Experience with the locking nail (author''s transl)

Although difficult, recurrent forms of pterygium are seldom seen in central Europe, they cause considerable therapeutic problems because they cannot be cured by simple dissection and conjunctivoplasty. A useful method of treatment in these cases is the marginal, lamellar keratoplasty, which, according to the type of involvement, can take the shape of a sector, ring, horseshoe, or semicircle. If the pterygium is extensive and affects the center of the cornea, a subtotal, lamellar keratoplasty can be performed. The rate of recurrence in the group of 35 lamellar keratoplasties which we performed amounted to a satisfactory 31%. Only rarely did a pronounced astigmatism cause a decrease in the visual acuity postoperatively. Essential for the success of the procedures are exact surgical techniques and local use of atropine and cortison postoperatively. Just as with other surgical procedures, however, the lamellar keratoplasty cannot be considered the perfect method for all pterygiums.     

Hemihypertrophy with wiedemann-Beckwith-syndrome (author''s transl)

Immunosuppressive agents were used to determine the relative importance of T and B lymphocytes in conferring protection to mice vaccinated with a live gal E mutant of Salmonella typhimurium, strain G30D. Lymphocyte transformation and serum agglutination tests showed that while cyclophosphamide (CPA) suppressed B lymphocytes, antilymphocyte sea (ALS) suppressed both T and B cells. The humoral response of vaccinated animals treated with ALS was therefore supplemented by the i.v. injection of serum from untreated vaccinated mice. CPA-treated mice could not control multiplication of the vaccinal strain which eventually killed them. There was little multiplication of the vaccinal strain in the controls and ALS-treated mice, all of which survived to challenge. The vaccinated controls and vaccinated ALS treated groups each survived infection with the challenge strain which was gradually eliminated. It was concluded that humoral immunity was of greater importance than cellular immunity in mice vaccinated i.p. with strain G30D.     

Experience with a one-stage hypospadias repair (author''s transl)]

In order to assess the relative significance of precordial ST-segment elevations and depressions, 32 patients with anterior transmural myocardial infarction were studied utilizing serial 49-lead precordial maps. Theoretically, zones of ST-segment depression adjacent to major zones of ST-segment elevation might represent border areas of mild ischemia, and hence could be more readily amenable to intervention therapy. As expected, an extensive zone of ST-segment elevation was observed precordially in each of these patients. However, zones of ST-segment depression in adjacent areas were noted to occur inconsistently, were limited in distribution and magnitude, and bore no fixed relationship to zones of ST-segment elevation. Thus, mapping of precordial ST-segment depression in anterior transmural infarction probably has a limited role in assessing evolution of ischemic injury or therapy in these patients. This finding does not, however, vitiate the significance of ST-segment depressions in angina, intermediate coronary syndrome, or non-transmural infarction, conditions which may deserve further study using mapping techniques.     

Histopathology and histochemistry of psoriasis under photochemotherapy (author''s transl)

Fifty-two biopsies from involved and clinically normal looking skin of patients with psoriasis vulgaris and from normal control subjects, all being treated with 8-MOP-UVA (PUVA) were obtained between days 2 and 300. The following parameters were investigated: 1. initial PUVA effects; 2. initial regression of psoriasis under PUVA-therapy; 3. late effects of PUVA-therapy on regression of psoriatic lesions; 4. EFFects on melanocytes and pigmentation; and 5. long-term effects of PUVA-therapy. Paraffin embedded and cryostat sections were prepared with routine stains for light microscopy and enzyme histochemical special stains. The regression of psoriatic lesions following PUVA-therapy was separately assessed for epidermal and dermal components. The sequence of events was as follows: re-establishment of a continous stratum granulosum, re-establishment of a continuous normal appearing stratum corneum, regression of acanthosis and papillomatosis, and regression of inflammatory infiltration. During the initial phase of PUVA-therapy there is a sharp increase of melanocytes which leads to a foamy appearance of the basal cell area. Long term studies did not reveal actinic damage of the skin, neither in the epidermis (absence of actinic keratoses or squamous cell carcinomas) nor in the dermis (absence of actinic "solar" elastosis).     

Infusiontherapy with colloidal volumesubstitutes (author''s transl)

All colloidal plasma substitutes carry the risk of anaphylactoid complications with a general incidence of 0.03%. This incidence seems low; however severe complications may occur after infusion of colloids, including also human albumin solutions. In spite of the risk of anaphylactoid reactions, however, colloids should not be ommited from volume replacement therapy. When choosing a colloid for volume replacement the solution-specific risk of anaphylactoid complications has to be taken into consideration. From an increasing number of recent case reports the impression of a rising rate of complications has emerged; this impression was not substantiated by a prospective controlled trial performed in 1975. Since dextran in addition to its safe volume effect possesses well documented antithrombotic properties, it cannot be replaced by any other colloid without the addition of another thromboprophylactic agent.     

