[Congenital multicystic renal dysplasia in the adult age]. In the multicystical renal dysplasia we have to do with a congenital malformation due to a developmental disturbance of the bud of the ureter. It is characterized by a conglomerate of cysts, rarely by a single cyst without a functioning renal parenchyma, atresia or complete absence of the ureter belonging to this as well as hypoplasia or atresia of the vascular stump. In childhood the clinical picture is not observed frequently, in adult persons only rarely. Though the case in question is a homogeneous disturbance of the development, in childhood and adult age pretty different findings are the result. In childhood in most cases a palpable tumour caused by a multicystical kidney is to be found, in adult persons often a more distinct formation of a defect occurs, particularly of the ureter as well as a nearly obligate calcification of the walls of the cyst. Often the clinical picture is to be found in combination with other, above all urological congenital anomalies. Two own observations of multicystical renal dysplasia in adult age are reported and in connection with 33 cases of literature they are comparatively investigated.


[Endotoxinemia in liver cirrhosis].

[Endotoxinemia in liver cirrhosis]. Endotoxins of gram-negative bacteria and of intestinal origin, insufficiently cleared by the hepatic reticulo-endothelial system are of an increasing interest within the pathogenesis of liver diseases. With purpose to obtain data concerning incidence and course of endotoxaemia in patients with liver cirrhosis an unselected group of these patients, sequentially admitted, was investigated by means of the Limulus-gelation test, regarded as most sensitive to endotoxins. At the admittance, 65% of the patients had endotoxaemia, further 14% developed endotoxaemia later. In total 79% of the patients investigated had endotoxaemia.---Bleeding from oesophageal varices was associated with endotoxaemia in 78%, functional renal impairment in 75%, consumption coagulopathy in 81%, encephalopathy in 77% and a pyrogen reaction in 82% of the patients. Regarding the Limulus assay, the dilution technique was more sensitive in detection of free endotoxaemia as opposed to the chloroform extract. It is concluded from the results that endotoxaemia in patients with liver cirrhosis is frequent and has to be viewed as relevant within the pathogeneses of chronic liver diseases.


[The effect of flavonoid compounds (+)-cyanidanol-3 in acute viral hepatitis]. A double blind study was carried out with 14 pairs of patients suffering from acute virus hepatitis in order to determine the action of (+)-cyanidol-3 (2 g daily, administered orally). Among these few patients no significant differences were observed between the two groups. This also holds true for the liver function test with the exception of total serum bilirubin. In the treated patients hyperbilirubinemia decreased significantly faster than in the untreated group (p smaller than 0.05). The values registered with a daily dosis of 1 g (+)-cyanidol-3 did not differ from those recorded in the groups of untreated patients.


[Rat jejunal xylose and galactose absorption dependent on the intestinal bacterial flora and after cytostatics administration]. The influence of the bacterial flora of the intestine and of cytostatic drugs on the intestinal xylose and glucose absorption in the rat is studied by a perfusion technique in vivo. Conventional, germfree and decontaminated animals show no different xylose absorption rates while the galactose absorption is decreased in germfree and decontaminated animals compared to conventional rats. Three days after a single injection of cytostatic drugs the xylose absorption is diminished in conventional and decontaminated animals compared to untreated rats. In germfree rats no effect of cytostatics on the xylose absorption can be proved. The galactose absorption is unchanged after cytostatics in conventional and decontaminated animals, but increased in germfree rats.


[Gastrointestinal hormones and blood circulation in the gastric mucosa]. The gastrointestinal hormones influence gastric mucosal blood flow in different ways. Gastrin, secretin and pancreocymin increase gastric mucosal blood flow, glucagon, vip and somatostatin decrease it. Motilin has a special position. Given alone motilin improves gastric mucosal blood flow, wheras it reduces gastric mucosal blood flow after previous administration of pentagastrin or histamin.


[Synthesis of gastrointestinal agents].

[Synthesis of gastrointestinal agents]. The importance of syntheses of biologically active polypeptides especially of gastrointestinal hormones for medical research, is analyzed; six points, as the main goals of a synthetic approach, are discussed with respect to their special significance and are confirmed by six examples.


[Benign diseases of the esophagus. An internist's view]. The work-up of patients with benign diseases of the esophagus should start with a diagnostic evaluation. This includes a carefully taken history, radiologic and endoscopic examinations and, in suspected reflux disease, recording of intraesophageal pH. For the evaluation of functional troubles esophageal manometry is recommended. Patients with complicated reflux disease and failures of antireflux treatment should be operated upon. In high peptic stenoses, Barrett's syndrome should be carefully looked for. Achalasia is treated by pneumatic dilatations with more than 90% good or satisfactory results. But diffuse esophageal spasm is little responsive to therapy. There is a risk of secondary carcinoma in Barrett's syndrome, achalasia, caustic lesions and Plummer-Vinson syndrome. Therefore these patients should be seen at regular intervals. There is an urgent need for controlled studies evaluating the comparative results of medical and surgical therapy.


[Benign diseases of the esophagus].

[Benign diseases of the esophagus]. Most benign esophageal affections may be successfully subjected to carefully selected non-invasive but mainly to surgical techniques; special attention is being paid today to refluxcaused esophagitis and its sequelae. They both require a special strategy of anti-reflux measures - sometimes combined with suppression of peptic aggression. Fundoplicatio according to R. Nissen - if necessary complemented by selective vagotomy - to a large extent meets the needs of a surgical technique adapted to this type of disease.


[The lower esophageal sphincter and manometry methods]. For measuring the closing strength in the lower esophageal sphincter an adequate method of manometrie is necessary. A pressure measuring device is placed into the esophageal occlusion segment and is filled with water under a variably fixed pressure. Thus a radial force tries to open the closed sphincter. The opening pressure can be equated to the closing pressure. Moreover the activity of sphincteric musculature influenced by drugs can be investigated under a constant radial pressure.


[Gastrointestinal hormones and lower esophageal sphincter]. In the gastroesophageal closing mechanism there is a digestive sphincter which as yet has only been identified by its function. This sphincter is subject to the action of gastrointestinal hormones; all hormones, except gastrin and possibly motilin have a relaxing effect. This action sets in only following administration of relatively large doses and thus corresponds to pharmacological effects. The physiological effect of gastrin long under discussion could not be proved in these tests - at least not for antral G 17. Whether or to what extent other hormones - perhaps Big gastrin - have an effect on the control of the lower esophageal sphincter under normal conditions remains yet to be determined.


[Acute hemorrhage of the upper digestive tract with special reference to stress ulcer. Prevention and surgical therapy]. For the surgical therapy of an acute stress-ulcer bleeding there are three methods to someones disposal: 1.) the local care of a bleeding source 2.) the partial gastrectomy and 3.) vagotomy with pyloroplasty and local care of a bleeding source and as prophylaxis of an acute stomach bleeding the highly selective vagotomy with or without pyloroplasty. On judging the success of these methods, some has to consider the basal illness with its letality, because it is to differ, wether a patient died postoperative on his basal disease, or on the effect of the operation, or out of deficient control of the situation. Considering such points it comes out clear, that today the vagotomy with a drainage operation is the method of choice, because: 1.) through this intervention patients are tainted less as for instance through a partial gastrectomy, 2.) through a technical faultless done operation, especially through a vagotomy a success concerning a relapse bleeding is guaranteed. Beside that, the highly selective vagotomy without drainage operation presents itself as prophylactic measure, to prevent an acute stomach bleeding in a number of transplanted patients (kidney transplantation). The first experiences with this method show, that a improvement of the results is to be expected.


[Summary of work session 3: Drug-induced dissolution of gallstones]. Since the successful dissolution of cholesterol gallstones is depending to a vast degree on the selection of patients put to test, selection of apt patients was to be the center point of the work session. Furthermore therapy and side effects was being discussed. The best method of choosing patients for chenodeoxycholic-acid-(CDC)-therapy is presented by oral, less by intravenous, cholecystography. Normally this examination provides us with a fair judgement on structure of stones, size of stones and total stone volume, factors which are of considerable importance for any therapeutic success. Determination of the lithogenic index and the finding of cholesterol cristals in the bile could be competent criteria of selection, but these methods are far to complicated. These measurements could only be applied for the determination of the minimal maintenance dosage before onset of long lasting therapy after stone dissolution. The toxic side effects of CDC-therapy seem to be of minor degree in human beings. Changes of liver tissue that could be unequivocally traced back to CDC could not be detected, in contrast to animal experiments, where as there seems to be a correlationbetween an often observed elevation of transaminases and the CDC-dosage applied. There is no negative influence upon fat metabolism of the patient. There were found no morphologic or functional disorders of the gastro-intestinal tract due to CDC-treatment with the exception of chologenic diarrhea. We have still to wait for the results of long-term studies.


[Gastrointestinal hormones].

[Gastrointestinal hormones]. Gastrointestinal hormones are considered to be those that are formed in the gastrointestinal tract and there, in physiological concentrations, develop their effects on motility, secretion, trophism, bloodflow and absorption. Structural analysis, synthesis or a high degree of purity after extraction, and its exact demonstration by means of a useful radioimmunoassay, form the basis for the establishment of a polypeptide as a gastrointestinal hormone. To this category belong, at the present time, gastrin, cholecystokinin-pancreozymin (CCK-PZ) and secretin. GIP, VIP, motilin, glucagon and somatostatin are considered likely candidates. The substances gastrin and CCK-PZ, which are structurally related and have a predominantly stimulating effect, and the structurally dissimilar motilin, contrast with the partially or totally inhibiting hormones of the glucagon family, namely, secretin, VIP, glucagon-enteroglucagon, GIP and somatostatin. By the combined action of these hormones with one another and with the autonomic nervous system, the digestive processes are regulated. Disturbances in the formation of these hormones, in particular an overproduction, give rise to disease syndromes that can now be diagnosed and, in part, treated by surgery. The therapeutic application of gastrointestinal hormones has now also become a possibility.


[Gastrin in internal medicine].

[Gastrin in internal medicine]. A pathophysiological role of gastrin has been established only in the Zollinger-Ellison-Syndrome. Hypergastrinemia may be found in cases with prenicious anemia, atrophic gastritis and after all forms of vagotomy; furthermore in the excluded antrum syndrome, the short bowel syndrome, in renal insufficiency, pyloric stenoses and after oral or parenteral administration of calcium. The role of gastrin in the pathogenesis of duodenal ulcer is unknown.


