[Structural and functional alterations of the mucosa of a jejunal segment, interposed isoperistaltically after total gastrectomy according to Longmire-Gütgeman (author's transl)]

Six patients had total gastrectomy because of carcinoma followed by jejunum isoperistaltic interposition according to Longmire. A jejunal biopsy was taken in every case during operation and three and six months later endoscopically for morphometric and functional evaluation of small bowel mucosa. Three months after the operation a rise of L-phenylalanin in vitro uptake, an increase in villus height, surface area and a deepening of the crypts with raised mitotic activity of the crypt cells was found. The ratio of villus height to crypt depth was increased, although not significantly. On the other hand the activity of sucrase was initially decreased. Six months postoperatively all parameters had become normal besides the disaccharidases. These changes may be due to adaptive mucosal hyperplasia after small bowel resection or to luminal mucosal damage followed by compensatory hyperregeneration. Finally a humoral stimulus for mucosal hyperplasia as a postoperative effect is discussed.

[Transparent adhesive tape as postoperative dressing. Randomized, clinical study for comparison with a conventional dressing technic]

To evaluate the effect of a thin, transparent, adhesive and elastic polyurethane drape permeable only to gas and water vapor molecules but not to bacteria in comparison to a conventional drape for postoperative dressings, a randomized trial was conducted in 90 male and female patients. 44 patients had the transparent adhesive drape and 46 a conventional dressing. Both groups were reasonably well matched according to age, sex, height, weight and type of operation. There was no difference in healing of skin wounds. But reddening around the stitches was seen more often in patients with the conventional dressing than in those with the polyurethane drape (p less than 0.05). Surprisingly, most of the patients with the transparent drape (42 of 44) accepted it. The transparent adhesive drape was found to be much less expensive than the conventional dressing.

[Quantitative investigations of the structure and function of the intestinal mucosa in endoscopically obtained biopsy material. Findings in patients with coeliac disease, patients with partially resected small intestine in Crohn's disease and in patients with small intestine resection for other reasons (author's transl)]

During an endoscopy of the upper gastrointestinal tract, biopsy material of the small intestine was obtained and structure and function of the small intestinal mucosa was investigated. The data were then compared with published results, gained by normally performed blind biopsy techniques. For that the findings of three groups of patients (1. patients with coeliac disease [9], 2, patients with ileal resection due to ileitis terminalis Crohn [9], 3. patients with partially resection of the small intestine due to other reasons [4]) were compared with healthy controls (10). The results indicate that obtaining small intestinal biopsy material endoscopically enables a valid characterization of differentiated properties of the small bowel mucosa. The data of the patients with coeliac disease are in complete agreement with the criteria of this syndrome, published in the literature. On the other hand the results of the group with partial resection of the small intestine resection (without chronic inflammatory bowel disease) show all signs of adaptive mucosal hyperplasia of the remaining small intestine. However, patients with Crohn's disease did not show any adaptive response to small bowel resection.

Characterization of pepsin fragments of laminin in a tumor basement membrane. Evidence for the existence of related proteins

Laminin was extracted with neutral buffer from a tumor basement membrane and subjected to extensive degradation by pepsin. The treatment released two homogenous fragments P1 (Mr = 290,000) and P2 (Mr = 45,000) in addition to a mixture of smaller peptides. Fragments P1 and P2 together contained more than 90% of the disulfide bonds and accounted for about one third of the mass of laminin. Both peptides differed in amino acid composition, immunological properties and a complex chain structure demonstrating the existence of two disulfide-bonded domains in the molecule. Part of the laminin in the tumor matrix could only be solubilized by pepsin treatment and several fragments were purified. The major fragment P1i closely resembled P1 of soluble laminin in its chemical and immunological properties. Minor fragments Pa, Pb, Pc and Pd (Mr = 44,000-74,000) were only related to P1 or P2 in amino acid composition, chain pattern and antigenicity. The data were interpreted as indicating that proteins similar but not identical to laminin exist in the basement membrane and account for the minor peptide variants.

Basal lamina glycoproteins are produced by neuroblastoma cells

Murine neuroblastoma cells have been widely used as a model system for neuronal cells as they can be induced to differentiate in culture by various stimuli, such as dibutyryl cyclic AMP (dbcAMP), prostaglandin, and serum starvation. The cells respond with assembly of microtubules, leading to neurite outgrowth, with increased activity of neuronal-specific enzymes, tyrosine hydroxylase, choline acetyltransferase and acetylcholine-esterase, and synthesis of neurotransmitters. The differentiated cells lose tumorigenicity. Cell-to-substratum adhesion is evidently crucial for neurone extension in vitro. Neurite outgrowth is induced by treatments that increase cell-to-substratum adhesion in some neuronal cell cultures. We have now identified the major high molecular weight proteins synthesized and secreted by murine C1300 neuroblastoma cells as fibronectin, laminin and type IV procollagen, of which the latter two were also found to be deposited in pericellular matrix form.

