Arrangement of elastic fibres in the integument of domesticated mammals

The hairy skin of important domesticated mammals (12 species) was studied with scanning electron microscopy, transmission electron microscopy, laser scanning microscopy, and several light microscopical methods, to obtain more information about three-dimensional elastic fibre arrangement. It was obvious that there is a basic construction scheme of the elastic fibre meshwork as present in the upper and mid-dermis, with special regard to the size, number, and grouping of hair follicles. In the densely-haired species, in particular, a typical elastic mat with horizontal fibres is formed. In many of the sparsely-haired animals, the upper and mid-dermis show a sponge-like elastic system. In the rather massive, collagen-rich skin of large species, the lower two thirds of the dermis without hair follicles only possess a loosely-structured elastic network, but thick elastic sheets are found at the border zone with the hypodermis. Specific features appear with regard to the type of mechanical strain exerted, different body regions, varying hair follicle density, or as connected with the anchoring of the hair follicle complex, blood vessels, and nerves.

Present results of neutron therapy. The German experience

Results of fast neutron therapy are reviewed with special reference to the main indications for this type of treatment and the experience of five German centers. Neutron therapy seems beneficial compared to conventional radiotherapy in advanced salivary gland tumors, inoperable or unresectable soft tissue sarcomas, some bone tumors, prostate cancer stage C and some rare low-grade tumors. About 3,000 patients with malignancies have been treated with neutrons at the German centers Berlin/Rossendorf, Essen, Hamburg, Heidelberg and Münster. Treatment results and treatment-related morbidity depend on the treatment techniques and the physical selectivity of the neutron machines. A critical appraisal suggests that fast neutrons are of advantage in about 5% of all radiotherapy patients.

Morphogenesis of the osteo-architecture in the carnassial region of the feline mandible, as demonstrated by microfocal radiography

For the first time, osteogenesis was observed using direct magnifying microradiography, a noninvasive technique that has a high power of resolution. Thus, it was possible to correlate different stages of bone maturation in the feline mandible with specific functional demands. Our observations suggest a relationship between osseous structure and the mode of feeding and content of the diet.

Carbohydrate histochemistry of skin glands in the Turkish Angora goat

The skin glands of the general body surface of the Turkish Angora goat were studied by means of selected carbohydrate histochemical methods, in particular several PO-lectin procedures. Both gland types exhibited intensive secretion production, irrespective of season and body region. The different histochemical staining procedures demonstrated that glycoconjugates, especially neutral glycoproteins are present in the secretory cells and secretion products of the apocrine glands. The peroxidase (PO)-lectin-procedures indicated the following saccharide residues: alpha-D-mannose, N-acetyl-beta-D-glucosamine, alpha-D-glucose, N-acetyl-D-galactosamine, beta-D-galactose, alpha-D-galactose, and alpha-fucose, including small amounts of N-acetylneuraminic acid and N-glycolylneuraminic acid. Relatively large amounts of glycoconjugates, probably also glycolipids, were found in the peripheral cells and the sebum of the sebaceous glands, exhibiting the following saccharide residues: N-acetyl-D-galactosamine, alpha-fucose, N-acetylneuraminic acid and N-glycolylneuraminic acid. The results obtained are discussed as related to findings from corresponding studies in other mammalian species. The secretory substances present obviously create a clearly alkaline pH milieu within the fleece of the Angora goat. Such conditions are also known to exist, for example, in the Merino sheep fleece.

[Psychosocial management in the general hospital--a survey of current status exemplified by Baden-Württemberg]

Expert psychosocial care for severely ill people has, time and again, proved both necessary and effective, in particular in the field of oncology. While this fact is reflected by the number of positions allocated to psychosocial care in Paediatric Oncology there remains a grave deficit with regard to adult cancer patients. A survey of all General Hospitals in Baden-Württemberg yields concrete figures in respect of the scarcity of positions available in this area. 149 questionnaires were sent out with a response rate of 78.5% (117). Almost a quarter of the hospitals have no social worker on their staff, and trained psychotherapists are almost unknown. In most cases patients are referred to out-patient institutions and self-help groups. 94 per cent of the respondees considered an improvement in psychosocial support to be necessary, placing particular emphasis on the training and supervision of hospital personnel.

