Decreased incidence of renal tumors in DMN treated Balb/C mice after orchiectomy. Dimethylnitrosamine (DMN) induced a significant incidence (45.5%) of kidney epithelial tumors in adult male Balb/C mice. The proportion of mice with renal tumors orchiectomized after DMN injection was reduced to 25.6%; whereas the proportion of tumor bearing animals at other sites, such as lung, liver, and lymphatic tissue, increased compared to intact DMN treated animals and controls. This experiment confirms other studies in rats and mice showing that androgens play a role in initiation and progression of nitrosamine induced renal cancer, paralleling the finding of increased male susceptibility in human renal cancer.


Adjuvant postoperative chemotherapy with 5-fluorouracil and methotrexate: effect of schedule of administration on metastasis of 13762 mammary adenocarcinoma. Metastasizing mammary adenocarcinoma 13762 in female Fischer rats has been used as a model for studying postoperative adjuvant chemotherapy, using methotrexate (Mtx) and 5-fluouracil (5FU) either singly or in combinations. All animals that received postoperative adjuvant chemotherapy of 5FU alone, 5FU and Mtx simultaneously, or Mtx followed by 5FU had significant improvement of survivals. Methotrexate alone was ineffective in treating the visceral metastasis. The addition of Mtx at the time of 5FU administration actually decreased the therapeutic effectiveness of 5FU given by itself. Fluorouracil alone improved survival of rats with small or large tumors, whereas Mtx followed by 5FU was better than 5FU alone in rats with smaller tumors. Among all rats treated with chemotherapy, those rats that got Mtx followed by 5FU had the lowest amount of lung metastasis, and concomitant administration of nonspecific BCG immunotherapy delayed death from visceral metastasis only for rats receiving drugs according to this schedule.


Acinic cell tumor of the palate.

Acinic cell tumor of the palate. A rare acinic cell carcinoma of the soft palate is reported and its potential for recurrence and metastasis discussed. A wide ablation created a speech-crippling defect that was reconstructed with an island flap from the opposite side and a pharyngeal flap for nasal lining and an island flap from the same side for oral cover. Speech is again normal.


Radical mastectomy for operable breast cancer. The experience with radical mastectomy in the treatment of 152 cases of operable breast cancer at the Hadassah University Hospital has been analyzed. An overall 5 year survival of 75% and a 10 year survival of 62% are reported and compared with results from other methods of treatment. Based on the excellent survival rates achieved and the low incidence of local recurrence (9.8%), the present study suggests that radical mastectomy is still the most suitable surgical procedure in the treatment of operable breast cancer.


The adverse effects of elemental diets on tolerance for 5-FU toxicity in the rat. The effects of a group of elemental diets on the gastrointestinal toxicity of 5-FU in the Sprague-Dawley rat were evaluated. Diarrhea, stomatitis, hypoalbuminemia, and early deaths were more frequent in the animals on elemental diets than in those consuming standard rat chow. Sepsis and hypoalbuminemia were directly related to the extent of protein hydrolysis of the particular elemental diet.


An unusual presentation of carcinoma of the lung: 26 patients with cervical node metastases. Carcinoma of the lung should be considered in the search for an unknown primary lesion when there is evidence of cervical lymph node involvement. Of 1,686 patients with a final diagnosis of bronchogenic carcinoma seen during a 10-year period at the University of Louisville Hospitals, 26 presented one or more clinically positive cervical nodes. The frequency of lung cancer in such instances varies from 1.5% (in the present report) to 32%, possibly because the term "cervical node" is used without clarification. More precise description of such metastases is urged.


The role of stress factors in the postoperative course of patients with rectal cancer. The authors studied 82 patients with rectal cancer who underwent radical surgical treatment at the N.N. Petrov Oncological Research Institute of the Ministry of Health of the USSR in 1974-1975. They defined the markedness of patients' psychogenic disturbances in the pre- and postoperative period and measured the level of catecholamines in urine and that of 11-oxycorticosteroids in blood. The findings showed the highest frequency of postoperative complications (68%) in the group of patients who evidenced severe psychic reactions when they were admitted to the clinic. These data correlated with a higher level of catecholamines in the urine and of 11-oxycorticosteroids in the blood before surgery, and with a marked decrease of catecholamine excretion on the sixth day after the operation. This may indicate sympathetic-adrenal system exhaustion and play a certain part in the development of postoperative complications.


The combined effect of radiotherapy and neuraminidase-treated tumor cells on 3-methylcholanthrene-induced fibrosarcoma. Active immunotherapy with tumor cells treated in vitro with Vibrio cholerae neuraminidase (VCN) plus mitomycin C augments the antitumor effects of local x irradiation in the treatment of firmly established methylcholanthrene-induced fibrosarcoma, MC-43, in syngeneic C3H/HeJ female mice. In most experiments, the inhibition of tumor growth was greater when VCN-treated tumor cells were combined with local irradiation than could be achieved with VCN-treated tumor cells or local irradiation alone. Even in those experiments in which the immunotherapeutic effect of VCN-treated cells was negligible, the combination of radiotherapy and immunotherapy appeared to be greater than irradiation alone. Similarly, total permanent regression of established tumors occurred more frequently after combined therapy than after immunotherapy or radiation therapy alone.


Squamous cell carcinoma of the esophagus: a study of 153 cases. The incidence of esophageal carcinoma in the United States is relatively low; total estimated cases annually are about 7,000 (Ca, 1975). The overall cure rate, however, is about the worst among all malignant diseases and is reported to be 3% (Ca, 1975). We reviewed cases of squamous cell carcinoma of the esophagus treated at Roswell Park Memorial Institute to understand the clinicopathologic features in order to improve our therapeutic results.


Serum polyamine alterations in surgical patients with colorectal carcinoma. Polyamines, by virture of their regulatory role in the cellular synthesis of DNA, RNA, and protein, are potential indicators of malignant growth. In view of this, serum polyamine levels of patients with colorectal carcinoma or benign bowel disease were examined. Of 53 patients with colorectal carcinoma, 35 (66%) showed elevations of 1 or more polyamines. Nine patients with benign bowel disease (villous adenoma, Gardner's syndrome, familial polyposis, and diverticulitis) showed normal serum polyamine levels except 1 patient with a villous adenoma. Patients with colorectal carcinoma were designated stage A, B, C, or D depending on the progression of their disease. All patients classified as D showed elevation of 1 or more polyamines. Serum polyamines became elevated following surgery in patients with colorectal carcinoma as well as those with benign bowel diseases, suggesting a relationship to the surgical procedure. Preliminary longitudinal studies of patients with colorectal carcinoma (B stage) undergoing curable surgical procedures show normal polyamine levels and no evidence of disease at 15 months.


Hibernoma: report of two cases.

Hibernoma: report of two cases. Hibernomas are rare tumors of fat which are most often benign. Arteriographic fingings may be misleading with respect to the diagnosis of malignancy preoperatively. These uncommon tumors may be confused prior to surgery with lipomas, soft tissue sarcomas, and hemangiomas.


Hematoma of liver: a lesion-mimicking hepatic neoplasm. A plethora of case reports of women on birth control agents who present with hepatic masses and who are ultimately found to have liver neoplasms have overshadowed the clinicians' awareness of other possible diagnoses in patients who present in a similar fashion. Hematomas of the liver, secondary to vascular lesions induced by these agents, must be considered and preoperative attempts to make the diagnosis must be ensured by obtaining appropriate studies.


Estrogen receptor levels in hormonally progressive mammary tumors. Tumor samples from 4 different stages of hormonal progression in the MT-W9 series of rat mammary tumors were analyzed for estrogen receptors by the dextran-coated charcoal method in order to further explore the clinical implications of the estrogen receptor assay. The findings indicate that although the presence of estrogen receptors is not an exclusive characteristic of hormonal dependency, their absence is indicative of a later stage of hormonal progression which might be of more immediate clinical consequence because hormonally autonomous tumors have faster growth rates than hormonally dependent tumors. It is also suggested that it may be necessary to initiate chemotherapy as an adjuvant to endocrine therapy for metastatic breast cancer patients with hormonally dependent tumors in order to avoid the eventual proliferation of hormonally autonomous tumor cells which are present in hormonally dependent tumors.


Nonsurgical treatment of pelvic rhabdomyosarcoma: a case report. A 2 1/2-year-old male child with rhabdomyosarcoma of the prostate was treated with radiation of the pelvis, consisting of 5,600 rads in 7 1/2 weeks, and combination chemotherapy of Vincristine and Actinomycin D. Surgery had been refused. The child is alive and disease-free more than 5 years after diagnosis, and over 2 years following the cessation of all therapy. Recent advances in radiotherapy and adjuvant chemotherapy have significantly improved the outlook in this aggressive childhood neoplasm and have made a less aggressive and less mutilating surgical approach often desirable. This, in turn, holds out the prospect of improved quality of survival in children so afflicted.


Cancer of the Colon: 32 years of experience in Bombay, India. Incidence rate of colon cancer is low in India compared to the Western countries. The dietary habits may be the protective factor in our population. During a 32 year period (1941-1972), 555 cases of colonic cancer were recorded at the Tata Memorial Hospital, Bombay. Among the social groups utilizing this hospital, the Parsis (Zoroastrians) have the highest incidence of colonic cancer. The frequency of cancer of the caecum and sigmoid are almost equal. Cancer of splenic and hepatic flexures are predominantly seen in men. Of the resected cases 50% survived for 5 years and 40% for 10 years. When cancer was localised, the 5 year survival rate was 64%. The 5 year survival rat among transverse colon cancer patients was 70%. The skin was the commonest site of a second cancer among colon cancer patients; the possible etiological association of these two cancers appears very intriguing.


Prognostic significance of blood vessel invasion in carcinoma of the breast in women. Prognostic significance of blood vessel invasion in carcinoma of the female breast has been evaluated by study of 242 cases of radical mastectomy done at the Tata Memorial Hospital. The significance of axillary node involvement with the disease has been simultaneously evaluated. In the absence of blood vessel invasion and lymph node metastasis the 5 year survival rate was 98%. Compared with this, 5 year survival rate was reduced to 59% when the blood vessel invasion was present but no lymph node metastasis. Only 12% survived for 5 years when both blood vessels and lymph nodes were involved with the disease. The study indicated that blood vessel invasion in the primary breast carcinoma is more significant than lymph node metastasis.


