity of the GIP radioimmunoassay is in the range of 30-50 pg per ml serum. The described radioimmunoassay is sensitive enough to determine fasting levels of GIP in normal subjects (287 +/- 59 pg/ml). The clinical and pathophysiological importance of GIP is discussed by means of various diseases (obesity, maturity-onset diabetes mellitus, duodenal ulcer disease).


[Pancreatic polypeptide (PP) (author's transl)].

Pancreatic polypeptide (PP) can be reproducible measured in serum and tissue extracts by mean of a standardized radioimmunoassay. Dispite extensive investigations into the biological actions of the polypeptide and a range of radioimmunological measurements in serum and tissue the physiological significance of PP is, at present, unclear. The normal postprandial increase of serum PP levels has been reported to be lacking after vagotomy and reduced in patients with chronic pancreatitis. If these observations can be confirmed then PP measurement may be a clinically usefull criterion as to the effectiveness of vagotomy and as an indicator for chronic pancreatic disease.


[Radioimmunoassay of motilin (author's transl)].

A specific radioimmunoassay for motilin is described and a few technical details concerning antibody production and tracer iodination are discussed. Though a variety of biological actions of motilin have been reported, its role in normal human physiology remains to be established. So far, the motilin radioimmunoassay brought no major break through to elucidate the physiology, disregard pathophysiology, of motilin.


[Radioimmunoassay of prostaglandins (author's transl)].

Prostaglandins (PGs) can be measured by bioassay or combined gas-chromatography/mass spectrometry or by radioimmunoassay. The main advantage of the latter method is its great sensitivity. On the other hand, difficulties, with this method can arise from the small molecular weight of PGs and the large number of structurally closely related PGs and PG metabolites which cross-react in the various radioimmunoassays thus influencing the specificity of the method. Exogenous PGs exert a variety of effects on the gastro-intestinal tract. The effects on the various organs differ between the PGs tested and are species-dependent. Endogenous PGs have been found both in human and animal tissues of the gastrointestinal tract. PGE2 and its 15-keto-13, 14-dihydro-metabolite are the main PGs found in human gastric juice, while much smaller concentrations of PGF2alpha and PGA2 and their metabolites were detected. In human gastric mucosa both PG synthetase and PG-metabolizing enzymes were found to occur. Both enzyme systems can be influenced specifically by drugs. Inhibition of PG synthetase seems to correlate with gastric mucosal irritation, while inhibition of enzymatic PG inactivation might be associated with protection of gastro-intestinal mucosa. Results from animal experiments as well as clinical observations on humans indicate, that endogenous PGs might be involved in such syndromes as diarrhea, colitis, gastritis, tumors, acute pancreatitis and gastric ulcers caused by nonsteroidal anti-inflammatory drugs. The exact role, however, played by PGs in physiology and pathophysiology of the gastro-intestinal tract, awaits further investigations.


[Determination of the gestation period by means of ultrasound. Cephalometry in twins (author's transl)].

In 147 twin pregnancies, the biparietal diameter of the skull was determined by means of an ultrasound B-scan method. 574 individual measurements were evaluated. It was found that a marked flattening of the growth curve sets in from the 30th week of pregnancy, compared with single births. The difference amounted to 6 mm in the 40th week of pregnancy. The wavy shape of the mean value curve in twins up to the 30th week of pregnancy, appears particularly remarkable. The reason for this phenomenon could be seen in high-grade placental insufficiency causing spontaneous abortion or premature delivery. Accordingly, an increased incidence of abortion was recorded in the 21st and 25th week, as well as a peak in premature births in the 29th and 30th week of pregnancy. The heads of the twins were not equal in size. The average difference of the diameters of the skull was 6 mm.


[Aspiration of meconium stained amniotic fluid (author's transl)].

Respiratory distress following aspiration of meconium stained amniotic fluid can be found in about 3% of newborn infants. The lethality rate of this disease is high. Pathophysiology and variability of the clinical course as well as radiological findings and further diagnostic procedures are being described. The therapeutic concept requires recognition of meconium stained amniotic fluid as early as possible, early suctioning of the nasopharynx, intubation and endotracheal suction. Further therapy consists in physical procedures, i. e. lavage, suctioning, positioning, vibration and percussing of the chest, and inhalation. Antibiotics can only be recommended if infection of the amniotic fluid has been proven.


[New aspects of drug induced lupus erythematosus (author's transl)].

Approximately 8% of patients with systemic lupus erythematosus have drug induced disease. Many drugs are associated with lupus erythematosus-like syndrom (Chart 1). It is also a well known fact that the administration of other drugs may exacerbate corticoid treated systemic lupus erythematosus (Chart 2). This report illustrates that it is obvious that we must learn the relationship of diseases and the drugs which induce antinuclear antibodies.


[Drug-induced lupus erythematosus].

There is a variety of immunologic and etiologic phenomena in Lupus Erythematosus Disseminatus (LED) sive Visceralis particularly when induced by drugs ("Pseudo-LE-Syndrom"). In this report a patient (age 22 y.) is presented suffering from LED in whom the disease exacerbated under treatment with Ethambutol. Various drugs known to either cause a "pseudo-LE-Syndrom" or to induce or aggravate a LED have been compiled in this paper and listed in tablets; Ethambutol apparently represents a new addition to the drugs listed.


[Clinical diagnosis of acute gonorrhic perihepatitis].

At the end of her menstruation a 25 years old woman develops acute pain in her right lower and upper abdomen radiating into the right shoulder. There are pains during breathing, coughing, and changing of position, vomitus, and local signs of peritonitis in the right lower and upper abdomen, subicterus and leucocytosis. Gonococci in the cervical smear are demonstrated by Grams stain and by culture. Two days after treatment with 3,5 millions IU of penicillin G sodium and 500.000 IU procaine penicillin per day the complaints disappeared. The demonstrated signs and symptoms are characteristic for acute perihepatitis gonorrhoica which seems to occur more often as a complication of gonococcal adnexitis than is suspected. The symptoms are so typical that the diagnosis can be made also without confirmation by laparascopy.


[The skin trichophytin reactivity in psoriasis vulgaris. A contribution to the pathogenesis and clinical aspects of psoriatric skin changes].

On the basis of the resultats of four years lasting studies on 330 patients with psoriasis the allergic mechanism of the dermatosis is discussed. In 65 cases it was able to make a clinical diagnosis of the primary psoriasis focus (PPH) and to cultivate from it in 12 cases trichophyton fungi. The possibility to show the relevant mycotic antigen from the PPH is demonstrated, the development of the disease from the initial focus is described by analogy to the clinical development and a difference is made between the acute--subacute psoriasis and the chronic psoriasis with regard to the responsiveness of the competent immunological system. With 330 patients intracutan-tests have been made with trichophytin, and at the same time control tests with tuberculin, toxoplasmin and candida alb. for a period of 12 months up to 24 months. The relative and even absolute blocking of the trichophyton immunological system (TAS) and which is in correlation to the pushes and remittences of the disease constitutes the impressing resultat of the tests. With regard to the working mechanism the opinion is held that the immunological complex which is existant in the psoriatic epidermis participates to a great extent in the release of the epidermopoesis which is typical for the psoriasis. The classification into the stade of PS I (early psoriasis), PS II and PS III (late psoriasis) makes the differentiation of the process possible.


[Perianal psoriasis--a reliable symptom in the differential diagnosis of psoriasis].

Psoriatic lesions of the perianal region are so frequent and characteristic that they may be used with striking accuracy for differential diagnosis of isolated lesions on the head, hands, glans or the nails.


[Initial systolic ejection rate as a parameter of ventricular function in valvular heart disease (author's transl)].

In patients with valvular heart disease the initial systolic ejection rate was determined in an attempt to characterize ventricular function in pressure and volume overload. By means of left ventricular cineangiography, the volume change during the initial third of the ejection phase was determined and the mean ejection rate of this period was calculated. A total of 40 patients were examined, 7 patients without heart disease, 15 patients with pure aortic regurgitation, 9 patient with pure aortic stenosis and 9 patients with pure mitral regurgitation. In patients with pure aortic regurgitation and high-normal values for ejection fraction and mean velocity of circumferential fiber shortening (mVcf) a significant increase in initial systolic ejection rate when compared to the group of normals was observed. The distribution of the stroke volume for each third of the ejection phase corresponded to the normal pattern. In contrast, in patients with low-normal values for ejection fraction and mVcf, a decrease in the initial systolic ejection rate below the normal value was observed, along with a pathological distribution of the stroke volume during the ejection phase. This finding was also noted in all patients with pure mitral regurgitation and pure aortic stenosis. In aortic stenosis, the decline in initial systolic ejection rate was regarded as a consequence of the outflow tract obstruction, whereas in volume overload, this was regarded as a sign of a decline in ventricular function which is not recognized with global parameters such as ejection fraction and mVcf.


[Effects of dopamine and orciprenalin on human metabolism (author's transl)].

10 healthy probands were given on several subsequent days by intravenous infusion lasting 20' only orciprenalin and dopamine in therapeutic doses of 0.1 mg/kg bodyweight and 0.5 mg, respectively. In all cases application of orciprenalin resulted in a significant rise of glucose, insuline, lactate and free fatty acids. By contrast, no such changes were observed after infusion of dopamine. This suggests that a rise of free fatty acids in the serum may be important for the occurrence of cardiac arrythmia.


