Münchhausen-Syndrom und chronische Otitis media

In this case report an artificial disorder with symptoms of chronic otitis media and progressive hearing loss is described. This represents a rare case of Munchausen syndrome. The difficulties in diagnosis and therapy are shown by the development of the disease, produced by self damaging activities.

[Not all vocal cord failure following thyroid surgery is recurrent paresis due to damage during operation. Statement of the German Interdisciplinary Study Group on Intraoperative Neuromonitoring of Thyroid Surgery concerning recurring paresis due to intubation]

Since the phoniatrician H. Bauer described the first case of recurrent laryngeal nerve palsy most likely caused by intubation some 45 years ago, several case reports have been published. However, systematic analyses regarding the frequency of recurrent laryngeal nerve palsies due to intubation are scarce, and none of them has used the proper methods to demonstrate clearly that such a mechanism exists. Currently available data justify the assumption that not every recurrent laryngeal nerve palsy following thyroid surgery is due to the operation itself and that the damage caused by intubation, however, may only account for a minority of these cases. The differential diagnosis of postoperative recurrent laryngeal nerve palsy requires the use of specific tools which go beyond simple laryngoscopy and include stroboscopy as well as intra- and extralaryngeal electromyography. A partial palsy of recurrent laryngeal nerve due to intubation would be associated with severe dysphonia or aphonia, not with dyspnea because of the typical intermediate position of the paralyzed vocal folds with a normal electromyographic function of the cricothyroid muscle. The use of these methods to identify the nature of postoperative recurrent laryngeal nerve palsy is recommended in cases of regular intraoperative neuromonitoring but postoperatively impaired function of the vocal cords.

Zuverl�ssigkeit und Konsequenzen des intraoperativen Neuromonitorings in der Schilddr�senchirurgie

Intraoperative neuromonitoring (IONM) has yielded an increasing effect on thyroid surgery. During IONM, the recurrent laryngeal nerve is stimulated electrically and an acoustically transformed electromyographic signal is derived via either a needle electrode placed in the vocalis muscle or an electrode adjusted to the intubation tube. The IONM is used for identifying and predicting the function of the recurrent laryngeal nerve. Especially under difficult anatomic conditions, IONM has proven a valuable tool for identification of recurrent laryngeal nerves. This can lead to decreased occurrence of nerve palsy rates, as shown in numerous studies. The reliability of the IONM signal (defined as the correlation between intraoperative signal interpretation and postoperative vocal cord function) is reflected by a specificity as high as 98.2%, as shown by German multicenter studies. Thus, normal vocal cord function could be demonstrated postoperatively in over 98.2% of patients with intraoperatively unchanged neuromonitoring signals. If the neuromonitoring signal changed during operation, 39% of the patients suffered from transient vocal cord immobility and 12% had permanent loss of vocal cord function.

Treatment of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type with cladribine: a phase II study

PURPOSE

As chemotherapy has not been extensively studied in patients with lymphoma of the mucosa-associated lymphoid tissue (MALT), we initiated a prospective study to evaluate the activity of the nucleoside analog cladribine (2-chlorodeoxyadenosine [2-CdA]) in this disease.

PATIENTS AND METHODS

Patients with histologically verified MALT-type lymphoma were enrolled. 2-CdA was administered at a dose of 0.12 mg/kg body weight on 5 consecutive days, as a 2-hour infusion. Cycles were repeated every 4 weeks for a maximum of six cycles.

RESULTS

Nineteen patients with gastric and seven patients with extragastric MALT lymphoma were enrolled. All patients were chemotherapy-naive, and two had been locally irradiated before systemic relapse of the lymphoma. A total of 102 cycles was administered to our patients (median number of cycles per patient, four). All 25 assessable patients responded to treatment: 21 patients (84%) achieved complete remission (CR) and four patients achieved partial remission. All patients (100%) with gastric presentation, but only three patients (43%) with extragastric presentation, achieved CR. Toxicities were moderate and mainly hematologic and required dose reduction and/or premature discontinuation of therapy in only three cases. Two patients died from vascular events, one shortly after the first cycle because of myocardial infarction and the other from stroke 3 months after the second course. Three patients relapsed after 13, 18, and 22 months and one patient showed progressive disease after 15 months. At present, 24 patients are alive at a median follow-up time of 32 months.

CONCLUSION

Our data demonstrate that 2-CdA is highly effective in inducing CR in 84% of patients with MALT-type lymphoma.