[Gastrin in surgery].

[Gastrin in surgery]. The clinical symptomatology of the Zollinger-Ellison-syndrome, the diagnostic treatment and the surgical procedure are reviewed. The syndrome with excessive non-regulated gastrin release from the ZE-tumor is the only form of ulcer disease with importance for the surgeon. The development of a sensitive radioimmunoassay for circulating gastrin facilitated its diagnosis. The possibility of Zollinger-Ellison-syndrome should always be considered if ulcer recur after surgical procedure by simple ulcer disease. If ulcers are located at atypical sites, if multiple ulcer are found, the diagnosis of a Zollinger-Ellison-syndrome should be established by measuring serum gastrin levels.


[The problem of functional achlorhydria]. It was examined whether in anatomically intact specific adenic parenchyma of the gastric mucosa achlorhydria can persist after maximal stimulation or whether there is support to the conception of functional achlorhydria ("functional anacidity") furthermore. Relating to the anatomic structure of the gastric mucosa secretion of chloric acid was studied after submaximal and maximal stimulation in 101 cases. It was shown that there is no correlation between the morphology and the secretion of chloric acid in anatomically intact gastric mucosa after submaximal stimulation. In 18 cases out of 28 only the secretion of acid was in correspondence to the histological condition. In two cases out of 37 with atrophic gastric mucosa diverging results were found. After maximal stimulation with histamine chloride and pentagastrine one out of two cases with histologically intact mucosa showed normochlorhydria after seven days, whereas the second case remained achlorhydric. These results must be interpreted as functional achlorhydria. Submaximal stimulation of gastric secretion as it is practised today does not allow corresponding consequences concerning the morphological condition of the gastric mucosa. Discrepant results are found especially in histologically normal mucosa. There is more congruence in atrophic gastric mucosa.


[Double contrast examination of the stomach. Definition, technic and indications]. Double contrast examination constitutes an important element in radiological gastric examination. The author examines the history of the term "double contrast" and defines the designation of "double contrast examination". The exclusive use of the double contrast method reduces the diagnostic value of gastric X-ray examinations. Thus a method is suggested that will avoid the disadvantages of exclusive double contrast examination while adequately including double contrast in the gastric examination. This is done by using various methods - according to the problem posed - in order to achieve the double contrast.


[Examination using the gastro-camera and gastroscopy--confrontation and complementation]. Both the gastro-camera and gastroscopy are methods of examination dating back to the last century. Since 1955 examination with the gastro-camera has gained major importance in Japan. Not until the efficient gastroscopic instruments based on fiber optics and with extremely flexible points as well as advance view optical systems were developed large-scale, introduction esophageal gastro-bulboscopy in hospitals and in offices of specialists became possible. In our view the replacement of the gastro-camera method of diagnosis as a basic examination by gastroscopy is not justified. The gastro-camera is highly efficient and easily applied if centers for early diagnosis of gastric tumor cooperate with the examining physicans; their own experience with the gastro-camera is a premise for this arrangement. The principal task of endoscopic diagnosis is the determination as to therapy, namely whether surgery or a conservative method should be applied: this is particularly true in the case of early carcinoma stages where a 90% 5-year survival chance prevails. For various reasons gastro-camera examination should be assigned a more prominent role. Gastroscopy and histological examination represent further steps in diagnosing malignant processes. It is not possible to preclude the possiblity of a malignant tumor by means of gastroscopic biopsy.


[Endoscopic tumor-cell diagnosis within the region of duodenum]. The technique spontaneously or siphoned after cholecystokinin stimulation. Our technique of cell collection within the region of the duodenum, the pancreas and the bile-ducts have been optimal performed by duodenoscopical methods. From the papilla of Vater, the cell brush abrasion is used. Pancreatic secretions are obtained by praepapillary drainage with a catheter after secretin stimulation or siphoned after canulation of the ductus Wirsungianus. Bile is obtained wth the same technique of material collection and processing is described. Characteristical tumor cell findings of the papilla of Vater, of the pancreas and the bile ducts are demonstrated and the cytodiagnostic's position within the tumor recognition in this area is discussed. We think the tumor cell search with the described duodenoscopical techniques as indicated in following cases: 1. suspicion of carcinoma of papilla of Vater, 2.obstructve jaundice, 3. in search of carcinoma of the pancreas.


[Sterilization during puerperium (author's transl)]. Sterilization of the woman during puerperium is performed immediately following delivery via a periumbilical incision during a caesaren section isthmica intraperitonealis via laparoscopy or 3--5 days following delivery by pelviscopy. The surgical procedure currently in use for ligating or severing the fallopian tubes is accompanied by extensive loss of blood. This procedure should, therefore, be replaced by the coagulation method which is safer and does not contribute to the formation of adhesions. If the abdomen has been dissected, either high frequency current or the Endo-coagulation procedure may be used to produce the destructive heat necessary to coagulate the fallopian tubes. If the abdomen has not been opened and the coagulation of the fallopian tubes must be performed via pelviscopy, the Endo-coagulation method should be used instead of the high frequency current procedure which cannot be absolutely controlled by the surgeon. The Endo-coagulation procedure works at or about the temperature of boiling water. The failure rate for this procedure is about 2--3 %0.


[Serum concentrations of SP1, HLP and estriol in last trimester of normal pregnancy: circadian variations and influence of labour (author's transl)]. Serum concentrations of SP1, HPL and estriol were investigated for circadian variations: levels of SP1 were significantly decreased at the 24th and 4th hour. An investigation of serum concentrations of SP1, HPL and estriol during labours revealed a tendency of decreasing levels of estriol.


The oxytocin challenge test in the prognosis of high-risk labor. In of 707 pregnant women in the last five weeks of pregnancy a total of 1025 Oxytocin-Challenge Tests (OCT) were performed. Perinatal mortality in the toral material was 16,8% crude and 14,2% corrected. The results of the test were classified into three patterns: normal, borderline (or prepathological) and pathological. The main characteristics of these three patterns are described. Normal OCT was found in 84.9% of the tests and 83,7% of the cases. Borderline OCT was present in 8% of the tests and 7,7% of the cases. Finally pathological profiles were present in 7% and 8,4% respectively. The results of the OCT were compared with the perinatal mortality in the three groups and with the percentage of fetal distress intra partum. It is concluded that the OCT is perhaps the most accurate method to ascertain acute placental insufficiency pre partum. Even the more controversial borderline cases, have a clinical significance.


[Uterine activity in late pregnancy (author's transl)]. In late pregnancy three different dinks of uterine activity can be observed by external tocography: Alvarez-waves, Braxton-Hicks-contractions and phases of inactivity equivalent to the intervals of labour. Contractions and phases of inactivity increases on to delivery, while the portion of Alvarez-waves decreases. Braxton-Hicks-contractions and phases of inactivity are opposed to the uncoordinated Alvarex-waves as coordinated activity. Accordingly these changes are explained as a process of increasing coordination of uterine activity, which finally ends in delivery.


[Gangrenous pyoderma and IgA-paraproteinemia]. A gammaAchi--paraproteinemia was found in a 73 year-old female patient with pyoderma gangraenosum. Since the paraporteins hitherto observed in pyoderma gangraenosum predominantly belong to the IgA class, a relationship may exist between pyoderma gangraenosum and this type of paraproteinemia.


The in vitro effect of diethylaminoethyl dextran on stimulation of mouse lymphocytes, and on the mitogenic activity of concanavalin A and lipopolysaccharide. Unpurified lymphocytes from spleen, lymph nodes, thymus, and T and B cell-enriched fractions of spleen cells from NMRI mice as well as lymphocytes of nude mice were cultured and stimulation of the lymphocytes by DEAE-D, Con A and LPS and combinations thereof was measured by incorporation of 3H-thymidine. It was demonstrated that DEAE-D is a rather weak mitogen for mouse lymphocytes, acting apparently on B cells as well as on T cells. Frequency and intensity of lymphocyte stimulation by the T cell mitogen Con A and the B cell mitogen LPS was much better. When combinations of DEAE-D with Con A or LPS, respectively, were used significant enhancement of lymphocyte stimulation occurred, as compared to the mitogens and DEAE-D alone. This enhancement was more prominent with the DEAE-D/Con A combination than with the DEAE-D/LPS combination, and more pronounced with the T cell-rich lymphocyte preparations than with the B cell-rich suspensions. The results are discussed and it is concluded that DEAE-D enhances both T cell and B cell functions, however, T cell functions are favoured. This enhancement is assumed to be mediated by a membrane effect of DEAE-D, and to be responsible for th immunological adjuvant effect of DEAE-D.


Antigenic relationship between chicken brain and granulocytes. Antisera prepared in rabbits and turkeys against chicken brain were tested in membrane immunofluorescence and lymphocytotoxicity tests for their reactivity with thymocytes and cells from the bursa of Fabricius of normal White Leghorn chickens. In contrast to the findings in mice and other mammals, these antisera did not afford any specific reaction with thymus cells after exhaustive absorptions of species specific antibodies with cells from various tissues. However, absorbed rabbit antisera could be shown to react specifically with cells from the granulocytic series in the bone marrow and, to a lesser extent, in the peripheral blood of chickens.


Genetic differences between endotoxin-sensitive and resistant C3H mice. Intraperitoneal cell response to lipopolysaccharide and prostaglandins. The 2 related mouse strains C3H/HeJ and C3/Han differe in their response to endotoxin. C3H/HeJ mice are endotoxin-resistant, C3H/Han mice are - like all other mice - endotoxin-sesinsitive. The uptake of fluorescent intraperitoneally injected lipopolysaccharide was similar in both mouse strains. The intraperitoneal injection of lipopolysaccharide produced a higher mobilization of neutrophil granulocytes in resistant C3H/HeJ mice than in C3H/Han mice. An opposite pattern of mobilization of neutrophil granulocytes could be observed after injection of the prostaglandins E 1, E 2, and F 1 alpha: which both mouse strains were compared, a normal mobilization was observed in C3H/Han mice. C3H/HeJ mice showed a markedly decreased mobilization. If the difference between the 2 strains resides in a single gene locus itis to be assumed that lipopolysaccharide resistance is controlled by the same gene which also effects an impaired response to neutrophil mobilization after prostaglandin application.


