[Diagnosis of aneurysms of the aorta and its large branches. A clinical pathoanatomical study (author's transl)]

On the basis of 67,352 autopsies 516 aorta aneurysms and 112 aneurysms of large branches of the aorta are classified according to their etiology, frequency, size and sex distribution. Cardiological, abdominal and neurological symptoms are predominant clinically. Palpation, auscultation, and X-rays with angiography and echography are still sufficient to arrive at the correct diagnosis in the majority of cases. In addition to conservative therapy a surgical intervention should be considered as far as circumstances permit.

[Central disequilibrium in boxers (author's transl)]

In 20 boxers the vestibular examination was made with pendular test. In 75% central vestibular changes of the per-rotatary nystagmus reaction were observes. Only in 3 cases the electronystagmogram was unremarkable. In 4 cases the EEG was normal although the nystagmus reaction was pathologic indicating central disorders.

[Susceptibility for infections in patients with chronic polyarthritis]

The case histories and autopsy findings of 79 patients with rheumatoid arthritis (RA)--15 patients with and 64 patients without a history of long term corticoid treatment--who had died in the years 1952-1977 and who had been autopsied in the University Institute of Pathology of Graz were evaluated with respect to organic lesions caused by infections and were compared with an exactly matched control group. Both in the rheumatoid group material and in the 64 RA patients without steroid. long term treatment there was a highly significant accumulation of putrid bronchitis and pneumonia and a significant accumulation of pyelonephritis in comparison to the control group. As far as bronchiectases and pulmonary tuberculosis are concerned, there was an increased prevalence in the RA group, but this was beyond the range of statistical significance. Possible reasons that might account for the elevated susceptibility to infections in patients with RA are discussed.

[Palliative or radical surgery for pancreatico-duodenal cancer?]

Reviewing the fate of 61 patients wih adenocarcinoma of the pancreatico-duodenal region in the context of a review of the literature leads to the following statements: 1. No radical surgery without histological confirmation. 2. Radical surgery for periampullary carcinoma, these tumors have the better prognosis than pancreatic carcinoma because of a different biological behaviour. 3. Radical surgery is the best palliation for pancreatic carcinoma, if pain is the leading symptom. 4. Palliative surgery is indicated for pancreatic carcinoma of the head with jaundice.

[Fatal course of a fungal pneumonia in glucocorticoid-treated recurrent febrile nodular panniculitis; Pfeifer-Weber-Christian syndrome]

The history of a 63 yr. old woman with a serious form of Weber-Christian's disease is reported. During treatment with glucocorticosteriods and antibiotics bilateral condida pneumonitis developed, which ended fatally. A short review of Weber-Christian's disease is given, and the problems concerning its treatment are outlined. The systemic application of glucocorticosteroids in this disease should be reserved for the serious forms.

Evidence of microchoerine evolution from Dielsdorf (Zürich region, Switzerland)--a preliminary report

Further evidence of parallel evolution of Necrolemur and Microchoerus is put forward. The two forms were found in a fissure filling of Upper Eocene age (Fons 4) from Dielsdorf (Zürich region, Switzerland). Not only the dentition shows different morphs, but also postcranial material represents two vertical clingers and leapers of different size.

[Adrenalin and cardiac output in pregnancy (author's transl)]

The heart rate performance, cardiac output and catecholamine excretion were observed at rest in the ergometer test (40 min at 50 watts) in a group of 8 pregnant women whose case history and clinical record did not reveal any abnormal findings, during the course of pregnancy (20th, 28th and 36th weeks of pregnancy) as well as 2 and 12 weeks post partum. It was found that the cardiac output increased, dependent upon the heart rate, the stroke volume remaining approximately constant (max. + 60%) during pregnancy, compared with the controls post partum. There is a close linear correlation (r = 0.983) between the measured heart rates and the corresponding excretion of epinephrine (adrenalin) with the urine at rest and under load. It may be assumed that there is a causative link between the increase in secretion of catecholamine by the mother and the well-known change in cardiac output during pregnancy.

[High spontaneous variability of ventricular arrhythmias limits the evidence gained by long-term ECG studies]

The spontaneous variability of ventricular arrhythmias was investigated in 8 patients with chronic coronary heart disease. In each patient 6 eight-hour long-term ambulatory ECG recordings were made. During the first three periods patients were without medication and during the following three periods they received a placebo b.i.d. Hour to hour variability was high in all patients. When compared with the first hour of an eight-hour period the number of ventricular premature beats (VPB) per hour in four patients declined by more than 90%, in two patients by more than 70% and in only two by less than 50%. On the other hand, increments of several hundred percent were often observed. Day to day variability of VPBs was also high. When compared with the first documented eight-hour period VPBs either decreased or increased substantially (-84% to +940%). A spontaneous reduction of VPB's for several hours may simulate an antiarrhythmic drug effect. For the group as a whole placebo had a significant effect on the number of VPBs (p less than 0.001). Beside variations of quantity, the complexity of ventricular arrhythmias (Lown classification) spontaneously changed several classes in one patient. Therefore, high spontaneous variability renders it very difficult to estimate the behaviour of ventricular arrhythmias in the individual patient with the Holter-ECG.

