[The correlation of glucose-concentration and acid-base-balance of the maternal and fetal blood during labor (author's transl)]. The aim of the present paper was to investigate if the glucose concentration of the fetal blood is reduced already during parturition. It was further of interest if there is a relationship between the glucose concentration in the maternal blood and the acid-base-balance of the maternal and the fetal blood, respectively. The observations comprised 40 patients during labor. Blood was sampled from the hyperemized fetal scalp and the umbilical artery. The maternal blood was collected from the hyperemized earlobe and fingertip, respectively. The blood was analyzed for pH, PCO2, base excess and blood glucose. The dip area (DA) was taken from the cardiogram and measured by planimetry. During labor the blood glucose increased in the fetal blood from 67 mg% (SD 12) to 87 mg% (SD 23) (2 alpha less than 0,001) and in the maternal blood from 88 mg% (SD 14) to 113 mg% (SD 29) (2 alpha less than 0,02). There was a significant correlation between the fetal and maternal blood glucose concentrations. The increase of the fetal glucose concentration is, however, less with increasing maternal blood glucose. (b = 0,66). The base excess in the maternal and fetal blood fell significantly. The rise of the maternal and fetal base excess (= base deficit) was related to the increase of the glucose concentration (2 alpha less than 0,001). If the base excess was zero, the fetal and the maternal blood glucose was 46 mg% and 78 mg%, respectively. The difference between the maternal and fetal blood glucose was 28 mg%. With increasing DA the fetal blood glucose increased (2 alpha less than 0,001.). From the observations it is concluded that there developes no hypoglycemia during parturition. This is due to the correlation found between fetal and maternal blood glucose and due to the rise in fetal blood glucose during hypoxia. Obviously, the decrease in fetal glucose following delivery is caused by a lack of glycogen which is enduced during labor and strengthened by a deficit of enteral glucose supply.


[A suggestion for the evaluation of the antepartal cardiotocogram (author's transl)]. An evaluation scale for the antepartal cardiotocogram is suggested which is intentionally based on the Apgar scale. Five criteria were evaluated: three characteristics of the basal fetal heart rate and two characteristic, recognized alterations in heart rate. In regard to the interpretation of the basal heart rate, level, range and number of flat readings per minute are significant for the prognosis. Alterations in heart rate permit a prognostic statement depending on the form and type of the acceleration and deceleration 0-2 points are given for every characteristic so that the index can vary from 0 to 10 points. The condition of the fetus is physiologic when the index is between 8-10, the prognosis is questionable when the index is between 5 and 7 and the condition of the fetus is critical when it is 4 or lower.


[The importance of the risk factor "obesity" during gravidy (author's transl)]. Between 1. 6. 1972 and 31. 12. 1974 obese gravidae with a body weight of 90 kg or more were observed (7,6% of all patients in this period). This 315 patients were compared with a group of 315 patients with normal body weight chosen by random. The results of both groups were compared and evaluated by statistic (t-test, x2-test). A significant higher rate of Diabetes, latent Diabetes, EPH-Gestosis and cases of over-term deliveries were found in the group of obese patients.


[The importance of the risk factor "obesity" during delivery, postpartal and for the newborn (author's transl)]. The course of delivery and labor, the post partum period and the postpartal condition of the newborn were reviewed in 315 obese patients with a bodyweight of 90 kg or more at delivery. The results were compared with those of a group of 315 patients with a body-weight of less than 90 kg, choosed by random and evaluated by statistic (t-test, x2-test). In the group of obese gravidae we found a significant higher rate of cases with induction of labor, protracted deliveries, breech presentation and operative deliveries. Also the rate of manual removal of the placenta, post partum uterine infections and disorders in the milk secretion was significant higher in this group. Post partum abnormal glucose tolerance tests ocurred abnormal more frequently in the obese patients. The weight of the infants of obese mothers was higher as in the control group. Significant higher were the perinatal mortality and the cases of fetal death in utero in the obese group compared to the non obese group.


[Are more girls than boys born in breech presentation compared with head presentation?]. In breech presentations a little more girls are born than boys, among head presentations there is a slight excess of boys. Among the factors favoring pelvic presentation birth weight has, according to present investigations, a decisive influence on the different sex relationship in the two presentations. Boys are little more common than girls in head presentation in the higher weight groups, in breech presentation in the upper and lower weight groups, while girls predominate in the middle weight groups. The absolute size of the middle weight groups in breech presentation causes the small excess of girls. A possible link with the slightly higher mortality of boys during the first year and its higher incidence in very high and very low weight groups are discussed as well as the dependence of the production of breech presentation on weight and mobility of the fetus.


Placental transfer of thiamphenicol.

Placental transfer of thiamphenicol. The placental transfer of thiamphenicol was studied in 29 subjects at term after intravenous bolus injection of 500 mg of the drug. Detectable plasma levels were present in umbilical blood and amniotic fluid as early as 5 and 18 minutes, respectively, after maternal administration. With the dosage applied, minimum concentrations required for the inhibition of many organisms causing intrauterine infections were reached in maternal and fetal plasma and in amniotic fluid. The value of thiamphenicol for the treatment of intrauterine infections is discussed.


[Prenatal weight loss in the infant (author's transl)]. Hillemanns and coworkers established, that infants born after induced labor were heavier, on the average, than those from a control group; who were born after spontaneous labor. Since it was postulated, that a weight loss preceded the onset of spontaneous labor, the birth weight and length of 444 infants born after induced labor and 70 infants born via a primary cesarean section was compared with a control group of 1,028 uncomplicated births via spontaneous labor. Thirty seven post term infants were also included in the study. The birth weight and length of infants after induced labor or delivered by primary cesarean section significantly higher than those in the control group. The post term infants were also significantly longer, but their weight was not significantly lower, than that in the control group. The major differences could not be accounted for by varying periods of gestation nor could they be accounted for by the special conditions of induced labor or cesarean section. Therefore, the only possibility remaining is that a weight loss precedes spontaneous labor. This may possibly be explained by the reduction in the relative water content which begins before birth and continues through the newborn period or by a relative placenta insufficiency. The infant weight loss and loss of amniotic fluid after the thirtyeighth week of pregnancy refutes the theory, that birth is induced by a stretching of the uterine wall. The possibility is discussed, that the onset of labor is influenced by a corresponding relief from tension such as that, which occurs following a premature rupture of the fetal membranes.


[Four cases of extrapyramidal effects following the treatment of hyperemesis gravidarum with triflupromazin (author's transl)]. Report of four cases of extrapyramidal effects following the treatment of hyperemesis gravidarum with neuroleptica (Triflupromazin). A short list is made of the common preparations and their neuroleptic potency. The pathophysiological theory is mentioned and the simple and very effectfull therapy with anti-parkinsonism-drugs.


Intolerance to aspirin: clinical and immunological studies. Skin-tests, patch-tests, Prausnitz-Küstner reactions, passive cutaneous anaphylaxis in guinea pigs according to Ovary and lymphocyte proliferation tests in vitro using thymidine 2-C14 have been carried out in 31 patients with aspirin intolerance. Acetylsalicyclic acid, aspiryl-polylysine, lysine acetylsalicylate, and sodium salicylate were used in these investigations. Collagen-induced platelet aggregation according to BORN in the presence of aspirin was also studied. An immunological mechanism was revealed in only a small percentage of the patients studied, indicating in the remaining cases the possible role of nonimmunological processes or the inadequacy of the test technique employed.


[Contributions to the mechanism of the Witebsky-test (author's transl)]. The assumption that immune and normal alloantibodies of the ABO system could be distinguished by partial neutralization with soluble specific blood group substance (Witebsky test) has been reexamined. The following results were presented: 1. ABO alloantibodies in both normal and immune sera as well as their IgG and IgM preparations were inhibited by their homologous soluble specific blood group substances. 2. Anti-A and anti-B immune antibodies as well as normal antibodies of the IgG class were found to be strong hemagglutinins in a saline medium; therefore they have to be called "complete" hemagglutinins as have anti-A and anti-B antibodies of the class IgM too. 3. ABO alloantibodies in both IgG and IgM preparations were able to form precipitation pellets with their homologous soluble specific blood group substances. IgM revealed a stronger precipitation power as IgG. 4. Agglutination reaction in saline was inhibited by the 50-200-fold group substance concentration needed for a optimal precipitation reaction, whereas agglutination of enzyme treated erythrocytes or red cells tested with antiglobulin (Coombs) sera was inhibited by a 20,000-80,000-fold concentration of the blood group substances. 5. Soluble antigen-antibody complexes, prepared from solubilized precipitates or from Witebsky test mixtures using chromatography, ultracentrifuge or ultrafiltration for separation were able to agglutinate erythrocytes in the antiglobulin or papain test. Following conclusions were drawn: A. Soluble antigen-antibody complexes are the main component leading to a positive Witebsky test. B. The mechanism of the Witebsky test as it has to be assumed in respect to our findings do not allow the distinguish immune and normal alloantibodies resp. IgG and IgM alloagglutinins in the ABO system.


[Calculation of the plausibility of paternity with blood group results using gene frequencies of foreign populations. I. Formulas for the manual computation of Y/X values (author's transl)]. Formulas for the computation of the Y/X likelihood ratio will be given when in view of a biostatistical evaluation of blood group findings frequencies other than Central European ones should be used for all participants concerned. The given formulas are applicable to all common blood group systems and factors currently used in blood group expertises, except the Rh and HL-A systems which are too complex for simple arithmetic formulas.


[Calculation of the plausibility of paternity with blood group results using gene frequencies of foreign populations. II. Description of a computer programme to calculate log Y/X and W (author's transl)]. A previously described computer programme designed to include any given relatives was modified to such an extent that also the plausibility of paternity with blood group findings can be computed for cases involving aliens.


