[Comparison of radiological findings in children with Hodgkin's disease and non-Hodgkin's lymphomas at disease presentation (author's transl)]. From January 1968 to March 1975, 115 patients with malignant lymphomas, all aged under 15 years were admitted to the Istituto Nazionale Tumori of Milan : 57 had Hodgkin's disease (mean age 9.7 years) and 58 non-Hodgkin's lymphomas (mean age 7.7 yrs). In this group of consecutive unselected and untreated patients the incidence of lesions radiologically evident at disease presentation was comparatively evaluated in relation to histology, 36 cases underwent a subsequent diagnostic laparotomy with splenectomy.


[Study of 12 cases of non-Hodgkin's lymphoma of the testicle (author's transl)]. Twelve consecutive cases of non-Hodgkin's lymphomas with initial testicular involvement have been considered in this retrospective evaluation. In 801 cases with referred for treatment to the Istituto Nazionale Tumori of Milan from 1962 to 1974 evidence of initial testicular involvement was observed in 1,4% of cases. Of the whole group of testicular tumors treated in our Institute only 3% were classified as non-Hodgkin's lymphomas. Six out of 12 patients with stage I (2 cases) and II (4 cases) diseases were treated with Cobalt therapy to the retroperitoneal nodes. Only one patient remained free of disease after radiotherapy. Three patients relapsed after primary irradiation and six patients classified as stage IV were treated with chemotherapy. Patients receiving combination chemotherapy had in general a better quality of response and a larger, but not significantly different, survival, compared to patients given simple agent sequential chemotherapy. Since the differential diagnosis between testicular lymphomas and seminomas may cause some difficulties and therapeutic implications are different, clinicians should be alert to this problem: in our case series testicular non-Hodgkin's lymphomas was the most frequent non-germinal tumor of the testicle.


[Primary hepatic infantile hemangioendothelioma (author's transl)]. Primary hepatic infantile hemangioendothelioma is a rare tumor, characterized by its appearance in early infancy as well as by the frequent association with various malformations and with similar angiomatous tumors of other tissues and organs. It may be single or multinodular and it is often complicated by severe peritoneal hemorrhage. Tow histologic types of this tumor are known: tipe 1 is sharply circumscribed and is considered similar to so called capillary hypertrophic hemangioma, while type 2, by showing aggressive, infiltrative and anaplastic features, is rather close to angiosarcoma. Clinical and pathological data concerning two cases of type 2 primary hepatic infantile hemangioendothelioma are reported. On the basis of experimental results and epidemiological data on hepatic angiosarcoma of adults, a possible etiopathogenetic relationship with maternal exposure during pregnancy to dangerous environmental factors is postulated.


Natural history of the familial medullary thyroid carcinoma-pheochromocytoma syndrome and the identification of preneoplastic stages by screening studies: a five-year report. 1. In the fifth year of followup, 8 of 12 original patients thyroidectomized for MTC, diagnosed solely by abnormal calcitonin values, are disease free by all criteria. Elevated calcitonin levels are the only manifestation of active disease in three patients with presumed metastases. 2. Routine annual screening of susceptible individuals is a practical measure and has in 6 cases detected the premalignant condition of G-cell hyperplasia and in 1 patient a premetastatic state of MTC. It is premature to conclude that yearly screening is sufficient to detect all cases of premetastatic disease and for this reason we are recommending a yearly screen with pentagastrin and calcium tests and the more convenient pentagastrin test at 6 month intervals for those in the high-risk age group between 8 and 18. If screening at such intervals proves to be ineffective in preventing the disease in every case, consideration must be given to prophylactic thyroidectomy although we are not currently recommending this precedure. 3. Pentagastrin injection is often a more effective secretagogue for calcitonin than is calcium infusion, but this is not uniformly true. We  therefore recommend use of both tests as the most appropriate screening procedure. 4. Epinephrine is a major secretory product of pheochromocytomas in the J-kindred and sequential E/N ratios may be of use in the early detection of pheochromocytoma in other kindreds. 5. Adrenal medullary hyperplasia has been found in 3 adrenal glands and is probably a preneoplastic condition analogous to C-cell hyperplasia.


[Significance of the chemical structure and composition of blood substitutes in the genesis of posttransfusion reactions]. The work is concerned with an attempt to formulate grounds for the occurrence of possible posttransfusion reactions and complications as a result of transfusing blood substitutors from the group of synthetic and semisynthetic polymers, protein hydrolysates and aminoacid mixtures. Also, the classification of the reaction types, depending on ehc chemical structure and content of substitutors, is suggested. Some trends of prophylaxis against possible complications and reactions arising as a result of transfusion therapy are delineated, and certain demands are made to the content of new blood substitutors that would provide for a minimum risk in their application.


[Treatment of posttraumatic edema of the extremities]. To treat posttraumatic edema of the extremities the authors suggest their method of liquidating edema. The method consists in a periodic production of negative pressure on a limited segment of the extremity proximally to edematous tissues. The principal grounds of the method are described. An experience with treatment of 83 patients is summarized. The results obtained are quite favourable.


[State of the coagulation system of the blood following treatment of varicose enlargment of the veins of the lower extremity with phlebosclerosing preparations]. The present work is concerned with the study of the coagulation blood system in 50 patients showing varicous veins of the lower limbs in phlebosclerosing therapy. It was found that coagulative properties of blood depend on a stage of the disease. The most pronounced changes in blood coagulation toward hypercoagulation were observed in patients with decompensated varicous veins of the lower limbs 24 hours following the instituted therapy. It is recommended that injection of phlebosclerosing solutions in varicous veins be followed by a strict bed rest during a day.


[State of regional hemodynamics and pulmonary ventilation following resection of the stomach]. The state of regional hemodynamics (the brain, liver, lower limbs) and separate ventilation of the lung was studied reographically in 219 patients, in 101 of them after gastric resection for ulcerous disease and in 118 healthy persons. It was found that vitally important organs (the brain, liver, lungs) after gastric resection are adequately supplied with blood, in younger patients peripheral compensatory mechanisms playing the most important role. In aged and senile patients the function of peripheral compensatory mechanisms was markedly reduced.


[Results of 7,000 fibergastroscopies].

[Results of 7,000 fibergastroscopies]. The authors report 7000 gastroscopic investigations for various gastric lesions. In ulcerous disease with localization of ulcer in the stomach fibrogastroscopy permitted establishing the precise diagnosis in 91.18% of cases, whereas roentgenological studies -  in 78.75%. Gastric polyps are also recognized rather more frequently (98.26%) while using gastroscopy than a roentgenological study. An application of fibrogastroscopy in the complex diagnosis of gastric lesions seems to be mandatory since it provides for the correct diagnosis in 100% of patients.


[Diagnosis and treatment of the Mallory-Weiss syndrome]. Twenty-six patients with the Mallory-Weiss syndrome were treated in the clinic, in 23 of them the diagnosis was established at the height of hemorrhage by means of esophagofibroscopy. Nine patients were operated upon, since conservative therapy was a failure. Postoperatively, 2 patients died. Suturing of linear ruptures of the cardiac mucous membrane, ligation of the left gastric artery, vagotomy and pyloroplasty are considered to the operation of choice. The recommended operative procedures are being grounded. The immediate and late results of operative treatment are described.


[Roentgeno-morphological changes and reorganization of the functions of the biliary tract following resection of the stomach in peptic ulcer]. One hundred and twenty four patients (males - 102, females - 22) aged 20-59 years were investigated. The first group comprised patients (72) suffering ulcerous disease of the stomach and duodenum, the second (43) - patients investigated in the immediate postoperative period, the third (50) - patients investigated in later postoperative terms. The routine cholegraphy was performed after a standard technic. Structual alterations and functional disorders in the gallbladder and bile ducts concomitant with gastroduodenal ulcerous disease are described. The results of Billroth-I and Billroth-II gastrectomies are compared, and it is condluded that the Billroth-I gastric resection can be considered the operation of choice, since it is not accompaned with any serious changes in the structure and function of biliary passages.


[Metabolic alkalosis in patients following resuscitation]. Among 3425 patients treated in the general reanimation department metabolic alkalosis was observed in 445 patients (13%). More than a half of these patients (241) showed marked hemodynamic disturbances on admission (massive blood loss, multiple grave traumas or major operations). The phenomena of hypovolemia and disturbances in peripheral circulation with recommendations on their correction are described.


[Surgical treatment of suppurative hydatid echinococcosis of the liver]. Among 140 patients with hydatid echinococcosis of the liver complications were noted in 58 cases: suppuration of the cyst - in 38 (27.1%), cyst rupture in the anterior abdominal wall and abdominal cavity - in 4 (2.8%), in bile ducts - in 10 (7.1%), its rupture into the right lung lower lobe, calcification of the cyst was noted in 4 patients (2.8%). It is concluded that open echinococcotomy with partial excision of the fibrous capsule and drainage of the residual cavity with a rubber tube seem to be the most effective operation for suppurative echinococcosis of the liver.


[Surgical approaches to the liver and spleen]. A three-edge arbalest access to subdiaphragmatic organs is suggested. The access in its total or partial extent was tested in 393 operations. This access is considered to be more advantageous as compared with the analogous known ones.


[Diagnosis of early disorders of kidney function in lesions of the pancreato-biliary system]. The renal function was investigated in 209 patients with the pancreato-biliary pathology. The investigation was carried out dynamically prior to and after the operation. All patients showed functional changes in the kidneys being aggravated in the postoperative period. The concentration and nitrogen excretion functions, the renal function of electrolyte metabolism and maintenance of the acid-base balance were found to be mostly impaired. These changes proved to be the least pronounced in calculous cholecystitis and mostly pronounced in mechanic jaundice. Recognition of early disorders in the renal function may prevent the development of hepato-renal insufficiency, which is one of the main causes of postoperative mortality in patients with the pancreato-biliary pathology.