Lymphography in the assessment of mycosis fungoides. Extracutaneous manifestations of mycosis fungoides imply a bad prognosis and are a major cause of death. Benign dermatopathic lymphadenopathy is associated with mycosis fungoides and often precedes lymphomatous infiltration. In this study, 10 patients in the early stages of mycosis fungoides underwent clinical and lymphographical examinations. In one the lymphoma was already present in lymph nodes. Six had signs of dermatopathic adenopathy which was verified by lymph node biopsy in 5. In one of these the disease later progressed to a malignant lymphoma. The frequent occurrence of lymph node involvement justifies the use of lymphography collaterally with staging laparotomy to determine the presence of pathologic retroperitoneal lymph nodes.


Allergic reaction to Patent Blue Violet during lymphography. A case of an allergic reaction to Patent Blue Violet dye used for the purpose of lymphangiography is reported. The clinical findings were urticarial reaction, edema of the eyelids and lips, and hypotension. Previous sensitization to triphenylmethane dyes, in drugs and other chemicals was likely, but not proven. Such commonly used compounds have been compiled in a Table. History of a previous hypersensitivity reaction to these compounds is not a contraindication for lymphangiography but should call for emergency planning and possible premedication.


Effect of transient intestinal ischaemia on the thoracic duct lymph absorption of endotoxin. One-hour intestinal ischaemia by clamping the superior mesenteric artery and interrupting the intramural collaterals was produced in 8 dogs. Thoracic duct lymph, mesenteric venous blood and arterial blood were examined before and during intestinal ischaemia and after revascularization of the small bowel. Venous blood was the major route of transport of lactic acid and lactate dehydrogenase from the ischaemic bowel. Endotoxin activity determined by the limulus test was found in the lymph before the induction of intestinal ischaemia in 4 of 6 dogs while it was absent in arterial blood. After one hour lasting revascularization endotoxin was present in the lymph of all dogs and in 3 and 4 dogs in arterial and mesenteric venous blood respectively. It was demonstrated that limulus-positive substances escape from the intestine both via the lymph and blood.


Lymphatic pathways and rate of absorption of 131I-albumin from pericardium of dogs. Labeled albumin diluted to 4.0 ml with normal saline solution was instilled into the pericardium of 14 dogs. Lymph from the right lymphatic duct (RD) and thoracic duct (TD) was collected at intervals as well as blood samples, and radioactivity measured.


Detection and localization of occult lesions with brainstem auditory responses. Seven vertex-positive potentials--the brainstem auditory response--can be recorded from the human scalp within 10 milliseconds of an appropriate acoustic stimulus. The first of these potentials is generated in the acoustic nerve, the third in the pons, and the fifth in the midbrain. Measurement of the relative latencies and amplitudes of these potentials allowed detection of subclinical lesions in 37 (53 percent) of 70 patients with suspected multiple sclerosis who had no signs or symptoms of brainstem involvement by the disease. Abnormalities in the brainstem auditory response provided the first evidence of the pressence of multiple lesions in 14 (35 percent) of 40 patients with suspected multiple sclerosis who had clinical evidence of only a single spinal or cerebral lesion. Response  abnormalities also suggested the presence of tumors of the posterior fossa in three patients with nonspecific symptoms and normal neurologic examinations, the test indicated the need for contrast studies, which then led to the correct diagnosis of infratentorial neoplasm.


Function of expanded-polytetrafluoroethylene laminated trileaflet valves in animals. A stent-mounted trileaflet cardiac valve prosthesis has been developed in which the valve leaflets were fabricated from 0.003-mm films of expanded polytetrafluoroethylene laminated in 4 to 15 layers. A total of 28 valves of varying leaflet thickness were implanted in the tricuspid position in dogs. Cardiac catheterization performed during the follow-up period between 1 week and 15 months after valve replacement in 20 surviving animals showed that the initial good function was maintained in 12 dogs for up to 15 months, whereas valve dysfunction developed in 8 other dogs within 6 months. Autopsy revealed that the cause of valve dysfunction among the eight dogs was cusp stiffening with or without retraction in six, dehiscence of the suture ring in one, and strut entrapment in one. This study demonstrated that the thickness of the leaflet material is an important factor affecting the long-term function in vivo.


Cardiac lymphatic obstruction: ultrastructure of acute-phase myocardial injury in dogs. Cardiac lymphatics exist as a network of intercommunicating channels in the myocardium and heart valves, and chronic obstruction of these vessels may result in endomyocardial fibrosis and mucoid degeneration of heart valves. The acute effects of experimental cardiac lymphatic obstruction were studied in the dog. Subendocardial edema and hemorrhage occurred within 150 minutes of the ligation of cardiac lymphatics. Ischemia-type myocardial injury was also observed. Attional changes detectable ultrastructurally included lymphangiectasia, myofibrillar degeneration, disruption of Z-band and intercalated disks, and various mitochondrial derangements. The spottiness of the changes was attributable to the known anatomic variability of lymphatic distribution in the heart. The findings reinforce the belief that greater attention should be focused on the role of cardiac lymphatics in the pathogenesis of a multitude of myocardial and vavular heart diseases.


Psychiatric consultation in the chronic pain patient. A process and technique for psychiatric evaluation of chronic pain patients are discussed. It is the task of a psychiatrist to rule in or rule out a psychiatric component rather than to assume the existence of "psychogenic" pain when there is a negative medical and surgical examination. Accurate communications about any psychiatric components to the referring physician, without premature judgment on "cause" of pain, lead to themost accurate decisions about future treatment.


The value of gastroscopy in clinical diagnosis: a computer-assisted study. The additional information obtained by gastroscopy in patients already examined by upper gastrointestinal roentgenography was assessed. For this purpose, a data sheet for computer analysis was filled in at the time of gastroscopy and again at patient dismissal. Overall, gastroscopy resulted in an altered diagnosis in 18 percent of 1, 368 examinations, and in another 7 percent of cases there were findings of possible clinical significance. Gastroscopic findings differed significantly from x-ray findings in 7 to 35 percent of cases, depending on the indication for the procedure.


Penetration of the small intestinal mucosa by asbestos fibers. Amosite asbestos fibers suspended in saline were placed in an isolated segment of rat jejunum in vivo. One hour later, segments of jejunal mucosa were taken for examination in three of the five rats exposed to the amosite suspension. Fibers also were presented in the lamina propria.


Medical sociology for whom?

Medical sociology for whom? This article defines the role of a medical sociologist in a medical institution concerned with health care delivery. The role in applied research and teaching is also discussed. The distinction is made between sociology in medicine and sociology of medicine. Five broad areas of research included under the category of sociology of medicine are the consumer of health care; the social, cultural, and economic enviroments as they relate to health and illness; health and illness behavior; patient education; and the evaluation of services provided to the consumer. Research methodologies utilized by sociologists are briefly presented, and research issues of concern in the sociology of medicine are outlined. The knowledge and information provided by a medical sociologist are supplemental to the physician's practice and are expressed ultimately as a benefit for the patient.


Movement of horseradish peroxidase in submandibular glands of dogs after ductal injection. Small volumes of solutions of a tracer enzyme, horseradish peroxidase (HRP), have been injected retrogradely via the main duct of submandibular glands in dogs, and the distribution of the peroxidase reaction product within the glands has been studied light microscopically and electron microscopically at different times after the injection. Tissue taken immediately after injections of 0.25 ml, given over 10 sec, showed that HRP had penetrated into the interstitial spaces of the gland. It was usually irregularly distributed and appeared to have reached the interstices of the gland by passing through the intercellular junctions of adjacent acinar cells. In time the tracer gradually disappeared from the interstices of the gland. Most of this removal was probably via lymphatic and blood vessels, into both of which peroxidase rapidly passed after ductal injection. At 5 hours after the HRP injection only very weak interstitial staining was present and at later times none was detected. An inflammatory reaction occurred in the gland, starting within minutes after the injection of this foreign protein and reaching a peak after about 12 hours. The events in dogs and those occurring in rabbits under similar experimental conditions have been compared. This study has given some indication how foreign substances may be distributed after retrograde injection into salivary glands.


Activation of adenylate cyclase from rat striatum and tuberculum olfactorium by adenosine. Adenosine caused a dose-dependent stimulation of adenylate cyclase in homogenates from rat striatum and tuberculum olfactorium (200 and 300% stimulation by 100 muM adenosine). The effect of adenosine was not antagonized by haloperidol. Subcellular fractionation suggested that adenosine stimulates a different adenylate cyclase than dopamine. Basal adenylate cyclase activity in freshly prepared homogenates was reduced by dialysis and by the addition of adenosine deaminase. Basal adenylate cyclase activity was enchanced by papaverine and dipyridamole, but reduced by theophylline and isobutylmethylxanthine. The results are compatible with the opinion that endogenous adenosine is capable of activating adenylate cyclase in these areas of the rat brain.


Effect of prolonged beta-blockade on energy metabolism and adrenergic responses in the rat. Rats were treated by daily alprenolol (10, 20 and 50 mg/kg) injections for 5 days a week for 4 weeks. At 20--21 degrees C alprenolol treatment retarded the weight gain of the animals and increased the weight of the adrenals. These changes were not seen at 29 degrees C. The reduction in size and fat content of the interscapular brovin adipose tissue in drug-treated rats was independent of experimental temperature. At 20--21 degrees C prolonged beta-blockade did not cause any changes in the enzymes of the energy metabolism. At 29 degrees C, however, alprenolol treatment antagonized the decrease in activity of oxidative enzymes (succinate dehydrogenase, malate dehydrogenase, citrate synthase) and the decrease in protein concentration of the cardiac muscle. In skeletal muscle alprenolol treatment significantly decreased the activities of oxidative enzymes and antagonized the rise in the activity of lactate dehydrogenase resulting from warm acclimation. The increased activities of oxidative enzymes in interscapular brown adipose tissue of aprenolol treated rats were coupled with an increase in protein concentration of the tissue. Although these changes were more marked at 29 degree C they were observable at 20--21 degree C, too. The difference in the drug effects at 20--21 degrees C and 29 degrees C can be accounted for by the compensatory catecholamine release at the lower temperature, due to impaired thermoregulatory capacity after alprenolol. Prolonged beta blockade decreased the exercise tolerance and cold tolerance of the rats. An increased response of the diastolic blood pressure to an alpha-adrenergic drug, noradrenaline, and a decreased response to a beta-adrenergic drug, isoprenaline, in alprenolol-treated rats indicates a shift from beta- to alpha-receptors.