[Intra-atrial conduction disorders of 2d degree]. Five patients with second degree intraatrial block are presented. The first three cases had a sick sinus  syndrome with sinus bradycardia, broad P waves and episodes of atrial flutter or fibrillation. In these patients a Wenckebach phenomenon could bei elicited by atrial stimulation at a critical driving rate between the stimulated site and the recording electrode. In the first patient this  conduction disturbance was obtained at several right atrial stimulation sites. The block could be elicited in the other two patients only in a limited area of the right atrium respectively only by left atrial pacing. In the remaining two patients an atrial tachycardia with block was observed. The intraatrial conduction disturbance was manifested as an exit block around the ectopic pacemaker. In one patient the tachycardia was induced by digitalis intoxication. In the other patient no etiologic factor of the tachycardia could be found. While the first three patients presented intraatrial conduction disturbances already in sinus rhythm, the last two cases showed after recovery from the atrial tachycardia P waves of normal duration and configuration.


[Chronic supraventricular reverse tachycardia in retrograde conduction through accessory pathway]. A 22-year-old patient with chronic supraventricular tachycardia is presented. This tachycardia was investigated by means of His-bundle electrography with atrial and ventricular stimulation. A circus movement with antegrad conduction through the AV node and retograde conduction through an accessory pathway was found as the underlaying mechanism of the tachycardia.


[Axis divergence in electrocardiography as a sign of heart disease]. In the ecgs of 3433 patients the QRS- and T-vectors were determined. The borderline between physiological and pathological ranges of axis-divergence is found to show fluctuations. The younger the patient and the steeper the electrical heart axis, the greater is the physiological axis-divergence. Ignoring this fact many young people by mistake are taken to suffer from a cardiac disease on account of a great axis-divergence. On the other hand the same setting often is the only sign of a heart disease. The axis-divergence can be a useful factor for the computer-analyzed ecg, although the evaluation of a tenfold of ecgs seems to be necessary to achieve a statistically significant statement.


[Effect of spinal anesthesia on peripheral hemodynamics]. In eight persons central hemodynamic parameters as well as peripheral circulatory parameters were measured before and during spinal anaesthesia (L3/4; 5 ml Carbostesin mit Adrenalin): heart rate, arterial pressure, central venous pressure, peripheral venous pressure, peripheral blood flow, venous capacity (Cv 70) using a venous pressure of 70 mm Hg (lethysmographic method) as well as intravascular basic volume. Intravascular basic volume and the venous capacity are representing total intravascular volume; changes in this parameter- in correlation to a well defind intravenous pressure - give information on the distensibility of capacitance vessels. During spinal anesthesia an increase in resting blood flow of the calf as well as in total blood volume was noted as a result of a decreasing total peripheral resistance and changes in blood distribution (shunting, nutritive blood supply). Intravascular total blood volume in the calf increased from 9.7 +/- 1.0 ml/100 ml to 10.9 +/- 1.1 ml/100 ml, being caused mainly by changes in basic volume not so much by changes in venous capacity. These results may be interpreted as an increase in distensibility of the low pressure vessels during spinal anesthesia.


[Dependency of heart rate on contrast medium temperature and coronary angiographic severity in coronary angiography]. The influence of temperature (24 degrees C, 34 degrees C) of contrast medium (Urografin 76) on sinus frequency was studied during diagnostic coronary arteriographies in patients with different degree  of coronary heart disease. 1. Injection of contrast medium in both coronary arteries was associated with a decrease of heart rate by 4.1-12.8%. There was no significant difference between the decrease in heart rate when injecting the contrast medium into the right or into the left coronary artery. 2. The change in heart rate during left and right coronary arteriography was independent from the temperature of the contrast medium (24 degrees C, 34 degrees C). Therefore, coronary arteriography made at 25 degrees C does not produce significant changes in heart rate when compared to coronary arteriography performed with contrast medium which has been warmed by 10 degrees C (34 degrees C). 3. Heart rate was decreased parallel to the increase in severity of coronary artery stenosis. The possible underlying mechanisms (changes in coronary artery perfusion pressure, hypoxic bradycardia) are being discussed.


[Course observations of hypertrophic obstructive myocardiopathy]. The course of HOCM is characterized by a slow progression. Symptoms can often be influenced favourably by medical treatment. Altogether there is some difference between the course of untreated and the propranolol-treated patient groups which is, however, not statistically significant. Furthermore, the rate of sudden death is uninfluenced. Comparing clinical and haemodynamic results in medicically treated patients we find a reduction of the outflow tract obstruction in case with clinical improvement but not a reduction of the enddiastolic pressure. Independent on the clinical course there was a significant increase of the enddiastolic pressure after 5.5 years. We may conclude that there is a progredient process of hypertrophy which is uninfluenced by the obstruction and by conservative management. The best results are obtained in the operated group. According to our results a surgical intervention should possibly be considereed more generously.


[Mitral valve prolapse or late systolic click syndrome in childhood]. 6 Children with late systolic murmur and systolic click in mitral valve prolapse syndrome are reported. The clinical, electrocardiographic, phonocardiographic and echocardiographic findings are represented. In  differentiating the mitral valve prolapse from the idipathic hypertrophic subaortic stenosis, the mitral insufficiency and the pure accidental murmur, this non-invasive technique is a good enrichment of the diagnostic procedures.


[Mitral valve function during frequency stimulation in coronary disease. Echocardiographic and hemodynamic comparative studies]. In 3 controls and 10 patients with coronary heart disease (CHD) and angina pectoris (AP) left ventricular enddiastolic pressure (LVEDP) and pulmonary artery diastolic pressure (PADP) are measured at rest (R) and during right atrial pacing with stepwise increments in heart rate. The values were compared to the simultaneously recorded DE-slope and EF-slope of the mitral valve echocardiogram. The following results could be obtained: 1. In the control group PADP increased sharply at a rate of aobut 120/min, while LVEDP further decreased. This "physiological dysfunction" of the mitral valve could not be detected by echocardiography. 2. In patients with CHD and AP both pressures rose concomitantly with the onset of the angina; moreover, the EF-slope showed a significant reduction. 3. This decrease of the EF-slope is due to an increment of LVEDP during angina and may be used as a diastolic tool, if the exercise electrocardiogram is negative. 4. LVEDP and EF-slope are correlated weil in most patients with CHD. However, there was a lack of correlation between the reduction of the EF-slope and left ventricular function.


[Left persisting, singular superior vena cava and pacemaker electrode implantation by right cephalic vein]. We are reporting on a case of a singular left upper vena cava with an outlet into the right atrium by a large sinus coronarius (that means, the right vena cava is lacking totally). In spite of the well-known anomaly of the upper vena cava, we successfully implanted a stimulating electrode by the typical access through the right vena cephalica through the right sinus coronarius into the right ventricle. Except of a thrombosis of the rightsided deep venous system of the arm, no complications were to be complained within sixteen months. We know from literature, that within four more cases this transvenous access has been used in pacemaker-therapy. Various complications have been discussed. Before definately implanting an electrode, one should secure severely, if there is any special anomaly of the upper vena cava. In case of the here described, but very rare anomaly of the vana cava, it is to be examined thoroughly, whether an implantation of a transvenous electrode is indicated or, eventually, a myocardial implantation should be preferred.


[The effectiveness of the criminal justice system in cases of opiate addiction (author's transl)]. On the 63 deliquent youth drug addicts examined by the author as a court-appointed expert during the years 1970-1973, an attempt was made in the summer of 1975 to ascertain their actual current condition. This was indeed possible with 58 of the subjects in question (43 male, 15 female--average age at the time of examination.: 21). On the day the sample was taken (August 15, 1975) 23 of them were in penal confinement, 13 had again become dependent on illegal opiates, 2 were dependent on surrogate drugs, and 1 person was in the hospital. 3 members of the sample population who had overcome their dependency on drugs, 4 were unemployed, 2 were living in therapeutic communities and the remaining 10 were either re-integrated into occupations or training programs. A comparative analysis of the cases indicates that penal care measures are predominantly effective in those cases where the delinquents are subjected to intensive expert diagnosis, therapeutic care and vocational counselling and vocational aidmeasures at the commencement, during and subsequent to their respective periods of confinement.


[Studies on investigation of primary pathologic deterioration of the lower limbs. The contents of calcium, magnesium, sodium and potassium in the walls of veins (author's transl)]. The content of calcium, magnesium, potassium and sodium in the walls of v.femoralis, v.saphena and v.brachialis was measured with atomic-absorption spectrometry. Calcium showed distinct differences among the veins with increasing age. There is a remarkably high increase and more inhomogenous distribution for calcium in the v.femoralis of older people.


[Critical examination of postmortem IgA-, IgG- and IgM serum levels in sudden unexpected deaths during infancy (author's transl)]. Postmortem concentration of the three immunoglobulins IgA, IgG and IgM has been studied by single radial immunodiffusion in 81 cases of sudden unexpected death in infancy and in 6 deaths between 2 and 11 years of age. The examinations of serum were repeated after several days after the sera had been kept at different temperatures. For comparison the serum immunoglobulin levels of IgA, IgG and IgM were determined in 11 corpses of adults directly after death and again 1 or 2 days later. With the radial immunodiffusion method postmortem serum immunglobulins are determinable. A critical estimation of postmortem IgA-, IgG- and IgM serum levels has to consider postmortem protein modifications and keeping sera at higher temperatures (+44 degrees C., + 20 degrees C.) For determinations at a later date sera must be kept at -35 degrees C. The measured postmortem serum levels of IgA and IgG in cases of sudden unexpected death in infancy correspond with the normal variation of value in healthy children of the same age. The lowest concentrations of IgG were found about the 5th. month in infancy. Many of the IgM levels were higher than the normal mean value in healthy children of the same age. This is not caused by postmortem influences. The higher IgM concentration in sera suggest an active immunological reaction before death.


