[The significance of mechanical factors in the development of spondylolysis. Experimental studies (author's transl)]

The cause of spondylolysis is a controversial subject. A variety of experiments were conducted at the University Orthopedic Clinic in Frankfurt am Main to determine the significance of mechanical factors. Experiments on dogs whose lumbosacral joints were forced into lordosis by a specially developed instrumentarium did not prove that processes tantamount to fatigue fracture occur in the pars interarticularis. Two series of experiments were carried out on the lumbar vertebral columns of adults, stretch measuring strips being attached to the pars interarticularis. The forces acting on the L5 pars interarticularis are, under all conditions, greater than those acting on the other parts, disproportionately so where there is lordotic stress. Therefore, in the certain instances of intermittent or rhythmic loading without a recovery phase, a fatigue fracture can occur. These results may also be assigned to the series of experiments pointing to spondylolysis as being responsible for a final fatigue fracture.

[Studies of monocytopoiesis in patients with malignant disease and after immunostimulation with BCG, using 3H-thymidine as a DNA-label (author's transl)]

Monocytopoiesis and blood monocytes were investigated in patients with Hodgkin's disease, non-Hodgkin lymphomas, mycosis fungoides, breast cancer or melanoma. The investigation was carried out before surgery and just before each application of BCG. Monocyte production was increased in untreated patients. Postoperative prophylactic BCG-vaccination gave rise to increased proliferation activity. However monocyte production returned to normal between the 4th and 6th month of BCG immunotherapy. These results indicate that monocytopoiesis is stimulated by human tumors. BCG immunostimulation is able to increase proliferation activity during the first month of treatment only.

Comparison of growth hormone stimulation induced by desimipramine, diazepam and metaclazepam in man

A comparison of the effect on growth hormone (GH) stimulation in men (n = 6) of desimipramine (DMI), a tricyclic antidepressant, and of the benzodiazepine derivatives diazepam and metaclazepam with that of a placebo, showed that only DMI caused a significant (p less than 0.01) GH stimulation. After DMI, all six subjects showed a GH stimulation greater than 7.5 ng/ml, whereas after diazepam or metaclazepam, only three of the six subjects showed GH stimulation greater than 7.5 ng/ml, and the other three showed only a very small change, or no change at all in GH secretion. Higher GH stimulation occurred after diazepam (10 mg i.v.) than after diazepam (10 mg p.o.). No dose-dependent difference in GH stimulation after metaclazepam (10 and 30 mg p.o.) was apparent. No side effects appeared after administration of DMI during the test period (180 min); however, after administration of the benzodiazepine derivatives, sedative effects were clearly noted. DMI thus causes reliable GH stimulation in healthy male subjects, whereas GH stimulation could only be measured in some of the subjects after diazepam and metaclazepam.

[Observation on the course of arterial hypertension after kidney transplantation]

The behavior of blood pressure was investigated in 65 transplantation (Tx) patients in a nephrological outpatient service for an average of 18.6 months after Tx. Before Tx 2/3 of the patients exhibited hypertension, after Tx this was reduced to 1/2. No correlation was found between behaviour of blood pressure and such factors as renal function, incidence of rejection episodes, prednisolonee dose, diabetes mellitus and urinary function, incidence of rejection episodes, prednisolon dose, diabetes mellitus and urinary tract infection of the Tx. Only in patients with glomerulonephritis as original renal disease there was in increased incidence of hypertension before and after Tx. Causes of hypertension are discussed and demonstrated in the case of Tx arterial stenosis.

