The respective roles of surgery and physiotherapy at the stage of intermittent claudication (author's transl)

The choice between rehabilitation and surgery must be made for each case after attentive consideration, and depends largely on the experience and the means of each therapeut. The proximal level represents the best field for surgery, above all in the case of instable or embolized atheroma. At medial level, both therapeutics may be discussed. At distal level, surgery is seldom indicated apart from lumbar sympathectomy. Practically, rehabilitation is most often indicated alone or associated with surgery.     

Radiation therapy in renal adenocarcinoma (author's transl)

Sole irradiation treatment for renal carcinoma or its metastases has to be regarded as only a palliative therapy, whereas postoperative radiation therapy brings about a distinct diminution of the frequency of local recurrences, and, at least in advanced tumor stages, an improvement of the 5-year survival rate. Long-term preirradiation (ca 3000 rd TD within 3 weeks, and operation after another three weeks) or short-term pre-irradiation (ca 1200 to 2000 rd TD within 2 or 4 days, and operation the next day) are tolerated well and do involve no disturbances of the wound healing. Surgical treatment is not complicated by short-term irradiation, but often is easier following long-term irradiation; beyond this, the latter may just render possible a radical extirpation of the renal tumor. It appears from first results that decrease of distant spread and improvement of recovery rates in advanced tumor stages may be within reach, particularly in connection with post-operative irradiation.     

Longterm potassium therapy in angina pectoris (author's transl)

The effect of a two month potassium therapy on maximum performance was systematically investigated in 12 patients with overt angina pectoris. The patients received 40 mEq potassium daily by mouth. The average maximum performance increased by 85% after 8 weeks' administration of potassium. The rise in the performance curve fell after 6 weeks to attain a steady state after 8 weeks. In particular it must be emphasized that the heart rate was reduced under maximum capacity in spite of considerable increase in performance. Furthermore, a comparison of heart rates after 8 weeks' potassium administration showed that in each case for the same level of performance the heart rate was 15% less than before potassium. The results of the investigation support longterm therapy with potassium in angina pectoris.     

Acute intermittent porphyria: report on 17 patients with 49 attacks (author's transl)

In 17 patients (15 women, 2 men) with acute intermittent porphyria in the incidence of 23 clinical symptoms during 49 attacks was calculated. The most frequent symptoms in percentage of attacks were: Red colour of the urine 100%, abdominal pain 92%, tachycardia 88%, hypertension 75%, vomiting 54%, peripheral neuropathy 50%. In 35% of acute attacks a transient normochromic, normocytic anemia developed which is probably due to a disturbance of heme synthesis. Oliguria was found in 25%, azotemia in 12.5% of attacks. 4 patients with an average of 5 preceding acute attacks showed a persistent reduction of renal function during the symptom-free interval, in contrast to 12 patients with an average of 1.7 previous attacks and normal renal function. During the observation period from 1960-1974 3 (= 18%) of the 17 patients died.     

Osteomyelitis, therapy and prognosis (author's transl)

The application of antibiotics at the treatment of osteomyelitis resulted in a rise of the permanent successful treatment rate. This is especially true for the acute hematogenous osteomyelitis, to a certain extent also for the chronic exogenous one, at which even today the antibiotical therapy is not as important as a surgical intervention. Under consideration of the generally accepted therapeutical principles the special importance of a much individualized treatment adjusted to the clinical picture and disease stage is pointed out. The advantages and disadvantages of an application of antibiotics at the osteomyelitis are mentioned and we try to explain the reasons for occasional therapy failures. A special chapter is devoted to the methods of filling and sterilization of the osteomyelitis bone hollows. Our own experiences with an operative combination process are reported.     

The treatment of intermittent claudication by physical retraining of the non-hospitalised patient. Evaluation of effectiveness in a group of 40 patients (author's transl)

The treatment of intermittent claudication by physical re-training of a patient with lower limb arteriopathy is not new (Alpert 1969, Cachovan 1976, Kindler 1965, Schoop 1964). It gives an effective improvement of walking distance and of physical performance capacity. Most programs used need the patient to be kept in an hospital and thus entail a significant social cost. We have set up a program for the retraining of patients that are not hospitalized and have checked the short and long term action achieved. The walking distance, the maximum performance in specifical exercises, the walking exercises on a tread mill, are studied during the clearance X133, the total leg blood flow before and after an arterial occlusive hyperhemic test is studied simultaneously.     

DTIC in the therapy of solid tumours (author's transl)

From 1975 to 1977 42 patients with advanced solid tumours were treated with imidazole-carboxamide (DTIC). It was applied in 18 cases as monotherapy: in the remaining patients it was administered in combination with other cytostatic agents. Tumour remission was recorded in 4/22 patients with melanoma, 2/2 with Kaposi sarcoma and 2/7 with soft tissue sarcoma. No change in tumour behaviour was recorded in 6/22 melanomas, 2/7 soft tissue sarcomas, 1/7 head and neck tumours and 1/1 thymoma. Side effects of DTIC monotherapy were comparably low. The optimum dosage and frequency of DTIC therapy have not yet been established. Combinations with other cytostatic agents are still being tested.     

Clinical picture and therapy of portal-systemic encephalopathy (author's transl)

The clinical syndrome of portal-systemic encephalopathy is caused by far advanced cirrhosis of the liver in most cases; it is characterized by increasing drowsiness, disturbances of mentation, flapping tremor and hyperreflexia. An early diagnosis can be established by testing writing and drawing abilities. Increased occurrence of spider nevi, a dry, deep red tongue, and hemorrhagic lesions of skin and mucous membranes are symptoms of incipient hepatic insufficiency. The syndrome is initiated in most cases by excessive intake of protein or alcohol, by intestinal bleeding, by diuretics, or by intercurrent infections. Therapy has to include elimination of causes, reduced intake of protein, enemas with acetate buffer solution and oral medication with lactulose, bifidum milk, and certain amino acids in order to lower hyperammoniemia; in serious cases neomycin has to be given. At the same time a normalization of fluid and electrolyte balance has to be achieved; replacement of potassium is especially important, when hypokalemia and alcalosis are present. In general prognosis of portal-systemic encephalopathy however is serious, depending primarily upon the fact, whether or not sufficient functional hepatic parenchyma is present.