The role of the nurse-practitioner in a pediatric team: patient definitions. Patient conceptions and evaluations of the nurse-practitioner role were explored in a random sample of families who attended a pediatric office team comprising a pediatrician and a nurse-practitioner. Patients do not perceive the nurse to have expertise in an exclusive domain of health problems. Thus, the majority of patients do not consider her addition to the office to have improved on the doctor services. Although many patients took advantage of the opportunity to discuss with the nurse issues they regarded unworthy of the doctor's time, they did not value time spent with the nurse as meriting dispensing with some of the doctor time or the payment of an additional fee. The low value placed by patients on the diffuse area of "care" as opposed to the application of medical science hinders the prospects of public recognition of the nurse-practitioner. This applies particularly to the nurse-practitioner as a team member, where an explicit attempt is made to articulate the unique domains and boundaries of the various professionals.


A method for analyzing resource use in ambulatory care settings. The major objective of this research is to develop a methodological framework to help analyze the use of resources in ambulatory care environments. Emphasis is placed on trying to understand reasons for variation in treatment patterns. Important methodological considerations include: 1) the selection of a set of medical problems appropriate for evaluating the interaction effects of the variables being considered; 2) the development of problem-specific computerized routines for defining episodes of care based on patient visit information; and 3) the selection of appropriate measures of utilization. The Frontier Nursing Service (FNS) was used as a study setting. FNS is a primary health care service and training center located in Leslie County in eastern Kentucky. an area that covers 1,000 square miles with a population of approximately 15,000. The analysis indicates that for common primary care problems, the level of provider training as well as accessibility of services significantly influence patterns of care.


A controlled trial of the impact of the family practice nurse on volume, quality, and cost of rural health services. Rural Newfoundland communities with and without expanded role nurses were compared on a before and after basis. The rural communities are located in a geographically isolated area served by a 40-bed hospital staffed by salaried physicians. Primary care visits within the community increased by 186 per cent after establishment of the family practice nurse community clinic and attendance at the hospital decreased by 35 per cent. Acute care days in hospital decreased 5 per cent in the experimental group and increased by 39 per cent in the control group. A major portion of the community based visits provided to the experimental group were classed as preventive. The total annual health service cost per 1,000 persons in the experimental group increased slightly more than in the control group (26 versus 21 per cent). Adequate management of certain indicator conditions and drugs was maintained by the family practice nurse when compared to the adequacy rating for the physician during the same time period.


[Current surgical management of mammary carcinoma in Austria (author's transl)]. The incidence of mammary carcinoma in Austria remains constant. Follow-up examinations of 6000 cancer patients, representing approximately one-third of all patients operated on during the period 1960 to 1974, show that the proportion of early stages is relatively low. This is evidenced by a five-year survival rate above and a ten-year survival rate below average. The operative procedure was almost exclusively the Rotter-Halsted operation; during the last few years, the modified radical mastectomy was preferred. Results of partial resections, performed in once center only, were unsatisfactory.


[Mammary carcinoma in Switzerland (author's transl)]. Combined surgical, radiotherapeutic, and sometimes chemotherapeutic treatment of early stages of operable mammary cancer results in 5-year survival without recurrence in a similar percentage of cases as modified radical mastectomy does. This is demonstrated with 1296 patients of two French and one American groups using comparable indication and therapeutic principles. No controlled studies of long-term results using these principles are thus far available. Preliminary results of a Swiss adjuvant polychemotherapy study after mastectomy show a significant favorable effect only in patients with negative axillary lymph nodes.


[Management of early breast cancer (author's transl)]. The results of clinical trials for early cancer of the breast were assessed in terms of survival, morbidity, and the rate of local recurrance. Simple mastectomy appeared to be the operation of choice because survival following this procedure was equal to that following more radical operations, but the morbidity was less. Partial mastectomy was found to be an unsatisfactory method of treatment. Simple mastectomy should be combined with removal of the lower axillary nodes to allow accurate staging of the disease. Postoperative radiotherapy did not influence survival, but did increase morbidity. It may be best to restrict its use to the treatment of local recurrance. Improvement in survival figures may be seen by use of adjuvant chemotherapy, or by more widespread use of screening programmes.


[Indications for plastic surgery (author's transl)]. The paper deals with the three main areas of indications for plastic surgery: 1. Reconstructive plastic surgery or treatment of defects resulting from trauma or disease. 2. Constructive plastic surgery or treatment of innate defects. 3. Anaplastic surgery or treatment of disfunction of appearance. By defining these different branches of plastic surgery criteria are elaborated that govern all plastic surgery. Differences between the general surgical approach and the plastic surgical approach are explained and emphasis is put on the patients' subjective situation and possible pressures from outside as well as environmental influences that may have bearing on the indication.


[Lipectomy and lipexhaeresia in the area of the lower extremities (author's transl)]. Lokalized fat can be removed for pathologic but also for purely aesthetic reasons. Lipexhaeresia is a method that enables one to do this without leaving any significant scars. Certain principles of approach must be observed if aesthetically satisfactory results are to be obtained. Experience shows that there are no limits as to indication. Combination with dermolipectomy in the area of the buttocks increases the range of application.


[Lipectomy of the abdominal region (author's transl)]. Indications and operative techniques for dermolipectomies in the abdominal and lumbar region are discussed including resections of excess skin after weight reduction, intestinal bypass, and pregnancy. Dangers and complications are discussed.


[Surgical disconnection of the small intestine as a contribution to plastic surgery]. The limitations of conservative therapy of extreme obesity compel the patient to seek a surgeon. He can do the following: Resect deposits of fat, create a condition of malabsorption by jejunoileostomy or perform a gastric by-pass, which reduces the capacity of the stomach. The gastric by-pass is the method of choice for treating the adipose child. We perform the jejunoileostomy only on patients with more than 100% overweight. With the weight reduction the pathologic metabolism is normalized. A plastic correction of pendant skin is necessary.


[Operative correction of leg length discrepancy (author's transl)]. Differences in the lengths of limbs can alter the appearance of the human body. A discrepancy in the lengths of the lower limbs, which eventually leads to difficulties in gait, can be corrected surgically either by shortening the sound limb or by gradual lengthening of the foreshortened leg. The advantages of lengthening are that the body's total height and normal proportions are maintained. Bilateral shortening or lengthenings can be done in exceptional cases for correction of the body height.


[Funnel chest deformities: operative treatment (author's transl)]. The frequency of chest deformities is 1:100; operative treatment, however, is necessary in only 1:1000 patients with such a deformity. The most frequent deformity--in 91%--is the funnel chest. Chicken breast, combined types, and fissures of the sternum are seldom seen. Indications for operative treatment are: deformity of more than 25% of the normal sagittal diameter of the chest; heart failure and the degree of pathologic signs on the EKG; alterations of the vertebral column; psychologic aspects. Our operative procedure consists of double cartilage incision and stabilization of the chest with a metal strut.


[Pathogenesis of gastric and duodenal ulcer (author's transl)]. "Anyone who claims to have discovered the ideal procedure in the treatment of gastric ulcer, should be considered immodest." These words by Schnitzler (1914) are in principle still valid. The pathogenesis and operative procedure are not identical. There is still no conclusive proof of the pathogenesis. The disclosure of other pathogenetic factors and facts is gradual. Locally active chemical noxae (e.g., propionitril) are responsible for the development of duodenal ulcer. Gastric ulcer is caused by the reflux of duodenal juice (e.g., lysolecithin, which is capable of corroding the mucosal barrier of the stomach. The current pathogenetic mechanisms of ulcer of the usual locations are specified.


[Peptic ulcer: indication for surgical treatment (author's transl)]. Treatment of duodenal ulcer has been improved by proxmial gastric vagotomy and the H2 antagonist cimetidine. These new types of treatment may also be useful in gastric ulcer. Thus, new guidelines for the elective surgery and the treatment of bleeding ulcer are needed. These guidelines are obtained by a compromise between the conflicting viewpoints of a surgeon and an internist.


[Gastroduodenal ulcer: resection procedures (author's transl)]. In recent years vagotomy has become more and more prefered in ulcer surgery. Based on the results of prospective trials, gastric resection should be abandoned as treatment of uncomplicated duodenal ulcer. Resections are still indicated for most ulcer complications, such as bleeding, penetration of chronic ulcer, and in recurrent ulcers after vagotomy. The same is true for gastric ulcer type I. Questionnaires indicate, however, that German surgeons still favor the two-thirds resection.


[The technique of proximal selective vagotomy (author's transl)]. A standard technique of proximal selective vagotomy is described (PSV) that has proved reliable and safe in a broad multicenter clinical trial. We proceed in six steps: (1) determination of the antral-fundic boundary by anatomic criteria; (2) preliminary vagomotor electrotest; (3) identification of the nerve trunks and branches to be preserved; (4) dissection of the lesser curvature; (5) dissection of the cardia and of the intraabdominal esophagus up to 6 cm above the cardia; and (6) intraoperative assessment of completeness by the vagomotor electrotest. PSV is usually carried out without a drainage procedure.


[Proximal selectivive Vagotomie. Intra-operative Vollständigkeitskintrolle]. In the treatment of peptic gastroduodenal ulcers the modified vagomotor electrotest according to Burge has yielded remarkably good results as an intraoperative test for the completeness of proximal selective vagotomy (PSV). The test is as useful for the surgeon in training as for the expert in vagotomy. Moreover the clinical value of the test is demonstrated. If, according to this test, vagotomy is complete, an extreme reduction of gastric acid and a very low rate of relapsing ulcers are seen in our patients. We cannot recommend performing the PSV without this test.