Factors influencing the phagocytosis-stimulated glucose oxidation in porcine leukocytes. The stimulation of the D-(1-14C)glucose and D-(6-14C)glucose metabolism in pig leucocytes during the phagocytosis of bacteria and inert particles was studied. The following results were obtained: 1. The magnitude of phagocytosis-stimulated glucose oxidation is directly related to the nature and number of particles added. 2. Live bacteria stimulate the glucose metabolism to a greater extent than do a similar number of heat-killed organisms. As to the extent of the stimulation the species of bacteria offered for phagocytosis is crucial. 3. After in vitro addition of a lipopolysaccharide a stimulating effect is observed, a depression has been shown after the addition of hydrocortisone.


[Studies on the mechanism and duration of antibody-mediated immunosuppression (author's transl)]. The simultaneous injection of either 10(8) or 5 X 10(5) sheep erythrocytes (SE) and an allogeneic anti-SE serum into mice produced not only a suppression of the primary immune response, but, moreover, the secondary immune reaction elicited, either 4, 8, 12, 16 or 30 weeks after the primary antigenic stimulation, was found to be impaired. This was mainly demonstrated by the significantly reduced numbers of 7 S antibody-synthesizing spleen cells. The suppression of the secondary immune responses is hardly compatible with the conception that the antibody-mediated immunosuppression is solely due to an inactivation of the antigenic determinants by the passively administered specific antibody in the periphery of the immune system. This objection against the so-called "peripheric theory" is supported by a further finding. When mice primarily immunized by a simultaneous injection of 10(8) SE and anti-SE-serum were treated with 2 X 10(7) SE 24 hours before boostering with 10(8) SE, in order to eliminate a possibly existing residual activity of the passively administered specific antibodies given together with the primary antigenic stimulus, the secondary 7 S response was likewise found to be significantly suppressed. On the basis of these findings it is suggested that besides the "peripheric mechanism" a "central" effect plays a significant role in the phenomenon of antibody-mediated immunosuppression, this being due to the reversible or irreversible inactivation of immunocompetent precursor cells by the attachment of antigen-antibody-complexes which results in an inhibition of their differentiation into antibody-producing cells.


Cooperative binding of a complement component to antigen-antibody complexes. III. Complexes containing IgM antibodies. The first component of guinea pig complement (C1)2) is bound in a cooperative manner to antigen-antibody complexes containing rabbit IgM antibodies, as was previously shown to be the case for IgG antibodies. The shape of the binding curves is consistent with an allosteric mechanism involving clusters of 10 interacting C1 binding sites. Similar results were obtained with IgM antibodies against an artificial hapten and against a natural constituent of the erythrocyte membrane.


[Diagnostic value of mitral and septal echocardiographic changes in aortic valve insufficiency]. 116 patients with aortic regurgitation of different severity with and without associated valvular lesions were studied with echocardiography. In all cases the diagnosis was proven by cardiac catheterisation. Typical fluttering of the anterior mitral valve leaflet and the interventricular septum were oftener observed with increasing degree of severity of aortic regurgitation. An associated fluttering of the posterior mitral valve leaflet is described. This is seen with increasing severity of the valvular lesion and in more than 90% of patients with severe aortic regurgitation as it is observed with the anterior mitral leaflet. An isolated fluttering of the interventricular septum was observed in two cases and is also regarded as a specific finding in aortic regurgitation. There was a significant higher pulse pressure in patients with fluttering of the anterior mitral leaflet and/or the interventricular septum than in those cases without fluttering. Fluttering of mitral leaflets in aortic regurgitation was seen even in patients with additional mitral stenosis with and without calcification and after commissurotomy. A premature mitral valve closure was noted in one of 93 cases, an incomplete diastolic aortic valve closure in 29 of 78 cases. The diastolic diameter of the aortic root was mildly increased in 17 patients with pure aortic regurgitation. In 8 patients, mostly with severe aortic regurgitation, the E-F-Slope of the anterior mitral leaflet ranged between 120 and 160 mm/sec. The presented findings do not allow a conclusion regarding the severity of aortic regurgitation. However, they do allow the echocardiographic diagnosis of aortic regurgitation with a high degree of accuracy, in particular in cases of fluttering.


[Autosomal dominant hereditary atrial septal defect with heart conduction defects and mitral valve insufficiency]. An autosomal dominant inherited ASD with conduction defects in one family is described. 6 members of 4 generations were fallen ill. In 4 patients the diagnosis was made clinically, in 2 sisters the diagnosis was confirmed by operation. Moreover, the last 2 patients had a mitral insufficiency--probably congenital. The ecg-findings of 4 patients additionally showed conduction defects in form of AV-and bundle branch blocks.


[Severe atrioventricular block in 2 cases with pre-excitation syndrome]. In two patients with WPW syndrome Type A suffering from syncopes and dizziness intermittent high degree A-V block was observed. The analysis of the surface Ecg revealed in the first case a complete A-V block within the normal conduction system at the level of the A-V node. In the second case there was a constant left bundle branch block with intermittent block in the right fascicle (intermittent trifascicular block). In both cases the preexcitation syndromes could be best explained by accessory tracts bypassing the normal nodal system left side. One-to-one conduction through the bypass occurred only at a distinct range of cycle lengths, at lower frequencies the accessory tracts were refractory and a IInd or IIIrd degree A-V block occurred. However, outside this frequency zone some P waves were conducted through the accessory tracts without changes in cycle lengths. The findings support the thesis of at least two functionally different atrioventricular pathways in patients with preexcitation syndrome.


[Atypical vagal Wenckebach period in a high performance athlete]. A 27-year-old man, engaged in heavy physical training, exhibited sinusbradyarrhythmia with atrial abnormality and second degree av-block (atypical Wenckebach period). Since abnormal sinusrhythms was established with exercise and following parasympathetic blockade, this rhythm disorder was considered consequential exaggerated vagal tone. With the aid of His-bundle electrocardiography the block was localized in the av-node (AH).


[Fascicular block and skeletal myopathies]. Ecg investigation of skeletal myopathies showed in the approximate half of cases mono- and bifascicular blocks (left anterior, left posterior, RBBB). In view of the possibility of development of complete AV-block, whose prognosis will not be the best, cardiological observation is recommended for life.


[Effect of somatic parameters on Frank's electrocardiogram in childhood]. Correlations were computed between 123 different electrocardiographic variables and constitutional parameters of 179 children aged seven to fourteen years using the Frank system. The constitutional parameters consisted of age, body weight, height, chest circumference and deviation from ideal weight related to height. The corrected orthogonal Ecg was automatically measured by a CD 3300 computer using the program of Pipberger. The results show that the greatest number of statistically significant correlations exist between Ecg variables and body height. In contrast to expectations, age takes only the second rank. Normal values of the Frank Ecg should be related to height not to age, at least in the studied age group.


[Metabolism of essential and endogenous serum fatty acids in healthy persons, coronary disease and patients with lipid metabolism disorder. Partial aspect of high risk problem patients with age-related lipid and fatty acid concentrations in serum and regulation of long-chain products from essential and endogenous precursors in healthy subjects]. Total lipid, free and esterified cholesterol and triglycerides significantly increase in concentration with increasing age. Palmitic, palmitoleic, oleic and linoleic acid behave in the same way. Free fatty acids, phospholipids and stearic acid show the same concentrations in all groups of age. C20 fatty acids demonstrate a competitive regulatory mechanism of desaturase activity in their age dependant distribution. While the 20:3(n-9), a product of the endogenous (n-9) family, increases, the 20:3(n-6) and 20:4(n-6), both desaturation and chain elongation products of the essential n-6 family, decrease. Such behavior has been demonstrated in many feeding studies (12, 13, 15, 16, 17, 29) and is interpreted as a result of competitive substrate interaction on desaturase activity.


[Working method of the Hannover program]. A view about the operation of the Hanover-Ecg-Program System is given. An essential, if not the most important mark of this system is the combined graphical and numerical print of the results. This print allows the physician a quick preliminary diagnosis and a control of quality. The rhythm diagnostic of the Hanover System is a remarkable progress. Also complicated arrhythms can be recognized in this manner. The rhythm diagram gives the physician a good control.


An electron microscopic and cytochemical detection of concanavalin A receptors on the cell membrane of Leishmania braziliensis guyanensis. Promastigotes of Leishmania braziliensis quyanensis cultivated in the NNN medium agglutinate with concanavalin A (con A). The protozoon was agglutinated at different concentrations of con A. Maximal agglutination was obtained with 150 mug/ml. Three types of agglutination were observed: flagellar-flagellar, flagellar-body and body-body. Cell surface polysaccharides, glycoproteins or glycolipids were demonstrated using the periodic acid-thiosemicarbazide-silver proteinate technic. A con A-horseradish peroxidase-diaminobenzidine (DAB) technic was used to detect con A receptors on the cell membrane of the parasite.


Studies on the ultrastructure, histochemistry and cytochemistry of the uninfected digestive gland of Bithynia tentaculata (Mollusca: Gastropoda) and on the ultrastructure of this host organ in snails infected with larval digeneans. The structure and function of the digestive gland of the gastropod mollusc, Bithynia tentaculata, was investigated using ultrastructural, histochemical, and cytochemical techniques. The digestive gland was shown to be composed of two main cell types, the "digestive" cells and "secretory" cells. The digestive cells appeared to be concerned with the absorption and digestion of nutrients, while secretory cells produced digestive enzymes and calcareous concretions. Undifferentiated cells were scattered between these two main cell types. The pathological effects of larval digeneans on the digestive gland were also investigated, at the ultrastructural level. In such infected snails the digestive gland appeared to be degenerating. The significance of this tissue destruction was briefly discussed.


