[Testing of a liquid, ready-to-use, breast milk substitute in the county of Funen]

A newly developed liquid ready-to-use cow's milk based formula (BD) was used as the sole nutrient in 314 healthy term infants below the age of 28 weeks--except for supplementary feeding introduced at an average age of 142 days. The incidence of dyspeptic problems (constipation, diarrhea, vomiting), the parents' and visiting nurses' comments on the product, and the causes of "BD failure" (termination of BD feeding because of suspected cow's milk allergy, dyspepsia, etc.) were recorded as were rates of weight gain and linear growth. It is concluded that BD is a valuable alternative to existing powdered milk formulas and that the growth of the infants compared satisfactorily with published reference values.

[The extent of radical axillary lymph node excision]

A study on histological findings in 1047 patients who underwent total axillary lymph node dissection (topographical levels I-III), was conducted. A mean of 20.3 lymph nodes (LN) was assessed; LN metastases were detected in 492 cases. Retrospective analysis showed that, by mere dissection of LNs level I, 10 of the 492 nodal positive cases (2.0%) would have been classified false negative. Additionally, according to the number of positive LNs detected in stage I, 85 of the 492 patients (17%) would have been assigned to a group with a better prognosis (prognostic groups 1-3, 4-9, greater than or equal to 10 pos. LNs). By mere dissection of LNs levels I and II, only 1 of 492 (0.2%) patients would have been categorized false negative and only 24 patients (5%) would have been included in a group with a better prognosis, on the basis of the number of positive LNs dissected. Thus dissection of LNs stages I and II provides sufficient prognostic information. Since, however, in 145 nodal positive cases (14% of the entire collective e.g. 29.5% of all patients with positive lymph nodes), metastases were detected in level III, these LNs should be removed as well, in order to prevent axillary recurrences. One could only dispense with dissection of level III, if LN metastases levels I and II could be excluded during the operation.

[The pH and acidity of feces in colorectal neoplasms]

The pH and faecal titratable acidity in fresh faeces were measured in patients with colo-rectal carcinoma or adenoma and in normal individuals. Significantly higher pH values and lower acidity were found in patients with cancer than in normal individuals. Patients with cancer had pH greater than 6.90 more frequently than normal. Patients with adenomata did not differ significantly from normal individuals. These results support performance of intervention trials with lowering of the pH in the colon with the object of cancer prophylaxis even although the causal connection is obscure.

[Side effects and complications in breast-saving therapy of breast cancer]

From 1975 to June 1987, a total of 664 women underwent breast-conserving therapy for invasive carcinoma at the University Hospital for Women, Heidelberg, FRG (562 patients: surgical procedure/radiotherapy, 102 patients: only radiotherapy). A subgroup of 203 nonselected patients was prospectively followed up for complications and side effects. The population examined was representative of the entire series with reference to age distribution, tumor stage and localisation. The mean follow-up period was 28.9 months after primary therapy. Complications of breast-conserving therapy (surgery, post-operative radiotherapy, adjuvant chemotherapy for node-positive patients) were assessed by one investigator including evaluation of a standardized patients' questionnaire. The most frequent and serious single complication was lymphedema (LE) of the arm. The incidence of severe LE (greater than or equal to 3 cm difference in circumference) was 6.4%. A total of 25.1% of all patients reported some degree of swelling of the arm. The overall LE-rate was 23.1% according to the newly introduced LE-score combining the degree of difference in circumference, individual handicap and need for physiotherapy. The LE-rate was significantly increased in patients with adjuvant chemotherapy (40.1%, p less than 0.01). General impairment of arm function was reported frequently (65.6%). Shoulder mobility was severely restricted (abduction of arm less than or equal to 90 degrees) in 3.6%. Further complaints were related to impairment of fine motor function (4.5%), shielding of the arm (15.4%), reduction in absolute force (22.1%) and/or rapid tiring of the arm (37.4%). Radiotherapy related toxicity accounted for cutaneous edema (50.3%) and fibrosis of the breast (slight: 33.8%, pronounced: 9.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Termination of inpatient treatment of anorexia nervosa

Following some general theoretical considerations, the paper empirically addresses the question of termination of inpatient treatment of anorexia nervosa. It identifies those factors which have been the causes of unsuccessful treatment (including fatal outcome) and which must therefore be taken into account, especially when terminating therapy. It is not the improvement of weight and somatic symptoms which turns out to be an adequate criterion for discharge, but rather the capability for generating new social relationships. The wish to go back to live with one's parents (when they did not participate in the therapy) or to live alone must not be accepted, following inpatient treatment.

