Micturitional disorders in multiple sclerosis (author's transl)

Micturitional disorders in multiple sclerosis have often an insidious onset; they aggravate during acute attacks of the nervous disease and are strongly influenced by the general condition of the patient, the evolution of his muscular spasms and the therapeutical measures. This changing behaviour of the bladder makes it necessary to perform repeated cystometries, uroflowmetries and electromyographies of the striated sphincter in order to adapt vesical therapy to the evolutive stadia of the disease. Although good results are frequently obtained by drugs (sympathicomimetics, sympathicolytics, muscle relaxants, parasympathicomimetics, parasympathicolytics), by transurethral resections of internal and/or external sphincters and by phenolisation, we feel that urinary derivations remain indicated for some patients, especially in order to facilitate social integration.     

Contraception and multiple sclerosis (author's transl)

This survey about the contraceptive behavior of women with multiple sclerosis (MS) established that they take less oral contraceptive (OC) agents than the general population; they were more frequently sterilized, or indicated that no sex relations were practiced. Young women in the group of MS patients and in the general population preferred OCs; while the number of sterilized women increased only for the general population with increasing age. Remarkably many 20-29 year old MS patients were already sterilized (16%). In half of the patients, who before their illness used OCs, MS began coincident with this use. However, only 14% of the women with MS deteriorated when they chose OCs. Considering that OCs were taken for many years, and that this time is also the susceptible age for MS, it may be presumed, that this is only a temporal coincidence. The calculation of the prognosis from the parameters "disablement" and "illness duration" does not distinguish between women with or without OCs. Accordingly, patients with MS can be advised in the taking of OCs insofar as no other contraindications exist.     

Pulmonary mechanics of bronchial asthma (author's transl)

Airway resistance was measured in 10 patients with bronchial asthma before and 5--30 minutes after gradual effort of 60 and 95 watt by means of bodyplethysmography. The resistance values showed three typical alterations: 1. no reaction; 2. decrease of resistance at 60 watt and increase at 95 watt; 3. increase at both degrees of exercise. In another group of patients with asthma the resistance was determined by means of the eosophagus-balloon method before, during and after exercise. The trend of resistance alteration was not identical during and after exercise. This behaviour of bronchial obstruction shows that unspecific factors affect the pulmonary mechanics because of the changed bronchial reactivity. The behaviour of a single patient with bronchial asthma is not predictable.     

Familial nephrotic syndrome with focal glomerular sclerosis (author's transl)

This is a report about three siblings (one boy and two girls) suffering from a clinically- and morphologically-identical form of renal disease. The disease began in each case with symptomless proteinuria at the age of 3 years and proceeded after several years to the full-blown picture of idiopathic nephrotic syndrome with the rapid development of renal insufficiency. Histologically, minimal proliferative intercapillary glomerulonephritis with focal sclerosis was found in all 3 cases. This condition was resistant to steroid and immunosuppressive therapy. The incidence and the morphological, clinical and therapeutic peculiarities and the prognosis of familial nephrotic syndrome are discussed on the basis of these case reports.     

Cystic changes in the lungs in childhood (author's transl)

Two boys with presumably congenital cystic changes in the lungs are described. In one child multiple cystic deformations led to acute symptoms of severe respiratory distress necessitating urgent resection of the right middle and upper lobes. The other boy had a large thick-walled cyst in the left upper lobe causing no distress whatsoever. This patient was observed for more than 6 years before operation. Multiple vascular anomalies and anastomoses were revealed during surgery. Both cases are presented in detail and the completely different clinical course is outlined. Only when careful supervision of intrapulmonary cystic changes is guaranteed can operation be postponed for longer than 6 months. Pulmonary cysts may lead to emergency procedures. They are always a potential source of serious complications such as rupture or infection. When no tendency for regression can be discovered surgical removal is indicated. Conservative treatment will not influence the course. Differential diagnosis is discussed briefly.     