[Diagnosis of focal spinal diseases - a critical review]

The article offers a critical review of the diagnosis of focal diseases of the vertebral column, based on 200 histological vertebral column examinations. The findings obtained by means of the roentgenological, histological and bacteriological examinations can be subdivided into 6 groups: 1. Non-specific and specific cases of spondylitis (59 patients); 2. Systemic malignant diseases and primarily malignant tumours (23 patients); 3. Metastases (71 patients); 4. Benign tumours (11 patients); 5. Miscellaneous cases (28 patients) and 6. Unclarified cases (8 patients). The authors comment on the following points with specific reference to the results obtained by them: a) Possibilities and limitations of roentgenological diagnosis: roentgenologically, the inflammatory diseases are most easy to identify, but is not always possible to differentiate safely between non-specific, specific and plasmacellular spondylitis. There are clear limitations to the diagnosis of the type of focal diseases of the spinal column; this applies particularly to the benign and malignant types of tumours. b) Necessity of arriving at an accurate diagnosis: it is imperative to aim at an accurate diagnosis before any meaningful therapy can be initiated. The mandatory need for this is explained via examples covered by the present study. c) Closed or open biopsy: it is shown by means of a review of the literature that open biopsy yields more representative material for the histological examination than closed needle biopsy. It goes without saying that this is a true prerequisite for an accurate histological diagnosis. In this connection, the authors go into the details of the difficulties governing any histological examination. d) informative value of further additional examinations: Scintigraphy, tomography and computer tomography may be valuable aids in the discovery and better visualisation of a vertebral focus, but they are not helpful in arriving at a diagnosis regarding the type of focus involved. Laboratory examinations are not very helpful, either. e) Accuracy of the authors' own diagnostic measures: in spite of open biopsy, 177 cases only out of 200 (88%) could be diagnosed on a purely histological basis. In 12 further cases, diagnosis was established after correlation of the histological finding with the x-ray film. 8 cases (4%) could not be clarified. In 7 patients (3.5%) it must be assumed that the focus was not located despite open biopsy.

[A new method of combined inhalation and perfusion scintigraphy for the diagnosis of pulmonary embolism (author's transl)]

The combined inhalation and perfusion scintigraphy as a specific identification method of thromboembolism of the lung was tried out in 132 patients. A fine aerosol with selected droplet size was produced in a newly developed atomiser device and inhaled by taking a few deep breaths. Perfusion scintigraphy, which was performed immediately after inhalation scintigraphy, was effected with the same radioisotope, 99mTechnetiun. The disadvantages of inhalation scintigraphy, which are inherent in the method itself, were reduced to such an extent that it was possible to distinguish clearly between primary and secondary disturbances of pulmonary perfusion even in obstructive diseases of the respiratory tract, provided perfusion was disturbed in sufficiently large areas, i.e. of segment or lobe size.

[Glomerulonephritis therapy. Immunosuppression or coagulation inhibitors - a comparison]

In 110 patients with mesangioproliferative glomerulonephritis the treatment (n = 48) with chlorambucil, warfarin, dipyridamol and prednisone (CAA) and the treatment with imuran and prednisone (CP, n = 23) are compared with the conditions of an untreated control group. The CAA-therapy is above all suited for active clinical pictures without sclerosis with short duration of the disease, even when the renal function is already restricted. The CP-therapy is suitable in non-active forms with sclerosis also in a longer duration of the disease.

Schwannomas of the orbit

The authors describe a case of intraorbital schwannoma. The tumour caused exophthalmos of 11 mm, and displacement with limitation of mobility of the eyeball. A review of cases from other studies is presented. This rare tumour orginates from the fifth cranial nerve. Exophthalmos is the primary clinical symptom. The value of several radiological examination techniques and possible surgical approaches are discussed.

Diagnostic value of urinary fibrin degradation products

The concentrations of fibrin degradation products (FDP) in the urine were determined by the passive hemagglutination test in 115 patients with biopsy-proven chronic proliferating glomerulonephritis (GN), 93 patients with urinary tract infection (UTI) and 23 patients who received kidney transplants. The active GN values (12.3 micrograms/ml) are significantly higher than those for latent GN (0.3 micrograms/ml). Those for acute UTI (9.2 micrograms/ml) are significantly higher than for chronic UTI (1.3 micrograms/ml). In contrast to the reports published by others, the numerous 'false-positive' and 'false-negative' values make diagnosis of the activity questionable. Prognostic value can be expected in GN with the nephrotic syndrome (NS): patients with steroid-sensitive NS excrete FDP and patients with steroid-resistant NS excrete larger quantities of FDP. We have confirmed that a rise in the urinary FDP level in transplantation is indicative of rejection. However, since 10 of 27 rejections were FDP-negative, the absence of FDP in the urine does not preclude rejection.

