[The risk for osteoporosis in persons treated with thyroid hormones]. Patients taking suppressive doses of thyroid hormones may have adverse effects from such treatment. To test conditions under which such treatment might be deleterious to bone, we studied a group of patients who had undergone thyroidectomy because of thyroid cancer 1 to 21 years previously and were treated with steady suppressive doses of exogenous thyroid hormone. The group consisted from 13 men, 20 premenopausal and 25 postmenopausal women. The level of serum tyroxin a trijodothyronin in average didn't differ from the control subjects; thyreostimulating hormone was significantly lower than in controls. Vertebral bone density (BMD) was significantly reduced and biochemical markers of bone formation and (osteocalcin and bone isoenzyme of alkaline phosphatase in serum) were significantly increased as compared with controls only in postmenopausal patients. Biochemical indices of bone resorption (urinary hydroxyproline and plasma tartrate resistant acid phosphatase activity) were significantly increased in premenopausal and also in postmenopausal women. In thyroid hormone treated women, biochemical indices of both bone resorption and bone formation correlated significantly negatively with serum TSH levels. The results suggest that in postmenopausal women there is no "safe" suppressive dose of thyroid hormone. Patients treated with thyroid hormone should be evaluated for a latent or early symptomatic stage of bone loss. The thyroid drugs used should consist of exact content of thyroid hormones, preferably thyroxin.


[Insulin resistance and arterial hypertension. Hyperinsulinism as a basic etiopathogenic factor in essential arterial hypertension and associated phenomena]. In 50 normotonic patients with type 2 diabetes (NIDDM) and controls matched for sex and age with NIDDM and hypertension a statistically significant difference was found as regards S-peptide values on fasting, cholesterol, triglycerides, BMI and atherogenic index (cholesterol/HDL, p < 0.01). C-peptide values correlated positively with values of the systolic and median BP and the atherogenic index in both groups. In normotonic diabetics there was also a positive correlation with the BMI and in hypertonic subjects with the triglyceride levels. The results confirm the hypothesis that in NIDDM there is a direct relationship between arterial hypertension, unfavourable lipid parameters and insulin resistance and compensatory hyperinsulinism resp. The authors discuss possible mechanisms by which hyperinsulinism mediates a rise of BP, hyperlipoproteinaemia, hyperglycaemia and hirsutism (hormonal metabolic syndrome X and 5H resp.). These phenomena are the main risk factors of cardiovascular diseases and lead via heart attacks and cerebrovascular attacks (IHD and stroke) to a high cardiovascular morbidity and mortality in our population. The morbidity and mortality is steadily increasing and thus we are among civilized countries among those with the highest morbidity and mortality.


[A laboratory test for the detection of androgen resistance using sex hormone-binding globulin]. A simple laboratory test for disclosure of peripheral androgen insensitivity has been suggested. The test is based on determination of sex hormone-binding globulin (SHBG) following single administration of testosterone preparation (Testoviron Depot, Schering, 2 mg/kg of body weight). The kinetics of SHBG response to exogenous testosterone was investigated first in a group of 5 healthy male volunteers. The highest highly significant decrease of SHBG level occurred 7th day after drug administration. The method of choice for SHBG determination is an immunoradiometric assay (IRMA). The test was used for a group of 15 children and young people suspected for androgen sensitivity disorder. In all cases, besides SHBG on days 0 and 7 testosterone, dihydrotestosterone and LH were measured, too. In three instances the response was negative: in the case of male Turner syndrome, with very low basal SHBG levels, in one case of confirmed diagnosis of testicular feminization and in the third case of suspected testicular feminization, which has not yet been concluded. In all other patients a significant decrease (in average to 62.8% of the basal level) was in agreement with clinical findings.


[Thyroid gland antibodies. Methods and clinical significance]. The author presents a brief account of the clinically most important antibodies against thyroid antigens (against thyroglobulin, against the microsomal fraction or thyroid peroxidase, against thyroid hormones and against TSH receptors). He describes the main ways of their assessment in serum and evaluates the practical contribution of their estimation or detection in clinical diagnostic practice concerning endocrinopathies. Usually these estimations are only auxiliary and do not replace functional thyroid tests. Antibodies against thyroglobulin and against the microsomal fraction are found most frequently (and in the highest concentrations) in thyropathies with an assumed autoimmune component, in particular in lymphocytic thyroiditis. The low specificity (they are as a rule present also in other thyroid diseases and also in clinically eufunctional subjects with and without goitre) due to the relatively low prevalence reduce the diagnostic value of the examination. The examination of antireceptor antibodies is important, in particular in the diagnosis of immunogenic hyperthyroidism. The prevalence of antibodies against thyroid hormones is low and their detection serves about all to elucidate cases where the patient's clinical status is not in agreement with assessment of thyroid hormones.


[Surgical treatment of endocrine orbital disease. Indications, methods,results]. Surgical removal of the thyroid gland in Graves-Basedow's disease has, beyond doubt, also a major effect on endocrine orbitopathy. After total or near-total removal of the thyroid gland after three months a slighter deterioration or even ameloriation of ocular protrusion is found, contrary to the effect of subtotal thyroidectomy. There exists a significant correlation between the volume of the residual gland evaluated according to 24 h-uptake of 131I, and between the regression of the protrusion (r = 0.385, p < 0.01). Total or near-total thyroidectomy alone even in the absence of other therapeutic methods leads after 1 to 4 years to an average regression of the protrusion by 1 mm which matches the results of prednisone treatment, if the latter is used as the sole treatment. Orbital decompression by the modified method of Ogura and Walsh led in patients treated concurrently with prednisone and thyroidectomy to improvement of the visual acuity on average by 50% (from the range of 0.008 to 0.33 to values from 0.4 to 1.0) and to regression of the protrusion on average by 3.3 mm. When determining the time of operation of the oculomotor muscles, in addition to the unchanged ocular finding also the echographic picture in sectorial visualization proves useful.


[Hyperthyroidism in the inappropriate thyrotrophic hormone secretion syndrome]. The authors draw attention to the possible presence of hyperthyroidism associated with the syndrome of so-called partial (hypophyseal) resistance to thyroid hormones in the absence of a pituitary tumour, based on the experience assembled during the follow-up of a 35-year-old female patient. The syndrome is characterized by elevated T4, T3 and also TSH levels. The syndrome of partial resistance to thyroid hormones differs from that of generalized resistance by a non-familial incidence and the presence of mild hyperthyroidism; from a pituitary tumour with overproduction of TSH it differs by a positive TSH response to TRH stimulation and the ratio of alpha- and beta- sub-units of TSH and also by the absence of pathological changes on the sella turcica during graphic examinations. Treatment by common antithyroid drugs does not lead to clinical improvement nor to normalization of T4, T3 and TSH levels. The syndrome is rare and according to, so a reports in the literature, the views on its cause and methods of long-term treatment are not uniform.


[New views on the pathogenesis of osteoporosis]. The author points out new aspects on pathogenetic factors of osteoporosis and its complications. the character of these factors shows that osteoporosis may be considered as a "civilization disease". The incidence of osteoporosis in all civilized countries is increasing and there is a striking resemblance of factors involved in the pathogenesis of osteoporosis to factors involved in the pathogenesis of other "typical civilization diseases" as are cardiovascular diseases or cancer. In more detail are mentioned the roles of physical exercise, nutrition, drugs and various toxic factors.


[The significance of ovarian and testicular steroids in lipid metabolism and atherogenesis]. Epidemiological, experimental and clinical data verify that the risk of atherosclerotic cardiovascular disease is increased by a long-term estrogen deficiency. This is, among other beneficial effects of estrogens on arteries, caused by alteration of lipid and lipoprotein metabolism [e.g. decrease in total cholesterol, LDL-cholesterol and lipoprotein (a) and decrease in HDL2 cholesterol in serum and decrease in the accumulation of cholesterol in the arterial wall]. The beneficial cardioprotective effects of estrogens are attenuated by estrogen overdosing (causing hypertriglyceridemia), the use of synthetic instead of natural estrogen products (increased incidence of adversary effects) and especially by use of inappropriate progestins. The effect of progestins may be minimized by selecting a lower dose of a more metabolically inert products (especially progestins of the third generation). Mild to moderate hypercholesterolemia may improve with oral estrogen, and this strategy may be used as an adjunct for treatment. The replacement treatment of menopause is not yet widespread in Czechoslovakia. The new forms of treatment, not causing menstrual bleeding (continual medication, tamoxifen) may achieve more interest in the therapy. Hypogonadal men are known to have a more advanced development of atherosclerosis. The appropriate replacement is done by administration of such testosterone derivatives which enable the conversion to estrogens.


[The favorable effect of hydrolytic enzymes in the treatment of immunocytomas and plasmacytomas]. At present attention is focused on research of biomodulating influences on tumorous processes, in particular inhibition of metastatic spread of tumors. In the aetiopathogenesis an important part is played by immune complexes, interaction of cytokines. The authors tested the supporting effect of hydrolytic enzymes in plasmocytoma and immunocytoma. The enzymes were administered along with cytostatic preparations according to the MOCCA pattern. They recorded a more rapid onset and longer persistence of remissions, a marked decline of total proteins, paraproteins, beta-2-microglobulin. Complications associated with paraprotein (hyperviscosity syndrome, nephrotic syndrome, peripheral angiopathy) improved. A combination of chemotherapy and enzymatic treatment proved effective and suitable, in particular for patients with interferon intolerance.


[A disaster medicine databank].

[A disaster medicine databank]. The effective system for the emergency health care in the disaster or calamity situations presupposes a wide application of computer facilities. The article shows the possibilities towards the improvement of medical support with the help of the disaster medicine information dissemination system. The authors give the main functional characteristics of this system which could make it possible to optimize the health care to the wounded and to make a correct distribution of assets.


[Kimmerle's anomaly and stroke].

[Kimmerle's anomaly and stroke]. The anomaly of cranio-vertebral area can frequently be the reason of acute cerebrovascular disorders in vertebro-basilar field. The frequent C1 pathology in the Kimmerle's anomaly. The anatomic studies has shown that 30% of people had this type of anomaly. This pathology can lead to severe vascular diseases of cerebrum because of the squeezing effect upon vertebral arteries in the zone of osteal ponticulus of the rear arch of atlas.