[Humoral indices of immunologic reactivity in the evaluation of the state of patients with cholecystitis before and after surgery]. As a result of studies of the complement and serum lysozyme titra, as well as its bactericide index in 250 patients with cholecystitis, it was found that inflammatory lesions of the bile outflow system were accompanied with a considerable reduction of humoral indices of natural immunity, the degree of this decrease being dependent on a gravity of the disease clinical course and a duration of the inflammatory process. Prompt normalization of the immune response factors postoperatively indicated the favourable outcome. Persistant inhibition of the humoral factors activity in most patients preceded the development of clinical signs of complications.


[Errors in the diagnosis and treatment of spontaneous perforation of the subcapsular bile ducts in patients with opisthorchiasis]. Ten cases of spontaneous perforation of subcapsular bile ducts in patients with opisthordiasis are analysed. In 8 of them perforation of the bile duct developed against the background of purulent cholangitis. In addition to opisthordiasis during the operative procedure cancer of the liver was found in 3 patients and cancer of the pancreas - in 1. All these patients were operated upon: suturing of the perforated bile duct wall and cholecystostomy were performed in 6 patients, cholecystomy - in 3, incision of a subhepatic abscess - in 1. Postoperatively 6 patients died, 4 of them having neoplasms.


[Diagnosis of retrocecal appendicitis].

[Diagnosis of retrocecal appendicitis]. Based on the analysis of case reports of 223 patients, operated upon for acute retrocecal appendicitis, there was found a definite dependence between the clinical course and anatomical features of the appendix position. Intramural, intraparietal and retroperitoneal forms of the appendix localization present the extreme dificulty for diagnosis. In free localization of the appendicular process retrocecally a typical clinical picture of the disease is observed.


[Preservation of tendon tissue in hordecin solution]. Rabbit tendinous homografts were preserved in 1% solution of an antibiotichordecin (in vaseline oil) during 30 and 60 days, after that these were used to replace a tendon defect of m. gastrocnemius in rabbits. Morphological observations in dynamics have shown that to the 9th month the homograft would be substituted by a tendon regenerate that carries the entire functional stress on the operated limb.


[Planning the surgical treatment of mandibular prognathism]. The method for calculating a required displacement of the mandible posteriorly in surgical treatment of prognathism by the technic of oblique osteotomy of the mandibular branches is suggested. The described technic was successfully employed by the author in 56 patients. The technic concerned would reduce the time of a surgical procedure (up to 50-60 min). The main advantage of the technic is that it completely excluded errors in calculating the displacement of the mandible posteriorly.


[State of the peripheral circulation-in the postoperative period in children with surgical pathology of the lungs]. The results of studies on the state of the peripheral blood flow in 43 patients with surgical forms of pulmonary pathology are reported. Studies were conducted by means of photopletismography and oscillometry pre-and postoperatively. The patients' age ranged from 5 to 15 years. The investigation was performed before the operation and induction of narcosis (initial data), to the end of the operation and narcosis, during the first 2 days postoperatively, as well as in the next days of the first week after the operation. A high informative value of photopletismography and oscillography in estimating the state of the peripheral blood circulation in these patients has been emphasized.


[Choice of surgical approach for embolectomy of an artery of the upper extremity]. According to the authors' observations 236 patients with embolism of major arteries of the upper extremities were treated: conservative therapy-in 43, surgery-in 193. Since 1972 in the clinic a unique access in the ulnar fossa with exposure of the brachial artery bifurcation has beem employed for embolectomy from any artery of the upper extemity. A direct access is used only if the necessity of simultaneous correction of the affection leading to embolism (proximally located aneurysms, jugular ribs) might arise.


[Pulmonary complications in acute hematogenic osteomyelitis in children]. An analysis of treatment in 49 patients has demonstrated that pulmonary complications aggravate the course of the disease and not infrequently are causes of lethal issues. It is considered that an early removal of the primary purulent focus by means of trephination and transosseous perfusion with antibiotic solutions in an acute stage provides for the prophylaxis of pulmonary complications and reduces the mortality.


[Development of the hip joint in children following supra-acetabular osteotomy of the bones of the pelvis in children]. The results of 91 supra-acetabular osteotomies of pelvic bones in children followed up for 6 years is presented. It was found that total anatomical and functional rehabilitation of the coxa was noted only in children who underwent supra-acetabular osteotomy of pelvic bones, associated with detorsion-varisation osteotomy of the femoral bone or antero-exterior tilt of its greater trochanter. Supra-acetabular osteotomy of pelvic bones in small children could result in a premature closure of a U-shaped cartilage, asymmetric growth of the bones and subsequent deformation of the pelvis with its oblique position.


[Experience in the treatment of open splintered diaphyseal fractures of the shin bones with a compression-distraction apparatus]. The authors present an analysis of the results of treatment for open comminuted fractures of crural bones in 51 patients, using the method of extrafocal osteosynthesis with Ilizarov, Tkachenko, Dem'yanov, Sivash and Gudushauri apparatuses. The data obtained evidence a possbility to apply compression-distraction apparatuses for this category of patients. Principal methodical errors, made while applying these devices, and also postoperative complications are analysed.


[Remote results of the treatment of fractures of the distal portion of the bones of the forearm]. Under observation were 309 patients with fractures of the distal portion of the antebrachial bones, in whom 311 fractures were observed (in 2 cases fractures occurred twice for a 9-year period). All these patients were subdivided into two groups: the Ist group comprised 139 patients treated at the in-and outpatient center of general surgery, and in the second group (172) patients were treated at the traumatological in-outpatient center. The results of treatment in both groups are analysed, and some appropriate conclusions are made.


[Some peculiarities of the treatment of burns of the lower extremities]. The results of treatment in 323 patients with burns of the lower extremities according to the materials of the CITO Burn Department for a 10-year period are reported. The authors described the method of treatment of circular burns of the lower extremities, based on suspension of the latter by needles stretched between arches, in Ilizarov apparatuses and by gauze bands supporting plaster dressings. The method is simple, convenient and facilitates the management of patients and obviates burn wound compression, prevents fusion of transplanted grafts due to compression and would permit to obtain favourable results of the treatment in the shortest time.


Investigations on the presence of antibodies to several flaviviruses in humans and some domestic animals in a biotope with a high frequency of migratory birds. Data are reported on the presence of HAI antibodies to several flaviviruses (tick-borne encephalitis, West Nile, and Ntaya viruses) in humans and some domestic animals in a biotope with a high frequency of migratory birds. The results obtained prove the presence in humans of specific antibodies in a proportion of 11.8% to tick-borne encephalitis and of 25.5% to West Nile and Ntaya antigens. Among domestic animals it was only possible to detect antibodies to West Nile (4.9% in sheep, 4.1% in cattle, and 12% in goats) and to Ntaya antigens (1.9% in sheep, 1.6% in cattle, 8% in goats, and 13.9% in swine).


The influence of smallpox revaccination upon the foetus. Serological, virological, anatomo- and histopathological investigations were performed in pregnant women subjected to smallpox revaccination. Serological findings were normal; no vaccinia virus was isolated from 210 placentae collected upon therapeutical abortion. Anatomopathological investigation of 15 placentae showed various lesions, while the embryo were free from any histopathological changes. The data prove that smallpox immunization does not affect the embryo directly, but only through the placenta.


Presence of hepatitis B antigen in the saliva of viral hepatitis patients. The presence of hepatitis B antigen (HBsAg) in the saliva of 14 (43.7%) out of 32 patients with viral hepatitis (VH) and antigenemia was revealed by discontinuous counter-immunoelectrophoresis. HBsAg was found in the saliva of both children and adults, more frequently during the first weeks after the onset of illness. The findings point out the possibility of non-parenteral VH transmission (kissing, sneezing, dishes, toys, etc.).


Variations in Coxsackie virus pathogenicity in the course of routine isolations in suckling mice and cell cultures. From 1961 to 1973 416 Coxsackie viruses were isolated, most of the isolations (303) being done in the last 5 years. Most of the isolates belong to a group A, with a predominance of types A6 and A8. Many variations were observed in strains belonging to the same type, as concerns their isolation in human embryo cell cultures and suckling mice; many Coxsackie A5, A6 and A8 strains showed a low pathogenicity for these animals.


Investigations on the presence of antibodies to several alphaviruses in humans and domestic animals of a region with elevated epidemiological potential. The paper reports on serological results obtained by HAI tests against several alphaviruses - eastern equine encephalitis (EEE), western equine encephalitis (WEE), Chikungunya, Midlebourg, Semliki Forest, Sindbis, and Ilheus viruses - carried out in humans and some domestic animals in a region with an intensive circulation of migratory birds. It was possible to detect in human antibodies to EEE, WEE, and Sindbis viruses, but in very low proportions (1.8%, 0.4%, and 0.6%, respectively). Serological results obtained in animals were practically negative: antibodies to EEE virus were found only in one out of 93 horses investigated.


[Ochronosis with severe arthropathy and internal organ lesions]. Observations upon a rarely met congenital disease is reported, developing symptomless up to the age of 40. The degenerative alterations of the big joints and the spine are of a special interest as well as the changes in urine, ear and nose cartilages, scleras and the skin in the armpits. A relation is supposed between the deposition of homogentisic acid and the functional changes in the vessels, latent diabetes and renal complaints.


[Temporary restoration of synchronous electrical cardiac activity in a human being after ventricular fibrillation lasting more than 3 hours]. The authors report the results from a continuous reanimation of a patient, aged 68 with thyrotoxicosis and hypertonic heart and frequent ventricular extrasystoles, in clinical death with ventricular fibrillation. The immediate and well performed measures--external hear massage and respiration with Ambu-kept the patient with manifested signs of reanimation: pupil reactions, rosy skin and muscle resistance for more than 80 minutes. The broad wave character of the ventricular fibrillation was kept during the same period. After that the waves became lower and almost receded after three hours and 20 minutes. Electric defibrillation, due to technical reasons, was carried out after that period. It was followed by a restoration of the electric activity of both ventricle and auricle with the presence of AV block--I stage and more severe changes in repolarization, but the mechanical heart work was not restored and the patient died in asystolia.


[Amyloidosis of the heart].