[Intraoperative neurophysiological monitoring (IONM) of the recurrent laryngeal nerve and microdissection. Surgical techniques for decreasing the risk of recurrent laryngeal nerve paralysis]

BACKGROUND

Frequently numerous recurrent laryngeal nerve injuries occur after operations on the thyroid glands. Compared with postoperative permanent hypocalcemia, unilateral and especially double-side recurrent paresis pose serious complication. As early as 1938 specialists [1] pleaded for a routine visualisation of the nervus recurrens in operations of the thyroid gland, to reduce the risk of permanently recurring paresis. In controversial discussions of the matter specialists have opted for a demonstration of the nerve also under medico-legal aspects. Implementing functionally-critical operational strategies requires the choice of an anatomically suitable operative procedure for the removal of morphological, functional and oncological changes, as well as the avoidance of complications.

METHOD

Intra-operative Monitoring is highly recommendable as a neurophysiological method of supervision combined with microdissection to ensure the safe handling of recurrent laryngeal nerve.

CONCLUSION

The rate of permanent paresis on the recurrent nerve can be lowered to less than 1 per cent when this is used as a routine procedure for all operations and the treatment of the thyroid gland diseases.

Observations on simultaneous perilymphatic motions and cochlear microphonics suppression

Very low frequencies interfere in the intact cochlea with higher frequencies and suppress these depending on the vibration phase of the low-frequency sound. Physiological functions of the body, mediated, for example, by the eardrum or perilymph coupling with the cerebrospinal fluid, cause a low-frequency pressure modulation of the perilymph, which generates a synchronous perilymphatic motion resulting from the unevenly distributed compliances in the cochlea. This slow streaming causes a displacement of the entire basilar membrane, with as a consequence a postponement of the operating point of the mechanoelectrical transducer as a result of the pressure drop in the helicotrema and the narrow apical cochlear turn. In this contribution, interference phenomena are described, which are caused by spontaneous contractions of the tensor tympani muscle and by respiration-synchronous perilymphatic flow. These two test signals have trapezoidal and triangular impulse functions. In both cases, as suppression pattern of the cochlear microphonics level-time function, the second derivative of the pressure-time function was observed. The suppression is found to lie between 1 and 2 dB. It depends on the level of the suppressed sound and shows a compressive nonlinearity.

[Keratocysts of the jaws with an expansion to the skull base]

Ceratocysts prefer attaint the jaws solitarily or multiply. Familiar heapings are described in connection with the naevoid basal cell carcinoma syndrome (Gorlin-Goltz-Syndrome). In most of the patients they are removable simply by enucleation. The histological typing as a cyst suggests a harmlessness of the disease. There is a significant higher amount of recurrent cysts compared to other odontogenous cysts, whereas clinical symptoms are absent for a long time. That give reasons for findings of breakthrough to the skull base. There are no real alternatives for the impairing operation procedures. It is reported about 69 patients with ceratocysts. In 6.9% a breakthrough to the skull base was found. Therefore a radical operation procedure and a close meshed postoperative checking management with regular MRI and conventional x-ray will be demanded.

[Intraoperative neuromonitoring of the recurrent laryngeal nerve--routine use in thyroid gland surgery]

We present a simple and reliable method for identification of the recurrent nerve by intraoperative stimulation. An electromyographic record from the vocal muscle is obtained using a bipolar needle electrode inserted through the cricothyroid membrane. The recurrent nerve could be easily identified in 176 cases out of 181 nerves at risk (97.2%). We have not seen any cases of recurrent nerve paralysis and discuss the advantages of intraoperative neuromonitoring as a routine procedure.

Determination of 1-methylhistamine and 1-methylimidazoleacetic acid in human urine as a tool for the diagnosis of mastocytosis

The determination of the metabolites of histamine, 1-methylhistamine (MHIS) and 1-methylimidazoleacetic acid (MIIA), in human urine is a useful tool for the diagnosis of mastocytosis. MHIS was extracted under basic conditions with chloroform and derivatized with trifluoroacetic acid anhydride, MIIA was derivatized with pentafluorobenzylbromide prior to extraction under basic conditions and the derivative was extracted with chloroform. The samples were assayed by gas chromatography-mass spectrometry. Normal concentrations of MHIS (2.01 micromol l(-1)) and MIIA (21.3 micromol l(-1)) in healthy volunteers' urine samples are clearly detectable with coefficients of variation of 7.0 and 8.9%. Pathological concentrations of 10.1 and 113 micromol l(-1) for MHIS and MIIA, respectively, are quantifiable with coefficients of variation of 6.6 and 4.8%.