[The correction of hypoxic and ischemic states with the use of antihypoxants (a review of the literature)]. The review of literature contains data concerning the highly efficient antihypoxant--"Hutemin". The article also describes the group of "standard antihypoxants" (Natrii oxydutyras, Pyracetam, Amtizol), and some perspective pharmacological drugs with antihypoxic activity (Trimin, Aethomerol, Perfluorine-carbonaceous emulsions) which actually undergo pilot clinical researches. Summarizing the data, the authors make a conclusion about the necessity to conduct search for new antihypoxants with various mechanisms of action on systemic and cell levels, and also to widen their clinical application.


[A data bank for the "Disaster Medicine" automated information retrieval system]. The article substantiate the necessity to improve the automatization of the information process in the system of medical support in extreme situations and thus to liquidate the disproportion between the medico-diagnostical and information accumulation storage facilities. These facts clearly define the importance of work which is being carried out by Medical Service towards an elaboration of the "Disaster Medicine" automated information retrieval system (AIRS). The data obtained as a result of AIRS processing could be directly used for reference or prediction purposes.


[The phytotherapy of allergic skin diseases]. The rational treatment of allergic skin diseases is one of the most actual questions in the modern dermatology. The end of this article is to familiarize dermatologists and other physicians with medicinal plants that are used in the therapy for allergic dermatosis. The treatment of these patients must have a complex character and include etiotropic, pathogenetic and symptomatic means. The further study of medicinal plants for the treatment of allergic skin diseases and making extracts of effective drugs from them is a matter of great importance for pharmacologists and dermatologists.


[The efficacy of enterosorption in bacterial intestinal infections]. The article studies clinic manifestations after the prescription of polyphepanum, SKN-1P (based on recovered carbon) and enterodesum in 35 patients with acute dysentery, 104 patients with acute gastroenterocolitis, and 123 patients with typhoid. The first two drugs turned out to be highly effective for treatment of these infections. Enterosorption produced an insignificant positive effect in cases of typhoid. An early prescription of enterosorbents in enhanced doses could rapidly stop the basic proliferation of acute intestinal diseases. It is reasonable to start enterosorption even at the pre-hospital stage.


[The prediction of the temperature conditions in mobile installations of ground radio electronics systems]. The method cited in this article gives the possibility to estimate (prognosticate) the temperature of air in the working zone at the mobile objects of the ground radio electronic complexes. This method is based on formulas which take into account the lineal dependency of the air temperature inside the manned sectors from the outside temperature, sunlight intensity, type of a mobile complex, ventilation regime, and the grade of heat diffusion made by radio electronic equipment. The proposed formulas could be used for estimation (prognostication) of temperature conditions of the mobile objects at the stages of their development or during operating periods.


[The tasks of the health inspection of the working conditions for the personnel of military pharmacies]. The article deals with the occupational problems of pharmacies, discloses the main limitations in the organization of prophylactic measures, stresses the basic trends for the practice of physicians-hygienists. The authors propose to enhance the efficiency of the current control regarding the personnel. Besides all it is necessary to made an object classification of all military pharmacies, and estimate the hygienic and sanitary conditions of personnel. The article stands for the unique method which could estimate these conditions and proposes to make the analysis of the health state of personnel, taking into account age specific rates, sex, conditions of daily life and job performance.


[The effect of physical training loads on the body function of sailors on a long cruise]. The article studies the influence of physical exercises at sports simulators upon the state of some bioenergetic systems of seaman's organism in the conditions of a 4-month cruise. The article discloses the dynamics of maximum oxygen consumption, pH value, the quantity of buffered bases and standard bicarbonate in blood; activity of lactic dehydrogenase and its isoenzymes in serum; activity of lactic dehydrogenase, alpha-glycerophosphate dehydrogenase, etc. in lymphocytes of peripheral blood. The authors discuss the reasons of changes that take place in aerobic and anaerobic processes of cells and the whole organism.


[Stage-by-stage diagnosis in conducting the cardiological screening of servicemen using a computer]. A 3-staged algorithm and a device named PKSV-01 were worked out to carry out a pre-doctor screening of servicemen. This method made it possible to define the sound servicemen, as well as patients with cardiovascular diseases including ischemic disease and postinfarctional cardiosclerosis. The specificity came to 91.9-93.9%, and sensitivity up to 81.4-97.8%. The application of lineal discriminative function ensured 93.1% of the right answers.


[Changes in the indices of the coronary amd myocardial reserves in myocardial infarct patients during rehabilitation]. The article analyses the results of the complex examination of 52 patients with large-focal and through-and-through myocardial infarction using veloergometry, echocardiography, tetrapolar rheography, diurnal ECG monitoring at cardioanalyzer. It was found out that veloergometry was more preferable in the late hospital period. Echocardiography was more preferable in the sanitary-polyclinic period for the young and middle-aged patients with through-and-through myocardial infarction, and at the late hospital period for elderly patients with large-focal and through-and-through myocardial infarction. In both periods described above echocardiography was effective in young and middle-aged patients with large-focal myocardial infarction. As for the volume of information obtained with the help of tetrapolar rheography and diurnal ECG monitoring it was equal in both periods.


[The clinical course of acute glomerulonephritis in Transbaikalia]. 452 case histories were analysed of patients with acute glomerulonephritis who were treated at the specialized unit of military hospital. 96.1% of these patients were enlisted men at the age of 18-20. Acute respiratory diseases had a great significance for etiological structure of acute glomerulonephritis. About 1/4 of all cases took place after the purulent affections of skin or subcutaneous fatty tissue. In the conditions of the Trans-Baikal region the clinical course of acute glomerulonephritis was basically represented by manifestative form of illness with pronounced swelling syndrome, arterial hypertension and typical changes in urine.


[The basic principles for the analytical study of epidemic-control measures in the modelling of epidemic processes]. For prognostication of epidemic aerogenic infections with the help of mathematical modeling the authors propose to regard the testing population as a unity of the following streams: susceptible to infection, embraced with emergency vaccination, just vaccinated, protected with the measures of specific or emergency vaccination. Each stream has its own equation which is analogous in its structure to the epidemic dynamics modeling made by O. V. Baroian and L. A. Rvachev, and besides this has correction coefficients which depict the grade of the mobility downtrend due to prophylactic measures. The model built on the bases of the proposed methods makes it possible to determine the level and dynamics of morbidity depending on the volume and efficiency of each sanitary measure described in it.


[The prevention of hospital infections in therapeutic gastroenterology departments]. The article studies the possibilities and conditions of the origin and factors that contribute to the proliferation of inpatient infections (I.I.) in therapeutic gastroenterologic units. The following risk factors of I.I. contamination and proliferation were disclosed: violation of sterilization methods, damaging of mucosa during invasive examinations, weak organism resistance of patients, etc. Measures for I.I. prophylaxis are proposed.


[Military occupational work capacity as a criterion of health]. The indices of physical, sensor and task performance were used to characterize and estimate the functional state of military specialists and their functional reserves. Application of these criteria gives the possibility for physician-prophylaxist to obtain a truly information about the health status in the military unit making a selective control in it.


[Efficacy of pretreatment with adrenergic beta-receptor blockers in the prevention of cardiotoxic effects of isoprenaline in rats]. Protective effects of beta-blockers, propranolol and atenolol, have been investigated in rats treated with cardiotoxic dose of isoprenaline. In saline-pretreated animals isoprenaline produced all morphological, biochemical and electrophysiological signs of myocardial necrosis: massive coagulation necrosis of cardiomyocytes, 2.6 to 3.5-fold increase of creatine-kinase, lactate-dehydrogenase and alpha-hydroxybutyrate-dehydrogenase plasma activity and Q-wave and ST-segment elevation in ECG. Both beta-blockers protected only partly the rats heart muscle from the cardionecrogenic action of isoprenaline while propranolol has been slightly more efficient, probably due to its combined beta-blocking and antiperoxidative activity.


[Use of 99mTc-pyrophosphate and coronarography in the diagnosis of simultaneous myocardial infarct of the right and left cardiac ventricles]. Myocardial scintigraphy was performed using 99m-Tc-pyrophosphate in 50 patients with suspected coexisting right ventricular and left inferior ventricular heart infarction and in 50 patients with left inferior ventricular infraction only. In all survived patients additional selective coronarography was performed and in all died patients autopsy was performed. The aim of the study was to evaluate reliability of myocardial scintigraphy using 99m-Tc-pyrophosphate in the diagnosis of coexisting infarction of both heart ventricles. In a group of patients with coexisting right and left ventricular infarction (45 proved by coronarography, and 5 by autopsy), scintigraphic finding was confirmed in 46 (93%) patients. In all 50 patients with left inferior ventricular infarction, scintigraphic finding was confirmed in 48 of them by coronarography and in 2 by autopsy (100%). Of 4 patients with false negative scintigraphic finding 2 were treated with fibrinolytic therapy immediately after admission and in 2 diffuse occlusive changes were found on all three blood vessels by coronarography. It has been concluded that myocardial scintigraphy using 99m-Tc-pyrophosphate is a very sensitive (92%), specific (100%), exact (96%), simple and safe diagnostical method in detecting coexisting acute infarction of both heart ventricles.


[Closed intracranial extradural traumatic lesions of the internal carotid artery]. Closed intracranial lesions of the internal carotid artery are severe complications of craniocerebral trauma. Intradural lesions of branches of this artery are common and well known while extradural lesions are less frequently found. This is illustrated also by a small number of lesions found in our patients within the twenty-year period, namely 8/1000 compared to intradural lesions of branches of the internal carotid artery. Traffic accidents are dominating in their etiology and the causative mechanism is transsphenoidal fracture of the skull base. Due to difficult surgical approach inadequate methods of ligature of the extracranial portion of the internal carotid artery have been used before but it has not led to cure. Contrarily to this, modern direct microsurgical approach or balloon embolisation successfully solve this problem.


[The effect of calcium antagonists on the cardiotoxic effects of isoprenaline in rats]. Rats were pretreated with either verapamil or nifedipine five minutes prior to isoprenaline injection in order to prevent the development of myocardial necrosis which was verified by biochemical, electrophysiological and histological changes in the control animals. Verapamil embolised completely the elevation of creatine-kinase, lactate-dehydrogenase and alpha-hydroxybutyrate-dehydrogenase plasma activity, Q-waves and ST-segment elevations in ECG as well as the coagulation necrosis and myocytolysis. Nifedipine failed to exerts any protective effect, making the biochemical alteration even more pronounced.