Perioperative systemic antibiotics for prophylaxis of infections in breast surgery: sulbactam/ampicillin versus mezlocillin/oxacillin

In a prospective, randomized, open trial, efficacy of one dose of sulbactam/ampicillin (1 g:2 g) was compared to three doses of mezlocillin/oxacillin (2 g:1 g), starting with induction of anesthesia in 80 breast surgery patients with an increased risk of postoperative infection. No infections at the site of operation were seen in either group. Fever due to postoperative pulmonary complications occurred in one patient in the sulbactam/ampicillin group. The only side effect was a moderate exanthema observed in one patient in the mezlocillin/oxacillin group. In this study of the prophylaxis of patients with an increased risk of postoperative infections having the potential to jeopardize the results of surgery, a single dose of sulbactam/ampicillin was as effective as a short term course of three doses of mezlocillin/oxacillin.

Empirical coverage of psychodynamic configurations of anorexia nervosa

For the last several years, the clinical picture of anorexia nervosa has been covered at the following three levels: (1) symptomatology (including partner and family relations); (2) psychodynamics; (3) narcissistic level. As far as the psychodynamic level is concerned, this paper presents the pertinent theory in its operationalized form for a clinical rating. The convergent validity of the five psychodynamic configurations is tested by a comparison of clinical rating, a questionnaire (IATAN) and a standardized interview (SIAN); divergent validity is tested by verifying the mutual differences of the five configurations.

An interaction model of anorexia nervosa

Noticeable similarities were found in the psychosocial field by a comparison of a group of anorexia nervosa patients with a representative sample of normal controls. In particular, no confirmation could be found of the mother dominance coupled with the weak and frequently absent father, as postulated under the interactional model of anorexia nervosa. Empirical discriminate analyses of the role of individual family members are necessary.

Pharmacokinetics of sulbactam and ampicillin intravenously applied in combination to healthy volunteers and patients. Determination of the ratio of the two drugs in serum and in various tissues

The pharmacokinetics of sulbactam, a new beta-lactamase inhibitor, and ampicillin were investigated in 9 healthy volunteers and 125 patients. The two drugs were administered intravenously in combination (Unacid). Each subject received 1 g sulbactam and 2 g ampicillin. The two drugs showed a similar pharmacokinetic profile in humans. Relevant pharmacokinetic parameters were calculated using a 2-compartment model on the basis of the serum and urine concentrations determined in healthy volunteers. The ratio of sulbactam to ampicillin was found to be nearly constant (approx. 1:2), both in the blood, in several tissues and at various time points. The two compounds apparently penetrated well into the myometrium, renal cortex and medulla, the gall bladder wall, the tonsils and the cutis of the skin. The sulbactam/ampicillin ratios in the bile ranged from 1:3 to 1:13 over 2 h after the infusion. The concentrations of the two compounds measured in the various fluids and tissues of the body reached levels which are effective against beta-lactamase producing bacteria. The similar pharmacokinetics of sulbactam and ampicillin in humans are considered an essential prerequisite for the therapeutic efficacy of such a combination product.

[Breast reconstruction using a skin expander prostheses following modified radical mastectomy]

In the period from September 1983 to May 1986, 116 breast reconstructions were performed at Heidelberg University Gynecological Clinic with the aid of skin expander prostheses, following modified radical mastectomy (89 primary and 27 secondary reconstructions). In 18% of all cases, complications occurred due to the expanders, the most common being loss of prosthesis material. A total of 82 women have meanwhile had the expander prosthesis replaced by a definitive gel prosthesis in a "second reconstruction phase". Reconstruction of the nipple and areola has been performed in six cases in a third phase. Today, breast reconstruction in one or two stages following modified radical mastectomy represents an integral part of surgical rehabilitation of primarily operable breast cancer in cases, where a primary conservative procedure is out of the question.

[Transposition and myocutaneous island flaps in primary or secondary locoregional surgical therapy of breast cancer]

New plastic surgical reconstruction techniques can today make a major contribution to locoregional therapy in breast cancer cases. The present paper reports on indications for and experience gathered in primary and secondary therapy with transposition (medial-pedicled thoracoepigastric) and myocutaneous island flaps (lower transversal rectus and latissimus dorsi) at the University Gynecological Clinic of Heidelberg between October 1981 and June 1987. Thirty-nine patients were treated using these techniques. Altogether nine rectus, 13 latissimus dorsi, and 21 thoracoepigastric flaps were used; in 16 cases for primary treatment with T4 tumors and in 27 cases for secondary treatment. In view of the rate of complications and recurrences seen, the indication must be established strictly and individually according to the location of the defect, the anatomic situation, and the prognosis for the patient. Today, the use of these plastic surgery techniques should lie in the hands of experienced surgeons and be an integral part of the treatment of primary advanced breast carcinomas or large locoregional recurrences.

