[Management of long-standing instabilities of the knee ligaments]

Since 1975, a total of 1015 knee ligament grafts have been carried out in the orthopedic department of the St. Elisabeth-Klinik in Saarlouis. Proceeding from the method of extra-articular stabilization that was taken over and modified by Mittelmeier, the authors initially favored Ellison's method of lateral ligament displacement, supplementing the operation by diverting the nerve tract. Although the results of surgery were not bad, the importance of rotational instability led the authors increasingly to turn to intra-articular stabilization. Today, the most commonly used methods for frontal instability are those modified by Brückner or Glency, both with good results. With regard to ligament prostheses, the authors tend to be more cautious. Certainly, the alloplastic artificial ligament replacement is an important advance in the case of certain indications, but is probably only a further element of future developments. Many of the problems encountered by Fritz Lange with his first, silk plastic ligament replacement, described by Max Lange in the 1960s, are still applicable today. Here one could mention in particular the surgeon's misgivings concerning indication and the cautious estimates of the changes of success of plastic surgery of the ligaments.

Peripheral arterial occlusions: a 6-year experience with local low-dose thrombolytic therapy

Early and long-term results of treatment with local low-dose thrombolysis in 554 patients with 564 peripheral arterial occlusions are reported. Of 92 embolic occlusions present for 2 months or more, 59 (64.1%) were recanalized with a cumulative patency of 89.5% after 5 years. Of 472 thrombotic occlusions present for up to 6 months and more, 254 (53.8%) were successfully treated with a cumulative patency of 58.8% after 5 years. The hospital mortality and amputation rate were 1.6% and 1.95%, respectively. The average age of the patients was 69.1 years and more than half of those treated had stage III or IV disease. A 6-year experience with local low-dose thrombolytic therapy has completely confirmed its efficacy and has led to improvements in technique, which are described. The doses of streptokinase and urokinase needed for a successful result have been substantially reduced and the duration of treatment shortened. The number of complications has also been reduced. Differential therapeutic considerations compared to vascular surgery are mentioned. The results should motivate a reconsideration of the diagnostic and therapeutic measures to be used in the treatment of peripheral arterial occlusions.

Immunochemical distribution of interphotoreceptor retinoid-binding protein in selected species

An enzyme-linked immunosorbent assay (ELISA) was used to quantitate interphotoreceptor retinoid-binding protein (IRBP) in tissues of monkey and other species using rabbit antiserum against monkey IRBP. A 1:7500 antiserum dilution was found optimal with the linear range extending to 250 micrograms IRBP/ml. The highest IRBP concentration was found in cannulation fluid of the monkey interphotoreceptor space, although vitreous and aqueous humors also contained IRBP. The presence of IRBP in the vitreous was confirmed by Western blot and 3H-retinol binding studies. The pineal gland of monkey and rat also was found to contain IRBP, as assessed by ELISA and immunocytochemistry; IRBP was below the limits of detection in turtle and chicken retina. IRBP levels were uniformly low in retinas of human cases with hereditary retinal degeneration, including retinitis pigmentosa (three cases) and choroideremia (two cases). The presence of IRBP in pineal as well as in the vitreous and aqueous humors may indicate a broader role for this putative retinoid-transport protein than previously suspected.

Enhancement of the antiemetic action of metoclopramide against cisplatin-induced emesis by transdermal electrical nerve stimulation

In a double-blind sequential trial, the influence of transdermal electrical nerve stimulation (TENS) was studied in patients who were treated with total infusions of metoclopramide 3.5 mg/kg to counter the emetic action of cisplatin 60-90 mg/m2. Transdermal electrical nerve stimulation further reduced the emetic episodes in ten of 11 treatment pairs (2 alpha = .10). This effect was blocked by naloxone. More surprisingly, TENS reduced the incidence of extrapyramidal effects of metoclopramide (i.e., akathisia and dystonia). These effects may be explained by the involvement of central nervous and peripheral TENS-induced production of opioid neuromodulators. An alternate hypothesis is the stimulation of serotonergic mechanisms via neuromodulation by opioid peptides, or by involvement of both systems.