[Proximal selective vagotomy: results of a prospective study (author's transl)]. In 728 patients operated on because of gastroduodenal ulcers there were early complications in 7.6% and a lethality of 0.13%. Primary drainage operation was performed in 9.5%, secondary drainage in 0.9%. One year after operation, reduction of BAO was 60% and of PAO 50%, in cases of recurrence only 35 and 30%. Postoperative recurrence of duodenal ulcer was seen in 3.1% after one year and in 5.5% after two years. Recurrence of gastric ulcer became apparent in 9.3% after one year and in 3.4% after two years. Reoperation for recurrence was performed in 1.3%.


[Gastroduodenal ulcer: surgical therapy (author's transl)]. In evaluating results after surgical therapy of gastroduodenal ulcer, lethality and recurrency rate are important criteria, but a third "quality of life" should be considered equally important. Proximal selective vagotomy seems to carry a very small lethality risk and extremely good "qualities of postoperative life." A minority of patients may need two "surgical steps" to achieve a good end result. The modified Burge test has been found useful in a prospective study. As to technical details, the denudation of the subdiaphragmatic esophagus over a distance of 5--6 cm seems paramount for achieving a good proximal vagal denervation of the acid-secreting area of the stomach.


[Reintervention for recurrent ulcer (author's transl)]. From 1967 to 1976, 158 patients were operated on for recurrent ulcer; of these, 75 patients had an ulcus pepticum jejuni after Billroth II. The most common causes of the p. op. ulcer arose from inadequate surgical techniques, i.e., incomplete vagotomy, retained gastric antrum, too large gastric remnant, or palliative primary intervention, such as simple closure. The results of retrospective analysis do not permit a comparison of the different procedures. Vagotomy (p.s.V.), however, is recommended because of lower mortality. Zollinger-Ellison syndrome must be ruled out before any reintervention for recurrent ulcer is undertaken.


[Retrograde endoscopic diagnosis and therapy in diseases of the bile papillae and the bile ducts (author's transl)]. Duodenoscopy with retrograde cholangiopancreatography including associated methods (cytology, manometry, endoscopic sphincterotomy, etc.) allows, with little risk, a more precise differentiation of jaundice. Considering the therapeutic consequences, the effort seems relatively small. Diagnostic improvements lead to more differentiated therapy. Therapeutic endoscopy is being substituted for classic therapeutic methods of internal medicine and surgery.


[Therapeutic endoscopic retrograde cholangiography (author's transl)]. Endoscopic papillotomy is a further development of endoscopic cholangiography. This therapeutic procedure was successful in 516 (94.7%) of 545 cases. Choledocholithiasis (405 cases) and papillary stenosis (97) were the main indications for the procedure. Of 405 patients with choledocholithiasis, 376 (93%) are now free of stones. There were 38 (7.4%) complications and 5 (1%) of these had a lethal outcome with (11) (2%) requiring emergency laparotomy. Cholangitis was the most serious complication. It is becoming increasingly evident that the endoscopic papillotomy is replacing reoperation in many cases of choledocholithiasis.


[Endoscopic retrograde pancreatography (author's transl)]. Endoscopic retrograde pancreatography is indicated in suspected malformations, chronic inflammation, and tumors of the pancreas. It is contraindicated in acute inflammation and severe obstruction of the main duct. The signs of chronic inflammation are deformities of the ductal system and/or intraductal calculi. Diffuse changes with beading were prominent in 51 patients studied. Malignant tumors cause stenosis, obstruction, tapering, or cavernous deformation of the ductal systm. Complete obstruction of the main duct was seen in the majority of 67 patients studied.


[Endoscopy in the diagnosis and therapy of surgical diseases. Colonoscopic diagnosis (author's transl)]. Fibroscopes and the techniques of introducing them are now so highly developed that, except for an impassable stenosis, the entire colon can be inspected in every case and the adjacent small intestine in 90% of the cases. Indisputable advantages as compared with indirect methods such as radiology are the direct inspection of the mucosa, the possibility of reliably differentiating between pathological findings and residual stool, the detection of minute lesions that escape radiological examination, and the possibility of removing tissue samples (forceps biopsy, big-particle biopsy, polypectomy). Thus it is possible for the first time to confirm diagnosis morphologically prior to surgery.


[Coloscopic treatment (author's transl)]. Treatment by coloscopy is almost exclusively identical to endoscopic polypectomy. From a technical standpoint, coloscopic polypectomy can be regarded as a sophisticated method: risks are minimal. Of a total of 1236 polyps resected endoscopically over a period of 4 years, two-thirds were resected with a coloscope. Almost 70% of the polyps were adenomas; 10 polyps proved to be carcinomas (without parts of an adenoma); 64 out of 797 polypous adenomas were associated with focal carcinomas. Indications for coloscopic polypectomy are all stalked polyps and those broad-based sessile polyps up to a diameter of about 3 cm.


[Endoscopic removal of foreign bodies and intraoperative endoscopy (author's transl)]. Foreign bodies of the upper GIT are regularly extracted with endoscopes, provided, that they have neither left the pylorus, changed their form, nor perforated the wall. Endoscopic extraction is recommended when safe and spontaneous discharge is uncertain. Impacted rectal foreign bodies usually need proctologic or abdominal surgery. Intraoperative endoscopy should be limited to those organs that are not attainable by preoperative inspection like cholangioscopy and peroral jejunoileoscopy.


[Biopsy and cytology in the diagnosis and treatment of surgical diseases (author's transl)]. Surgical lesions of the gastrointestinal tract are usually of an ulcerous or polypoid nature. The macroscopic pathologic changes can be given a clinical diagnosis only after the histologic findings are known. Endoscopic biopsy meets this purpose. Furthermore, endoscopic snare biopsy can be a curative therapeutic procedure. Cytology should only be used as a method of second choice, for example when stenosis proximal to the lesion hinders biopsy.


[Prevention of thromboembolism and therapy. Introduction]. One-third of all surgical patients develop a deep phlebothrombosis. This frequency of thrombosis after injuries of the lower extremities is estimated at 65%. Most of the thromboses do not become clinically manifest. Ninety-two percent of all fatal pulmonary embolisms originate from a clinically inapparent thrombosis. The ideal prophylaxis should compensate for the undesired effects of an operation or injury on the coagulation system, without subjecting the patient to the danger of elevated tendency to bleed. The discussion of this subject should help to clarify the present successes and risks of thromboembolism prophylaxis and therapy.


[Pathophysiology of venous thrombosis (author's transl)]. The pathophysiology of venous thrombosis is determined mainly by the triad of Virchow (hypocirculation, endothelial lesion of vessels, coagulation disturbances). Various predisposing factors are known. Thrombocytes are of utmost importance in the initial phase of thrombus formation, while fibrin and red cells influence the length of the clot and the extent of pulmonary embolism. Postoperative venous thrombosis occurs more frequently and earlier than hitherto thought (radiofibrinogen test). General prophylaxis is indicated for its effective prevention.


[Clinical diagnosis of thromboembolic complications. 125I fibrinogen test, thermography, ultrasound (author's transl)]. Early diagnosis of deep vein thrombosis (DVT) in all patients operated upon does not make sense. Prevention is better. Should dvt occur, phlebography is mandatory. The only other reliable objective method is the fibrinogen test, which is ideal for clinical research. Peripheral pulmonary emboli (pe) are more common than most people assume. Many are asymptomatic and lyse spontaneously, but often they are precursors of dangerous pe. Combined perfusion-ventilation scintigrams are often diagnostic. The combination of dyspnea, tachypnea, low pO2, and low pCO2 in the presence of a nearly normal chest X-ray makes a diagnosis of massive pe most likely. In all unclear situations pulmonary angiography is important.


[Prevention and treatment of thromboembolism: diagnosis by roentgenology (author's transl)]. In 30% of our patients, thrombotic disease was an indication for phlebography. Visualization of veins was performed preferably by taking X-ray films of the ascending contrast medium. The radiologic findings of the acute stages include filling defects, irregular margins, and convex delineation. Post-thrombotic signs include lesions of the valves, recanalization, and collateralization. In cases of occluded inferior vena cava and axillary vein (Paget-von Schroetter Syndrome) collateral circulation occurs. In 80% of cases, phlebography provides important information following medical or surgical therapy.


[Physical possibilities for the prophylaxis of deep vein thrombosis (author's transl)]. The optimal physical prophylaxis for deep vein thrombosis is to ride a "bed bicycle" with elevated legs and elastic stockings, when lying in bed. The venous velocities achieved in legs and pelvis are 3--4 times faster than those evoked by walking, the method usually used. The incidence of thrombosis (125I fibrinogen test) up to the 5th postoperative day was 7.7%; in the control group, 38.5%. In patients who were weak, paralyzed, unconscious, relaxed, or with one leg, we obtained with "motor cycle" exercises the same success. The frequency of pulmonary embolism (autopsy findings) was reduced from 2.5 to 0.2%.


[Carcinoma of the breast: introduction (author's transl)]. In the German Federal Republic, carcinoma of the breast and colon lie close together as the second und third most tumors. We owe to our surgical forefathers of 100 years ago, Dieffenbach, Rotter, and Halsted, the decisive therapeutic advance whereby as a result of a better understanding of the anatomy of lymphatic drainage, excision of axillary glands and pectoralis muscle was first undertaken. Neither increasing the extent of the operation (superradical excision) nor reducing it (enucleation, partial mastectomy) has so far with any certainly proved as effective as radical mastectomy. The prevalence of various operations used in the western world was ascertained from a survey of about 1000 surgical clinics. With less extensive operations (enucleation) there is the special danger that the understandable desire to strive for a cosmetic result may vitiate the chance of cure.


[Anticoagulant-induced prophylaxis of thrombosis (author's transl)]. In postoperative and posttraumatic states, thromboembolic prophylaxis results in tenfold lower occurrence of pulmonary embolism and venous thrombisis--on which the postthrombotic syndrome is based--without a determinable increase of bleeding risk. Heparin is the treatment of choice. The dosage should be calculated on the basis of body weight. A minimal laboratory program of control measurements can diminish side effects.


[Prevention of thromboembolism with antiaggregants (author's transl)]. Experimental investigations have shown that antiaggregants affect the size rather than the rate of venous thrombosis, while clinical trials with prophylactic acetylsalicylic acid have indicated primarily a reduced incidence of pulmonary embolism. Current experiences with acetylsalicylic acid in combination with dipyridamole or low-dose heparin suggest that the incidence of pathology diagnosed by 125I-fibrinogen and of deep vein thrombosis is equally reduced.