Successful treatment of disseminated facial verrucae with contact immunotherapy

Disseminated flat warts are a common therapeutic problem in immunocompromised patients. However, disseminated infection on the face is, even in the immunocompetent host, a challenge. We report on a 14-year-old girl who had suffered from increasing eruptions of multiple disseminated verrucae planae et filiformes of the face for 18 months. As an alternative to silk-touch CO2-laser, contact cryotherapy or systemic immune enhancer we administered topical immunotherapy with diphenylcyclopropenone (DCP). The initial challenge with DCP 2% was performed on the forehead and the challenge was repeated weekly with DCP 0.01%. After four applications, the girl reported peeling of single warts on the forehead but more importantly at distant sites which had not received DCP. After eight weeks the patient's face was free of lesions. So far, the patient has remained free from relapse. This is the first case report of successful topical immunotherapy with DCP in disseminated facial verrucae planae and should be regarded as an effective therapeutic tool in this indication, emphasizing the great advantage of prevention of scarring of the skin induced by other therapeutic modalities.

[Craniofacial abnormalities in the Charité Virchow Collection]

On 27 June 1899 Rudolf Virchow (1821-1902) inaugurated the Museum of Pathology at the Charité Hospital. The collection comprised 23,500 pathologic-anatomical specimens. Most of the collection was destroyed in World War II. About 2000 samples were saved. Meanwhile the stock has increased to about 9000 objects. The development, contents and structure of the famous Virchow Collection are described with special reference to craniofacial deformities.

[Natural coral calcium carbonate as alternative substitute in bone defects of the skull]

A biomaterial derived from natural corals with surgical applications is the calcium carbonate Biocoral. Since 1992 the author has been using this material as a bone graft substitute in maxillofacial surgery. Eighty-nine clinical implantations were done in 68 patients for different indications. The results suggested that coral grafts are well tolerated and are simultaneously partially ossified as the calcified skeleton is resorbed. Clinical cases show that use of this material has been successful.

[Second multicenter study of thrombocytapheresis using the Fresenius AS104 blood cell separator and ring study for quality control of cell counts. Members of the Preparative and Therapeutic Hemapheresis Section of DGTI]

The aim of the 2nd Multicenter study was to evaluate the separation protocol software version V 4.61 of the Fresenius AS 104 cell separator, for separation efficiency, WBC contamination and yield's deviation from prediction. Plateletpheresis data from 12 hemapheresis centers, using identical apheresis protocols and cell counting methods, were registered and statistically analyzed. Additionally, the counting methods of the centers were controlled by a ring study with biweekly cell counts. To get a comparison the apheresis data, which were dependent of the center effects, were corrected by the systematical deviation found in the quality control from the ring study. The results of 935 runs are 47.3 +/- 8.1% for the separation effectivity. 7.2% median deviation from predicted yield, whereby 90% of all runs deviated less than +/- 22% from predicted yields. 50% of products had a WBC contamination below 6 x 10(6), 99% below 5 x 10(7).

Radiographic manifestations of multiple myeloma in the mandible: a retrospective study of 77 patients

PURPOSE

This retrospective study was done to determine the frequency and radiographic pattern multiple myeloma in the mandible.

PATIENTS AND METHODS

Seventy-seven patients with multiple myeloma were studied using skull and panoramic radiographs of the jaws made at the time of initial diagnosis.

RESULTS

Skull manifestations were present in 46.7% and jaw manifestations in 15.6% of the cases studied. The pattern of jaw involvement was characterized by osteolytic lesions without other radiographic manifestations of bone involvement. There was no relationship between the pattern of jaw and extragnathic involvement and increased M-component of secreted immune globulin. Jaw involvement was largely unaccompained by oral symptoms.

CONCLUSION

The results suggest that mandibular lesions are a common finding in multiple myeloma.

Radical surgery (R2 resection) for gastric cancer. A multivariate analysis

BACKGROUND

Extended lymphadenectomy remains controversial in the Western world. Its evaluation and the identification of high-risk patients after surgery are important tasks.

METHODS

A retrospective prognostic study of 318 patients treated for potential cure of gastric cancer was performed. All patients underwent extended lymphadenectomy. Clinical histopathologic and surgical factors were examined for their influence on survival by univariate and multivariate analysis.