[Adjuvant radiotherapy following radical prostatectomy--results, acute and late toxicity]

Between 1975 and 1987, 53 patients with radical retropubic prostatectomy for adenocarcinoma of the prostate (pathological stage C or D1) underwent adjuvant radiotherapy. 26 of these patients additionally underwent subcapsular orchiectomy. Radiation therapy was given to 45 patients as 40 to 50 Gy to the pelvic lymph nodes followed by a boost to the tumor bed to a total of 64 to 70 Gy. Only five of the 45 patients received treatment to prostate and pelvis developed progression, whereas four out of eight patients who were irradiated to the prostate alone showed progression (p < 0.01). The five- and ten-year disease-free survival rates of 33 patients with stage C tumors were 91% and 83%, the local control rate 97% and 94%. 20 patients with stage D1 carcinoma showed a five-year disease-free survival of 79% and a local control rate of 95%. 25/26 patients with subcapsular orchiectomy are living disease-free, 8/27 patients without hormonal manipulation had a progression of disease (p < 0.05). All 13 patients with well or moderate differentiated tumor are alive without evidence of disease, 9/40 patients with poor differentiated carcinoma have shown tumor progression (p < 0.05). Compared to published results, our data suggest, that adjuvant radiotherapy can decrease local recurrence and probably increase disease-free survival in stage C and D1 carcinoma of the prostate.

High CO2 concentration alleviates the block in photosynthetic electron transport in an ndhB-inactivated mutant of Synechococcus sp. PCC 7942

The high-concentration CO2-requiring mutant N5 of Synechococcus sp. PCC 7942 was obtained by the insertion of a kanamycin-resistant gene at the EcoRI site, 12.4 kb upstream of rbc. The mutant is unable to accumulate inorganic carbon internally and exhibits very low apparent photosynthetic affinity for inorganic carbon but a photosynthetic Vmax similar to that of the wild type. Sequence and northern analyses showed that the insertion inactivated a gene highly homologous to ndhB, encoding subunit II of NADH dehydrogenase in Synechocystis sp. PCC 6803 (T. Ogawa [1991] Proc Natl Acad Sci USA 88: 4275-4279). When the mutant and the wild-type cells were exposed to 5% CO2 in air, their photosynthetic electron transfer capabilities, as revealed by fluorescence and thermoluminescence measurements, were similar. On the other hand, a significant decrease in variable fluorescence was observed when the mutant (but not the wild-type) cells were exposed to low CO2 under continuous light. The same treatment also resulted in a shift (from 38-27 degrees C) in the temperature at which the maximal thermoluminescence emission signal was obtained in the mutant but not in the wild type. These results may indicate that subunit II of NADH dehydrogenase is essential for the functional operation of the photosynthetic electron transport in Synechococcus under low but not high levels of CO2. We suggest that the inability to accumulate inorganic carbon under air conditions stems from disrupture of electron transport in this mutant.

[Use of an improved transmission ultrasound camera for diagnosis of rheumatic joint diseases]

Transmission (TM) sonography allows a reliable and fast imaging of soft tissues like joint capsules and tendons, especially of hands and feet. Bony structures appear blurred, but serve as landmarks for easy orientation on the ultrasonic images. The quality of imaging allows a reproducible measurement of joint capsule parameters. Inflammatory alterations of joints are recognized earlier than with conventional x-rays. TM sonography contributes to the diagnostic panel for rheumatic diseases, which involve soft tissues and joints of hands and feet. Today, TM sonography cannot compete with conventional reflex sonography in general arthrosonography, but it is an interesting addition. Follow-up studies will show whether objective joint parameters available by TM sonography may help to both indicate disease progression and to monitor therapeutic interventions in rheumatic diseases.

