Thermal measurements on divers in hyperbaric helium-oxygen environments.

During a series of three saturation dives to simulated depths of 1000, 1200, and 1400 fsw at the Ocean Simulation Facility, measurements were made to establish the rate of heat loss of unclad divers in helium-oxygen gaseous environments. These measurements were part of a program to determine the dangers of cold stress and the temperature/time relationship tolerated by divers in cold diving bells or in hyperbaric chambers in which environmental conditions are uncontrolled. Three specific gaseous temperatures of 15, 20, and 25 degrees C were considered. In each experiment, as many as four subjects were monitored for body core and mean skin temperature over a 2-h testing period. One or two of the subjects were also monitored for mean body convective heat loss to determine physiological (shell) thermal insulation. Results of these experiments are expressed in depth-time-temperature three-dimensional graphs in whic, the temperature variable is one of the following: mean skin temperature change, mean body temperature change, or mean rectal (core) temperature change, each suitable for defining diver thermal limitations. It was also possible to rank body areas of the subjects in relation to heat loss and temperature decrease during exposure to the cold environment.


Nitrogen elimination during steady-state hyperbaric exposures.

Nitrogen elimination was measured in six divers during steady-state exposures in an oxygen-nitrogen atmosphere at 1, 2, and 3 ATA using both oxy-helium and pure O2 as washout gases. This was accomplished by using mass spectrometry to measure the expired N2 concentration breath-by-breath over periods of 120 min in all experimental conditions except for O2 breathing at 3 ATA, which was limited to 30-min periods. In all cases the area under the elimination curve increased with pressure. Total area under the curve was also greater when breathing O2 than when breathing oxy-helium, but this difference decreased with depth and washout time. Nitrogen elimination on a semilogarithmic plot falls rapidly during the first four minutes and then shows a slow linear fall for the remainder of the measurement period. Effective elimination of nitrogen decreased with depth and oxygen was more effective than oxy-helium in washing out nitrogen at all depths studied. Possible causes of the different variations noted in the washout curves during the experiment are discussed.


Protection against high-pressure oxygen seizures by amino-oxyacetic acid.

A variety of autonomic blocking agents, general anesthetics, and anticonvulsants have been shown to offer protection from seizures caused by hyperbaric oxygen. Amino-oxyacetic acid (AOAA) has been shown to offer rats only minimal protection from such seizures. This study investigated whether AOAA protected cats and mice from hyperbaric-oxygen-induced seizures. Cats and mice were exposed to 100% oxygen at 5 ATA until seizures occurred or for a period of up to 60 min. Approximately half of the animals were pretreated with AOAA either 30 or 240 min before oxygen exposure. Results showed that the interval between exposure and grand mal seizures increased significantly in cats pretreated 30 or 240 min before exposure with 17 to 25 mg/kg AOAA; the number of cats remaining seizure-free for 60 min also increased markedly. However, mice received little protection even at doses up to 40 mg/kg. At higher doses the AOAA itself caused seizures even in the absence of hyperbaric oxygen.


Diver adaptability during a nitrox saturation dive at 7 ATA.

The major objective of this study was to demonstrate the advantages of transforming raw scores to ipsative form (deviation scores calculated around each subject's mean), particularly in diver research characteristically involving small subject samples in a self-control design. Measures of reaction time, response accuracy, anxiety, hostility, and depression were obtained from three U.S. Navy divers (Ss) during a nitrox saturation dive at 7 ATA (bottom time 7 days). It was argued and to some extent demonstrated that normative (interindividual) statistics obscure individual differences which are clearly delineated with the scores in ipsative form. Further, this score transformation allowed for meaningful between-Ss (same measure) and between-measures (same S) comparisons. These relationships could not be demonstrated with the scores in normative form. Application of P-technique of factor analysis within each S's arrays of data suggested that the characteristic adaptive patterns of two Ss in this study reacted to the pressure-stress by directing affect inward; for the third S, affect was directed outward. However, none of the 20 scales from the Minnesota Multiphasic Personality Inventory clearly discriminated among the three adaptive types.


Decompression sickness in the goat: nature of brain and spinal cord lesions at 48 hours.

An investigation was undertaken to determine whether permanent damage to the central nervous system (CNS) is associated with transient decompression sickness in the goat. Twelve goats were compressed in air at 100 fsw for one hour. After decompression over a period of 2.5 min, seven animals showed signs of decompression sickness and four of these were treated by recompression in oxygen. Residual clinical signs after 12 h were present in one animal only. The seven affected goats were killed 48 h after decompression. Lesions in the CNS (other than hemorrhage) were confined to the spinal cord of three animals that had shown paralysis, and consisted of infarction of white matter with occasional microthrombi and perivascular proteinaceous edema of the gray matter. In all seven animals, there was hemorrhage in the spinal cord and in four, hemorrhage in the brain. Infarction of the spinal cord was not present in the four animals that had shown only slight clinical signs (limping); one of these goats had been treated by recompression in oxygen.


Susceptibility of fetal sheep to acute decompression sickness.

Studies were conducted to determine the susceptibility of the fetus to decompression sickness. Sheep were used because fetal and maternal circulation of sheep and human placentas are dynamically similar. Seven sheep that were within three weeks of parturition were used. A Doppler ultrasonic transducer was placed around an umbilical artery of the fetus in utero and the electrical leads were exteriorized. Umbilical artery blood flow could thus be monitored together with any bubbles appearing in that part of the fetal circulation. Results of 17 dives showed that exposing the mother to a 100-fsw, 25-min standard no-decompression dive produced massive air emboli in the fetus, though no bubbles were detected in the maternal circulation either by Doppler or visual inspection. An 80-fsw dive for 40 min caused an occasional bubble to appear in the fetus. Sixty-fsw dives for 60 and 70 min, respectively, did not produce bubbles in the fetal circulation.


Chamber-based system for physiological monitoring of submerged exercising subjects.

A system has been designed which allows for measurement of cardiorespiratory parameters in the fully submerged subject performing graded exercise. It consists of a horizontal wet chamber; a waterproofed, electrically braked bicycle ergometer; and a low-resistance "bag-in-a-box" breathing apparatus. Chamber and breathing apparatus design allow for a great deal of flexibility in both positioning of the subject and instrumentation. The 200-liter "bag-in-a-box" configuration provides the subject with humidified gas through 2.5 in. i.d. tubing. A rolling seal spirometer provides the lung counter volume. Provision is made for breath-by-breath gas analysis with a mass spectrometer. Hydrostatic pressure on the diver's thorax relative to chamber pressure can be easily and reproducibly varied over a wide range of positive and negative static lung loads. This system has been used on over 100 man-dives to depths equivalent to 6.5 ATA with oxygen consumptions up to 4.0 liters/min.


Chromatographic studies on a chorionic gonadotropic activity in the placenta of the rat, mouse and hamster.

Acetone-ether extracts of rat, mouse and hamster placentae were fractionated by molecular sieve chromatography on Sephadex G-200. The fractions were tested for immunoreactivity in human chorionic gonadotropin (hCG), hCG-beta-subunit and alpha-subunit radio-immunoassay systems. The elution profiles were compared with those of similar chromatographic studies of a human placental extract and of purified preparations of hCG and its subunits. The results indicate that rodent placentae have a chorionic gonadotropin and that this hormone in the rat, mouse and hamster is structurally similar to hCG with its alpha- and beta-subunits. Extracts of rat and hamster placentae had a gonadotropic activity similar in concentration to that found in normal human placentae at term. Until now, it has been difficult to find an animal model for studying how the production of chorionic gonadotropin is regulated. Our results suggest that rodents may be suitable for such an investigation.


Early cutaneous reactions to local traumatization with heat in alloxan diabetic rats.

The effect of cutaneous traumatization with heat in connection with intravenous injection of Evans blue was studied in short-term alloxan diabetic rats. The effect of traumatization was dependent on the degree of traumatization. There was no difference between diabetic animals and controls. The water content of traumatized and non-traumatized skin was determined. There was no difference between diabetic animals and controls with regard to the increase in water content of traumatized skin. Histological and histochemical studies on the effect of surgical cutaneous traumatization did not reveal any differences between diabetic and non-diabetic animals. The results are compared with earlier observations in alloxan diabetic animals with and without ketosis and in long-term diabetes.


Studies on toxemia of pregnancy with special reference to blood pressure. I. Incidence and some characteristic features of the mothers and infants.

An investigation was made of 150 women who were diagnosed at the Department of Obstetrics and Gynaecology, University Hospital, Uppsala in 1964-68 as having toxaemia of pregnancy. Eleven had eclampsia and the remainder pre-eclampsia. Toxaemia occurred in 0.88% (average) of all parturients during the study period. Some characteristics of the mothers and their infants are reported. Thus, there were more instrumental deliveries in the toxaemia group than in the non-toxaemic patients delivered in the clinic. The maternal weight at delivery was also greater in the toxaemia group. The frequency of complications among the infants was higher in the group with toxaemia. There were more stillbirths, lower birth weights and more congenital malformations. With regard to blood pressure, almost identical pressures were noted in the eclamptic and pre-eclamptic groups, with one exception. The maximum blood pressure recorded during delivery was higher in the eclamptic than in the pre-eclamptic group (198/127 and 175/117).


Thyroid carcinoma: presentation of a clinical material with special aspects on the classification and operative treatment.

During the years 1969-1975, 58 patients were treated for thyroid carcinoma. 48 patients had differentiated and 10 had anaplastic carcinomas. The material is presented with special attention given to diagnostic methods and treatment for the differentiated forms. The value of cytological examination of fine needle biopsy is clearly documented. 40 patients with differentiated carcinomas were treated with total thyroidectomy, with low complication rate. Accidental persistent recurrent nerve paralysis as well as persistent hypoparathyroidism occurred in less than 3%, Subdivision of papillary and follicular carcinomas on the basis of their local growth pattern is emphasized as being of value in the determination of subsequent therapy.


Comparison between videodensitometric and angiocardiographic determination of left ventricular ejection fraction in patients with cardiac disease.