[Dextran for the prophylaxis of postoperative thromboembolism (author's transl)]. Dextran has a well-documented antithrombotic effect that is due to a reduction in platelet adhesions, increased lysability of thrombi, and improved blood flow. Anaphylactoid reactions may occur during the first 30--50 ccm of dextran infusion. They have an incidence of 1:80000 during anesthesia. The main advantage of dextran prophylaxis is the lack of bleeding complications. It is extremely effective in lowering the incidence of lethal pulmonary embolisms.


[Medical treatment of venous thromboembolism (author's transl)]. In view of recent developments in thrombolytic therapy and in vascular surgery, practical treatment schedules are proposed for both superficial and deep venous thromboses of the leg and acute pulmonary embolism. The optimal selection and combination of physical, medical, and surgical measures are advocated.


[Operative therapy: thrombectomy, umbrella filter, caval ligation (author's transl)]. The goals of our therapeutic trials in acute leg and pelvic vein thrombosis are to 1. Prevent embolism, 2. Salvage the limb, 3. Prevent the postthrombotic syndrome. Early surgical thrombectomy guarantees salvage of the limb in most cases; the frequency of pulmonary embolism can be significantly reduced compared to the spontaneous course and frequency of the postthrombotic syndrome. For recidivistic pulmonary embolism the umbrella filter of Mobin-Uddin, which is implanted via a transjugular pathway, is today the treatment of choice. Further embolisms are rare. For massive lung embolism, extracorporal circulation is necessary: The formerly used Trendelenburg operation is no longer justified.


[Recent injuries of the femoral condyles (author's transl)]. The results of a multicenter study comprising 210 operated distal femoral fractures are reported and conclusions for the technique of internal fixation are outlined: After discussion of some details in osteosynthesis of easy supracondylar and condylar fractures, the stabilization of comminuted supracondylar fractures is described. The special steps in reconstruction of comminuted condyles are reported exactly, and the use of the condyle buttress plate is recommended.


[Injury of the patella (author's transl)]. Fractures of the patella account for about 1% of all fractures. They result from the impact of direct or indirect forces. Various fracture types are distinguished. Treatment of simple transverse or oblique fractures consists of anatomic reduction, with special attention to perfect reconstruction of the retro-patellar gliding surface. Tension banding is used for fixation to achieve functional stability. Comminuted fractures in the pole region may require partial resection along with careful reconstruction of the extensor mechanism. In cases of complete communition of the patella, early patellectomy is recommended and gives better results than late patellectomy.


[Injuries to the tibial plateau (author's transl)]. Conservative management of considerably displaced tibial head fractures tends to stretch the ligaments and damage the soft tissue. Plateau steps impair mobility and lead to secondary osteoarthritis. Therefore operative procedures are prefered: A buttressing plate supports the displaced condyle after exposure and immaculate reduction. Impacted fragments call for elevation and underlining by cancellous graft. Postoperatively, early active motion and late weight bearing is the rule. Operative procedures will only produce satisfactory results when performed by an experienced surgeon.


[Diagnosis of chondral injury in trauma of the knee joint (author's transl)]. Diagnosis of chondral lesions as the only injury in knee trauma is difficult: Lesions of the cartilage were found by arthroscopy, months or years after trauma, in 153 patients; the diagnosis was never suspected immediately after injury. Chondral lesions may be suspected from clinical examination but never proved. Contrast arthography may reveal the injury in exceptional cases. Only arthroscopy or arthrotomy can really prove or exclude injury to the cartilage. Arthoscopy is to he preferred because of the far lower morbidity and is more reliable because of a better view of the articular surfaces.


[Acute traumatic cartilage damage--therapy and results]. There is a high incidence of articular cartilage lesions together with other injuries of the knee joint. Single lesions are far more seldom. Difficulties in diagnosing cartilage lesions and the slow tendency toward recovery cause severe problems in treating this type of knee disorder. Elimination of enzymatic and mechanical interference and restoration of normal metabolic processes should be the therapeutic result. The plan of treatment depends on the pattern of the lesion. Conservative procedures or surgical intervention are possible methods of treatment. Both forms of therapy should avoid any immobilization of the knee joint whatsoever. Intraarticular injections are not indicated.


[Experimental studies on the pathophysiology of knee ligament lesions (author's transl)]. The cruciates and the collateral ligaments of the knee compare well with a crossed four-joint chain. In surgery of the ligamentous lesions of the knee it is essential to reinsert the ligaments exactly at their anatomic position. Studies of cadaver knees have demonstrated that the medial collateral ligament ensures medial rotational stability to a greater degree than the meniscofemoral and meniscotibial bands. In every stage of medial and anterior ligamentous lesions, external rotation in 90 degrees of flexion shows the same amount of anterior laxity of the medial tibial condyle as the test of Slocum. In contrast to Nicholas the pivot point in anteromedial complex instability is situated posterolaterally.


[Breast cancer--evaluation of diagnostic procedures (author's transl)]. The different diagnostic procedures used in the diagnosis of breast cancer are discussed. Clinical examination and mammography are the most important diagnostic steps. Needle biopsy with cytology is a very helpful further diagnostic procedure for the so-called triple diagnosis. The most important diagnostic procedure should be the diagnostic extirpation of the tumor with examination by frozen resection.


[Quality control of surgical care (author's transl)]. Based on studies carried on for more than ten years, various methods for voluntary quality control of surgical care are proposed. Besides short-term measures (e.g., "strategy of therapy"), a long-term pilot study would permit detection of defects and errors in surgical care through the recording of comparable data. An organization (similar to the Dutch "Concilium chirurgicum") should sponser visitations to various surgical centers. These two, strictly voluntary measures should form the basis for quality control that boots self-esteem of surgeons and does away with the need for state-sponsored measures.


[Explanations to the patients: a proposed method (author's transl)]. A stepwise explanatory process is proposed: through a brochure in which the type, significance, and, for the cautious patient, the major as well as minor risks are described (1st step), through a conference in which the individual circumstances are considered and the patient has the opportunity to ask more detailed questions (2nd step). The patient should guarantee in writing that he received the brochure, that he does or does not wish further explanation of the risks, that he consents to the operation and to necessary changes or elaborations.


[Prospects in surgery (author's transl)]. A discussion of prospects suffers from the fact that preduction of the future must be based on current modes of thinking. However, without prospects, i.e., without rational planning, the individual is left to chance. Reasoning governs the careful estimation of prospects and is applied to the following areas of interest: The importance of history in surgery, the necessity of supervised studies, operative training, instructing young surgeons, rotation, assessment of position, anthropologic nosology and surgical consequences, assistance in decisions about surgical work, the kind and function of linguistics in medicine and surgery, and the relationships between surgical colleagues.


[Regional anesthesia today--possibilities and limits: introduction (author's transl)]. The various procedures of regional anesthesia were widely used before the introduction of intratracheal anesthesia; thereafter, it was replaced by the today commonly used general anesthesia. Regional anesthesia nonetheless plays an important role, primarily in outpatient treatment, because a large number of surgical departments still have no anesthesiologist on the staff. Often the surgeon is responsible for both the operation and the anesthesia. Indications, risks, and complications including legal problems related to regional anesthesia are discussed.


[Indications and contraindications of regional anesthesia (author's transl)]. A short introduction about common techniques of regional anesthesia and statistical data about the percentage of such procedures carried out in our institute are presented. Important techniques and aims of regional anesthesia are clearly pointed out. The results of our study are discussed in detail, as are the advantages, disadvantages, indications, and contraindications of regional anesthesia. Finally the paper concludes with our impression of regional anesthesia, its significance and status in China.


[Interdisciplinary limits of jurisdiction and responsibility from a legal viewpoint (author's transl)]. In the interdisciplinary cooperation between the surgeon and the anesthetist, the following factors are in effect: the principle of strict division of labor; each brings the functions of his specialty and carries complete responsibility for them; the principle of trust: each can depend on the meticulousness of the other, as long as no obvious qualification deficiencies are apparent; obligation for coordination: each must accommodate himself to the requirements of the other specialty.


[New aspects of field blocks and peripheral nerve blocks (author's transl)]. There have been no new developments concerning field blocks. The need for limiting the dosage of local anesthetic agents is stressed. Two methods for perivascular block are described and the use of CO2 containing local anesthetic solutions is discussed as well as the employment of peripheral nerve stimulators.


[Experiences with brachial plexus blocks (author's transl)]. Experiences and results of 7212 brachial plexus blocks by the supraclavicular and 404 by the axillary approach are reported. The times of onset and duration of several local anesthetics are compared. The incidence of pneumothorax was 0.42% (30 cases) when the supraclavicular approach was used. Therefore the axillary technique is recommended to avoid this serious complication.


[Epidural anesthesia: indications and limitations (author's transl)]. The effectiveness and indications for epidural anesthesia have progressed in the last two decades. Better techniques, new long-acting local anesthetics, and better understanding of pathophysiologic changes after epidural block made this technique widely used and rather safe. Nowadays, limitations of epidural block include the absolute and relative contraindications, the lack of pharmacologic and pathophysiologic knowledge, and insufficient techniques and equipment. In experienced hands, epidural block is one of the safest techniques for surgical anesthesia.


[Intravenous regional anesthesia (author's transl)]. Experiences, with about 1500 cases of intravenous regional anesthesia in outpatient surgery of the limbs over 10 years are reported. In 1975, 158 operations out of 5960 were done using this technique. Intravenous regional anesthesia is suitable for surgery of the limbs, but time of operation should not exceed 90 min, nor should hemostasis be a major problem to consider and the course of surgery should be predictable. Contraindications for this type of anesthesia are hypertonia, lack of accessible veins, heart failure, children, as well as surgery of undefinite extent or for local sepsis. When these rules were followed, no serious complications were seen.


[Hygiene and asepsis in surgery: introduction (author's transl)]. Since the development of asepsis and clinical hygiene by European and American surgeons in the second half of the nineteenth century, the prevention of infection has been one of the most important concerns of surgical practice. However, owing to the rapid expansion of therapeutic methods, medical practice now makes greater demands on clinical hygiene than has hitherto been the case; it has not always been possible for developments in clinical hygiene to keep pace in this respect, and the closing of the resulting gap represents one of the most urgent tasks confronting medicine today.