[A randomized clinical study of stress ulcer prophylaxis with cimeytidine in severe multiple injuries]

In a surgical intensive care unit a controlled clinical trial for stress ulcer prophylaxis with cimetidine was performed in patients with severe polytrauma. Severe polytrauma was defined as affection of at least 3 body cavities (head, thorax, abdomen), 2 body cavities and 1 extremity fracture, 1 body cavity and 2 extremity fractures of 3 extremity fractures. An extremity fracture was defined as a fracture of a long bone i.e. humerus, femur. Initially the trial was planned as randomized double-blind using a fixed sample size. It was executed as a sequential single-blind study only and stopped for ethical reasons before the bounderies were reached and was analyzed according to the advice of an external referee using Fisher's exact test (p < 0.025). Cimetidine was highly effective in preventing stress ulceration in severe polytrauma patients, but mortality was the same in the cimetidine and in the placebo group.

Radioimmunoassay for type III procollagen peptide and its application to human liver disease

A sensitive and specific radioimmunoassay was developed for the precursor-specific peptide segment located at the amino end of bovine type III procollagen. Human material showed high cross-reactivity in this assay. Two forms of human procollagen peptides were detected in body fluids. The larger peptide (45K) was found in serum and ascites, and resembled the whole precursor-specific segment which is presumably released from human type III procollagen by a single enzymatic cleavage. The smaller peptide (10K) was found mainly in urine indicating that further degradation of circulating procollagen peptides is required prior to their passage through the kidney. Compared to peptide concentrations in normal human serum two to twenty-fold increases were observed in all patients with alcoholic liver disease, in fifteen of seventeen patients with acute hepatitis, and in ten of fourteen patients with chronic active hepatitis. Much higher levels were detected in ascites fluid. Patients with rheumatoid arthritis and other diseases showed far smaller elevations of the serum peptide. In alcoholic liver disease peptide levels correlated well with inflammation and necrosis observed in liver biopsies, but not with other laboratory parameters.

Immunochemical characterization of the basement membrane glycoprotein laminin

Laminin was recently characterized as being a major non-collageneous protein of the basement membrane matrix produced by a mouse tumor. It was extracted from the tumor matrix with neutral buffer and purified under non-denaturing conditions. Rabbit and guinea pig antisera raised against laminin or a large pepsin fragment P1 of laminin showed strong binding to both laminin and peptide P1 but only a weak reaction with reduced and alkylated laminin. The major antigenic determinants of laminin were located in a disulfide knot, comprising one third of the molecule, which resisted degradation by pepsin or cyanogen bromide. Minor antigenic determinants shared by the native and reduced protein could also be identified. The data were interpreted as showing that laminin consists of conformationally rigid as well as more flexible domains. Absorption studies with mouse kidney homogenate indicated that authenic basement membranes contain a protein immunologically identical to laminin. Tissues from other species contain a related protein which exhibits partial cross-reaction with mouse laminin. Together with immunofluorescence data the findings demonstrate that laminin, like type IV collagen, occurs in most basement membranes of the body.

Laminin--a glycoprotein from basement membranes

We have isolated a large noncollagenous glycoprotein, laminin, from a mouse tumor that produces basement membrane. The protein consists of at least two polypeptide chains (Mr = 220,000 and Mr = 440,000) joined to each other by disulfide bonds. Laminin and type IV collagen are major constituents of the tumor. Laminin is distinctly different from fibronectin, another component of basement membranes, in amino acid composition and immunological reactivity. Pepsin digestion of laminin releases a large, cystine-rich fragment which retains most of the antigenicity of the original protein. Immunological studies using purified antibody against laminin show that it is produced by a variety of cultured cells. In addition, these antibodies react with the basement membranes of normal tissues, suggesting that this protein or an immunologically related protein is a constituent of the basement membranes of these tissues.

[Symptoms and therapy of spontaneous osteonecrosis of the medial femoral condyle in elder patients (author's transl)]

The author reports on symptoms, therapy and results of a follow-up of 17 patients with the rare disease of osteonecrosis of the medial femoral condyle. The therapy depends on the extend of the necrosis, the axis of the leg and the results of scintigraphy or scintimetry and arthrography or arthroscopy. Small necroses can be treated conservatively, but in case of a genu varum a valgus-osteotomie should be performed. Bigger necroses are bored or bolted combined with a valgus-osteotomie, if necessary. Extensive osteonecroses can only be treated by partial endoprosthesis or autologue bone-cartilage-transplantation.

Structure of antigenic determinants in the N-terminal region of dermatosparactic sheep procollagen type I

About half of the rabbit antisera raised against type-I procollagen, p alpha 1(I) chain or nonreduced procollagen peptides reacted in a radioimmunoassay with the reduced form of peptide Col 1, which comprises the whole non-collagenous region at the N-terminus of procollagen. Proteolytic fragments prepared from reduced peptide Col 1 were still effective inhibitors of the antibodies and allowed the localization of two antigenic determinants. The antigenically active regions have the sequences less than Glu-Glu-Glu-Gly-Gln-Gln-Glu and Gly-Asp-Thr-Gly-Pro-Arg, and are located at the N- and C-termini of the peptide respectively. Antibodies raised against reduced peptide Col 1 bind to a determinant localized in a different region of the peptide.