Comparative clinical and pharmacokinetic aspects of cefotetan versus cefoxitin plus metronidazole in vaginal hysterectomy

In a randomised clinical trial, 102 women who underwent vaginal hysterectomy were given a single preoperative 2g dose of cefotetan (CTT) (52 pts) or three perioperative 2g doses of cefoxitin (CFX) plus 0.5g metronidazole (50 pts) as antibiotic prophylaxis. No statistically significant differences between the groups were detected in the clinical response (100% for both groups). The incidence of major wound infection (2% CTT and 0% CFX) were also comparable between the two treatment groups; post-operative changes in body temperature, duration of hospitalisation and post-operative urinary tract infections (16% CTT and 20% CFX) were similar. Both drugs were well tolerated. Twenty nine of the 102 patients were further investigated to determine the pharmacokinetics following a single 2g dose of CTT or CFX, in both serum and tissue. Although both antibiotics provided good concentrations during the early phase of surgery, CTT levels persisted for a longer time period. These results confirm that single dose cefotetan is equally as effective and safe as multiple dose cefoxitin plus metronidazole for prophylaxis in patients undergoing vaginal hysterectomy.

Adrenocorticotropic hormone in the control of renal tubular hydrogen ion secretion. Balance of non-metabolizable base in ACTH-stimulated weanling rats subject to acid or base loading

Groups of weanling rats subject to ACTH-stimulation (tetracosactrin, 1 mg kg-1 day-1) were exposed to heavy oral loads of ammonium chloride (approx. 21 mmol kg-1 day-1) or sodium bicarbonate (approx. 40 mmol kg-1 day-1) for 8 days. During loading with sodium bicarbonate, the animals maintained a normal positive external (whole body) balance of non-metabolizable base (NB), excess NB being excreted quantitatively in the urine, whereas loading with ammonium chloride caused a fall in the mean balance of NB from a reference value of 12.1 mmol per 8 days to about zero. However, in the two groups the concentration in plasma of NB rose from the reference value (41 mmol l-1) to the same level (57 and 59 mmol l-1, respectively; P greater than 0.5) despite extreme differences in rates of gastrointestinal NB absorption, despite a significant rise in the rate of endogenous sulphuric acid production and despite the presence of ample chloride in diet and urine. These results indicate that ACTH determines the extracellular concentration of NB at which exchange of NB takes place by influencing, directly or indirectly, the relative rates of renal tubular H- secretion and Cl- reabsorption at any given rate of tubular reabsorption of Na-. Some cybernetic considerations of the disturbance are presented.

[Rate of local recurrence and survival in patients with breast reconstruction following mastectomy]

A retrospective study was conducted covering 100 patients who underwent breast reconstruction with plastic prostheses following mastectomy during the period from 1975 to May 1986. They were compared with 100 patients (matched pairs) who had not undergone breast reconstruction. No significant difference between the two groups could be found as regards locoregional recurrences or the overall survival rate. The mean observation period was 86.5 months. Surgical removal of local recurrences did not necessarily involve removal of the prosthesis. Therefore, given adequate operability, and experience on the part of the surgeon, a breast reconstruction following mastectomy can now be performed on any patient desiring it to alleviate mental suffering.

[CA 15-3 and CEA as tumor markers in the diagnosis of the recurrence of breast cancer]

The significance of the tumor markers CA 15-3 and CEA for the oncological follow-up of breast cancer was examined in a retrospective analysis of 108 patients in whom, before and after hospitalization, it was possible to locate a local recurrence, a contralateral breast carcinoma, or a distant metastasis. Overall, examination of the group of patients showed that CA 15-3 was significantly more sensitive than CEA (57%/38%), with an increase of only 3% in sensitivity when investigating both markers simultaneously. Neither marker is suitable for the diagnosis of a relapse in the same region or a contralateral breast carcinoma, as pathologic values are only to be observed in one-third or, respectively, one-quarter of all cases. In cases of distant metastasis, CA 15-3 is significantly superior to CEA (osseous: 62%/41%; visceral: 73%/34%). Only where there is combined osseous/visceral metastatic spread is no significant difference manifested (87%/74%). In 15 out of 17 patients with an apparently relapse-free course both during and after hospitalization, the CA 15-3 value was normal where the CEA value was pathologic. Tumor progression would thus seem improbable where there is a pathologic CEA value in conjunction with a normal CA 15-3 value. In follow-up of breast cancer, simultaneously assay of both "nonredundant" tumor markers, which represent a useful spectrum for tumor control, is to be recommended.