[Alterations of systolic and electrocardiographic time intervals in normal patients by Ro 11-1781, a new calcium-antagonist (author's transl)].

Five minutes following intravenous application of calcium antagonist Ro 11-1781 (1 mg/kg BDW) PQ duration increased significantly in 10 healthy volunteers without more severe atrioventricular conduction disturbances. Both, systolic and diastolic blood pressure decreased and heart rate increased significantly. Left ventricular ejection time (LVET) and the time from the beginning of QRS to the first sound (QS1) did not change in contrast to a significant decrease of the electromechanical systolic interval (QS2) and of the total pre-ejection-period (PEP). The decrease in PEP is explained by a decrease in isovolumic contraction time (IVCT). This can be regarded in connection with a decreased PEP/LVET-ratio, an expression of better heart performance. In spite of the negative inotropic effect of the calcium antagonist Ro 11-1781, our results point to an increase in left ventricular performance and in heart rate caused by an exaggerated sympathic reaction to a fall in blood pressure.


[The effect of oxyfedrine and intervall training in intermittent claudication (author's transl)].

In 23 patients suffering from intermittent claudication due to chronic occlusions of the femoral artery proved on angiography, a double-blind study was performed to compare the effects of treatment with oxyfedrine and interval-training and of interval-training alone. The claudication distance, physical work capacity and physical work intensity were measured on the treadmill before, during and after 10-weeks training period in each case. After training, the walking ability improved in both groups, however, quantitatively being more pronounced in the oxyfedrine group. In the placebo group, the increase in physical work intensity was mainly caused by the improvement of walking ability in patients with higher levels of performance at the beginning of the training. In the oxyfedrine group, on the other hand, a continuous and regular increase in physical work intensity was found at all levels of performance and during the whole training period. For the differences found, blood supply lowering mechanisms after physical training and improvement of collaterals after combination oxyfedrine and physical training are discussed. The possibility of additive action of the pharmacologic treatment and physical training are pointed out.


[Vagal tone in symptomatic sinus node dysfunction (author's transl)].

Under investigation in this study were the role of vagal tone in symptomatic sinus node dysfunction and the relationship between hypersensitive carotid sinus reflex (HCSR) and sick sinus syndrome (SSS). In 168 symptomatic patients (pts) resting heart rate (HR), maximal corrected sinus node recovery time (CSRTmax) and maximal carotid sinus pressure results (CSPmax) were determined before and after Atropine, 1 mg i.v. (A). According to test results, 103 pts had HCSR (1), 33 had HCSR + SSS (II), 30 pts had isolated SSS (III) and 20 pts with normal test results served as controls (IV). Mean age was the same in groups I--IV (p greater than 0.05). Groups I--III had a HR less than or equal to 60 bpm, rising 31% after A in groups I--IV, but absolute values were below those in group IV. In groups I--III CSP normalized after A and CSRT remained unchanged (p greater than 0.05). We conclude that increased vagal tone plays but one role in groups I--III and the combination HCSR + SSS seems rather frequent. Specific testing clearly separated HCSR from SSS.


[The significance of electrophysiologic findings and clinical course in symptomatic sinus node dysfunction (author's transl)].

Under investigation in this study were the relationship between hypersensitive carotid sinus reflex (HCSR) and sick sinus snydrome (SSS), the significance of clinical symptomatology versus electrophysiologic test results and the natural course of both syndromes. In 186 symptomatic patients (pts) resting heart rate, maximal corrected sinus node recovery time (CSRTmax) and maximal carotid sinus pressure results (CSPmax) were determined. According to test results, 103 pts had HCSR (I), 33 had HCSR + SSS (II), 30 pts had SSS (III), and 20 pts with normal test results served as controls (IV). Mean age was the same in groups I--IV (p greater than 0.05). Groups I--III had a heart rate less than or equal to 60 bpm. There was no correlation between patients test data and the occurrence of syncopes in each of groups I--III (p greater than 0.05). In 16 pts with SSS, test results remained unchanged 16 months later (p greater than 0.05). More pts (31%) in group II died in a shorter period of time after pacer application (1.4 +/- 1 year) than pts with AV III degrees block (25%, 1.8 +/- 1.6 years) after pacer application. We conclude that the combination HCSR + SSS seems rather frequent. Specific testing separated HCSR from SSS, but failed to predict syncopes and thereby cannot aid in the indication for pacer application. The 16 months prognosis of SSS proved unfavorable. Mortality after pacer application in HCSR + SSS seems less favorable than in AV III degrees block (p less than 0.05), but depends largely on the severity of associated diseases.


[Dihydrogenated metabolites of digoxin: clinical importance and identification (author's transl)].

Several methods for the determination of dihydrometabolites of digoxin are described. Dihydrometabolites of digoxin are essentially inactive. They are the most important group of metabolites of digoxin. Seven (7) percent of a group of in-patients excreted more than 35% of these metabolites. The average was 13%, with respect to total extractable digoxin and metabolites in urine. In blood up to 40%, and in urine up to 52% dihydrogenated metabolites were found. The main metabolite was dihydrodigoxin, but the hydrolytic metabolites of digoxin exist also in reduced form. Neither the dose of digoxin, impaired renal function, nor an increased body content of digoxin seems to affect the rate of formation of these dihydrometabolites.


[Detection of right-to-left shunts by one- and twodimensional contrast echocardiography (author's transl)].

33 children with different congenital cardiac malformations--aged one day to twelve and a half years--were investigated by peripheral and central, 1- and 2 dimensional contrast echocardiography. 11 patients were studied during routinely performed cardiac catheterization and 23 in the early postoperative period (one patient pre- and postoperatively.) Contrast echocardiography peripherally performed represents a very sensitive diagnostic method to detect right-to-left shunting at atrial and/or ventricular levels. Quantification of shunts seems to be possible, if standardization can be achieved. Contrast echocardiography centrally performed can detect right-to-left shunts in residual postoperative defects, delineate and identify intra- and extracardiac structures, assess "low-output" states and should be applied in complex cardia malformations.


[Antiarrhythmic effect of propafenone in relation to serum concentration and conduction time (author's transl)].

7 patients with stable cardiac dysrhythmias (ectopic beats of ventricular origin) received a single oral dose of 900 mg Propafenone. Besides the antiarrhythmic effect of propafenone the effect on changes of PQ- and QRS duration as well as the corresponding serum concentration was measured. A significant correlation between changes of PQ-time and serum concentration (r = 0.6810, p less than 0.001) was found. The half-life of serum level was 3.6 +/- 0.2 h, that of PQ-time prolongation 3.8 +/- 0.6 h. A complete suppression of all ectopic beats has been achieved in all treated patients for 6--8 hours.


[Course and prognosis of patients with myocardial infarction during 7 years (observations in a cardiological clinic with an intensive care unit (author's transl)].

In a group of 701 male patients with acute myocardial infarction treated in intensive care unit from 1969 to 1976 30.0% died within the time of 1969--71 during the stay in the clinic. The lethality decreased significantly to 22.3% from the year 1972 until 1973, between 1974 and 1976 to 21.7% respectively, while the average age of the patients was growing. The number of patients with myocardial infarction in the age group of 50 to 69 years has decreased since 1974, whereas the number of patients in the age group of 70 years and older has increased, lethality sinking in this age group (from 57.4% 1969--71 to 32.3% 1974--1976). The incidence of threatening disorders of cardiac rhythm and their lethality has decreased. The high lethality of patients with cardiogenic shock remained unchanged high.


[Rupture of sinus of valsalva aneurysm. Differentiation from cardiac contusion (author's transl)].

The diagnostic aspects of rupture sinus of Valsalva aneurysm are discussed. The indication for corrective surgery can only be derived by angiocardiography. Important is the demonstration of pathophysiological hemodynamics, due to the cardiovascular anomaly. The importance of echocardiographic findings in an early phase of the clinical examination is stressed.


[Surgical interruption of the accessory pathway in a case of WPW-syndrome with persistent supraventricular tachycardia provoked by sinus node suppression (author's transl)].

This is a case report of a 60-year-old woman with a WPW-syndrome Type A developing persistent supraventricular tachycardia refractory to medical treatment. The re-entry mechanism was based on av-junction escape beats leading to retrograde conduction through the accessory pathway in presence of sinus node dysfunction i.e. long periods of sinus arrest probably enhanced through antiarrhythmic drug therapy and/or digitalis. With the aid of electrophysiological examinations and intraoperative epicardial mapping the accessory pathway was located in the upper lateral region of the left ventricle and interrupted by an incision in the av-groove from inside of the lfet atrium. Although an additional accessory pathway, not interrupted by surgery was suggested by the postoperative electrophysiological study, the patient remained free from tachycardia over more than 18 months, except for one episode terminated promptly by overdrive pacing from the right atrium. Postoperatively sinus bradycardia and av-junctional escape rhythm prevailed.


Babesia bovis (= argentina): changes in erythrophylic and associated proteins during acute infection of splenectomized and intact calves.

Saline eluates were prepared from sucrose-washed erythrocytes of cattle infected with B. bovis (= argentina). Fibrinogen, plasminogen and IgG2 were constituent proteins of the eluates and all three proteins increased in concentration during infection. The significance of the protein changes and their contribution to coagulation and fibrinolysis during infection are discussed.