[Fractures of the zygomaxillary complex: indications for exploration and reconstruction of the orbital floor]. Within the period of 11 years 132 patients with fractures and dislocations of the zygomatic maxillary complex have been treated at the Clinic of Maxillofacial Surgery of the M.M.A. In all cases the Converse-Valentine method was used which provided good reposition and fixation of fragments in the correct anatomic position as well as insight into the state of the orbital floor. In 75 operated patients (56.81%) it was necessary to reconstruct the orbital floor by osteo or allotransplants. The results have pointed out the necessity of operative reposition and fixation of fragments on three typical sites as well as the necessity of exploration of the orbital floor in order to prevent diplopia, sensibility disorders as well as traumatic neuralgia.


[Tissue polypeptide antigen and tumor trypsin inhibitor in pleural effusions of various etiologies]. In 47 patients with pleural effusions of different etiology concentrations of the tissue polypeptide antigen (TPA) and tumour trypsin inhibitor (TATI) were measured. Malignant disease was found in 24 patients and benign one in 23 patients. In a group of patients with malignant pleural effusion the average concentration of TPA was 3102 U/L and of TATI 76.8 ug/L. In a group of patients with nonmalignant effusion these concentrations of TPA were 2381.8 U/L and of TATI 28.3 ug/L. Higher concentration of TPA was found in pleural effusion of malignant nature with specificity of 96% but with a small sensitivity of 12.5% and positive predictive value of 43%. TATI concentrations were also higher in malignant pleural effusion with good sensitivity and specificity (78%, 50% respectively) and positive predictive value of 66%.


[Early treatment of acute nephrotic syndrome in patients with acute post-streptococcal glomerulonephritis]. In the period of five years 54 patients with acute poststreptococcal glomerulonephritis were treated. Acute nephritic syndrome was manifested in 45 (almost 4/5 of all) patients. Edema and hematuria were found in all patients, hypertension in 89%, and acute renal failure in 49% of patients with the acute nephritic syndrome. For successful treatment of acute nephritic syndrome of decisive importance have been application of measures intended primarily to correction of positive sodium and water balance by dietetic regimes, diuretics and antihypertensives and rest, while the application of the dialysis has not been necessary even in patients with acute renal failure.


[Efficacy of alcoholates and clay in percutaneous contamination of rats with highly toxic organophosphorus compounds]. Efficacy of decontamination by alcoholate and clay has been examined in animals percutaneously poisoned by nerve war gases (VX, soman) and organophosphorous insecticides (parathion, dichlorvos, terbufos) at exposure of 2, 5 and 60 minutes. High efficacy was achieved after two minutes using alcoholates which, except for VX, was lower for 50% after 5 minutes. The similar results were also achieved with clay in nerve war gas poisoning, however, the efficacy of this material was somewhat lower. By delayed decontamination (after 60 minutes) in animals poisoned by parathion and terbufos somewhat lower but still satisfying efficacy was achieved (ZI = 3.3, that is, 11.5). The results obtained have shown that efficacy of decontamination, except for the used materials, depends also on duration of the procedure.


[Determination of tannins in the rhizomes of Potentilla tormentilla]. A modified permanganometric method for determination of tannin in tormentile rhizome is proposed. The results compared with values obtained by the regulations of Ph Yug II, Ph Yug III, Ph Yug IV and DAB 9 are reproducible and the method is fast and simple.


[Similarities in morphologic changes in heart valves in acquired heart defects of noninflammatory etiology and in damaged menisci without a history of trauma]. Histologic, histochemical and ultrastructural analyses were performed of the leaflets of all four heart valves in 50 subjects with acquired heart defects of noninflammatory etiology and 88 surgically removed damaged menisci without trauma anamnesis. On the basis of the detailed analysis some morphologic similarities were found in the heart valves and menisci such as myxomatous degeneration as the main pathologic lesion, lack of blood vessels in the altered tissues which point to noninflammatory nature of the lesion, similarity in nourishment by diffusion, degradation of the collagenous fibres which present the main histologic structure and the increased accumulation of acid mucopolysacharrides at the site of their degradation as well as the increased number of fibroblasts, that is, chondroid cells which are considered to excrete acid mucopolysacharrides. Sometimes these changes are hardly identify clinically, especially in meniscal diseases which could simulate rheumatic disease.


[Correlation of clinical and autopsy diagnosis during a 10-year period at the Institute for Pathology and Forensic Medicine at the Military Medicine Academy in Belgrade]. The comparison between the clinical and pathohistoanatomic diagnosis of 3.929 autopsied cases is performed. In 82.5% of cases the clinical and pathohistoanatomic diagnosis were in the absolute correlation; in 8% of cases the clinical diagnosis of the basic disease has no adequate pathoanatomic characteristics, while in 4.5% of cases the clinical diagnosis of the basic disease, immediate cause of death and condition which was important for the course and outcome of the treatment were not adequate. Among the pathologic states diagnosed as: pulmonary thromboembolism, myocardial infarction and cerebrovascular insult--pulmonary embolism most often was not confirmed by autopsy (47%), while in 58% of cases it remained clinically unrecognized. Malignant tumours of the liver, pancreas and kidneys have been most frequently clinically unrecognized compared to other malignancies. Duration of hospitalization has not had the essential influence on correct establishment of the clinical diagnosis.


[Pulmonary thromboembolism--an autopsy study with clinico-pathologic correlations]. The study comprised 3.629 autopsies performed at the Institute of Pathology and Forensic Medicine of the M.M.A. in the period 1980-1990. Pulmonary thromboembolism (PTE) was found in 533 (14.68%) of autopsied cases, that is, 10.88% of all causes of death. In the studied period there is an increased frequency of all PTE, especially of those with fatal outcome (p < 0.05). Of the total number of PTE found at autopsy (533), clinical diagnosis was established in 136 (25.51%), and of all fatal PTE found at autopsy (395) the clinical diagnosis was established in 123 (31.14%) during life. The clinical diagnosis of PTE was confirmed by autopsy in 42.42% of cases. Operations and neoplasms are the most frequent conditions in which PTE is occurred while myocardial infarction is the most frequently misdiagnosed for PTE during establishment of clinical diagnosis.


[Analysis of intracranial aneurysms from autopsy material]. The analysis of 44 intracranial aneurysms found at 7.687 autopsies is performed. The largest number of aneurysms was of congenital (secular) type, then, of arteriosclerotic type while inflammatory and traumatic aneurysms were very rare. The elastic and reticular fibres in the aneurysmal wall and the normal arteries of the base of the brain were identified by a standard and special staining. Significantly decreased quantity and disturbed distribution of the reticular fibres were found in the congenital aneurysms which was considered to be a consequence of degenerative processes. The finding of the preserved elastic internal lamina in the wall of the congenital aneurysm and its absence or fragmentation in cases of arteriosclerotic aneurysms suggest the different etiology and pathogenesis of these aneurysms.


[Hürthle cell carcinoma of the thyroid gland]. The authors have analysed 9 cases of Hürthle cell thyroid carcinoma diagnosed on the bioptic material in the period 1975-1991. In 7 patients subtotal and in 2 total thyroidectomy was performed. In one patient only signs of metastases of the tumour in the region of the mediastinum, neck lymphatic nodes and brain developed and the patient died a year after surgery. For differential diagnosis of Hürthle cell thyroid carcinoma and Hürthle cell adenoma the authors recommend as necessary that beside the presence of the basic criteria for malignancy (infiltration of the capsule and adjacent tissue, invasion of the blood vessels, pleomorphism and pathologic mytoses) the electron microscopic examination and immunohistochemical methods should be also used which could be of a great help for establishment of a correct diagnosis on which depends further therapy as well.


[Morphologic characteristics of HBV markers and products of iron metabolism in liver tissue in patients with hepatitis B virus]. In the histomorphologic analysis of 126 liver biopsies with hepatitis B virus (HBV) infection the authors have met some difficulties in the interpretation of findings of three biopsies which showed the presence of hemosiderine and ferritin deposits in hepatocytes. The lack of cells with the appearance of "ground glass", that is, ground glass hepatocytes which are one of the important features of HBV infection and aberration from the standard features in some histochemical stainings are noticed in all three biopsies. Since only few authors have noticed the same problem, it is possible that these results open new ways in the study of pathogenesis of HBV infection in the liver and its relationship with iron metabolism.


[Ultrastructural changes in the dermal blood vessels in patients with psoriasis]. The ultrastructural analysis of psoriatic dermal lesions has shown the alteration of the dermal arterioles into specialized postcapillary venules, the so called high endothelial venules (HEV) which are characterized by the presence of tannic acid staining materials (TASM) located among the endothelial cells. This type of venules seen in the lymphatic nodes and other lymphoid organs is considered to be an important site of lymphocyte recirculation. Similar venules are seen in the lymphatic nodes too. In correlation with the immunologic evidences in the lymphoid tissues and in psoriasis most probably in question are the identical surface antigen-lymphocyte receptors on the HVE which support selective binding of the definite subset of lymphocytes and migration from blood to tissues.


[Tuberculous inflammation of the synovial membrane]. Four patients with tuberculous synovitis of the large joints are reported in whom primary tuberculous process has not been confirmed as a possible foci of spreading of the acidoresistant bacilli. The authors, describing in details the histologic picture of tuberculous synovitis, point out the importance of an early biopsy of the synovial membrane and obligatory microbiological confirmation of the established diagnosis.


[Identification of bodies of soldiers carbonized in an armored transport vehicle]. The authors have presented the process and possibilities of identification of the carbonized bodies of the crew of the exploded military armoured transporter. In identification of the invaluable importance have been description, autopsy findings, questionnaires and their comparison as well as ways of identification of the carbonized bodies.


Transfusion management of patients with IgA deficiency and anti-IgA during liver transplantation. Severe anaphylactic or allergic reactions may occur during blood transfusion to patients who are IgA-deficient and have anti-IgA in their blood, particularly those with class-specific antibodies. These patients are a particular challenge to the hospital transfusion service when large volumes of blood components are required for transfusion support, as in liver transplantation. We have successfully provided blood components for 3 such patients undergoing liver transplantation. Red cells were washed manually or by automated technique. Platelets were washed manually. All plasma was from IgA-deficient donors. One patient's entire plasma requirements were supplied by autologous plasmapheresis. Serial determinations of IgA levels and anti-IgA titers in 1 patient demonstrated an abrupt fall in anti-IgA with the appearance of barely detectable amounts of IgA during the surgery. IgA-containing plasma cells were demonstrated in the biopsies of liver homografts of 2 patients following transplantation. IgA deficiency with anti-IgA can be successfully managed during liver transplantation with advance planning.