Pulmonary artery end-diastolic pressure recordings after myocardial infarction (author's transl)

29 patients with acute myocardial infarction were subdivided into 3 groups using the information gained by continuous measurement of the pulmonary artery end-diastolic pressure (PAEDP) during a stay of 3 to 5 days in the coronary care unit of this hospital. Group I comprised patients with a PAEDP of below 12 mm Hg (without treatment), group II those with a PAEDP of between 12 and 20 mm Hg and group III those patients with a PAEDP of above 20 mm Hg. 3 to 6 months after rehabilitation and ambulant "coronary training' a follow-up control PAEDP measurement was performed at rest and during ergometric stress with the bicycle exercise test. 2 out of the 15 patients in group I had a pathological PAEDP at rest, whilst exercise of 50 watts raised the PAEDP to pathological values in 40% of this group of patients. Group II: 58% of the patients with an initially-raised PAEDP showed a normal value at follow-up examination 3 months subsequently. Exercise of 50 watts raised the PAEDP to pathological values in 66% of the patients in this group. Group III. The pathologically high PAEDP recordings at rest made it impossible to subject these patients to stress with the bicycle ergometer. The prognostic value of the classification of patients with myocardial infarction into pressure groups and the importance of PAEDP follow-up measurements on patients after myocardial infarction at rest and after ergometric stress are discussed.     

Preovulatory changes of steroidogenesis in isolated rabbit follicles (author's transl)

In an attempt to investigate the effect of ovulating hormone on the steroidogenesis of mature follicles in the course of ovulation, transitory changes of steroidogenesis in isolated rabbit follicles have been studied at several intervals after injection of an ovulatory dose of human chorionic gonadotropin (hCG). Five to ten follicles of approximately 1-2 mm in diameter were isolated from ovaries of a mature rabbit (2.5-3.0 kg) under streomicroscope, before and at the 3rd, 6th, 9th and 12th hours after intravenous injection of of 100 IU/kg of hCG. Follicles were incubated with 100 muCi of acetate-1-14C in 2 ml of Krebs-Ringer bicarbonate buffer (pH 7.4) at 37 degrees C for 3 hours under 95% oxygen plus 5% carbon dioxide. Each incubation was terminated by quick freezing and stored forzen at -20 degrees C until eighty follicles had been collected for each time period before commencement of analysis. Incorporation of radioactive acetate into pregnenolone, 17-hydroxypregnenolone, progesterone, 17-hydroxyprogesterone., 20 alpha-dihydroxyprogesterone, dehydroepiandrosterone, androstenedione, testosterone, estrone and estradiol-17beta were analysed by the reverse dilution technique and identified in radiochemically pure form by recrystallization to constant specific activities. The steroidogenic activity of the follicles was evaluated by overall as well as fractionated incorporations. A peak in the overall incorporation of 14C- acetate into the ten steroids at the 3rd hour after hCG injection, followed by gradual decrease up to the 9th hour was observed. The incorporation decreased markedly to a minimum level at the 12th hour after hCG injection, which was below the level of preinjection control. Comparable quantitative fluctuations were found with the fractionated incorporation of 14C-acetate into the C21 and C18 steroids in the time sequence following hCG injection. However, the fractionated incorporation into C19 steroids reached to a maximum at the 6th hour after hCG injection. 5istribution patterns of incorporation among the individual steroids were varied at each interval of time. In the non-injected control, mature follicles synthesized predominantly estradiol-17beta, testosterone and androstenedione. Divergent steroids were formed from radioactive acetate at the 3rd hour after hCG injection. These included porgestogen, androgen and estrogen, but pregnenolone and 17hydroxyprogesterone were the two principal steroids produced. There was no essential difference in the steroidogenic patterns between the 6th and 9th hour, the major products being C21 and C19 steroids such as pregnenolone, 17hydroxyprogesterone, dehydroipiandrosterone and testosterone. The three androgens were the major steroids formed at the 12th hour after hCG injection. Thus the chages in the steroidogenic profile of the follicle was obvious in the course of ovulation. The basis of qualitative changes in follicular steroidogenesis during the process of ovulation have been discussed in connection with an accompanying effect of an ovulatory dose of hCG.     

Dumping-prophylaxis (author's transl)

The dumping syndrome is due to a vigorous reflex distension of the jejunum, caused by the stomach violently evacuating its contents. The aim of treatment is to overcome the drastic evacuation by restoring the rhythmic peristalsis of the stomach (eukinetics). This can be achieved by a special diet. Every meal should begin with well chewed solids (pulp) and avoid all fluids. With a well organised medical staff a complete success can be achieved. Surgical measures in Dumping can be avoided.