[Experiments in vitro with Litomosoides carinii (Nematoda: Filarioidea). I. Maintenance of adult females and microfilariae as well as release of microfilariae in different culture media (author's transl)].

Embryos of L. carinii continue intrauterine development to microfilariae and are totally released into the medium within 5--6 days when the latter (Tc 199) is changed daily and air is used as the gas phase. Oogenesis or further fertilization of eggs, however, does not occur in vitro in any of the media examined by us. One female releases 140 X 10(3) microfilaria/day on an average in vitro within 5--6 days. Mean initial numbers of 300 X 10(3) Mf/female/day are observed. Addition of equine serum inhibits microfilarial release in vitro; normal cotton rat serum prolongs survival of females while total numbers of released microfilariae or retained embryonic stages are not increased. The serum of post-patent animals does not influence the numbers of released microfilariae or their viability or survival of females. Microfilariae released in vitro in Tc 199 + 33% normal cotton rat serum survive for more than 8 days, when air is used as the gas phase and the medium is changed daily. Microfilariae isolated from the blood of patent animals survive for at most 6 days, at a 48-hourly change of medium survival does not even exceed 4 days.


[Reproduction and sexuality of parasitic copepods of fishes. I. The reproductive apparatus of Chondracanthus angustatus Heller, 1865: anatomy, histology, and spermiogenesis (author's transl)].

The pygmy males of Chondracanthus angustatus are fixed on the genital segment of the female on two anterior-ventral tubercules. The genital system is formed by two dorsal testes, two broad vas deferens and two seminal vesicles each one containing a spermatophore. Two types of cells can be seen in the interstitial tram: the sexual (normal and abortive) and the somatic ones. The plasmic and nuclear membranes joined together on one end of the spermatid; on the opposite pole, the mitochondria penetrate into the cytoplasmic expansions. The non-motile starfish spermatozoa present neither di-ferentiated acrosome nor centrioles. The male gametes are stocked in the spermatophore and enveloped by many kinds of secretions. Spermatozoa are discharged into the female integument folds and they reach the seminal receptacle with the help of the villosities movement; they stay there till fertilization occurs.


Morphology of the spermatid and spermatozoon of Amblyomma hebraeum Koch (Acarina; Ixodidae).

Spermatids and spermatozoa of Amblyomma hebraeum were examined by scanning and transmission electron microscopy as well as by freeze-etch and freeze-fracture techniques. The external surface of the spermatid is smooth except for a rim of two parallel grooves near the anterior apex. This rim probably marks the level at which a cap detaches, permitting extrusion of the inner cord during spermatozoon maturation. Both ends of the spermatid are closed, the anterior part being slightly thicker than the posterior. The spermatozoon is clavate anteriorly and tail-like posteriorly. The tip of the anterior part is a hemispherical structures carrying numerous bulbous expansions. Apart from the hemispherical structure, the entire spermatozoon surface is covered with parallel longitudinal cellular processes. Waves of constrictions on the tail-like part of the spermatozoon and undulations of the cellular processes are considered to be involved in sperm motility.


["Apert's foot" (in acrocephalo-syndactyly) (author's transl)].

The authors discuss foot abnormalities in Apert's syndrome (acrocephalo-syndactyly). Characteristic of these deformities are bilateral, mostly symmetrical syndactlys of the toes; incorrect hyperextension positions of the first toe with large toes in flexed positions; intermetatarsal synostoeses, above all between the first and second metatarsal bones; multiple synostoses in the tarsal region; bi- and monophalanges with pseudo-, delta- or arcuate epiphyses. A classification of Apert's foot is presented, using 68 examples from the literature and 12 cases treated by the authors. The calssification is analogous to the hand deformities in Apert's syndrome. Three types can be distinguished: In type I, toes II-IV are webbed together. However, the large and small toes are still well separated. Syndactilys of toes II-V are present in type II, and all toes have grown together in type III. The deformity can be accompanied by stress pain and difficulties in providing shoes. In this case surgical correction is indicated in childhood: the incorrect position of the large toe is eliminated. Good results can be achieved via osteotomies of the metatarsal bones and resections of the intermetatarsal bone bridges.


[Early results of the operated patients with a femoral neck fracture. Experiences with the AO techniques in the Central Hospital of Central Finland in 1972--75 (author's transl)].

The results of 223 patients with fractures of the femoral neck treated by AO osteosynthes were evaluated. The series consisted of 140 women and 83 men, 114 femoral neck fractures and 109 trachanteric fractures. One year after the operation the nailing results were poor in 22.9 per cent of the femoral neck fractures and in 2.7 per cent of the trochanteric fractures. The reasons of the poor results were mainly the perforation of the nail. Pseudoarthrosis were founded in 3 cases and in one case the AO nail was broken. The mortality after 2 weeks was 3.1 per cent, after one month 6.3 per cent, after 6 months 15.7 per cent and after 12 months 20.6 per cent. Infection and thrombosis were founded both in 3.1 per cent.


[Walking with canes and forearm-crutches (author's transl)].

Partial weight bearing is frequently prescribed but cannot be controlled adequately. In a previous paper the change of forces at the hip joint as effected by a one sided cane was determined by instrumentation of the cane and a mechanical analysis of gait on a walkway. In the present study we looked at the conditions for control of partial weightbearing when two forearm crutches are used. Instrumented crutches and a forceplate were used. In walking with two forearm crutches the total of the ground reaction forces and the force pattern differ from those in free walking. The total of two crutch forces plus the force at the leg with partial weightbearing exceeds that caused by body weight alone. This is due to mass accelerations in a changed gait pattern. When the maximal leg force is reduced from 100% body weight to zero, the additional dynamic forces exceed those caused by body weight alone by 4%-19%. Only 2% of the additional dynamic forces act on the controlateral crutch while the rest is transmitted through the ipsilateral crutch. The crutch force pattern on the ipsilateral side depends more on individual gait characteristics than does that on the controlateral side. Load reduction is more pronounced in the late stages of the stand phase than in the early ones.


[The sacroiliac joint after hip arthrodesis (author's transl)].

After an introductory chapter about the anatomy and the function of the sacroiliac joint we examined the influence of an arthrodesis of the hip joint on the sacroiliac joint. We observed that an arthrosis of this joint is being formed because of the change in statics and dynamics, which appears radiologically, but rarely clinically. Subjective symptoms, if existant, have their cause mostly in alterations of the lumbar spine. Finally we observed that alterations of the sacroiliac joint after an arthrodesis of the hip joint are mostly insignificant for the patient and do not influence the success of this operation.


[As to the traumatic etiology of the Freiberg-Köhler's epiphyseonecrosis (author's transl)].

There is demonstrated the case of a Freiberg-Köhler's epiphyseonecrosis developing without any doubt after a direct massive contusion of the forefoot by hit against the edge of a swimmingpool. While the X-ray from the date of accident only showed a tiny osseus avulsion fracture out of the base of the proximal phalanx II--in spite of the immediately taken accurate therapeutical provisions (by fixation with plaster and later on paviment dressing)--there took place a massive epiphyseonecrosis of the capitulum II within only three months.--The etiology of the necrosis--direct trauma of the nutritive arteries passing through the collateral ligaments--is discussed. There is given a reference to the particular problems arising by critical examination of similar cases for instance at medical reports.


[Modification of the operative technics for the ventralisation of the tuberositas tibiae (Maquet-Bandi) (author's transl)].

There is given a modification of operative technics for ventralisation of the tuberosity of the tibia (Maquet-Bandi-Operation). Similar to a sand-glass two triangular cortical/spongious bone grafts are taken from the medial side of the tibia, just beside the tuberosity. Their size can be determined exactly. After having chiseled the proximal part of the tuberosity from both sides and lifted it up, the bone grafts are put under it, one from the medial, the other one from the lateral side by the way, that the top of the triangle is looking in distal, the base in proximal direction. The cortical surfaces of the grafts, showing to the medial and lateral side, make sure the stable keeping place, while their spongious surfaces, showing to the internal side, by direct contact to the spongious backside of the tuberosity and its spongious bed guarantee the quick osseous consolidation. A minimal osteosynthesis by drilling 2 Kirschner-wires in ventro-dorsal direction through the tuberosity, the cortical part of the bone grafts up to the opposite cortex of the tibia finishes the operation. 1. The bone graft can be taken directly at the field of operation. 2. The bone material is homogenous. 3. The cortical part of the grafts guarantee stable keeping place. 4. Their spongious parts make sure the quick osseous consolidation. 5. Minimal osteosynthesis is necessary.


[The inguinal incision for the open reduction of congenital hip dislocation (author's transl)].

Operative reductions of congenital hip dislocation are sometimes difficult when lateral incisions are used since the medial part of the acetabulum and the lower limbus are difficult to visualize. In the Ludloff technique this part of the acetabulum is seen excellent, but not the lateral part. High dislocations with inverted limbus are difficult to reduce and only with partial excision of the limbus. An inguinal incision beginning lateral at the spina ilica ventralis offers the best view and can be used for all different degrees of dislocation and age groups. The technique is described, the advantages and the rate of avascular necrosis compared with other incisions. Femoral osteotomies and acetabular or pelvic osteotomies should not be done at the same time because of a higher percantage of avascular necrosis. In high dislocaitons shortening osteotomies should not be done in the intertrochanteric region but deeper in the shaft to avoid additional disturbances of the vascular system of the proximal femur.