RESULTS

Postoperative mortality was 4.4% (14 of 318), and the 5-year adjusted survival rate was 57.8%. Multivariate analysis using the Cox model identified seven factors as having independent influence on survival. Detrimental factors were male gender, age over 65 years, high pN category, increasing number of lymph nodes invaded by metastases, total gastric resection, splenectomy, and increasing number of perioperatively required blood units.

CONCLUSION

Extended lymphadenectomy was possible without sacrificing low postoperative mortality rates. The importance of certain prognostic factors, in particular lymph node status, could be confirmed.

Transfusion results of cytapheresis platelet concentrates stored in two different polyolefin containers for five days

OBJECTIVE

Two different types of polyolefin storage containers were compared in order to estimate their ability to preserve apheresis platelet concentrates for 5 days.

MATERIAL AND METHODS

Ten pairs each consisting of one patient with thrombocytopenia following chemotherapy and one healthy platelet apheresis donor were examined. The platelet concentrates stored in the LE-2 bag were collected with a Fresenius AS 104 cell separator and those stored in the PL 732 with a Fenwal CS 3000.

RESULTS

The separation efficiency of both cell separators was similar; the mean yields were 3.37 +/- 0.83 x 10(11) platelets in 274 +/- 26 ml for the AS 104 and 3.87 +/- 1.31 x 10(11) platelets in 318 +/- 22 ml for the CS 3000 (mean +/- SD). Storage for 5 days did not influence the platelet count significantly. The platelet loss due to filtration was 16 and 13%, respectively. The mean platelet volume obtained with both systems was reduced from a mean of 8.4 fl immediately after harvesting to 7.6 fl after storage (p < 0.0001) and to 7.3 fl after filtration (p = 0.001). The established corrected count increments (CCI) and the pre- and posttransfusion platelet counts were satisfactory and comparable for the 2 systems tested. The mean CCI of the AS 104-LE-2 system was 14.5 1 h and 7.4 x 10(9) platelets 24 h after transfusion, the mean CCI of the CS 3000-PL 732 system was 12.5 and 5.2 x 10(9) platelets, respectively.

CONCLUSIONS

Single-donor apheresis concentrates with a large platelet content may be stored in the new LE-2 polyolefin container for up to 5 days and used in clinical transfusion.

Phonemic structures of delayed phonological systems

The phonemic inventories of 30 children (aged 3;4-5;7) with phonological delays were examined in terms of featural distinctions in order to address universal vs. individual accounts of acquisition. Phonetic inventories of these same children were also identified for comparison purposes. Across children, four hierarchical and implicationally related types of phonemic inventory were identified. The typology uniquely captured common distinctions maintained by all children, and at the same time, allowed for individual differences in the specific phonemic composition of each system. These cross-sectional results have theoretical implications for the longitudinal course of phonemic acquisition. In particular, children appear to have a number of linguistic choices that relate to the course, the specifics, and the mechanism of change in acquisition.

German multicenter studies on plateletpheresis from healthy donors. German Hemapheresis Study Group

It is reported on two German Multicenter Plateletpheresis Studies with the Fresenius AS 104 cell separator accompanied by a Multicenter Counting Study. 15 centers participated, a total of 1884 separations were evaluated. It could be shown that multicenter studies help to give a more objective opinion about a cell separator and the separation protocol used if it is possible to improve the counting methods and to eliminate individual center effects by an accompanying Multicenter Counting Study. The AS 104 proved to be a good cell separator for platelet collection regarding platelet yields (3.1 x 11" from 3.5 I citrated blood), separation efficiency (about 45%), yield prediction (SD = not equal to 15%) and leukocyte contamination (median WBC 47 x 10(6)).

[Preliminary results of the 2nd multicenter study. Thrombocytapheresis with the Fresenius AS-104 blood cell separator and ring study of cell counting. Section of Therapeutic and Preparative Hemapheresis of the DGTI]

Only multicenter studies on cell separators give valid data to compare different cell separators. The aim of the 2nd multicenter study was to evaluate the separation protocol, software version V 4.61, of the Fresenius AS-104 cell separator for efficiency and deviation from predicted yields. Plateletpheresis data from twelve hemapheresis centers, using identical apheresis protocols and cell counting methods, were registered and statistically analyzed. Additionally, the counting methods of the centers were controlled by a ring study with biweekly external cell count trials. To get a comparison, the apheresis data, which depend on the center effects, were corrected by the values from the ring study. Preliminary results of 380 runs are 45.2 +/- 8.1% for the separation effectivity, 1.95% deviation from the predicted yield, whereby 90% of all runs deviated less than 20% from the predicted yield. 50% of products had a WBC contamination below 6 x 10(6).