[Amyloidosis of the heart]. Two necropsic cases with heart amyloidosis in seninle age are described. The peculiarity in the first case is the parallel affect of myocardium and live with the absence of a disease, which might lead to secondary amyloidosis. The high elevated gamma-globulins (44%) in that case give grounds an autoimmune determined primary idiopathic amyloidosis to be presumed. The second case is with isolated senile myocardial amyloidosis.


[Rhythmic and conductive disorders in the acute stage of cardiac infarct]. Rhythm and conductive disturbances were established in 170 (63,8%) out of 266 patients with fresh cardiac infarction, in the greatest part with prophylactically applied lidocain i.m. With age advancing a growth in their incidence is established but no statistical difference between the age groups 20-59 and 60-90 was found. Rhythm disturbances are found more frequently in women (81,6%) as compared with the men 58,7%) while the incidence in patients with posterior (62, 5%) and anterior (65, 7%) infarction is the same. Th-disturbances due to electrical instability and failure are more frequent in anterior infarction. Statistical difference (P less than 0,001) was established concerning the rhythm disturbances in patients with heart failure and without it, with a prevalence of sinus tachycardia, auricular fibrillation, ventricular extrasystoles, ventricular tachycardia and bundle branch block. The timely diagnosis and the treatment with medicaments led to the restoration of sinus rhythml in 79 out of 94 disturbances and with electrical shock in 12 out of 16. Parallelly with the classica netirhythm medicines (chinidine and procainamid), newer ones are used as tachmalin, lidocaine, abta-blockers, sympaticomimetics and temporary intracardial electric stimulation.


[Bundle-branch block depending on the heart rate]. Five patients are reported, admitted to the hospital, with diseases predominantly of the cardio-vascular system. During the electrocardiographic examinations bundle branch block was established, depending on heart rate. It fluctuated within the physiological limits from 50 to 90/min. In three of the patients, the bundle branch block appeared with the quickening of the heart rate (tachycardia-depending bundle branch block) and in two of the patients--the bundle branch block appeared during the slowing down of the heart action and disappeared with its quickening (bradicardia-depending bundle branch block). A brief literature review is presented and attention is paid to the possible diagnostic errors and the treatment mode of those patients with cardiac tonic and antiarrhythmic medicaments.


[Interdependence between the main hemodynamic indices and alveolar-capillary diffusion in mitral stenosis patients]. The basic hemodynamics indices were studied in 100 patients with mitral stenosis as well as the lung diffusion capacity (DLCO) with its components--membrane component (DM) and blood volume in lung capillaries (VC). Certain correlation dependence between the indicies were studied the correlation coefficients were calculated and the regression lines plotted. The author established that the indices of blood output has a considerably direct correlation with blood component (VC) and with the diffusion capacity (DLCO). A moderately expressed reverse correlation exists between VC and the general peripheral resistance. The circulation times have a moderately manifested reverse mutual dependence with diffusion capacity. It is better manifested with DLCO and DM and decreased with VC.


[Thromboembolic complications in rheumatism, atherosclerosis and hypertension]. A total of 1084 deceased with basic diseases atherosclerosis, hypertonic disease an rheumatism have been studied retrospectively for 11 years (1962-1972). Thrombo-embolic complications were established in 37,7% the examined. Considerably higher incidence of thrombo-embolic complications were found in rheumatism (44%) and atherosclerosis (43%). Arterial and cardiac thrombosis predominate in those three diseases. Venous thrombosis is relatively rare. Pulmonary thromboembolia, the most frequent cause for the lethal end, is found in 43,71% of the deceased with thromboembolias. The chronic cardiac decompensation is an important additional factor, favouring the thrombo-embolic complications. The rheumatic process activity in theumatism plays a relatively not so important role.


[Changes in the corticosteroids and their alpha-ketol metabolites in the urine of hypertension patients treated with metopirons]. Results from the examinations of 20 hypertonics treated with methtopyron 4.5 g/24 h are presented. The values of S, THS, THF, THE and aldosterone in urine are determined, parallelly with plasma cortisol prior to and post hydroxilase blocker. An elevation of urinary THS and DOK was found, with depressed levels of aldosterone in urine and plasma cortisol. Those four indices permit a considerably precise assessment of involving and notinvolving of the different links of hypothalamo-hypophyseal-suprarenal system and the eventual location of the disturbance. Three of the hypertonics did not elevate THS and DOK in urine after methopyron, in spite of the inhibition of the urinary aldosterone and plasma cortisol. That was admitted to be a manifestation of a disturbance in the hypothalamo-hypophyseal functional reserves which might participate in the development and maintenance of the hypertensive disease.


[Electrokymographic diagnosis of myocardial infarct]. Thirty six patients with myocardial infarction were examined electrokymographically. The parodoxical movements with diastolic collapse, established in 25 of the patients, might be pointed as important features as well as symptomes that aid the diagnostics, being without a pathognomonic significance--considerable decrease of the curve amplitude without or with parodoxical movements and considerable elongation of the latent time in 8 patient. The electrokymographic curve, though rarely, is more indicative than the electrocardiogram. The electrokymographic method surpasses in every respect the diagnostic potentialities of the kymography.


[Complications and mortality in temporary and permanent electrostimulation of the heart]. The author, after performing a brief analysis of the observed patients, treated according to the more important methods of heart electrostimulation and illustrating that in four tables discusses the problem of the complications he had observed. He describes briefly the causes of their presence in the clinical practice and proposes a working classification of the latter. Then, proceeding from his experience and the literature data, he discusses each larger group of complications, presenting percentages that were found in his patients in the course of his long work upon that problem. At the end he draws the attention to the mortality problem, causes and percentage, observed among his patients. As a convinience for the clinical practice he subdividies mortality into early and late and presents his good reason for the problem.


[Morphological characteristics of the destructive and reparative changes in tuberculosis in those dying of nontubercular diseases]. The evolution of destructive and restorative alterations was morphologically followed up in 82 tuberculotics that died of non-tiberculous diseases. In the majority of the deceased, the restorative alterations were observed with manifested mesenchymal and immunologic reactions with morphological peculiarities as in the treated with anti tuberculous remedies. The destructive alteration are clearly manifested and the restorative manifestations are depressed in tuberculotics with non-treated diabetes and osteomyelitis treated with cortison. In a negligible part of the patients died of non-tuberculous diseases, a reactivation of the foci developed around the fibrocaseous lung foci, tracheobronchial lymph nodes, kidneys and suprarenals, manifested with filamented neutrophyils in the calcified and caseous matter, fresh necrosis, tubercula, specific granular tissue, friable capsule with appearance of lymphoid cells and specific granular tissue.


[Immunoglobulins in the gastric juice in some stomach and duodenal diseases]. IgA, IgM and IgC content in blood serum and gastric juice were determined in 89 patients with different gastric and duodenal diseases (57 with duodenal ulcers, 13 with gastric ulcers 8 with chronic atrophic gastritis, 9 with superficial chronic gastritis and gastroduodenitis and two with gastric cancer). Immunoglobulin was established in gastric juice (over 0,3 mg/100 ml) in 49 per cent of all the patients examined with gastric and duodenal diseases. No correlation was found between serum immunoglobulin level and their presence in the gastric juice. No correlation exists between the volume of the basal secretion and the presence or absence of immunoglobulins in the gastric juice. Immunoglobulins were established more often in the gastric juice with lower secretion of hydrochloric acid (in chronic atrophic gastritis and gastric ulcer), while in cases of higher secretion they are more frequently absent. A certain parallelism was established between the changes of hydrochloric acid output and JgA secretion in the gastric juice after stimulation of gastric secretion by Pentagastrin or histamine.


[Diagnosis and treatment of gastrocolic fistulae and erroneous anastomoses following gastric resection]. Results are reported of a clinical examination and surgical treatment of seven cases with gastro-jejunocolic fistulas and five cases with gastroileoanastomosis. The clinical picture, irrigography, steatorrhea, hypoproteinemia, etc. are stressed upon as important for the diagnosis. The operation result depended on the degree of the resorbtive disturbances, on successful reanimation and frequent postoperative complications. Postoperative lethality is five out of 12 cases.


[Stimulation of adrenocortical secretion in healthy persons with hypoglycemia provoked by insulin]. Results are reported from the carried out test for adrenocortical secretion stimulation with hypoglycemia, provoked by insulin in 63 healthy individuals. Plasma cortisol elevates to 37,4 mkg from the average initial levels 16,1 mkg/100 ml. The elevation is with 21,3 mkg/100 ml. The indices for the negative (abnormal) hormonal response are derived--when the elevation is under 5,4 mkg and the plasma cortisol level after stimulation with insulin remains under 19,7 mkg/100 ml. The clinical application of ITT is discussed.


[Some problems in rheumatic valvular defects]. The post-mortem examined rheumatic valvular diseases are confronted for the period 1961-1967 and 1968-1973. Advanced age with one decade is established in the deceased during the second period, as well as increased per cent of thromboembolic complications and chronic cardiac insufficiency and decreased per cent of rheumatic activity. A considerable per cent of rheumatic activity is observed in the deceased during the fourth and fifth decade. No difference concerning sex and valvular lesions are established in both groups.


[2 cases of the encephalitic form of tuberculous meningitis]. Two cases of tubercular meningitis, with a course under the form of severe acute encephalitis are discussed. The significance of those forms are emphasized, especially from diagnostic point of view, and the importance of the paraclinical investigations are stressed upon as well as the epidemiological data for the diagnosis.


[Early postinfarction syndrome occurring with paresis of the N. recurrens]. The authors describe, in the paper, an early developed post infarction syndrome in a patient of 32, with extensive anterior infarction, preceeded by one year period of not typical coronary insufficiency, manifested by a dramatic picture-- with rhythm and conduction disturbances and combined with paresis of the recurrent nerve, fading parallelly with post infarction syndrome.