Prevention of primary HLA class I allo-immunization with leucocyte-poor blood components produced without the use of platelet filters. In a prospective study the incidence of allo-immunization and platelet refractoriness was investigated using a consequently leucocyte-poor blood product regime. Twenty-five previously non-transfused patients with acute leukaemia (11 men, 7 women) or autologous bone marrow transplantation for Hodgkin's or non-Hodgkin's lymphoma (2 men, 5 women) received at least 80 donor units of filtered red cells (filtration within 24 h after donation, leucocyte content 8.5 +/- 3.9 x 10(6)/U) and/or of platelet concentrate (produced by the buffy coat method, leucocyte content: 7.8 +/- 4.2 x 10(6)/U). A 1-hour recovery of 20% in three consecutive transfusions, in the absence of clinical factors known to impair increment, was defined as platelet refractoriness. HLA class I antibody screening with a panel of 60 cells was performed before the first transfusion and after 80 U of blood components. Of 25 patients who entered this study, 6 patients developed platelet refractoriness after a mean of 38 units of blood components (range 26-45 U); all 6 were female with a history of multiple pregnancies. In 19 patients regarded as non-refractory, no HLA antibodies were demonstrated (13 men, 6 women). This study, though limited in size, suggests that the use of blood products containing less than 1 x 10(7) leucocytes/donor unit prevents primary HLA class I immunization and platelet refractoriness.


An enzyme-linked antiglobulin test to detect red cell globulins after glutaraldehyde fixation. The purpose of this study was to develop an enzyme-linked antiglobulin test (ELAT) for IgG on RBC without the hemolysis caused by the high pH of the alkaline phosphatase reaction. This was achieved by fixing the RBC with 0.05% glutaraldehyde after attachment of the antibodies. Assays using anti-D reference standards demonstrated the sensitivity to be 1-2 ng of antibody as compared to 7.5 ng for the manual indirect antiglobulin test. The coefficients of variation of these assays ranged from 10.4 to 20.1%. The mean background absorbance at 405 nm of 105 normal RBC samples was 0.08 +/- 0.03 SD. There was an increase in sensitivity of the test after the fixed RBC were stored. Dilute glutaraldehyde stabilizes the RBC membrane and the antigen-antibody linkage resulting in a more sensitive ELAT.


[Morphologic, morphometric and ultrastructural characteristics of tumor cell nuclei during various stages in colorectal carcinoma]. The comparative analysis was performed of 29 colorectal carcinomas (CC) by the original Duke's classification and quality features of tumour (i.e. nuclear and histologic grades), on the one hand, and the number of the nucleolar organizer region (NOR) as well as the mean nucleolar organizer region area (MNORA), irregularity of the nuclear shape (based on the morphometrically determined "form factor"--FF) on the semi-thin sections, on the other hand. In the same time, the quality ultrastructural analysis of CC nuclei in different stages has been also performed. The significant correlation was found among values of MNORA, clinico-pathologic stage of the disease, histologic differentiation and nuclear grade, while a number of NOR correlated exclusively with the clinico-pathologic stage of the disease. It has been concluded that determination of the number of NOR and MNORA in the nuclei of tumour cells can be an important and objective parameter in evaluation of proliferative CC activity. Accordingly, MNORA represents a more objective and more reliable indicator of proliferative tumour activities.


The quantification of fetomaternal hemorrhage by an enzyme-linked antibody test with glutaraldehyde fixation. A modified enzyme-linked antiglobulin test (ELAT) for quantifying D-positive red blood cells in the circulation of D-negative pregnant women is described. The antibody-antigen bond was stabilized and the problem of hemolysis eliminated by the use of 0.05% glutaraldehyde. The r value for the standardization curves for measuring cord RBC in mixtures was 0.98; coefficient of variation 5.8%. Reproducible quantitation of 0.125% D-positive cord RBC mixed with D-negative RBC was demonstrated. In comparative studies of artificial mixtures, Kleihauer-Betke results for more than 1% cord RBC were 50-100% greater than the true values. In several examples of large fetomaternal hemorrhages, the ELAT results matched the clinical data more closely than the Kleihauer-Betke based estimates. 2 ml of fetal RBC in a 1,600-ml red cell mass can be quantified using the modified ELAT.


[Conditions required for chemical binding of Dactylis glomerata grass pollen to inert stable carriers]. The results of the direct RAST (Radio-Allergo-Sorbent-Test) procedure used to standardise own-prepared pollen extract of the Dactylis glomerata grass are presented. Based on the performed standardisation, a system was set up for binding allergens to the stable inert carriers. The results of examination of the quality of D. glomerata allergen, bound covalently to paper disc, are presented also. Evaluation was made in INEP laboratories by comparing the D. glomerata allergen-bound discs and the corresponding discs of Phadebas, Pharmacia Uppsala, confirming a high degree of correlation in the direct RAST procedure.


An enzyme-linked antiglobulin test to quantify nanogram quantities of IgG on polystyrene microspheres. A method is described in which polystyrene latex beads are used for constructing standard curves to estimate the number of protein molecules on cell surfaces by an enzyme-liked immunoassay test (ELAT). A series of immune globulin (IgG) dilutions in pH 9.8 carbonate buffer were coated on 3-microns microbeads by incubation overnight at 4 degrees C and subjected to ELAT. The r value of the curve derived from four assays was 0.9991. This standard curve applied to previously recorded ELAT data resulted in estimating that normal RBC have 63 +/- 19 (SD) IgG molecules and that the lower level of sensitivity of the antiglobulin test is 155 IgG molecules per RBC. The method should be useful for more precise standardization of procedures for measuring proteins on cell surfaces.


Immunoglobulin classes and subclasses of platelet antibodies in a case of post-transfusion purpura. A multiparous white woman developed severe thrombocytopenia following transfusion of red blood cells. Six ineffective platelet transfusions (a total of 42 random donor concentrates) were given from day 0 to day +6, high-dose steroids from day +1, progressively tapered until day +30, and a total of 150 g of intravenous immunoglobulins from day +2 to day +6. As platelet count had not increased significantly by day +8, four plasma exchange procedures, each consisting of 2,000 ml of plasma exchanged with 5% albumin solution, were performed on days +8, +10, +14 and +18. Platelet count was 5, 50, 100 and 234 x 10(9)/l on days +8, +14, +26 and +32 (discharge), respectively. The patient's acute phase serum contained increased levels of platelet alloantibodies with anti-HPA-1a (PlA1, Zwa) specificity and a titer of 3,200. IgG1, IgG2 and IgG3 subclasses of platelet-reactive antibodies in the patient's serum were elevated, whereas IgG4, IgM and IgA were within the reference values. Levels of IgG1, IgG2 and IgG3 of antiplatelet antibodies showed a marked and parallel reduction during treatment, but were still above the reference values at the end of treatment and 1 year later, when the patient platelet count was normal. Although a failure of intravenous immunoglobulins cannot be proven in this case, plasma exchange seems to have contributed more than intravenous immunoglobulins to clinical remission.


Do HLA antigens play a role in intermediate uveitis? A total of 52 nonrelated Caucasian patients (21 male, 31 female, age at onset of the disease: 7-74 years, average: 31.6 years) suffering from intermediate uveitis were tissue typed for 56 different HLA-A, -B, -C and -DR-antigens. No significant association between any specific HLA-antigen and the disease, both when comparing the total patient group with a large, healthy control population, or any of the different subgroups (male vs. female, early vs. late onset, mild vs. severe course) could be demonstrated.


[The status of the rheumatology service of the city of Kiev]. An analysis is presented of the dynamics of morbidity, incidence and working losses due to the main rheumatological diseases in the city of Kiev. Data are presented on the structure of the city rheumatological service, its activities in out- and inpatient departments. The current status and perspectives of the rheumatological service are analysed.


[The optimal periods of temporary disability in myocardial infarct]. The effect of age, character of work, rehabilitation program and length of temporary invalidity on the results of medicosocial rehabilitation were studied in patients with a history of different forms of myocardial infarction. On the basis of this data optimal time of temporary loss of working capacity was established.


[Experience with the use of rating control over knowledge in a department of internal disease propedeutics]. Data are analysed on current rating form of training and knowledge control at the chair of propedeutics of internal diseases based on 900 tests. The efficacy of this system is confirmed.


[Changes in the dehydrogenase activity of the cardiomyocytes in experimental acute massive pulmonary embolism]. A study of the activity of SDG, LDG, NAD-D in several structures of the heart was carried out in acute compensated massive embolism of the pulmonary artery. TV-histophotometry demonstrated heterogeneity of metabolic processes in the myocardium in the control and experimental group. The animals with pulmonary artery embolism showed diverse hemodynamic changes in the lesser and greater circulation. Loads to right cardiac compartments were accompanied by an elevation of SDG, NAD-D in the interventricular septum.


[Erosive gastritis after an organ-preserving operation for duodenal ulcer]. Examined were 243 patients with duodenal ulcer after the operation of selective proximal vagotomy. Pyloroplasty was performed in 49.9%, duodenoplasty in 53.1%. A 1-2 year follow-up revealed erosive gastritis in the proximal region in 18.5%, in the antrum in 13.9%, combined location in 5.8%. Differences in the mechanisms of formation of erosions in different zones of the stomach in erosive gastritis were established. The tactics of treatment of erosive gastritis is discussed.


[The characteristics of prostaglandin and cyclic nucleotide biosynthesis in patients with peptic ulcer and chronic atrophic gastritis during digestion]. Prostaglandins (PG) and cyclic nucleotides (CN) were assessed radioimmunologically in the blood plasma under basal conditions and after a standard breakfast in 20 patients with duodenal ulcer, 16--with gastric body ulcer and 18 patients with atrophic gastritis. It was established that the patients showed an increased PG level, cAMP-dependent processes. Neurohumoral mechanisms of regulation of gastric secretion were abnormal.


[The role of prostaglandins in the activity of mononuclear cells in liver cirrhosis patients]. The effect of prostaglandins (PG) E1, E2, F2 and prostacyclin in vitro on the content of cAMP and cGMP in mononuclear cells of the blood was studied in 17 patients with liver cirrhosis. PG synthesis by mononuclears from 3H-arachydonic acid was also evaluated. Patients with liver cirrhosis showing no disorders of PG synthesis by non-stimulated mononuclears and reduction of basal cAMP content revealed significant changes of functional responses of cyclase systems PG loads as well as a relative reduction of PG synthesis in conditions of stimulation with phytohemagglutinin and Ca A23187 ionophore. This is an important link in deadaptation of immune reactions in patients with liver cirrhosis.