Multicenter study of standardization of cell counting. Haemapheresis Scientific Workshop Group of DGTI

Multicenter studies on cell separators give valid data (which can be compared between the different centers) only if the cell counting methods are uniform. This has to be demonstrated by ring studies or multicenter counting studies. Twelve apheresis centers involved in a multicenter study for the evaluation of the Fresenius AS 104 cell separator participated in such a ring study from July 1990 to July 1991. The twelve participating centers split into three significantly different groups according to the platelet counts in the platelet concentrates and a calculated pseudo extraction efficiency. No differences could be found in the white and red blood cell counts. No mailing effect--or time effect--and no personal effect could be found in the reference center.

Improvement of separation efficiency and concentrate purity of the Fresenius cell separator AS 104: results of a multicenter study. Haemapheresis Scientific Workshop Group of DGTI

The aim of this multicenter study, initiated by the Haemapheresis Scientific Workshop Group of the DGTI was to evaluate separation protocols for the cell separator AS 104, marketed by Fresenius, using modified software and parameters which were believed to allow a more effective platelet collection with a significantly lower leukocyte contamination of the concentrates. Plateletpheresis data from 950 runs in ten hemapheresis centers, using virtually the same equipment, identical pheresis protocols, and cell counting methods were registered and statistically analyzed for each center and machine-related differences. Additionally, the counting methods of the centers were controlled by bi-weekly external cell count trials, and the plateletpheresis data were corrected using the results of these cell count trials, to obtain a comparison of the two versions of the protocol independent of the center effect. For protocol (or software version) 4.1, 610 runs were registered. The results of cell countings (chamber) are (given as means+/-standard deviations) 3.452x10 11+/-1.009x10 11 for the platelet yield (or thrombocyte yield), 9x10 6+/-23x10 8 for leukocyte contamination, and 17x10 6+/-70x10 6 for the erythrocyte contamination, and 53%+/-13.5% for the extraction efficiency, respectively. For software version 4.4 with 340 runs, the results are 3.642x10 11+/-0.974x10 11 for the platelet yield, 15x10 6+/-74x10 8 for leukocyte contamination, 20x10 6+/-44x10 6 for erythrocyte contamination, and 59%+/-12.4% for the extraction efficiency, respectively. For the leukocyte and erythrocyte contaminations, the means and standard deviations must be interpreted carefully since the statistical distribution showed a considerable skewing of the data. From the automatic counts, marginally smaller means were found. The data were corrected by the values from the ring study; and for these mathematically corrected data, statistical tests showed a significant improvement in the extraction efficiency from software version 4.1 to 4.4. At the same time, the leukocyte contamination was significantly lower with version 4.4.

New polyolefin foil for 5-day storage of platelet concentrates (PC) collected by apheresis

In a paired study 12 platelet concentrates (PC) of Fresenius AS-104 cell separator were stored in new polyolefin bags of Fresenius (LE2) and Fenwal PL-732 bags. On day 0 and after 3 and 5 days of storage pH, pO2, pCO2, cell counts, platelet morphology and aggregability, plasma glucose, lactate, LDH and beta TG were determined. The overall changes fell within the expected range. No relevant differences between the two bags could be detected, although a few parameters (pH, pCO2) are slightly but statistically/significantly different. It can be concluded that the new polyolefin bag is well suited for 5-day storage of PC's from the AS-104.

Teaching and learning /θ/: A non-confound

The purpose of this study was to replicate and extend the findings on the effectiveness of homonymous versus non-homonymous treatment approaches for children with phonological disorders, following Gierut (1991b). The present study was motivated by a potential confound noted in the previous report; namely, the specific sounds /θ, θ/ treated in the presumably less effective homonymous condition may have inhibited degree of phonological change. It was thus necessary to teach these more difficult, late-acquired interdental fricatives in the more effective non-homonymous treatment condition using identical methods and procedures. Results indicated that a non-homonymous teaching approach again motivated greater phonological change than a homonymous approach, regardless of sounds that were taught. These findings have implications for the independence of linguistic structures of treatment in inducing sound change, and bear upon assumptions about ease of sound learning based on normative developmental sequences.