Angiocardiograms have been widely used to calculate volumes of cardiac chambers. By determining the left ventricular volume in end-diastole and end-systole the ejection fraction can be calculated. The ejection fraction is considered a clinically useful index of left ventricular function and is widely used in the preoperative evaluation of patients with cardiac disease.


Primary hyperoxaluria (glycolic acid variant): a clinical and genetical investigation of eight cases.

The clinical features of eight cases of primary hyperoxaluria have been summarized. The possibility of different phenotypes is discussed. A reduction, but no normalization, of the oxalate formation during pyridoxine therapy was found. A renal transplantation performed in one of the patients failed because of the formation of nephrocalcinosis.


Total body haemoglobin estimated with the alveolar CO method as compared with a 51Cr technique.

Total body haemoglobin was estimated by the alveolar equilibrium CO method and by dilution of 51Cr-tagged erythrocytes in 22 patients with a wide range of haemoglobin concentrations (51-190 g/l). The resulting regression equation: THBCO =47 + 0.81 X THbCr, where THn is expressed in grams, shows that with increasing THb successively lower values were obtained with the THbCO method as compared with the THbCr method. Individual values were calculated for the M-factor, i.e. the ratio of the haemoglobin affinities to O2 and CO. These values were positively and significantly correlated to the red-cell content of 2.3-diphosphoglycerate. The findings are consistent with a recent hypothesis that the effect of 2.3-DPG on CO affinity may not be equivalent to its effect on oxygen affinity. The discrepancy between the two methods of estimating THb may therefore be apparent only and due to a systematic variation in the M-factor.


[Use of Aloglutamol in uremic patients on dialysis (author's transl].

The authors experimented Aloglutamol (an organic salt of aluminium) in uremic patients on dialysis to detect its phosphate-binding properties and study its use in the treatment of uremic osteodystropy. They report good results: predialysis Ca increased; serum PO4 and alcaline phosphatase levels decreased; Ca X PO4 was normalized; itch, muscular weakness and constipation decreased; no side-effects appeared, and the drug has a good taste. Therefore it is considered to be most useful in the treatment of hyperphosphatemia in uremia.


[Tantalum is contrast material for the better presentation of the ureter in retrograde pyelography (author's transl)].

Suspension of Tantalum dust can be used as contrast material. It helps in producing X-ray films which are rich in contrast and details. The composition of the suspension and the technique of retrograde pyelography with the suspension is described.


Ureteral obstruction by endometriosis.

The clinicopathological features of 2 cases of ureteral endometriosis are presented. The difficulties in diagnosis and surgical management of ureteral endometriosis are discussed. We emphasized the importance of frozen section during surgery for the lower one third of ureteral obstruction in premenopausal woman. Moreover, it is suggested that the surgical procedure for ureteral endometriosis should be uretero-ureterostomy or ureterocystoneostomy in the early stage.


[Myotropic spasmolysis in the treatment of ureteric colics (author's transl)].

The effectiveness of parasympathicolytic drugs in the treatment of ureteric colics is doubtful. Bencyclane is a new myotropic substance. Its spasmolytic effect on smooth muscle is five times stronger than that of papaverine. The results of the clinical use of Bencyclane in cases of ureteric colic are described and discussed.


Development of reflex activity of detrusor and striated sphincter muscles in experimental paraplegia.

Reflexes concerned with viscerosomatic and somatovisceral interplay in the sacral spinal cord were evaluated in spinalized animals, as part of a study on direct spinal cord stimulation of micturition. Urodynamic evaluation consisted of continuous recording of bladder pressure, urethral pressures and electromyograms of striated anal and urethral sphincters. All exteroceptive stimuli to urethral or anal mucosa caused an inappropriate increase in afferent input to the sacral micturition center: such stimuli should be avoided in the evaluation of suprasacral lesions of bladder innervation. Early in the spinal shock phase, hyperreflexia of striated pelvic floor muscles was apparent, in the absence of detrusor reflex activity. Clinical implications for early management of neurogenic bladder dysfunction are discussed. In all spinalized animals early balanced bladder function could be achieved, due to the absence of detrusor-sphincter dyssynergia: the opposite is true for spinalized man.


The significance of bladder capacity under aspect of continence and micturition in neurogenic bladder dysfunction.

The bladder capacity of patients with a neurogenic bladder disorder was determined. Since the bladder capacity varies according to the type of neurogenic lesion (supranuclear, infranuclear), it was to be determined, whether reflex detrusor activity and duration of the lesion would influence bladder capacity. It was found that in supranuclear lesions s sufficient bladder capacity can be maintained with a balanced micturition, and that spincterotomy does not result in reduced bladder capacity. In infranuclear lesions intermittent catheterization is a good therapeutic method to preserve continence and an intact renal function as well.


Indications for bladder transection.

Over the last 8 years 64 cases of bladder hyperactivity have been subjected to bladder transection. The patients seleced have been mainly adult enuretics, but have also included some others with daytime bladder hyperactivity without nocturnal incontinence who had failed to respond to medical and simple surgical procedures. A bladder capacity greater than 400 ml under general anaesthesia was used as a major criterion in selecting the cases for operation. The operation was very successful in the enuretic syndrome where the daytime symptoms or urgency and urge incontinence were severe. Other patients who had frequency, urgency and urge incontinence without demonstrable neurological or urological abnormalities also responded well.


Bladder training and surgical correction of vesicoureteral reflux: useful association.

18 children, from 1 year of age to 15, presenting lower motor neuron bladder (myelomeningocele) were studied. All had overflow incontinence and urinary infection resistant to all trials of treatment, attributed to severe vesicoureteral reflux. The failure of training on bladder emptying for urinary infection control and/or the severity of reflux and its consequences over upper urinary tract, motivated the reflux surgical correction associated to bladder training as a first step alternative treatment to urinary diversion.


Urethral pressure profilometry with membrane catheter compared with perfusion catheter systems.

Urodynamic evaluation of urethral sphincter function can be carried out by constant carbon dioxide perfusion, constant water perfusion, or by the use of membrane catheters. A comparison of these 3 techniques was made in in vitro experiments. Results, and advantages and disadvantages of each technique are discussed. From all factors considered in this study--response to pressure changes, sensitivity to pressures along the urethra, and reproducibility of the profile--the membrane catheter was concluded to be superior to either of the perfusion systems.


Human sympathetic bladder innervation. A morphological investigation.

A method for histochemical determination of noradrenergic nerve fibers in human bladder biopsies is described. The importance of an objective criterium for distinguishing between specific noradrenaline fluorescence and autofluorescence of connective tissue is stressed. In 2 females and 3 males without neurogenic bladder disease the noradrenergic innervation of the detrusor as well as the trigonal muscle was found very scarce.


Gracilis interposition in fistulas following radiotherapy for cervical cancer. A retrospective study.

Irradiation fistulas following treatment for cervical cancer are a great challenge even to a skilled surgeon. Because of ischemia and necrosis around the fistula, repair is possible only by interposition of viable tissue. Interposition of 1 or 2 mm gracilis has been used at Sabbatsberg Hospital since the beginning of the 1950's. 27 vesicovaginal fistulas have been treated with this method, with a cure rate of 60%. The corresponding cure rate for 16 rectovaginal fistulas was 43%. The mean diameter of the fistulas was 2.5 cm. Considering the unfavorable circumstances caused by radiotherapy, in some cases combined with fulguration, these results seem satisfactory.


A study of the capacity for regeneration of rat and human Leydig cells.

The capacity of Leydig cells for regeneration was investigated in 12 patients with prostatic carcinoma, who underwent subcapsular orchidectomy, and in rats after testicular necrosis produced by cadmium chloride. In rats, reappearance of Leydig cells originating from the tunica albuginea could be demonstrated by histology. Testosterone concentrations increased parallel to regeneration of Leydig cells, while LH concentrations declined. In contrast to these findings, no rise of testosterone concentrations could be observed in patients up to 8 months after subcapsular orchidectomy. Human Leydig cells seem to have no capacity for regeneration, or endocrine function, despite the fact that some of these cells, which are present morphologically in the tunica albuginea or spermatic cord, remained.


[Double malformations of the upper urinary tract: complications in adults (author's transl)].

Forty-five adult patients underwent surgical treatment for complications of double malformations of the upper urinary tract. Compared with children, the percentage of incomplete duplications rose from 3--43%, and nephrectomy was necessary in 25% instead of 0 to 8%. The possible effect of the yo-yo phenomenon is discussed. Early surgical intervention might improve the possibilities of saving the organ.


[The susceptibility to urinary tract infections after antireflux operations (author's transl)].

The results of a prospective bacteriologic follow-up of 21 consecutive female patients, who had an antireflux operation are given. Only those patients with a proven active susceptibility to urinary tract infection at the time of operation were included in this study. Of these patients, 89% had persistent recurrent urinary tract infection, though the reflux was corrected. Bacteriologic controls and long-term chemotherapy seem warranted in those patients after operation.


[Meatus stenosis of girls--clinical demonstration and therapy (author's transl)].

This report concerns meatotomies performed on 50 girls, aged 2--13 years, suffering from meatus stenosis. The symptomatic and diagnostic procedures are described. Miction difficulties, pollakiuria, and imperative micturition connected with chronic-recurrent cystides are emphasized. Calibration of the urethra is the decisive diagnostic procedure. The miction cystourethogram, however, provides only a hint as to the presence of a meatus stenosis with the pathological description of the urethra in the form of a prestenotic dilation and of an 'onion' or 'wineglass' shaped configuration. The therapeutic results are considered very good, because 48 of the 50 girls had neither subjective complaints nor urinary infections 1--2 years after the meatotomy. This represents a recovery rate of 96%.


[Influence of leakage of the bladder mucosa on the results of external ureterovesicoplasty (author's transl)].

The significance for the results of external ureterovesicoplasty of damaging the vesical mucosa was investigated in rabbits. On one side, the submucosal ureter was lengthened by myotomy, and on the other side, an additional incision of the mucosa caused the ureter to be shifted intravesically. In 10 animals, results were symmetric; in 7 cases, stasis occurred on the side of the sunken ureter; 2 animals showed marked hydronephrosis on the Grégoir side. Increased mobility and thereby kinking of the intravesical ureter and inflammatory reaction on temporary leakage of urine are shown to be the causes of worse results following mucosa leakage. As consequence of the study importance of careful closure of any mucosal defect occurring during Grégoir operation is stressed.