Qualitative analysis of substances excreted by Isoparorchis hypselobagri (Trematoda) during aerobic in vitro culture. Isoparorchis hypselobagri from the swim bladder of the catfish, Wallago attu was aerobically cultured in vitro. The dialyzed incubate was microchemically analysed for either individual or group of compounds excreted by the parasite. Amino acids, amines, amides, ammonia, aldehyde, glycine, alpha-alanine, tyrosine, alpha-aminocarboxylic acids, haemoglobin, nitrogen, reducing materials, and lactic, pyruvic, succinic, propionic and acetic acids were found in the incubate, but acetaldehyde, formaldehyde, O-dioxo and oxomethylene, and formic acid were not detected.


Studies on the infectivity of Fasciola hepatica miracidia to Lymnaea truncatula. Attachment and penetration of miracidia into non-infected and infected snails. Fasciola hepatica miracidia labelled in vivo with radioselenium have been used in studies on the capacity of the miracidia to attach to and penetrate the tegument of infected compared with non-infected host snails (Lymnaea truncatula). The results show that the penetration of the larvae into the snail tissue is not influenced by an already existing infection, regardless of its developmental stage.


Studies on host-flea relationship. IV. Progesterone and cortisone do not influence the reproductive potentials of rat fleas Xenopsylla cheopis (Rothschild) and X. astia (Rothschild). Experiments carried out to study the influence of progesterone and cortisone on the initiation of ovarian maturation, fecundity rate and fertility of the two species of rat fleas Xenopsylla cheopis (Rothschild) and X. astia (Rothschild) indicated that these hormones do not exert any influence on their reproductive potentials. This along with earlier observations show that the factors which regulate ovarian maturation and fecundity in these rat fleas are different from those of the rabbit flea Spilopsyllus cuniculi (Dale).


[About a substance with antithrombinic activity, found in the latero-oesophageal glands of Meinertia oestroides (Risso, 1826) (Isopoda, Flabellifera, Cymothoidae; parasite of fishes) (author's transl)]. An anticlotting factor was found recently in the cephalothoracic latero-oesophageal glands (G.L.O.) of Cymothoid Isopods (blood-sucking fishparasites). This substance is efficient on the blood of hosts such as Boops boops (L.), and also on the human plasma. The way of action and the chemical kind of this factor were investigated: Plasmatic coagulation-tests (Howell, Quick, Cephalin-kaolin, Stypven, Stypven-cephalin, Thrombin and Thrombin coagulase times) were realized on citrated plasmas of Boops and man; enzymatic activities of latero-esophageal glands and hepatopancreas of Meinertia oestroides (Risso, 1826) were also studied. Our results show that the anticlotting action of G.L.O. extracts proceeds from an anti-thrombinic factor, certainly carbohydrate-like as heparin.


Babesia hylomysci in mice: Preference for erythrocytes of a particular age-group and pathogenesis of the anaemia. Scintillation counting on 59Fe-labelled haemoglobin in erythrocytes, serum and urine during B. hylomysci infection in mice demonstrated that the parasite had a predilection to older mature erythrocytes and that the anaemia produced during the infection was mainly due to the direct destruction of infected erythrocytes. An autoimmune reaction has also been incriminated as a factor in the pathogenesis of the anaemia, but was of a lesser magnitude and its manifestations were masked by the direct destruction of infected erythrocytes.


Ultrastructure of macrogametogenesis of Eimeria mivati. The development of the macrogamete of Eimeria mivati Edgar and Seibold 1964 was studied with the electron microscope. Development of the young gamont was characterized by a loss of organelles such as the apical complex, subpellicular microtubules, rhoptries and micronemes, followed by an increase in micropores, mitochondria, rough endoplasmic reticulum (rER), and Golgi complexes. Nuclear detachment bodies and canaliculi were present in maturing macrogamonts. Amylopectin was first observed as small electron-dense rod-like bodies that eventually became large electron-transparent bodies. Type II wall-forming bodies developed in the cisternae of the rER. Type I wall-forming bodies appeared shortly thereafter in close association with numerous Golgi complexes. Many small vesicles located between the cisternae of the rER and the Golgi complexes formed what appeared to be a secretory pathway whereby protein formed in the cisternae and, modified by the Golgi complex, may produce the type I wall body material. The outer wall of the oocyst developed between two distal membranes on the surface of the macrogamete. Although the actual mechanism of deposition of the wall material was not seen, it was probably by some secretory process. Wall-forming bodies did not fuse.


Qualitative distribution of neutral lipids and phospholipids in Hymenolepis microstoma from the cysticercoid to the egg producing adult. The distribution of neutral lipids and phospholipids in Hymenolepis microstoma has been studied using Fettrot, Sudan Black B, Sudan IV and copper phthalocyanin staining techniques. In the cysticercoid, neutral lipids are found in the outer membrane, the lining of the cysticercoid cavity, the tegument of the larval worm and the calcareous corpuscles. A decreasing gradient of phospholipids is found starting from the acellular layer, through the circular fibrous layer, the longitudinal fibrous layer, the adjacent dense zone and ending with the lining of the cysticercoid cavity. Phospholipids are also found in the calcareous corpuscles and the tegument of the larval worm. In the young adult (3 days p.i.) fat globules are first seen to accumulate in the last 2-3 proglottids. Until the 6th day p.i. they are found in the posterior third of the worm, surrounding developing gonads, but mostly concentrated along the transverse line. The mature proglottids contain fat, (a) in both granular and globular forms: in the folds of the uterus, sperm ducts, cirrus pouch and tegument (proximal cytoplasm), (b) in a diffuse form: in the vitellaria, ovary, testes and the tegument (distal cytoplasm). Pre-gravid and gravid proglottids show the largest fat globules. From the cleaving embryo to the fully developed oncosphere the concentrations of neutral lipids and phospholipids vary in form, intensity and location. In all strobilar forms of the parasite neutral lipids and phospholipids are found in the tegument and calcareous corpuscles. Although in H. microstoma lipid droplets are found in the excretory canals, all lipids in the proglottids are not absolutely waste products. From the results it would appear that they play a role in the maturation of gonads and transformation of the fertilized ovum to the oncosphere.


Jugular venous pulse recording in a patient without a tricuspid valve. The unusual contour of the jugular venous pulse tracing (JVPT) in a patient whose tricuspid valve was excised is described. The appearance of an early positive systolic wave (SW) followed by a prominent "V" wave and a delayed deep "Y" descent were noted.


Postoperative arrhythmias in open-heart surgery, A study on fifty cases. 50 consecutive patients undergone open heart surgery were analyzed regarding postoperative arrhythmias in the first postoperative 3 days. Disturbances of rhythm occurred in each case of our group, serious or not serious (100%). Ventricular premature beats were the most frequent type of arrhythmia in the first and second postoperative days (80%). Two cases expired postoperatively. In one of them complete atrioventricular block developed after double valvular replacements (mitral and tricuspid). The other died of low cardiac output syndrome. Etiology of the arrhythmias after open heart surgery is not clear in the absence of electrolyte and metabolic disturbances, digitalis intoxication and surgical trauma to the conduction system and coronary arteries. Low cardiac output syndrome, hypotension and hypoxia can also be blamed in the formation of these arrhythmias. Other factors such as the prolongation of anoxic arrest, irritation of the ventricular septum by valvular prostheses, cardiac irritation by thoracic tubes, psychologic trauma, halothane anesthesia and coronary arterial disease in the old age group may be the possible predisposing factors in these patients.


Celiac artery obstruction after arteriography. The first case of celiac artery obstruction due to selective arteriography is reported. Impairment of flow to liver and duodenum was present; but the patient recovered uneventfully with non-operative treatment. Management of this problem centers around observation, liver support, and putting the gut at rest. If non-operative treatment is failing, operation should be done, vascular reconstruction carried out, and the duodenum inspected to ensure its viability.


Axillary sympathectomy for upper extremities. Among the several various surgical approaches to the cervico-dorsal sympathetic system, the axillary approach seems to us the operation of choice. The operation is simple, gives excellent access to the required sympathetic ganglions, including the lower part of the stellate ganglion, down to the fifth thoracic ganglion. In all cases the sympathectomy was clinically complete. The postoperative course was mostly smooth, and the few cases of transient Horner's Syndrome, pneumothorax and hemothorax could have been avoided.


Complications encountered during arterial embolectomy with the Fogarty balloon catheter. The Fogarty arterial embolectomy catheter, while indispensible in the armamentarium of the vascular surgeon, is not entirely benign instrument. A case is desribed in which the balloon was lost in its entirety from the catheter and immediately retrieved using a second identical instrument. A comprehensive survey of the literature reveals that a variety of arterial injuries have occurred during the use of the Fogarty catheter. Each of the major ones is discussed in depth. Amongst the most serious are arterial perforation and rupture occasionally followed by loss of the involved extremity. All previously reported complications following use of the Fogarty catheter are tabulated and reviewed. Additionally, a formal classification of these complications is proposed. Since the time of its introduction in 1963 the Fogarty ballon-tipped catheter has become an indispensible tool in the armamentarium of the vascular surgeon. Its use for arterial embolectomy has been responsible for the salvage of many thousands of limbs. Over the course of the past decade, however, a number of complications referable to this instrument have appeared in the literature. These include perforation of vessels, intimal disruption and foreign body embolization amongst others. To our knowledge, however, there has been only one reported case of a balloon having been lost intra-arterially in toto without obvious cause. It is the purpose of this paper to present the second such case where the balloon, which had separated entirely from the catheter during the course of an arterial embolectomy, was later retrieved by passage of a second Fogarty catheter. In addition, a comprehensive review of the literature is undertaken, and all arterial complications reported to date summarized and tabulated.


Major peripheral veins injuries.

Major peripheral veins injuries. The injury was severe in wounded limb patients of this series who suffered from an associated major peripheral vein trauma. The presence of such an injury weighed heavily on the prognosis. Thirty eight patients with major peripheral veins injuries are reviewed. The injury had resulted from war wounds, work or road accidents. The superficial femoral vein was the most frequently injured vein. Associated injuries were frequently noted: soft tissues injuries in 35 patients, fractures in 33, arterial injuries in 32 and peripheral nerve injuries in 22 patients. Shock was more often present and more severe in patients who suffered also from a vein injury than in patients with an arterial injury only. The lacerated femoral vein was ligated in the majority of patients. Attempts were made to repair the lacerated popliteal veins. Repair of the vein was usually done by anastomosis of debrided ends. When an arterial injury was also present, it was repaired first. The postoperative complications were frequent and included infections, thrombophlebitis and pulmonary embolisations. Twenty four patients were discharged with a viable limb. Complete function was recovered in seven patients only. Partial neurological deficit remained in twelve patients and complete paralysis in five. Twelve patients underwent subsequent amputation of the injured limb. Indications for amputation were ischemia in eight, infection or extensive destruction of tissues in four. Two patients died.