Father types of anorexia nervosa patients: the 'bonding', the 'brutal', the 'weak' and the 'absent' father. An empirical study based on a comparison with fathers of a representative normal group

Increased attention has been drawn in recent years to the importance of the father in the genesis of anorexia nervosa. Four types of fathers were identified and investigated by comparing, under this aspect, fathers of 96 most severely affected patients with those of 111 families of a representative normal group. The investigation showed significant differences with regard to the 'bonding' and the 'brutal' father, whereas the 'weak' and the 'absent' father showed no significantly different values; the latter was even more frequent in the Unormal population. The results shall be discussed with regard to anorexia nervosa therapy.

Dimensions of the 'endangered self' in anorexia nervosa. Empirical study based on comparison with normal controls

In addition to the diagnosis of symptoms we recently proposed the empirical analysis of psychodynamic levels; this paper aims at an empirical study of a third, and most essential, problem area: disturbances and/or regulatory processes of the self-system. Based on Deneke's newly developed questionnaire, 30 anorexia nervosa patients were examined, and then compared with 64 normal controls (female university students). A self-profile comprising 18 scales is used to graphically illustrate the disturbances. The primary deficits were found in the subscales of the 'endangered self' and the 'hypochondriac self', while the subscales of the 'classic narcissistic self' and the 'idealistic self' were found to be irrelevant. The significant self-system scales were then related to the symptomatology. The conclusion of the paper contains some therapy considerations.

Prognostic factors in anorexia nervosa

Preclinical inpatient therapy and postclinical prognostic factors concerning 113 cases were empirically scrutinized and hierarchically classified in accordance with their importance, especially in light of the relative weight of somatic, psychologic, or social variables. The criterion is the state of health at the time of follow-up, after 6.4 years. The results thus obtained are the basis of therapy recommendations.

Clinical process studies on anxiety and aggressiveness affects in the inpatient therapy of anorexia nervosa

Under the assumption of affect defense (alexithymia), 20 anorexia nervosa patients being treated in the University Hospital of Hamburg-Eppendorf were examined with respect to their affects of anxiety and aggressivity by employing speech samples (three times a week)--according to Gottschalk-Gleser--and questionnaires (ANIS) during hospitalization and compared to 10 control patients from somatic clinics (orthopedics, surgery, gynecology). Particular attention was given to emotional responses toward events during the inpatient period. The most important result found was the distinct affectivity in the anorexia patients, which was partly stronger than that of the somatic control patients, so that judging from our anorexia nervosa sample the hypothesis of alexithymia will have to be renewed and requires a more differentiated discussion.

Therapy results and follow-up of an integrated inpatient treatment for severe cases of anorexia nervosa

The therapeutic elements of an inpatient treatment for anorexia nervosa are presented with the therapy results as well as a 2-year follow-up of 39 patients who were treated at Hamburg University Hospital from 1980 to 1983. The favorable results (high weight gain, short duration of therapy, distinct psychological improvement with a total of 53% of virtually cured patients at the end of therapy) declined partially during the 2-year follow-up period (51% virtually cured). The results are compared with those of an earlier concept which was focussed rather on strict regimen and medical treatment, which also resulted in 53% virtually cured patients (n = 218; follow-up period 9.6 years). We will discuss the question whether the methodology presented here can be an alternative to family therapy for somatically severe cases with structural (psychic) lability, lack of patient motivation and uncooperative families.

Methionine-induced acidosis in the weanling rat

Whole body balances of non-metabolizable base (NB) were studied in weanling rats fed a cereal-based diet with or without added L-methionine. In response to L-methionine loading (2.5 mmol day-1) the rats exhibited a significant reduction in rates of food intake (109 vs. 160 g per 8 days) and body growth (3 vs. 52 g per 8 days); fractional oxidation of absorbed dietary amino acid sulphur increased from 0.28 to 0.64; and mean urinary sulphate excretion increased from 2.3 to 14.8 mmol per 8 days. Mean rates of renal excretion of NB and filtered titratable organic acid decreased from 20 to -11 mmol per 8 days and from 22 to 8 mmol per 8 days. Balances of calcium and NB remained at reference values despite a decrease in whole blood 'base excess' from -1.0 to -6.4 mmol l-1. The concentration of NB in plasma rose but slightly. It is concluded that L-methionine loading in the weanling rat leads to extracellular non-carbonic acidosis subject to renal compensation. This acidosis is due not to retention of H+ released by ionization of endogenous sulphuric acid but possibly to accumulation of (acid) organic metabolites of methionine which are efficiently conserved by the kidneys. The rise in sulphuric acid production leads to an adaptive decrease in fractional reabsorption of filtered sulphate. Even during inhibited growth, absorbed dietary NB is retained and deposited in the skeleton, probably as calcium carbonate.