[Transureteroureterostomy in unilateral distal damage of the ureter (author's transl)].

Transureteroureterostomy creates an artificial ureter bifidus. In the common branch, the resting pressure is a little bit higher than in its bifurcation and the peristalsis of the bifurcation is never synchronous. That is why an ureteroureteral reflux may be produced by the anastomosis. The ureteroureteral reflux created by a ureteral dyskinesia, however, causes an infection in the recipient kidney only if there is a predisposition to infection or a vesicoureteral reflux in the recipient ureter. A transureteroureterostomy was performed on five female patients suffering from unilateral distal damage of the ureter, four of them after gynecologic operations. One patient had a single kidney right. The damaged ureter was anastomized with the left ureteral stump of the nephrectomied side. In one case, an abscessing retroperioneal urinoma with a serious diffuse peritonitis developed as a direct complication of the operation because of an insufficient suture. On revision, the transplanted ureter had to be drained into the skin. Despite this serious complication, the recipient ureter remained uninjured and the recipient kidney was not damaged. The four other patients had no complications.


[Complex urogenital malformation of the Wolffian ducts (author's transl)].

A case report of a 30-year-old man with both vasa deferentia draining into a large right seminal vesicle cyst, with an ectopic ureter opening into the left seminal vesicle and associated with agenesis of the corresponding kidney. A similar case has not been previously reported in the world literature. Preoperative studies, surgical approach, pathological findings and the embryological explanation of the malformation is discussed.


[The effect of varicocele on male fertility with particular consideration of progressive motility (author's transl)].

Two-hundred patients with varicocele were examined for fertility, which was found to have diminished in 75% of the cases because of a decreased sperm count (less than 40 million/ml); 40% of these, the largest group (categorized only with regard to oligospermia), had a sperm count of 21--40 million/ml. The most remarkable finding was restrained fertility in 90% of the cases because of decreased progressive motility (speed of forward progression). Here, the largest group (nearly 50%) was in the category of 21--30%. Decreased progressive motility was mostly combined with a diminished sperm count to an oligoasthenospermia. In 20% of the cases, however, fertility was restrained only by decreased progressive motility in the sense of an asthenospermia. The first effect, due to varicocele, is seen in decreased progressive motility. However, because spermatozoa acquire their progressive motility by means of maturation in the epididymis, the varicocele causes the first damage to the epididymis.


[Urinary retention caused by large cyst of the Müllerian duct (author's transl)].

The rare case of urinary retention caused by a large Müllerian duct cyst in a 41-year-old man is described. The embryological fundaments and frequency of these cysts are discussed as well as the necessary diagnostic steps and operative procedures. A survey of the literature is presented and the different diagnostic findings in these and other cystic tumors of the male pelvis are shown.


[Obstructive anuria due to renal candidiasis in a newborn male (author's transl)].

Mechanical anuria developed in a neonate during a period of intensive care following birth trauma. The obstruction of the urinary tract was due to yeast clumps from a candida pyelonephritis. Urine flow was reestablished after a unilateral nephrostomy and antimycotic therapy. There were no anatomical abnormalities of the urinary tract.


[Inguinovaginal sling operation in the treatment of female urinary incontinence (author's transl)].

Sling operation have long occupied an established position in the treatment of severe female urinary incontinence and recidivous incontinence. The inguino vaginal sling operation as modified by Narik and Palmrich is described and the operation results for 73 female patients are differentially evaluated. A precise preoperative urodynamic clarification and a previous or simultaneous hysterectomy are prerequisites for satisfactory operation results. In certain instances, this surgical procedure represents a possible method for the restoration of continence even in the case of neurogenic bladder dysfunction.


[Spontaneous recovery of ligature of the ureter after surgical gynecologic treatment (author's transl)].

Reported are three cases of spontaneous recovery of ligature of the ureter after hysterectomy. After temporary drainage of the pelvis, showed retrograde filling or intravenous urogram the unobstructed passage after the dissolution of cat ligature. No further urologic surgical treatment was necessary.


[The pharmacological treatment of the incontinent neurogenic bladder (author's transl)].

An attempt is made to describe the action of sympathic, parasympathic and somatic innervation of the urinary bladder by means of a receptor model and to present the theoretical basis of a successful treatment of the neurogenic bladder. Radiographic and urodynamic examination of 15 children revealed that ephedrine was successful in improving or curing urinary incontinence in 12 cases with congenital or required neurogenic bladder. The requirements and limitations of a successful sympathomimetic treatment of the neurogenic incontinence are presented.


Modified radical retropubic prostatectomy.

A significant modification of the traditional radical retropubic prostatectomy is presented. A logical stepwise surgical sequence is discussed in detail. The technique described provides excellent visualization, early ligation of vascular and lymphatic channels, decreased intraoperative blood loss, and a tension-free vesicoureteral anastomosis.


Modification of Marshall-Marchetti-Krantz operation.

In a classic article published in 1949 Marshall, Marchetti, and Krantz demonstrated that stress incontinence in women without uterine prolapse could be corrected by a simple vesicourethral suspension. Beginning in 1960 one of the authors (W.E.C.) became concerned about suturing the urethra to the periosteum of the pubis. It occurred to him that use of the upper sutures only to pull up the bladder and hold its anterior wall to the back of the rectus muscles might be just as effective, and this has proved to be so.


Anterior urethral valves.

Three cases of anterior urethral valves, a rare congenital anomaly are reported. Anterior urethral valves probably represent an attempt at duplication of the urethra in the first twelve to fourteen weeks of intrauterine life. The most common type is cusp-like and most frequently located in the bulbar urethra. The presenting complaints are lower tract symptoms, and the diagnosis is usually made by a voiding urethrogram.


Iatrogenic renal vascular injury.

Bilateral arteriovenous fistulas secondary to percutaneous needle biopsy of each kidney developed in a patient with malignant hypertension and chronic failure. The fistulas with aneurysmal formation and hematuria were of such magnitude that bilateral nephrectomy was required for control. The patient is now normotensive and is maintained on hemodialysis. The advisability of renal needle biopsy in uncontrolled hypertension is questioned. Cases of intrarenal arteriovenous fistulas resulting from percutaneous needle biopsy of the kidney are being reported with increasing frequency. The exact incidence of fistula formation after kidney biopsy is unknown, but several series based on arteriographic studies show an incidence as high as 18 per cent. Although many of these fistulas disappear spontaneously, approximately 4 per cent persist. A review of the literature failed to reveal the incidence of aneurysmal formation. Our case was complicated by formation of bilateral renal arteriovenous fistulas secondary to repeat bilateral percutaneous needle biopsy and right open renal biopsy. Subsequent gross hematuria from the right ureteral orifice also resulted which was proved by cystoscopy and required replacement with several units of blood. The likelihood of rupture led to bilateral nephrectomy.


Unusual presentation of genital tuberculosis.

We report two cases of unusual presentation of genital tuberculosis. One patient had an enlarging perineal mass as the only clinical evidence of genitourinary tract involvement. The second had a testicular mass difficult to distinguish clinically from testicular tumor. There was no evidence of upper tract disease.


Gonadal stromal tumor in black male.

A twenty-five-year-old black male presented with a right testicular mass which had progressively increased in size over three years. He was in good health and noted no other general abnormalities. Taking all malignant precautions, excisional biopsy of the lesion revealed gonadal stromal tumor by frozen section. The testis was left in situ, and the patient has continued to remain asymptomatic.


Prostatic carcinoma: plasma kinetics and intraprostatic metabolism of testosterone in low-dose estrogen-treated patients in vivo.

Plasma kinetics, in vivo uptake, and intraprostatic metabolism of 3H testosterone was investigated in 9 patients with advanced carcinoma of the prostate. The metabolic effect of low-dose ethinyl estradiol was studied (estrogen suppressed testosterone, luteinizing hormone, and follicle-stimulating hormone). The production rate of testosterone was lowered, the elimination of androgen from plasma delayed. The uptake of testosterone and metabolites by the prostatic carcinoma was suppressed. Estrogen did not alter significantly the intraprostatic androgen turnover.


Triple contrast percutaneous nephrocystography and analysis of cyst aspirate.

Accumulated experience with triple contrast percutaneous nephrocystography (water-soluble contrast, iophendylate [Pantopaque], and air) in 42 patients with avascular lesions is presented. Diagnostic studies were accomplished in 40 with surgical correlation in 11. Of the 35 patients with intracystic iophendylate, progressive cyst shrinkage was observed in the 29 with adequate x-ray follow up. The reduction in cyst size was attributed to a marked reactive inflammatory proliferative response with fibrosis of the cyst wall which was found in 6 patients after introduction of iophendylate when compared with a control group of 13 others with surgically proved cysts. Intracystic iophendylate may be especially therapeutic in the nonsurgical management of renal cysts associated with pain, calyceal obstruction, and hypertension. The cyst aspirate was analyzed for appearance, culture, cytology, fat content, and multichannel chemistries (SMA). The index accuracy of these combined tests is high although instances of false positives and negatives for tumor are stressed. The nonsurgical diagnosis of renal cystic lesions is incomplete without percutaneous cyst puncture, contrast study, and analysis of cyst aspirate.


[Possibility of using a pedicle flap made from the musculus latissimus dorsi for cardiopexy].

Myocardiopexy is an expedient operation for a deep sclerotic injury to the coronary vessels. In the experiments on 8 human cadavers and 24 animals the authors developed the technic of cutting out and transposition of pedicle grafts from the broadest muscle of the back to the heart. Various methods of pathomorphologic and functional investigations have proved the connection existing between the vessels of the graft and those of myocardium. This connection prevents the death of animals from myocardiac infarction following ligation of the right coronary artery above the zone of myocardiopexy.


[Flap trepanation of the skull with removal of the bone plate and its replantation in traumatic brain compression].