[Post mortem temperature equilibration of the structures of the head. I. Thermometric techniques and principal investigations (author's transl)]. Special thin and flexible thermometric probes showing a diameter of 1 mm and a sharp end were used for post mortem (p.m.) thermometric studies in several tissues. Brain temperatures were measured by inserting a double probe through the superior orbital fissura thus allowing to record the central and the peripheral brain regions separately. Another probe was inserted into the galea and a fourth into the liver. Temperature changes were recorded simultaneously. Many variables of the human head were measured. Sixteen corpses were investigated. The results were as follows: 1. Of all temperature curves registered those of the central brain regions showed the smallest variance. 2. The p.m. temperature curve of the brain shows a sigmoid shape with a rather short "plateau" in the beginning. 3. In the early p.m. phase there is an increasing difference of temperatures between central and peripheral brain regions amounting to 2-4, 6 degrees C in the time period between 78th and 128th minute. 4. The insertion of the thin probes does not cause visible damages. Thus it should be considered for use in forensic practice. 5. Some artificial "head models" were constructed and temperature decrease recorded after warming. The curves showed the same type of sigmoid shape as those obtained from the corpses. 6. Of the possible variables measured that could influence the temperature decrease only the density of the hair seems to be of interest.


[Fatal arsenic trichloride poisoning (author's transl)]. Report on a 24-year-old chemical engineer who committed suicide by means of arsenic trichloride. The clinical course and the autopsy findings are discussed briefly. The results of the toxicological examination leave no doubt as to an acute arsenic poisoning. In addition to this, extreme corrosion was found, especially in the region of the oesophagus. If an anamnesis on this patient had not been present one would probably have been satisfied with a diagnosis of acid poisoning and the possibility of intoxication by arsenic would not have been taken into consideration. This case indicates that especially where persons come into contact professionally with chemical and drugs, the chemo-toxicological examinations cannot cover too braod a spectrum.


[Fatal injuries by blank warning firearms (author's transl)]. Contact shots with blanks can produce lethal injuries such as penetration of the chest with rupture of lung and perforation of cardiac wall just by the effect of powder gases emerging from the muzzle of modern gas pistols.


Field studies on the African fruit bat Epomophorus wahlbergi (Sundevall), with special reference to male calling. Social interactions, site attachment and group cohesion were studied in a free-living colony of Epomophorus fruit bats. Daily activites in an undisturbed colony were recorded. Special attention was paid to the peculiar calling behavior of courting male during the night. Structure and repetition rate of their sounds were analyzed in the laboratory. A special mode of acoustic interaction was found and related to the observed spacing out of calling males. By following feeding animals in the field and by analysis of their faeces we found that besides fruits they eat special leaves which afford steroidal sapogenins.


Sexual behaviour following castration in experienced and inexperienced male rabbits. Sexual behaviour following castration was studied in rabbits with varying precastrational sexual experience. Although most aspects of sexual behaviour declined within a few weeks of castration, experienced animals of mixed strains continued to mount with unreduced frequency for at least 10 weeks following castration. Inexperienced animals, as well as experienced New Zealand White animals, ceased to ejaculate and mount within 4 weeks. The effect of experience on postcastrational sexual behaviour thus seems to vary between different rabbit strains.


The behaviour of red kangaroos (Megaleia rufa) on hot summer days. To investigate the functional significance of the behaviour of large mammals in hot, arid conditions, field observations were made of the behaviour of red kangaroos. The behaviour of individual animals was recorded in detail during hot summer days and measurements  of the prevailing temperature and radiation environment were made. Changes in the postures adopted by animals during the day are described in relation to environmental conditions; and the occurrence of certain postures and behaviours at periods of greatest heat stress is reported.


[Animal experiment studies on the damage caused by barium sulfate]. An experimental study is reported on different injections of barium sulfate into peritoneal cavity of 10 dogs and intravasal. All experimental animals died. The experiments show that barium sulfate causes not only local reaction but the most important is it's general deleterious effect. There results macro- and microembolies yet another adverse effect which is not widely appreciated. Barium sulfate medium only may be considered non toxic as long as staying in the gastrointestinal tract.


[Controlled modification of fetal lung-maturity using dexamethasone]. A report is given on the induction of the fetal lung-maturity by administering glucocorticoide dexamethazone to the mother. The lecithin-level and the L/S ratio are established in amniotic fluid before and after tthe treatment. Before the 32. week of gestation no influence of the phospholipidlevel was evident. After the 32. week and after treatment the physiological increase is deeper. Propositions of treatment for premature and induced premature delivery are given corresponding to the results.


[Influence of hypertension in the 2nd half of pregnancy on the fate of the fetus and newborn infant with reference to mean pressure using Wezler-Böger's method]. It is demonstrated retrospective calculation of mean arterial pressure (method of Wezler-Böger) in 1086 cases of hypertensive toxemia in pregnancy from the year 1966 to 1972 of the Department of Obstetrics and Gynecology University Rostock and Department of Obstetrics and Gynecology, Country Hospital Rostock. The grading of the values of mean arterial pressue in 3 groups shows an increasing of fetal retardation and increasing of perinatal mortality due to increasing of mean arterial pressue. This procedure allows a more different prognostic prediction of fetal outcome, than the separate systolic and diastolic blood pressure measurements.


[Acid-base equilibrium of fetuses delivered by breech presentation]. Acid-base balance of fetus in capillary and umbilical blood has been examined in two series of newborns: 30 newborns delivered by breech presentation and 15 newborns delivered spontaneously by vetex presentation without complications. Following parameters have been evaluated: pH, pCO2, BE and HCO3 (actual bicarbonate content). Differences between the parameters of acid-base balance, mainly the values of pH and pCO2 in capillary blood and in a. umbilicalis of the fetus direct to the fact that acidosis of the fetus with elevated values of pCO2 is a typical finding in labors by breech presentation and is due to compression of umbilical vessels during labor.


[Psychological-sociological views on S 218 (study on 379 pregnant women and women in puerperium)]. Studies on the attitude towards the abortion law and abortion have practical significance if women in the reproductive age group are questioned. Pregnant women and women in childbed are especially adequate for this purpose. They may realize best the situation of a women who has to think over an abortion. Therefore we asked 379 pregnant women and women in childbed in our hospital. 70% of them could imagine a situation which would justify an abortion. Women with high school degree and average or above average intelligence were more frequent in this group. 38% expected a very severe stress by an abortion, 40% severe stress and 22% a rather moderate one. Most frequently women with high education level as well as more introverted women expected an emotional disturbance by such an operation. 62% of the questioned women favored a change of the abortion law, 38% did not. Again women with high school degree and above average intelligence wanted a change more often than those who had passed primary school and had an intelligence below average. Moreover age, wellbeing and experience of menarche had a relation to the attitude towards the abortion law. The results were statistically checked by the X2 -method.


[Atrioventricular block in gynecologic-obstetric surgery]. Delivery ending with cesarotomy in women with A.-V.-block is thought to be the least hazardous. In cases where cardiac syncope occured before delivery, temporary cardiac pacemaker is applied. A complicated course of gynaecologic operation in a patient with permanent pacemaker on demand is described.


[Colposcopic picture of vessels in decidual ectopy (deciduosis) at the portio vaginalis uteri]. The types of bloodvessel visible on colposcopic examination in various forms of decidual ectopia are described. The two main tapes are linear-spiral vessels and "asymmetrical loops". The possible differentiation, on the basis of the vascular picture of decidual from malignant changes in the cervix uteri by colposcopy is pointed out stressed. The functional state of the bloodvessels, probably newly-formed during the proliferation of the decidually transformed epithelial stroma, is briefly discussed.


[The neurovegatative reaction-situation in climacteric. Modification of blood pressure regulation by estrogens]. 48 women complaining of climacteric disorders were treated with an estrogen preparation for 1 year. Before an intervalls of 2 month during the treatment period studies of the Kupperman index, the vaginal karyopcnotic index and 3 neurovegatative (hemodynamic) tests were carried out: The orthostase-test according to Schellong, the cold-pressor-test according to Hines and Brown, the Pholedrin (Veritol-)test. During estrogen substitution the following alterations could be stated: A significant decrease of systolic and diastolic blood pressure values, a tendency of adjusting the systolic blood pressure values after standing up to the values in rest (Schellong-test I), a shortening of the interval needed to establish stable values of blood pressure and heart frequency, a tendency to reduce the increase of blood pressure in the cold pressor test, and a significant amplification of the increase of blood pressure and blood pressure amplitude in the Pholedrin test. These results are believed to indicate an alteration of vegetative reactivity in the parasympathicomimetic direction. Estrogens seem to exert a favourable influence on the mechanism of blood pressure regulation.


[Control methods of intrauterine contraceptive devices]. In other to examine the control possibilities of the intrauterine devices, the importance of the ultra-sound-examinations and significance of its adaptation is demonstrated.


[Unusual form of genital malformation with aplasia of the right kidney]. We report on a rare form of bicornuate uterus with simple vagina and isolated hematocervix on right without connection of the right uterus to the vagina. Besides we found an aplasia of the right kidney and ureter. The case specially the isolated hematocervix and therapeutic problems of this double anomaly are discussed.


[Comparative study of different nutrient media used for the isolation of Salmonella in routine laboratories]. For a comparative study on the merits of Selenit broth and Enterobacteriaceae-enrichment broth (EE-broth) by MOSSEL, the media were inoculated with 629 faecal cultures obtained from Salmonella carriers and contacts of a Salmonellosis sufferer. The Selenit broth incubated at 37 degrees C showed better results than the EE-broth incubated at 30 degrees C. After 24 hrs incubation plating was done on XLD-, SS-, and MACCONKEY-agarplates with the result that the XLD plate gave the highest yield of 21% isolations, followed by the SS-plate showing 17%, whilst the MACCONKEY-plate produced only 7%. In our routine laboratory the XLD-plate has now superseded the LEIFSON-plate and is used in parallel to the SS-plate after enrichment in Selenit-broth.