Psychoendocrinology of remenorrhea in the late outcome of anorexia nervosa

Within a late follow-up of our former anorectic patients 38 consented to an endocrine checkup in addition to clinical and sociopsychologic assessments. Univariate comparisons of still or again amenorrheic patients (n = 22) versus remenorrheic patients (n = 16) showed many significances. However, some of these variables intercorrelated substantially. Therefore, we performed a stepwise discriminant analysis which yielded as the most differentiating variables 'subjective well-being' (24%), follow-up interval (16%), Frisch's 'fat percentage within body weight' (12%) and 'sexual behavior' (5%). As the mean follow-up intervals were 10 versus 6 years, anorectic patients seem to need considerable time for remenorrhea, or rather for the psychosocial-sexual adaptation necessary for it. The equally necessary weight gain does not correlate with the follow-up interval. Then there is a factor which seems to be 'constitutional': Early onset of amenorrhea predicts late nonremenorrhea (3%).

Therapy motivation in anorexia nervosa: theory and first empirical results

Anorexia nervosa patients are considered to be unmotivated for psychotherapy of eating disorders, because they present a lack of understanding and feeling for their disease. In order to objectify this lack of therapy motivation we formulated two questionnaires for patients and therapists. The items were obtained from 15 theoretically determined fields of both intra- and interpersonal subsets of motivation, and a 'motivation profile' was gained. In a first clinical application these profiles are obtained from an anorexia sample at the beginning and at the end of an inpatient treatment and combined with the corresponding therapist ratings. The results are compared with two control groups (preattended psychosomatics and somatic patients). Results collected hereby are used for the improvement of our questionnaires and for suggestions concerning further studies.

Interests and specialty choice in medicine

The study deals with the origin of occupational satisfaction in the medical profession. It examines the relationship between the specialty choice within the medical profession on the one hand, and satisfaction with the occupational choice on the other. Following an intensive analysis of the medical profession and interviews with senior physicians, three dimensions along which the medical specialties differ were defined: contact with people (contact), usage of instruments and equipment (instruments), and occurrence of dramatic events in the physician's daily work (sensation). Eighty-one medical practitioners answered the IIP (interest inventory for physicians) which was constructed to measure their vocational interests. Results show: reliability coefficients of 0.85, 0.92 and 0.83 for the contact, instruments and sensation components of the IIP, respectively; and correlations of 0.31, 0.27 and 0.53 between interest-specialty congruence in contact, instruments and sensation, respectively, on the one hand, and satisfaction with the medical specialty choice on the other. Several implications and applications are discussed.

Amenorrhea and predictors for remenorrhea in anorexia nervosa: a psychoendocrinological study in inpatients

34 consecutively admitted anorexia nervosa inpatients were studied for variables relevant for 'early' vs. 'late' amenorrhea and for probable remenorrhea after therapy. The subsample reporting 'early' amenorrhea, i.e. preceding weight loss (n = 11), was characterized by less 'anorexia-specific' psychological traits and more weight loss before admission and a more marked (= pathological) FSH responsiveness to GnRH stimulation. Hence--contrary to our expectation--'early' amenorrhea seems to be a 'nonpsychogenic' phenomenon. Analysis according to FSH hyperresponsiveness yielded no additional information. Studying LH changes during therapy we found that a nonrise in basal LH secretion is associated with a type of anorexia characterized by early onset and a less severe but protracted course before admission, which then proves also more recalcitrant to therapy. The subsample which attained LH fluctuation before discharge showed a clear reduction of 'weight phobia' and a higher weight both on admission and before discharge.