The results of 104 operations for traumatic compression of the brain have been studied. The advantages of bone-plastic approach are demonstrated. The indications for a primary removal of a flat bone graft plate in acute and subacute traumatic compression of the brain are precised. The results of a delayed plasty of skull defects following decompression trepanation are analysed. The flap bone plates, removed (on indications) during decompression trepanation through bone-plastic approach and kept in a weak formalin solution were used as grafts. Good results were obtained in the most of cases.


[Allotendoplasty in Achilles tendon injuries].

Experimental studies and clinical observations over allotendoplasty were carried out. A new method of the combined autoloplasty of old ruptures of the Achilles tendon was developed and carried out upon 13 patients. Allotendoplasty was applied upon 31 cases of injuries to the Achilles tendon. Late results were followed up in 30 patients; in 29 out of them a complete functional restoration of the injuried extremity was obtained. Clinical and experimental data allow to recommend banked allografts for the use in reconstructive surgery.


[Use of thawed and washed erythrocytes in the overall therapy of burn disease].

An experience with the transfusion of 178 doses of defreezed and washed red blood cells kept at an ultra-low temperature of --196 degree C (in liquide nitrogen) has demonstrated a good hemotherapeutic effect. The transfused suspension of washed and defreezed erythrocytes did not provoke any complications which was especially important for the patients whose reaction to the transfusion of the whole donor blood had previously been unfavourable.


[Phonography of the abdominal cavity as a diagnostic method in gastroenterology].

Phonography of the abdominal cavity has been applied in 115 patients before and after stomach resection. This method provides an additional valuable information, helps to establish a correct diagnosis and so it can be recommended as an auxilliary diagnostic method. For diagnostic purposes the phonography findings should be evaluated within the complex of clinical, X-ray and laboratory findings, and data provided by other investigations.


[Causes of anastomositis after gastric resection].

The control fibrogastroscopy of the resected stomach in patients showing the clinical picture of postoperative anastomositis has proved that the application of an unresolving suture material (caprone) for a marginal suture of gastroenteroanastomosis causes post-resection inflammation of anastomosis in about 50% of cases. For improvement of surgical results the authors suggest to substitute marginal caprone sutures with catgut or tantal agraffes.


[Effect of gastric resection on water-salt homeostasis].

In a chronic experiment on 44 dogs with 2/3 of the stomach resected it was found that stomach resection resulted in a pronounced instability of blood constants and decrease of the renal ability to keep constant values of the internal media following water load. The levelling out takes place in the late period after resection of the stomach.


[Gangrene of the extremities in diabetes mellitus].

The results of the treatment of 111 patients, who have developed obliterating diseases of the arteries of the lower extremities against the background of diabetes mellitus, are set forth. The author strongly recommends not to come hastily to amputation as an intense treatment may bring about a persistent remission of the pathological process even in senile patients.


[Recurrence of varicosity of the lower extremities].

The authors analyse the causes of the recurrence of varicosis of the lower extremities superficial veins in 40 patients. They believe that successful treatment of such cases in warranted by a complex clinico-functional examination including a compulsory angiography aimed at revealing of the causes of the recurrence. Surgical intervention should be reduced to the elimination of errors admitted in primary operations.


[Cancer of the thyroid gland in an endemic focus].

The authors present 28 (1.1%) cases of cancer of the thyroid gland. The volume of surgical intervention for cancer of the thyroid gland depends on the stage of the process. Thyroidectomy and bilateral Crile's operation are indicated in presence of metastases in the lymphatic nodes in both sides of the neck. This intervention should be followed by postoperative radiotherapeutics. Average survival up to 5 years has constituted 50%, above, 10 years = 25%.


[Clinical aspects and treatment of postoperative parotitis].

The clinical picture and treatment of postoperative parotitis in 31 patients are described. An early operation is recommended in case of the failure of conservative therapy. 22 patients were operated upon, 11 out of them recovered, and 11 died. Postoperative parotitis is directly responsible for the death of three out of them.


[Diagnosis and the surgical approach in abdominal trauma with pancreatic injury].

The material comprising 14 observations over abdominal trauma with an injury to the pancreas is presented. An analysis of morphological changes in the pancreas and other organs is displayed together with literature and own data concerning diagnosis, surgical tactics and methods of drainage of the omental bursa in this severe pathology. 2 patients out of 14 died.


[Characteristics of the clinical course and treatment of trauma to various areas of the body combined with facial and jaw injury].

The cases with combined maxillofacial injuries and traumas of other localization should be considered as cases of a higher risk of septic complications. The specialized stomatologic acid ought to be rendered to such cases with the nearest post-shock period, not later then within 36 hours after trauma. The analysis of 291 clinical observations is set forth.


[Characteristics of the course and treatment of mastitis].

From the experience with 106 mastitis cases it has been found that this condition occurs in women following pathologic pregnancy and delivery. The leading procedures of the treatment are the following: stimulation of protective forces of the body, control of anemia, broad dissection and drainage of the abscess and, in case of a suppurative-infiltrative form, sectoral resection.


[Use of the Ilizarov apparatus in treating diaphyseal fractures of the leg bones in the middle-aged and elderly].

The results of the treatment of diaphysial fractures of the leg in 42 elderly and senile patients are mirrored in this paper. The details concerning the time and procedure of the application of the apparatus, the time of its demounting are set forth. Good results of the osteosynthesis by means of the Ilizarov's apparatus allow to recommend this method for a broad practical use.


[Clinical x-ray diagnosis of the depth of necrosis in 4th degree burns].

Findings obtained from the examination of 236 burned with the IV degree burns of various localization are presented. A differential diagnosis table of three main forms of burns involving deep anatomical structures is devised. The essential clinical and X-ray symptoms of necrosis of the soft tissues, joints and bones related to the form of the injury and time of its onset are grounded. The use of these features in the clinical practice has permitted to define the depth of the injury in 82% of cases within the first month.


[State of tissue microcirculation in burns of the hand].

A radioisotope method was applied for investigation of 50 cases divided into three groups according to the depth of the burn. It has been found that this method of investigation of microcirculation in hand burns cases is a valuable diagnostic test allowing to find out disorders of the capillary circulation and to trace the dynamics of its restoration.


[Diagnosis and treatment of frostbite of the extremities].

The method of thermography is believed to be a valuable means of an early diagnosis of the depth of the injury in frosbites of the extremities. The use of immune preparations aimed at the lessening of the percentage of infectious complications, both with conservative and surgical treatment of the frostbites of the extremities, should be applied for prophylaxis of the above-mentioned complications.


[Disseminated intravascular coagulation syndrome in sepsis in infants].

In 40 out of 45 children dead from sepsis in 1974--1976 the development of the syndrome of disseminated intravascular coagulation was proved on the grounds of the pathologic picture. In 27 cases histological changes were combined with characteristic clinico-laboratory manifestations of the syndrome. The latter was not found in 10 children who died of a severe local purulent process.


[Late results of the surgical treatment of children with bilateral hydronephrosis].

The authors report on the results of surgical treatment of 17 children with bilateral hydronephrosis. Corrective operations gave better results in patients who had not yet developed irreversible structural changes in the kidneys. The authors believe that an early detection of hydronephrosis and removal of obstructions to normal urinary outflow from the kidneys are necessary.


Radiological studies of the alimentary tract in two Greek tortoises (Testudo graeca).

Barium sulphate was administered to two tortoises (Testudo graeca). Gastric emptying was not completed until 23 and 80 hours after barium administration and complete passage of barium through the gastrointestinal tract took 25 and 28 days. The consequences of these findings are discussed with reference to artificial feeding and medication regimes in chelonians.


Shaky leg syndrome and hip lesions in turkeys.

A leg weakness condition of turkeys, often called the "shaky leg" syndrome, is described and studies on its pathology reported. There appeared to be no consistent histopathological changes in the nervous, muscular or skeletal systems that were characteristic of the syndrome. During the course of the investigation it became clear that almost all turkeys examined from the age of four weeks, regardless of their locomotor status, strain or management, displayed small degenerative lesions situated medially on the neck of their femurs.


[Effect of insulin on the amount of somatotropic hormone, immunoreactive insulin, blood sugar and free fatty acids in sheep].

Studied was the effect of the venous injecting of insulin at the rate of 0.2 IU/kg body weight on the changes in the amount of the somatotropic hormone (STH), the immunoresponsive insulin, the free fatty acids (FFA), and the blood sugar in the serum of sheep, following their dynamics up to the 150th minute after application. The STH level rose to its peak value at the 60th min., after which it showed a lowering trend. The level of FFA dropped sharply after the injection of insulin, its lowest value being registered at the 60th min., after which it rose. By the end of the experiment the blood values of STH and FFA were close to those of the control animals. The blood sugar level started to drop 30 min. following the injection of insulin, and up to the end of the experiment a hypoglycaemic reaction was observed.


[Pathomorphological studies in experimental simazine poisoning of sheep].

Studied were the morphologic changes in the viscera of 14 sheep and 2 goats experimentally intoxicated via the oral administration of simasin at various rates. The gross lesions consisted of catarrhal and hemorrhagic typhlitis, liver dystrophia, and enlargement of the gallbladder. Histologically, the acute cases presented granular degeneration of the liver and kidneys, oedema of the lungs, fatty infiltration of the myocardium, oedema, hyperemia, and hemorrhages in the brain. In the cases of chronic intoxication there were fatty degeneration of the liver as well as dystrophic changes in the testes, cerebrum, and cerebellum and diffuse granular degeneration of the kidney. Chronic intoxication of sheep with simasin at 1.4 and 3.0 mg per kilogram led to hypofunction of the thyroid; doses of 6.0 and 25 mg kg caused colloid struma while acute toxicity with 250 mg/kg (once and twice treated animals) caused parenchymal struma. A drop in the content of liver glycogen and degranulation of the mastocytes of the mesentery were also observed.


[Changes in the biochemical and morphological indices of broiler chickens depending on the temperature and humidity conditions].