Amino acid sequence of the N-terminal non-collagenous segment of dermatosparactic sheep procollagen type I

The non-collagenous N-terminal segment of type I procollagen from dermatosparactic sheep skin was isolated in the form of the peptide Col 1 from a collagenase digest of the protein. The peptide has a blocked N-terminus, which was identified as pyrrolid-2-one-5-carboxylic acid. Appropriate overlapping fragments were prepared from reduced and alkylated peptide Col 1 by cleavage with trypsin at lysine, arginine and S-aminoethyl-cysteine residues and by cleavage with staphylococcal proteinase at glutamate residues. Amino acid sequence analysis of these fragments by Edman degradation and mass spectrometry established the whole sequence of peptide Col 1 except for a peptide junction (7--8) and a single Asx residue (44), and demonstrated that peptide Col 1 consists of 98 amino acid residues. The N-terminal portion of peptide Col 1 (86 residues) shows an irregular distribution of glycine, whereas the C-terminal portion (12 residues) possesses the triplet structure Gly-Xy and is apparently derived from the precursor-specific collagenous domain of procollagen. The central region of the peptide contains ten cysteine residues located between positions 18 and 73 and shows alternating polar and hydrophobic sequence elements. The regions adjacent to the cysteine-rich portion have a hydrophilic nature and are abundant in glutamic acid. The data are consistent with previous physicochemical and immunological evidence that distinct regions at the N- and C-termini of the non-collagenous domain possess a less rigid conformation than does the central portion of the molecule.

[Prospective controlled clinical trials in surgery. controversial issues in motivation and performance (author's transl)]

Controversial aspects in prospective controlled trials in surgery can be detected at various stages in the course of this research work, such as in motivation, planning and performance as well as in assessment and evaluation of the results. Especially the introduction of control groups, randomization and "blindness" of patients, operators and doctors running the follow-up are subjects of a controversial discussion. Subthreshold arguments for defenders and eniers of the trial are taken from different theories of science, such as empirism and rationalism which are more effective in the daily routine work than expected. Provided that convincingly only therapeutic and diagnostic procedures are compared which were considered as equi-effective and reliable to the same extent according to the best and most complete knowledge available it is ethically justified to perform controlled randomized trials. It should, however, not be expected that they (always) produce differences between treatment of high degree of difference. The aim of the controlled trials is not the introduction of sensational novelties into medicine, but the abolition and prevention of unnecessary and unworthy modes.

[Fracture and pseudarthrosis of a synostosis between os lunatum and os triquetrum and its treatment (author's transl)]

The unusual case of fracture and pseudarthrosis of a synostosis between os lunatum and os triquetrum is described. Aetiological factors, clinical symptoms and operative treatment are explained and legal aspects concerning insurance-problems are discussed.

Localization of antigenic activity and immunogenic capacity in different conformational domains of procollagen peptide

The antibody response to the amino-terminal CNBr peptide of sheep procollagen which consists of a globular and a collagenous segment, was studied in inbred strains of mice. The determinants reacting with antibody could be localized in the globular domain and were lost by reduction of disulfide bridges. The ability to induce an antibody response required the collagen-like sequences and was independent of the triple-helical conformation of this segment. The data were interpreted as indicating a different conformation dependence of hapten and carrier determinants.

Effect of selective gastric vagotomy on histamine concentration in gastric mucosa of patients with duodenal ulcer

In a prospective controlled trial, histamine concentrations in human gastric mucosa were determined fluorometrically in 23 patients 6–11 months after selective gastric vagotomy with drainage and in patients who had undergone other types of operation for duodenal ulcer. The study was in two parts: part 1, a synchronous investigation of mucosal histamine concentrations in patients who had undergone vagotomy, in duodenal ulcer patients before operation and in control subjects; part 2, a consecutive study of the same patients before and after vagotomy.

In part 1, patients with Hollander-negative vagotomy were found to have significantly higher mucosal histamine concentrations than ‘healthy’ control subjects or duodenal ulcer, however, had as low mucosal histamine concentrations as duodenal ulcer patients who had not been operated on. In part 2, all duodenal ulcer patients showed an increase in gastric mucosal histamine concentration after vagotomy (P &lt; 0·01). The smallest increase was in a patient with an incomplete vagotomy. Control patients who were not operated on but who underwent endoscopy and biopsy twice in the period of investigation, did not show any increase in mucosal histamine concentration between the times of the first and the second biopsy. The overall results of selective vagotomy and drainage in this study, with respect both to clinical Visick gradings and to radiological and acid secretory findings, were comparable to those reported by other authors. No significant change in numbers of parietal cells was found after vagotomy. Thus, selective gastric vagotomy with a drainage procedure leads to increased concentrations of histamine in the mucosa of the body of the stomach in man. The mechanism is not clear, but might be through inhibition of histamine release from mast cell stores.