Non-repetitive DNA sequence divergence in phylogenetically diploid and tetraploid teleostean species of the family cyprinidae and the order isospondyli

Non-repetitive DNA of anciently tetraploid teleostean species was analysed for the presence of duplicated sequences. Closely related diploid species were investigated in comparison. From the reassociation kinetics of total nuclear DNA, rate constants and fraction sizes of classes of repetitive and non-repetitive sequences were determined. DNA fractions enriched in the slowest renaturing sequence class were determined. DNA fractions enriched in the slowest renaturing sequence class were prepared and subjected to reassociation. The rate constants of these reactions were compared with the values expected for single-copy DNA from analytical genome size determinations. From reassociated DNA enriched in non-repetitive sequences also the melting temperatures were determined as a measure of internal base sequence heterogeneity. It has been shown that the two ancient tetraploids Cyprinus carpio and Thymallus thymallus are, with regard to the thermal stability of reassociated non-repetitive DNA, and with regard to the correspondence of reaction rates with the values expected for single copy DNA, indistinguishable from diploid controls (Rutilus rutilus, Clupea harengus and Sprattus sprattus). The tetraploid species Salmo irideus, Salvelinus fontinalis and Coregonus lavaretus appear as very recent tetraploids with regard to these criteria. The significance of the results for estimating the time of occurrence of polyploidisation events in these taxa is discussed.

[Therapy of primary glomerulonephritis. Comparative study on the effect of cytostatics-prednisone and cytostatics-anticoagulant-aggregation inhibitor combination]

The result of the treatment with chlorambucil, dipyridamol, heparin/warfarin and prednisone on 50 patients as well as with imuran and prednisone on 32 patients is compared. Basis for this is a detailed morphological and clinical subdivision. With the help of therapy results is tried to derive regions of indication: the therapy with cytostatics, anticoagulants and aggregation inhibitors is above all suitable for patients with a short duration of the disease and with sign of activity, also in renal insufficiency. On the other hand the therapy with cytostatics and prednisone is also successful in patients with longer duration of the disease and missing signs of activity.

Monocytopoiesis in malignant melanoma: untreated, during immunotherapy and chemoimmunotherapy

Monocytopoiesis and blood monocytes were investigated in patients with superficial spreading melanoma stages I and II. Monocyte production was moderately increased in 4 of 9 untreated patients. Postoperative prophylactic BCG-vaccination gave rise to increased proliferation activity in 3 of 4 patients with previously normal monocytopoiesis. However, monocyte production returned to normal between the 4th and 6th month of BCG immunotherapy. Monocytopoietic hyperproliferation did not occur if DTIC was administered simultaneously with BCG. These results indicate that BCG-vaccination increases monocytopoiesis during the first months of treatment only. This effect is abrogated by concomitant chemotherapy.

Serum complement and protein metabolism in chronic dialysis patients

1. Patients receiving regular hemodialysis treatment who are permitted to select their own diets are in danger of a protein deficiency manifested by a significant reduction in serum transferrin and in complement C3c. 2. Correlation analysis within the dialysis group revealed no secure connexion between the complement C3c and total hemolytic activity respectively, and transferrin levels. 3. Analysis of diets showed that protein intake and the serum transferrin level correlate. No such correlation was found for the complement C3c or total hemolytic activity. 4. Low transferrin levels in the serum appear to result in more severe anemia among dialysis patients. 5. Knowledge of the serum transferrin level permits much more exact assessment of the protein metabolism in regular hemodialysis patients than knowledge of the total hemolytic activity or the level of the complement C3c.