Acid-base balance in ruminating calves given sodium hydroxide-treated straw

1. Studies of whole-body balances of non-metabolizable base (NB) and several minerals, and of relevant acid-base quantities in blood and urine, were carried out in two 6-month-old ruminating Holstein X Friesian bull calves fed on fixed rations containing 500 g barley straw/kg diet (group A) to examine the quantitatively important components of the balance of NB and determine the rates of mineral and NB retention associated with normal body growth. 2. Parallel balance studies were conducted in six other bull calves given fixed rations containing 500 g alkali-treated barley straw/kg diet to evaluate the effects of long-term alkali-straw feeding on the rates of body growth and skeletal mineral and NB deposition and the renal control of extracellular electrolyte and acid-base status. The straw component was treated either with 50 g sodium hydroxide/kg dry matter (DM) (group B; two calves), or with 50 g or 100 g NaOH/kg DM and subsequently neutralized with hydrochloric acid (groups C and D, two calves per group). In all groups the animals were given free access to tap water. 3. Throughout the total 105 d experiment, all animals remained healthy and gained weight. Normal body growth group A) was associated with a positive balance of NB (1-2 mmol/kg live weight (LW) per d) due to continuing deposition of dietary NB in 'new tissue', largely in the developing skeleton. 4. During 105 d alkali-straw feeding, the animals showed a remarkable ability to cope with dietary loads of NAOH or sodium chloride, up to about 30 mmol/kg LW per d, without any significant disturbance of extracellular acid-base and electrolyte status or body growth rate. The surplus mineral and NB loads were absorbed and subsequently excreted in an increased volume of urine. Rates of mineral and NB retention were not significantly different from the reference values of group A and remained within the range of values reported from similar studies. In all groups, maintenance of normal whole blood and plasma acid-base and electrolyte status was accounted for by efficient renal control of the composition of the extracellular fluid compartment.

[Advantages and hazards of preventing infection following cesarean section--clinical and bacteriologic results of a high-dosage treatment with mezlocillin and oxacillin short-term preventive following clamping of the umbilical cord]

Between August 1980 and August 1981 a prospective randomised study was conducted at the Krankenhaus Nordwest , Dept. of OBGYN , Frankfurt, to investigate the efficacy of a short term prophylaxis using mezlocillin and oxacillin ( Optocillin ) in reducing infections after Caesarean section (6 gs Optocillin after clamping the umbilical cord and after 8 and 16 hours, respectively). Both the study group (sg) and the control group (cg) consisted of 50 patients each. Both groups were statistically homogeneous . Infections were significantly reduced by the prophylaxis: sg 26%/cg 64% - p less than 0,001, febrile morbidity: sg 10%/cg 38% - p less than 0,001, endometritis: sg 6%/cg 20% - p less than 0,08, UTI: sg 18%/cg 36% - p less than 0,05, wound infections: sg 2%/cg 18% - p less than 0,02. Severe infections, however, were seen in neither group. The duration of infections was shorter in the sg. The various postoperative infections were associated with different risk factors (rf) - endometritis: green amniotic fluid, operating time greater than 75 min; cervical dilatation less than 2 cm, UTI: PROM (greater than 6 hs), operating time less than 75 min, internal monitoring, cervical dilatation greater than 2 cm, wound infections: green amniotic fluid, internal monitoring, frequent vaginal examinations (greater than 6), cervical dilatation greater than 2 cm and operating time greater than 75 min. The prophylaxis was especially effective in the presence of the following rfs: green amniotic fluid, internal monitoring, frequent vaginal examinations (6), operating time greater than 75 min and when associated with combined rfs. The reduction of wound infections following the prophylaxis can be ascribed to the elimination of organisms (Staph. spec., enterococci,) at the site of operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Corticotropin-induced alkalosis in the weanling rat and its relation to the balance of non-metabolizable base

Studies of whole body balances of non-metabolizable base (NB) and several electrolytes and of the acid-base status of blood and urine during development of corticotropin-induced alkalosis in the weanling rat were carried out in order to identify the primary source of base and factors instrumental in maintenance of the alkalotic state. The data were compared to baseline and running control values and to the results of whole carcass analysers. Primary accumulation of NB was accounted for by ongoing gastrointestinal NB absorption in the weight-losing animal, distributed to extracellular and non-extracellular compartments of the body. An increase in the rate of renal excretion of non-metabolizable acid (NA), from negative values to zero, corresponded to an increased load of endogenous sulphuric acid and a reduced rate of gastrointestinal NB absorption. Accordingly, the renal response did not per se contribute to the induction of extracellular alkalosis. Maintenance of alkalosis occurred in spite of ample chloride in the renal tubular lumen and a moderate increase in relative extracellular volume. In the absence of evidence of overloading (with base) or malfunction of the kidney, corticotropin-induced alkalosis is classifiable as a 'set-point disturbance' of acid-base metabolism in which fluctuations in the (non-renal) load of NA lead to commensurate changes in renal NA excretion at an elevated extracellular pH. Withdrawal of corticotropin injections was followed by prompt restoration of a normal extracellular acid-base status and a return to reference values for renal NA excretion despite a marked fall in the balance of NB. This observation supports a concept of the extracellular compartment as the immediate reference system of the kidney.

