The Wyburn-Mason syndrome (author's transl)

A patient aged 39 years with Wyburn-Mason syndrome is presented. He had an apple-sized intracranial arteriovenous angioma racemosum of the left temporo-medical region, which was inoperable, as it extended to the basal ganglia. It was diagnosed by carotid angiography and by sequential brain szintigraphy. More than 50 retinal arteriovenous anastomoses were observed in the left eye, involving all quadrants and the macular region. Some of these anastomoses were only found by fluorescence angiography. Clinical signs were hemiparesis and decreased sensibility of the right side, headaches, speech disorders and right homonymous hemianopia. Vision was decreased to 0.4. By partial embolisation via the right common carotid, it was possible to reduce the size of the intracranial hemangioma.     

Osteodysplasty (Melnick-Needles syndrome) (author's transl)

Authors report a new case of osteodisplasty (Melnick-Needles syndrome) and describe radiological findings that are typical of this entity: bony sclerosis of base structures, abnormal dental alignment, sclerosis and irregularity of clavicles and ribs, described as "band-like" deformity, cortical irregularity of tubular bones with metaphyseal flaring and diaphyseal bowing. Flat bones are broadened, particularly iliac crest and vertebral bones. Facial features described by the majority of authors in this entity are present in our patient in an incomplete form: craniofacial disproportion, micrognatia, depressed temples, exophthalmus (not in our patient) and broadened forehead. The paper is intended to gather clinical data of already reported cases in order to facilitate clinical research in the future from the immunological, genetical and biochemical points of view. Our patient has the same clinical history as the patient studied in the original paper. Dr. Melnick was kind enough to send us clinical data and autopsy findings.     

The role of neurasthenic syndrome in depression (author's transl)

In endogenous depression a neurasthenic syndrome is partially included. In 100 male cases whose diagnoses merely stated "endogenous depression" without further remarks like "neurotic traits" or "reactive influences", we found in 48 cases a clear neurasthenic syndrome. It is suggested that these symptoms often lead to the diagnosis of endogenous depression. Pharmacotherapy is partially directed to the neurasthenic condition. Hereditary factors may play a part in the unability of the later endogenous depressive to relax.     

Vater or Vacterl syndrome (author's transl)

Analysis of malformations in 65 newborns with limb anomalies, 39 with esophageal atresia with tracheoesophageal fistula, and 41 with anal atresia confirmed the nonrandom tendency for the defects of the VATER or VACTERL syndrome to associate together. 11 new patients with 4 or more of these anomalies were compared with 41 previously reported cases. There was good agreement with reference to the frequency of the major malformations noted in the VACTERL association. While anal atresia was not so common in our patients, cardiac anomalies and radial limb dysplasia occurred somewhat more frequently. In accordance with previous findings we also emphasize a single umbilical artery as one of the malformations in the spectrum of the VACTERL association (V = vertebral defects and vascular anomalies). Because of the high incidence of rib anomalies in our patients and in earlier cases with complete medical records it is suggested that the scope of the VACTERL association should be enlarged by this malformation. Thus the R in VACTERL would stand not only for renal defects but als for rib anomalies. Furthermore, the spectrum of anomalies could be extended by auricular defects (A = anal atresia and auricular defects). When one of these VACTERL components is found attention should be drawn to the possibility of the presence of the other associated anomalies. The developmentally correlated malformations seen in the VACTERL syndrome are generally sporadically observed. At the present time the etiology is unknown but heterogeneity is suggested. Although a causal relationship between maternal intake of progesteron/estrogen during the vulnerable period of embryogenesis and the VACTERL syndrome has been suggested, none of the mothers of our patients were exposed to these hormones during early pregnancy. Cytogenetic investigation in one patient and his mother showed a so-called marker chromosome 9 (C9qh+ variant) which is difficult to interpret at the present time.     

The syndrome of inappropriate secretion of vasopressin (SIADH) (author's transl)

The syndrome of inappropriate ADH secretion ("SIADH") was first recognized 1935 by Roth et al. and described in detail 1957 by Schwartz et al. The clinical symptoms (hyponatremia, hypertonicity of urine and inability to excrete a water load) are caused by inadequately elevated ADH secretion under a variety of situations and diseases. Some recent work was focused on the pathogenesis of this syndrome and new clinical findings (low plasma levels of uric acid and potassium) as well as special forms ("SIADH" without elevated vasopressin levels in plasma) are thought to be of relevance. New therapeutical recommendations will be discussed.     