Bovine artegraft arteriovenous fistulas for hemodialysis in one-hundred patients after "conventional" arteriovenous fistulas failed. The use of the Bovine artegraft for creation of arteriovenous fistulas in the hemodialysis patients was first carried out in the midsummer of 1971. Since that time, there has been considerable material reported in the use of this substitute as an access for hemodialysis. In this article information gained from an ongoing study of the first 100 patients in chronic hemodialysis who had Bovine artegraft arteriovenous fistulas was reviewed. The indications for operation, the standard technique, the results, the complications, and the future plans for study of the physiology and hemodynamics of this type of fistula are described. The Bovine artegraft, AV fistula can be created successfully in a high percentage of patients, offers ease of needle placement, and effective dialysis with very little complication.


[Guar II. Feeding Trials with Animals].

[Guar II. Feeding Trials with Animals]. Feeding trials with guarbeans or its protein- or carbohdrat-rich fractions with cattle, poultry and rats are briefly summarized. The protein fraction of the bean contains toxic substances of unknown structure. The toxic effect is diminished by heating. In case of addition of the carbohydrate-rich fractions of the bean in the feeding experiments depression of growth is observed probably in connection with the bad utilization of the galactomannan or the decrease of fodder consumption due to the expanding volume of the fodder in the gut.


[Isolation of the Derivatives from Coca-Powder Fumigated by Ethylene Oxide 1,2-14 C and their Structure Suggested on the Basis of I. R. and Mass-Spectrometry]. In Coca-powder fumigated with Ethylene Oxide-1,2(14)C, several derivatives were isolated by extraction and preparative Thin Layer Chromatography. Of the two compounds isolated from the water-extract, the structures have been suggested as N,N-Bis-(Di-Ethoxy-O-Hydroxy-ethyl)-Isoleucyl-Alanyl-Cysteine (MW = 569)and N-Ethoxy-O-Hydroxyethyl)-Tyrosine (MW = 269), based on I.R. and Mass Spectrometry. Their approximate concentrations were found to be 20 and 50 mg/kg respectively.


[Differentation and timeinterval for detection of tissue cells on a weapon used in a crime (author's transl)]. There are numerous methods of examining  the weapon used in a crime to detect evidence of blood or of blood-group properties. Forensic literature also contains references to the tracing of organic tissue. In the case against Jaccoud the two medical experts called upon, UNDRITZ and HEGG, found evidence of cells from internal organs on a knife which had possibly been used to commit the crime and which had been stored away for some considerable time. Practical experience has shown that the likelihood of finding cells on the weapon used is small; however, it is greater in the case of abdominal injuries than in the case of stab wounds in the chest. Tests carried out on corpses have revealed evidence that cells from the liver can adhere to a blade plunged into the organ. This happens mostly when a knife with a serrated or wavy edge is used. The abdominal wall has a greater cleaning effect on a blade than clothing does. It is of crucial importance to clarify the environmental conditions to which an object bearing certain traces has been exposed. Over a long period of time it is much easier to detect parts of organs if they have been subjected to swift dehydration (by the wind, for example). A location which is either warm or damp and humid makes identification, even after a few hours, no longer possible. The presence of a single tissue cell, especially if it should have managed to retain its structure after several months' dessication, can never suffice for an organic diagnosis. How many determining characteristics then must be traceable? And how great is the certainty of identification with regard to cells from other organs or to nun-human cell structures - all of which are also subject to environmental and time factors? How many single tissue cells must be identified to determine conclusively that the cells in question came, for example from the liver?


Serum glucose, serum free fatty acids and adipose tissue lipids after fatal hypothermia of cold acclimatized, reserpine or propranolol treated guinea-pigs. Surviving ability in frost (-20 degree C) was studied in cold acclimatized guinea-pigs given either reserpine, propranolol or saline. Survival time, rectal temperature at death, serum glucose, serum FFA and triglycerides in the interscapular adipose tissue were determined. Rectal temperature was highest in the reserpine group, in the same animals that endured the frost the shortest time. The survival time had decreased by about a half of that in the controls. Propranolol treatment decreased the living time only slightly. The fact that serum glucose remained high in the reserpine treated animals was obviously related to the short survival time. In the propranolol group glucose values were somewhat higher than in the control group (saline-animals). Reserpine seemed to have inhibited the release of FFA in the warm-acclimatized animals as interpreted from the low serum values. On the other hand, FFA were rather high in the cold-acclimatized reserpine animals. The blocking effect of reserpine reflected also in the higher contents of triglycerides in the adipose tissue both in cold-acclimatized and warm-acclimatized animals. Propranolol prevented slightly the depletion of the triglycerides. Amount of total lipids in the adipose tissue was lower in the cold-acclimatized animals than in the warm-acclimatized ones because of the change of the type of the adipocytes from unilocular to multilocular. The results corroborated the importance of FFA for longer survival in severe cold. Sensitization to reserpine seems to develop during cold-acclimatization. It calls attention to a possible hazard of reserpine treatment in cold environment.


[Some new aspects in the study of human cremations (author's transl)]. Thermally induced reactions of bone mineral are outlined. The shrinkage of cremated bones is due to sintering of bone mineral. In an electron microscopic study changes of bone structure caused by thermal treatment and sintered mineral units are described. The problems of estimating the shrinkage factor and the use of cremation weight for identification and discussed. There is a significant difference between mean weights of cremations of senile males and females. The absolute difference indicates, that cremation weight is not a useful criterion for identification. Even in cremated bones, cuts and saw marks can be detected.


[The dangerousness of revolvers cal 4 mm, long (author's transl)]. Different models of revolvers (cal 4mm, long), which are obtainable without special permission in Germany, were examinated as to their dangerousness. Both measurements of the kinetic energy of the missiles and investigations on cadavers were performed. Firing of the weapon in its original state yielded kinetic energies of the missiles well below the legal limit of 7,5 Joule. However, even then, fatal injuries of lung and heart could be demonstrated (In one case the os temporale was penetrated). Alteration of the revolver by closing the gas pressure releasing channels with expoxy resin yielded an increase by 45% of the kinetic energy of the missiles. If, in addition, the propelling charge of the ammunition was augmented with some more gun powder the kinetic energy of the missiles rose by 220 %, while such altered ammunition alone caused an increase of 75 %. In every case fatal injuries on head and thorax  could be produced. Based on the results of this investigation proposals to amend the existing laws were made.


[About the problem of "lungs in drowning" (author's transl)]. In order to remove any misunderstanding I would like to reply to the publication by HEINEN und DOTZAUER as follows: The statements and conclusions of the authors must inevitably give rise to the impression that my detailed investigations of the reticular fibre texture of the drowned lung is to a large extent non-specific and thus of no use for an expert opinion on death by drowning. The authors, who base their statements on a dissertation by Mrs. HEINEN, have apparently overlooked the differences in aetiology between typical and atypical drowning and thus also have misunderstood the pathogenesis of the typical drowned lung both with respect to gross and fine tissue aspects. Characteristic of typical drowning is acute diffuse bronchostenotic emphysems of the lung.


[Alteration of textilfibres by explosion gases expelled distant from the muzzle (author's transl)]. This paper presents the reconstruction of an unusual case of suicide. After raiding a branch-bank a robber fled shooting with his Sauer-Western revolver caliber .44 magnum at the pursuing policemen and succeeded in wrestling a pistol Walther caliber 7,65 mm from them. Under the fire of sub-machine guns he destroyed himself by a shot to the neck. Our investigations concerned a textile damage at the front of the sweater of the deceased surrounded by primer residue, showing characteristics of a close-up shot. The damage was identified as effect of explosion gases exhausting far-off the muzzle. The distance between this injury and the bullet hole corresponded with the length of the barrel of the Sauer-Western revolver and could be used for identification; it confirmed the diagnosis of a close-up shot at the neck, too. Collateral experiments with shots from distant ranges developed spadiceous melt figures of textile fibers around the bullet hole, the appearance of which is considered proof for a close-up shot commonly.


[Concerning evidence of parathion (E 605) in an exhumed corpse after 21 months (author's transl)]. In a corpse exhumed after 21 months evidence of E 605 could still be found in the stomach and in the intestinal contents after isolation by steam distillation, extraction with either followed by identification with palladium chloride reagent, as well as by thin layer chromatographicenzymatic detection. A ccording to investigation and analysis, the dose of E 605 administered in the present murder case should have but slightly exceeded the lethal dose.


[Serology and genetics of the Duffy-system (author's transl)]. Experiences in using anti-Fy(a) and anti-Fy(b) in paternity cases are described. Seemingly incompatible mother-child-pairs are due to a silent allele also present in whites. Dosage differences are inconstant and not fit to proof a single or double gene dose. Because of the uncertainty of genetical background the use of both Fy(a) and Fy(b) in paternity cases gives no more information than does Fy(a) alone.


[Forensic usefulness of coronarometric studies (author's transl)]. Authors examine the forensic usefulness and scope of angiometric studies in cases of sudden death that are presumably caused by coronary heart disease (CHD). Hearts of 35 men aged between 40 and 59 years who died of CHD are studied angiographically, morphologically and microscopically. The control group consists of 34 men of the same range of age who died of unnatural causes. Following to a schematic model with special regard to hemodynamic aspects and the degree of the stenosis a stenosis score is made up for each heart and correlated on a diagram with the corresponding heart weight. It appears that the cases of both groups are different areas but are showing a certain degree of overlap. The variation within both groups is discussed. With regard to the CHD group it is presumed that the factors causing death are too variable as to be defined by the deviced methods exclusively. The causal role of factors other than atherosclerosis in the occurrence of CHD is discussed. Authors conclude that the methods examined could be useful in special forensic problems.