[Psychosocial factors in carcinogenesis: on the problem of the so-called cancer-prone personality]

Without distinguishing between the heterogeneous types of the disease which are implied in the term "cancer" a stereotype--the cancer-prone personality--is regarded as the essential cause of the disease. Their striking characteristics are quoted as follows: depressive mood, social conformity, restrained expression of needs and emotions, reduced perception of physical symptoms, etc. In a prebioptical prospective study, basing on semi-structured interviews carried out at two different points of time, with 230 women with breast tumours and 95 patients with a suspected lung cancer, the theory of a psychosocial cancer ethiology was examined with regard to the following aspects: do the psychological phenomena observed reflect a premorbide personality structure or do they represent reactions to the disease? Is it possible to register personality related phenomena in the preventive behaviour and are there specific differences in the perception of the symptoms? Through this quasi-experimental approach it was possible to distinguish between the influence of the personal expectancy concerning the diagnosis and the effect of the actual disease. This way it was proven that psychological phenomena of cancer patients are to be understood as the result and not as the cause of the disease.

Phenotypic Complementation of High CO(2)-Requiring Mutants of the Cyanobacterium Synechococcus sp. Strain PCC 7942 by Inosine 5'-Monophosphate

The high CO(2)-requiring mutants of Synechococcus PCC 7942, D4 and R14, were obtained by deletion or inactivation (respectively) of an open reading frame immediately downstream of rbc (the operon encoding the subunits of ribulose 1,5-bisphosphate carboxylase/oxygenase). These mutants exhibit photosynthetic characteristics similar to those of high CO(2)-grown wild type, unlike other cyanobacterial high CO(2)-requiring mutants, where the apparent photosynthetic affinity for inorganic carbon is approximately 2 orders of magnitude lower than that of the wild type. Sequence analysis and metabolic complementation of the mutants by inosine 5'-monophosphate identified this open reading frame as the cyanobacterial equivalent of purK, the eubacterial gene encoding subunit II of phosphoribosyl aminoimidazole carboxylase in the purine biosynthetic pathway. Exposure of high CO(2)-grown Synechococcus to low CO(2) conditions led to the induction of transcription of purK. It is suggested that the high CO(2)-requiring phenotype of these mutants resulted from the defect in purine biosynthesis after exposure to low CO(2). We also raise the possibility that the level of cellular purines is involved in the process of adaptation of cyanobacteria to low concentrations of CO(2).

A Cyanobacterial Gene Encoding Peptidyl-Prolyl cis-trans Isomerase

The rotA gene encoding peptidyl-prolyl cis-trans isomerase has been identified, sequenced, and shown to be transcribed in the cyanobacterium Synechococcus sp. PCC7942. Inactivation of the gene by replacement of a region containing the open reading frame with a gene conferring kanamycin resistance resulted in merodiploids containing both the wild type and the modified genomic region. We were not able to isolate a kanamycin-resistant mutant in which all the genomic wild-type copies were substituted, which suggests that such replacement could have been lethal.

Advantage of three-dimensional treatment planning for localized radiotherapy of early stage prostatic cancer

Conventional two-dimensional (2-d) treatment planning was compared to three-dimensional (3-d) treatment planning for patients with prostatic carcinoma. Both types of treatment planning were performed for all ten patients with five fixed fields. In 3-d planning we used irregular shaped fields. For further evaluation we performed conventional planning in rotation technique in two patients. The target volume included prostate, seminal vesicles and a surrounding security margin of 2 cm. Using the MPR-version of the MEVAPLAN planning system, the three-dimensional dose calculations were performed. For the volumes of interest (VOI's) we discussed quality of the dose distribution concerning homogeneity in the target volume and isodose distribution in the organs at risk, which are the rectum and the urinary bladder. We defined the tumor encompassing reference isodose (ca. 95%) for the calculation of the involved rectum- and bladder volume. Using the five-field technique our results show a reduction of the radiation related rectum- and bladder volume concerning the tumor encompassing reference isodose (ca. 95%) for the rectum in between 9.5 and 36.6% (median: 19%, n = 10) and for the urinary bladder in between 15.7 and 47.8% (median: 28%, n = 10). Calculated for 80% of the reference isodose the difference for the rectum was 15.7 to 31.3% (median: 23%) and for the urinary bladder 24.5 to 56.7% (median: 42%). A significant reduction of radiation related side-effects concerning rectum and urinary bladder can be expected by a reduction of volume involvement and a consecutive dosage limitation.