A varying temperature and humidity regime was tested on a total of 200 hybrid birds (White Plymouth Rock x Cornish crosses). Investigated were some indices of the carbohydrate metabolism and the deposition of vitamins in the organism as well as the effect of the temperature and humidity regime on the growth and development of broilers. It was established that the content of glycogen in the liver and the muscles in birds raised first at 32 degree C and relative air humidity of 65--70 per cent was higher than in birds raised at 36 degree C and relative air humidity of 45--50 per cent. Besides, these observations were coupled with some changes in the content of blood sugar and the amount of A and E vitamins in the liver. The body weight of the test broilers by the end of the experiment was 30 grams higher than that of the control group broilers.


[Pharmacological and toxicological studies of novoolean].

A toxicologic study and some pharmacologic investigations were carried out with the novobiocin salt of oleandomycin, formulated as novoolean. The LD50 of the of the preparation for i/m application to mice proved equal to 1500, and to rats--1800 mg per kg of body weight. For oral introduction the average lethal dose for mice amounts to 3250 mg/kg. At such route of application on deaths were observed in rats after the administration of 5 000 mg/kg. A 30-day treatment via i/m application to rats of 180 mg/kg (which is equal to one tenth part of LD50) did not lead to changes in the growth, blood picture, and a number of clinical and biochemical indices of the blood and urine; there were no changes in the development and the structure of the viscera as well as the reproductive capacity of the test animals. Electron-microscope studies with rats treated in the same period with 360 mg/kg (one fifth of the LD50 value) revealed certain injuries of the liver kidneys. With cats the venous infusion of the preparation at rates of up to 15 mg/kg showed no changes in the blood pressure and the rhythm and pulse rate, and the addition of novoolean to the nutrient solution in concentrations of up to 100 mg/cu. cm did not influence the tonus and the motor function of isolated (after Magnus) sectioned portions of the small intestine of rabbits and guinea pigs.


[Fluctuations in susceptibility of pigs to erysipelas depending on age].

The results of experiments have shown that up to their second month of age pigs are not susceptible to Erysipelothrix rhusiopathiae infection. The invasion of the infective agent into the body of sich pigs neither causes an outbreak of the disease nor brings about changes in the immunologic indices under investigation, which shows that no infection process develops in these animals. At a later age infecting the pigs both with a broth culture of the pathogen and with material from organs, using the same doses as in the case of younger pigs has led to the development of a clinical process followed by enhancement of phagocytosis and rise of agglutination titers.


[Morphological changes in the liver of gamma-irradiated chick embryos and chickens].

The morphologic changes produced in the liver through irradiation at the rate of 1000 rad are characterized chiefly by a well expressed fatty dystrophia. At many sites there are pycnotic and lysed nuclei of the parenchymal cells. In the embryonic liver these changes are most strongly manifested in 12-day-old embryos. In contrast to the irradiated adult birds the embryonic liver presents no processes on necrosis after radiation treatment.


[Study and identification of the respiratory syncytial virus isolated from a leukemic cow].

A virus was isolated from the lymph nodes of a cow. By its cultural, physical, chemical, and biologic properties it proved identical with the standard bovine respiratory syncytial virus. It multiplied well in cell cultures of calf kidney at pH 7--7.5. Introduced in 20-day-old guinea pigs the virus caused anorexia, bristling up of hairs, stunting, and occasionally death. The inoculated guinea pigs developed pneumonia of a proliferative type with Langhans' giant cells. The interrlationship between the isolated virus and the standard oncorna virus, type C, is discussed.


[Dynamics of the immune titers in commercial layers raised under increased lighting intensity].

Investigations were carried out into the dynamics of the immune titers in commercial layers raised under equal conditions (exceptxor intense illumination for the control group). The trials were performed in the conditions of industrial poultry farming. Studied were the imune titers against NDV on the 14th, 21st, 35th, 68th, and 88th day following aerosol immunisation with the vaccinal strain Komarov. A higher titer for a more prolonged period in birds raised in the conditions of increased intensity of electric light within the range of 70--75 lx was established.


[Atrophic rhinitis in swine].

Four 60-day-old pigs were experimentally infected with Bordetella bronchiseptica at a state in which the animals were clinicylly normal. A single pig only, killed on the 180th day, presented a slight deflection of septum nasi. Morphologically, there were severe dystrophic and necrotic changes in the mucosa of the conchae, the nasal cartilages as well as in the bones. The pathogen was reisolated from two of the pigs. Clinical and morphological investigations were carried out also with spontaneously affected animals, isolating Pasteurella multocida, Pseudomonas aeruginosa, and Mycoplasma organisms, but not Bordetella bronchiseptic. Morphologically, there were in 37 of the pigs severe dystrophic and necrotic lesions in the nasal mucosa, cartilages, and bones. Basophilic inclusion bodies were demonstrated in the epithelial cells of the tubulous glands. It is concluded that a combined method of prophylaxis and treatment would be most effective, and of the drugs borgal has proved likewise most promising.


[Distribution of radioactive phosphorus (P32) and intensity of ATP metabolism in the cardiac muscle of rats following partial parasympathectomy and physical stress].

ATP turnover as well as incorporation of 32P into various parts of myocardium were studied after left-side vagotomy and physical loading. An increase in 32P incorporation was observed within 5, 10, 30, 105 days after the operation. Physical loading decreased the isotope incorporation into heart tissue of vagotomized and control animals under these conditions. The vagotomy did not alter the ATP content in rat myocardium but increased the turnover of ATP.


[Properties of cholinesterase preparations from human erythroyctes].

A modified method is described for isolation of acetylcholinesterase from human erythrocytes using an additional step of gel filtration on Sephadex G-75. Preparations of acetylcholinesterase were liberated from thromaboplastic activity and their specific activity was increased due to removal of low molecular proteins and of the products of destruction of hemoglobin. Content of A and B isoantigens in the preparations obtained was rather low and content of hemoglobin, combined with other proteins in the form of oxyhemoglobin, did not exceed 12% of the total protein.


[State of protein and mineral metabolism following thyrocalcitonin administration during experimental osteogenesis].

Prolonged administration of thyrocalcitonine (TC) into rats (at a dose 5 un per animal) led to some alterations in protein and mineral metabolism: decrease in content of calcium and phosphorus in blood, activation of alkaline phosphatase in blood, decrease in excretion of hydroxyproline, increase in excretion of aminonitrogen with urine. Distinct correlation was observed between the metabolic activity and definite steps in reparative osteogenesis. Exogenous TC activated the cellular structures, which participated in the regenerative processes, promoted the rapid turnover of bone generation and decreased the periods of tracture healing.


[Serotonin inactivation by tissues of the gastrointestinal tract and liver in the presence of dysenteric poisoning].

Intravenous administration of serotonin into healthy rabbits was accompanied by an increase in content of serotonin in blood of vena cava inferior but the level of serotonin in blood of vena portae and vena centralis hepatis was unaltered. Concentration of serotonin was increased in all parts of the venous system studied after administration of serotonin into andogenous histamine was stimulated. Administration of iproniazid, simultaneously with the dysenteric toxin, led to decrease in inactivation not only of serotonin, but also of histamine.


[Effect of acute hypoxia on the metabolic activity of lung tissue].

Metabolic activity of rat lungs were studied in normal state and in acute hypoxia, caused by an effect of rarefied atmosphere (3 hrs, "height" 10,000 m). Glycolytic splitting of carbohydrates and catabolism of proteins were increased in lungs under hypoxic stress. In hypoxia activities of adlobase, pyruvate kinase, succinate dehydrogenase, 5-hydroxytryptophan decarboxylase were increased, but hexokinase activity was decreased. Activities of lipase, lactate dehydrogenase and NAD-dependent malate dehydrogenase were not altered, whereas the ratio in specific activity of cytoplasmic malate dehydrogenase and lactate dehydrogenase was decreased.


[Adrenaline and noradrenaline elimination from the blood of rats of different ages].

Elimination of adrenaline and noradrenaline from blood of adult and old rats was studied within different periods after administration of the catecholamines. Adrenaline was eliminated from blood of rats of both age groups with the similar rate; however, the time of elimination of noradrenaline was distinctly longer in old animals are compared with the adult ones. The alterations observed may be due to the effects of sympathetic system on metabolic process in various tissues in the old age.


[Incorporation of 2-14C-acetate into the glycolipids of the spinal cord and brain stem of normal guinea pigs and guinea pigs in the paralytic stage of triorthocresylphosphate poisoning].

Paralytical form of chronic intoxication was caused by single intracutaneous administration of tri-O-cresyl phosphate (TOCP)/2=2.2 ml/kg/ into guinea pigs. Within the first 27--33 days after the treatment, the animals with pronounced symptoms of neurotoxic effect of TOCP were subcutaneously administered with 2-14C-acetate/100 mu Ci per 100 g of body weight/2 hrs before decapitation. Purified cerebrosides, gangliosides and acid-soluble fraction, containing 14C-precursors, were isolated and their specific radiactivity was measured in a gas-flow counter. The rate of 14C incorporation into cerebrosides and gangliosides in spinal cord was found to exceed that in brain stem. In paralytical stage of disease, caused by TOCP, synthesis of cerebroside was depressed in spinal cord and in brain stem, according to calculated value for relative specific radioactivity. In spinal cord the rate of 14C incorporation into gangliosides was also decreased. These data suggest that neurtoxic drug TOCP affects metabolic processes both in oligodendroglial cells and in neurons, where ganglioside biosynthesis occurs.


[Activating effect of indolylhdrazides on rat brain monamine oxidase].

Effects of hydrazide and isopropyl hydrazide of beta-/2-methyl indolyl-3/propionic acid as well as dihydrazide and isopropyl dihydrazide of alpha-butyl-beta/2-methyl-5-carboxyindolyl-3/propionic acid on activity of monoamine oxidase from rat brain were studied in vivo and in vitro. The effects of the preparations depend on the initial activity of the enzyme, concentrations of the compounds and on the substrate used. Decreased monoamine oxidase activity was the most suitable condition for detection of activating effect of compounds studied.


[Effect of acetylcholine on protein biosynthesis in regions of the heart in adult and old rats].