[Group process studies within the scope of directed dynamic group psychotherapy]

Footing on specific prämisses of Intended Dynamic Group Psychotherapy three different types of development are described on the basis of factor analytical investigations towards the behaviour and experience of the group members and of the therapeut. At a period of 34 sessions of stationary psychotherapy data of 15 groups were comprehended and globally related to the effectivity. There are shown up the problems of therapeuticle behaviour, of indication and of effectivity.

Drug-induced inhibition of platelet function delays progression of peripheral occlusive arterial disease. A prospective double-blind arteriographically controlled trial

240 patients were admitted to a double-blind study to determine the effect of long-term treatment with platelet-function inhibiting agents on occlusive arterial disease in the lower extremities. Patients were randomised into 1 of 3 treatment groups: aspirin 330 mg; dipyridamole 75 mg and aspirin 330 mg; or matching placebo 3 times daily. The duration of treatment was 2 years. Arteriography was carried out at the beginning of the study and 2 years later or before if deterioration was observed. 199 patients completed the study according to the trial protocol. The serial arteriograms were assessed in pairs qualitatively, by means of simple comparative viewing, and semiquantitatively with Bollinger's score system. Progression of the disease was most pronounced in the placebo-treated group, less so in the aspirin-treated group, and least of all in the dipyridamole-and-aspirin group. Patients who smoke and those with hypertension may benefit most from treatment with the 2 preparations under investigation.

Thrombolytic therapy and its combination with transluminal catheter dilatation

The material for complete occlusion of an artery is predominantly thrombotic. The longer the occluded segment the worse are the results of PTA since the thrombotic material is not compressible. As long as this thrombotic material is not already organized, it can be lysed by thrombolytic therapy, and thus removed. Remaining stenoses can be dilated subsequently. Thrombolytic therapy was carried out either systemically, i.e. by intravenous infusion of high doses of streptokinase or by selective local infiltration of an occluding clot with low doses of the same drug via a catheter. This study deals in particular with local low-dose streptokinase therapy. Out of 205 patients treated, primary recanalization was achieved in 145 (75%) and in 107 of these cases additional balloon dilatation was necessary. In 36 patients (25%) reocclusion occurred within the first 2 weeks. Out of the other patients the cumulative patency rate after 2 years was 50%. The combination of PTA with local low-dose thrombolytic therapy has several advantages: It facilitates probing of the occlusion by softening the clot. It removes the lysable component of the clot, giving the possibility of restricting the dilatory procedure to a shorter segment and, thus, diminishing the vascular trauma and risk of rethrombosis. It helps to prevent rethrombosis by the after-effect of thrombolysis. It provokes hyperaemia lasting for 1 to 2 days. It is capable of rapidly dissolving early reocclusion or macroemboli. Local low-dose thrombolytic therapy in combination with PTA has effectively extended the number of non-surgical recanalizations of peripheral arterial occlusions in our clinic.

Improved benefit/risk ratio of higher-dose metoclopramide therapy during cisplatin-induced emesis

Metoclopramide (Paspertin) was infused intravenously in the high doses of 1.75, 3.5, 7.0, and 14 mg/kg body wt. per treatment cycle as antiemetic therapy for cisplatin-induced emesis (363 cycles, 25-120 mg/m2). The antiemetic potency of metoclopramide increased in a log linear manner, giving from 40% to 95% protection against emesis. Gastrointestinal motility showed a similar increase, i.e. diarrhoea. In contrast, the extrapyramidal reactions, namely akathisia, rigidity and acute dystonia, did not show a dose-dependent increase in frequency and remained constant over the dose range of 3.5-14 mg/kg per cycle. The results suggest increasing benefit of metoclopramide treatment with increasing doses of the drug.