[Biochemical and serological investigations of flagellae of Campylobacter fetus (author's transl)]. Flagellae of Campylobacter fetus group O, types 1, 2 and 7 were prepared. First they were separated from cell bodies using an ultramix. The suspension was then centrifuged for 20 mins. at 10000 rpm and the supernatant frozen at -40 degrees C. This is a simple method for the enrichment of preparations of flagellae, as they become tangled up and accumulate in the inferior third part of the frozen liquid. The physicochemical basis of this phenomenon was discussed. After thawing and spinning for 20 mins. at 5000 rpm, the sediment was suspended in 0.9% of NaC1. The purity of the preparation was checked by electron microscopy. Antibodies to this antigen showed no cross-reaction with O-Antigen, when tested by tube agglutination. The amino acid composition of flagellae from different O-antigen serotypes was different (see Tab. 1). Cysteine could not be detected and proline only in traces. After breakdown with urea followed by gel filtration on Sephadex G 200, breakdown products of diminishing molecular size were obtained (see Fig. 2). Discelectrophoresis after ultrasonic gave 8 zones (see Fig. 3). Irrespective of serotype, thin-layer chromatography of trypsin-hydrolysed flagellae always showed 9 ninhydrin-positive spots (see Fig. 1). Only breakdown products of ultrasonic reacted with antibody. After absorption of flagellar antibody with heterologous antigen, agglutination only occurred with homologous antigen (tab. 2-5). This showed that there were different flagellar antigens. Further experiments using immunoprecipitation demonstrated two common antigenic components, a and c, and a partially common antigenic factor bb (Fig. 4), and was the basis for a classification by three groups. The three antigenic components could be separated by gel electrophoresis and detected by immunoprecipitation (Figs. 5,6).


[The Bacteriodaceae flora in the faeces of pigs (author's transl)[]. A total of 180 Bacteroidaceae strains from the fecal specimens of 31 clinically healthy pigs aged 120 to 180 days from 4 farms were isolated in numbers of 10(8)-10(10) per gram feces and differentiated for their morphological, cultural and biochemical properties. 161 of these strains belonged to Bacteroides ruminicola and related species, 10 to B. fragilis ss. fragilis, 3 to B. fragilis ss. vulgatus, 4 to Fusobacterium necrogenes, 1 to F. mortiferum and 1 to a non-motile variant of F. novum. The taxonomic relationships between B. ruminicola and B. oralis are discussed.


[Studies of enterotoxin production by strains of Staphylococcus aureus of different origins (author's transl)]. 376 Staphylococcus aureus strains of clinical and epidemiological origin were tested for their ability to produce the enterotoxins, A, B and C1. For these investigations, microagargel precipitation against specific antisera has been used. Additionally these strains were studied by phagetyping, biochemical typing and for their antibiogram. The strains tested came from human pathological processes, mouth throat swabs of healthy people, persons working in hospitals, outbreaks of food poisoning from cows suffering from mastritis and some from milk samples. Most of the strains isolated from food poisonings were associated with enterotoxin-A-production. Among the group of strains from autopsy material, the enterotoxin-B-producing strains were predominant. The strains from human pathological processes which were found to be enterotoxin producing, were mostly belonging to phage group III. With regard to the antibiogram, the enterotoxin-producing strains were somewhat more resistent than the enterotoxin-negative strains. Correlations between the production of enterotoxin B and methicillin resistance did not become evident in our material. The strains were differentiated, too, as to their classification as var. hominis or var. bovis. With one exception, all enterotoxin-producing strains which could be classified in this way, were belonging to var. hominis. From five enterotoxin-producing strains isolated from cattle, only one strain belonged to var. bovis, the other to var. hominis. Obviously the ability to produce the enterotoxins, A, B and C1 is very rare in the group of var. bovis strains.


Staphylococcus aureus and Candida albicans infection (animal experiments). During a certain period of the course of infection in white mice inoculated intraperitoneally with the pure culture of a proteolysing strain of Candida albicans, Staphylococcus aureus and C. albicans both, were isolated simultaneously from the peritoneal abscesses, especially those adhering to the stomach, duodenum, pancreas and the upper part of small intestine. This concommitant occurrence of the two pathogens was further corroborated by histopathological examination which revealed large number of staphylococci present in the close neighbourhood of Candida cells, usually in the center of the granulomata caused by the fungus. In view of the facts that the proteolytic end-products of C. albicans can offer a good substratum for the growth of S. aureus and the latter may be isolated from the intestinal tract of apparently healthy mice, possibly as a constituent of the transient microflora, the co-existence of these two important aetiologic agents of endogenous infections as encountered during this study appears to be of great clinical interest. Furthermore, these observations also demonstrate the importance of controlling the bacterial flora of mice for pure mycological studies.


Serotyping of strains belonging to the Citrobacter-Levinea group isolated from diagnostic material. A proposal is presented for the serotyping of Citrobacter-Levinea strains: 9 serotypes for Citrobacter diversus (Levinea malonatica) and 13 serotypes for H2S-negative, indole-positive variants of Citrobacter freundii (Levinea amalonatica), which showed a  considerable antigenic diversity. By means of both kinds of antiserum types 80 per cent of the strains (L. malonatica 100 per cent, L. amalonatica 72 per cent) from a series of 106 strains isolated from different diagnostic material were serologically classified. According to results presented in this paper, a direct relationship between biotype and serotype was found among the strains of biotype b for Levinea amalonatica and c for L. malonatica, which were agglutinated by the antisera prepared from biotypes b and c, respectively, only. Serotyping will evidently greatly contribute to a more perfect identification, especially of those strains that are, for various reasons, classified among so called intermediates. The importance of the Citrobacter freundii and C. diversus species in the clinical material is emphasized with a view to their increasing occurrence. Taxonomic and nomenclature questions with regard to Citrobacter-Levinea are discussed in detail.


Restriction and modification of typing phages by an R factor in S. typhi. We have investigated the qualities of one R factor 552 discovered on a strain of S. typhi resistant to A, C, S, T, nontypable, isolated from stool cultures; from the same patient, before starting the treatment we isolated, from his blood sample, the strain S. typhi 221, sensitive to A, C, T, degraded phage-type Vi A. Factor R 552 fi- when infecting strains of S. typhi Vi A and of A degraded 221- leads to the conversion of the respective phage-types into non-typable ones, as a result of the restricting and modifying effect on phage Vi A and on the derivatives resulting from it. Derivative R 552-1 as a resistance marker to ampicilline has a restrictive effect on the phage of S. panama A 47 too. Not taking into account possible causes such as spontaneous mutation, lysogeny, and adsorption of phages, we reach for the conclusion that R factor 552, through is restrictive effect, is the only cause responsible for the existence in the same patient of two strains of S. typhi different from the point of view of phage-type and antibiotype.


Examination of the envelope antigen K1 in Yersinia enterocolitica which was identified as fimbriae. The envelope antigen K1 found in the majority of Yersinia enterocolica (Y. ent.) strains belonging to the O group 10 as described by WAUTERS, was re-examined under the electron microscope, and identified as being fimbriae. These fimbriae envelop the bacterial cell with a dense fringe. Single filaments show a width of 2.5 to 1.7 nm whilst their length is variable, often many times the size of the bacterial cell. Fimbriated Y. ent. cultures do not form pellicle, and the haemagglutination test is negative. They are O and fimbriae agglutinable. Test results for the acknowledged 3 antigenic differences, i.e. agglutinability, agglutinin-binding capacity and agglutinogenic capacity showed that: 1. there is a certain thermo-lability as to the agglutinability. For its total suppression, half-an-hour's boiling at 120 degrees C of the culture fim+ is necessary. Chemical treatment of such a culture hardly impairs the agglutinability of fimbriae. 2. the agglutinin-binding (= absorbing) capacity of the fimbrial antigen is little affected by continuous heating, even up to 3 hrs. However, at least half-an-hour's boiling at 120 degrees C or alternatively chemical treatment with 50% alcohol or nHC1 practically destroys this ability. 3. The heating process has a significant and progressive effect on the agglutinogenic capacity of the Y. ent. fimbriae which is destroyed irrevocably after 30 mins. boiling at 120 degrees C. Chemical treatment hardly affects this character. It is recommended to use a formalised culture Y. ent. fim+ for the preparation of a specific Y. ent. fimbrial serum. For the elimination of O antibodies, this antiserum should be absorbed with a strain fim- of the same O group. Provided the strain was incubated at 37 degrees C, no H absorption is required, because Y. ent. strains do not form flagella at that incubation temperature.


[Electronic data processing system for clinical microbiology]. A computerized clinical microbiology data storage and retrieval system, which was introduced at the Institute of Medical Microbiology 14 month ago, is described. This institute has to perform routine diagnostic microbiology for hospitals in the Kanton of Zuerich including the university hospital. In addition, it serves as a public health laboratory for Zuerich and adjacent districts. Patient and physician data are entered into a data station IBM 3741 and stored on discettes. Each afternoon, these data are printed on special report forms, which then are transferred to the diagnostic laboratories. After completion of the investigation, a copy of this form containing the results is sent to the physician. Every two weeks, the information stored on the discettes are converted onto the magnetic tape "discette". In addition, the original report form, containing the codified results and the fees, are read by an optic reader, which transfers the information onto the tape "report". Both tapes then serve the computer to print the accounts as well as to summarize the results monthly in form of the medical statistics. These provide valuable information to enhance patient care. All data are stored in a cumalative microbiology data bank for later retrieval.


[Otoneurologic symptomatology in glial tumors of the cerebral hemispheres]. The author describes the otoneurological symptomatology of 213 patients with glial tumours of the hemispheres which were verified during surgical operations. The use of modern methods in studying the audition permitted to give a differentiated characteristics of vestibular and acoustic disorders. Vestibular disturbances irrespective of the tumor localization were more frequently seen. In moderately expressed general cerebral symptoms vestibular symptoms of the subcortical and diencephalic level prevailed. The authors mark their early appearance and especially their crude expressiveness in lesions of the posterior areas of the hemispheres. There were frequent combinations of vestibular disorders of a subcortical diencephalic level with cerebral posterior. The focal symptomatology depends upon the localization of the tumour.


[The diagnostic value of screening the subarachnoid space in syringomyelia and other diseases of the spinal cord and its meninges]. The paper is concerned with the results of myeloscanning of the subarachnoidal space in 32 patients with diseases of the spinal cord and its pia. The studies were conducted with albumin of human sera and labeled I131. The authors give a scannographical characteristics of the pathology of the subarachnoidal space in syringomyelia which included a change in the configuration, a deformation of the silhouette contour with marginal defects and focal irregular distribution of the isotope. In tumors of the spinal cord this method permits to defict the existence of a complete or partial block of liquor paths and the level of their occlusions. The author recommends a wider use of sabarachnoidal scanning when examining patients with lesions of the spinal cord and its pia pointing to the preciseness, simplicity and security of this method.