[The immune and fibrinolytic potentials of patients with a postpneumonic lung abscess from the viewpoints of systemic-regional correlations]. The immune and fibrinolytic systems were studied in 55 patients with postpneumonic lung abscess; 17 of them were operated on. Revealed were reductions of the number and functional activity of the T-cell immunity and a systemic-regional fibroanalysis data (high fibrinolytic activity in the systemic circulation and bronchial lumen; high activity in the blood of the resected lung portion). High activator activity of the sputum and its absence in the pus of the abscess cavity evidence that the source of the plasminogen activator is the bronchial wall not the destructed pulmonary tissue.


[Lipid disorders and their correction in iron-deficiency anemia in pregnant women]. A study of 96 pregnant women indicates, that those suffering of anemia showed essential changes of all indices of the lipid content in erythrocytes. The author recommends to include uvesorb in the complex treatment of pregnant women suffering of iron-deficiency anemia.


[The clinico-laboratory characteristics of glomerulonephritis]. Results are reported of 83 patients with glomerulonephritis with the hematuria syndrome and 75 patients without hematuria syndrome. 19 clinico-laboratory signs were analyzed. Data indicate that hematuric nephritis may be signaled out in a separate nosological entity necessitating differentiated treatment.


[The use of low temperatures in treating patients with trigeminal neuralgia]. Complex treatment including local use of low temperature (cryotherapy, hypothermia) was used in 142 patients with trigeminal neuralgia. Cryotherapy was applied to trigger and reflexogenic zones of the involved nerve (-6-10 degrees C). In hypothermia the applicator was applied to the zone of the involved nerve (+2 +4 degrees C), four sessions. The result was positive in 75.41% of patients. Use of cryotherapy and hypothermia allowed to increased the treatment efficiency, reduce the pharmacological load on the body, reduce treatment time and increase the remission period.


[Disordered blood supply of the brain in bradyarrhythmia patients]. Results are reported of a study of the blood flow in patients (age: 18-70) with different grades of bradyarrhythmia due to atrioventricular block with weakness of the sinus node. Examined were: CBF rheoencephalographically, ultrasound dopplerography, products of lipid peroxidation in the blood. Bradyarrhythmia was found to occupy a major place in the pathogenesis of cerebrovascular disorders. Adequate therapy allows to achieve good rehabilitation of this category of patients.


[The distribution of the content of chemical elements and metals in the brain tissue in bacterial meningoencephalitis]. The quantitative distribution of chemical elements and metals was assessed in the brain of 10 autopsy cases. The patients died of bacterial meningoencephalitis. It was found that the most "water-soaked" regions of the brain showed an increased accumulation of the concentration of metals correlatingly bound with water. The state of cerebral microvessels play a main role in regulation of the mineral metabolism.


[The individual characteristics of the operators of the Zaporozhye Atomic Electric Power Station]. A clinico-psychological study was carried out of a randomly taken group (104 persons) among operators of the Zaporozhye Atomic Power Station. Personality accentuation was found in 91%, with over accentuation in 74% and hidden form in 17%. Prophylactic measures are outlined.


[The antiemetic activity of buspirone].

[The antiemetic activity of buspirone]. The low activity of conventional antiemetic drugs by chemotherapy of oncological diseases has determined the necessity to evaluate the activity rate of 5-hydroxytryptamine receptors' agonists. Experimental data show, that buspirone exceeds significantly all the used antiemetics what allows to expect its high activity in the clinic.


[The use of clinical, immunogenetic and immunological indices for predicting the development of the recurrent form of erysipelas of the lower limbs]. A consecutive alternative analysis has been carried out of clinical, immunogenetic and immunological indices in patients with primary erysipelas of the lower extremities with and no recurrences during the last 3-5 years. The authors compiled a special scale allowing precise and early prediction of unfavourable, recurrent course of primary erysipelas of the lower extremities.


[The laser therapy of patients with a long-term nonhealing stomach ulcer]. Results are presented of treatment of 109 patients with prolonged nonhealing gastric ulcers using a new method of highly intensive impulse laser radiation. A scarring effect was achieved in 87% of cases. Correction of immunological indices and sanation of pathological flora, apparently, contributes to the favourable effect.


[The transplacental uptake of xenobiotics]. It was shown theoretically and experimentally that the placenta does not prevent entering of toxic chemical compounds to the fetal blood but vice versa provides their larger concentration than in the blood of the mother. Namely this may be related to an increase of the incidence of congenital abnormalities and other kinds of pathology in the newborn.


[The effect of thymalin on lipid metabolism and the clinical course of ischemic heart disease]. The effect of the thymus polypeptide factor-thymidin on the lipid spectrum of the blood, thymic factor content in the blood and clinical course of the disease were studied in 156 patients with exertion stenocardia (II-IV functional class). Results indicate that patients with exertion stenocardia show with advance of the disease a reduction of the blood thymic factor and 85.6% develop hyperlipidemia. Complex treatment with inclusion of thymalin resulted in an increase of the thymic factor, normalization of the lipid metabolism increase of the contractile function of the myocardium and, thus, increases the treatment efficacy.


[Nondrug methods in the combined treatment of peptic ulcer patients]. Use of treatment complexes including non-drug methods (auricular acupuncture, pathogenetic dietotherapy, ILBR) or reduced doses of modern pharmacopreparations allowed to achieve rapid clinical and endoscopic remission in patients with ulcer disease. Simultaneously occurs normalization of the aggressive and defensive properties of the gastric juice, immunological, microcirculatory changes in the body and gastroduodenal mucosa. The vascular laser blood radiation reduced antacid dose and pathogenetic dietotherapy.


[The characteristics of the treatment to prevent recurrence in patients with chronic bronchitis in different regions taking into account concomitant diseases]. The author carried out ultrasound diagnosis of pancreas diseases in 250 patients with chronic gastritis inhabiting different regions of the Ukraine. In rural districts the incidence of pancreas lesions was more frequent, apparently related to alimentation factors. It is recommended to use enzyme drugs in the complex antirecurrence treatment of patients with chronic obstructive bronchitis.


[Escherichiosis in adults and the carriage of pathogenic Escherichia in some regions of Ukraine]. The role is shown of pathogenic Escherichieae (PE) in the development of escherichiosis in two regions with socioeconomic differences. The epidemiological picture of these infections depending on the age of the examined is analyzed. The seasonal character of circulation of pathogenic Escherichieae serogroups was found to play a major role in the etiology of escherichiosis in adults. The biological properties of the isolated strains were studied.


[Immune reactivity disorders in poisoning by the pyrethroid sumi-alpha]. After subchronic intoxication with synthetic sumi-alpha pirethroid rats developed pronounced changes of macrophagocytic function; reduction of cell-mediated and humoral immunity, accumulation of pathogenic circulating immune complexes. In these conditions one-week thymalin treatment produced a normalizing effect. Sodium nucleinate was of low efficacy.


[The working conditions and occupational morbidity of tunnellers engaged in the construction of underground mining installations]. During 1963-1990 professional disease were registered in 336 sinkers (vibration disease--42.6%; hypoacusis--35.1%; silicosis and dust-induced bronchitis--11.3 and 7.4% respectively). The mean morbidity level of professional diseases in sinkers was 12.0 per 1000 (vibration disease--4.9, hypoacusis--6.4). The level of silicosis reduced 2.9 times.


[Nervous system lesions in the female workers of hydroponic hothouses]. A follow-up (1985, 1990, 1991) study revealed in female workers of hydroponic hothouses an increase of the incidence of nervous system diseases depending on the length of work (vegeto-vascular dystonia, angiodystonic syndromes, vegeto-sensory polyneuropathy). It is suggested that the main cause of nervous lesions in these cases was the complex effect of pesticides.


[The efficacy of interstitial electrophoresis in treating trophic ulcers of the lower extremities]. A clinico-laboratory study revealed the efficiency of intratissue electrophoresis of drugs in the complex treatment of patients with trophic ulcer of the lower extremities. This is related to the favourable effect of the electromagnetic field on the lesion focus and possibility to increase the concentration of drugs in the inflammation focus.


Radiofrequency catheter ablation of cardiac arrhythmias: initial WVU experience. Radiofrequency catheter ablation is a method of selectively destroying cardiac tissue to treat various arrhythmias. In a relatively short time, it has evolved from an investigational tool to a widely applied clinical technique (1). This article reviews the current status of radiofrequency catheter ablation and reports on the results of its initial clinical use in 14 patients at West Virginia University Hospital.


Coronary artery bypass in two patients with immune thrombocytopenic purpura without preoperative splenectomy. Two patients with severe coronary artery disease and idiopathic thrombocytopenic purpura underwent coronary artery bypass grafting without preoperative splenectomy. The patients' thrombocytopenia and bleeding were controlled with platelet transfusion alone. This report indicates that the use of cardiopulmonary bypass in patients with immune thrombocytopenia does not invariably mandate splenectomy, particularly in those in whom performance of a splenectomy may be associated with an increased risk of intraoperative cardiac morbidity.


[Molecular cloning and identification of 130kd mosquitocidal protein gene of Bacillus thuringiensis var. israelensis (Bti)]. The location of 130kd mosquitocidal protein gene of Bti 4Q5 strain on its 75Md plasmid was confirmed by southern hybridization using a 18-base oligonucleotide probe. The crystal protein containing the component of 130kd toxic protein was purified. The crystal protein exhibiting the mosquitocidal activity against larvae of Aedes aegypti was shown by bioassay. The purified 75Md plasmid DNA of Bti 4Q5 strain was completely digested with HindIII restriction enzyme, ligated with the vector pUC18 and transformed into the recipient cells of E. coli TG1. From Apr transformants, four clones with HindIII restriction fragment inserts highly homologous to the 18-base oligonucleotide probe were obtained by in situ hybridization and southern hybridization. The 5.2kb HindIII restriction fragment insert was obtained in clone pFH2 and clone pFH4, and 2.3kb HindIII restriction fragment insert in clone pFH1 and pFH3. For pFH2 and pFH4, the 5.2kb fragment was inserted in pUC18 in opposite orientation. It contained 130kd mosquitocidal protein gene (type I) identified by restriction enzyme map analysis. The 2.3kb HindIII fragment insert in other two clones (pFH1 and pFH3) harbored a part of the type II mosquitocidal protein gene which can be used as a probe for cloning of the type II mosquitocidal protein gene.