[Surgical treatment of the mammary carcinoma according to stage (author's transl)]. Improvement of the results of treatment was achieved only when an increased number of patients were diagnosed in stage I. The prerequisite for limitation of radical surgery is histomorphologic classification of the stages. The central axillary group of lymph nodes appears to be representative of lymph node involvement. Differentiated methods of operations range from local excision to mastectomy in case of precancer. In histologic stage I, modified radical mastectomy; is the treatment of choices; operations with further limitations are recommended only within the scope of controlled studies. In stage II, the classical ablation is still the safest procedure.


[Surgical and hospital hygiene (author's transl)]. The decades-old rules of surgical asepsis and antisepsis are more valid than ever before. The responsibility for hygiene must be clearly established: in his particular area, the surgeon, and he alone, is responsible. Patients with an increased susceptibility to infection as well as human and personnel inadequacies represent the greatest stumbling blocks in efforts to improve the status of hygiene.


[Clinical hygiene: practice vs. theory (author's transl)]. The purpose of clinical (hospital) hygiene is to prevent health hazards, above all hospital-acquired infections, and thereby to support the clinician. Its measures are always applicable in hospitals and clinics where clinical hygiene is considered important. Clinical hygiene procedures are not practical if the necessary though inconvenient changes in personnel practices have not been established. Personnel requirements are hard to meet in that there is still a shortage of qualified individuals, i.e., hygienists, etc. Expensive constructional changes are worthwhile only if the clinical staff is prepared to observe the hygiene measures as closely as possible.


[Urological and nephrological complications after general surgery. Urological complications. Kidney and ureter]. Urologic complications can result from abdominal, gynecologic, and retroperitoneal operations. As a result, surgical treatment of colonic tumors, genital tumors, the vertebral column, the lymphatic system, and the aortoiliacal vessels assumes a greater importance. Immediate therapy is possible as a result of intraoperative diagnosis. The postoperative diagnosis may become manifest as early or late symptoms. Certain criteria for avoiding such complications are mentioned. Following diagnosis of a urologic complication, immediate therapy seems to produce the best results and the shortest period of hospitalization.


[Disturbances of micturition after general surgical operations (author's transl)]. Impaired micturition after general surgical operations can be due to three causes, which occur individually or in combination. The first comprises side effects of anesthetics upon the autonomic nervous system. Inhibition of the abdominopelvic reflex, initiating micturition, due to the operative trauma represents the scond cause. Both the vegetative and the mechanical traumas, lead to decompensation of the urinary bladder, whose function is impaired by neuropathic factors and outflow obstruction. Pulmonary, cerebral, and abdominal insufficiency prolong the effects of both traumas. The third cause is direct operative injury of the sacroplexus pelvus.--Approximately 25% of all patients undergoing surgery will shown voiding disturbances in the postoperative period. The treatment consists sympatholytic therapy. In cases of neuropathic and obstructed bladders, the treatment of choice is transurethral correction of the bladder outlet.


[Urologic complications after general surgical procedures: genitalia]. Atrophy of the testicles after herniorrhaphy is the most frequent (1.8%) urologic complication in general surgical procedures. In two-thirds of the cases the damage is bilateral. Tips are pointed out to avoid the loss of penile erection after amputation of the rectum or evisceration of the pelvis, as well as to avoid complications after Bernardi-Ivanissevich or Palomo procedures and sterilizing vasectomy.


[Renal complications after general surgical operations (author's transl)]. Oliguria, an easily recognizable symptom of postoperative acute renal failure, is analyzed schematically in terms of various diagnostic aspects and a pragmatic therapeutic procedure. Differentiation among pre-, intra-, and postrenal disturbances is important. Acute renal failure caused by simultaneous and often severe insufficiency of other organs, especially in combination with septicemia, still has a bad prognosis. Prophylaxis in the form of adequate volume substitution and shock therapy is urgent in each case.


[Breast cancer: postoperative care (author's transl)]. Sixty percent of breast cancer patients show postoperative morbidity due to local recurrence or metastases. For these women and those who suffer from therapy-dependent somatic or psychologic disorders, organized postoperative care is necessary. Mode of action and organization of the Heidelberg postoperative care unit are described. An evaluation of postoperative care programs in Germany, Austria and Switzerland reveals the necessity of increasing our activities. An interdisciplinary approach in this field is of great importance.


[Carcinoma of the breast. Reconstructive surgery]. Every year in the German Federal Republic there are 15000 new cases of carcinoma of the breast in woman. In those cases in which metastases in the lymph nodes have not appeared, the rate of recovery is so high that a rehabilitation is worth careful consideration in each case. Methods of operation have been worked out over years of experimentation, with results that are now so good that not only breast-like forms, but genuine female breasts are created. With the reconstruction possibilities, the quality of the patients' survival time is improved.


[Malignant tumors of the small intestine (author's transl)]. Tumors of the small intestine are rare as compared to other tumors of the gastrointestinal tract; clinical symptoms are unrevealing for long time, thwarting an early diagnosis. Detection of these tumors by x-ray examination is successful often only after several attempts. Case reports are given of 7 patients and difficulties of making a diagnosis are discussed. Radiological methods are described; differential diagnosis of x-ray findings is expecially difficult. A histological diagnosis by endoscopic or intraoperative biopsy should always be tried. Surgery is necessary in every case in order to restore normal passage.


[Eosinophilic granuloma of the gastrointestinal tract (author's transl)]. The eosinophilic granuloma of the intestine is a rare disease and is difficult to classify as far as etiology and pathogenesis are concerned. Unexplained, recurrent colicky obstipation and diarrhea accompained by anemia should induce x-ray examination of the small intestine and selective angiography in case of acute bleeding. Therapy with corticosteroids is justified in cases with diffuse involvement of the intestine without stenoses or ulcerations. Otherwise surgical removal of the involved segments with cure the disease, which is always benign.


[Demonstration of a bile fistula caused by liver biopsy by way of endoscopic retrograde cholangiography (author's transl)]. ERP may be indicated in hepatic disease with or without cholestasis. A complete display of the bile duct system has to be achieved, if cysts or tumors are to be detected, by direct or indirect involvement of the bile ducts. A case is reported of a bile fistula caused by liver biopsy.


[Corrosive lesions of the upper intestinal tract in gastrectomized patients (author's transl)]. Lesions of the upper gastrointestinal tract caused by acid or alkaline solutions are generally limited to the esophagus and the stomach, because of physiological blocking mechanisms. In patients partially gastrectomized noxious solutions however can enter into lower parts of the gastrointestinal tract and cause severe lesions. Among 74 patients observed with corrosive lesions of the gastrointestinal tract two had undergone partial gastrectomy (Billroth II) previously. In these 2 patients very severe lesions of the intestinal mucosa were initiated; one of these patients died in spite of two resections of parts of the small intestine after massive gastrointestinal hemorrhage. These additional complications have to be foreseen in gastrectomized patients with corrosive lesions of the gastrointestinal tract.


[Inhibition of histamine-sensitive adenylate cyclase system of human gastric mucosa by cimetidine (author's transl)]. Human gastric mucosa contains a histamin-sensitive adenylate cyclase system. The activation of this enzyme system by histamine is competititively inhibited by the H2-receptor blocking agent cimetidine. Our results underscore the rational basis for the use 0f H2-receptor antagonists in the therapy of peptic ulcer.


[Tolerance of carbenoxolone sodium in elderly patients (author's transl)]. Eighteen elderly patients (average age 72.3 years) suffering from cardiac failure and from chronic gastric ulcers received carbenoxolone sodium, the risk of surgery being considered too high. The effects of this medical treatment were followed up closely. Side-effects were observed in 12 patients. In 9 patients these effects had to be taken care of (hypokalemia in 5 cases, rise of blood pressure in 3 cases, edema in 3 cases). In 2 cases treatment had to be stopped. The side effects observed in elderly patients with cardiac insufficiency make it mandatory to administer carbenoxolone sodium to this group only during hospitalization, which allows, frequent controls of body weight, blood pressure, serum potassium and transaminases. In most cases side effects can be detected early enough and treated.


The medicolegal investigation: evaluation of cases with potential medical litigation. A medicolegal autopsy protocol must serve as something more than an esoteric scientific document. It will be read by all persons interested in knowing how and of what the person died, and these readers might include family members, insurance representatives, police officials, attorneys, judges, and juries.... The writing of a medicolegal autopsy protocol is a difficult task since it must not only enable the author to recapture the details of the event at a later date if he is called to testify, but it must also provide necessary and understandable information to a variety of other individuals with varying backgrounds whose understanding of the findings is essential to a final disposition of the case.


The medicolegal investigation of operating room associated deaths. For those medicolegal investigative systems charged by statute with the responsibility of investigating and examining known or suspected iatrogenic deaths--whether in a perioperative or operative situation, or in some other relationship to medical intervention--there is usually little doubt that these types of investigations constitute the most difficult, often perplexing, and far-reaching investigation, examination, and reporting problems of any of the types of cases referred. Much of this difficulty derives from the changing attitude of the public at large, including the medical and the legal community. In the United States, as recently as 15 years ago, the loss of life or injury subsequent to a therapeutic or operative procedure, with rare exception, was accepted virtually as an act of God.


Leucine and isoleucine as in vitro precursors for lipid synthesis by rat aorta. The in vitro conversion of 14C-labeled leucine, isoleucine, and pyruvate to specific lipids was compared in rat aorta, diaphragm, anf fat pad. Total lipid specific radioactivity from all precursors was greatest in aorta. The ratio of label incorporated into polar lipids vs. neutral lipids by aorta was generally several-fold that incorporated by muscle and fat pad. The labeling of sterols in the aorta from 14C-leucine and pyruvate was equivalent. It is concluded that leucine may be a substantial precursor to polar lipids and to sterols in rat aorta.