Effect of acetylcholine on incorporation of labelled amino acids (14C hydrolysate of chlorella protein) into the free amino acid pool and total protein was studied using slices of auricles, right and left heart ventricles, obtained from 2-month, 8--10 month and 26--28-month old rats. Changes in the intensity of protein biosynthesis were estimated by following relative specific activity (RSA--protein specific activity/free amino acid pool specific activity). Maximal increase in the RSA value was found: in auricles of 2-month old rats in presence of 2.5.10(-4) M acetylcholine, in adult rats--in presence of 1.10(-3) M acetylcholine and in old rats--in presence of 5.10(-4) M acetylcholine; in right ventricle of all age groups--at the concentration of 1.10(-5) M acetylcholine. In left ventricle of all age groups the changes in RSA value were statistically unsignificant. Atropine blocked the stimulating effect of acetylcholine on protein biosynthesis in auricles.


[Effect of biogenic amines on phosphorolysis and gamma-amylolysis of glycogen in the cardiac muscle of rats under anesthesia].

Adrenaline, poradrenaline, serotonin, triptamine and 3-hydroxytyramine activated glycogen phosphorolysis in heart of nonanesthetized rats due to increase in the phosphorylase A activity. Anesthesia with nembutal and ether prevented the stimulating effect of biogenic amines (excluding serotonin) on phosphorolysis. Adrenaline, administered into animals anesthetized with nembutal, inhibited the glycogen phosphorolysis. Noradrenaline caused a decrease in gamma-amylolysis of glycogen in anesthetized and untreated rats. The inhibitory effect of adrenaline on glycogen gamma-amylolysis occurred in rat heart muscle only under the conditions of anesthesia.


[Method of studying collagen metabolism in human skin].

Rate of collagen biosynthesis was evaluated by monitoring total radioactivity of 14C-proline in soluble and unsoluble collagen. The rate of collagen maturation was estimated by following radioactivity of 14C-hydroxyproline in unsoluble fraction of collagen. Correlation between the concentration of collagen in skin and the rate of its biosynthesis enabled to determine the rate of collagen degradation. The modified method differed from the original one in the procedure for estimation of total and radioactive hydroxyproline, in technique for extraction of collagen fractions, soluble in 0.45 M NaCl, in composition of experimental samples. Some reagents were substituted for more easily available analogues. The modified method, as compared with original one, was more informative, simple and less expensive, but maintained the good reproducibility and sensitiivity of the original method.


[Tumors in animals irradiated during embryogenesis].

In experiments on 465 male and female white non-lineal rats irradiated in their embryonal (7th day--240 rats), organogenesis (14th day--105 rats) and foetal periods of embryogenesis (19th day--120 rats) with 60Co--rays in a dose of 100 r, its actual power 168 r/m, and on 73 control rats the authors have studied the frequency and terms of tumors appearance. A group comprising 219 experimental rats and 53 control animals, died during a period of 200--600 days following their birth, was analysed. Irradiation at different stages of embryogenesis would provide a statistically significant increase in the frequency of tumors and shorten the terms of their appearance. In control animals tumors arose in 16,9% (in 9 of 53 animals). Embryonal and foetal periods of embryogenesis proved to be mostly susceptible as evidenced by the yield of radiation tumors. In animals exposed to irradiation in their embryonal period tumors arose in 64,5% (in 69 of 107 rats), in the foetal period--in 62,8% (in 44 of 70 rats), and during the period of organogenesis--in 42,8% (in 18 of 42 rats). Rats exposed to irradiation in the embryonal and foetal period of embryogenesis developed tumors to the 120--180th day of the experiment, while in the organogenesis period--to the 400th day. Maximum tumor appearance was observed in the last third of the lifetime. Male rats irradiated in the period of embryogenesis developed tumors of the mammary gland and bones, females- ovarian and bone tumors, which were absent in control animals.


[Type-C viral particles in cell cultures of chemically induced glioma in Sprague-Dawley rats].

Long-term cultures of a glioma induced in a Sprague-Dawley rat exposed to methylnitrosourea were examined by thin-section electron microscopy. Budding and extracellular lying C-type virus particles were numerous in several samples of the highpassage cultures. This is the first report of a chemically induced rat glioma associated with C-type virus particles. Studies with an aim to characterize this rat glioma associated virus are in progress.


[Mechanisms of the immunodepression caused by ortho-aminoazotoluene and its noncarcinogenic analog in mice].

Single injections of ortho-aminoazotoluene (OAT) or aminoazobenzene (AB) decrease the immune response of DD mice to the strain-nonspecific Krebs-2 tumor. The immunosuppressive action of AB is due to its toxicity for lymphoid cells, whereas the OAT effect is mediated by adrenal glands. After OAT injection,II-oxycorticosteroids level is elevated although their production by adrenal glands is not increased. The accumulation of glucocorticoids in blood after OAT injection is assumed to be the result of a decreased hormone utilization because of the blockade of receptor proteins or metabolizing enzymes in liver cells by a carcinogen.


[Nephrogenic hypertension and carcinogenesis].

The results of studies conducted on 355 white nonpedigree male rats (268 experimental and 87 intact animals) indicated that nephrogenic hypertension: a) potentiates the development of benz(a) pyrene induced blastomas; b) enhances, as a rule, the growth of transplantable tumors: carcinoma RS-1 and sarcoma 45; c) results in a tendency to more frequent metastasization of the tumors (Walker carcinosarcoma and Zajdela ascites hepatoma).


[Significance of modifying factors in the development of peripheral nervous system tumors in rabbits].

The experiments conducted on 170 rabbits have indicated that the development of neurogenic tumors under the exposure to methylnitrosourea procedes more rapidly in immunization with the tissue homogenate from the rabbit sciatic nerve (using a complete Freund's adjuvant) in chronic irritation of the peripheral trunk and in hypothyroidism and estrogenization of the organism of animals under test. Castration and thyroidin administration would reduce the number of experimental tumors of the peripheral nervous system and lengthen the latent period of their development.


[Kinetic patterns of the development of transplantable AKR leukemia].

Under study was the kinetics of the development in primary passages of AKR leukemia transplanted by different number of cells. The indices of the leukemic process (the spleen, lymph nodes, the liver, thymus, blood leucocytes) vary with time in extreme curves. The leukemia transplantability is reduced from 100% to 24% with lessening of the transplant from 10(4) to 10(1) cells. The latent period duration and the survival of mice are linearly related to the transplanted cells number logarythm.


Endobronchial metastases in breast carcinoma.

In a consecutive series of 1,628 patients with breast carcinoma, six cases of endobronchial metastases were diagnosed for an incidence of 0.4 percent. The median latent interval from the diagnosis of the primary carcinoma until the time of diagnosis of endobronchial metastases was 21 months. Endobronchial metastases can be the initial manifestation of recurrent cancer and can present with no abnormalities shown on x-ray films of the chest. Because of similar symptomatology, the diagnosis of endobronchial metastases may be confused with a central bronchogenic carcinoma but the histological appearance could differentiate the two entities. Local treatment with radiation therapy is usually inadequate and patients should also be treated with some form of systemic treatment such as chemotherapy. The median survival after the diagnosis of endobronchial metastases was 13 months.


Urinary tract infection/vaginitis protocol. Use in a walk-in clinic.

A process, outcome and salary-cost analysis was made of the use of a urinary tract infection/vaginitis protocol. Three nurse practitioners, in a university-based, walk-in clinic, cared for 128 women presenting with complaints of dysuria or vaginal discharge, or both. There were no significant differences among the nurse practitioners in data collection, diagnostic accuracy or patient outcome. The diagnoses were correct in 92 percent, incorrect in 6 percent and indeterminate in 2 percent of the patients. Incorrect diagnoses were due to presumption of urinary tract infection in patients with the urethral syndrome or vaginitis. Of the patients, 78 percent were actually sent home without seeing a physician. Concordance with the nurse practitioners' physical examination was 100 percent in those patients examined by a physician. In 82 percent of the patients there was alleviation of symptoms. Patient satisfaction with this method of care was extraordinary, with 98 percent of the patients giving favorable reports. True physician extension was achieved with a reduction in physician time per patient from 20 minutes to 6 minutes. In contrast to previously reported data, only a modest reduction in salary cost savings (10 percent) could be shown. The author concludes that nurse practitioners working in an acute care clinic or emergency department can see the patients defined in the study and provide high-quality care at a reasonable cost.


Unifocal bone findings by scintigraphy. Clinical significance in patients with known primary cancer.

Preliminary findings suggest that in patients with known primary cancer, a large percentage of unifocal lesions seen on radionuclide bone scans are not metastatic. In a survey of radionuclide bone studies done on 861 consecutive patients, 30 patients with known primary cancer had solitary lesions. Adequate follow-up information was available on 21 of these 30 patients. In only four did the lesions prove to be caused by metastatic malignancy.


Child health assessment and screening using a volunteer staff.

A child health assessment and screening program, staffed by volunteers, has evaluated approximately 5,000 children in a general pediatric clinic. A sample of 500 children was studied to determine characteristics of the population served, quality of the work of the volunteers and the number of new problems identified. Use of well-trained volunteers, provided with adequate supervision and follow-up physical examination of the children, identified many new problems at minimal cost and proved an effective means of expanding quality health care.


[Diagnostic standards in geriatric surgery (author's transl)].

The diagnosis in the field of surgery of the old age is to be standarized if you suppose that not all illnesses or consequences of accidents are the real problem, but the old age which is accompanied by multi-illnesses. So it must be examined in how far it is possible to realise the great existing risk. Besides most of the operations of the old age belong to the urgent surgery and care connected with a great risk. A standardized diagnosis must think of the individual factors and must recognize--because of the little time--the most important signs of the heart circulation-, the lung-and the kidney-function. This must be united with the results of the diagnosis of the organes to a pre- and postoperative therapeutic programme.


[Diagnostic standards in the ophthalmological geriatrics (author's transl)].

Diagnostic standards have a big practical importance in the ophthalmological geriatrics above all in glaucoma, apart from the presbyopia, which depends to the age in a big way. It is expected by the putting up of diagnostic standards only a low effect for other changes of the eye in old age.


[Diagnostic standards in geriatrics (author's transl)].