[The diagnostic value and possible mechanism of the dynamic characteristics of the electroencephalogram in tumors of the brain]. It was established that the trajectory of the excitative area (an increase of negativity) on the surface of the brain does not go through the place of the tumor. It either stops there during a certain period of time or makes a sharp turn, or is subjective to a splitting. In such cases the excitative area does not extend in the usual way in one direction, but speards simultaneously to opposite sides. The author discusses the possible influence of the pathological corticofugal impulsations from the perifocal zone of the tumor on the mechanism of pacemaker scanning.


[Changes in the ultrastructure of nerve cells subsequent to cortical compression by supratentorial tumors]. During a study of the ultrastructure of cortical neurons in the development of an intracranial newgrowth, the authors demonstrated a gradual and increasing severity of the condition. There is a certain correlation between the stage of the neuron damage also correlates with the expressiveness of neurological symptoms. The polymorphism of the changed structure in the nerve cells is due to complicated and multifold pathophysiological and biochemical mechanisms being involved in an intracranial volumetrical process.


[Lesions of the cervical region of the spinal cord in so-called infantile cerebral palsy]. A EMG study of the brachial muscles in 41 children with spastic paralyses of the lower extremities, weakness of the hands concomitant with a mild hypotrophy of the muscles, disturbed functions of the III, VII and vestibular nerves and satisfactory mental development revealed the following: there were signs of motoneuron excitation in the cervical part of the spinal cord (motor units at rest in a maximum muscle contraction and in an elaboration of tenden reflexes), their destruction (a decreased amplitude of potentials of volitional contraction in combination with muscle hypotrophy) and a desinhibition of spinal mechanisms. Causes of such damage may be intrauterine pathology, perinatal hypoxia, delivery complicated by an incorrect position of the foetus and a mechanical trauma in an incomplete ossification of the spine, in premature infants.


[Autonomic provision for some forms of activity in focal lesions of the limbo-reticular complex (results of a mathematical analysis of cardiac rhythm)]. The author studied vegetative provisions in different forms of activiity (mental, physical and emotional) detected in focal lesions of the limbico-reticular structure of 91 patients and 9 normals. Among the studied contingent 38 had focal lesions of the temporal lobe, 31 -- of the hypothalamus and 22--of the brain stem. Vegetative activity was studied by registrations of the frequency of heart contractions and by a subsequent mathematical processing. It was possible to demonstrate an excessive degree of vegetative provision in all groups the following factors: the localization of the process, the initial degree of vegetative disturbances, the expressiveness of emotional changes. In a moderate expressiveness of psycho-vegetative disturbances there is a higher degree of vegetative provisions than in expressed psychovegetative syndromes. These data may serve as an explantation to the origination of such clinical conditions as asthenical states and disorders of adaptation in different forms of activity.


[The clinical picture and pathogenesis of cerebral symptomatology in diseases of the cervical region of the spine]. A study of 145 patients with pathology of the cervical region of the spine demonstrated that the cerebral symptomatology in 59% of the cases is due to disorders of circulation in the vertebro-basillar basin, in 31% due to disorders of vascularization of the border-line sympathical trunk and vagus nerve in their cervical region and in 10% -- to a combination of disturbed circulation of stem and vegetative structures. In the first case there is a stability and expressiveness of manifold symptoms in lesions of the stem structure with a disordered vascularization. In the remaining cases -- there are prevalently-lability, inconstant and periodical nature of the symptoms inherent in different areas of the brain.


[A study of the interaction between the peripheral motor neurons of muscle antagonists by the H-reflex method under normal conditions and in spastic hemiparesis]. With the aid of the reflex method the authors studied the functional condition and interconnection of peripheral motoneurons of the muscles-antogonists in normal conditions and in spastic hemiparesis. In patients with spastic hemiparesis there was an increase in the inhibition latent period of the H-reflex following a conditioning stimula of the fibular nerve and a nonmonotonous restitution in the amplitude of the H-reflex during the periods of "late inhibition". These data permit to assume that in patients with pyramidal insufficiency the changes in the system of reciprocal inhibitive interaction of muscles-antagonists are fixed and are not subjected to a supraspinal control. This may determine the spastic character of the muscle tone in such patients.


[The dynamics of morphologic changes in the sensomotor cortex of rats with acute hypoxia and its sequelae]. The authors studied by light optical methods the dynamics of morphological symptom of functional and organic changes of neurons in the sensomotor cortex, in paraphine and semithin layers of the cortex of postmortem cases in white rats who had suffered from acute hypoxial hypoxia with a subsequent survival from 0--4 hours. These data were correlated with electronomicroscopic studies as well as with biochemical data presented in current literature. On the basis of such information the mechanism of cellular polymorphism changes as well as the pathogenesis of irreversible shifts in the brain cortex during hypoxia or discusse. The results of such studies may serve to a certain degree as a morphological basis for a clarification of pathomorphological changes in early and late neurological symptoms in the post reanimation periods in humans. Evidently, such data may promote an eleboration of therapuetical and prophylactical measures, preventing the development of irreversible changes in the brain due to hypoxia.


[Functional asymmetry of the cerebral hemispheres in clinical variants of schizophrenia]. The paper is concerned with a study of lefthandedness, the distribution and combinations of characteristics in laterality according to the signs of finger linkage, folding of hands and a directing eye in 610 females and 600 males with schizophrenia. A bimanual correlation of the finger ridges were determined in 560 females and 560 males. In patients of both sexes with continuous schizophrenia there were most frequent cases of lefthandedness, a left type of finger linkage and a left directing eye. Besides, there were more males with a higher ridge on the left hand or equal ridges on both hands. The author believes that the genotypical traits on the organism which are fenotypically expressed in the abovementioned signs exert a modifying influence on the clinical features of schizophrenia.


[Cerebral auto-antigens in the serum of schizophrenic patients]. Brain autoantigens in the blood of 200 schizophrenic patients were investigated. It was established that the introduction of brain autoantigens caused the formation of antibrain antibodies in the animals. The brain autoantigen, limitted by the species, is also present, and there is a possibility of autoimmunization by each of them. It is shown that the autoantigen which is connected with the species of the brain, is stable to organic dissolvent activity in the paranoid form of schizophrenia (87.5%) and in the malignant and shift-like form (20%). In the other forms of schizophrenia and also in epilepsy and viluy encephalitis its inactivation is marked. The qualitative heterogeneity of brain autoantigen in different forms of schizophrenia is suggested.


[Catalase in the blood and leukocytes of patients with nuclear schizophrenia]. The presentation deals with catalase activity in the whole blood and in the leukocytes of patients with nuclear schizophrenia. The catalase activity in the whole blood was higher than in normals. During insulin shock the enzyme activity both in the blood and leukocytes was significantly higher. A low catalase activity in the blood leukocytes in patients with nuclear schizophrenia may be conditioned by a drop in the aerobe respiration and oxidative phosphorilyzing of leukocyte mitochondria.


[Adaptive reactions in the auditory analyzer of patients with schizophrenia, presenile psychoses and alcoholic hallucinosis]. Some results of audiometric studies in 272 patients with different psychoses (schizophrenia, presenile psychoses, alcoholic hallucinoses) were analyzed. The authors examined the auditory adaptation to threshold stimula and the time of reverse adaptation. In most of the cases adaptation was not attained or was lengthened. These studies did not reveal any nosological specificity in adaptational disturbances. In cases of auditory hallucinations the index of adaptational time had no principal differences either. These facts gave ground to consider the adaptational shifts as general nonspecific mechanisms in the pathogenesis of psychoses. An analysis of audiometric data make it possible to use them for prognostical purposes.


[The early stages of schizophrenia].

[The early stages of schizophrenia]. A total of 385 schizophrenic patients were studied (including 96 cases of an intially erroneous diagnosis of schizophrenia). It was possible to reveal early signs of schizophrenia in 84.3% of the patients, and in 50% -- to establish factors predisposing to exposure or which expose initial manifestations of the disease. Schizophrenia can be rightly diagnosed in the early periods if character peculiarities and the course of the initial period of the disease are taken into account, as well as the influence of such factors as heredity, age and periods which provoke the disease. It is stressed that the early forms of schizophrenia are often atypical, incomplete in their clinical picture where neurotic-like and psychopathic-like phenomena often predominate.


[The clinical picture and dynamics of long-term late remissions in the outcome of shift-like schizophrenia]. In 59 patients with shift-like schizophrenia above 60 years the author studied some clinical traits and the development of long-term (10--20 years and more) hypersthenic, paranoial and psycopath-like remissions. The development of such remissions actually reflected the tendency to a regressive course and a stabilization of the process at old age. There was a slow extinguishing of affective swings which were observed in the majority of the cases in the initial stages of such remissions. There was also an alleviation of productive disorders (paranoial, hallucinatory, psychopath-like, abscessional, etc.) as well as a certain compensation of negative disturbance. At the age of 55--65 the patients displayed a long-term stable condition with a monotonous (mainly hypersthenic) mood, rudimentary psychotic symptoms, certain personality abnormalities, an increased level of social adaptation and working capacity.


[A catamnestic study of shift-like schizophrenia with long-term remissions]. On the basis of a study of 206 patients in conditions of in-patients services and 1124 patients in one of Moscow's district psychoneurological dispensaries it appeared possible to prove the significance of exogenous factors in the development of attacks in schizophrenia. The study did not show any significant differences in the frequency of combined attacks with exogenous factors depending upon the severity of schizophrenia. The frequency of attacks related to exogenous factors is in a direct dependence upon the existence or absence of exogenous factors in the manifest attack.