[Treatment of glomerulonephritis]

The therapeutic effect of the prednisone therapy, of the short-time (duration of treatment 2-4 months) and of the long-term (duration of treatment 1.5 to 2 years) imuran and prednisone therapy was investigated on 218 patients with chronic, functionally compensated glomerulonephritis. The importance of the urine symptomatology for the control of the therapeutic success and for the prognosis of the disease was elaborated. Corresponding to the clinical picture the experiment of a clinical classification of the chronic glomerulonephritis was performed.

Amount of repeated and non-repeated DNA in the genomes of closely related fish species with varying genome sizes

1. Within the teleostean family Cyprinidae, diploid species occur with wide variation in genome size. There also exist species which were anciently tetraploid. 2. The quantitative changes of DNA content in the diploids are primarily due to differences in the amount of intermediately repeated DNA. DNA sequence composition of the ancient tetraploid genomes suggests that the species derived from diploid ancestors of small genome size. 3. The average base composition and the base compositional heterogeneity are similar in all the species examined.

[Diagnostic value of determining urinary fibrin split products in glomerulonephritis, pyelonephritis and graft rejection]

On 112 patients with bioptically ascertained chronic proliferative glomerulonephritis, 94 with pyelonephritis and 23 patients with kidney transplantation altogether 1,050 times the fibrin fission products in the urine were estimated by the passive haemagglutination after Merskey. It was the aim of the investigation to test the diagnostic evidence described in literature concerning the floridity diagnostics in glomerulonephritis and the recognition of rejection in kidney transplantation as to its reproducibility. In comparison to the latent glomerulonephritis (0.3 microgram/ml) the florid glomerulonephritis (12.3 microgram/ml) as well as the acute pyelonephritis (9.2 microgram/ml) in comparison to the chronic pyelonephritis (1.3 microgram/ml) has significantly higher values. On account of the numerous "falsely positive" and "falsely negative" values in contrast to the data of other authors an activity diagnostics is not possible. Only in the glomerulonephritis with nephrotic syndrome a prognostic use is to be expected: Patients with steroid-sensitive nephrotic syndrome do not secrete any fibrin fission products in the urine and patients with steroid-resistant nephrotic syndrome secrete them in a large number. We could confirm that an increase of the fibrin fission products in the urine after kidney transplantation refers to an acute rejection crisis. Since 10 of 27 rejections were fibrin fission product-negative, in the lacking fibrin fission products in the urine a rejection is not be excluded, by which the diagnostic value is restricted.

Monocyte production in Hodgkin's disease and non-Hodgkin's lymphoma

Monocytopoietic proliferation activity was investigated in patients with untreated Hodgkin's disease, Hodgkin's disease in long-term complete remission, and untreated non-Hodgkin's lymphoma of the lymphosarcoma and reticulosarcoma type. Untreated Hodgkin's disease was found to be associated with a rise in medullary monocyte production which returned to normal during long-term complete remissions. In contrast, monocyte production was increased in only 5 out of 14 patients with lymphosarcoma and reticulum cell sarcoma, normal in 3, and reduced in 6. In neither of these lymphomas was any relation between monocyte production and stage or histology of the disease detectable.

[Studies on the socio-medical and psychological situation of persons suffering from osteogenesis imperfecta tarda (author's transl)]

A group of 22 patients suffering from osteogenesis imperfecta tarda were evaluated on their school and vocational education, sport activities as well as personality development with the help of follow-up studies, questionnaires or medical records. 21 patients had at least received elementary school education and had been average or good pupils. Five of six patients who had meanwhile reached adulthood had received higher education and vocational training. Owing to their disease five of six patients had to give up their original jobs or occupational plans. There was only one female patient who had received vocational guidance. Of ten children and six adults five and four respectively carried out sports in their leisure time. To improve the patients' situation it is immediately necessary that (1) the parents be informed of the nature of the disease as well as its heridity, and be advised how to handle these children; (2) the patients and their parents receive educational and vocational guidance.