[The problem of late results of total endoprostheses of the hip (author's transl)].

This is the report about our collective of 1000 hip-TEP operations from 1967--76. The relatively low loosening- and infection rate of other clinics without sterile box is confirmed: 2.9% loosening, 0.7% infections. The results of 5 years amounted to 1.1% infections and 1.38% loosenings. We refer to the inexplicable high loosening rate of 11% in patients operated within 12 months in 1973/74. The author thinks that the low loosening rate measured during the other periods is due to the consequent application of the "low-friction" original prosthesis of Charnley.


[On the roentgenologic observation of wrist flexion (author's transl)].

To analyze adduction (ulnar flexion) or abduction (radial flexion) at the wrist, a simple calculatory method is described (quitient from the length of the scaphoid bone--navicular bone or os scaphoideum--in radial and ulnar flexion), converted to angle measurement via the cosine value. The normal values are limited by the pathologic values, so that beginning lesions can be identified in this manner. Description of a few pathologic cases and of the limits and possibilities of the method.


[Draft of a detailed total hand evaluation status (author's transl)].

In a comprehensive study dealing with the function of the hand and its impariment, difficulties are encountered owing to the lack of a standardised method of estimating the findings. Consequently, even until the present time, it has not proved possible to obtain a precise documentation and assessment, or to obtain comparable results. A hand examination form has been produced and presented for discussion, with the aim of standardising, and thus improving, the report of findings.


[Calcification of glenoid labrum in the aged (author's transl)].

200 radiographs of 100 elderly patients considering themselves to be fit are compared. Calcification of the glenoid labrum at the shoulder is due to age, without clinical importance, a radiologic finding. It was seen in 84%, symmetrical and independent of sex, bodyweight, occupation and left- or right handedness. It is, therefore, not considered to be a sign of arthrosis.


["Example of clinic rehabilitation" (author's transl)].

After ten years' activities of a working group for rehabilitation in an orthopedic clinic, the actual success as reported by the rehabilitated persons, is checked and evaluated in a questionnaire operation. The aim of this inquiry was to assess the work done by such a group within the general framework of clinical activities. Particular emphasis was places on the results in respect of rehabilitation, i.e., the extent to which the patient was able to resume his normal professional or employment activities.


["Fibula-pro-tibia-fusion" (Hahn-Brandes-Graft) in treatment of bone defects of the tibia (author's transl)].

The authors use the "fibula-pro-tibia fusion" (also called Hahn-Brandes Graft, for the treating large bone defects of the tibia shaft. This method is preferred both with congenital partial tibial aplasias with acquired extensive pseudarthrosis defects of the tibia. In congenital cases, grafting of the distal end of the fibula onto the calcaneal end of the foot with careful preservation of the epiphyseal disc, should precede surgery. Large differences in leg length can be treated after fusion surgery by means of elongation osteotomies. Attention is drawn to this method in the second example of pseudarthrosis defect. Lastly the authors mention a further method for mediation of large diaphyseal tibia defects, namely the transplantation of the opposing fibula. This can lead to good results when an aggressive form of fibrous dysplasia is not present, as was the case however in the third example. In such a case the process only heals after removal of the cover of the periosteum as well.


[Transplantation of periosteum-coated cortical and cancellous bone grafts for treatment of fractures and pseudarthrosis (author's transl)].

Bone grafts are used in the treatment of fractures just as in the treatment of atrophic pseudarthroses of long tube bones. Only autologous bone graft is a reliable transplantation material. The discussion about different values of cancellous grafts and cortical-cancellous grafts is not completed yet. It will be reported about the own results of 110 transplantations of fresh and ununited fractures of long tube bones between 1968--1975. Only the autologous cortical-cancellous periosteum-coated single graft was used.


[Postoperative complications of wound healing in orthopaedic surgery (author's transl)].

From 1. 1. 1971--30. 6. 1977 (6.5 years) 4,169 aseptic orthopaedic operations were performed in the Orthopädische Universitätsklinik Düsseldorf. 42 complications of wound healing have been observed (1%)9 Without an ultrasteril operationbox it is also possible to reduce the complications of wound healing in orthopaedic surgery. It is important to know the principles of asepsis and antisepsis, the method of our preoperative preparation of patients is described; the indication of prophylaxis of chemotherapeutic agents should be severe.


[Chondrosarcoma. (An electronmicroscopic study) (author's transl)].

The ultrastructure of 6 chondrosarcomas was analysed. These areas which by means of light microscopy appear benign, displayed the same appearance as chondromas. Malignant areas are characterised by distined variation of cells, nuclei and nucleoli. There is an electron-dense zone of 400 A between the inner membrane of the nucleus and the chromatic in some nuclei containing dense chromatin. The amount of cytoplasmatic organellae decreases as differentiation decreases. Nevertheless there are sometimes cells with an unusual accumulation of cytoplasmic organellae.


[Electromyographic examination of the femoral muscles in hemophilic effusion in the knee-joint and in irritated conditions of the knee-joint (author's transl)].

In ten patients with acute effusion in the knee-joint due to hemophilia, or with chronic knee-joint affection, the maximal isometric contraction of the M. vastus medialis and lateralis and of the M. rectus femoris was measured by electromyography. Measurements were taken before and after puncture of the effusion, or before and after intraarticular injection of a local anesthetic. In all examined patients, the contraction tests were performed below the pain threshold. The proportionate share of energy of the quadriceps muscle was considerably enhanced by reducing the intraarticular pressure and injecting a local anesthetic. This increase differs, depending on the state of the knee-joint affection.


[On crossed reflexes in human leg motoricity (author's transl)].

Crossed reflexes induced in the muscles of the calf were studied in 30 neurologically healthy volunteers. Almost half of the volunteers showed a pronounced reaction of the contralateral gastrocnemius muscle and of the soleus on ipsilateral stimulation of the corresponding muscle. The results vary, but they show that fundamentally there are processes of facilitation and inhibition due to the stimulation of the tension receptors or Golgi tendon organs of the stimulated muscle and also to the muscle spindle afferents of the antagonistically stretched muscle. It is assumed that the contralateral reflexes can exercise a modulatory effect on the central locomotor program, although they do not monitor it.


[Caudal regression syndrome and diastematomyelia. What is contained in Hohl's first publication of sacral dysgenesis? (author's transl)].

Hypoplasias and defective development of the caudal end of the spine are called caudal regression-syndrome. Occasionally such patients also show diastematomyelia. This combination, clinically important and of developmental interest is described on the basis of the first description and an observation of the author. The means of diagnosis are discussed.


[Retropatellar facet replacement using the McKeever patellar prosthesis (author's transl)].

110 knees were evaluated after retropatellar facet replacement (McKeever). In 105 of these cases high tibial osteotomy has been additionally performed. Indication and operative technique are discussed in details. The evaluation of the pre- and postoperative status bases upon an observation period of 1--7 years and concerns the criteria of pain, movability of the joint and ability to walk. Due to the magnitudes of compressive forces in the patella joint during flexed-knee stance, the position of the patella is considered to be essential for the result of this surgical treatment.


[Diastematomyelia--a harmless finding or cause of late neurological disturbance? (author's transl)].

Diastematomyelia is said to produce neurological lesions. Several new cases of diastematomyelia are reported without any neurological defect. They are discussed and compared with similar cases from the literature. Apparently the fixation of the spinal cord by diastematomyelia seems not to be the primary cause of the "tethering cord syndrome". Other conditions which are sometimes associated with diastematomyelia (myelodysplasia, dysraphia of the spinal cord etc.) may be the primary cause of progressive neurological lesions.


[Metabolic diseases and idiopathic ischemic necrosis of the femoral head in adults (author's transl)].

100 patients suffering from osteonecroses (including 95 with necroses of the head of the femur) were subjected to comprehensive clinical, roentgenologic and chemical laboratory examination. A triangle was established from the range of factors considered as pathogenetically important by various authors. These three outstanding factors were: disturbance of lipid metabolism, found in 41% of the patients, deviation of the liver function data, and, finally, abuse of alcohol as discovered on the basis of the case history. The statistically significant correlation of these factors makes it probable that there is actually a pathogenetic chain abuse of alcohol--hyperlipoproteinemia--arteriosclerosis--osteonecrosis. No specific importance of the uric acid and glucose metabolism could be established, since the metabolic disturbances associated with these processes are mostly linked with the observed hyperlipoproteinemia. Deliberations regarding the genesis of necrosis of the head of the femur must also take into account, over and above the relation between metabolic disturbances and stenosing vascular processes, the presence of a locally predisposing factor, such as mechanical strain or the state of enzymatic supply of the osseous tissue.


[Long-term follow-ups in adult idiopathic necrosis of head of femur (author's transl)].

28 patients were subjected to follow-up examination after having suffered for more than 10 years from idiopathic necrosis of head of femur. The high incidence of the bilateral affection of the hip joint as well as the occurrence of multiple osteonecroses are correlated with distrubances of lipid metabolism. Under conservative treatment the disease takes a progressive course, which, however, can remain subclinical for a long time. Good postoperative results can only be expected from intertrochanteric corrective osteotomy which often leads to a regeneration of the head of femur. Caution is recommended before confirming the indication for athrodesis or total endoprothesis because of the risk of disturbances of consolidation or loosening of the implant.