[Wounding capacity of bullets after ricochet from sand or concrete (author's transl)]. Investigation is made upon the ricochet of different bullets (full jacketed and soft nosed) from concrete or sand. The deformation resp. disintegration of the bullets depends on the target material, on the design of the bullet and on the striking velocity. The major resulting bullet fragments are classified following their depth of penetration into pinewood, thus giving an approximate measure of their danger to man. The relation between angle of impact, angle of ricochet and the criteria mentioned above is shown in graphs.


[The pneumothorax as complication of continuous artificial ventilation (author's transl)]. The authors discuss briefly the main lesions produced during intensive therapy in 500 patients who died under treatment in the Intensive Care Unit of Padova during the period Dec. 13, 1971--Sept. 9, 1974. Specifically 36 cases of pneumothorax induced by automatic respiration are analyzed from a clinical and pathological viewpoint.


[The ratio of the concentrations between the components of a two phase hypnotic in relation to the time of intoxication (author's transl)]. Two cases of poisoning with a double phase effect hypnotic were investigated in respect to the extent to which concentrations of short and medium acting barbiturates (hexobarbital, cyclobarbital) could be used for estimating the duration of poisoning. The analysis of brain turned out to be especially suitable. Increasing the duration of poisoning the ratio of the concentrations was shifted towards the longer acting component. Blood the liver seem to be less informative. The method might be used to estimate the interval between beginning of the poisoning and death in case of intoxication with different acting barbiturates.


[Deaths resulting from combined action of alcohol and drug intake (author's transl)]. 11 cases of rapid central death following combination of sublethal doses of alcohol and sedativa are presented with case-history, histology, alcohol-concentrations and toxicological findings.


Microscopic comparison of the synovial changes in rheumatoid arthritis and ostroarthritis. Whereas the histopathologic picture of the synovial membrane in rheumatoid arthritis varies widely and that in osteoarthritis displays a small range of changes, light- and transmission electron microscopic studies of synovial sections from both disease entities complement each other and assist reciprocally to corroborate the observed changes. Beyond that comparative survey of the ascertained histopathologic features and their correlation with clinical observations disclose that a study of a larger material of specimens permits with some limitations to infer the nature of the joint disease.


[The value of synovial biopsies in the diagnosis of rheumatoid arthritis and in estimating local inflammatory activity]. Fifty surgically removed synivial membranes from large joints of patients with rheumatoid arthritis were examined histologically from 10 different areas. The diagnostic reliability and the histologically graded basic and actual activity were estimated. All 3 parameters differed considerably within the individual synovial membrane. To assess the diagnostic value of synovial needle biopsies the results were compared with those of simulated biopsy cylinders. The morphological results gained from the biopsy cylinders were much poorer, showing that needle biopsies are limited diagnostic value.


[Elevated C3-proactivator serum levels in patients with chronic polyarthritis]. The C3-Proactivator (C3-PA) and the C3 and C4 complements were determined by radio-immuno diffusion in the serum of 72 patients with definite or classical rheumatoid arthritis, 51 patients with osteoarthrosis and 42 healthy subjects. C3-PA and C4 levles were significantly higher in the serum of patients with rheumatoid arthritis than in the control group (C3-PA in 72%, C4 in 37% of the RA patients). There was also a significant difference between seropositive und seronegative cases. Elevation of both components was more frequently found in patients with seronegative rheumatoid arthritis than in the seropositive cases. However, the C3-PA serum level is not correlated with the ESR. Also an elevation of  the C3-PA serum level is not specific for rheumatoid arthritis, it is also found in other inflammatory diseases as well as after surgery.


[Variability of the clinical picture and the classification of progressive systemic scleroderma]. Fiftythree patients with progressive systemic sclerosis were studied. Four of them (3 males) had the diffuse form of the disease. The skin manifestation of this clinical picture is characterized by diffuse progression of the cutaneous sclerosis over almost the whole body surface, except for the hands where it eventually may appear late. The prognosis for these patients it especially poor. Fortyfive patients (44 females) had acrosclerosis in the widest sence. Twentyseven of these ("acrosclerosis stricto sensu") had cutaneous sclerosis of the hands, face, and often other parts of the body, but not on the abdomen, arms or thighs. The remaining 18 patients had sclerotic alterations on these surfaces also. In this syndrome (which the authors call "the intermediary syndrome"), i.e. where the abdomen, arms, and thighs also are affected, certain internal organs and the joints are more involved than in "acrosclerosis stricto sensu". With rare exceptions, a symptomatic tetrade (REST-syndrome) occurred in acrosclerosis and all the intermediary syndromes. This consisted of Raynaud's syndrome (R), esophagopathy (E), cutaneous sclerosis (S), and telangectasia (T). Fifty % of the patients in addition had calcinosis (C), either subcutaneous or para-articular. The tetrade "REST syndrome" becomes in these cases the pentade "CREST syndrome". The addition of calcinosis to the other four phenomena of the REST syndrome does not alter the frequency of internal organ involvement or the prognosis of the disease. The term "REST syndrome" and its variant "CREST syndrome" should replace the conservative term "acrosclerosis" because they add to the purely cutaneous phenomena other characteristic manifestations of the disease. Two patients could neither be classified under the REST syndrome nor the progressive diffuse syndromes. Two other patients had no cutaneous phenomena ("scleroderma sine scleroderma").


[Morphologic studies on rats with adjuvant disease of long duration]. Morphological studies were performed on Wistar-AF/Han-EMD-SPF-rats with adjuvant disease of 3 tp 14 months duration. Synovitis was observed in the noninjected paw up to the 6th month. While in the central bones resorption and new bone formation had ceased about the 7th month, periostal bone resorption proceeded until the 14the month. Morphological end results of the longlasting disease were pannus formation and fibrous ankylosis of the joints and severe sclerosis of the affected bones. Amyloid deposits were never observed.


[Dealing with time in psychoanalysis].

[Dealing with time in psychoanalysis]. Psychoanalysis offers two alternatives: Timelessness as well as the division of time into individual sessions. Experience of analytical time by the patient is being demonstrated by examples from analytical practice in such a manner that from it the phase of development of anal-narcissistic problems can be deferred as the dominating one. The discussion of analytical literature arrives at the same result. In digesting the considerations of H. Kobut on narcissism the problem of the limit, in particular of the asolute limit of death is being described as basic threat to narcissism. The attempt is made to defer the evolutionary conditions of some mechanisms of defense against the conception of death from the anal-narcissistic context.


[Model of a course of psychosomatic medicine and psychotherapy]. In 1970 new directions for the training of medical students in Germany have been issued. They include for the first time several compulsory lectures and courses on psychological-medicine, which covers: psychosomatic medicine, psychotherapy, psychoanalysis and medical psychology. Our paper puts to dicussion a new teaching model for psychological medicine that proved to be useful and effective many terms. The standards for our "practical course in psychosomatic medicine and psychotherapy" have been derived from the post-graduate training courses for psychoanalysis as offered in Germany for the last 25 years by the two psychoanalytical societies of the DGPPT (German Society for Psychotherapy, Psychosomatic Medicine and Deep Psychology).


[2 criteria for making differential diagnosis between primarily psychogenic and primarily organic body symptomatology easier]. Attation has been drawn to two criteria, which have been found to be helpful in the differentialdiagnosis between primary psychogenic and primary organic symptoms. 1. Psychogenesis is doubtful in cooperative patients from whom an initiating conflict-situation cannot be evaluated, if the time of onset does not relate to onset of symptoms, even if the pattern of symptoms seem to correlate with the structure of personality. 2. If a patient is too readily convinced of an exclusively mental source of his problems, one has to be aware of to deal with mechanisms called "inhibition of bodily threat" or "inhibition of death". These states of mental inhibition may also serve to demonstrate feelings of revenge against the respective individual.


[Anorexia nervosa - thoughts on psychogenesis and psychotherapy]. In this work I tried to classify Anorexia nervosa into two groups, the central group and the reactive group. The central group contains four different subgroups, the immature, the schizoid, the hysterical and the compulsive type. In the first two subgroups the lack of appetite appears primarily at the onset of the disease, and the fear of growing up plays an important role. In the latter two subgroups the lack of appetite comes later on the basis of a conscious or subconscious suppression of the appetite; here prevails a wish to be slender and the disturbance of the aesthetic value orientation. The basis of this syndrome lies in the interpersonal constellation in the family during the childhood. In tests and interviews of the parents of 20 patients was proved, that the fathers have weak and immature character structures, show little interest in the family, they are hypochondriacl, undecisive and not self-confident. On the contrary the mothers are more normative and they endeavour to accept or compensate some parts of the father-role. In the course of these excessive efforts they lose their motherhood and become secondarily dominating grumbling persons. By the lack of the normal father-daugher-relationship, the maturation of sexuality and feminity is disturbed. The method of psychotherapy of those ambivalent, unmotivated patients with ego-splitting is different from that of other neuroses in many points, such as activity, flexibility and educational control on the part of the therapist instead of the psychoanalytic neutrality. In such cases therapists should not be reluctant to act as an object of identification for these patients.


[Psychodynamics of psychovegetative disorders]. Based on quotations from Freuds writings on the actual neurosis and quotations from Schultz-Henckes writings on neurasthenia and nervousness, the psychodynamics of psychovegetative disturbances are demonstrated through an examplatory case. In a first attempt the symptoms are categorized, a classification is proposed, and the differential diagnosis is reflected. Next a report is given about the special defence-mechanism known as repression, the highly strained ego-ideal, and the importance of the triggering situation in relation to the etiology. Psychodynamic hypothese about psychovegetative disturbances are supported through therapeutic experiences.


[Remarks on the physician-patient relationship with cancer patients. Prerequisites, function, and goal of so-called Balint groups in an internal-oncological department]. Drawing on their experience with their own cancer patients and with the Balint Group in the Oncological Department of Zürich's University Hospital, the authors describe the special problems arising in the doctor-patient relationship in this field. They show how the diagnosis of cancer can give rise to a feeling of sudden and complete object loss in the patient, thereby confronting the doctor with his own fear of death. The mobilization of archaic defence mechanisms in both the doctor and the patients can lead to an insoluble double-blind situation unless the doctor is able to give up his defence position and thus make it possible for the patient to give up his own fear of death and to accept the nature of his illness. The authors show how the doctor can break through the isolation of the patient in whose body-ego an archaic bad inner-object has been activated by the cancer, and build up good inner objects for him again. In the last chapter Winnicott's idea the "intermediate area" is shown to shed a new light on the phenomenon of redenial or belief in immortality.