Effect of polyunsaturated fatty acids of the alpha-linolenic series on the development of rat testicles. The effect of 22:6 omega 3 acid provided by dietary fish oil on the development of germinal tissue of rat testes, fatty acid composition of lipids, and linoleic or alpha-linolenic acid delta 6 desaturation capacity was investigated. Results were compared to those obtained in animals fed methyl palmitate and sunflower seed oil (linoleate). At 7 and 9 weeks of age, development of germinal tissue of animals fed fish oil was normal. The fatty acid composition showed a decrease in 22:5 omega 6 acid content and an increase in 22:6 omega 3 acid in triacylglycerol, phosphatidylcholine, and phosphatidylethanolamine. The fatty acid delta 6 desaturation capacity of testicules microsomes was increased. It is suggested that 22:6 omega 3 acid may functionally replace 22:5 omega 6 acid in germinal tissue.


A simplified colorimetric micromethod for determination of serum cholesterol. A simple and rapid micromethod is described for quantitation of cholesterol in 5-10 microliter of serum using uranyl acetate to deproteinize the serum and o-phthalaldehyde reagent to develop color. Independent analyses of serum samples by the present method and by two reference methods, Abell-Kendall and automated colorimetric method, indicated accuracy of the micromethod (r = 0.99). Use of capillary blood specimens makes this procedure applicable for screening infants and small children.


Fatty acid and sterol synthesis by rat small intestine in vitro. Slices of rat jejunum were incubated with [2(-14)C] pyruvate, [1(-14)C] acetate, or [3H]H2O to determine lipogenic activity. Under all conditions studied, pyruvate acted as a better precursor than acetate for fatty acid synthesis but not for the synthesis of sterol. Exogenous glucose significantly (P less than or equal to 0.05) increased the conversion of both pyruvate and acetate to fatty acids. By contrast fasting resulted in a decrease (p less than or equal to 0.05) in lipogenic activity. The highest levels of lipogenesis were observed when [3H]H2O + glucose at a concentration of 20 mM was used. From such experiments, the absolute rate of fatty acid synthesis in the tissue preparation was calculated: 734 +/- 54 nmoles acetyl units incorporated into fatty acids/g tissue/hr.


Triglyceride composition of bovine milk fat with elevated levels of linoleic acid. The effect of increasing the linoleic acid (18:2) content of milk fat on the composition and structure of the triglycerides (TG) was investigated. Protected sunflower seed supplement was added to the diet of a cow grazing on pasture, and the structure and composition of the milk fat compared with the milk fat from its monozygous twin which had been fed a control diet. The relative proportions of TG fractions of high, medium, and low molecular weight in the milk fat with elevated levels of 18:2 (15.5% 18:2) were 43.0, 19.5, and 37.5 moles %, respectively, compared with 36.1, 19.7, and 44.2 moles %, respectively in the milk fat from the cow fed the control diet. Separation of these three TG fractions of each milk fat into TG classes with different levels of unsaturation showed that the milk fat with elevated levels of 18:2 contained higher proportions of diene, triene, and tetraene TG and correspondingly lower proportions of saturated and, to a lesser extent, monoene TG. The saturated and monoene TG from the two milk fats had similar fatty acid compositions. However, the diene TG of the 18:2-rich milk fat included high proportions of the combination of 18:2 with two saturated fatty acids (FA) which are minor constituents of normal milk fats. Likewise, the triene TG reflected the presence of 18:2 in combination with 18:1 and a saturated FA.


Capacity of young males and females for running in desert heat. Tolerance for sustained activity in the desert at about 40 degrees C was assessed on high school students, mostly athletically oriented and scholastically superior. The 14 males compared with the 12 females had an aerobic capacity greater by about one-half and a percentage of body fat smaller by about one-half. Each sex attained about the same percentage of aerobic capacity in their maximal sustained effort. This involved an increase in metabolic rate of 3 to 5 fold in females and 6 to 8 fold in males. In maximal sustained effort responses of males and females were alike in respect to rectal and skin temperatures and heart rate. At a rate at which nearly all walked for one hour, 100 m/min, there were no significant differences in metabolic rate, sweat rate nor in composition of sweat. Running at 120 m/min required maximal effort by most females; their maximal sweat rates ranged from 7.4 to 14.2 ml/m2.min. Most males were able to run at 160 m/min for one-half hor to one hour; their maximal sweat rates ranged from 11.3 to 14.6 m/m2.min. Superior capacity of males over females for sustained exercise in desert heat is related to their higher aerobic capacity and not to a difference in capacity for thermoregulation.


Cardiac outputs of post-myocardial infarction patients during swimming and cyclic. We compared the cardiovascular response of post myocardial-infarction (MI) patients and inactive normal subjects at submaximum and maximum intensities of tethered swimming and upright cycling. At any given oxygen uptake (VO2), the inactive normals had similar cardiac outputs (Q) and heart rates (HR) during swimming and cycling, whereas the post-MI patients had lower Q's and higher HR's during swimming compared to cycling. The maximum response of inactive normals were not significantly different during swimming and cycling, but during swimming the post-MI patients had a 21% lower VO2. The lower VO2 swimming was due to a lower Q. While swimming at any exercise rate including maximum, the stroke volume (VS) of the post-MI patients did not increase above resting VS seated. Therefore, any increase in Q during swimming was due solely to increases in HR. Since the HR's of the post-MI patients were not significantly different during maximum effort swimming and cycling, the intensity of swimming can be safely prescribed from the maximum HR achieved cycling.


Exercise-induced changes in blood, red cell, and plasma volumes in man. Changes in blood (BV), red cell (RCV), and plasma (PV) volumes were computed from hemoglobin and hematocrit values during submaximal treadmill exercise at 5 work intensities (30, 45, 60, 75, and 90% VO2 max) in 5 male subjects. RCV remained constant under all conditions. Changes in BV (hemoconcentration) could, therefore, be accounted for entirely by decreases in PV at all work levels. PV was a linear function of work intensity from rest through 60% VO2 max. However, a "break" occurred at that point in the data. Modeling of this break was accomplished by the use of one model (the "Fold" catastrophe) taken from the generalized catastrophe therory. However, several limitations to the acceptance of the model are presented, including the need to demonstrate a hysteresis in PV occurring at about 65% VO2 max.


Hemodynamic response to submaximal exercise after dehydration and rehydration in high school wrestlers. Cardiac output (Q), heart rate (HR), stoke volume (SV), and arteriovenous oxygen difference (AVD) were measured in 16 high school wrestlers during submaximal work (65%Vo2 Max) at normal weight (T1), after a four or five percent weight loss (T2), and following one hour of rehydration (T3). Weight losses were accomplished over 48 hours by fluid and food restriction as well as intermittent exercise. An ad libitum volume and commercial glucose-electrolyte solution was used to rehydrate the subjects. At T2 the mean weight loss was 4.6%, with the average plasma deficit estimated to be 4.9%. Under these conditions significantly higher HR and lower SV were observed during standardized exercise. Although Q was 7.8% lower and AVD was 7.3% higher after dehydration, neither change was statistically significant. Following rehydration all dependent variables returned to near T1 levels. It was concluded that despite a short rehydration period, the cardiovascular dynamics of these high school wrestlers rapidly returned to normal during moderately heavy work because of the small plasma changes that accompanied the 48-hour weight loss.


The exercise electrocardiogram in trained and untrained adolescent males. Exercise electrocardiograms (Ex ECG) were performed on both trained and untrained adolescent males to determine whether a difference exists between the normal adolescent and normal adult male. Exercise was performed on a mechanically braked bicycle ergometer using an intermittent work load protocol, and the Ex ECG's were analyzed according to J-point displacement and ST segment slope. No J-point depression was seen and the ST segment slope was positive during exercise in both trained and untrained subjects. There was no difference in the J-point displacement or the ST segment slope between the trained and untrained subjects. This study suggests that any J-point depression during exercise may be abnormal in the adolescent male. Training does not have an effect on the J-point or ST segment at maximum exercise.


The psychobiological model and multiple discriminant function analysis of high-calibre oarsmen. Candidates for New Zealand rowing teams (N = 181) were given a battery of physiological, performance, anthropometric and psychological tests in order to test the psychobiological model for prediction of athletic success. A series of stepwise multiple discriminant function analyses were conducted on both separate sub-sets of variables and their combinations. The expectation that the model would not differentiate between the three age categories of oarsmen (Juniors, Colt and Senior) except for age-related factors was upheld. A more specific test of the model was an examination of the accuracy of discrimination within each age group between those who were selected for New Zealand teams and those who were not selected. The results indicated that such differentiation was best when the biological and psychological variables were used in concert. The major discriminators between selected and nonselected oarsmen on the psychobiological functions were certain anthropometric and psychological variables. Further support for the notion of the existence of a rowing stereotype was provided by testing the Senior discriminant function on the other two groups. It was concluded that the results were in accordance with the multidisciplinary psychobiological model.


Parameters of injury reporting in skiing. An injury survey of 505 skiers from the 1971-72 and 5,459 skiers from thh 1972-73 season collected 601 time loss injries for a rate of 9.31000 skier days. Forty percent of these injuries were reported to a ski patrol and almost 60 to physicians. Fractures and lacerations were reported to the patrol more frequently than other injury types, bruises and strains less commonly. Injuries not reported to patrols and physicians were primarily bruises, sprains and strains. Although fractures were almost invariably reported to physicians, one in four was not seen by the ski patrol. Patrol-only or physician only reported injuries thus do not represent the full spectrum of time loss skiing injuries.


Metabolic responses to interval training programs of high and low power output. The metabolic responses of 30 college-aged males were compared following high power (30-sec runs with 19 repetitions-Group HP) and low power (120-sec runs with 7 repetitions-Group LP) interval training programs (8-wk, 3 days/wk). Measurements included: maximal aerobic power (Vo2max, open circuit spirometry); maximal lactacid capacity (net-LAmax, blood LA accumulation following exhaustive exercise); net energy production (net Vo2 and netLA) following a 2-min run that was exhaustive before but not following training; and maximal muscular power (stair-climbing procedure). The results indicated: 1) significant but equal increases in Vo2 max in both groups; 2) no change in either group in netLAmax; 3) net Vo2 during the 2-min run was unchanged, however, netLA was significantly greater in Group LP; 4) no changes in either group in muscular power. It was concluded that low power and high power output interval training programs elicit similar changes in maximal aerobic and anaerobic metabolism, and that the physiological and or biochemical changes responsible for lowered lactic acid production during heavy, but submaximal exercise following training are produced to a greater extent by the low power program.