[Indications for reoperation in radicular syndromes following surgical removal of lumbar disk hernias (author's transl)].

In case ischias-type pain persists or recurs following surgical removal of lumbar disk prolapses, it will be necessary to carefully weigh against one another as possible causes: disk prolapse recidivation, epidural or intradural cicatrization, and pseudoradicular pain in myotendinoses. Postoperative diskitis or spondylitis must also be considered as a possible cause.


[Roentgenologic investigations on surgical treatment of Perthes' disease. First communication: results following spiking operations with Moore's pins (author's transl)].

The present investigation of 84 operations effected because of Perthes' disease, was conducted with the aim of comparing and assessing two surgical methods. For this purpose, preoperative and postoperative measurements and statistical calculations were effected of the epiphyseal index, the radius quotient, the acetabular head index, the acetabular index, and the angle of the capitular epiphysis of the femur. The shape and kind of congruence was also included in the assessment. Fixation with Moore's pins or with Kirschner wires was conducted 28 times up to 1971. The patients remained in the clinic for an average period of six months with an average immobilization period of twelve weeks. Physiological congruence 1 was achieved in only 15% of the cases; deformed femoral heads were seen in 36% of the patients. The influence of the operation on the central positioning of the femoral head was only slight. 81% of the diseased hip joints showed an enlarged acetabular entrance. The angle of the capitular epiphysis of the femur showed average values near the boundary to the predysplasia range (19.8 degrees). Objective total assessment (Bauer and Jünger 1974) yielded 45% good or very good results and 37% poor results. Basing on these results this surgical method can no longer be recommended.


[Roentgenologic investigations on surgical treatment of Perthes' disease. Second communication: results following intertrochanteric varisational osteotomy (author's transl)].

Follow-up examinations of 37 out of a total of 56 intertrochanteric varisational and partly derotational osteotomies after an average period of 62 months showed more favorable results in all respects. The in-patient treatment period was on the average 15 weeks when using Schanz' screws. In fixation with AO angular plates, the average hospitalization period was 8 weeks (including the second stay in the hospital for the removal of the metal). The regeneration period of the necrotic femoral head was 18 months, and was, therefore, 7 months shorter than after the spiking or nailing operation. Most of the operations took place in the beginning rehabilitation phase (stage 3a), resulting in a below-average regeneration period. Physiological congruence was achieved in 24% of the cases, and deformations of the femoral head were seen in only 19% of the patients. In 62% of the cases, good central positioning of the femoral head was achieved, whereas in 68% the entrance of the acetabulum was wider than on the contralateral, healthy side. The improved head/acetabulum ratio was also documented in a postoperative increase of the angle of the capitular epiphysis to almost 24 degrees. The objective total assessment yielded 68% very good and good results, whereas 19% of the results were considered poor. Basing on the favorable roentgenological and also clinical results which are mainly confirmed by literature references, this method can be considered as the method of choice according to the present state of knowledge.


[Model investigations on the static abnormal strain on the homolateral knee joint following arthrodesis or ankylosis of the hip joint in the frontal plane (author's transl)].

The static abnormal load on the homolateral knee joint after stiffening of the hip in the frontal plane (abnormal load associated with abduction or adduction) is examined via a simplified pelvis and leg model. Besides the direct impairment of the homolateral knee joint, it has also been possible to demonstrate the indirect impairment of the ankle joint and of the foot.


[What is the value of the corrective osteotomies in the therapy of the coxarthrosis (author's transl)].

Followup examinations of 29 corrective osteotomies carried out near the hip show that surgical removal of a contracture can yield quite favorable results in osteoarthritis of the hip. Surgery is indicated in cases where rotation and extension of the thigh is no longer possible, resulting in immobilization, whereas, on the other hand, flexion is still possible to a satisfactory extent and the patient is still too young for plastic surgery.


[Aimed partial immobilization (author's transl)].

A method for treating dislocation of the hip is described which is relatively problem-free. The paper also describes how to apply a partly immobilizing plaster cast. Success of the treatment is confirmed by the reduced quota of necroses of the femoral head. Easy care is another remarkable feature of this method.


[Avoidable surgical errors in hallux valgus surgery according to Brandes (author's transl)].

In postoperative follow-ups in a large number of patients who underwent Hallus valgus surgery according to Brandes, residual pain was found due to insufficient resection of the proximal phalanx. It is pointed out that the results of this frequent and beneficial Hallux valgus surgery can be improved by using a more subtile surgical technique. Figs. 1-5 show that errors continue to be made. If these errors can be avoided in the future this report will have fulfilled its purpose.


[Considerations in a long-term study on progressive cranio-carpo-tarsal osteolysis (author's transl)].

A long-term study conducted in a female patient who is now 21 years old and who showed a disease pattern similar to cranio-carpo-tarsal dystrophia, investigated thoroughly by Liersch and Hoevels when the girl was 6 years old. It must be stated as a result of this long-term study that in our case, the osteolyses at the wristbone (carpalia) and tarsal bone remained progressive up to the onset of puberty. The radiological changes came to a standstill after puberty had set in; in fact, there was even a certain amount of clinical compensation of the radiologically visible defects during the years that followed. It seems that the disease pattern described here, is limited to the growth period of the patient. It was not possible to classify this disease pattern as belonging to a particular category, and its cause remains largely unknown. The author describes the disease pattern as an "essential" one.


[The problem of surgical therapy of bone cysts at the coxal end of the femur (author's transl)].

The problem of the juvenile bone cyst in the region of the coxal end of the femur is described on the basis of the case histories and references. Surgery is always mandatory, whereas the type of surgery depends on the dimensions and shape of the juvenile bone cyst.


[Arthrolysis in the treatment of post-traumatic extensor rigidity of the knee (author's transl)].

Extensor rigidity of the knee may be due to a wide variety of causes and is certainly quite often a sequela of an injury. Rigidity is caused by damage to tissue distant or proximal to the knee joint, in the joint itself, or simultaneously at several locations. In many cases considerable improvement can be achieved by arthrolysis. However, this requires detailed knowledge of the involved and expected pathologic changes. Besides detailed clinical and x-ray examination via arthrography it is particularly important to select and prepare the patients properly. Knee arthrolysis can never be based on only one surgical procedure. The authors differentiate between covered and open loosening of the stiffened joint besides intraarticular and extraarticular arthrolysis, and a combined intraarticular and extraarticular procedure. Postoperative followup treatment is at least just as important as the surgical procedure itself. Complications can be largely avoided via subtile technique and sufficient experience. The authors report on 16 followup examinations effected during the past four subsequent to arthrolyses of the knee. On the average there was an improvement in flexibility and stretch-ability by 70 degrees, or a relative flexibility increase by 80%. No serious complications were seen. Arthrolysis of the knee is recommended as a well-tried and highly successful surgical procedure.


[Experimental experiences with intra-articular injections of the alpha-emitting radionuclide 224Ra (ThX) into the knee-joint of rats (author's transl)].

224Ra is used within the therapy of rheumatoid arthritis. The distribution of this radionuclide in the organism was investigated up to 7 days after incorporation in order to estimate a possible risk of late effects. In the autoradiographs we found strong blackenings at those bonesurfaces which faced the injected knee-joint hole. In addition the radionuclide was deposited in skeletal growth-zones similarly as after i.v. and i.p. injections. The dosimetric data (particularly of knee-joint and skeleton) were calculated and compared with those which occur after the therapy of ankylosing spondylitis using i.v. 224Ra injections.


[Perthes' disease: a roentgenological clinic study (author's transl)].

Perthes' disease (a condition also known as Legg-Calvé-Perthes disease), or osteochondrosis of the head of the femur, has been repeatedly subdivided into several stages and subjected to classifications which are hardly satisfactory in practice. Catterall has presented a new group classification on the basis of untreated cases of Perthes' disease, which has been combined in the present paper with Somerville's subdivision into different stages. This subdivision into groups and stages was examined for feasibility and practical usefulness via 51 cases of Perthes' disease. It was found that both systems of grouping and classification sometimes required repeated correction in the course of the disease. Hence, this subdivision remains unsatisfactory, especially when therapeutic consequences are expected to be drawn. Cases for Perthes' disease treated by the authors are described and compared with the data given in medical literature.


[Experience in 77 changes of hip-joint prostheses (author's transl)].

The article reports on 77 changes of hip-joint prostheses. The main indications are deep infections and loosening. The surgical procedure and complications are described. Results are encouraging. Even in cases of changes of prostheses on account of fistulating, deep infection, the infections can be controlled in 75% of the cases. Long-term results must be awaited.


[Prognosis and therapy of the congenital scoliosis (author's transl)].

Patients, suffering from congenital scoliosis, offer multiple problems for the prognostic judgement and consequent therapy. The diagnosis has to include the patterns of malformation, the lack of balance and accompanying malformations of other organs. This requires an interdisciplinary cure. Physical therapy or redressing plaster-shells do not guarantee a sufficient treatment. In most cases the Milwaukee-brace will not stop the progredience, but just an early operative intervention. Indications and techniques of stabilizing or correcting operative procedure from dorsal or ventral are described.


[Comments on pseudarthrosis of the cuneonavicular joint (author's transl)].