[Sonographic diagnosis of a placental tumour with high-grade intrauterine foetal development deficiency, increasing anhydramnia and subsequent foetal death (author's transl)]

The article reports on prenatal diagnosis of a large tumour of the placenta (chorioangioma) and, for the first time, on sonographic observation of the course of the disease with intrauterine deficient development of the foetus, increasing oligohydramnia and subsequent intrauterine foetal death. The complications associated with large chorioangiomas, which are well known, with an intrauterine and perinatal mortality of up to 30%, underline the need for timely sonographic diagnosis. Chances of sufficiently early intervention have been created via closely meshed checkup controls.

[Computer tomography for tumours of the oesophagus and stomach (author's transl)]

The diagnostic scope of CT has been demonstrated for malignant tumours of the oesophagus (41 patients) and tumours of the stomach (18 patients). Of importance is the demonstration of circumferential spread of tumours of the oesophagus, the early demonstration of mediastinal lymph node metastases and the demonstration of infradiaphragmatic lymph node involvement from tumours of the middle and lower thirds of the oesophagus. In the presence of tumours of the stomach, it is possible to demonstrate infiltration of neighbouring organs (pancreas, spleen, hilum of liver) and haematogenous or lymphatic spread.

[Research on results and psychoanalytic therapy. Experiences in the planning and carrying out of a follow up project]

The present project, now entering the initial stages after a 3-year preparation period, covers all patients admitted to the Psychosomatische Universitätsklinik Heidelberg a the beginning of 1978 or later. The project is a prospective one; therapeutic goals are formulated from a psychoanalytic perspective at the commencement of treatment, establishing criteria by which later treatment results can be evaluated as successful or unsuccessful. Furthermore, various criteria have been elaborated to observe changes in the patients during the waiting-period, in treatment and two years after treatment termination. Determining which patients and patients-groups have been successfully treated and which less so provides a basis for the study of the influence of individual factors in the therapeutic process: the various psychoanalytic techniques used, the patient variables and the therapist variables. The project is designed to affect treatment in progress as little as possible, while at the same time using empirical methods to elucidate treatment results and the factors significantly involved in producing such results. The planning aspect and the difficulties encountered in operationalising such a project centred around "Work in progress" are also dealt with.

Balance of net base in the rat: adaptation to and recovery from sustained hypercapnia

Net base and mineral balances were evaluated in a group of male 350 g Wistar rats exposed to 10% carbon dioxide in air for 10 days with a view to identifying the source of net base subject to retention during renal compensation of sustained respiratory acidosis. In response to hypercapnia, the rate of renal net acid excretion rose but insignificantly. However, a rise in whole body net base concentration from about 215 mmol/kg to about 250 mmol/kg came about by ongoing gastrointestinal absorption in the weight-losing animal, absorbed net base being distributed to extracellular and non-extracellular compartments of the body, presumably including bone. During an 8-day recovery period, a small decrement in whole body net base concentration was observed.

[Parents of children dialysed at home. Psychological assessment (author's transl)]

Ten married couples with children undergoing home dialysis were examined by means of different tests used in family interaction diagnosis (Joint Rorschach, SIMFAM, Giessen Test, Bales Scale, Expert Rating). The couples showed a similar cooperation as found in a group of psychologically "ordinary" couples, but emotional problems between the parents of home dialysis children were at least as frequent as in a group of psychologically, disturbed couples needing family therapy. The role of the psychologist for the stability testing in parents of children destined for regular dialysis and for psychotherapeutic preparation to home dialysis is described.

Balance of net base in the rat. V. Effects of oral ammonium chloride loading

The physiology of oral ammonium chloride loading was studied in four groups of male weanling rats weighing about 100 g and fed either standard ground Rostock rat food (containing 317 mmol net base/kg) or ground barley (containing only 20 mmol net base/kg). One group of animals on the Rostock diet received oral supplements of ammonium chloride (approximately 32 mmol . kg-1 . day-1) sufficient to provide a net zero rate of oral net base intake. In this group, ongoing fecal net base excretion caused net acid to be absorbed at an average rate of 15 mmol . kg-1 . day-1. The mean rate of renal net acid excretion rose markedly (by 29.4 mmol . kg-1 . day-1); and over an 8-day balance period the animals were able to maintain near-normal balances of net base. During a subsequent 8-day recovery the pattern of mineral turnover returned to normal. Even in the barley-fed rats, gastrointestinal net acid absorption was observed. These animals suffered a 61% reduction in the rate of body growth, but the overall rate of net base retention, per kilogram of mass gain, was close to the reference value. Finally, the combination of barley and ammonium chloride led to weight loss, positive net acid balances (8.5 mmol . kg-1 . day-1), and a maximal rate of renal net acid excretion (50.8 mmol . kg-1 . day-1). Some implications for the metabolism of organic acids are discussed.