["Counting" experiments with ravens using "matching-from-sample" methods. A contribution on problem-solving behavior in higher aniMALS]. The research goal is divided into two parts: 1. Detailed analysis of behavior in selection in a 6-choice matching-from-sample task. 2. Discussion of all observed preferences on the basis of the models of Sutherland and Mackintosh and of Miller, Galanter and Pribram. The experiments were run with 4 one-year-old ravens (Corvus corax); two of them were probably 2 males. The design is similar to Koehler's. In the task the correct responses were equally distributed between all stimuli and positions (random system). Although the task ("counting") was learned, a lot of relevant preferences for stimuli, positions, patterns etc. show that problem-solving in higher animals can be very complex. It could be shown that only a detailed analysis may clarify animal learning processes.


Vocal communication in the pallid bat, Antrozous pallidus. The communication sounds of the pallid bat, Antrozous pallidus, wre studied in the laboratory. Adult pallid bats communicate via four main types of sound emissions: directives, squabble notes, irritation buzzes, and FM orientation pulses. Newborn bats emit only isolation calls. These calls evolve into the adult directive by the twentieth day. Ultrasonic orientation pulses do not appear until 7--9 days postnatally. These appear to arise de novo or may be derived from a shortened isolation call. Irritation buzzes and squabble notees are first emitted at one and two weeks of age respectively, without an apparent precursor. Mother bats nurse only their own infants and recognize them on the basis of auditory and olfactory cues. An apparent vocal signature is present in the temporal patterning of frequencies in the isolation call, and this may function in individual recognition.


Guinea-pig vocalizations: their structure, causation and function. A colony of approximately 150 adult and infant guinea-pigs was studied in order to investigate the structure, causation and function of guinea-pig vocalizations. Behaviour and sound recording were made in a wide variety of contexts and sounds were analysed on the Kay Electric Sonagraph 6061 B. Sonagrams were measured, and on the basis of physical structure alone, 11 call types were distinguished. Behavioural records were examined and it was suggested that 5 functional categories existed. The significance of vocal communication in guinea-pig social behaviour was discussed.


[Ethology of the Mediterranean blenny Blennius rouxi Cocco 1833]. The Mediterranean blenny Blennius rouxi has been studied mainly in the Banyuls-sur-Mer region. Data on its behaviour have been obtained by skin diving, SCUBA diving and observations in captivity. At Banyuls-sur-Mer Blennius rouxi lives at a depth of 1 to 42m. As an exception among Mediterranean blennies, Bl. rouxi feeds by grazing off the substrate. Algae, sponges and polychaetes (Sedentaria) are the main components of its food (HEYMER and ZANDER, in press). We could not confirm that the colouration, a white body with a conspicuous dark horizontal band, can be regarded as a signal of cleaning activity in statu nascendi. The male male have a spatial territory in which they occupy haptic holes. The female female lead a vagabond life and actively join the male male in their territories during the breeding season. Head nodding is an agonistic behaviour against other female female and has an attractive significance for spawning-motivated female female. The male male threaten with a widely opened mouth (threat yawning). Our data and observations on the ethology of Bl. rouxi are discussed and compared with those known of Bl. sphinx, Bl. incognitus, and Bl. zvonimiri, its nearest relatives.


Vocalizations of male Euplectes in captivity. The dramatic visual displays of the Euplectes- male male have led to their vocalizations being neglected. 6 male male of Euplectes franciscanus and E. after, and 2 E. hordeaceus- male male were kept in aviaries in sound-proof rooms, where vocalizations were recorded during observations of their behaviour, and later analysed on a sound spectrograph. The calls described and illustrated do not represent the complete repertoire of these species. However, the distinctive songs of E. after and E. franciscanus indicate that detailed field studies of vocalization in this genus are required.


Ranks and relationships in Highland ponies and Highland Cows. Recent studies of primates have questioned the importance of dominance hierarchies in groups living under natural conditions. In a herd of Highland ponies and one of Highland cattle grazing under free-range conditions on the Isle of Rhum (Inner Hebrides) well defined hierarchies were present. The provision of food produced a marked increase in the frequency of agonistic interactions but had no effect on the rank systems of the two herds. While rank was clearly important in affecting the distribution of agonistic interactions, it was poorly related to behaviour in non-agonistic situations.


[Tumour frequency in autopsy cases. VI. Hodgkin's disease (author's transl)]. The analysis is based on the catalogue of neoplasms notifiable in the German Democratic Republic (ICD-Code Nrs. 140-209, 210.2, 211.3, 211.9, 225, 226.2, 226.3, 253.0, 253.2, 702, 757.2). At the Medical Academy of Erfurt 22155 autopsies (12212 males, 9943 females) of adults (15 years and upwards) were registrated in the period from 1950 to 1966. 128 cases of Hodgkin's disease (0.6% of autopsies and 1.7% of malignant tumours) were observed among them. The cases are distributed among 80 males (0.7% of males) and 48 females (0.5% of females). There is no difference in frequency. Age and sex distribution, frequency and localization of lymph node and organ involvement are presented.


[The pathomorphology of the arteria primitiva trigemina, together with some critical comments on the pathomorphology of its adjacent structures and the morphological cerebral complications (author's transl)]. In the light of six self-reported observations an account is given on the pathomorphology and pathohistology of the arteria primitiva trigemina including morphological changes of neighbouring organs and tissue structures as well as of the brain which are directly casused by the anastomosis. Furthermore, our own findings and those described in the pertinent literature are compared. In three of our own cases considerable calcification of the intima and media of the persistent artery have been demonstrated histologically, On the other hand only a slight involvement of the blood vessel from which it originates and of that one into which it flows as well as of the other arteries of the base of the brain has been observed. This suggests to be the result of special flow and pressure relationships of the blood, and interpreted as locus minoris resistentiae. The discrepancy between the frequency of the neuroradiological demonstration and the clinico-neuropathophysiological importance of the anastomosis, on the one hand, and the obtaining of neuropathological autopsy findings, on the other, has been pointed out.


[Distribution of the chorionic vessels of the human placenta and their arteriovenous crossings (author's transl)]. We examined 100 selected placentas concerning architecture and distribution of the vessels of the chorionic plate. The eccentric insertion of the umbilical cord as well as the mixed type of distribution of the chorial arteries and equal areas of arterial blood supply were found to be most frequent. In no case the anastomosis of Hyrtl was absent. A marginal and a very eccentric cord were more frequent in combination with a mixed and magistral type of distribution of the vessels that the lesser eccentric and the central type of insertion. There was no significant correlation between insertion of the cord and the infants' birth weight. Arteries pass over the veins when they cross. Serial sections of 15 crossing vessels have been examined, one specimen was reconstructed graphically. When crossed by major arteries the veins bypass below whereas small arterial branches override larger veins not affecting their course. The cross-like vessels are wrapped up in connective tissue and anchored to the chorion plate. There are equivalents in the morphology of the vessels of the chorion and the retina. Both vessel systems are embedded in hollow bodies exposed to an inner pressure, however, sharing a common media, the crossing artery and vein of the retina represent a more intense anatomical unity. The connective mesenchymal frame of the crossing vessels of the choroin plate, the thickened arterial wall-segments and the venous wall-sectors let functional valves suspect as is known from other areas of blood supply.


[Comparative morphometric investigations for the determination of the degree of stenosis of the femora artery (author's transl)]. Planimetry, point-counting-technique and gravimetry were tested for their suitability for determining the degree of stenosis on the same material, the arteria femoralis dextra out of 103 unselected obduction cases. Pilot studies on the circle showed the planimetric method to be most accurate. On transverse sections of the femoral arteries the results of the point-counting-technique deviate significantly stronger from the planimetric test results in comparison with those of the gravimtric method. The point-counting-technique shows the smallest, the gravimetric method the highest time expenditure. Attention is drawn to the necessity of taking into account the plane of the intact intima when determining the degree of stenosis. Also in the case of high-grade stenoses there are frequently no clinically conspicous disturbances of the blood flow.


[The evaluation of classical morphologic patterns in allergic conditions (author's transl)]. The main classical morphologic features of the allergic diseases comprise fibrinoid necrosis, tissue eosinophilia, vasculitis, capsulitis and trabeculitis in the spleen (exceptionally also in the lymph nodes) and histiocytic granulomatous reaction. The greatest diagnostic value is attributed to capsulitis and trabeculitis in the spleen and further to vasculitis and fibrinoid necrosis. The other morphologic changes, i.e. tissue eosinophilia and histiocytic granuloma are, from the point of view of differential diagnosis, of minor value. The allergic histiocytic reaction in the lymphnodes seldom exhibits a pseudotumorous pattern.


[Coronary atherosclerosis, coronary thrombosis and myocardial infarction in autopsy cases. 1st communication: Preliminary investigations: atherosclerosis of the aorta and the large arteries (author's transl)]. 28978 autopsy reports of young (after the 14th year of age) and adult patients autopsied during the period from 1.1 1951 until 31. 12 1969 were scored for atherosclerotic changes of the aorta and the large arteries. The informations were transferred to punched cards and processed with electronic data equipment. The methods of the statistical evaluation are described. 52.96 per cent of the cases revealed an aortic atherosclerosis. 17.96 per cent showed an atherosclerosis of the cerebral arteries, 31.16 per cent of the cases had atherosclerotic changes of the kidneys. All groups of diseases showed an increase during the observation period. No sex differences were detected.