This paper reports on the result of central bone chip bolting in the treatment of pseudarthrosis of the cuneonavicular joint, using an autologous bone chip according to the method evolved by Wilhelm and Sperling. The surgical procedure and postoperative course are described in detail, as well as the findings of a followup check effected two years later.


[A method for measuring the distal torsion of the femoral bone (author's transl)].

A new method of measuring the distal torsion of the femoral bone is introduced. The term "torsion" is defined, and the etiology of femoral torsion is scrutinized. The sources of error are discussed after a description of the process of measurement and of the calculation of the angle of torsion. The aim and value of this method are, firstly, to supply evidence for the existence of a prearthrosis factor of the patellofemoral joint, and, secondly, to be of practical importance for the consequences of surgery. These consequences will be discussed elsewhere.


[Intercentral interactions in the neocortex of 2-year-old children when exposed to verbal signals].

It has been shown by the EEG correlation analysis method that perception by children of the third year of life of signal verbal stimuli consderably increases spatial synchronization of biopotentials as compared with the action of indifferent verbal stimuli. Perception and recognition of words is attended with involvement in the synchronous activity of potentials of the inferior parietal and frontal associative zones and the projection zone of the auditory analyser in the left hemisphere. In addition, children of the indicated age, as compared with a younger age, display an involvement in the sensory analysis of a word of the projection zones of the articulation apparatus, which establish an interconnection with the frontal zones of the dominant hemisphere.


[Significance of the relative position in space of associated stimuli for formation and performance of motor conditioned reflexes].

In experiments on cats the rate of formation of conditioned reflexes to sound (running to the feeding trough) depended on the spatial interrelations of the paired stimuli: the closer the source of the conditioned signal to the feeding trough, the sooner the formation of the conditioned reflex. It has been assumed that during formation of a conditioned reflex the closing of connection between conditioned and unconditioned stimuli is also attended with the closing of connection between the spatial parameters of the paired stimuli. Experiments with inactivation through cold of the temporal area (cortical representation of the vestibular system) of one hemisphere have shown that such a connection is formed in central parts of the vestibular analyser. When the conditioned reflex is elaborated to one feeding trough, the connection is duplicated by both hemispheres; in reflexes to two feeding troughs (i.e. spatial choice) such connections are lateralized in each hemisphere.


[Effect of activating the putamen on alimentary conditioned reflexes in dogs].

The influence was studied of the near-threshold high- and low-frequency stimulation of the putamen on achievement of alimentary conditioned reflexes in dogs. Both low- and high-frequency activation of the examined structure significantly changes the parameters of intermediate secretion, of the salivary conditioned reflexes, without influencing unconditioned ones. Unilateral stimulation disturbs the achievement of positive and inhibitory conditioned reflexes to a greater extent than bilateral one. Difference between the effects of low- and high-frequency stimulation has been revealed.


[Formation of a defensive conditioned reflex to an acoustic stimulus in rabbits after early visual deprivation].

The formation of a defensive conditioned reflex to sound has been studied in rabbits raised from birth up to 30 days of life in dark. It was shown that, as compared with control animals of the same age, elaboration of reflex to sound takes place in them in shorter times periods and with less pairings. This corresponds to changes in electrographic manifestations of conditioning: increased amplitude and reduced peak latency of evoked potentials to acoustic stimuli in the auditory and sensorimotor cortical zones. The data obtained testify to enahcned functional activity of the auditory cortex, apparently due to a compensatory enhancement of impulse activity coming from the intact receptors of the auditory apparatus. It has been assumed that the observed functional changes appearing in the cortical end of the signal analyser (auditory zone); in response to sound, following visual deprivation, are a consequence of an early nature training of synaptic structures with regard to perceptionof impulses of acoustic modality.


[Dynamics of the activity of rabbit visual cortex neurons during elaboration of elementary conditioned reflexes to time and association].

Elaboration of a reflex to time (with omissions of stimuli) and of association; light--light + electrocutaneous stimulation of the paw was studied on neurones of the rabbit visual cortex. It was shown that by similarity of patterns of the discharge to a conditioned stimulus and to reinforcement, 83% of neurones reveal the formation of a reflex to time, and 57%--elaboration of association. Three ways of coding plastic reorganizations of the neuronal discharges are suggested; by the total number of spikes in the response, by the total sum of inhibitory periods, and by the pattern of the response. It has been found that in the reflex to time the early components of the response to the stimulus are reproduced during omissions; in elaboration of the association the late components of the discharge reaction to reinforcement are mainly repeated. Most cells with plastic reorganizations possessed polysensority and revealed discharge sensitization during habituation.


[Dynamics of acetylcholinesterase activity in the brain during elaboration and stabilization of defensive conditioned reflexes].

Electro-defensive condtioned reflexes (CR) to light were elaborated in rats in Y-maze in one experimental session and their training was continued during subsequent 20 sessions. Immediately after CR elaboration or the 20th session of its training, AChE activity in the motor and visual cortex and the hippocampus decreased, increasing again in 24 hours. Animals used as active control which received non-paired photic and electric stimuli, exhibited opposite changes of AChE activity.


[Neuronal correlates of an alimentary instrumental conditioned reflex in rats].

Elaboration of an instrumental reaction of getting the food from a narrow tube with a defnite forepaw (handedness) brings about a distinct re-distribution of cellular activity in the motor cortex and in the caudate nucleus, contralateral to the instrumental paw. The changes were observed at a 250 msec. interval before and 512 msec. interval after the beginning of the movement. Two types of cellular discharge changes were recorded: phasic and tonic. The phasic reactions (both inhibitory and activating) were grouped around the beginning of movement, with an average duration of about 100 msec. The tonic reactions lasted a few hundred milliseconds.


[Effect of stimulation of the reticular formation on the motivational and reinforcing effects of the self stimulation zones].

The influence was studied on the midbrain reticular formation (RF) on motivational and reinforcing effects of stimulation of the same selfstimulation zones (SS) of hypothalamic area. A current of gradually increasing intensity was used, by means of which three groups of functionally (behaviourally) specific reticular points were revealed: motivationaly neutral, positive and negative. The data obtained show that influences of RF on SS zones of hypothalamus differand depend on functional properties of various RF areas. Changes of motivational effects in SS zones reflex the specificity of reticular foci in a lesser degree than changes in reinforcing effects. It has been suggested that reinforcing effects of the SS hypothalamic zones possess their own activating mechanism specifically related to its "positive" link and differing from reticular mechanism of unspecific activation.


[Sensitization and habituation of command neurons during a defensive reflex in grape snails].

All investigated neurones were classified into functional groups depending on their participation in unconditioned avoidance reflex of pneumostome closure. Habituation was produced by tactile stimuli applied with a frequency of 0.1 c/s. Spike responses of neurons participating in processing sensory information habituated gradually, while reactions of command neurones of avoidance behaviour became sensitized to the second or third stimulus of the series. Behavioral reaction was sensitized in parallel with command neurones in spite of habituation in other types of nerve cells. A conclusion is drawn that behavioral habituation is due to waning of responses in all the participating neurones, but the independnet process of sensitization is due to sensitization of command neurones. Probable mechanisms of neuronal sensitization are discussed.


[Generalization of activation reaction extinction during consecutive stimulation of different parts of the brain].

The process of extinction of the brain activation reactions ("arousal") was studied in chronic experiments on cats with implanted electrodes during repeated electrical stimulation of alternated points in the cortex and in the brain stem reticular formation. Extinction of the reactions achieved by stimulation of one point resulted in the loss of excitability both at this point and in other activating structures at different levels of the brain. The sequence of stimulated structures was of no importance. A possibility is suggested of development of a generalized inhibition in the neural net of the non-specific reticular system of the brain which may be inciated in any point of this system: in the brain stem, in the thalamus or in the cortex.


[Neuronal activity of the "isolated hippocampus"].

Spontaneous and evoked activity of the field CA1 neurones were investigated in long-lasting experiments on unanesthetized rabbits with "isolated hippocampus" (destruction of both septal and perforant path's afferents). Testing by various sensory stimuli as well as by electrical stimulation of Schaffer's collateral's, subiculum, posterior cingulate cortex, neocortex and midbrain reticular formation was used. The sensory reactions were virtually absent during first 1--2 weeks after the operation, but by the 4--6th week the level of reactivity became normal (65--70%). The first sensory reactions encountered were of diffuse tonic type; later on complex patterned on-responses appeared. The sources of hippocampal reactions, the possibility of plastic rearrangement of synapses and the absence of intrinsinc ability for generation of the theta-activity are discussed.


[Relationship between the frequency of self stimulation and the strength and duration of stimulation].

In experiments on thirteen rats with electrodes in the lateral hypothalamus, with a simultaneous change in current intensity I and of stimulation duration T, two variants were obtained of the empirical response surface of the self-stimulation (SS) frequency: with the maximum SS frequency, located within the surface boundaries (peak variant), and with the maximum at one of its boundaries (side variant). An equation has also been deduced on the regression of SS frequency on the parameters I and T, which quite accurately defines the experimental and rated data (R = 0.57 divided by 0.97). It has been established that current intensity has a greater effect on SS frequency as compared with the stimulation duration and that the influences of these parameters are relatively independent of one another.


[Several properties of the connections between the dentate fascia and field CA3 of the hippocampus in vitro].