[Variants in the course of circular schizophrenia (an epidemiologic study)]. The authors report of the clinico-statistical characteristics in the development of circular schizophrenia in 645 patients. An analysis of the course of the disease was convened in respect to the correlation of the affective disorders, the clinical structure of the attacks and remission, their duration, the amount of attacks in the past, sex and age. It was demonstrated that all of these parameters are closely connected with the type of the manifest attack. This circumstance may be used for the prognosis of the disease and for clarifying the problem of the typology of circular schizophrenia.


[A method of carrying out ECT under anesthesia with relaxants]. During EST of schizophrenic (with a prevalent depressive symptomatology) and manic-depressive patients refractory to medicinal therapy, it was possible to find the following conditions. There was a definite advantage in the use of a narcotizing preparation such as epontal with a relaxant listenon compared to a tiopenthal narcosis. This may be due to a short-time narcotic effect of epontal, the absence of postnarcotic symptoms such as expressed apathy, weakness, headaches, which can be observed during 2-3 hours, following tiopenthal narcosis.


[Clinico-morphologic characteristics of X-linked pseudohypertrophic myopathy]. A clinical, genealogical, EMG and morphological study of the development of pseudohypertrophic myopathy linked with X-chromosome allowed one to distinguish 2 variants: 1) the malignant (Duchenne form) and 2) benign (Baker form). Although both forms have similar clinical symptoms, the Baker form has a later onset, a more favourable development and more preserved motor functions. The activity of fructosodiphosphataldolase and creatinphosphokinase in the blood serum of these patients was significantly lower than in Duchenne' myopathy. In the muscular bioptates of patients with Duchenne's myopathy as the disease progresses there is a gradual smoothening of the diameter of preserved elements at the expense of almost complete disappearance of hypertrophysed filaments. In Baker's myopathy besides expressed processes of muscular sclerosis and lipomatosis there are also hypertrophysed filaments.


[Dystrophic myotonia (a clinico-morphologic study)]. The paper contains data of a clinico-morphological study of 14 patients with dystrophic myotonia. The muscular bioptate was studied by means of electron microscopy. In the muscular filaments there were 2 types of changes. In the initial phase of the disease there were focal changes in the myofibrillar apparatus, a mild hypertrophy of the sarcotubular system and an increase of the mitochondria. These changes are similar to disturbances in Thomson's myotonia. The existence of common traits in these disorders, motor disturbances and similar morphologocal changes permit to consider that they are an expression of a myotonical phenomenon. The second type of disorders was characterized by dystrophical and atrophical changes, with distinct correlations between the severity of the disease and expressiveness of morphological changes.


[Condition of the nervous elements of skeletal muscle in Duchenne myopathy]. In order to determine the role of the nervous system in the pathogenesis of myopathy, the author examined the nervous apparatus in a bioptate of the widest muscle of the back in 8 patients with Duchenne's myopathy and in some other muscles in one post-mortem case of the same disease. The morphological changes in the nervous structures of skeletal muscles were expressed in signs of irritation, substituted by destruction which began in the terminal parts and was more expressed in the atrophized muscles. Besides there were symptoms of excessive growth of the nervous filaments especially in the initial phases of the process. The regenerating nervous filaments are subjected to destruction and do not provide an innervation of the muscles.


[Lipid metabolism disorder in ataxia-telangiectasia]. A clinico-morphological study of ataxia-teleangiectasia permits to establish the depth and distribution of lesions. Morphological findings indicate to lesions mainly in the extrapyramidal system, cerebellum, subcortical structures and in the stem structures and spinal cord. Besides, there were changes in the hemispheres in the form of cell atrophy, demyelinization, degeneration and gliosis. Demyelinization was found in the posterior and lateral columns of the spinal cord; in the extrapyramidal conductive paths. A study of lipid metabolism in 14 patients with ataxia-teleangiectasia also demonstrated an increase of lipid content in myelin, free cholesterol, etherconnected cholesterol, triglycerides and diglycerides in the plasma. There was  a correlation between the degree of the nervous system demyelinization and an increased level of the main fractions in the lipid spectrum. In some patients following a transplantation of a neonatal thymus-sternum complex there was a drop in the previously increased content of the lipid fractions. The authors discuss some problems of the pathogenesis of ataxiateleangiectasia.


[The functional state of the neuromuscular apparatus in patients with Urov (Kashin-Bek) disease]. In order to clarify the state of bioelectrical muscular activity in relation to the severity of the disease and the localization of the pathological process in Urowsche disease, the author examined 107 patients and 27 normals. The achieved data point to quantitative and qualitative differences of the bioelectrical muscular activity in patients and normals. In Urowsche disease in all stages of rest, in deep inhalation and synergia, electrical activity was not present. In a voluntary muscular contraction in 45.5% of the muscles there was type I in the EMG, 33.4% -- type II and 21.1% -- type IV. In all stages of the disease there was a drop in the potential amplitude fasciculation and a decrease in the frequency of acter-action fluctuations. With the development of the disease the frequency of pathological forms in the EMG was statistically higher. These data testify to lesions of the motoneurons and suprasegmental structures.


[Cytochemical characteristics of nucleic acids in the peripheral blood lymphocytes of patients with multiple sclerosis]. DNA and RNA was determined with the aid of cyto-chemical methods in lymphocytes of the peripheral blood of 101 patients with disseminated sclerosis. Changes of the DNA were not found. Quite possibly, the increase of cyto-chemical indices of RNA in the lymphocytes of such patients depends upon the reactivity of the organism the degree of its sensitization and activity of the pathological process.


[Clincio-electroencephalographic syndromes in several diseases of the nervous system]. An analysis of the indices of bioelectrical brain activity and clinical symptoms was accomplished by a computer according to the principle "man-machine". The authors examined 2 groups of patients with some hereditary forms of diseases of the nervous system (62 cases) and with disorders of cerebral circulation (106 cases). It was demonstrated that there is a possibility of clarifying the typical localization of lesion and of differentiating the different clinico EEG syndromes.


[Use of the polarographic method of analyzing blood and cerebrospinal fluid for diagnosing nervous system diseases]. The report contains the results of a palrographic study of the blood and CSFin 726 patients with different disorders of the nervous system. It was possible to demonstrate statistically significant differences in the degree of expressiveness of the Brdicki filtrate test in benign and malignant tumors. The authors also established the significance of a differential diagnostical test, permitting to distinguish a vascular (pseudotumor) brain disorder from a tumorousone. A polarographic analysis of the CSF may be used as a supplementary diagnostical method in tumors of the CNS. The role of sulfhydrile groups in the mechanism of the polarographic effect is discussed.


[Current state of the problem of vertigo]. On the basis of literature and personal data the author qualifies vertigo as an important subjective symptom of a number of diseases. The author proposes and evaluates the existing classifications of vertigo and the applied terminology. The systematics of vertigo based on the clinical experience is proposed. The paper contains qualitative and quantitative characteristics of separate types of vertigo which were singled out according to the character of sensations, conditions of their appearance, time of their duration, attendant neurological and another objective symptomatics and categories of diseases. In this connection the author divides vertigo into peripheral (labyrinthiform and radicle) and central (nucleus, supra-nuclear, "higher"). Principals of treatment are described.


[Ultrastructural features of cerebral nervous tissue under conditions of specific sensitization and desensitization of the body]. On the basis of a study of the ultrastructural traits of the brain matter under conditions of specific sensitization and desensitization of the organism, the author comes to the following conclusion. A sensitization of the organism by brain antigens is accompanied by a physiological activation of the nervous system cells, especially of their defense mechanisms. In specific desensitization when it is considered that there is a disappearance of increased sensitivity of the organism, an electronomicroscopic study of the brain revealed an expressed activation of the ultrastructures, both in the nervous and glial elements of the brain tissue.


[Human hypnosis and super-slow electrical activity of the brain]. The authors studied the transformation of infraslow oscillations of brain potentials in 15 patients with neuroses during 50 sessions of hypnosis. The results of such studies permitted to distinguish some important traits in the changes of infraslow oscillations of brain potentials in different stages of hypnosis. It is concluded that a study of these changes during hypnosis may establish some correlations between the physiological state of the brain and the unconscious mental processes.


[Pubertal decompensation in the clinical picture of schizoid psychopathy]. The author examined 30 patients in whom the psychic condition in adolescence was characterized by "metaphysical (philosophical) intoxication". This phenomenon was qualified as an adolescent variant of over-valued ideas. It was established as well that these traits develop in personalities of a schizoid character. The conditions as a whole was considered as pubertal decompensation in schizoid psychopathy. The report contains criteria for a differentiation of these conditons with slowly progressive forms of schizophrenic process.


[Delusions of self-justification, innocence, forgiveness and justification in schizophrenia]. Delusions of selfjustification directed towards a denial of imaginary guiltiness are characterized by an activity of delusional speech and behaviour. In delusions of innocence the patients partially acknowledge imaginary guiltiness, their opinions and behaviour are passive. These forms of delusions are encountered in the structure of depressions with delusions, paranoid-depressive, hallucinatory-paranoid, acute delusional and paraphrenic syndromes. Delusions of appeal and justification are frequently seen in the structure of paraphrenic syndromes. These forms of delusions occupy a subordinate position in relation to other forms of psychopathological structures.


[Attack-like schizophrenia with a "progressive" course and profound long-term remissions in old age]. The author examined 131 patients with conditions of deep and durative remissions who had not been hospitalized during the past 20 years. Clinically they were characterized by some common traits. In most of the cases the premorbid personality and the character during the state of remission had hypersthenic traits. Manifest psychoses were seen mainly from 25-45 years. The subsequent development of the disease had infrequent prevalently affective-delusional attacks with a tendency to an intensification of phasic disorders in the involutional period and a subsequent regressive development of the disease in all cases in senescence.


[Clinical features and problems in the differential diagnosis of schizophrenic psychoses developing after delivery]. The authors report of some results of a clinical follow-up study of 76 schizophrenic patients in psychosis observed during the puerperal period. Two types of the process were distinguished: a recurrent type and attack-like progressive. Some diffrential diagnostical criteria are given permitting to differ recurrent schizophrenia from somatogenic and infectious psychoses.