[Exercise tolerance of patients with artificial cardiac pacemakers (author's transl)]

In order to determine their exercise tolerance, 20 patients with artificial ventricular demand pacemakers below the age of seventy were studied by bicycle ergometry. Only 30% of the patients showed a normal exercise tolerance according to the criteria by Kaltenbach, while 70% stopped the test prematurely because of leg fatigue, dyspnoe or chest pain. In terms of their exercise tolerance, there was no difference between patients who developed normal sinus rhythm or rapid atrial fibrillation during the exercise and those who remained at the fixed pacemaker rate throughout the test. It is concluded, therefore, that the exercise tolerance of pacemaker-patients is not only limited by the fixed heart rate but mainly by the underlying heart disease (coronary heart disease, cardiomyopathy, hypertensive heart disease etc.) and the general physical condition of the patients. In an age-matched control group of 20 patients 50% showed a normal exercise tolerance and the duration of exercise in this group was only slightly longer (21%) than in the pacemaker-group.

[Echocardiographic results in female athletes, nonathletic women and patients with arterial hypertension (author's transl)]

Echocardiographic studies and radiological measurements of heart volume were performed in 30 female track athletes, 17 female shot-putters or javelin throwers, 12 nonathletic women and 8 female patients with arterial hypertension. The following observations were made: The hearts of the female athletes undergoing endurance training were in the whole larger than the hearts of the nonathletic women, although the ratio of internal diameter to wall thickness was unchanged. There was a relative increase in the ratio wall thickness to internal left ventricular diameter in the female shot-putters and javelin throwers compared to the nonathletic females. This is interpreted as being a result of the static training imployed. In all female patients with severe arterial hypertension the heart wall thickness was increased, the internal heart diameter was dependant of the stage of the illness. Using echocardiography it is possible to draw conclusions as to the ratio wall thickness to cavity diameter. This is not possible with radiological heart volume studies.

[Effect of biguanids on the lactate metabolism. Studies in diabetics under submaximal ergometric exercise (author's transl)]

24 diabetics without any complications were subjected to an exercise test before and after biguanid therapy. The schedule of the physical strain was a modification of the Kaltenbach diagram. Changes of lactate, pyruvate, pH-standard bicarbonate and base excess values were analysed. Additionally to antidiabetical therapy each of the 8 patients was given either metformin or buformin or phenformin now. Each one of the biguanid derivates induced a rise of the lactate level before and after the exercise test. Phenformin showed the greatest influence on the lactate metabolism, metformin the smallest. Reasons causing the lactogene effect and the quantitative differences of the biguanides are discussed.

[Influence of centrophenoxin administered for one year in high dose on maximal oxygen consumption in aged persons (author's transl)]

The influence of centrophenoxin (meclofenoxate) administration in a high daily dosage of 3 grams has been investigated in 10 persons with a mean age of 64 throughout 12 months. The mean age of the control group was 59. The function of bone marrow and a number of indicators of renal and hepatic function has shown no harmful changes after this long term treatment with an extremely high daily dosage. To investigate a possible influence on aging we chose the oral glucose tolerance test, a test battery for pulmonary function and the maximum oxygen consumption capacity. A highly significant (2P smaller than 0,335) influence of the drug for increasing the maximum oxygen input has been found. The hypothesis is presented, that this effect is due to an increase in cardiac functional capacity. Furthermore a significant decrease in fasting glucose levels has been found, while the glucose concentration one and two hours after administration of 100 grams of oral glucose have shown no significant changes. Body weight revealed a small but significant decrease. Side effects: we found a mild gastric pain in 4 patients that disappeared after 20 minutes. 5 Patients complained of a very small increase in jitteriness.

[Echocardiographic and hemodynamic studies on the influence of verapamil in hypertrophic obstructive cardiomyopathy (author's transl)]

15 patients with obstructive hypertrophic cardiomyopathy were studied by m-mode echocardiography and 9 of them also by left heart catheterism before and after 10 mg Verpamil. The following results were obtained: 1. The systolic anterior movement (SAM) of the mitral valve was reduced (p less than 0.005), 2. the enddiastolic and endsystolic diameter were increased (p less than 0.02 and 0.05 respectively), 3. the EF-slope remained unchanged. 4. The left ventricular systolic pressure was reduced (p less than 0.025) and the gradient diminished from an average value of 58 to 34 mmHg (p less than 0.02), 5. heart rate and left ventricular enddiastolic pressure remained constant. The results of this acute study suggest a beneficial effect of Verpamil in patients with hypertrophic obstructive cardiomyopathy.

