[Computer tomographic and sonographic demonstration of renal haematomas following percutaneous renal biopsy (author's transl)]

The incidence of post-puncture haematomas following percutaneous renal biopsy in 23 patients (24 punctures) is reported. The incidence of renal haematomas was 29.1%. The diagnostic value of computer tomography and sonography is discussed. Amongst small haematomas (less than 7 ml. blood), which could only be demonstrated by computer tomography, 8.2% were purely intrarenal, 8.2% were sub-capsular and 12.3% showed combined intrarenal, subcapsular and perirenal bleeding. The incidence of sub-capsular and perirenal haematomas of 20.5% is considerably lower than has previously been reported in literature.

Heparin levels and activated clotting time (ACT) during open heart surgery

Heparin levels were followed by an amidolytic method during open heart surgery in 10 adult patients and correlated to the activated clotting time (ACT) (Haemochron). There was a good correlation between the 2 parameters when the ACT was below 600 s. Based on the present and previous studies of the ACT the authors conclude that the ACT is a useful tool in control of heparinization during open heart surgery.

[Asymptomatic haematuria (author's transl)]

Mesangioproliferative glomerulonephritis of varying severity was found by renal biopsy in 86.2% among 130 patients with asymptomatic haematuria. 3.2% had benign nephrosclerosis, 3.2% had benign nephrosclerosis, 1.6% had interstitial nephritis and one patient showed a previously undiagnosed perimembranous glomerulonephritis. Normal renal parenchyma was observed in only 6.9% of cases. Iummunohistological findings were positive in 25.7% of investigated cases. The majority were IgA deposits combined with IgG and C3 complement. The intensity of haematuria is not correlated with the type and severity of histological changes. "Physiological" haematuria (erythrocytes less than 7/ml) which is usually considered normal must be re-evaluated as a consequence of these histological findings. After exclusion of urological or extrarenal disease only histological investigation of the kidneys will bring the final diagnosis. Repeated radiographical or urological investigations can thus be avoided. The risks of percutaneous renal biopsy under fluoroscopic or sonographic control are decidedly less than the information gained from histological evaluation. The different histological findings indicate that isolated haematuria should be considered only as a symptom and not as a uniform disease indicating focal nephritis.

Evaluation of the activated whole blood clotting time (ACT) in vitro

The activated whole blood clotting time (ACT) was analyzed in vitro using blood samples from normal individuals and from patients with heart disease, scheduled for open heart surgery. The ACT was found to be normally distributed in a group of normal individuals with a mean of 135 sec. In patients with heart diseases, the average ACT was slightly shorter than in normal individuals. A linear relationship between ACT and heparin concentrations was established. Haemodilution and depletion of platelets did not significantly influence the ACT. When a clean venipuncture with disposable needles is used, ACT is a reliable, uncomplicated bedside technique by which heparinisation can be monitored.

[The value of echography in the care of patients with chronic renal insufficiency (author's transl)]

Echography permits information on the shape of the kidneys and ureteral system without reference to their function, and on the perirenal tissue. This is illustrated by a typical example. Echography also provides rapid orientation in the recognition of collections of fluid in the preformed body cavities, which can rapidly bring the affected patient into a life-threatening condition, particularly in the shape of a pericardial effusion. For this reason the inclusion of echography in the investigation program in the care of patients with chronic renal insufficiency is recommended.

[The importance of echography in the differential diagnosis of renal insufficiency (author's transl)]

Experience with echographic investigation of the kidney and the urinary efferent system in the diagnosis of renal insufficiency is reported. Taking into account a number of criteria (size, differentiation from the surrounding tissues, position of the kidney in relation to neighboring organs and to the body surface, mobility or change of shape on respiration, on altehe evaluation of the nephroechographic findings an attempt is made to rationalize the applicatinon of further diagnostic measures. The method is recommended both for the initial diagnosis of renal insufficiency and for the supervision of patients with confirmed renal insufficiency.

On the nature of rheumatoid rice bodies: an immunologic, histochemical, and electron microscope study

The nature of rice bodies was studied, utilizing histochemistry, immunofluorescence, and scanning and transmission electron microscopy. Rice bodies were found to consist primarily of fibrous material, most of which was fibrin with small amounts of collagen. Channels containing a variety of viable cells permeated the rice bodies. Blood vessels occurred in a few rice bodies indicating a former connection with the synovial membrane. Nonvascularized rice bodies might represent a further degeneration of the vascular type. Rice bodies seem to be a nonspecific response to inflammation.

Synovectomies in moderately to severely involved rheumatoid knees: an alternative to implant arthroplasty

A retrospective study of 19 synovectomies revealed significant relief of pain for two to ten years in selected patients with moderate to severe rheumatoid arthritis of the knee diagnosed roentgenographically. The usual indications for this procedure may be extended to include well-motivated patients when synovectomy is combined with good medical and physical therapy. Need for further operation was considered a failure of synovectomy.

[Acute carbon tetrachloride poisoning (author's transl)]

Three cases of acute CCI4 poisoning are reported which came for admission in the stage of hepatorenal insufficiency. All three intoxications occurred in the home by inhalation as a result of disregarding the safety precautions. The patients remembered using the noxa only after renewed questioning by the doctors. All three patients were able to be discharged cured after appropriate therapy, including peritoneal or hemodialysis. A disturbance of the capacity for urine concentration could be demonstrated up to 3 years after the exposure, as a last limitation of function.

Indications for and results with the Swanson distal ulnar prosthesis

Classically, wrist synovectomy, when the distal radioulnar joint is involved, includes excision of the distal ulna (the classical Darrach procedure). Orthopedists and rheumatologists are well aware of the propensity for extensor tendon rupture, particularly of the ring and little finger, in this area. Dr. Alfred Swanson has presented his results with a silastic interposition to substitute for the excision of the distal ulna. This paper presents a surgical technic, indications, and results in five cases of rheumatoid arthritis in which wrist synovectomy and repair of extensor tendon ruptures were done as appropriate. This distal ulnar prosthesis is recommended for routine use in wrist synovectomy when excision of the distal ulna is performed.

Cardioplegic cardiac arrest in aortic surgery

Cardioplegia according to Bretschneider is able to protect the myocardium during long periods of cardiac arrest and a quiet relaxed heart has in many cases of congenital heart disease been of great surgical advantage. In the last 100 consecutive aortic valve replacements in cardioplegic arrest we have lost 6 patients and none of the deaths seems to be related to the method. In our hands it has been superior to coronary perfusion.