This paper, which is based upon and interdisciplinary discussion of the subject by members of the Geriatrics Division of the G.D.R. Society of Gerontology, deals with questions concerning the elaboration of standards of diagnosis in geriatrics. In addition to general considerations, the author discusses a number of those problems which general practitioners and specialists in internal medicine usually come up against. Complete solutions cannot, in the present state of development, be offered. Rather, efforts are being made to invite experts, by the raising of questions, to further discuss the whole subject in order to arrive at definite rules of specific diagnosis by drawing on as wide a range of experience, findings, and information as possible.


[Diagnostic standards for geriatric patients in orthopedics (author's transl)].

Geriatric patients in orthopedics frequently fail ill of some typical diseases. For clearing up of diagnosis in the clinical investigation the application of Neutral-O-transitional method and of some supplementary investigation (who lead likewise to numerical findings) are recommendable. Selected roentgenograms and laboratory methods are necessary additional for clearing of diagnosis. The application of this "diagnostic standard" is an effective guide for diagnosis and an improvement in the exchange of findings between medical specialists.


[To the question of borderline case between psychology and psychopathology in higher age (author's transl)].

Proceeding from the general problems of geropsychiatric lines of research, a number of developments of psychitc functions (intelligence, memory, speed of psychic-cognitive and psychomotor processes, cerebral fatigue, concentration power, higher perception functions) are discussed in dependence on the age. The paper explains that the process of ageing has different effects on the various psychic subfunctions. This fact is of great significance for rehabilitative measures for old-age people.


[Change of clinical stomatological parameters in ageing (author's transl)].

Morphological-functional changes occur in the oral cavity also in depended from the age. The morphological changes of the enamel, dentin, dental pulp, periodont, oral mucosa, salivary glands, tongue, maxillary bone and temporo-mandibular-joint change not only the functional cooperation of all parts in the orofacial system. They show effects for the whole body also. A complete gerostomatological standard does not exist for the whole gnathological system. But single indices for some partial components are known. For the judgement of the caries involvement it is possible to use the DMF-index, for which a special gerostomatological type exist. The periodontal diseases are classified adequately to the ARPA-nomenclature. For the judgement of odontolithiasis and oral hygienic conditions you can use the so called odontolith-Index (CI), the OH (oral hygienic debris) and the so called calculus-index (OHI-S). It is refered to different possibilities for classification of dentition with gaps.


[Problems of surgery in old age (author's transl)].

Objects of surgery of the higher age are accident injuries, malignant tumors, thoracial and gastrointestinal emergency conditions as well as disorders of the central and peripheral circulation of blood. The aim of surgery of the old age is the complete recovery of the old men and the integration in his familiar surroundings. In many cases this aim can be realized only to a certain degree on account of the polymorbidity of the higher age. For men older than 50 years the risk of operation is continuously increasing. In the 10th decennium the value of postoperative letality is reaching almost 30%. The reason is not in first line the basic disease or the accident, but the complication for intervention is in most cases an absolute one, because cases of emergency are predominant. The consequence of surgery with high risk is the prophylaxis, that means: all pathologic, already in younger years existing states, which are generally treated by operation, ought to be operated early, in order to prevent complicationsin the higher age. In tumor surgery, which is characterized by a high delay rate, looking for tracks of cancer and early diagnosis are the ways to diminish the burden of the older men.


[Digestion and absorption in elderly man (author's transl)].

Morphologically first indications of an age-related alteration of pancreatic microscopic structures can be proved an age of fourty. In healthy elderly man functional capacity of exocrine pancreas is lowered. It can be proved by means of pancreatic function tests. Normally the digestive capacity will be sufficient provided a reasonable nourishment. Usually the intestinal absorptive capacity tends to decrease in the elderly. But following delayed intestinal transit of nutritients absorption to a certain degree can occur sufficiently. Considering the nutrition of elderly people recommendations are given.


[Psychology of ageing and age (author's transl)].

Aging is a biological process being experienced. The experience of ageing is associated with disappointment and renuciation. Thus, aging is a task which can be mastered in different ways.--It is asserted that there is an ageing having a social sense.--It is demonstrated by some parameters which advancements and which hindrances may play a role in ageing as well as which defective developments may be possible. The traditional norms and ideas from former generations as well as the social evaluation of age have to be taken into consideration when an approach to the problems of aging is designed.--The different situation of the sexes is briefly outlined.--The physician can help best if he himself is able to cope with his own ageing.


Preparing for old age: necessity, possibilities, contents, limits.

International findings and our own results in gerohygienic sociogerontological, geriatric, medical epidemiological and psychogerontological research have positively confirmed the need for preparing for old age. Demographic data in the GDR has brought to light the growing need to put the preparation for an active old age into practive making use of research data and of the existing resources. The means of implementing the programme life in the overall resources of our developed socialist society, in our laws, in our well-organized public health system and above all in the industrial health protection service. It is shown that the society's potentials and the industrial health protection service, which operates on a country-wide scale, can have a positive influence on ageing and on life of old people. The ways in which this can be achieved are described. These ways are based on the main medical, psychological and social aspects of preparing for old age. The existing limits must be taken into account when translating the schemes of preparation for old age into practice of socialist health protection. It is indispensable to concentrate on problems of focal importance. The preparation must first benefit factory workers exposed to health hazards. Medical preparation should come first, followed by psychological and social preparation. In the long term, preparation for old age must be integrated into the overall process of education and it must start at school, where it should be integrated into biology and civicx classes. Such a process corresponds to the life-long process of ageing, to socialist principles and to the efforts of the public health system to preserve health, working capacity and joy of living up to a ripe old age.


[Preparing for old age. (II) (author's transl)].

Looking back on the beginning of the efforts for preparing of working pensioners for activity and creative life in the pensionary there is demonstrated the present state of the request of research for social preparing on age in the socialism. Our new labour law and some results of research of gerohygienic studies show which way for preparing on an active age is further to go.


[To some tasks, marks and programme-contents of geropsychohygiene in preparing on age (author's transl)].

Leading and shaping of life should have a positive influence also on the psychic health until the old age. One of the marks of geropsychohygiene is to shape this process. Therefore the new role of the active old people as integrated member of society must be defined and mediated a real attitude to the ageing. There are given geropsychohygienic impulses for interdisciplinary working with this problems. There is demonstrated by the thematic complexes intelligence, reactivity and ability to learn, that introductions on the necessary regress of such psychic results with the age are scientifically refuted. Concensions for the preparing on the age are contained in the demand consciously to put in special training, positive motivations and contacts to the environment for maintenance of the psychic efficiency.


[Therapy of thromboembolic diseases in old age (author's transl)].

It can be established, that thromboembolic diseases in higher age are suited for a thrombolitical therapy and for a treatment with anticoagulations also. In higher age of the patients we should pay attention especially to possible contraindications and a thrombolitical therapy should be carried out under clinical conditions. The results of treatment justify our therapy, because the mortality of the patients treated with anticoagulations lies clearly under the mortality of those patients without anticoagulations.


Bone diseases in advanced and old age: diagnostics, prophylaxis, therapy.

The authors give a short overview on:--Diseases characterized by too small a number of osteoblasts and insufficient osteoid formation--Bone diseases in the presence of osteoid overproduction with concomittant disturbed mineralization can quasi be summed up in two statements as regards ageing and aged people--Diseases associated with excessive resorption due to increased osteoclastic activity--Diseases caused by great resorption of bone in the presence of bone marrow proliferation, their diagnostics, prophylaxis and therapy.


[Clinical evaluation of the arterial system in hemophiliacs as a model for long-term anticoagulation].

Issuing from the question of the value of a prophylactic anticoagulation for the purpose of prevention of arteriosclerosis 25 patients with haemophilia were examined with the aim to detect possible connections between coagulation potential and arteriosclerosis taking into consideration factors of risk and age. Indeed, also in these patients who were "anticoagulated" from birth factors of risk and references to an existing arteriosclerosis were found. Correlation analyses, however, indicated tendencies, which suggest a protective influence of the hypocoagulability concerning factors of risk and arteriosclerosis.


[The differential diagnostic significance of neurological syndromes in a malignant tumors].

It is reported on a 35-year-old patient with carcinoma of the stomach. The disease became manifest above all neurologically in form of a clinically and autoptically clear preterminal carcinomatous meningitis and a clinically probable paraneoplastic sensomotoric polyneuropathy as early symptoms. The case is discussed and classified on the basis of literary data. Here the differential-diagnostic significance of the paraneoplastic neuropathy as early symptom is emphasized.


[The behavior of free fatty acids and free glycerin in functional thyroid gland disorders].

It is reported on the behaviour of the fasting serum levels of the free fatty acids and the free glycerol in patients with hyper- and hypothyroidism. The two parameters were significantly increased in hyperfunction of the thyroid gland, whereas a decrease was found in hypofunction. The possible causes are discussed with the help of literature.


[Possibilities of diagnostic standardization in the differential diagnosis of comatose conditions on the basis of the working methods of a grade IIb laboratory].

In the paper life-threatening diseases which may be accompanied by profound unconsciousness are explained from the laboratory-chemical point of view. It is referred to the significance of a laboratory-diagnostic programme for the differential diagnosis of comatous conditions. In this case the material and personal prerequisites and the laboratory capacity of a district hospital are taken into consideration.


[Hemorrhagic diathesis as a rare lead symptom in Addison-Biermer's anemia].

It is reported on a patient with Addison-Biermer's disease who was admitted to hospital under the diagnosis of a bleeding ventricle ulcer and in whom was detected a thrombocytopenic haemorrhagic diathesis. By means of injections of vitamin B12 a complete haematologic remission was achieved. The absence of a clear increase of reticulocytes as a sequel of the blood transfusions performed before the specific therapy is discussed.


[Modulation and proliferation of the vessel wall muscle cell and its importance for atherogenesis].