[Isolation and characterization of mutactimycin-producing mutant]. Natural non-antibiotic producing Streptomyces sp. 1254 was mutagenized by UV irradiation and two active mutants were isolated. Mutant 113 produced novel anthracycline compounds designated mutactimycins. Mutactimycin A was active against the bacteriophage of Bac. subtilis and some viruses in tissue culture. The mutant 2-6 synthesized a basic water-soluble antimicrobial antibiotic. Chemical analysis of the whole cell hydrolysate and the morphological characterization showed that the strain 1254 and its mutant 2-6 were of chemotype I, belonging to the genus of Streptomyces, and the mutant 113 was of chemotype IV without mycolic acid. Co-synthesis test of strain 1254 and a blocked mutant of strain 113 gave the active compounds identical with mutactimycins. Using the actI gene as a probe, the Southern hybridization revealed homology between the actinorhodin polyketide biosynthase gene and the total DNA of the strain 1254. Based on these data it was deduced that Streptomyces sp. 1254 should have a biosynthesis pathway for mutactimycin, but some of its genes might fail in expression and mutagenesis would make the silent gene(s) active.


[A new virus of rabbit. III. Study on morphological superstructure and antigenicity of rabbit hemorrhagic disease virus (RHDV)]. In the spring 1986, an acute infectious disease occurred in Wuhan Second Producing Medical Manufactory, and the rabbit almost died. We tested the mortal symptom and confirmed rabbit Hemorrhagic Disease (RHD) as same as Huang Yinyao report. Hubei Traditional Chinese Medicine Institute appear this RHD also. After we purified virus of above two source by low speed, high speed and sucrose density gradient centrifugation, they can react with antiserum of RHDV from Nanjing Agricultural University in agar gel immunodiffusion tests. These results proved that they belong to the same serotype. Data indicate RHDV have difference morphological superstructure, viral polypeptides and especially RHDV can't react with antiserum of standard Parvovirus of rabbit and so on, so we suggest RHDV is a new virus.


[Detection of Mycobacterium tuberculosis in sputum specimens of pulmonary tuberculosis by DNA amplification]. The PCR was used to detect M. tuberculosis DNA sequences in uncultured clinical specimens. Two oligonucleotide primers with 20 bp each amplified target template DNA of M. tuberculosis. Amplified DNA product was 245 bp which was identified by agarose gel electrophoresis. The sensitivity of detection of M. tuberculosis genomic DNA and bacteria suspension by PCR was lpg and 13 viable bacteria cell/ml, respectively. In specificity experiments, only M. tuberculosis, M. bovis and BCG were positive by PCR, but all other 14 Mycobacterium tested, including streptomyces lividans and E. coli plasmid PUC19 were negative. The sensitivity of detection of M. tuberculosis by PCR was determined by comparing the fast-acid staining and culture on total 54 sputum specimens of pulmonary tuberculosis and 12 nontuberculosis lung disease. The positive rate of PCR in pulmonary tuberculosis were 37.0%, culture method showed only 14.8%, fast-acid staining were 16.7%. Nontuberculosis lung disease were negative. The results show that DNA amplification is a superior method with high degree of sensitivity and specificity for rapid diagnosis of pulmonary tuberculosis.


[Identification and characterisation of 200 strains of Brucella canis under test from China]. 200 cultures of Brucella canis under test were received from some provinces in our laboratory. 167 (85.59%) of them were identified as Brucella according to morphology, growth properties and serologies. And then, they were proved as Brucella canis with R-serum agglutination and lysed test of phage R/C. Some strains also were performed DNA homologous determination and observation of electron microscopic morphology. The results found out that the genetic constitution and picture of them identified with that of reference strains. Non-agglutination reaction was 4.75% of all strains in R-serum test. 72.49% of them appeared typic reaction in dye sensitivity test. 22.75% was resisted to both thionin and fuchsin, which separated difficulty with R phase strains of Brucella melitensis lysed by phage R/C.


[Studies of cockroachcidal toxin].

[Studies of cockroachcidal toxin]. A cockroachcidal bacterial isolate CW-W-90-3 was selected by egg yolk agar plate. The isolate produced phospholipase C (PLC) which was pathogenic to the nymph of cockroach. The conditions for production of high level PLC indicated that using LB medium supplement Tween-80 or minimal medium could effectively increase the activity of PLC. The optical phase for production of PLC was in the period of 12-18 hours and below pH8.0. The activity of PLC was reduced along with the culture time until 48 hours. The PLC was resistant to heat. The partially purified PLC from the culture supernatant was assayed by using cockroach nymphes and produced 71.74% mortality.


[The state of development of interventional cardiology in Austria]. 3,157 PTCA were performed in Austria in 1991, this is 27% more compared to 1990. Prognosis for 1992 is another 27 to 30% more. Frequency of PTCA exceeded bypass surgery in 1990 for the first time in Austria. WHO-guidelines of 1,000 interventions per year and 1 million inhabitants will be achieved in Austria by 50% in 1992. In this context it is worth while to state, that installation of further cathlabs is recommended preferably within established centers including established heart surgery. The following NON-POBA-PTCA-techniques ("New devices") were used in Austria for the first time: Atherectomy, stent, lasers, TEC, ROTABLATOR, ROTACS, magnum wire and angioscopy accounted for 11.3% of all PTCA cases in Austria recently. A total of 447 valvuloplasties were performed in Austria until now, frequency of pulmonary and mitral valvuloplasties is increasing, that of aortic valve interventions decreasing. High frequency, Radiofrequency and Direct current Ablations of supraventricular- and ventricular- or WPW-arrhythmias were performed in 184 patients in Austria until now. In 247 patients with rare conditions, interventions like atrioseptostomy, implantation of umbrellas, etc. were performed. State of interventional cardiology in Austria is appropriate, compared to other European countries.


[Acute management of myocardial infarct patients in Austria (cross-sectional study of 8 intensive care units)]. 8 Austrian Intensive Care Units provided data from 6,317 cases (including 1,667 cases with acute myocardial infarction) admitted during 1990 and 1991 for a documentation system offered by the Austrian Heart Foundation. Significant differences were observed between the units concerning admission policies and the use of diagnostic methods. 71% of the AMI cases were first infarctions, 10% were Non-Q-infarcts. The median of the prehospital period varied between 2.5 and 6.5 hours. The evaluation of the admission mode showed that on average 42% of the AMI cases had contact to their G.P. before hospital admission, this figure varying, however, between 24 and 90% in different areas. It seems that this contact takes place to a much lower extent in big cities. On average G.P. contact before hospital admission in AMI resulted in doubling of the duration of the prehospital period. Thrombolytic treatment was applied in 24.7% of AMI cases with a variation between 13.9 and 48.4% in the different centers. It is suggested that regular use of this kind of quality control should offer means for optimizing the acute care of infarct patients on a regional and on a national level.


The role of PTCA in acute myocardial infarction. 2 closing remarks should be made. In the 1st place: Under optimal conditions (experienced house staff and experienced interventional cardiologists, well equipped catheterization laboratory all available on a 24 hour service) primary PTCA can be done safely with excellent results as demonstrated by Hartzler et al. and by the Zwolle study. In the 2nd place: Recent reports have demonstrated better results from a combination of thrombolytic agents and probably this is due to higher patency rates and possibly less deleterious effects on plaque morphology and ischemic myocardium. Anti platelet therapy is still a major concern because of the limited efficacy of aspirin and heparin. Specific binding of platelet membrane glycoprotein. IIB/IIIA to monoclonal antibodies (7E3 Fab) is a promising and potential new concept. Other agents may also be effective of which hirudin and angiopeptin should be mentioned. All these factors may contribute to a better treatment strategy for acute myocardial infarction.


[Ventricular tachycardia and ventricular fibrillation. Diagnostic procedure for selection of patients for non-medicamentous therapeutic procedures]. The use of nonpharmacological methods in the treatment of life-threatening ventricular tachyarrhythmias is increasing. These include surgical procedures, the application of direct and radiofrequency current for endocardial ablation, antitachycardia stimulation techniques and the implantation of cardioverter defibrillators. Each of these therapeutical procedures is characterized by its specific indication. Based on the underlying cardiac disease and the characteristics of the electrophysiological properties of the ventricular tachyarrhythmia as well as based on the specific properties of the different nonpharmacological procedures an individual therapeutical approach has to be tailored for a patient given. Primary goal is application of a nonpharmacological procedure exclusively, however, in selected cases additional administration of an anti-arrhythmic drug (decrease in tachycardia frequency in patients with implanted defibrillators, widening of the termination window in patients with antitachycardia devices) may be necessary to achieve satisfactory tachycardia control.


[Ablation of AV nodal tachycardia: new aspects on mechanism and therapy]. Dual AV nodal pathways are the substrate for the occurrence and induction of AV nodal reentry tachycardias (AVNRT). Characteristics of fast or slow pathway conduction are amenable to selective ablation by radiofrequency energy. Thus, the substrate of AVNRT is eliminated with preservation of antegrade AV nodal conduction. Radiofrequency catheter ablation is a highly effective and safe modality of treatment with success rates ranging from 80 to 100%. The risk of inadvertently inducing complete heart block is substantially lower with slow when compared to fast pathway ablation. Thus, selective ablation of slow pathway conduction has been recently advocated as the procedure of choice. When regarding to concomitant atrial fibrillation or flutter, ablation of slow pathway conduction might be preferable given the resulting higher antegrade Wenckebach cycle lengths after slow pathway ablation.


[Magnetic resonance tomography in coronary heart disease]. Although magnetic resonance imaging is currently only employed to solve diagnostic problems in a few selected patients, the special features of the technique such as its inherent three-dimensional capabilities and the prospect of angiographic noninvasive imaging suggest that this technique will become more important with future technical improvements. This overview summarizes the present status of magnetic resonance imaging in the depiction of coronary arteries and bypass grafts, the diagnosis of myocardial ischemia, the depiction of chronic myocardial infarcts including the detection of residual viable myocardium, and the diagnosis of complications associated with myocardial infarction.