Topography of connections between the dentate fascia (DF) and the field CA3 was investigated on transverse hippocampal slices of guinea pigs in vitro. Recording of the extracellular spike activity from different loci in the CA3, during threshold electrical stimulation of DF has shown that while each pyramidal neurone responded to 3-4 widely spaced stimulated points, any CA3 locus responded to nearly all points in DF. The dispersion of latencies for each DF-CA3 distance was about 5--7 ms. Increase in intensity of stimulating current was followed by a decrease of long latencies to the minimal theoretically counted value characteristic for a given DF-CA3 distance. The same process was observed in the course of post-tetanic potentiation. It is suggested that dispersion of response latencies depends upon different levels of synaptic modification, obtained in vivo.


[Effect of stimulation of the mediodorsal nucleus of the thalamus on the synchronous flow of cortical electrical processes].

It was shown in chronic experiments on rabbits that stimulation of the mediodorsal thalamic nucleus brings about, as a rule, en enhancement of amplitudes of the spatially-synchronous cortical theta-rhythm and a decreased frequency of its oscillations. Analysis of the phenomenon by means of a simple mathematical models shows that such a connection between amplitude and frequency EEG parameters may be accounted for by the existence of two-way cyclic interactions between the cortex and the thalamus, forming a closed contour of a feedback connection. The capacity of the mediodorsal thalamic nucleus to influence the synchroneity of cortical electrical processes is compared with published data on its role in conditioned activity.


[Effect of light deprivation on cytochemical features of visual cortex neurons in rabbit brain].

A cytophotometric measurement of protein concentration and content in the neuronal cytoplasm and in the structures surrounding the neurones was made with the view of studying the plastic properties of units in individual layers of the visual cortex. The data obtained attest that the absence of specific impulse activity from the moment of birth up to 2.5 months brings about  a distinct rise of concentration and a drop in protein content along with a decrease of the cytoplasm surface of neurones in layer IV and large pyramides of layer V as well as a decrease of protein concentration in the structures surrounding the neurones in the lower part of layer III, in layer IV and in the area of large pyramids in the layer V. It is suggested that such changes are related to the fact that neurones belong to groups differing in the degree of reactivity of biochemical changes, depending on their functional significance.


[Changes in glutamate dehydrogenase activity in the neurons of the motor cortexof the cerebral hemispheres during light deprivation].

It has been shown that early light deprivation (keeping the rats for eight weeks from birth in a dark chamber) produces compensatory changes in the majority of pyramidal neurones in layers III and V of the brain motor area: significant enhancement of glutamatdehydrogenase activity activity in the bodies and processes of the neurones, increase of their volumes, augmentation of the number of neuroglial satellites with a high ferment activity. The revealed morphochemical changes, more pronounced in the layer V, are considered as a manifestation of enhanced functional activity of the coritcal end of the motor analyser, resulting from visual dereceptation.


A micromethod for the isolation of drugs from blood using amberlite XAD-2.

The extraction of drugs from small blood samples (1 ml or less) for subsequent quantitative determination is described. Isolation was carried out by adsorption of the drugs to Amberlite XAD-2 resin utilizing a batch procedure that enabled the simultaneous extraction of up to 200 samples in approx. 5 hours. A new desorption technique yielded extracts of high purity that could be used directly for gas chromatographic or radioimmunological determinations, even if hemolyzed or putrid blood was to be examined. The following 26 substances were quantitated after addition to postmortem blood speciments at concentrations of 1-10 microgram/ml: tilidine, diphenhydramine, dibenzepine, imipramine, chlorpromazine, amphetamine, pentazocine, phenacetin, methaqualone, meprobamate, parathion, diazepam, digoxin, beta-methyldigoxin, carbromal, glutethimide, amobarbital, pentobarbital, cyclobarbital, phenobarbital, diphenylhydantoin, carbutamide, tolbutamide, glycodiazin, tolazamide and chlorpropamide. Thereby recoveries of 60-100% could be achieved. The reproducibility of the procedure was satisfactory as demonstrated by coefficients of variation of 3.7-8%.


[Comparative analysis of the effects of alcoholic drinks of different qualities (author's transl)].

The authors compared the effects of alcoholic drinks rich in fusel oil with the effects of diluted pure alcohol of the same quantity on 19 clinically healthy university students. The investigations utilized EEG and physiopsychic testing methods. The clinical symptoms were observed both under the effect of drinks and in a crapulous state ("hang-over"). It was found that alcoholic drinks rich in fusel oil can produce a more deviating EEG curve, an increased worsening of physiopsychic performance and of clinical and subjective symptoms. The necessity of regular quality control of alcoholic beverages is pointed out.


[Fatal decompression sickness following therapeutic hyperbaric environment (author's transl)].

In Hannover/Germany in 1976 a so called "Society for Regenerative Hyperbaric Therapy" (Gesellschaft für Regenerative Uberdruck-Therapie) subjected 20 patients within two coupled multi-place chambers to a simulated hyperbaric environment, equivalent to a maximum of 4 ata, followed usually by gradual reductions of the pressure. The patients were of an average age of 67.2 years and were afflicted by various disorders. During one of the "dives" a patient developed air embolism of the central nervous system. During ensuing confusion of the chamber was opened suddenly, with resultant explosive reduction of the high pressure. This resulted in five letal accidents of decompression sickness. Post mortem examination revealed diffuse distribution of gas bubbles throughout the entire body. By elecronmicroscopy each bubble was covered by an osmiophilic coat. Post mortem findings are discussed and correlated with well-known and new clinical symptomes. These observations present for the first time fatal accidents of decompression sickness in humans, associated with hyperbaric air-therapy.


[On fingertips of "washerwoman's hands" (author's transl)].

An investigation method is proposed to find out quantitatively the beginning and the degree of "washerwoman's hands" at the fingertips. To answer the question, for how long there was contact with a fluid medium, systematic investigations are necessary to measure the width of the "cristae papillares" of several test persons with an onlight-photomicroscope under similar fluid conditions.


[Distribution of blood in lungs in the sudden infant death (author's transl)].

In 67 cases of Sudden Infant Death Syndrome (SIDS) the distribution of blood in the lungs was examined by staining paraffinsections of 50 mu with benzidine. A focal, acute emphysema and, frequently, a diffuse, alveolar and also interstitial emphysema exists in all cases. In all parts of the lungs atelectases and dystelectases, some of them covering larger areas, are found. Both atelectases and dystelectases show a high degree of hyperaemia coupled with expanded alveolar capillaries, while emphysematous areas show reduced blood volume. The possible functional significance of the disorder in blood distribution in the lungs for increased hypoxemia and the death mechanism are discussed.


[The use of childbirth alterations of the pubic bone for identification (author's transl)].

This paper discusses whether parturition or the number of parturition events can be determined from certain gross alterations, which are caused by pregnancy and parturition, found around the symphysis area of the pubic bone. The study is based on the analysis of 49 pairs of pubic bones, for which the number of parturitions and/or abortions were known. No criteria were found to be useful for a clear forensic diagnosis. However, this investigation did show a certain probability of correlation between the extension of grooves on the posterior pubic cortex and the number of parturitions. Examples of remarkable misleading conclusions in special cases are given.


[Current possibilities of preoperative diagnosis in planned partial kidney resections].

Sequential and functional scintigraphy utilizing the regions of interest technique has a definite place in preoperative diagnostic renal evaluation prior to partial nephrectomy. Whereas scintigraphy offers information regarding parenchymal function and eventual therapy, renal angiography enables one to visualize the vascular tree, which is technically important for the urologist during surgery. The fate of the diseased parenchymal portion should not only be determined from the subjective intraoperative findings, but rather from more exact methods which measure function and morphology.


[Lymphangiography--a guide in tumor nephrectomy?].

The anatomy of renal lymphatic vessels is described. Marked discrepancy in the results of lymphangiography carried out in 47 patients with kidney tumor and the histological examination of the lymphatic tissue removed by lymphadenectomy is discussed. However, there is a conclusive evidence of the prognostic value of lymphangiography concerning the postoperative survival of patients with kidney tumors. Due to misinterpretations of lymphangiography, the variability of the lymphatic outflow of the kidney as well as the predominant hematogenic spread of metastases of kidney tumors, lymphangiography does not appear to be a valuable diagnostic approach in renal carcinoma.


[High-grade Urinary retention in the upper urinary tract due to ovarian cysts].

The obstructive uropathy of the upper urinary tract the reason of which is to be searched e.g. in congenital malformation, concrements hindering the passage, strictures and tumors of the urinary tract itself as well as in growing and displacing processes of the adjoining organs have often been observed and described. More seldom this is suitable for benign expansive processes of the ovary. Especially smaller growing and displacing benign processes in the ovary area may result in considerable difficulties concerning differential diagnosis. It is reported on a case of chronic urinary retention with cystic changes of the ovary.


[Malignant lymphoma of the testis--an urological or nonurological disease?[].

Malignant lymphomas of the testis have a special position among the tumours of the testis. Also in such cases, in which only the testis is perceptibly diseased, nevertheless must be started from a systemic disease which is clinically not yet recognizable. These special problems demand a multidisciplinary, oncological collaboration in diagnostics and therapy. After establishment of the diagnosis and semicastration by the urologist further diagnostics and therapy should be performed by the representatives of other specialities.


