[Current significance of Gram's stain in the treatment of ENT infections in the clinic and general practice]

The aim of our investigations was to evaluate the current importance of Gram's stain in ENT infections. This long established easy microbiological method was compared with culture and sensitivity tests. For this purpose 549 Gram's stains were performed on 384 patients. In 88.8% of the cases Gram's stains gave reliable information in a few minutes so that a correct and effective antimicrobial treatment could be started. In 5.7% no pathogen could be found using a Gram's stain, probably because the concentration was too low (10(5)/ml) whereas a pathogen could be cultured in these cases. However culture revealed microbiological information in 11.5% of the cases that was unreliable or even misleading in deciding treatment. In conclusion, Gram's stain is a very cheap, quick and easy method which has been forgotten by many clinicians but which is sufficient as the only microbiological method in uncomplicated ENT infections and is of great importance for a correct interpretation of the results of culture in severe infections. In life-threatening cases it may even be of a crucial value.

Brain serotonin levels and metabolism in the non-hibernating bulbectomized European hamster

Serotonin levels and turnover were measured in different brains areas of full bulbectomized and partially bulbectomized European hamsters and their controls. Full bulbectomized hamsters did not hibernate and ate more than the two other groups in which hibernation patterns were similar. The levels of serotonin were of the same magnitude in the three groups. The turnover rates were slower in amygdala and hypothalamus in the full lesioned animals. These results were discussed for their implications in the mechanism of entrance into hibernation.

Timentin--clinical and pharmacokinetic evaluation in otorhinolaryngology

The efficacy and tolerance of Timentin was studied in 41 patients with various infections of the ears, nose and throat. The pharmacokinetics of Timentin were determined in pus, mucosa and polyps of the nose and paranasal sinuses, the tonsils and submandibular gland as well as in the interstitial fluid collected in Redon vacuum drainage. Experimental pharmacokinetic studies in the guinea pig were performed in the inner ear and eye fluids and in serum. Ticarcillin and clavulanic acid concentrations were determined by a microbiological micromethod. The clinical studies demonstrated that Timentin was very effective and well tolerated. The clinical and experimental pharmacokinetic studies provide a good explanation of this high degree of effectiveness.

Incidence of gastroesophageal reflux following repair of esophageal atresia

Gastroesophageal reflux (GER) was looked for retro- and prospectively by various diagnostic methods in 67 patients, subdivided into three groups according to age at time of investigation. Pathological reflux was found in only one-quarter of the patients aged 16-23 years, but in three-quarters of both younger groups followed up for 1.5-14 years so far. Whereas pathological findings were most frequently disclosed by manometry in the older patients, radiological findings were most often decisive in younger patients. Following closure of recurrent tracheoesophageal fistulas and resection of anastomotic stenoses, eight patients developed reflux complications during the first months of life; these were so severe that antireflux plasty became unavoidable. Factors influencing the incidence of GER following esophageal repair were: the definition of GER based on the diagnostic method employed, the patient's age at the time of diagnosis, and anastomotic complications requiring a second operation. The essential time for treatment was the first year of life.

[Metronidazole pharmacokinetics in perilymph, aqueous humor and cerebrospinal fluid]

Since metronidazole is very effective against anaerobic bacteria, we studied its pharmacokinetics in perilymph, cerebrospinal fluid, aqueous humour, and serum. 1, 2, 4, 6, 10 and 16.5 hours after intraperitoneal injection of 200 mg/kg metronidazole to six groups of six guinea pigs each, we determined the drug concentrations by high-pressure liquid chromatography. In the serum, 1, 2 and 16.5 hours after application, drug levels of 194 +/- 22 mg/l, 127 +/- 54 mg/l and 2 +/- 1 mg/l respectively were found. Half-life was 6 hours. Similar high and long-lasting concentrations could be determined in the aqueous humour, cerebrospinal fluid and perilymph. In contrast to our findings with aminoglycoside antibiotics, beta lactam antibiotics and fosfomycin, we could not observe any retention of metronidazole in the perilymph.

[Trials for optimization of the culture conditions of human pathogenic trypanosomas and leishmania]

Due to the extended political, cultural and economic relations with tropical countries a good knowledge of tropical diseases is required. Since the direct parasitological diagnosis is superior to the serological one it seems logical to improve the culture conditions for laboratory diagnosis and for immunological and chemotherapeutical tests. Trypanosoma cruzi (Chagas) and Leishmania donovani (kala-azar) were tested in vitro. Enlargement of the culture surface at the same volume of the medium at 22 degrees C yielded an increase in the number of protozoa by 100%. When blood of different animal species was added to the medium, rabbit blood and that of other rodents such as rat and mouse showed the highest rate of growth. By using the newly developed semi-defined medium 4 as overlay and as monophasic medium high rates of growth were obtained similar to those obtained with known complex media. Therefore, no further import of relevant substances is necessary.

Significance of esophageal manometry and long-term pH monitoring for the evaluation of gastroesophageal reflux in infancy and childhood

From examinations and clinical observations of 40 infants and a varying number of children from 2 to 11 years who all had characteristic symptoms of gastroesophageal reflux (GER), an attempt was made to establish the diagnostic contribution of esophageal manometry and long-term pH monitoring. A correlation between decreased resting pressure (less than or equal to 12 mmHg), or a sphincter insufficiency, and the degree of reflux symptoms was completely absent in infancy and increased only very slightly in young children. The most influential pH monitoring parameters were reflux during sleep, beyond 2 h postprandial, and during crying. These correlated most with the symptoms in infants. On the other hand, clinical developments were independent of the extent of the pH monitoring findings.