[Our experience in using temporary and permanent electric stimulation in conduction disorders]. The results from the observation of 49 patients with complete and incomplete AV block are reported, 33 of them with attacks of MAC syndrome; asystolia 25, ventricular tachycardia and ventricular fibrillation--8. Temporary electric stimulation is carried out in 31 patients (21 with chronic complete AV block and 10 with incomplete and complete with recent cardiac infarction). In all patients with chronic AV block but one, implantation of a permanent artificial rhythm nuide was necessary. The prognosis of the patients with implanted permanent stimulator is determined by the myocardial state, out of six patients with cardiac insufficiency -- three died in a period of 1 to 12 months. Recommendations are presented for active finding out and dispensary control of patients with conduction disturbances and wider application of temporary electric stimulation in the intensive care and treatment units.


[Inverse dynamics in atrioventricular conduction in rheumatic myocarditis]. ECG changes in 1000 patients were studied, 950 with rheumatic disease attack and 150 controls with other diseases. The phenomenon of increase dynamics in AV conduction is established in 67% of ECG in the group of rheumatic patients with attacks, characterizied by inverse non-physiological correlations between heart frequency and atrioventricular conduction. With heart frequency acceleration--AV conduction time (PQ) is lengthened and vice versa--in slowing down of heart frequency--the conduction time PQ is shortened. In the control groups its frequency ranges between 3 to 8%. In healthy individuals and vegetoneurosis it can be isolated met. That inverse dynamics of AV conduction marks the pathophysiological and electrophysiological changes in myocardium in rheumatism and is of high diagnostic value.


[Comparative electro- and vectorcardiographic study of patients with systolic overloading in the left ventricle]. The potentialities of the two methods for hemodynamic disturbance degree assessment are studied in 80 patients with arterial hypertension (16-first stage, 59-second and 5-third). Five electrocardiographic and five vectorcardiographic indices are confronted to the systolic pressure in brachial artery. The electrocardiographic indices sensitivity is in the range of 25 to 62% and the sensitivity of vectorcardiographic-from 14 to 50%. The correlation dependence level of the same indices (in 30 patients) is from 0, 37 to 0, 52 for ECG and from 0, 11 to 0, 60 for VCG. Statistically significant differences of the "diagnostic" potentialities of both methods were not established as well.


[Changes in the alkaline-acid status and some plasma electrolytes in chronic hemodialysis patients]. Prior to and post hemodialysis, a determination of plasma potassium, sodium, calcium, phosphorus and the indices of acid-base state is performed in 16 patients with chronic terminal renal insufficiency, with 560 hemodialyses, applied once or twice a week with deionized water and dialysis solution with 1, 5 mEq/1 potassium. Considerable hypopotassemia was established after hemodialysis--3, 3 mEq/1 and in 35% of the cases--hypopotassemia under 3.0 mEq/1. Metabolite alkalosis was established after dialysis: elevated pH in blood from 7,353 to 7,491; standard bicarbonates--from 21, 2 to 29, 1 m Eq/1; basis-excess: from (-3, 78) to (+5, 26) mEq/1; buffer bases: from 41, 3 to 51, 0 Eq/1, normalization of the elevated phosphorus in plasma from 7, 4 mg% to 4, 6 mg%. No significant changes in plasma sodium and potassium, as well as pCO2 were established after hemodialysis.


[Place of serum cholinesterase in the diagnosis of chronic liver diseases]. Serum cholinesterase activity (ChE) was studied in 84 patients with chronic liver diseases (cirrhosis, chronic hepatitis, chronic cholecystocholangiohepatitis, hepatolenticular degeneration). Most pronounced alterations were found in cirrhosis. Significant difference is not established between cardiac and "noncardiac" cirrhosis but is well established between decompensated and compensated cirrhosis. As a rule ChE is normal in chronic hepatitis and cholecystocholangio-hepatitis. The values in agressive and persisting hepatitis do not differ significantly. Essential correlation of ChE with serum albumins is established. The diagnostic ChE value is confronted with that of the routine laboratory indices. Critical values are established (1500 ME, 1100 ME resp) that may be helpful in the differentiation of cirrhosis from chronic hepatitis, compensated from decompensated cirrhosis resp.


[Correlation between the diffusion capacity of the lungs and certain ventilation indices in mitral stenosis]. A study is performed on the correlation relationship between diffusion lung capacity (DLCO) and its components (DM and VC) and the ventilatory indices, VC, FEV1 and FEV 1% VC in 100 patients with mitral stenosis. The determined correlation coefficients and the constructed regression lines show that DLCO and DM have a considerable direct reciprocal relationship with VC and FEVI. The correlation dependence of blood component (VC) with VC, FEV1 and FEV1%VC is low. The close reciprocal relationship of DL CO and DM with VC and FEVI reveals that in patients with mitral stenosis one can judge, to a certain extent, about the severness of the disturbance in the alveolo-capillary diffusion.


[Thrombagglutination test (TAT) in hyper- and hypocoagulation]. Breddin thrombagglutination test is followed up in patients with hypercoagulation states--atherosclerosis, atherosclerotic myocardiodysthrophia, angina pectoris gravis and acute myocardial infarction and hypocoagulation states--esential and symptomatic thrombopenia. TAT is positive in 88% of the patients with atherosclerosis and in patients with angina pectoris gravis and myocardial infarction TAT is Vth stage in 100%. TAT is zero stage in 91% in patients with thrombopenia and only in 9%-I stage. The term "zero stage" is introduced.


[Origin of rectosigmoid cancer from precancerous processes]. Three hundred sixty two patients with rectosigmoid cancer are examined by rectoromanoscopy and biopsy in order to establish those of them with manifestations of a proceeding precancer process. Cancer, originated on the base of single polypus was established in 50,94 per cent and 7,54 per cent in relation with preceeding generalized polyposis, in 30,19 per cent malignant villose tumor is concerned, in 4,71 per cent -- cancer, originated on the base of preceeding ulcerohemorrhagic proctocolitis and in only 1,91 per cent -- malignant chronic fibrosclerosed hemorrohoids. Precancer process is established in 29,29 per cent in all of the examined 362 patients with rectosigmoid cancer and in 70,71 per cent of the cases no manifestations of preceeding precancer disease was established, i.e. the malignancy ratio with established precancerosis towards malignancy without established precancerosis is approximately 1 : 2,5. That fact requires acute attention in all cases with established precancerosis of the terminal segment of large intestine, treatment without delay and dispensary control.


[Changes in blood coagulation in diabetic nephropathy]. Investigations on certain hemocoagulation indices are carried out of 52 diabetics, 32 of them with diabetic nephropathy. The following indices were determined: thrombocyte numer, thrombocyte adhesion and aggregation, recalcification and heparinrecalcification time, partial thromboplastin time (PTT) and prothrombin time, coagulation retraction and thrombelastography. Data for increased blood coagulation are established in diabetics and especially in the presence of nephropathy. Most manifested are the changes in thrombocyte adhesion, in PTT, recalcification and heparin-recalcification time. Changes in thrombelastogram and the rest of the indices are less manifested. In patients with more advanced forms of nephropathy--the increased hemocoagulation is more pronounced. The changes described are considered non diabetes specific and are associated with the accompanying atherosclerosis. Those changes might indicate inclusion of anticoagulants and antiaggregating medicines in the therapeutic program of patients with diabetic nephropathy with the respective indications.


[Clinical importance of macroscopic hematuria]. The authors established macroscopic hematuria in 13,8 per cent of the examined 1618 renal patients. It is most often met in patients with chronic calculus pyelonephritis and nephrolithiasis (45,2%). In 9,0 per cent of the patients with chronic glomeruloneshrihs and in 14,9 per cent of those with acute glomerulonephritis the painless macroscopic hematuria is the initial clinical manifestation of the disease. The latter is a frequent symptom (40,6%) in patients with congenital kidney anomalies. In 5,8 per cent of the patients with macroscopic hematuria -- the reason is not elucidated.


[Congenital anomalies of the excretory system and their relationship to endemic nephropathy]. The author has studied the congenital anomalies of the urogenital system according to the clinical data of the Nephrology Ward, District Hospital--Vratza, by means of urography, ascending pyelography and reno-vasography. A total of 1960 patients were examined and congenital anomalies of the urogenital system established in 167 (8, 5%). Congenital anomalies of the excretory system, according to the author, are more often met in females (59, 9%) as compated with males (40, 1%) and in left kidney (58, 6%) as compared with the right one (35, 9%). At the same time, the most frequent complication of renal embryopathies was established to be the inflammation process of urinary ducts and kidneys (41, 9%) urinary-calculus disease (19.1%) and endemic nephropathy (8, 9%). The combination of endemic nephropathy and congenital anomalies of the urogenital system is rare (1, 1%) and most likely by chance. The author admits that endemic nephropathy most probably is not causality with the congenital anomalies of the excretory system.


[Quantitative prognosis in acute myocardial infarct; the efficiency of the Peel index and its modificantion with 398 patients]. Making use of "coronary prognostic index" of Peel and its modifications, a retrospective assessment is performed on the state of 398 patients with acute myocardial infarction with a mark, equal to the sum of marks of the signs of the initial myocardial period, allowing the prediction of the lethal end in the first 28 days of the onset of the disease. The predicted lethality for the corresponding mark intervals was established to be close to the real and that both systems show similar real lethality for the separate mark intervals. Modified Peel system proved more effective: it provides an average of 0,015 bits more information for the disease outcome than the analogic system of Peel. Peel index and its modification are insufficiently complex but easily accessible and sufficiently provable as to be used in every day practice in order to differentiate the patients with poor prognosis and take better care of.


[Studies of the antistreptolysin titer in patients with acute pneumonic processes]. Antistreptolysin O level in blood serum is determined in double tests in 164 patients, 116 out of them with acute pneumonic processes. Antistreptolysin titre was established to be over 300 ASE in about 1/5 of the patients with acute focal pneumonias. In 10,4 per cent of the cases with acute pneumonic processes, an ascending dynamics of antistreptolysin O titre is observed in the course of the treatment and in 2,6 per cent the titre elevation is three and fourfold. In the interpretation of the data of the antistreptolysin titres in patients with acute focal pneumonia the possibility of oculte streptoccocal infection with another localization must not be neglected as well as pathological processes in liver parenchyma, leading to non-specific titre elevation.