[Positron emission tomography: principles and uses in cardiology]. Positron emission tomography (PET) is a noninvasive imaging technique of nuclear medicine that permits to delineate the temporal and spatial distribution of PET tracers on tomographic images. When compared to other imaging techniques commonly used in nuclear medicine such as SPECT imaging (Single Photon Emission Tomography), PET offers several advantages: 1. PET isotopes are available for the basic elements of organic chemistry such as nitrogen, carbon, or oxygen, so that physiologic tracer substances can be synthesized to study perfusion and metabolism. 2. The use of coincidence electronics for the detection of radiation leads to electronic collimation and results in high image resolution. 3. Photon attenuation is corrected individually for each patient using transmission images, so that quantitative measurements can be obtained. When compared to other imaging modalities used in cardiology, PET uniquely offers the capability to measure noninvasively and quantitatively regional myocardial perfusion (ml/g/min) and different metabolic glucose utilisation (mumol/min/g). Clinical applications of PET include the diagnosis of coronary artery disease and the assessment of myocardial viability after ischemic tissue injury. Particularly for patients with reduced left ventricular function or with regional wall motion abnormalities, PET can be considered the standard method for patient selection and risk stratification with respect to revascularisation procedures. The identification of persistent glucose utilisation in ischemically injured myocardial tissue accurately discerns myocardium with potentially reversible dysfunction from scar tissue with irreversible tissue injury.


[Non-drug therapy of ventricular tachycardia/ventricular fibrillation]. In the majority of patients with ventricular tachycardia/fibrillation drug treatment is not effective. The non-pharmacological treatment of this high-risk patients is of increasing importance. In Austria about 900 patients per year need non-pharmacological treatment of malignant ventricular arrhythmias. For this purpose 4 or 5 specialized centers would be necessary.


[The effect of ginkgo biloba special extract (EGb 761, Tebofortan)]. Ginkgo biloba special extract exerts positive effects on hemorheology and platelet aggregation, is a free radical scavenger and possesses PAD antagonistic properties, protects against hypoxia and ischemia, hampers an experimentally induced cerebral edema, has favourable properties on neurotransmitters and enhances cerebral bloodflow. Clinically EGb has proven favourable effects on intellectual deficiency, equilibrium disturbances and peripheral artery occlusions thus being a drug with a clear cut indication for these diseases.


[Sequential parenteral and oral therapy with ofloxacin in urogenital infections]. 125 hospitalized patients (56 men and 69 women) suffering from urinary tract infection (UTI) and 15 women with endometritis or pelvic inflammatory disease were treated with ofloxacin 6 mg/kg/d i.v. divided into 2 doses. Two thirds of the patients were switched to oral ofloxacin using the same dose regimen after 4 days. The median duration of treatment was 10 days. 98 patients were evaluable for efficacy: 45 had complicated lower UTI, 32 had upper UTI (75% of them with complications), 13 had endometritis and 8 an uncomplicated lower UTI. The most frequent complications of UTI were: obstruction (n = 27), indwelling catheters (n = 23), urinary concrements (n = 12), residual urine (n = 8) and a neurogenic bladder (n = 6). 22 patients had diabetes mellitus. A total of 103 pathogens was isolated from the urine of 85 patients, the most frequent being E. coli, Proteus spp. and Enterococcus faecalis. 98% of patients with UTI and 85% of patients with endometritis were clinically cured. Adverse drug events were observed in 6 patients.


[The spectrum of pathogens in positive blood cultures--Tyrol 1991]. In a recent study by the Centers for Disease Control (CDC) it was noted that there had been a resurgence of Gram-positive bacteremia together with an increase in fungemia. This reported trend is confirmed by data from the Austrian Tirol. In 1991 1,750 out of 13,679 specimens (12.8%) yielded bacterial or fungal growth, accounting for 1,248 cases of "bacteremia"; no decision was made about the clinical significance of the culture isolates. We consider laboratory reports of blood isolates to be fairly well suited to reflect the frequency of the various bacterial and fungal pathogens. The most common organisms were coagulase-negative staphylococci (41%). The proportion of Staphylococcus aureus (17%), E. coli (4%), Klebsiella-Enterobacter (4%), Pseudomonas (5%) and Candida (3%) corresponded well with the situation in the USA and the UK. Remarkably, anaerobes accounted for only 0.3%, possibly due to our use of a "single bottle"--blood-culture system. Various fastidious organisms, including Brucella melitensis and Haemophilus aphrophilus, were detected by this blood-culture system. Also 15 Haemophilus influenzae-strains, nontyphoidal salmonellae (9 strains), and meningococci (7 strains) were isolated. These data show that the microbiologic features of blood-cultured seen in Austrian Tyrol are broadly similar to those in the UK and North America.


[The more effective immune system of women against infectious agents]. Even the reactions of the immunological system are dependent on the sex. Estrogens are the natural stimulants of the general resistance. On the other hand, androgens especially testosterone have an anabolic effect on the voluntary muscles but they inhibit the immunological system. Therefore, women show more resistance to the most infectious agents with the exception of intestinal parasites. To some extent the higher expectation of life of women may be due to that stronger female resistance to infectious agents. It is true, sport is able to decrease the cardiovascular mortality. However, the training of the voluntary muscles is a burden to the resistance especially in the second half of the life. There is therefore some probability that sport is not prolonging the life.


Characteristics of putrescine uptake by human brush border membrane vesicles. Both putrescine and the polyamines spermidine and spermine are essential factors for growth and differentiation in all cells of higher eucaryotes. In principle, increased requirements of polyamines in mucosal cells either can be met by de novo-synthesis or by increasing the uptake from lumen (brush border membrane) or bloodstream (basolateral membrane). We therefore evaluated putrescine uptake in intestinal mucosal cells by using human brush border membrane vesicles (BBMV). Intravesicular uptake of putrescine was shown by osmoplots. This process was not saturable over a substrate range from 1 to 80 microM. Putrescine transport was also found to be independent of temperature (Q10 = 1.23). No differences in putrescine uptake rates were found in the presence or absence of Na+, and there was no evidence for any dependence of putrescine uptake from other cations. Our data indicate that putrescine uptake by human intestinal brush border membrane vesicles occurs by passive diffusion. It is concluded that a formerly described saturable and carrier mediated uptake in isolated intestinal mucosal cells from different species is probably influenced by active transport across the basolateral membranes. Therefore, further studies with isolated basolateral membranes are advocated.


Chronic erosions of the antral mucosa: a sequela of Helicobacter pylori-induced gastritis. The etiopathogenesis of chronic erosions of the antral mucosa still remains to be clarified. In order to investigate the question as to whether chronic erosions might be a sequela of Helicobacter pylori-induced gastritis, we submitted biopsy material obtained from 250 patients with chronic erosions of the antral mucosa to a histological evaluation. The grading of Helicobacter pylori colonisation, and gastritis was compared with the results of histological evaluation of the biopsy material obtained from 1,196 patients with Helicobacter pylori gastritis, but no lesions of the gastric mucosa. The results of a histological analysis showed that Helicobacter pylori gastritis was present in 99.1 percent of the patients with chronic erosions of the antral mucosa. A comparison of the histological findings in patients with no lesions of the gastric mucosa revealed, that the density of Helicobacter pylori colonization, the severity of the antral gastritis together with its activity were statistically significantly more pronounced (p < 0.001) in patients with chronic erosions. In contrast, no differences in the morphological parameters were seen in the case of corpus mucosa. On the basis of these results, we conclude that chronic erosions of the antral mucosa represent a sequela of Helicobacter pylori gastritis, and that these Helicobacter pylori-induced chronic erosions should, in future, be differentiated from other erosions.


[High-dose ranitidine protects stomach and duodenum completely against piroxicam. An endoscopic double-blind pilot study]. In a randomized placebo-controlled parallel and double-blind study the gastroduodenal effects of 20 mg piroxicam daily was evaluated endoscopically in the presence of ranitidine 150 mg bid or 300 mg bid in 31 healthy volunteers. Drugs were taken over a period of 14 days. Endoscopies were performed at entry and repeated after 14 days of treatment. A damage-score according to Lanza was used. At entry, all groups showed comparable mucosal damages in the stomach and in the duodenum. After 14 days the mean lesion score increased in the piroxicam/placebo group (group A) to 4.5 +/- 1.6 (+/- SEM) in the stomach and to 2.7 +/- 0.8 (+/- SEM) in the duodenum. The corresponding values in the piroxicam/ranitidine 150 mg bid group (group B) were 3.3 +/- 1.2 (stomach) (p > 0.05 vs. group A) and 1.4 +/- 0.7 (duodenum) (p < 0.05 vs. group A). The values in the piroxicam/ranitidine 300 mg bid group (group C) averaged 1.0 +/- 0.0 (stomach) and 0.3 +/- 0.1 (duodenum) (for both p < 0.05 vs. group A). Our data suggest that profound acid inhibition--achieved by doubling the usual dose--afforded complete protection of human stomach and duodenum against piroxicam.


[Proctoscopic Doppler ultrasound in diagnosis and therapy of symptomatic first degree hemorrhoids ]. Within the framework of a prospective study two comparable collectives with each 62 patients and symptomatic first grade hemorrhoidal disease were examined. Guiding symptom was painless hematochezia. The hemorrhoids of collective A were evaluated with the aid of transproctoscopic Doppler ultrasound. The depth of the vessels was determined and a Doppler located injection therapy was performed. The patients of collective B were only investigated by means of proctoscopy and sclerosed without Doppler. Sclerosing injection was carried out in all cases with 6 ml Phenylamygdalic oil by 3, 7 and 11 o'clock lithotomy position. Success of therapy was controlled in all patients 2 weeks later Doppler sonographically. In 87% of the Doppler controlled treated patients the hemorrhoids were completely eliminated and no more arterial blood flow could be scanned. On the contrary only 37% of the initially not Doppler scanned patients were cured. Endoscopic Doppler ultrasound is and effective method in evaluation and treatment of symptomatic first grade hemorrhoids.


[DNA ploidy and dysplasia in ulcerative colitis--interim analysis of a prospective study]. DNA ploidy and cell cycle phases were evaluated by flow cytometry in colonic biopsy specimens from 107 patients with ulcerative colitis in order to analyse the prevalence of DNA aneuploidy as an indicator of numerical chromosomal aberrations and the cell proliferation in all forms of ulcerative colitis. Whereas G2/M-phase fractions in ulcerative colitis and in controls were comparable (2.7 +/- 1.1% vs. 2.8 +/- 1.1%), S-phase fractions in ulcerative colitis exceeded those of controls (7.5 +/- 3.2% vs. 6.5 +/- 2.3%; p < 0.01). In 28 control patients, only diploid DNA histograms existed. Single or multiple aneuploid stem lines were detected in 10 patients with ulcerative colitis (9.3%). Aneuploidy was nearly exclusively associated with pancolitis. Dysplasia was present in 13 patients (indefinite: 8; low-grade: 5), of whom 5 patients also showed DNA aneuploidy. 5 patients with non-dysplastic mucosa exhibited DNA aneuploidy. Because dysplasia and DNA aneuploidy can be discordant and might therefore identify different subgroups at risk, flow cytometry might play a role as a valuable complement to histological examination in surveillance programs of ulcerative colitis.