Balance of net base in the rat. III. Effects of oral sodium bicarbonate and sodium citrate loading

The balance of net base in groups of male weanling Wistar rats exposed to sustained oral loads of net base were studied. In response to dietary loads of sodium bicarbonate (approx. 50 mmol.kg-1.day-1) an average increment in the mean rate of retention of net base of 21.8 mmol.kg-1.day-1 was observed in the absence of significant changes in the blood 'base excess'. Following withdrawal of sodium bicarbonate, mean rates of gastrointestinal absorption, renal excretion, and retention of net base promptly returned to control values, accumulated net base being retained in the body, presumably as skeletal sodium carbonate. In response to equimolar loads of net base in the form of trisodium citrate, a similar, albeit less pronounced, rise in the rate of retention of net base occurred.

Balance of net base in the rat. IV. Effects of oral calcium and phosphate loading

Mineral and net base balances were studied in groups of male weanling Wistar rats given oral loads of calcium chloride, monocalcium phosphate plus monosodium phosphate, and disodium phosphate plus monopotassium phosphate, respectively. A group of adult nongrowing rats loaded with calcium chloride was included for comparison. In response to CaCl2 loading, gastrointestinal net base absorption was inhibited due, largely, to luminal precipitation of tertiary phosphates of calcium and magnesium. In the weanling animal, however, a rise in the rate of renal net acid excretion matched the concomitant decrement in the rate of net base absorption, permitting of continued skeletal net base storage. Similarly, in the adult animals augmented renal net acid excretion offset a positive rate of gastrointestinal net acid absorption with a resultant (normal) zero net base balance. Loading with monocalcium phosphate and disodium phosphate at a constant oral net base intake did not influence the overall net base balance, but disodium phosphate loading caused significant sodium retention.

Testing cooperation in parents with children destined for home dialysis

Ten married couples with children in the dialysis department of the University's Children Hospital of Heidelberg are examined by means of different tests (Joint Rorschach, Simfam, Giessen Test, Bales scale, Expert rating) and compared with a group of ten psychologically 'extraordinary' as well as ten psychologically 'ordinary' couples. The problem was to find out whether the emotional family atmosphere is stable enough to provide the child with home dialysis or whether the parents need psychotherapeutic preparation.

An improved procedure for the electrochemical determination of serum ionized calcium

The "Orion model 99-20 serum calcium flow-through system" has been rendered insensitive to protein poisoning by the plascing of a dialysis membrane in front of the electrode membrane, making the addition of trypsin and triethanolamine to standards unnecessary. Flow dependency of the results obtained has been investigated.

Physiological viewpoints on clinical acid-base diagnostics

Acid-base physiology is concerned with sources, extent, and control of hydrogen ion donation in the body, at the organ-physiological as well as the molecular level of study. With the introduction of Van Slyke's methods for quantitative carbon dioxide measurements in biological fluids, one important source of hydrogen ion donation became identifiable; and these and derived methods have permitted of fairly precise quantitative descriptions of transport and pulmonary elimination of carbon dioxide. However, the inevitable operational concept of non-carbonic (non-volatile) contributions to the titratable acidity of the body fluids has been a cause of considerable methodological and conceptual difficulties; and whereas it is now possible by means of the micro-equilibration technique to make accurate assessments of the concentration of non-volatile titratable acid (base) in blood, the question of the physiological relevance of the concept of 'base excess' remains open. In particular, the concept of non-carbonic acid does not possess a specific relevance with respect to the acid-base physiology of kidney, bone, and gastro-intestinal tract comparable to the 'substrate-specificity of carbon dioxide with respect to the lung. Our studies indicate that a subdivision of the titratable non-carbonic acid of any biological medium in two subcomponents will provide an improvement of specificity, adequate for a system physiological approach at the organ level. Thus, a distinction should be made between (1) processes of hydrogen ion donation, reversible by endogenous metabolic means (quantitated in terms of the component MA = metabolizable non-carbonic acid) and (2) processes of hydrogen ion donation associated with gastro-intestinal, skeletal, and renal transport, storage, and control of non-metabolizable non-carbonic acid (NA). Some implications of this distinction for acid-base physiology and acid-base diagnostics are discussed.

Male hamster preference for odors of female hamster vaginal discharges: studies of experiential and hormonal determinants

Male hamsters approach sources of odors from female hamster vaginal discharges and spend significantly more time around these odor sources than around control locations in the test box. This preference for female hamster vaginal odors appears in sexually inexperienced as well as experienced males, even in individuals isolated from females since the time of weaning. Castration significantly reduces the sex odor preference, and treatment with testosterone propionate partially restores it.