[Transfer of behavior patterns through transplantation of systems of neuroanatomic structures in amphibian larvae. II. Xenoplastic transplantation of hind brain systems between Xenopus laevis (Daud.) as well as Hymenochirus boettgeri (Torn.) and Triturus vulgaris].

By replacing parts of the neural plate (prospective medulla oblongata) of Triturus vulgaris by neural ectoderm of Xenopus laevis larval chimaeras were obtained, which showed donorlike rhythmical movements of distinct parts of the visceral musculature according to the place of implantation. Especially the branchial region with its external gills showed rhythmical movements and is the special object of this investigation.


[Mesenchymoma of the chest wall in childhood (author's transl)].

A case report on the mesenchymal mixed tumor (mesenchymoma) of the chest wall of a baby is given. It was composed of chondroblastoma and osteoblastoma and of areas of angioblastoma. This neoplasm shows immature areas and infiltrates extensively the adjacent tissues. The morphologic classification of benign and malignant mesenchymoma is uncertain and does sometimes not correspond to the behaviour. The significance of different histological features of these tumors in relation to the prognosis is discussed.


[Viability assay on animal cells with ethidium bromide by fluorescence microscopy (author's transl)].

The present paper reports on a viability assay on animal cells with the fluorochrome ethidium bromide and its combined use with fluorescein diacetate. The fluorescence microscopic investigations were quantified by pulse cytophotometry, slide preparation, and counting chamber.


[The consequences of fibrosis of spleen capsule and perisplenitis cartilaginea for the postmortem diagnosis of hypertension and cor pulmonale (author's transl)].

The statistical investigation of fibrosis of the spleen capsule and of perisplenitis cartilaginea in 444 consecutive autopsy cases revealed a significant correlation between the changes of the spleen capsule and cor pulmonale, but no significant correlation to hypertension was detected. Therefore, fibrosis of the spleen capsule and perisplenitis cartilaginea can be used as a criterion for the postmortem diagnosis of cor pulmonale.


[Fibrosarcoma of the right ventricle of the heart--a contribution to the pathology of the primary sarcoma of heart and pulmonary arteries (author's transl)].

The clinical signs as well as the pathological-anatomical and histological peculiarities of a case of fibrosarcoma of the right ventricle of the heart in a fifty-years-old women are described. Examining of all cases described in literature it becomes evident that when ascertaining the starting points, there is a fluent transition from the sarcoma of the endocardium to the sarcoma of the pulmonary arteries. Four types become evident. The morphological pecularities of the appearance of Anitschkow-cells are described. Origin and importance of these cells are not known yet in all their details. The Survey over the single observations speaks in favour of their affiliation to the cellular defence system of the heart.


[Coronary atherosclerosis, coronary thrombosis and myocardial infarction in autopsy cases. 8th communication: Relationship of coronary atherosclerosis and myocardial infarction (author's transl)].

The autopsy reports of the Pathological Institute Erfurt of the period from 1.1.1951 until 31.12.1969 were scored for cases of coronary atherosclerosis and myocardial infarction and analysed concerning frequency and distribution of age and sex, resp. In 89.05 per cent (2131 cases) of all myocardial infarctions a coronary sclerosis was present. Males suffered significantly more frequent from these forms of ischaemic heart disease. During the period of nineteen years a significant increase of the coronary atherosclerosis in combination with a myocardial infarction was observed. This is due to the more frequent occurrence of severe forms. The increase of the frequency of the myocardial infarctions and of the weak and moderately coronary sclerosis particularly concerns the younger age groups. Callous infarcts were more frequent than fresh and relapsing ones.


[Polypoid eosinophilic granuloma of the small intestine (author's transl)].

The case of a circumscribed polypoid eosinophilic granuloma of the small intestine is reported. The tumor caused an intussusception with consecutive ileus. After resection of the involved bowels the patient was healed. No allergic history was found. The morphology, clinical features, and the therapy of this type of tumor is discussed and the relationship to the Histocytosis X is emphasized.


[Alveolar soft-part sarcomas in the skeleton (author's transl)].

The rare alveolar soft-part sarcomas, tumours with well defined histological pattern but uncertain histogenesis, are up to now described only in soft tissues, especially in those of the extremities of adolescents and young adults. We can report two cases of alveolar soft-part sarcomas in the sceleton, both in the right femur of 22 years old women. The delimitation of these tumours against others with similar histological pattern may be very difficult. The occurrence of these tumours in the sceleton does not require to substitute the term alveolar soft-part sarcoma by an other one.


[Psychological care of surgical patients (author's transl)].

Today the effective psychical management of patients has become more difficult because the doctor is confronted with a modern critical patient. The relations between doctor and patient are complicated due to many doctors cooperating in treatment and diagnosis. Information of the patient and organisation of the psychical care concerning the prae, intra- and postoperative period are discussed.


[Postoperative psychical disturbances (author's transl)].

Abnormal psychical disturbances after surgical procedures may either be attributed to the experience of illness or to cerebral dysfunction, directly or indirectly including the brain in the process of the disease. The latter results in somatic psychotic states and "Durchgangssyndrom". The postoperative psychosis is not a nosological entity.


[Acute haemorrhage from ulcers of the stomach and duodenum; rate of transfusion and complications (author's transl)].

It has been shown in 35 patients with severe acute gastrointestinal haemorrhage that there is a limit regarding the amount of transfused blood needed for substitution. Whereas patients over 65 years had a 100% mortality rate after more than 10 units., the limit in younger patient was 15 units. The time of the beginning of surgical therapy is decisive for the chance of survival. After 4 transfusions in few hours the surgical intervention should be started. Under these conditions even older patients have a better chance of survival. The number of transfusions given and the time is directly proportional to the rate of complications.


[Spontaneous perforation of the gall bladder (author's transl)].

We suggest to differentiate between the real spontaneous perforation of the gallbladder and the inflammatory rupture and contrast both with the traumatic form. In one case treated by us we suceeded in finding the cause of the perforation to be an antatomical deficiency. Sterile cholascos should be distinguished from severe bile peritonitis.


[Surgery of old age (author's transl)].

The importance of surgery in the aged is based on the increased life expectancy of the population. Besides the multimorbidity of geriatric people psychological and social aspects must be taken into consideration. In old age the danger of shock is increased therefore the indication for urgent surgery permits no delay. In 1975 649 patients over 60 years out of a total of 2532 operations underwent surgical procedures; 349 were urgent cases. Mortality rate below 10%.


[Should the B-I gastric resection no longer be used? Results of 228 cases (author's transl)].

Clinical indications, operative findings, technical details and pathological studies in 228 Billroth-I-Pean gastrict resections for gastric ulcer, are represented in detail. 186 of these patients could be followed up with a maximum of 18 years: 8.6% had troubles after meals, 8.6% gastritis of the remaining stump, 5.9% a small stomach syndrome and 0.5% a reflux oesophagitis. But no one of them had to be reoperated nor for functional troubles, nor for recurrent ulceration. According to the Visick classification the following results have been obtained: V. 1:75.3%, V. 2:13.4%, V. 3:7.5% and V.4:3.7%.


[Behaviour of serum phosphorus level during the postoperative period (author's transl)].

Behaviour of serum phosphorus and phosphate-excretion in urine has been observed during the postoperative period in 40 patients who obtained different amounts of phosphate-substitution. The findings were compared with 8 patients who had a phosphate-depletion syndrome. It was shown, that the appearance of hypophosphataemia during the postoperative period can be prevented by a daily supply of at least 25 mmol phosphate. If a phosphoate depletion syndrome has occurred, the substitution of 40 to 50 mmol phosphate and simultaneous reduction of caloric supply is recommended. Furthermore, routine control of serum phosphorus level and, if necessary, measurement of phosphate excretion in urine should be performed in any type of postoperative parenteral nutrition.


[Monday to Friday-clinic (author's transl)].

On a Monday to Friday ward with 21 beds in 1 1/2 years 1149 patients underwent the following operations: appendectomy 23%, hernioplasty (femoral and inguinal) 20,5%, phimoses 14,4%, cryptorchidism 9,7%, anal fistula and fissure 7,8%, hydrocelectomy 2,9%, saphenectomy 2,7%, haemorrhoidectomy 2,9%, excisions of Dupuytren's contracture 1,0%, varicocelectomy 0,4% pacemaker implantations 2,7%, other operations and patients for diagnostics 8,5%. The standardised diagnostic procedure is performed during the prehospital time. On Monday all patients were operated upon and dismissed on Friday. The operative results are good. The in-patient time is 4,5 days. - The advantage of this system is: increase of scheduled in-patient surgery, short stay, prophylaxis of noso - comial infections, more efficiency.


[Surgical hand disinfection with "Fesia cito" (author's transl)].

Fürbringer's classical method of scrubbing has been compared with the procedure of embrocation of Fesia cito after Kanz. Concerning the reduction of bacilli both methods are equivalent.


[More effective surgical care and its regional organisation (author's transl)].

The decrease of the number of surgical cases within the past few years was not essentially due to the decrease of the number of hospital surgeons or to the decrease of the number of beds in surgical units. Decrease in the length of stay and increase in bed occupancy rate might effectively respond to increasing demands. A community comprising about 60 000 inhabitants will occupy a fulltime outpatient surgeon. Smaller communities should be served by an integrate inpatient-outpatient service. There is no need for each surgical unit to run a separate emergency service of its own.