Decisive for the progression of the arteriosclerosis is the increase of thickness of the intima, as it is shown by histological and morphometrical investigations on the human coronary arteries. A light-optic and electron-optic analysis of animal-experimental, induced and spontaneous proliferations of the intima has the result that the process of progression is maintained by structural and functional variants (modulations) of the myointimal cells. Under the influence of specific and unspecific stimulators they are able to proliferation and migration, abnormal fibre synthesis and lipid storage as well as to phagocytosis and formation of boundary surfaces. Most of the modulations described of the activated muscle cell are temporary adaptations to a changed micromilieu and they are reversible to contractile cells after decrease of the stimulation effect. Therefore it is assumed that in the early stages of the arteriosclerosis a progression phase is to be diagnosed light- and electron-optically essentially at the appearance of proliferation-active and synthesis-active modulations of the smooth muscle cell. An inactive, non-progressive thickening of the intima may be diagnosed by the proof of contractile muscle cells.


[Transport in the vessel wall in early changes of arteriosclerosis].

In various model experiments the change of the surface was examined in arteries by means of grid electron microscopy. By means of a newly elaborated method the increased permeability was pursued. Lipofundin S and colloidal iron allow the observation of the plasma transport from the intima to the adventitia. In the adventitia lipofundin can be proved also in the adventitial lymphatic vellels. This confirms that the plasma after having leaved the arterial wall is drained through the lymphatic vessels of the adventitia.


[Progression and regression of diet-induced arterial changes in the domestic pig].

Under atherogenic diet in the pig changes of the intima developed in predisposed places of the arteries which have close relations to the atherogenesis in man. 4 months after the end of a 4-month atherogenic diet no decisive regression of lipid infiltrates could be established in spontaneous thickenings of the intima, however, signs of a lipid mobilisation.


[Pathways of intracellular cholesterol metabolism in a model study].

We had concluded from former own investigations that the cells in the arteriosclerotic plaque effect a change of the ester proportion of cholesterol. One of the possible mechanisms ible bond and from double unsaturated (linoleic acid) to higher unsaturated acids. Therefore we investigated by radioactive labelling of the fatty acid moity of cholesterol esters whether such desaturation reactions take place in the model experiment. For this purpose we implanted cholesterol stearate which was 14C-labelled in the proportion of fatty acid subcutaneously into the skin of a rat. We demonstrated radiohistochromatographically that after 7 to 14 days the fraction of the cholesterol esters with 1 double bond was additionally labelled. Other fractions were not labelled. From this results that the proportion of the saturated fatty acid of the cholesterol ester is actually desaturated, in which case the desaturation as we expect only goes to the fraction with one double bond, because the double unsaturated linoleic acid is not synthetized in vivo in the mamal.


[Fibrinogen: structure, function and interaction with proteins and cells].

The dimerous three-chained protein fibrinogen has at its disposal different functional zones which are included in the process of polymerisation and which possess importance for the specific reaction of fibrinogen with certain cells. The present paper is particularly engaged with the activation of fibrinogen by thrombin and with the mechanism of the arrangement of the activated units of fibrinogen concerning the fibrin fibre. Finding concerning the interaction of the platelets with fibrinogen connected to sepharose plead for the fact that a change of conformation in the molecule of fibrinogen precedes the specific platelet reaction.


[The initial stage of thrombus formation in early stages of arteriosclerosis].

An arterial thrombosis develops via a lesion of the vascular wall. By the contact of the flowing blood with subendothelial collagen and basal membrane proportions the adhesion and aggregation of platelets develop which, depending on flowing conditions and local conditions, such as ADP-concentration, may lead to manifest thromboses. The prostaglandines have an essential influence on these processes. The relations of thrombosis to arteriosclerosis consist in the stimulation of the smooth muscle cells to proliferation by a factor of thrombocytes, in the organisation of experimental arterial thromboses with formation of an intima proliferation and in the complications of manifest arteriosclerosis by secondary thromboses. Methods for the proff of an increased inclination to thrombosis on the basis of an increased platelet function are critically discussed as to their clinical usability. A spontaneously increased aggregation of platelets is regarded as a reference to progressing arteriosclerosis. In these cases the significant increase of the spontaneous aggregation is of special importance in diabetics.


[Lipoproteins and fatty acids--hyperlipoproteinemia and arteriosclerosis].

At first on the basis of literature a short description of the interrelations between lipoprotein metabolism and fatty acid metabolism as well as hyperlipoproteinaemia on the one hand and arteriosclerotic-degenerative diseases of the coronary vessels on the other is given. Finally, the findings of gas-chromatographic analyses of the patterns of fatty acids of the cholesterol ester and triglyceride fractions of the serum of 252 patients with primary hyperlipoproteinaemia are represented. In contrast to persons with healthy metabolism increase of the proportions per cent of palmitic acid, stearic acid, palmitoleic acid, oleic acid, and eikosatrienic acid was shown and decrease of those ones of linoleic acid, linolenic acid, arachidonic acid, and eikosapentaic acid in the cholesterol ester fractions in hyperlipoproteinaemia type IIa and IIb and in the triglyceride fractions in hyperlipoproteinaemia type IIb and IV. The shifts within the patterns of fatty acids in hyperlipoproteinaemia are an expression of an atherogenic risk. Disturbances of the hepatogenic synthesis of fatty acids and oxydation of fatty acids, increased reesterification from the depot fat of mobilised fatty acids as well as a partially increased LCAT-activity are causally discussed.


[Foundations of arteriosclerosis therapy].

Since for the time being there might not be a causal therapy of arteriosclerosis one depends on recognition and influence upon the so-called factors of risk. Up to now these factors have only a statistical but no inevitably causal significance. The aim should be to comprehend groups of endangered persons in the stage of health or, respectively, in the still repairable early stage of the disease to perform a true primary and secondary prevention. In the later stages in the best way a cure of the defect or possible a retardation of the course of the disease and prevention of complications may be achieved.


[Possibilities of prevention and therapy of arteriosclerosis by influencing hemostatic functions].

Thrombotic processes play a role not only as a sequel of arteriosclerosis, but also for its pathogenesis. Under this aspect a pharmacological regulation of the course of the reaction of thrombpcytes, the blood coagulation and the fibrinolysis gets significance. The prevention of the formation of fibrin by well-known anticoagulants, such as coumarines and heparin, seems little suited for a prophylaxis of arteriosclerosis. By a pharmacological regulation of the reaction of the blood platelets which are decisive for the initial phase of the formation of thrombi new possibilities for an intervention into the pathomechanisms of arteriosclerosis are the result. Her also realizations concerning the prostaglandin metabolism of the blood platelets and of the wall of vessels can be evaluated. The activation of fibrinolysis by means of the hitherto introduced fibrinolytics, such as streptokinase and urokinase, is used above all for the treatment of acute thrombi. In the sense of a prevention of arteriosclerosis the activation of the endogenic fibrinolysis with the help of indirect fibrinolytics, which effect a liberation of the activators of fibrinolysis localised in the wall of the vessels, is a hopful way.


[Nutrition and arteriosclerosis].

Issuing from the present state of the influence of the basic nutritive substances (protein, fat, carbohydrates) and various nutritive factors discussed again and again (cholesterol, erucaic acid, sodium, calcium/magnesium quotient, pressor amines) on the development of the arteriosclerosis, the indididual factors of influence are critically evaluated. The investigations are getting under way, so that ascertained results are standing beside insufficiently claified or open problems, From the abundance of the observations conclusions are drawn which are of significance for practice. Unfavourable influences of nutrition on the factors of risk (hyperlipoproteinaemia, disturbance of the carbohydrate tolerance, hyperuricaemia, hyperalimentation) and on the manifest diseases (hypertension, diabetes mellitus, uric arthritis, obesity) of the metabolic syndrome which finally contribute to the development of arteriosclerosis are emphasized. In front of this background a clinically and ambulatorily tested basic metabolic diet is described. About 20% of the energy content (kcal or kJ) of this diet are protein, 35% fat and 45% are carbohydrates. The saturated fatty acids lie below 30%, the manifold saturated fatty acids, however, above 20% of the total fat proportion. The cholesterol content is below 400 mg, the purin-nitrogen below 200 mg, and the sodium content is about 2g per day. This diet can be produced for the treatment of persons with normal weight and overweight in different energetic degradations.


[Physical activity in the prevention of arteriosclerosis].

Epidemiological investigations show that morbidity rate and severity of coronary sclerosis seem to decrease in regular physical activity. The influence of regular physical activity on coronary factors of risk, such as hypertension, fat parameters, glucose tolerance, and uric acid is summarized with the help of literary data. An essential intermediary role seems to belong to the height of the insulin levels in the metabolic factors of risk. The result of own investigations was that by training basic and stimulated insulin secretion clearly diminish. Apart from this, during physical load particularly an increased rate of lipolysis is reduced during physical load. Together with a decrease of lipogenesis the two factors might play an essential role in the prevention of coronary sclerosis by regular physical activity.


[A programmed universal stimulator for the diagnosis and therapy of bradycardial and tachycardial arrhythmias].

Special kinds of electrostimulation, particularly the so-called programmed stimulation, are necessary for the specialised diagnostics of disturbances of nervous impulses of the heart and of the conduction system with intracardiac ECG (His-electrocardiography). A pacemaker using constituents of microelectronics is described which apart from fixed frequent, coupled, P/R-linked, bifocal and higher frequent atrial stimulation makes possible a programmed stimulation according to a preelected programme. Apart from the use for diagnostics the stimulator is suited for the therapy of bradycardic disturbances of the rhythm and for the termination of tachycardias.


[Clinical aspects of the endocrinologically inactive small intestinal carcinoid].

Casuistically is reported on two patients with an endocrine inactive ileum carcinoid, in whom the anamnesis with 5 weeks or 10 months was very short and atypical. Continuously increasing abdominal pain and gradual formation of a lower ileus of the small intestine or profuse watery diarrhoeas were the leading symptoms. Intraoperatively or autoptically in each case a very small (less than 1.5 cm) ileum carcinoid was found, which had led to a stenosing of high degree, there were no fibroses of the endocardium, no liver metastases--accordingly the secretion of serotonine metabolites (5-HIES) in the urine had been normal. The possibility of a so-called endocrine-nervous enteropathy in the female patient with the diarrhoea symptomatology and the necessity of a rapid diagnostic clarification in suspicion of a tumour in the lower small intestine are discussed, since such a suspicion in most cases corresponds to a carcinoid and thus there exists a great chance of cure.