[The function of the esophagus following cardiomyotomy in childhood achalasia]

Cardiomyotomy and fundoplication were performed in 7 children with achalasia of the oesophagus. They were followed up clinically, radiologically and manometrically from 7 to 18 years. Virtually all clinical symptoms and complaints disappeared immediately postoperatively and the patients remained free from symptoms well into adolescence except for very mild intermittent dysphagia in two of them. The residual mega-oesophagus and the disturbances of motility were least apparent in those operated on in early infancy. It may, therefore, be assumed that the motility pattern is more likely to return to normal in the oesophagus of the infant due to the relatively short period of dilatation. Fundoplication after Nissen did not alter the existing motility but was able to prevent gastro-oesophageal reflux and its possible grave consequences in all cases.

Echography in retinoblastoma

A total of 60 eyes with retinoblastoma were examined by echography using the A-scan (Kretz 7200 MA) and B-scan (Ocuscan 400) at different sensitivity levels. The results documented by polaroid photographs were analysed quantitatively. Some additional diagnostic criteria were obtained. The differential diagnosis of a broad spectrum of vitreoretinal diseases is discussed.

Hyperphagia and obesity after olfactory bulbectomy performed at different times of the year in the European hamster

Olfactory bulbectomy was performed on wild male European hamsters at different phases of their circannual body weight rhythm. Olfactory bulbectomy was always followed by an immediate hyperphagia the magnitude of which varied with the time of the year it was performed. The bulbectomy did not affect the phase of the circannual body weight rhythm, although in certain cases the rhythm is attenuated or apparently phase-shifted. Hyperphagia was delayed by food restriction but reappeared when animals were placed on ad lib food. The possible role of olfactory bulbs in the regulation of body weight, and the possibility that the maintenance expenditure of the bulbectomized animals is higher than that of the controls are discussed.

[Surgical indications in cardial insufficiency in infants]

Indications for fundoplication in 70 infants with cardiac sphincter insufficiency are analysed and subdivided into absolute and relative indications in accordance with complications conditioned by reflux. Endoscopy has proved to be the most important diagnostic method for deciding whether antireflux surgery is necessary. It enables proof or exclusion of oesophagitis as the most frequent and most severe consequence of reflux. Functional tests, such as manometry and long-term measurement of pH, are important especially in cases where severity and pattern of the disease have not been clarified. Such tests enable assessment of the function of the cardia and tubular oesophagus, and hence the hazards to which the oesophagus is exposed by the reflux of the gastrointestinal contents. Hence, they represent a contribution to a reduction of the incidence rate of surgery to the absolute minimum which is a "must" at this age, without exposing the young patient to the risk of a serious complication.

Primary and secondary structure specificity of the cleavage of 'single-stranded' DNA by endonuclease Hinf I

The interaction of endonuclease Hinf I with single-stranded fd DNA was examined. The sizes of the cleavage products indicate that the enzyme cuts this substrate at the same sequences as double-stranded DNA (GANTC). To determine whether or not the recognition sites in single-stranded DNA have to be present in double-stranded form in order to be cleaved, DNA fragments containing complementary or non-complementary Hinf I sequences were prepared and treated as substrates. The results suggest that completely base-paired recognition sites are necessary for cleavage. Sequences surrounding the Hinf I pentanucleotides significantly modulate the reaction rates.

[Paediatric urethral injures: initial management and long-term results (author's transl)]

Thirteen cases of urethral trauma in childhood are reported. The nature and management of such injuries are discussed. As a rule urethral ruptures are difficult to treat but long term results are surprisingly good irrespective of the initial procedure. Nevertheless, we do have the impression that with an initially aggressive operative treatment - aimed at a good anatomic reconstruction of the urethra - this goal is achieved much faster and with less complications.

Excessive hypermetropia: review and case report documented by echography

The case of an 11-year-old boy with hypermetropia of +22.0 diopters is reported. Axial length was only 14.8 mm. The features and extreme rarity of this variation in the shape of the globe is outlined. The dimensions of the eyeball were measured by echography and compared to the emmetropic eye of the adult. Only vitreous length was found to be shortened, while the dimensions of the anterior segment were within normal limits. The term posterior microphthalmos without microcornea was chosen. Associated pseudopapilledema and choroidal folds were found. The literature is reviewed.

Cellular uptake of L-lactate in mouse diaphragm

Early uptake curves of L-lactate and of mannitol were measured in quartered, incubated mouse diaphragms. Uptake was determined at 15, 30, and 45 s for various concentrations of lactate in the external solution as well as in the presence and absence of the competitive inhibitor of lactate transport, alpha-cyano-4-hydroxycinnimate. In normal preparations, when the external lactate concentration was 10 mM or less, the ratio of lactate-to mannitol space in the tissue was 1.7. This value was nearly independent of time and of external concentration. In normal preparations, when the external lactate concentration was greater than 10 mM, the ratio of lactate-to-mannitol space rose with time. At a fixed time, however, this ratio fell with increasing lactate concentration. In the inhibited preparations, the ratio of lactate-to-mannitol space rose with time at all concentrations. When lactate concentration was greater than 5 mM, this ratio was independent of the external concentration. The results suggest that there are two modes of lactate entry into these muscle cells. Entry can occur by means of a saturable system. When external lactate concentration is low, entry rates for this process are rapid compared with diffusional rates. This system probably saturates at concentrations near 10 mM and can facilitate transport in either direction. In addition, an appreciable passive leak is present. This leak accounts for about one fourth of the membrane transfer when external lactate is low, but is equal to the carrier transfer when lactate concentration is 30 mM. A model was developed to describe the entry of a permeating solute, such as lactate, into an isolated tissue.