[Studies of the normal tonometric values of the right branches of the cardiovascular system in young people]. The data from right cardiac catheterization 68 youths (aged 18--22) with murmurs of functional nature are used. Through the methods of oxihemometry, tonometry and intracardial phonocardiography the possibility of clinically supposed heart defect-congenital or acquired--is excluded. Based on statistical processing, the author proposes norms for the pressure in right auricle, right ventricle, pulmonary artery and pulmonary arterioles.


[Insulin hypoglycemia, a functional test of the state of the hypothalamo-hypophyseo-adrenal system in obesity]. By provoking insulin hypoglycemia (activating the hypothalamus action) and by following-up of the subsequent cortisole response in plasma, the authors study the functional state of the hypothalamic-hypophyseal-suprarenal system in 18 patients with obesity, fourteen of them with regulative type, three -- with metabolic and one -- with hypogonadial type. The cortisole response proved to be within the normal limits in the patients with metabolic and hypogonadial obesity type. the insulin test shows pathological deviations in six, out of all 14 patients with regulative type of obesity. In those cases the cortisole response is low, its curve is with a plateau-like progress and represents a reliable index for a lesion in the hypothalamic-hypophyseal region. The normal test does not speak against the existence of similar lesions. In the presentce of other clinical and paraclinical data for hypothalamic-hypophyseal damage, the normal hypoglycemic test shows that the functional link between hypothalamus-hypophysis-suprarenals is still preserved and in that sence it also aids the determination of the lesion degree and is of diagnostic value. Based on their experience, the authors recommend a wider application in the clinical practice of insulin-hypoglycemic test.


[Diagnostic possibilities of fibroesophagoscopy and target biopsy of the esophagus]. The results from the 195 performed fibroesophagoscopies and 114 purposeful biopsies in different esophgus diseases are reported. In 65 of the examined -- cancer of the esophagus or cardia ventriculi was establised. The rest 122 patients are with non-malignant disease -- ulcers, polyps, diverticulums, varices, strictures, esophagitis, cardiospasm, etc. Cancer of esophagus and cardia ventriculi is proved in 93.93 per cent on the base of endoscopic data while another diagnosis was given in 29.30 per cent at the X-ray examinations of the same patients and at the clinical examinations of the patients in 40.1 per cent -- diagnostic errors were made. The purposeful biopsy gives 70.58 per cent of positive results and enables the differentiation of the tumor histological characterisitics.


[Onset of the disease process in endemic nephropathy]. Patients with endemic nephropathy family aggravation are described, that had left-their native endemic villages at the age of 6 months to 6 years and had lived in non-endemic settlements and in spite of that suffered and died of endemic nephropathy. The diagnosis, of all of themt is pathologoanatomically and histomorphologically confirmed. It is concluded that a long time sojourn in the endemic region is not necessary for those born there with endemic nephropathy family aggravation, in order to suffer of the same disease even in the new residence. The author admits, based on those data, that the beginning of the pathological process of endemic nephropathy is during the first infant years, so that the children of sick patients would be the best objects for investigation of the endemic nephropathy initial stage.


[Study of the distribution of kidney calculi in Vrastsa District]. The authors have studied the RCD spread in Vratza district according to the material of the therapeutic departments in the district for the period 1969--1973 and according to the material of the out-patient department -- polyclinical--1971--1973. During that period 16,294 patients with diseases of the urinary system were registered, 6311 out of them with RCD, i. e. 38.7 per cent. The region of Mezdra was established to be the highest affected by RCD in the district (60,8%), followed by Belaslatina region (43.4%), Vratza (40%), Kneza (37.9%) and Orejahovo the last--(22.4%). Females were established to suffer more frequently (56.7%) as compared with males (43.3%) and the peasants 51.8%) insignificantly more often in comparison with the the townsmen (48.7%). All ages are affected by the disease but most frequently the individuals aged 31--50 (49.5%). Workers (36.4%) are those that most frquently suffer of RCD in the district of Vratza, followed by employees (23.4%), cooperative farmers (21.6%), etc. The authors have established that renal calculosis affects most frequently the right kidney (56.6%) as compared with the left (40.4%) and very rarely both kidneys (2.94).


[Carbohydrate tolerance, serum insulin and triglycerides in coronary disease]. The authors set up the task to study the changes in blood sugar, immunoreactive insulin and triglycerides in patients with manifested coronary disease during an oral glucoso-tolerance test in the course of three hours. They examined 32 patients with coronary disease and 19 control subjects, similar in age and body weight, divided into three subgroups: with normal glucose tolerance (NGT), suspiciously-pathological glucose tolerance (SPGT) and pathological glucose tolerance (PGT). They are led by age conformed criteria in the assessment of the blood sugar curves obtained. For a better idea about the insulin response volume, provoked by glucose loading, they compare the sums of the insulinemic values and "insulinogenic index", among the control subjects and the patients examined. The study of the carbohydrate tolerance of the patients examined, show that manifested or suspiciously pathological deviations in carbohydrate metabolism were found in almost 60% of them. Insulinemia during the glucose loading was found to be higher than that of the control subjects, maximal point appearing later and restoration to initial values delayed. The highest absolute insulin values and increased volume of insulin secretion were established in the patients with NGT and the lowest--in patients with PGT. The highest insulinogenic index is in NGT patients and is with about 50% higher than that of the control subjects while in patients with PGT it is quite the reverse, i. e.--glucose tolerance deteriorated parallelly with the reducing of insulin response to glucose stimulus or, in other words--normal glucose tolerance in patients maintained by the increased insulin production. The correlation of blood sugar and insulinemic curves with those of triglyceridemia reveals that with blood sugar elevation and insulinemia during glucose loading--triglyceride level rapidly elevates--i.e. a positive correlation was found among blood sugar, insulinemia and triglyceridemia where triglyceridemia correlates with hyperinsulinemia more intimately than with glycemia. Basing on the data obtained and the general theoretical conditons--the problem of pathogenetic commonness (at least in certain relations) between atherosclerosis, obesity and diabetes mellitus is discussed. A practical conclusion is drawn that the establishment of increased serum triglycerides and hyperinsulinism in pathological and even in still normal carbohydrate tolerance in one subject may play the role of an important diagnostic test, speaking of the possible development or for the presence of already manifested atherosclerosis.


[Kidney morbidity in Smolyan District based on out-patient-polyclinical network data for the period 1967-1973]. The renal morbidity data in Smoljan district for seven years (1967-1973) are analyzed according to the documentation of the out-patient links. Internal diseases with a total number of 229 704 are covered, 17 261 out of them being diseases of the kidneys. Increased renal morbity was established. The highest increase found is for the urolithiasis group. With respect to appropriate prophylactic measures, the necessity of complex investigations on the causes of the high urolithiasis percentage is stressed upon.


[Changes in the large intestine after cholecystectomy]. Aiming at the establishment of the type and incidence of morphological and tonometric large intestine changes post cholecystectomy--64 patients were examined, 36 aged up to 50 and 28 over 50 by means of rectoromanoscopy, transrectoscopic biopsy, X-ray examination (passage and irigoscopy), balloon signography and anal tonometry. Morphological changes--catarrhal type (34.38%) were established to originate often in large intestine post cholecystectomy. Tonometric changes were observed in 56.25%. They are: hypertonic hypokinesia (45.32%) and hyperkinesia (10.93%). All patients with morphological changes are also and with tonometric disturbances. Ergo, 21.87% of the patients are with tonometric disturbances without pathomorphological changes. In the correlation of the morphological with tonometric changes, the catarrhal changes with hypertonic hypokinesia were established to be the most frequently met morbid combination and considerably more rarely--"catarrhal changes with hyperkinesia". Normotonia and normokinesia are most often found in cases with normal mucosa and considerably less rarely--hypertonic hypokinesia. The morphological as well as the tonometric changes are more frequent with age advancing of the patients and the growth of the time post cholecystectomy. Subjective complaints are reported from 56.25% of the patients. The most frequently met are feeling of heaviness in the abdomen, more rarely meteorism and rumble of the intestines and most rarely--pains along the large intestine. Objectively pain findings in the physical examination of abdomen and large intestines are established in 56.25% of the patients. Meteorism is most frequently established and relatively more rarely spastic large intestine and pain with its palpation (almost with equal frequency). Defecation is normal in 29.69% of the patients. The rest complain more often of diarrhea (45.32%) and more rarely of constipation (25%).


[Histomorphology of the microcirculation of the skin in physiological and pathological processes]. On the base of skin histomorphological investigations of 985 deceased with different diseases age morphological pecularities in microcirculation were concluded to exist as well as changes depending on the duration and character of the pathological process. The involvement of a great number of vessels is an index for increased functional microcirculation requirements. The microcirculation character cannot be defined only by the morphological pecularities of single capillaries, by quantitative and qualitative changes in them. The capillary changes relfect only part of the microcirculation changes. All microcirculation peculiarities cannot be deciphered by the histomorphological method of the investigation but that method supplies valuable data that cannot be obtained by the other investigation methods. Three stages of changes in microcirculation are specified, being morphologically characterized. The changes in the microcirculation of the nail mantle skin are non-specific, functional, organic, reversible, non-reversible and usually compensated.


[Diagnostic value of the electrocardiographic changes during bicycle ergometer loading]. The diagnostic value of ST-T changes in working ECG on veloergometer with submaximal loading is assessed in 286 cases--83 with coronary disease, 44--healthy, 112 with indistinct precordial pains and neurovegetative dystonia and 46 with some other non-coronary heart diseases. The reduction of ST-segment 1 mm with horizontal or descending form is the most accurate criterium in the differentiation of pathological and normal ECG-reactions. An appropriate criterium for coronary disease diagnosis is also the negative T wave with an amplitude of 2 mm or more in at least three leads, regardless of its form and time of appearance. The reduction of ST segment with ascending form gives a considerable opportunity for positive false diagnosis. The false negative diagnosis is 24%. The causes are to be found in the appearance of rhythm and lead disturbances and insufficient loading.


[Subacute thyroiditis].