The jet-wash-technique (author's transl)

For the early detection of the endometrial adenocarcinoma the Gravlee-Jet-wash-technique was used in 600 cases. The procedure is simple and requires only 2 to 3 minutes to the gynecologist. An anesthesia is not necessary. In women with stenosed os externum and in anxious patients we use an analgesia of the paracervix (PCB). The technique allows a cytologic and/or cytohistologic investigation. In 600 examined cases we found 37 endometrial adenocarcinomas. We obtained a 100 per cent accuracy in the detection of the 37 malignant lesions. Our experience up to now with the Jet-wash-technique should stimulate its wider use also for outpatients with a high risk for the endometrial adenocarcinoma.     

Myocardial infarction after accidents (author's transl)

In a 27-year-old man blunt chest-wall trauma after a car accident gave rise to several retrosternal pain. Coronary angiography demonstrated severe generalised coronary arteriosclerosis. The history revealed heavy smoking (60 cigarettes daily for ten years). Although it must be assumed that there was severe generalised coronary arteriosclerosis without angina pectoris before the accident, the infarction was considered to be a direct consequence of it: it prematurely precipitated the infarction. In a second case, of a 37-year-old woman, severe precordial pressure and contusion of the thorax occurred after a collision. Cardiac symptoms developed two months later and two weeks after this acute myocardial infarction occurred. Coronary angiography demonstrated isolated sub-total occlusion of the anterior interventricular branch in the upper third of the septum without other abnormalities. Because of the two month symptom-free interval, trauma and subsequent myocardial infarction are thought not to be causally related, especially as the patient was a heavy smoker and taking oral contraceptives.     

Physiotherapy after lung resection (author's transl)

Physiotherapy for lung resection begins well before the operation and should serve to improve the respiratory function and to prevent complications. The whole training programme should be carried out in an automated manner, this is especially important for the time immediately after the operation. Postoperative physiotherapy aimsat thorough cleaning of the bronchi, adaption of the ventilation, good peripheral circulation and helps to diminish would pain. In a later period physiotherapy should help to rehabilitate the patient's external respiratory function to train the respiratory stereotype and to improve cardiopulmonary effiency.     

The emptying process of the residual stomach after various methods of anastomoses (author''s transl)

Similar to the high pressure zone of the lower esophageal segment (LES) gastric emptying results from alternating intraluminal pressure in the antrum, pylorus and duodenum. Alterations of this antro-duodenal pressure zone depend on hormonal and nervous control mechanisms and are regulated by intraduodenal localized pH-, osmo- and fat-receptors. Experimental investigations in partially gastrectomized dogs emphasize the important role of the duodenum for gastric emptying. After resection of the lower half of the stomach and reconstruction of the orthograde passage between the gastric remnant and the duodenum by gastroduodenostomy (b i-anastomosis), a hormonally controlled gastric emptying comparable to that of the intact organ can be noticed.     

Further reproduction after clomiphene-induced pregnancy (author's transl)

The study of menstrual pattern and further pregnancy after clomiphene-induced pregnancy showed a comparatively high rate of improved menstrual pattern and of spontaneous conception. 12 of 29 women, who concluded a clomiphene-induced pregnancy more than 2 years ago, showed an improvement of menstrual pattern. Spontaneous conception occurred in 16 of the 29 women, in 2 cases once more. It is remarkable, that 7 of these 16 women conceived spontaneously without any improvement of menstrual pattern following the clomiphene-induced pregnancy. It is therefore difficult, to advise patients and to make a prognosis concerning further fertility. It is not possible to say, that spontaneous conception can be excluded respectively that it will occur. In case of desire for pregnancy another induction of ovulation is indicated, on the contrary contraceptive questions are to be discussed.     

The Stepanik arteriotonograph (author's transl)

A pressure-sensitive probe, specially developed for this purpose, is built into a contact lens in such a manner that when adjusted to the patient's eye the probe registers the intraocular pressure whilst the observer compresses the eyeball and observes the arterial collapse phenomenon on the disc over the contact lens on the slit-lamp microscope. The standard deviation of a clinical measurement is 1.5 mm Hg. Derived from measurements on 65 eyes of patients without signs of vascular disorder, the correlation of the systolic and diastolic ophthalmic artery-pressure (y) to that of the ipsilateral brachial artery (x) is given by Y =0.79x-1.33 (r=0.96) and the correlation of their median pressure by Y=0.93x-17.2 (r=0.94).