["DKS4T-01 Monitor" complex for the control of the status of critically ill patients]. To exercise control over the condition of critically ill patients a monitoring unit DKC4T-01 which permits it to measure the cardio- and hemodynamic parameters is recommended. The monitoring unit signals "alarm" when the pertinent indicators deviate from the permissible values. The block-wise design of the unit allows also the separate use of individual instruments and devices of this complex setup.


[Comparative study of different artificial heart designs]. The results subsequent to investigations of 3 artificial heart constructions effected on a hydrodynamic stand are reported. The values of the artificial heart resistances during the systole and diastole were determined, these being shown to stand close to one another in all of the designs under review.


[Universal broadband ultrasonic apparatus for use with biological objects]. To obtain bacterial and medicinal aerosols and to study the action of an ultrasonic field on various biological objects an all-purpose broad-band ultrasonic set-up, operating within a frequency range of 0.2-5.0 MHz has been constructed.


[Device for studying the kinematics of movement of closing elements in artificial heart valves]. A device designed for studying the motion kinematics of locking elements in the artificial cardiac valves is described. The principle of its operation is based on the photoelectric registration with subsequent electronic differentiation of the electric displacement signal. The length of measurable linear displacement is 0+20 mm. The amplitudinal-frequency characteristics of the differentiator is linear within the range of 0+120 Hz. The error of the displacement and speed error--not more than 5 per cent.


[Universal electrocardiographic belt for precordial leads]. For recording ECG in precardial leads sucker electrodes which have a limited application and short service life are employed most often. A construction of an elastic belt for precardial leads, suitable for examination of adults and children in any patient's posture, is proposed. The belt is distinguished by its long service life and it cuts in half the time needed for examination of the patients.


[Method of bench testing an artificial heart]. A procedure for bench trials of the artificial heart (AH), that comes to determining the relationship between the AH performance and the duration of the systole with constant pressure differentials at the in- and outlets of the AH and pulse rate. The results of the AH trials by the proposed procedure are described.


[Apparatus for electric stimulation of the neuromuscular apparatus]. The application of the unit for electric stimulation of the neuro-muscular system with the use of a selected stimulus permits it to produce contraction of the muscles with the minimal energy of the stimulus and the least possible pain sensation. As such a stimulus serves a radio-pulse with a carrier frequency of 10 kHz and having a form enveloping the impulse emerging in the motor fiber. These stimuli are produced in electric stimulators of the type "Bion".


[Test of the "Biopulse-3" aortic balloon pumping apparatus]. Experiments on a specially constructed laboratory stand were set up with a view to determining power and dynamic possibilities of the translatory motion drive in the "Biopulse-3" unit when operating an intra-aortic ball-pump and also assessing the service properties of individual unit-blocks intended for injection, measurement and registration. Trial testing showed the drive to the suitable for using in the intra-aortic ballooning.


[Dimethylpolysiloxane reinforced film in a membrane oxygenator]. With the purpose of diffuse membranous oxygenation of blood the possibility of employing a Soviet-made dimethylpolyxyloxane-reinforced film "Sigma" was investigated. The test-trials were carried out with a membranous oxygenator of the "Sandwich" type. In 15 acute tests on dogs a partial cardio-pulmonary pass-by shunting with oxygenation of the blood after the veno-venous or veno-arterial perfusion was performed. With the mass-exchange area of 1.15 m2 the oxygen transport in different tests varied within a range of 20-50 ml/min and depended upon the arterio-venous difference and the circulation rate. No disruptions in the elimination of carbon dioxide were in evidence. In the course of investigations the "Sigma" material was found to be strong, impermeable to liquids and is not subject to swelling following its long-term use.


[Working organs of actuating devices for assisted circulation]. Business ends of operating mechanisms for assisted circulation, based on the principle of contrapulsation, must satisfy a number of requirements on which the safety and the effectiveness of their performance depend. Among these of particular importance are the working volume of the arrangement, correct conformity of the balloon and aorta diameters and also the duty cycle of the arrangement.


[Blood microfilters].

[Blood microfilters]. In preserved blood and during extracorporeal circulation there become formed micro-aggregates which fail to be entrapped by standard filters. The emerging there-from microembolisms provoke functional disorders in vital organs and account for unfavourable outcomes of the treatment. Basic trends in the microfiltration of the blood are analyzed, a classification of microfilters according to their design features and purpose is given, along with the medico-technical requirements they have also to meet the performance characteristics of the most wildly used microfilter models, are listed.


[Hydrodynamic stands for testing assisted circulation and artificial heart apparatus]. Problems arising in devising the assisted circulation apparatus and artificial heart can be solved only with investigations conducted on hydrodynamic models of the circulation system--the stands. An analysis of literature sources dealing with test stands justifies their classification according to the purpose, the types of tests, the specific structure and basic characteristics. It is necessary to proceed with further improvement of the stand equipment in the direction of creating a sufficiently accurate imitation of the anatomic structure and resilient properties of major arteries and veins, of constructing a geometrical and elastic model of the aorta, of pressure and flow control instruments at different points of the vessels, of the ones regulating the energy parameters, as well as of working out criteria for effectiveness of the devices to be used.


[Efficiency of a new blood membrane oxygenator]. Three modifications of a stationary membranous oxygenator (SMO) with utilization of new selective compositional membranes were developed. Test procedures for the SMO in the system gas-gas and gas-blood on a stand and in acute experiments on animals are described. The results obtained demonstrated that as concerns the transport of oxygen and carbon dioxide, as well as the stability in operation it is the model with the projections coincidently positioned on the upper and lower membranes whereby the peripheral blood is fed most efficiently.


[Activity of beta-glucuronidase in peripheral blood leukocytes in rats subjected to subacute benzene vapor poisoning]. The work presents the results of investigations on the activity of beta-glucoronidase (B-GR) in neutrophiles and lymphocytes of peripheral blood in rats of Wistar strain exposed to benzene vapours of the concentration 27000 mg/m3, 6 hrs daily for 10 consecutive days. The activity of the enzyme in both types of cells was determined by cytochemical method; Hayashi et al. After an exposure to benzene, a statistically significant reduction of the number of granulocytes and lymphocytes was found. The activity of B-GR in granulocytes was lowered 5--times compared with the initial value (before exposure). The per cent of B-GR--positive lymphocytes was not changed. Instead, apparent changes in proportional values of individual types of enzyme--positive cells were found. The per cent of granular lymphocytes decreased, and at the same time the per cent of granular--diffusive and diffusive lymphocytes increased. The authors think that benzene affects granulocytes cells depressively and that it is an active labilisator of lysosomal lymphocytes. They set their hopes on the observed phenomenon to elaborate an exposure test to benzene.


[Epidemiological examinations of peptic ulcer in coal miners. III. The course of peptic ulcer and its effect on work efficiency]. These examinations are based on an individual questionnaire and medicinal documentation of 8302 miners employed in 3-coal mines. In the previous parts an influence of occupational factors and socio-living conditions upon the occurrence of peptic ulcer in miners was presented. At present, on the ground of an analysis of 657 cases of peptic ulcer found among the examined population, considerable differences in the course of the disease in individual employed groups were found. In underground miners the cases with frequent recurrences were more frequent, compared with the staff employed on the surface. The amount of sick leaves caused by peptic ulcer was five times greater; the rate of absenteeism was the greatest. Recent cases (lasting no longer than 5 years), prevailed. Among the surface workers, as opposed to the under-round staff, almost all the cases of peptic ulcer called for hospital treatment. The percentage of chronic cases was much greater, the amount of complications and operations was twice as great. Sickness absenteeism caused both by peptic ulcer and other diseases was incresed. Hence it is evident that the work underground is too strenuous for those suffering from gastric ulcer and the miners with a heavy course of the disease most probably change the work i.e. they are transferred to the surface.


[Myocardiopathy and arterial hypertension in coal miners in the Rybnik region]. Examinations were carried out on the frequency of the occurrence of myocardiopathy and arterial hypertension in 492 miners and 175 manual workers employed on mines surface. Physical symptoms of cardiac muscle degeneration were found in 7,3%, electrocardiographical symptoms in 11,1%, whereas in 9,9% miners hypertension was found. No significant difference between the frequency of these diseases in pit miners, as compared with those manual workers working on the surface of the mines, was found.


[ECG picture in persons exposed to carbon disulfide]. Electrocardiograms were examined in 121 persons exposed to carbon disulphide (CS2). The control group consisted of 77 persons, employed in the divisions whose activity range is similar to that of exposed workers. A more frequent occurrence of abnormal electrocardiograms was found in the workers exposed to CS2, compared with the control group. Most frequently they comprised dysrythmia, disturbances in conduction, and occurrence of focal changes of cardiac muscle--which were not found in the subjects of control group. The occurrence of changes in ECG picture should be connected with the occurrence of premature atherosclerosis in the workers exposed to CS2. A permanent observation of ECG picture in those exposed to CS2 will allow an earlier prophylaxis of carbon disulphide intoxications.


[Relations between working conditions and occurrence of vibration disease in forestry workers. I]. The level of mechanic vibrations intensity of 20 motor saws of the BK-3a type and 5 saws of the Partner R-11 type was determined and the evaluation of 460 motorsawers' vibration exposure--in case of working on these types of saws--was performed. The evaluation covered saws of various technical conditions, with which felling, cross-cutting and trimming of soft and hard timber were performed. The vibration measured exceeds 3--5 times Soviet hygienic normatives and ISO, especially in octave frequencies of 63 and 125 Hz. The intensity level of vibrations was significantly dependent on the technical conditions of the saw, activities performed with it and the hardness of timber. The evaluation of the woodcutters' exposure to vibration in a day, a year and the whole employment period was performed on the basis of the test-checking, the ammount of timber produced, fuel used for the saw and days of saw-work. Daily exposure to vibration was 2,4 +/- 1,2 hours and was of intermittent, irregular character. Motor-sawers worked with saws from 31 to 296 days a year, producing yearly from 973 to 10.503 m3 of timber as m3 of timber felled.