[Subacute thyroiditis]. Six cases with subacute thyroiditis of De-Kerven are discussed, considered as a relatively rare disease. The clinical manifestations are analyzed as well as the diagnostic tests, evolution and treatment and the etiological factors, leading to its origination. An opinion is expressed that the disease is not so rare as considered so far.


[Prognostic value of SGOT, LDH and LDH1 activity in myocardial infarct]. The authors follow up SGOt, LDH and LDH1 enzyme activity in 102 patients with first transmural myocardial infarction. The results confirm the considerable diagnostic value of that enzyme spectrum and its significance for the prognostic assessment of the state of such patients. The high values of SGOT and primarily of LDH and LDH1, their persistence during the acute period of myocardial infarction correlate with the percentage of the patients with severe progress of the disease and high lethality. Prognostically unfavourable are especially the values over 800 mU/ml for LDH and 80% for LDH1. In 56.2% of the decreased LDH was over 800 mU/ml and in 70% of the decreased--80% LDH1 enzyme activity was found.


[Observation of a male patient with the empty sella turcica syndrome]. One case with secondary developed syndrome of sell turcica is described, after hypophysis radiation on the occasion of acromegaly. Of special interest is the preserved tropic hypophysis secretion with a clinical picture of hypopituitarism (secondary developed hypogonadism, hypothyroidism and hypocorticism) as well as the combination with another brain neoplasm--astrocytoma.


[The action of insulin on ribonucleic acid metabolism (author's transl)]. The incorporation of 3H-uridine into liver ribosomes is reduced in alloxan-diabetic rats. This reduction affects mRNA as well as rRNA. Insulin-substitution therapy of diabetic animals restores to normal the incorporation rates of uridine into both mRNA and rRNA. There is a manifest connection between the known reduction of polyribosomes in diabetes mellitus and reduced synthesis of mRNA; moreover, a connection to the reduced production of rRNA seems also to be possible.


[Follow-up study of patients implanted with a pulse width controlled pacemaker (author's transl)]. The output of a pacemaker system can be adapted to the individual need of the patient by means of a pulse width controlled pacemaker. The achievement of an optimum pacemaker impulse reduces the energy drain, therby allowing a prolongation of adequate functioning of the implanted pacemaker for up to 5 years. Follow-up studies demonstrate the reliability of a pulse width controlled system. The energy drain, measured in microcoulombs, is lower in all patients implanted with impulse width controlled pacer system as compared with output controlled pacer system.


[Isoenzymes of alkaline phosphatase in pleural effusions (author's transl)]. By separation of alkaline phosphatase into isoenzymes, an isoenzyme fraction corresponding to the intestinal isoenzyme was isolated in a case of chylothorax. Since this fraction is transported from the intestine through the thoracic duct, the appearance of this fraction in a pleural effusion is typical of chylothorax.


[Some considerations on clear cell tumors, especially in the lungs (author's transl)]. On the basis of 4 cases seen by the author and comparative reports in the literature the following observations were made: 1. Clear cell tumors of the lungs must be considered as semimalignant (or malignana). 2. Malignant degeneration may be associated with a loss of the clear cell character. 3. Clear cell areas are not infrequently seen in common pulmonary carcinomas. 4. Histological differentiation between primary clear cell tumors and metastases (e.g., metastatic hypernephroma) may not be possible. In addition, some general observations on extrapulmonary clear cell tumors will be discussed.


[Analysis of middle lobe-resections of the lung (author's transl)]. The present paper investigates the reasons for 26 resections carried out the diagnosis of the so-called "Middle-lobe-syndrome". In 25 of them the diagnosis could be confirmed by postoperative pathological examinations. The term "Middle-lobe-syndrome" means only a roentgenological findings. Its etiology must be investigated as soon as possible with all diagnostic procedures and too, by operation. This is expecially urgent in men older than 40 years.


[The clinical significance of abnormalities of bronchial anatomy (author's transl)]. Abnormalities of the bronchi were found in 0.7-1.4% in patients examined by bronchoscopy or thoracotomy. In most cases there are no clinical symptoms. Anatomical abnormalities of the bronchi are the favoured localization for deformities, chronic inflammations and bronchial neoplasms. The altered topography must be considered if surgery is necessary. Case studies of 12 patients, 1 with bronchus trachealis, 7 with deformities of the lobus superior and 4 of the lobus inferior were analyzed and selected cases are described.


[Inhalations with L-arginine in the treatment of cystic fibrosis (author's transl)]. 12 patients were treated with L-arginine hydrochloride 1-3 times per day for a period of 4 till 8 weeks. All children had been in control in our hospital longer than one-year. The patients received beside administration of digestant enzymes and vibration massages, inhalations with N-acetylcystein (Mucosolvin). The frequency of the daily inhalations was not changed. We compared the results of clinical, x-rays scintigraphic and laboratory investigations during the period of N-acetylcysteine treatment and after the administration of L-arginine. The mucolytic effect by L-arginine is much less than by N-acetylcystein.


[Transbronchial puncture and instillation of contrast medium for the radiographic visualization of a mediastinal cyst (author's transl)]. A new method for preoperative diagnosis of mediastinal cysts is described. A transbronchial puncture of a mediastinal cystic tumor was performed in one patient with a mediastinal enlargement and stenosis of the right main bronchus. Afer aspiration of fluid material a water-soluble contrast medium was instilled under fluoroscopic control via a normal biopsy needle. Summarizing their experiences the indications for this new technique is discussed.


[Morphological changes in experimental lipid pneumonia (author's transl)]. Male rats showed 6 and 8 weeks after aerosol application of mineral oil and interstitial pneumonia, histiocytic foreign body reaction with foam cells and a focal emphysema. Relations to the correspondent human disease are shortly discussed.


[Combined mass X-ray examinations of the respiratory tract (author's transl)]. 2908 persons were investigated by mass chest x-ray combined with mass x-ray of the paranasal sinuses to find respiratory tract diseases. In 412 persons a sinusitis was diagnosed. 212 persons had a positive history, that is headache, cough and/or bronchial secretions, the other 200 persons had a negative history. 91 persons with a negative history and 21 persons with apositive history showed spontaneous remissions. The results of the bacteriological tests and antibiogramms corresponded with the preceding reports. In the investigated population groups a high percentage of new undetected cases of sinusitis was found one year after their previous treatment needing a new treatment. The frequency of undetected sinusitis in adults is often underestimated. Mass chest x-ray examinations should be combined with x-ray examinations of the paranasal sinuses.


[Etiology and clinical diagnosis of diffuse pleural mesothelioma (author's transl)]. Diffuse malignant mesothelioma are no longer uncommon diseases within the geographical regions of Halle and Merseburg. These tumors are provoked by the deposition of dust particles of asbestos near the pleura. Asbestos particles are not only obtained by mining and preparation the mineral but also in its use for various purposes - in the past in shipyards mainly and now in the chemical industry as well. The period from the first absorption of these dust particles up to the manifestation of the malignoma is said to last 20-40 years approximately. At present, asbestos is contained in a remarkable great variety of products. Consequently, there is now a general danger, independently of the profession concerned. Possibilities of an exact clinical diagnosis will be discussed on the basis of the experience gained with 100 cases. Only with 17 out of 100 cases the oncogenesis was not accompanied by pleural exudation. The Female/male ratio was 1.0/4.5. 1 - the demonstration of mesothelial cell structures by the transthoracic tumour punctate.  2 - the cytological findings of the effusion cell sediment in connection with the determination of the WELTMANN coagulation band in the effusion and in the blood serum or 3 - the pleuroscopy in connection with the excision of material for cytological and histological tests. A therapeutical treatment is not known till now. Highly restricted use of asbestos is an imperative prophylactic measure.


Effect of dietary fibre on gallstone formation in hamsters. This study aimed at investigating the effect of different sources of dietary fibre on gallstone formation in hamsters. The substances studied were pectin, lignin and psyllium hydrocolloid. The two latter compounds protected hamsters against cholesterol gallstone formation. Lignin resulted in a decrease of the deoxycholic acid conentration and in a rise of the cholic/chenodeoxycholic acid ratio. These changes which are similar to those observed with cholestyramine suggest that lignin acts as a bile acid sequestrant. Psyllium hydrocolloid effected a similar shift of the cholic/chenodeoxycholic acid ratio but it also resulted in a rise of the deoxycholic concentration. This latter finding is not compatible with a bile acid sequestering role of this compound. The addition of alcohol to the drinking-water resulted in the formation of stones rich in pigment. Under these conditions the tendency to form such stones was not checked by either of the investigated substances.


[Protein and amino acid composition of newborn rats under defective nutritional conditions]. The law protein nutrition of the nursing rat inhibits the growth of the new born rats. A percentage reduction of the dry substances by decrease of N2-free substances takes place. In relation to g dry substance the body protein content, collagen also, rises. Absolutely, these parts rest unaltered, just so the relation of the parenchymatous protein to collagen. The often support of view that starving provokes a collagen formation of the body, that means an exceed of the framework, can not be confirmed. Though in this paper we can give an explanation for the occurrence of this conclusion. Long interuptions of lactation periods remarkably have no effect on the growth and on the amin compartments of the body of new born rats. Only tryptophane is reduced in favour of the serine-fraction in the body of those animals. We discuss this finding as a change of the metabolisme of tryptophane depending of stress.


[Indication for surgery in lumbar disk displacement]. After the description of the operative risk and the results of the operation in the lumbar dislocation of the disk the indications for an operation are demonstrated. According to our experiences the indication for the operation of disks may be a necessity in a part of patients, in order to avert remaining lesions. In a second group the operation should be carried out, since conservative measures cannot bring about a change of the complex of complaints and, apart from this, may be dangerous for the patient. In the third group the operation can be indicated, as after conservative treatment recidivations may appear again and again. The contraindications are described in short and our indication for lumbar myelography is demonstrated.