[Clinical experiences with the acute normovalemic hemodilution (author's transl)]. Acute normavolemic hemodilution is a mean of autotransfusion and allow hepatitis prophylaxis in major surgical procedures which general require homologous blood transfusions. The dilutional drop in blood viscosity is followed by an increased cardiac output, while blood pressure and heart rate remain stable. The CO incerase compensates for the reduced oxygen capacity of the diluted blood. Hemodilution was applied in a total of 88 patients. In 46 cases thorough circulatory and laboratory investigations were performed. While an average of 1785 ml blood was withdrawn and replaced synchronically by plasma substitutes, hematocrit was lowered to 24.8% mean and CO rose from 4.4 to 6.01 l/min. In one half of the patients side reactions were observed that occurred in combination as a syndrome in 8 patients: rise in systemic blood pressure and pulmonary artery pressure, disproportional CO increase, peripheral vasoconstriction, and ST-depression in ECG. The possible pathomechanisms of these side reactions are discussed. A sympathetic adrenergic reaction could be excluded by catecholamine estimation. Hyposia may be assumed to be the more probable reason. Since severe side reactions only occured at hematocrit levels below 26%, the dilution waslimited lately to hct 27%. Patients with coronary heart disease, age greater than 70 years, and anemia less than 12 g% hgb were excepted. In 70% of major surgical procedures, e.g. colonic surgery, homologous blood becomes necessary, in 50% in the amount of 2-4 units. The corresponding blood loss of 1000-2000 ml may be compensated by acute normovolemic hemodilution and autotransfusion. In fact, only 15% of our patients required homologous blood transfusions.


[Experiences with acute moderate controlled hemodilution (author's transl)]. The authors present an own method of hemodilution and experiences gained from 10 patients operated for chronic gastric or duodenal ulcer. The therapuetic results of the method show that it can be applied easely and safely in everyday surgical practice. In the patients treated with it no surgical and anaesthesiological complications could be observed during the operations as well as after them. The autors believe that the method of hemodilution for planned surgical operations will contribute to a more economical use of blood transfusions and to reduction in the occurrence of virus hepatitis.


[Avoidance of blood transfusion by acute normovolemic hemodilution (author's transl)]. The authors report on 52 cases of acute normovolemic hemodilution carried out in the course of surgical operations planned in advance in the period from February to September, 1975. In this connection questions of method, indication and contro-indication as well as juridical and economic aspects are dealt with discussion. The advantages of acute normavolemic hemodilution by transfusing the patient's own blood taken from him some days before the operation are particularly stressed.


[Bacteroides infection in surgical patients (author's transl)]. More than 80 cases of bacteroides infections are reported. 54 cases of these infections were postoperative complications. Relationships between bacteroides infection and diseases of the colon are significant. Not very impressive local symptoms made the diagnoses of abscesses difficult. In most cases bacteroides are susceptible to chloramphenicol and tetracycline. Patients develop agglutinable antibodies after bacteroides infection.


[Is there any decline in the frequency of perforative appendicitis? (AUTHOR'S TRANSL)]. The authors are concluding the letality of appendicitis displays a steadily declining tendency. The rate of perforations observed at their institution corresponds to the average in international surgical literature. They found that letality statistics of appendicitis improved considerably during the last century, whilst perforation percentage has remained practically the same, though the conditions in public health care and possibilities of hospitalization have considerably improved. They expect the number of perforations to decline by establishing the diagnosis even more consistently stage and by performing operations at an early stage, as well.


[Yersinia enterocolitica in acute appendicitis, lymphadenitis mesenterialis and regional enteritis (author's transl)]. In 895 patients operated on for acute appendicitis we found Yersinia enterocolitica in 41 cases. Another two cases were detected in postoperative serological examinations. Lymphadenitis mesenterialis was present in 17 cases during operation. Once we detected a regional enteritis. Histological examination of the appendix revealed a purulent inflammation in 21 cases and a phlegmonous-gangrenous inflammation in 4 cases. The other 18 patients suffered from Oxyuriasis, coprostasis or scars of the appendix. For this reason it is impossible to exclude an acute appendicitis in patients with cultural or serological identification of Yersinia enterocolitica.


[Influence of abortions and interruptions of pregnancies on subsequent deliveries. I. Course of pregnancy]. About complications in delivered pregnancies after spontaneous abortions and after interruptions was reported. Altogether the pregnancies of 782 I-parae and 452 II-parae were analysed. Especially we must expect bleeding in pregnancy after interruption. Farther on the cervical insufficiency appears more frequently.


[Influence of abortions and interruptions of pregnancies on subsequent deliveries. II. Course of labor]. In continuation of information about complications in pregnancy the complications of first and second stage of labour were analysed. Preceded abortions and interruptions do not influence the duration of first both stages. Against that we found an increase of rupture of amniotic membrane and laceration of cervix in birth after interruption. The frequency of premature birth is extraordinary increases at I-parae (21%) and II-parae (15%) after interruption. The Apgar-score showed lower values. The causes of these complications were discussed.


[Influence of abortions and interruptions of pregnancies on subsequent deliveries. III. After-labor-period and puerperium]. In the third stage of labour we must expect an increase of blood lost and placental retentions after preceded interruption. An accumulation of manual detaching of placenta we ascertained for preceded abortion only. In the childbed we found an certained increase of disturbances in uterine involution. We think, that some consequences for medical care in pregnancies, following abortion and interruption, are very important.


[Hormonal contraception--throboembolism and surgical risk]. Epidemiological, coagulational, haemodynamical, and morphological studies are critically analysed in this review. Our attitude about the surgical operation risk under hormonal contraceptives is explained. In smaller operative measures there musn't be a break in hormonal contraception. Planned greater operations are to performe only 4 to 6 weeks after cessation of hormonal contraceptives, i.e., after the first spontaneous menstrual bleeding. Hints for the necessity greater operations without a removal after pill or an additional risk factors are given.


[Changes in ligated blood-vessel stumps during abdominal hysterectomy including the removal of the adnexa uteri]. Histological changes of ligated blood vessels were studied on 30 women of 41 to 57 years who had been selected according to certain criteria. For this purpose we usually resected the ligg. suspensoria ovarii, parts of the mesosalpinx, lig. latum and rotundum, the vasa uterina, segments of the basale parametrium the plexus vesico-vaginalis and others after 15 to 25 minutes. The abdominal hysterectomy was in most cases indicated due to uterus myomatosus. The histological examinations showed that, in spite of the ligation of the vessels the organism protects itself by forming a closing thrombus preventing a hemorrhage threatening life as well as a secondary hemorrhage at a later stage due to demarcation of the distal stump end. The occlusion consist of merged thrombocytes, coagulated fibrin and other blood elements; the lesion of the endothelial cells isvery important. Proximal, to the centre, the intravasal mutations decrease rapidly, the lumen is in most of the cases empty. Only in 16% of the lumina of arteries or arterioles and in 20% of the veins there were no hemostatic plugs found. The problem of hemostasis during the gynecological operation is only being touched upon, possible complications due to circulation and perfusion lesions are mentioned. A pathological extent of the coagulation in small pelvis is likely to be the reason for an embolism.


[Morphological problems of chronic placental insufficiency]. The possible causes of chronic placental insufficiency you can subdivide in maternal, maternal-uterine, placental and, fetale factors. Among the maternal-uterine factors are morphological changes of the myometrial and decidual spiral arteries evident in respect of the uteroplacental exchange function. Further are commented intensively the placental factors of fetal malnutrition. There we will put in the front the disturbances of implantation, of circulation in the maternal and fetal system and of placentation (maturation). We demonstrate two possibilities of quantification in chronic placental insufficiency. That are measures of the uteroplacental contact area as well as the estimation of placental basal membrane thickness. We mean, by both the methods important references for the existence of a chronic placental insufficiency can be given.


[Histological changes on the wound- and ablatic-areas of the placenta in uterus during the after-labor period]. 30 women were examined to determine the postpartal hemostasis during a section caesarea. Immediately after the ablatio of the placenta the wound is covered with tightly adhering blood clots containing a large amount of fibrin. The fibrin have mostly a lamellar structure, there are mainly erythrocytes incorporated. Fibrin can also be found in the neighbourhood of rare aggregates of bloodplatelets and the plugs. Thus the decidua is being covered in varying degrees of intensity, the lumens of the blood vessels are invisible. The obstruction of the vessels contain large amounts of fibrin, platelet thrombi and, in places, erythrocytes, which indicate a mixed form of thrombi. The intravescular thrombi continuously changes into extravascular coagulation process. Residual decidua and trophoblast cells are also involved in the obturation. There are also other changes of blood vessels evident, such as constrictions, deformations, deposits of fibrin on the walls and parietal thrombi. The role of the fibrin on hemostasis is an important one, whereas the importance of the platelets is rather small. After 5 to 15 minutes there is still more fibrin available which supports the hardness increase and stabilization of hemostasis. The mutations are limited to the bed of the placenta and do not go deep, as deep as the wall of the uterus, where the vessels are usually bloodless and narrow. The hemostasis itself is being induced by the separation of the placenta which happens simultaneously with the activities of the muscular system.


[Chorionic epithelium in the resorption-villi of placentas of hypotrophic term-born infants. Morphology in chronic placental insufficiency]. The chorionic epithel of 61 placentas of hypotrophic term-born (small for date) with or without the sign of dysmaturity will be compared with the chorionic epithel of 25 placentas of eutrophic term-borns after clinical and anamnestic normal pregnancy or enzym-incubated Cryostat- and semi-thin-slides. Different degrees of predegenerative plasmoditrophoblast by proliferation or persistence high differentiated and degenerated Langhanscells are signs of disturbed regeneration processes in chorionic epithel by chronical fetal malnutrition. This functional- morphological disturbance of villous trophoblast low-weighted newborns will be evaluated as a morphological correlat by chronical insufficiency of placenta. The possible connections with functional capacity of chorionic epithel will be discussed.


[Pregnancy in adolescents].

[Pregnancy in adolescents]. The course of pregnancy to patients aged 16 and under during 1957 to 1961 and 1967 to 1973 is reported. There is an increasing number of pregnancies in these groups of adolescent girls. The frequency of delivery has not changed but the number of abortion has become more important. This fact and the complication by a substantially higher frequency of gestosis and by a tendency to premature delivery causes the pregnancy in young girls as a high risk pregnancy which needs intensive care.


[Prevention with antibiotics in cesarean section]. The investigation of 222 patients with caesarean section showed an increasing bacterial invasion of the amniotic fluid, when in the patients preoperative was found: - clear or green colored (meconic) amniotic fluid and intact membranes, - clear amniotic fluid with ruptured membranes and - green-colored (meconic) amniotic fluid and ruptured membranes. In support to some conceptions from the literature a perioperative prophylaxis with antibiotics is recommended in the groups, which are potentially endangered postoperatively.