Hallucinantion and illusion (author''s transl)

The value of an anaesthetic attachment during the first two postgraduate years is considered under three major headings, the value to the recent graduate, the value to the specialty, and the value to the community. The anaesthetic attachment offers all recent graduates an opportunity to perfect practical skills which should from part of the armamentarium of all doctors, and for some there is the option to acquire the ability to administer a safe anaesthetic. Exposure to the specialty at this time is important for recruitment to the specialist ranks.     

Critical flicker frequency (CFF) in the central and peripheral visual field (author''s transl)

The concentrations of total fatty acids and free cholesterol in the plasma of Ayrshire calves decreased following, but not during, short-term exposure to heat. Lower concentrations of total fatty acids and free cholesterol were maintained on prolonged heat exposure. Blood and plasma volumes were little affected by either short-term or prolonged heat exposure. Haematocrit rose during short-term heat stress and on prolonged heat exposure there was a decrease in erythrocyte fragility.     

Repeated method operations in recurrent urinary incontinence (author''s transl)

The author thinks that psychiatric examination (asked by the judge) can be a therapeutic act: the first. The expert should not think he is a therapeutic man, nor should he say he is, but he must create by his intervention the circumstances that are necessary for a therapy.     

Clinical and experimental results with acupuncture-analgesia (author''s transl)

Transfer RNA and aminoacyl tRNA synthetases were obtained from hormone dependent and independent mammary tumors of GR mice. We have studied the possible changes in the tRNA level by comparing the specific activities of the hormone dependent and independent mammary tumor tRNA's, but no differences were observed. Differences were found in the ability of enzymes from normal male GR mice liver, independent mammary tumor and dependent mammary tumor to cross-react with heterologous tRNA.     

Long-term observation of ablatio-prophylaxis with kryopexy (author''s transl)

Five cases of laceration of an extraocular muscle without involvement of the globe or significant involvement of the adnexa occurred after injury with a pencil, mower blade, screen door, and building nail, and at surgery when the surgeon operated on the wrong muscle. The inferior rectus muscle was involved in three cases, the lateral rectus muscle in one, and the medial rectus muscle in one, Traumatic muscle laceration involves the inferior or medial rectus muscles more often than the other muscles. This may occur for two reasons: these muscles are closer to the corneoscleral limbus, and they are more visible during the protective blink with associated upward and usually outward movement of the globe (Bell's phenomenon). When the lacerated muscle could be found, it was repaired either by reinsertion to the sclera or reunion of the severed muscle segments. When the muscle could not be found, a muscle transfer procedure was carried out. Patients with fusion before injury regained fusion in part of the visual field after muscle repair.     

Examinations of the verbal patient-doctor-communication (author''s transl)

Any impairment of audio-phonatory control by background noise is followed by an increase in both the intensity and pitch of the speaking voice (Lombard reflex, 1911), thus increasing vocal strain. As a consequence, it might be anticipated that persons reacting to noise with marked changes in voice might be more liable to develop dysphonia. 22 singers, 34 normal controls, and 22 patients with hyperfunctional dysphonia where studied. In all patients, both ears were gradually masked with white noise. The change of the mean intensity level and of the mean pitch level of the speaking voice were then measured objectively with a special fundamental frequency analyzer (Fedders and Schultz-Coulon, 1975). Results show that the increase of intensity is comparable in all subjects, whereas the elevation of the mean pitch level differs significantly: trained voices (singers) react with the least pitch increment whereas dysphonic patients react with the most. The following conclusions were made from the present investigation: 1. Extreme increments in pitch level can be considered to be a more significant etiological factor of dysphonia than intensity increments; 2. Vocal therapy and voice training may have a favorable effect on the Lombard reflex (probably by improvement of the kinesthetic control mechanism) so that the speaking voice in a noisy environment is raised less with less vocal strain. The study also indicates that measurement of pitch changes during binaural masking can provide important information for the diagnosis, therapy and prophylaxis of dysphonia.     

Phlebography of the lower limb (author''s transl)

The deformities observed in 2 Clydesdale foals are described. Both had abnormal joint positions in the forelimbs and discrepancies in the symmetry of the vertebral column. The changes were only mild in one case but extreme in the other where it was accompanied by torticollis, scoliosis and vertebral fusion. A comparison is made with deformities described in the contracted foal syndrome and some of the developmental implications discussed.