[Influence of coronary-effective substances on the concentration of nonesterified fatty acids in the serum of patients with angina pectoris]. In a study of patients with angina pectoris the influence of coronary-effective medicaments on the concentration of non-esterified fatty acids was investigated. Supplementary establishments were carried out experimentally on pigs. Compared with normal persons patients with angina pectoris had a significantly higher level of non-esterified fatty acids. In an oral dose of 150 mg a day propranolol decreased the non-esterified fatty acids to normal values. Dipyridamol decreased the concentration of non-esterified fatty acids in the serum in an average dose of 450 mg a day also significantly. The combination of propranolol and dipyridamol did not evoke a particular additive effect on the decrease of non-esterified fatty acids. In a dosage of 300 mg a day orally trapymin had no clear influence on the non-esterified fatty acids. D,L-oxyfedrin (64 mg orally a day) increased the concentration of the non-esterified fatty acids in the serum. The decrease of the level of non-esterified fatty acids seems important for the prophylaxis of the infarction. The antilipolytic effect is a desirable therapeutic mechanism among others in the coronary therapy.


[Venous capacity and venous drainage capacity of the legs in subjects with healthy vascular systems]. In altogether 102 probands (51 men and 51 woman) with an average of 35 and 27.5 years, respectively, on the two calves and the two ankles the venous capacity and the average inclincation of the tissue to swelling were determined in the deep positioning experiment. Apart from this, with the help of the venous drainage experiment we established the venous reflux speed in the region of the lower extremities. From the 2040 measured values received for each measuring place the mean values x and the standard deviation s were calculated. Besides, it was sought for statistically significant differences between the individual mesuring places as well as between men and women. With the help of these investigation methods we succeeded in establishing several parameters of the venous haemodynamics quantitatively and on an unbloody way and in making them usable for the recognition of disturbances of the venous circulation in the region of the legs.


[Relationships between body build, overweight and energy exchange in standardized bicycle erogometer test]. Of 70 healthy probands, among them 28 males and 18 females with moderate to large overweight, by means of indirect calorimetry were determined energy exchange and respiratory quotient in rest as well as with 60 and 95 watt bicycle ergometer load. Furthermore, from body-weight, height and 4 measures of skinfolds relative weight, body surface, fat content of the body and lean body mass were calculated. Energy exchange of obese persons in rest and during work were significantly increased, compared with the control groups the differences decreased with increasing size of load. As to the two degrees of watt in males and females resulted ascertained positive relations between oxygen consumption and all anthropometric sized investigated (correlation coefficient between 0.79 and 0.43). As basis for the calculation for the prognosis of the energy requirement of obese persons the degrees of overweight and absolute body weight appear particularly suitable.


[Carditis in mononucleosis].

[Carditis in mononucleosis]. In this paper are described epidemiology, symptomatology and clinic without entering the variety of the possible appearances of the infectious mononucleosis. Through the affinity of the virus to parenchymatous organs the carditis mononucleosa develops. On the basis of 3 own observations the clinical pictures of pericarditis and myocarditis mononucleosa are described. A late immunological reaction with the development of autoantibodies is discussed as cause of myocarditis.


[Generalized allergic reaction to chloralhydrate]. It is casuistically reported on a severe drug allergy of the immediate type compared with chloral hydrate. The unusually manifold allergic symptomatology allows a classification into the feature of the allergic mononucleosis.


[New, non-invasive index for recognition of the early stages of cardiac insufficiency]. Proceeding from the highly significant correlation of the pre-ejection period (PEP) with usual measures of contractility a new non-invasive index is given which allows to recognize a decrease in left ventricular contractile adaptability and, therefore, to diagnose early stages of heart failure. The so-called pre-ejection index is based on measuring the pre-ejection period in upright and supine posture under resting conditions. By means of series of measurements with 30 normal subjects and 30 patients with latent heart insufficiency is demonstrated that a highly significant separation of the two groups is possible. A newly developed so-called thermistor pulse transducer is described which is essential for an easy application technique. Suggestions are presented for determination of the pre-ejection index by means of a single channel E.C.G. apparatus and for automatic digital data acquisition.


[Hematologic function tests in early diagnosis]. The functional tests in form of tolerance tests allow an insight into the adaptibility of the organism to changed inner and outer conditions.  The majority of haematological functional tests demands a temporary and economic expediture which excludes it a priori as screening test.  According to a previously published phase program for the haematological functional diagnosis a report is given on simple methods for judging the disturbed partial functions of the blood.


[The significance of morphologic-hematologic methods]. A survey is given on the value of the haematologo-morphological examination methods, especially the differential counting of leucocytes, the smear of a concentrate of leucocytes and the cytomorphological judgment of the bone marrow. None of these methods is suitable for the search for cases in the sense of a preliminary diagnosis. This is also of importance especially for the differential counting of leucocytes. However, with aimed methods of proceeding these methods are of great diagnostic value, so that they may be very much in front in a graduated diagnostic program. The diagnostic evidence of a cytomorphological preparation of the bone marrow must highly be estimated concerning a situation of deficiency of iron, a diffuse or small nodular metastasizing of the bone marrow or lesion of the bone marrow by exogenic factors.


[Screening tests for the determination of risk groups in respiratory insufficiency under conditions of epidemiological serial studies]. A report is given on a system of effective respiratory functional tests which proved its value when used in epidemiological mass examinations in connection with the mass miniature radiography in Berlin, Brandenburg and Halle as well as in mass examinations in Berlin enterprises. Thereby a new development - Pneumotest - is presented, an electronic spirometer for the recognition of ventilatory and distribution analytic preliminary parameters with digital indication of 5 sizes of the breath test manoeuvre which is to be applied as successor of the well-known spirotest device. In this paper the functional capacity of the further developed fluorographic densimetry as preliminary emphysematic test is proved. The application of the rapid helium or O2/N2 breathing back technique for the determination of residual volume and closing volume has in connection with the automatic establishment of the measuring values proved as basic diagnostics for emphysema with a large efficiency and at the same time with high reliability. The digestion of the epidemiological functional data with the help of electronic data processing is carried out in the own microcalculator system following immediately the application during examination.


[The information content of bronchial reactivity tests (acetylcholinetest) for screening purposes]. It is described a methodology of the test of bronchial reactivity (acetyl choline test) in the area of occupational medicine. Experiments of retesting resulted in a good reproducibility without regard to the fact that the problems of aerosol dosage and retention are not exactly to be clarified at present. Concerning the information value of tests of bronchial reactivity their value in early diagnosis is emphasized compared with the spirometry without provocation. As essential factors of influence for the results of the tests proved to be the eventually existing diseases of the respiratory tract and the ventilatory initial values. Habits of smoking and age are of less influence.


[Transformation surgery in dumping syndrome after Billroth II stomach resection]. After ineffective conservative therapy of the dumping-syndrome the transformation of Billroth's second operation into Billroth's first operation or the interposition of a jejunum segment between reamins of the stomach and duodenum are indicated. The increased risk of operation demands a careful selection of the patients. By means of these interventions an essential improvement of the complaints may be achieved.


[The behavior of the parathyroid hormone secretion in hemodialyzed patients with chronic kidney failure]. In 15 patients with chronic renal insufficiency the influence of the haemodialysis on the level of the blood serum of immune-reactive parathormone (iPTH). In the therapy of dialysis a wash with high calcium content (= 8 mg/100 ml) was used. After a single haemodialysis a decrease of the iPTH-level was observed. After a dialysis therapy lasting several months the values of the iPTH-concentration in 7 of 8 examined patients were significantly lower than before this therapy. The results cited prove that by means of a wash with high calcium content the increased PTH-secretion may be diminished in patients with chronic renal insufficiency.


[Application of a mathematical model to the penetration of amino acids through a dialysis membrane in chronic hemodialysis]. With the help of a one-pool-model from the clearance values measured for 4 different dialysator models the elimination rates for amino acids are calculated with special regard to the essential amino acids. In these cases the body-weight of the patient also belongs to the calculation of the elimination of the amino acids. The loss of the amino acids under the dialysis procedes corresponding to an e-function and is particularly high during the first period of dialysis.


[Diagnostic possibilities in aortic arch syndrome in ambulant care]. The diagnostic possibilities in the syndrome of the aortic arch in the surgery of the outpatient department are described. The importance of the leading symptoms in the anamnesis, the pulse palpation and auscultation, the inspection and the bilateral measurement of the blood pressure is elaborated. It is referred to the value of the simple functional test. Apparative investigation methods which are also used in the outpatient department are mentioned. The exhaustion of all possibilities which are at disposal for diagnosing already the early stages of the syndrome of the aortic arch is regarded as prognostically important in order to prevent irreversible cerebral lesions by a timely induction of necessary therapeutic measures.


[Use of efficiency test as a standard method in occupational aptitude evaluation]. The judgment of the functional capacity of the body in the practice of occupational medicine is imperatively necessary for fitness examinations and controls. Issuing from the climbing apparatus method developed by Kaltenbach and Klepzig a simple screening test concerning the functional diagnosis is controlled as to its applicability in the practice of occupational medicine and its evidence with the help of ergometric comparative examinations. 266 healthy workers as well as 92 patients with chronic disease of the respiratory tract or ischaemic heart disease were examined. The results showed: -A good reproducibility of the measurement of the heart rate in the screening test of functional capacity, -a good correlation with submaximal loads on the bicycle ergometer and -a correspondence between the scaled results of the screening test and the loads of the bicycle ergometer from 53 to 71%, on an average 58%. For the whole group of persons examined the correlation coefficient r was 0.52.


[Diabetic coma as a task for intensive therapy]. On the basis of 763 cases with diabetic coma from 1960 to 1973 is referred to the advantages of the foundation of a coma ward as department of intensive observation. It is reported on some successful changes of therapy in recent years. The introduction of methods of intensive therapy has led to a significant decrease of lethality. A sufficient administration of potassium (not less than 200 mval/die) and the prevention of a cerebral oedema are actual demands for the improvement of the prognosis of diabetic coma.


[Morbidity and mortality of poisonings in hospitalized patients in the German Democratic Republic]. In evaluation of the hospital statistics a survey is given on the kinds of intoxication and their frequency, age distribution and lethality. It is elaborated the necessity of the concentration of patients with intoxications, in order to decrease the lethality. An organisation model for the GDR is designed and the author adopts a definite attitude to th establishment of intoxication centres.