[Metastatic hemangiopericytoma of the stomach. Case report and review of the literature]. Hemangiopericytoma is a vascular tumor originating from the pericytes which surround the capillaries. The tumor occurs anywhere in the body preferably at head and neck and the extremities. In less than 3% it grows in the stomach. In spite of surgical excision local recurrence or hematogene metastases must be expected. We report a case of primary hemangiopericytoma of the stomach which could only be diagnosed by metachrone liver metastases. This case shows that hemangiopericytomas and their metastases belong to the differential diagnosis of cystic liver lesions. Diagnostic procedure, therapy and prognosis of this rare tumor is discussed by an analysis of the literature.


[Primary intestinal tuberculosis in AIDS]. More than 50% of all HIV-infected patients have gastrointestinal symptoms like dysphagia, abdominal pain, diarrhea or intestinal bleeding. We describe an emergency situation with gross gastrointestinal bleeding in a twenty-seven year old drug addicted female. Colonoscopy and histological examination of the biopsies were the main diagnostic procedure to locate an extrapulmonary manifestation of a mycobacterium-tuberculosis-infection.


[Regulation of gastrointestinal functions by the ileocecal area]. The importance of the distal small intestine and the ileocecal region for the regulation of gastrointestinal functions in humans has not been investigated in depth until recently. A regulatory role is postulated because even in healthy subjects, undigested nutrients pass across the ileocecal junction after most meals (physiologic malabsorption). Nutrient exposure of the ileocecal region causes slowing of gastric emptying and small intestinal transit, and decrease in small intestinal motor activity; under certain experimental conditions, ileal nutrients induce conversion of intestinal motility from digestive to interdigestive patterns. In addition, the secretory activity of the proximal gastrointestinal tract is inhibited by the ileocecal region. Inhibition of gastric secretion and exocrine pancreatic secretion are well established responses to ileal nutrient exposure; inhibition of bile secretion likely occurs, but is not proven. The intermediary mechanisms of these effects have not been clarified; the most likely candidates include endorphins, peptide YY (PYY), and glucagon-like-peptide-1 (GLP-1). Overall, the available data support the concept that the ileocecal region participates in the physiologic control of gastrointestinal motor and secretory functions. Whether disturbances of these regulatory mechanisms participate in the pathophysiology of gastrointestinal disease has not been investigated.


[Clinical relevance of endosonography in diagnosis of pancreatobiliary diseases]. Endoscopic ultrasonography allows a high-resolution imaging of the pancreas and the extrahepatic biliary tract due to the high ultrasonic frequencies employed. This is of clinical benefit in the delineation of small pancreatic carcinomas complementary to ERCP and in the preoperative localization of endocrine tumors of potential pancreatic origin. Endosonography is the most accurate method presently available for the local staging of pancreatobiliary malignancy and thus helps avoiding diagnostic laparotomy for staging purposes. The role of endoscopic ultrasonography in the diagnosis of benign diseases such as chronic pancreatitis and choledocholithiasis has not yet fully been established. Endosonography, however, has no role in the differential diagnosis of benign and malignant disorders of the pancreas and biliary tract.


[Psychotherapeutic management of aging patients in a neurologic practice]. In a neuropsychiatric practice in a large metropolitan area which works together with 274 therapists (psychoanalysts, behavior therapists, etc.), of the 606 patients that were seen during a 3-month span, 52% were over the age of 50, and 17% were more than 60 years old. Either a short- or a long-term psychotherapy was indicated in 6.25% of the cases involving these older patients. However, only 1.69% of the patients over the age of 60 received treatment. Twice the number of psychoanalysts as compared to behavior therapists was not willing to treat a patient over the age of 50.


[Inpatient behavior therapy of depressed elderly patients]. Though cognitive-behavioral approaches have been shown to be suitable for and efficient in the treatment of depression in old age, they are not yet frequently applied with elderly patients. Our clinic has developed a concept for in-patient psychotherapy with older depressed people based on cognitive-behavioral methods. The theoretical foundations and practical implementation are described.


[Psychotherapeutic goals for elderly patients]. The psychotherapy of elderly people in the past seems to have paid less attention to the treatment of (neurotic, psychoreactive) illness and instead concentrated on coping with getting older, the final stage of life and/or the search for sense in life. The aims published concentrate more on the contemplative or deficient view which psychotherapists themselves have of the process of getting older, on their own distance to old age and on their insufficient treatment experience. The result of this is reductionist planning leading to decisive therapy modifications.


[Cognitive behavior therapy with depressed elderly patients: initial experiences and results]. Our understanding of depression in old age focuses on a) restrictions and changes in living conditions, in social and somatic functions, in social contacts; b) real or perceived lack of control over those changes; c) rigid, absolute, negative expectations and assumptions; d) deficits in alternative behavior. A group program for treatment of depressed older patients based on those elements is described and first results of pilot studies are presented. These findings are quite promising and congruent with the few available Anglo-American studies. Despite the results, we are still far from being able to give empirically supported advice on how to efficiently treat depressed older patients. Further controlled investigation is necessary, including larger samples, multiple assessments, and well-designed pharmacological and psychological control conditions.


Structural and putative regulatory sequences of Kluyveromyces ribosomal protein genes. The transcription of the majority of the ribosomal protein (rp) genes of Saccharomyces cerevisiae is activated by cis-acting elements, designated RPG boxes, which specifically bind the multifunctional protein RAP1 in vitro. To investigate to what extent this global system of transcription regulation has been conserved, we have isolated a number of rp genes of the related yeast species Kluyveromyces lactis and Kluyveromyces marxianus, whose counterparts in Saccharomyces are controlled by RAP1. The coding regions of these genes showed a sequence similarity of about 90% when compared to their Saccharomyces counterparts. In contrast, little or no sequence similarity was found between the upstream regions and the intervening sequences of Kluyveromyces and Saccharomyces homologs. However, the occurrence and the position of the introns is conserved. The sequence data also show that the physical linkage that exists in S. cerevisiae between the rp genes encoding RP59 (CRY1), S24 and L46 is conserved in Kluyveromyces. Northern analysis demonstrated that each of the isolated Kluyveromyces genes is transcriptionally active. By sequence comparison we identified a number of conserved sequences in the upstream region of each of the Kluyveromyces rp genes, which we designated the X, Z and RPGK boxes. The last one is highly similar, though not identical, to the S. cerevisiae RPG box. Functional analysis of the intergenic region between the genes encoding Kluyveromyces ribosomal proteins S24 and L46 showed that the RPGK box (+Z box) functions as a transcriptional activator, while the X box acts as a transcriptional repressor. Band-shift assays confirmed the existence of a RAP1-like protein in Kluyveromyces that binds to the RPGK box but not to the S. cerevisiae RPG box. In contrast, S. cerevisiae RAP1 did recognize the RPGK box.


[Inpatient focal therapeutic treatment of elderly patients--concept and initial results]. Acute neurotic and functional symptoms in the elderly are undervalued relative to the frequency. The authors demonstrate the indication criteria and an inpatient focal therapeutic treatment conception for elderly patients. The 11 patients from 50 to 68 years, treated in this setting in 1991, are characterized by sociodemographic aspects, symptoms and length of treatment. At the end of the treatment period (on an average of 8 weeks) seven patients are well recovered with regard to their symptoms, one patient is somewhat improved, and two patients are not recovered. According to a short casuistic some fundamental reflections on psychoanalytic focal therapy in the elderly are discussed.


[Inpatient psychotherapy of elderly patients in a psychoanalytically structured psychosomatic clinic]. Because of the insufficient outpatient psychotherapeutic care of elderly people, treatment in a clinic is of great importance. A year ago a psychosomatic clinic introduced psychoanalytically oriented treatment especially designed for people over 60. The concept of this treatment and its realization phase are presented here and explained on the basis of a case study.


[Anxiety and self-assurance in elderly patients]. The concept of social competence covers emotional, cognitive and behavioral abilities in the field of interpersonal communication and behavior patterns to cope with practical problems of life. Under the specific conditions of age, aging, and diseases in one part of the elderly, a loss of psycho-social competence may reduce the ability and quality of independent living. To improve social competence in old patients, an age-adapted assertiveness-training, based on the Assertiveness Training Program was proved in a group of psychogeriatric inpatients in a controlled study. In the self-rated activities of daily living and state-anxiety as well as in observer-rated self-confidence and assertiveness, the training group showed significant improvement compared to the controls.


Schizosaccharomyces pombe mitochondria: morphological, respiratory and protein import characteristics. A technique is described for the isolation and purification of intact, respiratory-competent mitochondria from Schizosaccharomyces pombe. The purified mitochondria are capable of oxidizing NADH and succinate as respiratory substrates, indicating the presence of succinate dehydrogenase and an NADH dehydrogenase located on the outer surface of the inner membrane. Mitochondria display good respiratory control with an ADP/O ratio of < 2. Respiratory activity is linearly dependent upon the redox poise of the quinone pool, suggesting the presence of an unbranched respiratory pathway to molecular oxygen. Immunogold labelling using antisera raised against mitochondrial HSP70 proteins (SSP1, SSC1 and PHSP1) from three different species, namely S. pombe, Saccharomyces cerevisiae and the plant Pisum sativum respectively, has been used to investigate the presence and ultrastructure of the mitochondria isolated by this procedure. The immunocytochemistry was carried out using cells containing wild-type levels of SSP1 protein and cells over-expressing the protein. These results also demonstrate the capacity of mitochondria to import increased levels of protein in vivo. In vitro import experiments using COXIV-DHFR indicate that purified S. pombe mitochondria can efficiently import this precursor, and that protein translocation is dependent upon an oxidizable substrate and a membrane potential.


[Depression in the elderly. Contribution of music therapy to grief work]. If one understands the physical manifestation of minor depressions or multiple functional disorders in the elderly as being indirectly expressed dissatisfaction because of unfulfilled aims in life, a practical recovery process is necessary in order to confront the underlying psychic process. The aging person has to come to terms with his eventual demise. If he faces this, he will have a chance at renewed energy to accomplish incomplete aims. Many people need help in order to continue the recovery process. Even if speech or reflexive possibilities are inhibited, it is possible accomplish therapy by the medium of sound, which is a preverbal language. Music therapy is able to work at a psychotherapeutic level in persons seemingly unable to be influenced by conventional psychotherapeutic-methods. Two case studies with different techniques (singing of well known songs and free improvisation) illustrate this theses.