Metoclopramide kinetics at high-dose infusion rates for prevention of cisplatin-induced emesis

Eleven male subjects aged 24 to 58 yr received cisplatin, 90 to 120 mg/m2 iv, in combination with other cytostatic drugs such as doxorubicin HCl and bleomycin. To prevent emesis, two high-dose metoclopramide regimens were started 2 hr before cytostatic therapy. Regimen A (n = 7) consisted of a loading dose infusion of 1 mg/kg/hr over 2 hr, followed by a maintenance infusion of 0.5 mg/kg/hr over 24 hr (total dose was 14 mg/kg in each cytostatic cycle). Regimen B (n = 6) consisted of half the metoclopramide dose. The following kinetics were derived from the metoclopramide steady-state plasma levels and the t1/2 of the elimination phase 26 to 38 hr after dosing (median value and range are listed): Steady-state plasma concentration in group A and group B was 750 (480 to 1520) and 360 (300 to 480) ng/ml plasma. Drug clearance in group A and group B was 0.67 (0.3 to 1.0) and 0.70 (0.5 to 0.8) l/hr/kg. Volumes of drug distribution in group A and group B were 4.4 (1.9 to 6.5) and 4.3 (3.2 to 5.9) l/kg. Values for the t1/2 in the elimination phase in group A and group B were 4.7 (3.0 to 5.4) and 4.3 (3.7 to 5.1) hr. It appears that metoclopramide kinetics at high doses were dose linear, i.e., without evidence of cumulation. There were few side effects; vomiting was effectively suppressed by both regimens.

[Characterization of membrane antigens from human kidney and renal adenocarcinoma]

The brush border of the proximal tubule of human kidney consists of peripheral, integral as well as of transmembranous antigens. Peripheral (surface) antigens are associated with the presence of 5-7 nm globular particles sensitive to limited proteolysis; particles were found to contain a multienzyme complex and exhibited strong affinity towards ConA and WGA. PM-antigens can be solubilized from different portions of PM by differential treatment with proteases and detergents. Labelled antisera against isolated surface glycoproteins reveal a specific reaction with luminal PM of the proximal tubule only, supporting their value for quantitative image analysis (histometry) of kidney tissue sections and for screening of tissue-proteinuria. PM were capable of binding cationic serumproteins (esp. immunoglobulin) and certain O/K-antigens from E.coli, where adhesion was observed on peripheral and intrinsic PM-antigens as well. Major markers of the distal tubule are Tamm-Horsfall protein (cytoplasmic compartment) and a PNA-binding glycoprotein originating from the luminal PM. PM from renal adenocarcinoma exhibit not the globular surface structure found in renal PM, show low immunogenicity, a modulation in the glycosylation pattern of the marker gamma-Glu-transpeptidase and are characterized by a marked depletion of normally differentiated renal antigens. Due to solubilization experiments the presence of cryptic antigens are likely. In addition common determinants between cancer antigens and distinct proteins of the distal tubule and placental trophoblast became apparent.

[Effect of ticlopidine on peripheral obliterating arteriopathy]

The efficacy of and tolerance to ticlopidine, a platelet inhibitor, in preventing progression of obliterative arterial disease was compared with that of a placebo in a double-blind and randomized trial in 43 patients (22 on placebo, 21 on ticlopidine) over a period of one year. The course of the disease in both groups was assessed by serial angiography of the lower limbs, both at the beginning and at the end of the study. There was a significantly reduced progression in the ticlopidine group (P less than 0.01). The results support the hypothesis that platelets are of great importance in the progression of arteriosclerosis and that inhibition of platelet function is an effective principle of prevention. Ticlopidine in this respect is an alternative to the use of acetylsalicylic acid.

[Arteriovenous fistula of the vertebral artery: a rare complication following central venous catheterization. A case report]

Arteriovenous fistulas of the vertebral artery are in most cases caused by penetrating injuries. This report concerns a patient with ankylosing spondylitis, whose fistula most probably was brought about by puncture of the internal jugular vein for aorto-coronary-bypass surgery.

[Auditive analysis (a new method in group psychotherapy research]

The principle of auditive analysis is that the type and degree of different emotional states expressed in the voices of the mentally ill are analyzed as accurately as possible. Patients receiving group centred non-directive treatment were examined by this method and the results were compared with those obtained by sociometric tests. It was found that patients, and also psychotherapists, with high standards of auditive ability were accepted into the group and were popular, whereas persons with poor auditive ability were rejected by the group. Experiments with the same method in the GDR yielded the same results as in the USSR. The application of this method as a means of checking the success of training in group centres non-directive therapy is being considered.