[Bases of medical treatment of acute poisonings]. The measures of the physician who is first in charge of the case often decisive for the course of the intoxication. Severe intoxication with disturbance of the vital functions immediately demand the removal of the acute danger to life. The effectivity of the detoxication treatment following the elementary therapy increases with the degree of exactness of the diagnosis. Therefore, already at the place of establishment the differential diagnostics of the cause of intoxication begins. To this belongs the asservation of poisons. In certain intoxications the detoxication is a constituent of the elementary therapy. Since only few antidotes are known the dominant factor of the detoxication treatment is above all in the unspecific detoxication treatment is above all in the unspecific detoxication. Its most important means are the prevention of the enteral resorption as well as forced renal elimination and dialysis. Experiences with barbiturate intoxications only with restriction are to be transmitted to other medicaments. Aslo among the groups of the barbiturates, the barbiturate-free sleeping drugs, the psychopharmaca, analgetics and others certain medicaments distinguish themseleves by characteristic effects which must be taken into consideration during treatment. Indication and differential indication of forced diuresis, haemodialysis and peritoneal dialysis are last not least determined by individual conditions and reactions on the part of the patient, concomitant diseases and complications. Taking into consideration the fact that a schematisation in detail is not to be proposed it is tried to derive and to prove recommendations for the medical action in acute intoxications.


[Problems of infrequent and often underestimated drug poisonings in emergency medicine]. Intoxication with medicaments which do not belong to the class of sedatives or psychopharmaca are often underestimated and not treated in hospital if they have no influence on the sensorium. In the Central First Aid and Intensive Therapy Department Berlin-Friedrichshain about 400-500 patients with drug intoxications of all kind are treated annually. Out of these on the average 30 intoxications are not conditioned by psychopharmaca, sedatives or analgesics. In these intoxications the drugs in question are above all cardio-active medicaments (glycosides and antiarrhythmics), rauwolfia and ergot alkaloids as well as industry and household chemicals. 3 patients with such intoxications are described concerning their clinical symptomatology, the course and the therapy.


[Water intoxication].

[Water intoxication]. In uncharacteristic clinical symptomatology the excess of water or the water intoxication render themselves conspicuous less by the signs of an increased fluid content than by central-nervous disturbances. Among the results of laboratory examinations the hypoosmolarity measured cryoscopically always, the hyponatraemia in most cases prove the excess of free water. Exceptions are discussed. A decreased capacity of the elimination of water pathogenetically plays a larger role than primarily excessive water supply. Apart from acute and chronic renal insufficiency the various forms of the Schwartz-Bartter-syndrome (inadequate ADH-secretion) play an increasingly more important role. The therapy demands the reduction of every supply of free water, the treatment of the evoking cause and only in cases of exception the administration of hypertonic saline solution, at the most dialysis treatment.


[Poisoning with nitrosifying gas].

[Poisoning with nitrosifying gas]. Nitrosifying gases are nitrogen-oxygen mixtures which are used in many branches of industry or which develop as a sideproduct. They are toxic already in a relatively slight concentration. It is reported on 12 patients who on account of an accident in a Berlin metal factory fell ill with an acute intoxication by nitrosifying gas. Symptoms, clinical and paraclinical findings are compiled and compared with the cases described in literature. Therapeutic orders are discussed.


[Recent aspects of thrombogenesis and thrombosis prevention]. Proceeding from experimental and natural conditions the modern opinion concerning the importance of Virchow's triad for the development and prophylaxis of thrombosis is explained. As to the point change of the quality of blood the author enters the newer findings of the behaviour of heparinocytes, fibrinolytic proactivators and split products as well as other endogenous protective mechanisms. The dependence on age of the heparinocytes and thymocytes is compared and the possible common root of the thrombogenesis and the genesis of tumours is taken into consideration. The influence of sexual steroids, nutrition, the consumption of coffee, tea, cigarettes, alcohol, etc., influence of weather and light on the endogenous and medical prophylaxis of thrombosis is discussed.


[Primary prevention and non-linearity in cardiovascular adaptation]. The size of the healthy heart and its function stand in a significant reciprocity. An enlargement of the heart in the sense of the formation of the athletic heart is characterized by an optimation of the function. On the basis of a larger sample the functional behaviour of healthy hearts between a size of 600 and 1,380 ml was tested. The function of the heart is not linearly connected with the size of the heat in the whole breadth of adaptation. When a small adaptation level is present a larger functional change is to be attached to a defined change of the size of the heart than in a high adaptation level. The curve of functional indices reveals a parabolic form above the size of the heart. This situation is present in rest, in submaximal load, in the phase of final load and in the phase of after-load. On the basis of representative parameters of the cardiovascular function this fact is demonstrated. The adaptation optimum is found nearly in the middle of the possible phase of adaptation. The author deals with the importance which these findings have for the primary prevention of cardiovascular diseases.


[Clinico-pharmacological studies with Nifedipine--a new coronary substance]. On 19 test persons (10 healthy persons, 9 patients with heart diseases) mechanocardiographic and haemodynamic examinations were carried out with the new preparation Nifedipine (05-072) which effects on the coronary vessels. Insignificant positively inotropic effects with invariable heart rate and cardiac output, decreasing heart action and decreased oxygen consumption were found. Arterial blood pressure and peripheral resistance were only slightly diminished. Own results and reports from literature show that the application of Nifedipine in the ischaemic heart disease appears to be successful.


[Problems of hepatitis in dialysis patients, technical personnel and their relatives]. In a centre for dialytic treatment of the district Karl-Marx-Stadt during 16 months patients and staff underwent a continuous clinico-epidemiological observation. By means of determinations of serum enzymes and Au-antigen-investigation regularly carried out in these cases the special risk of hepatitis could be confirmed. Hygienic-antiepidemic and organization measures are discussed and recommendations are given concerning the prophylactically more aimed course. Further investigations are necessary in as far as certain basic diseases (i.g., renal insufficiency) have an influence on the Au-antigen-persistence by impairment of the immune system and which epidemiological effects may result from this.


[Computer disk for the evaluation of body weight in adult men and women as based on their broca-weight]. In this paper is described a calculating disk for the percental deviation from the Broca-weight. By exact references to the mathematical derivation and to the construction a practical use is striven for.


[Determination of immunoglobulins in acute and chronic coronary disease]. 51 patients with chronic ischaemic heart disease showed on the average increases of IgA and IgG, but a significance concerning a control group could not be calculated. Compared with the normal group 41 patients with acute myocardial infarction did not reveal a significant increase of all three immunoglobulins. The observations of the course after myocardial infarction had the following result: During the first five days IgG in the majority decreased to 90% of the initial value and in the second to third week it increased to a maximum of on the average 150% of the initial value. 8 patients did not show a change of the IgG-level after infarction, in 4 patients the IgG-level still continuously decreased also in the second week. In 23 patients IgA increased to the double in the second and third week, in 18 patients it remained uninfluenced. The increase of IgM was to be established in 15 patients in whom at the same time in increase of IgA appeared. A relation between the values of IgG and the clinical parameters of the myocardial infarction could not be proved.


[Therapy and prognosis of autoimmune hemolytic anemia]. Of 48 patients with autoimmunohaemolytic anaemia who were treated in our clinic during the  last 10 years 13 could fully be cured, 20 exhibited a satisfying improvement, 7 remained without improvement and 8 died (3 of them of the basic disease). The results obtained allow the conclusion that the therapeutic use of corticosteroids, particularly at the beginning of the treatment as well as in the acute haemolytic attack is justified. Cytostatics, however, are especially suitable for long-term therapy, whereas splenectomy should be performed when no sufficient therapeutic success was achieved and in special cases. Under optimal therapy and repeated control the prognosis is to be regarded as favourable. For this reason treatment and further care by a haematological centre are demanded, since in such a facility are the most favourable conditions for the best care of the patients with autoimmunohaemolytic anaemia.


[Cell-mediated immune-phenomenona in progressive chronic polyarthritis]. With the help of the lymphocyte transformation test 34 patients with ascertained progressive chronic polyarthritis and 20 control persons were examined. A proteoglycan fraction from normal cartilaginous tissue was used as antigen. Hereby was found: 1. The antigen-conditioned stimulation of the lymphocytes in the group with progressive chronic polyarthritis was greater than in the control persons. 2. In the formation of the transformation index the difference between the two groups could be statistically ascertained. With the help of the present examination a further proof was given that in the process of rheumatoid arthritis cellular immune phenomena play a part. However, which value cellular immune mechanisms have in the etiopathogenesis of the progressive chronic polyarthritis, cannot be answered with the results of the examinations.


[Cell-mediated immune-phenomenona in hyperthyroidism and euthyroid goiter (studies using the lymphocyte transformation test)]. For the establishment of cellular immune phenomena in hyperthyroidism and the euthyreotic struma 27 patients with hyperthyroidism, 18 patients with euthyreotic struma and 33 healthy control persons were examined with the help of the lymphocyte transformation test as to their ability to the blast cell transformation under addition of watery extract of the thyroid gland. In the cases of hyperthyroidism significantly increased transformation indices were found compared with the controls. Also in the euthyreotic strumae increased values were found compared with the controls. They lay at the borderline to significance. Three different extracts were used as antigen. The transformation indices calculated in these cases were partly significantly different. From this is concluded that not in every watery extract of the thyroid gland the responsible antigen exists in sufficient quantity and/or quality.


[Zollinger-Ellison syndrome].

[Zollinger-Ellison syndrome]. A survey of pathogenesis, pathobiochemistry, pathological anatomy, clinic, diagnostics and therapy of the Zollinger-Ellison-syndrome is given. The Zollinger-Ellison-syndrome is, it is true, relatively rare, but its limitation from the usual peptic ulcer has great practical consequences. The suspicion of a Zollinger-Ellison-syndrome is aroused by therapy-resistent ulcers, which in every third person are associated with a diarrhoea, by recidivations of ulcer after gastric operations and by a large basal secretion of acid. The decisive diagnostic means is the serum gastrin determination. The only promising therapy is, as a rule, the gastrectomy.