Retroperitoneal sarcoma in a series of 51 adults

Fifty-one patients with retroperitoneal sarcoma underwent surgery at the University Clinics of Hamburg from 1970 to 1988. Malignant schwannoma, liposarcoma and malignant fibrous histiocytoma were the most common histological types. High grade sarcomas (G3) predominated (42%), while 26% were graded G2 and 33% G1. Complete resection was possible in 59% of cases. Reoperation for local recurrence and debulking in case of not completely resectable disease was common. Regional lymph node metastasis was found in 20% of cases. The peritoneum was the preferred location of metastatic spread. All adjuvant chemotherapies were followed by tumour recurrences. After adjuvant radiotherapy three of six patients remained free of disease. In cases of residual tumour we observed few partial responses on chemo- and radiotherapy, and all patients died because of the disease. The mean survival time was 60 months, the 5- and 10-year survival rates were 35% and 15%, respectively. Factors influencing prognosis in univariate analysis included grade, size, resectability, presence of metastatic spread, histological type, microscopic local growth (infiltrative vs intact pseudocapsule of fibrous tissue) and local recurrence. With multivariate analysis grade, size and lymph node metastasis retained their prognostic significance.

[Occlusion of a vesicovaginal fistula with Latzko-repair]

The Latzko procedure is a well-known method for the closure of small vesico-vaginal fistulas occurring in the vaginal dome after hysterectomy. This method is favoured by gynaecologists. In three Departments of gynaecology, a total of 104 patients were treated. 76% had been referred from other hospitals. 56.7% resulted from gynaecological operations. In 69.2% was a benign and in 28.8% a malignant disease. In only 2 cases, the primary disease remained unknown.

RESULTS

In 97 of 104 (= 93.3%) cases, the procedure according to Latzko succeeded at the first attempt. 5 of 7 recurrences were resolved by the second attempt with the same operative technique according to Latzko, signifying a secondary success rate of 98%. There were only 2 notable complications: the one, where a postoperative bladder haemorrhage attributed to anticoagulants, and the second with a bladder stone noticed 11 years after the Latzko procedure. This technique can be performed in 95% of all vesico-vaginal fistulas occurring. The fundamental advantages of its use are: short duration of the procedure, high cure rate and few complications.

[Compartment resection as therapy of choice in subfascial soft tissue sarcoma exemplified by the thigh]

Soft-tissue sarcomas tend to have local recurrences after inadequate therapy. So reactions with wide margins are required. If a sarcoma is localized subfascially, such wide margins are often hard to achieve in a "wide resection". Concerning the growth behavior of soft-tissue sarcomas and the intraoperative orientation it makes more sense to resect these tumors with their whole anatomical compartment. This kind of operation is described by the three large compartmental resections of the thigh.

Soft tissue sarcomas of the extremities and trunk in the adult. Report of 124 cases

Between 1970 and 1988 surgery was performed on 124 patients with soft tissue sarcomas of the extremities and trunk in the University Clinics of Hamburg. Liposarcoma, malignant fibrous histiocytoma, fibrosarcoma and malignant schwannoma were the most common histological types. High-grade sarcomas (G3) predominated, with 41%, while 26% were graded G2 and 33% G1. Resection with wide margins all round was achieved in only 54% of the patients. The quality of the operation proved to be only therapy-related prognostic factor. In addition, tumour grade, size, regional lymph node and distant metastasis and histological type proved to be relevant to the prognosis. With multivariate analysis, distant metastasis, grade, resectability and histological type retained prognostic significance. The efficacy of adjuvant chemo- and radiotherapy was related to the quality of the preceding tumour resection. In case of gross tumour the rate of either partial or complete response was 28% for chemotherapy and 22% for radiotherapy. The mean survival time was 102 months; the 5- and 10-year survival rates were 48% and 37%, respectively.