[Clinical experience with different modes of preoperative radiotherapy in advanced carcinomas of the tongue and the floor of the mouth]

In a controlled prospective study of 90 patients with locally advanced but operable epidermoid carcinomas (T2/T3N0-3M0) of the tongue and the floor of the mouth underwent 3 types of preoperative radiation: 1.5 x 5 Gy; 2.15 x 2 Gy and 3.5 x 2.5 Gy. The preoperative radiation led to a marked decrease of local recidives and to a lengthening of the recidive-free interval respectively. The type of preoperative radiation 5 x 5 Gy seemed to have the most favourable results. Otherwise the preoperative radiation had no advantages in regard to a better prevention of regional metastases and because of that there is no indication for it.

[Reasons for the neglect of orofacial and alveolar malignancies]

In 1983 we treated 71 patients with orofacial and alveolar malignancies. In 25 cases the tumor had advanced beyond T2. An evaluation of their inpatient treatment data demonstrated that the lesion had been neglected by patient and physician. Our results clearly stress the need for information of the citizen and specialised postgraduate training of physicians and dentists about the early detection of orofacial malignancies.

Early evening ranitidine administration promotes faster duodenal ulcer healing

In a prospective double-blind clinical trial, 141 patients with endoscopically diagnosed duodenal ulcer were randomly assigned to treatment with ranitidine 300 mg, taken either at 6 PM or at 10 PM. After 2 wk of treatment, 52 of 70 patients (74%) in the 6 PM treatment group had healed, compared with 32 of 64 patients (50%) taking ranitidine at 10 PM (p less than 0.01). After 4 wk, the cumulative healing rates were 100% and 94%, respectively, for the 6 PM and 10 PM treatment regimens. These results suggest that ranitidine, taken as a single daily 300-mg dose at 6 PM after dinner, provides more rapid duodenal ulcer healing than the same dose of the drug taken at 10 PM.

Improvement of the safety systems in cell separators. The new safety concept for the cell separator AS 104 (Fresenius)

The new, extended safety requirements for cell separators call for a new generation of machines to address current safety needs. In order to ensure safe treatment, the complete safety concept is of decisive importance - this includes closed seal-less systems, continuous operation, fractions collected externally to the centrifuge, and pump tubings, connections and clamps which are color and direction coded. 'Human failure' as a cause of fault should be excluded for these highly technical appliances - for example, through the use of 'fail-safe' circuits, drip-controlled ACD flow by a separate adjustable pump, detection of damages to blood components by hemolysis control.

[The effect of prednisolone bisuccinate on the prenatal development of the Wistar rat]

The action of prednisolone bisuccinate (Prednisolut) was tested on Wistar rats during two stages of prenatal development (embryonal development and early fetogenesis). Prednisolone application leads to phase-specific and dose-dependent disturbances in normogenesis (increased rate of resorption and retardation).

[Relations between sperm findings and fertility prognosis in childless couples]

In eight andrological centres more than 2,000 childless married men were examined catamnestically. Fertility was compared with the findings of the routine spermatograms. Conception rate is reduced significantly if sperm density is below 10 million, in motility of spermatozoa under 50% and in ejaculates with less than 60% normal-shaped spermatozoa. However, lower values of spermatozoa must not be compared with absolute infertility.

[Catamnestic study about the fertility of the man (author's transl)]

Collective investigations of fertility in childless married couples were carried out in 9 andrological health centres of the GDR. Analysis of 1937 spermatograms in comparison to fertility after 1 to 2 years shows: (1) Fertility decreases significantly at sperm density nearly 10 million per ml. (2) Motility below 60 per cent caused reduced fertility. Normal motility is more important than normal density of spermatozoa. (3) Fructose level doesn't correlate to motility or fertility of man.

[Influence of centrophenoxine on the effect of cyclophosphamide and chloramphenicol in teratological experiment]

Cyclophosphamide and chloramphenicol underwent a teralogical test in the animal experiment. The prenatal changes in the application of cyclophosphamide reveal the cytostatic remedy as a strong teratogenic remedy, whereas chloramphenicol in the first place has an embryotoxic effect and only a weak teratogenic one. The possibility of an influence on the prenatal changes caused by cyclophosphamide and chloramphenicol was tried with centrophenoxin. Apart from the weight of the foetuses the induced changes remained without influence in cyclophosphamide, whereas in chloramphenicol even in increase of the toxic effect could be observed.