Muscular equivalent of the lower esophageal sphincter

In order to measure muscle thickness and to define the muscular architecture at the gastroesophageal function, both en bloc fixation and a new method of preparing dried fiber specimens were used. Specimens were obtained from 32 kidney donors and human cadavers. Wall thickness was measured at 32 identical locations in the esophagus and stomach. The oblique gastroesophageal ring (GER) was the site of greatest muscular thickness and served as a reference point. From the GER the muscle thickness tapered (P less than 0.05 to P less than 0.001) in both a cephalic (esophageal) and caudal (gastric) direction for a length of 31 mm +/- 2.5 SD. The increase in thickness was due to an increase in the muscle mass (fiber aggregation) of the inner muscle coat. The muscle bundles of this coat split up 10.2 mm +/- 3.0 SD above the GER (fixed specimen) and for a length of 25 mm +/- 8 SD formed short transverse muscle clasps on the lesser curve side. Those muscle bundles on the greater curve side formed long oblique gastric fiber loops. The angle of His was inconstant in location and distal to the uppermost gastric oblique fibers (18 mm +/- 7 SD) and to the GER (9 mm +/- 6 SD).

Distal 2q duplication: report of two familial cases and an attempt to define a syndrome

Two cases of partial trisomy 2q are described, both resulting from a balanced translocation in one of the parents. In one case the chromosomes 2 and 11 were involved [paternal karyotype: 46,XY,t(2;11)(q33;q23)]; in the second case, chromosomes 2 and 8 [paternal karyotype: 46,XY, t(2;8(q32;p23)]. When the two patients were compared to the few cases reported in the literature, it was concluded that the associated clinical syndrome is characterized by severe psychomotor retardation and relatively mild abnormalities involving skull and facies.

[Surgical therapy of axial hiatal hernias and reflux disease. 1. Results of an inquiry among Swiss surgeons in 1977]

Of the 153 heads of surgical departments in Switzerland, 152 joined in an inquiry into diagnostic procedures, surgical indications, and types of procedure in the treatment of axial hiatal hernia and reflux disease. Fundoplication is by far the most frequent procedure. Of the modifications performed in complicated reflux disease, 34% are controversial. Surgery for hiatal hernia and reflux disease is performed 3 times less frequently in the German part of Switzerland than in the other parts. German-speaking surgeons ascribe to themselves a greater willingness to perform preoperative diagnostic procedures--endoscopy, radiological and non-radiological tests of esophageal function--than the surgeons of the other parts of Switzerland. However, the German-speaking surgeons are more reluctant than the other surgeons to perform surgery in patients with esophagitis. The German-speaking surgeons are even more reluctant to perform surgery on the basis of subjective symptoms. Axial hiatal hernia is considered a relative indication for surgery by half of Swiss surgeons. Only a few surgeons consider this condition an absolute indication for surgery.

[Nature and incidence of causes of death in chronic polyarthritis]

The study comprises 79 patients with rheumatoid arthritis and their death rate and causes of death in comparison to an age- and sex-matched conrol group. The patients had died in the years from 1952 till 1977 and an autopsy was done on all of them in the University Institute of Pathology. Infections turned out to be the most common cause of death (48%), second in rank were various cardiac diseases (20%) while the percentage of other causes of death never exceeded 10 per cent. Possible relations between infections and their importance as a cause of death are discussed.

Specific weight loss in hyperthyroidism

To assess metabolic turnover in patients with hyperthyroidism weight loss in mg . kg-1 . min-1 (specific weight loss, SWL) was measured by means of a new type of scale working on the buoyance principle with a minimal susceptibility of 10 mg per 100 kg. Weight loss rate was significantly increased in hyperthyroid patients (n=22;SWL, 22.0 +/-1.4 (SE) mg. kg-1 . min-1) compared to health controls (n=11; SWL, 10.0 +/-0.4 (SE) mg . kg-1 . min-1). The fall in SWL paralleled the decrease in thyroid hormone levels in serum in the beginning of antithyroid treatment and remained unchanged thereafter in spite of a further drop in thyroxine (T4) and triiodothyronine (T3) levels. After six weeks of treatment SWL reached the upper normal range despite hormone levels in the low range of normal. The findings indicate that the normalization of the basal metabolic rate as assessed by the estimation of SWL is slower than the decline in serum hormone levels. There was no correlation between thyroid hormone levels and SWL before initiating therapy or during antithyroid treatment (T4 vs. SWL, r = 0.22;n = 56). Thus serum levels of T4 and T3 appear to be rather insufficient indices regarding the respective metabolic state as estimated by SWL.

[Clinical and socio-medical aspects of long term uricostatic treatment of primary gout (a 5-10 year study)]

In 60 patients (48 cases were evaluated) with primary gout a longterm therapy (5--10 years) with Allopurinol was performed. Without treatment 4.4 sudden onsets of gout per patient and year were registrated; under Allopurinol only 0.062 (p less than 0.001) onsets were observed. This resulted in a large decrease in hospitalisation time from 44 days to 0.62 days per patient and year. In the majority of cases involution or diminuation of the tophi was found. In 7 cases of nephrolithiasis no further renal colic took place. In 8.3% a skin rasch and in 12.5% a slight gastrointestinal side effect was observed. Together with the clinical results the socio-medical aspects are discussed and the importance of gout in respect to the socioeconomic point of view is pointed out.