[Prognosis of the frequency of attacks of schizophrenia (according to findings from an epidemiologic study)]. In 915 patients with attack-like schizophrenia with a duration of the disorder not less than 15 years, the authors studied some clinical and endogenous factors in order to determine the criteria of prognosis of the attacks. It was displayed that in most of the cases schizophrenia proceeded with a small amount of attacks. Manifestation at young age (irrespective of the duration of the disorder), its affinity to the periodical pole of the disorder and concomitance of subsequent attacks of manic disturbances correlated with a large amount of attacks.


[Family formation by schizophrenic and manic-depressive patients according to an epidemiologic study (birth rate)]. The birth rate among patients with endogenous disorders is considered as an index of the degree of their social adaptation. It was established that in all forms of such disorders the level of birth rates and the rate of family formation is lower than that in the general population. However, in all endogenous disorders (except the malignant schizophrenia) there are some patients the adaptation of whom is not disturbed.


The effect of unilateral nephrectomy on the activity of ribosomes in the remaining kidney. 1. Ribosomes isolated from hypertrophic kidneys were examined at different time intervals after unilateral nephrectomy. The activity of ribosomes measured by [14C] leucine incorporation and synthesis of polyphenylalanine from [14C]Phe-tRNA, was increased after 24 h, whereas changes in the composition of ribosomal protein fractions appeared as early as within 6 hours after the operation. 2. In hypertrophic kidney the content of ribosomes increased but the ratio of free and membrane-bound ribosomes remained practically unaltered. However, the specific activity of free ribosomes was twice as high as that of bound ribosomes. 3. It is concluded that the enhanced activity of free ribosomes is one of the factors responsible for the increased protein synthesis in hypertrophic kidney.


Large-scale isolation of tRNA from barley embryos. 1. Large-scale isolation of tRNA from barley embryos is described, involving: phenol extraction, RNA deproteinization with the chloroform-isoamyl alcohol mixture, batch sorption on DEAE-cellulose, NaCl gradient elution of tRNA from DEAE-cellulose, and deaminoacylation of tRNA in the presence of bentonite. The procedure yielded tRNA free of protein and RNase activity. 2. The amino acid acceptor activity of the crude barley tRNA, its melting profiles and chromatographic patterns on Sephadex G-100 and BD-cellulose were similar to those of tRNA from other sources.


Some features of DNA-tRNA hybrids in the rat. 1. Sequences complementary to rRNA in rat DNA amount to 0.04% which corresponds to about 300 rRNA genes per haploid genome. 2. Purified DNA-rRNA hybrids had a DNA: rRNA weight ratio of about 1.1:1. Their melting temperature estimated on hydroxyapatite column was 75-80 degrees C. In CsCl gradients hybrids banded at 1.728 g/cm3 as compared to 1.699 g/cm3 for bulk DNA. 3. Length distribution histogram of DNA-rRNA hybrid molecules visualized by electron microscopy revealed that most of them possessed a length of 0.2-0.5 mum which corresponds to 4 X 10(5)-1 X 10(6) daltons, i.e. 670-1600 nucleotide pairs. 4. DNA sequences complementary to rRNA are localized on the heavy shoulder of the main band at a CsCl density of 1.709 g/cm3, and in a DNA fraction which re-associates at a Cot=10(-1)-10(2).


Metabolism of 1-3H-ethanol by isolated liver cells. Time-course of the transfer of tritium from R,S-1-3H-ethanol to lactate and beta-hydroxybutyrate. Parenchymal cells isolated from the liver of 24 h fasted rats were incubated with 65 mM R,S-1-3H -ethanol plus 3 mM pyruvate as substrates in the absence and presence of 1.7 mM 4-methylpyrazole. Metabolite levels and the time-course of the transfer of tritum from ethanol to lactate and beta-hydroxybutyrate was measured during the first 15 min of ethanol metabolism. The time-course of the loss of tritium from 2-3H-L-lactate and 3-3H-beta-D-hydroxybutyrate in experiments identical to the above-mentioned was estimated. A GLC method for the isolation of lactate and beta-hydroxybutyrate and the preparation of 2-3H-L-lactate and O-3H-beta-D-hydroxybutyrate is described. The incorporation rate of tritium from ethanol into lactate and beta-hydroxybutyrate decreased with time. Addition of 4-methyl-pyrazole decreased the incorporation rate roughly proportional to the decrease in ethanol and acetaldehyde metabolism. The observed incorporation rates of tritium to lactate were corrected for the detritiation rates measured in experiments with I-3H-L-lactate and 3-3H-beta-D-hydroxybutyrate as substrates. The rate of extramitochondrial acetaldehyde oxidation was calculated from the corrected initial rates of incorporation of tritium into lactate to 0-0.4 mumol min-1 (ml of cells)-1.


[Neurosurgical wounds in the defensive war]. In Yugoslavia there is a defence war act by which every hospital has to have prospect about defence of whole population in case of attack from abroad. First step of every prospect is the evaluation of casualties. Evaluation of casualties in possible war and neurosurgical discipline should be made from following aspects: estimation of amount of neurosurgical injuries, number of neurosurgical patients before the war, disposal of hospitals and beds for neurosurgery, equipment, and number of neurosurgeons. Management of neurosurgical injuries in the war begins with the first aid. After that casualties should be divided into several groups. Certain amount of patients with minor injuries of the head could be managed by general practitioner or general surgeon. The first group of really neurosurgical cases is consisted of injuries which must be operated upon by neurosurgeon immediately, without any delay. The second group are made of patients who need neurosurgical help, but it can be delayed several hours or so. The third group is consisted from injuries which should not be treated operatively. And the last one is a group of cases who will die with or without neurosurgical help. The treatment in these cases should be paliative without neurosurgical staff and equipment involved.


[Gunshot injuries of the limbs (5 years of experience; 1970-1975)]. In this study the authors present 19 patients with injuries caused by firearms. Six patients had injuries of soft tissues only, while the remaining 13 had bone fractures as well. Special attention was drawn to wounds inflicted by hunting and military rifles. The study provides data concerning the degree of injury caused by bullets with high muzzle velocities. The importance of early management of wounds and preventive treatment with antibiotics was pointed out. The fact that one patient died, and three patients had to undergo amputation does not tend to lessen the success achieved in the treatment of these severe, life endangering injuries.


[Peacetime shooting injuries of the long bones]. 1. In our short reference we have shown the complete number of injuries sustained through shooting and we have indicated their enormous frequencies which can be regarded to be equal to those injuries in traffic communication. 2. While treating the injuries of extremities, as war injuries using the same principals as in war, we have obtained the best results and lessened the possibility of complication. 3. In the above cases for osteosinthesis of long bones, we held the principles of prolonged osteosinthesis while the primary osteosinthesis were use in special cases.


[Treatment of open war injuries of the limbs in Ethiopia during the 3-year period with regard to 2 cases where a big part of the ulnar bone was missing]. I. When a patient with open compound fracture arrives at the hospital he should be given 1500 u TAT, 25000 u Serum Antigangrenosum, one million Penicillin and one gram of Streptomycin, provided that these were not given before. II. Immediate operation of the cases with injury of less than six-eight hours duration is a must here. But still it must not be forgotten that those with shoc need to be left aside for primary treatment of the shoc before they are due for operation. Debridement of the wound should be done perfectly before starting to indulage one self with the operation. Any operation of this kind is not complete if the torn or nut nerves and tendons are primarily sutured after refreshing their ends. If necessary, plastic of the skin should be accomplished at the same time. III. We must be very considerate in dealing with bones. Bones that look dirty should be cleaned by spoon curretage rather than resecting them and facing shortage in bone. Shertage of small length of bone, can be substituted by bone grafting with either method of sliding or transplanting from one bone to another. IV. Up to the time that infection can be controlled, the primary sutture should be postponed and the only cautious debridement must be done. V. Post operative antibiotic treatment should extend from seven to ten days.


[Gunshot injuries of the gastroduodenal region]. The injuries of the abdomen and in the region of duodenum sustained through shooting, present a delicate and difficult problem in treatment. During the years 1970/74, 375 cases were treated in our clinic, out of which 38 patients were with abdominal injuries while 12 cases were with gastro-duodenal injuries all derived through shooting. Special delicate problems represent the treatment of pancreas injuries if only the tissue of the pancreas is only made with simple stitch. The difficulties represent the treatment of injuried principal duct. Every attempt of sewing the principal duct leads to mortal inflamation of the gland. The problem of treatment of this kind of injury, apart from using different methods which are recommended in the world literature still remains open and unsolved.


[Organization of surgical work in hospitals under special conditions]. A check-list consisting all the importants measures in hospital care for handling all sorts of disasters is described. In those situations the management of organization is primarily more important than medical attendance. The doctor educated in individual medicine overestimates the medical problems. In every hospital a disaster plan should be step up as a precuation. The importance of triage has been confirmed, and several aspects of its planning have been stressed. Excercise and test alarm are necessary to check the set upa organization.


The papaverine test for blood flow potential of ileo-femoral arteries. To establish drug and an optimal dose for a pharmacological test of the blood flow potential of an artery, the effect of intra-arterial injection of papaverine in varying doses was observed. The response to papaverine was then compared with that of other vasodilating drugs and with the physiological vasodilation of sympathectomy, exercise and postischemic hyperemia. In reconstructed atheromatous arteries, the injection of 40 mg papaverine HCl was found to induce a maximal local flow response, increasing blood flow in artery by approximately 250%. In normal arteries the response was higher. Tolazoline and isoxuprine induced a lower blood flow  response and a higher fall in systemic blood pressure. The flow induced by papaverine was higher than flow after sympathectomy and light exercise and amounted to 88% of the maximum seen after 5 minutes ischemia. It is concluded that the blood flow induced by intra-arterial injection of 40 mg papaverine HCl represents a useful reference for flow potential of this artery.


Influence of a rigid plate for internal fixation on the maximum torque capacity of long bones. The unfavourable effect of the rigid internal fixation plate on the strength (measured as maximum torque capacity) of the diaphyseal bone, with due attention to the importance of the screw holes, has been studied on the femora of 7 dogs. When the plates that had been applied for 7 months without previous osteotomy were removed, a significantly reduced maximum torque capacity was observed, as also a significantly reduced maximum angle of torsion, and a significantly changed distribution of the amount of bone mineral.


A new modification of the technique of arthroscopy of the knee joint. Experience from arthroscopy in 224 patients with knee complaints is reported. The common method for arthroscopy is compared with a new modification developed during the study. The new method includes introduction of a 5 mm arthroscope through the patellar tendon at the level of the joint line and the use of hooks to test the menisci and the ligaments. The experience from this method shows that it gives an expanded field of vision and that technical failures are less frequent. No complications occurred. It is stated that arthroscopy is of great value in the diagnosis of knee injuries. However, a high diagnostic accuracy can only be reached by an experienced operator using a strictly standardized method.


Results of liver dearterialization combined with regional infusion of 5-fluorouracil for liver cancer. 40 patients with primary or metastatic liver malignancies have been treated with hepatic dearterialization, 19 of them in combination with regional infusion with 5-fluoroacil. The survival was longer than expected from untreated materials. This was especially shown to be valid for patients with primary liver cancer and liver metastases from cancer coli-recti, in which the prolongation of survival was associated with an acceptable quality of life. The long term results were correlated with the "aggressiveness" in therapeutic approach. Only studies of prospective randomized series can settle whether the results depend on the specific measures against the liver tumours or on the general treatment.


Liver resection for cancer.

Liver resection for cancer. Liver resection was performed for primary and secondary cancer in 46 patients. Left lobe resection was performed in 11 patients, right lobe resection in 22 and extended right lobe resection in 13. There was no post-operative mortality after left lobe resection, 9 after right lobe and 5 after extended right lobe resection. Ten patients have survived two years after the liver resection. This surgical procedure seems to be of benefit especially for patients with primary liver cancer and with metastases from cancer coli-recti.


Retained bile duct stones.

Retained bile duct stones. Residual bile duct stones were found in 69 out of 4078 patients subjected to cholecystectomy. In 5 of these patients the outcome of the residual stones was unknown, but in 64 patients the complete course of events could be followed. In 32 patients the stone(s) were lodged in the intrahepatic ducts; in 15 patients the stones were overlooked owing to incomplete or technically unfeasible post-explorative cholangiographies; in 12 patients the stones were not visualized in good peroperative cholangiograms and in 5 patients the stones were misinterpreted as air bubbles. Spontaneous passage of the retained stones was verified in 24 patients. In 40 patients re-exploration was performed. Organic changes in the bile duct wall, a large (greater than or equal to 10 mm) and solitary stone were factors that precluded spontaneous passage. Re-exploration of residual bile duct stones, especially during the first month after the primary surgery, was found hazardous. If possible re-exploration should not be performed earlier than 4-6 weeks after the primary operation.


Morphological changes of the small intestine following jejuno-ileal shunt in obese subjects. The forty-seven patients in this study suffered of massive obesity and underwent jejuno-ileal shunt operations. Seventeen of them had a second laparotomy for various reasons. At both operations, a number of measurements were made; the length of the functioning jejunal and ileal segments and, in biopsies, the intestinal villus height were determined. The second laparotomies were not performed until at least 6 months after establishment of jejuno-ileal bypass. The mean length of functioning jejunum was increased by 33% (p less than 0.05) and the mean elongation of functioning ileum by 73% (p less than 0.001). The mean villus height in functioning jejunum increased by 33% (p less than 0.001) and in functioning ileum by 70% (p less than 0.001). The mean villus height in the jejunal blind loop decreased by 30% (p less than 0.001). The demonstrated hypertrophic changes in the functioning part of the small intestine following jejuno-ileal bypass represent the morphological basis of functional intestinal adaptation. The effect of this adaptation is clearly shown in the characteristic weight diagram of an obese patient after bypass operation: the loss of weight cases, a period of stability ensues and then the patient begins to regain weight to some extent.


Protein patterns in serum and peritoneal fluid in Crohn's disease and ulcerative colitis. The protein content in serum and peritoneal fluid has been determined and analysed electrophoretically in patients with Crohn's disease and ulcerative colitis and the data obtained compared with previously published data on serum and ascites content in liver cirrhosis, heart failure and intestinal tuberculosis. Ascites fluid in liver cirrhosis and heart failure, representing a true transudate, had a comparatively low protein content while the ascites fluid in inflammatory bowel diseases including Crohn's disease had high protein content. There was no difference in ascites protein content or ascites/serum protein ratio between patients with Crohn's disease and patients with ulcerative colitis. An exudative nature of both these inflammatory bowel conditions appears to be the main cause to the peritoneal fluid often observed at laparotomy. It cannot be excluded, however, that a lymphatic stasis, which is thought to be involved in Crohn's disease, might at least partly contribute to the development when larger quantities of ascitic fluid are at hand in this disease.


Renal artery injuries following blunt trauma. From 1861 to 1975 fifty-three cases of blunt renal pedicle injury have been reported. Sixty-five kidneys were involved (twelve bilateral injuries) and 32 of them were removed. Reconstructive surgery was tried on 17 kidneys, of which only one healed without complication and with recovery of normal function. In addition, in 4 patients with bilateral injury, operation preserved enough kidney function to save the patients from hemodialysis, though 2 of them developed hypertension. This paper reports 4 further cases. In 2 patients with renal artery thrombosis nephrectomy was eventually performed after preceding reconstructive or conservative treatment. The third patient with thrombosis was not seen until several years after the trauma and was treated conservatively. The fourth patient had a ruptured intrarenal arterial branch with massive hematuria and finally required resection of the kidney. An early diagnosis of renal artery injury following severe abdominal trauma requires immediate aortography, sometimes with subsequent selective catheterization. If renal trauma is not strongly suspected, intravenous large dose pyelography may be indicated as the first step. Surgical repair should consist of resection of the injured artery and reconstruction with a venous graft, or autotransplantation of the kidney. If treated conservatively, the patient must be followed up at regular intervals for hypertension and other complications.


Effects of dextran 40 on the proximal renal tubule. Studies on transfer maxima of glucose and hippuran in the rat. The effect of a single large dose of dextran 40 on transfer maxima for glucose and hippuran was studied in the rat. A close relationship between these transfer maxima and the glomerular filtration rate and/or transport of water and electrolytes was demonstrated. Despite the presence of dextran 40-induced "osmotic nephrosis" the observed parameters, expressed as mg/ml glomerular filtrate, were unchanged.


Value of routine estimation of erythrocyte sedimentation rate in surgical patients. The value of the erythrocyte sedimentation rate (ESR) as a screening test has been assessed through a retrospective analysis of 1648 surgical patients, in whom this test was not necessary for diagnosis, treatment or evaluation of risk factors. The ESR was inexplicably elevated in 42 patients (2.5%), but a marked increase was found in only very few cases, and in none had this finding been of any consequence for the admission in question. One patient had a malignant disease, which was not diagnosed during hospitalization, but the reasons for this were incorrect interpretation of relevant diagnostic procedures. We conclude that ESR can be excluded as a screening test in surgical patients, when diagnosis and therapeutic measures can be decided by history-taking and physical examination.


Wound infections in general surgery. Wound contamination, rates of infection and some consequences. Rates of wound infection have been studied in a clinic performing to an equal degree both clean surgery and potentially contaminated surgery. Included in the study were 2827 patients with 213 (7.5%) postoperative wound infections. The postoperative mortality was 2.1%. Primary illness and cardiovascular complications were the main causes of postoperative death, while infectious complications (pneumonia, peritonitis and wound infection) were associated with or caused 1/3 of all postoperative deaths. Positive cultures from the wound before closure and from the wound dressings, immediately after operation, were followed by an increased risk of wound infection compared to negative cultures. Rates of wound infection were significantly higher in potentially contaminated operations compared to clean operations. Gram negative bacteria dominated in isolates from infected wounds after the former type of surgery, while S. aureus was the most common bacteria in wound infections after clean surgery. The time interval between operation and the discovery of wound infection was in the mean 10 days for staphylococci, and 9 days for Gram negative bacteria. The average time of hospitalization for patients contracting postoperative wound infections was 9 days longer than that for non-infected patients, which means that 3.4% of all nursing days were lost owing to excess hospitalization of infected patients.


Wound infections in clean and potentially contaminated surgery. Importance of bacterial and non-bacterial factors. Postoperative wound infections in clean--and potentially contaminated surgery were studied with regard to demonstrable wound contamination and the occurrence of non-bacterial wound infection promoting factors. The incidence of demonstrable wound contamination in clean surgery was low, and observed rates of wound infection could not be related to differences in wound contamination, but to the occurrence of non-bacterial wound infection potentiating factors, e.g. implantation of foreign materials (osteosynthesis), cicatrical tissues or a compromized host. Corresponding studies in potentially contaminated surgery revealed a significantly higher incidence of wound contamination compared to clean surgery and a significant correlation between Gram negative wound contamination and rates of postoperative wound infections in certain types of gastrointestinal surgery. Patient factors, such as age or malignancy, did not influence the wound infection frequency when the incidence of wound contamination was taken into consideration.


Absorption of missile energy in soft tissue. Soft tissue wounds caused by spherical steel projectiles at various impact velocities have been studied. Energy absorption by the penetrated tissues and the size, form and location of the maximum of the temporary cavity are discussed on the basis of theoretical calculations. Morphological and angiographic findings support the assumption that steel spheres hitting at high velocity cause most damage near the beginning of the wound channel. The possible occurrence of transonic strong shock waves above certain velocity limits and their role in increasing the destructive effects of the temporary cavity, are discussed.


The treatment of thyroid cysts by ultrasonically guided fine needle aspiration. 28 solitary thyroid cysts diagnosed by ultrasonic examination were punctured under guidance of ultrasound, as a therapeutic trial and for cytological evaluation. No case of malignancy was encountered. At follow-up 3--6 months later no cyst could be demonstrated in 20%, 30% of the cysts had decreased, while 50% were unchanged or increased in size.