A clinical study of the non-Hodgkin's lymphomas according to the Kiel classification (author's transl)]

A study of 138 patients with Non-Hodgkin's lymphomas was performed. The results were compared with retro- and prospective investigations of patients of the Kiel lymphoma study group. The aim of the study is to evaluate the value of the Kiel classification for the therapy and prognosis of malignant lymphomas. The malignant lymphomas of low- and high-grade malignancy differ significantly in their biological behaviour. Especially the clinical progress of the disease and the response to therapy are different. The lymphomas of low-grade malignancy may not need any treatment for long periods in some patients. In contrary, patients with lymphomas of high-grade malignancy need an active treatment immediately after the establishment of the diagnosis. In stages I and II radiotherapy is sufficient, in stages III and IV chemotherapeutic regimens are necessary. Each type of malignant lymphoma may be accompanied by leukemia. Most of the malignant lymphomas, particularly the immunocytomas, may produce monoclonal gammopathies, most of them being macroglobulinemias. Thus the macroglobulinemia Waldenstr?m is just a clinical necessary to evaluate the significance of the subtypes of the Kiel classification for the planning of specific treatment.     

Traumatic injury to the heart. A clinical study (author's transl)]

Nonpenetrating chest injuries often lead to cardiac traumas. Posttraumatic coronary thrombosis with myocardial infarction is shown in two cases. Large anterior aneurysm occured after total occlusion of the descending anterior in both cases. There was no correlation between the severity of the chest injury and the ensuing cardiac damage. An intramural anterior infarction was seen in a third case; because of a normal coronary angiogram an intramyocardial bleeding without coronary thrombosis can be suspected. A direct connection between chest injury and myocardial infarction can only be assumed if there is an onset of symptoms within 24--48 hours after thoracic trauma. A coronary angiogram should be performed in any case of myocardial infarction following chest injury especially in medico-legal cases.     

Cytological classification of lung carcinomata (author's transl)]

By comparing the cytological examinations and the final histological classification, the author discusses the possibilities of cytological type judgement. Using a staining method invented by himself, he was able to achieve a conformity of the cytological and of the final histological classification in 80 per cent of all cases. Abstaining from the differences in the judgement of maturity, the results of both methods were in conformity even in 89 per cent of all cases. As compared to the biopsy during bronchoscopy the cytological type classification was more exact. The difference had, however, proved to be insignificant (p greater than 0,05). The advantage of the author's own staining method is particularly obvious at the detection of mucus-forming carcinomata. In this way, two out of three mixed forms of epidermoid carcinomata and of adenocarcinomata could be correctly diagnosed.     

A clinical study on the effect of extrinsic corticotropin on the pituitary-adrenocortical function (author's transl)]

The effects of ACTH preparations on the pituitary-adrenocortical function remain to be clarified in more respects than those of steroid drugs. In the present study, the author investigated the effect of synthetic ACTH-Z on the pituitary-adrenocortical function in a series of 76 patients under synthetic ACTH-Z therapy using the daily urinary excretion of 17-KGS as an index. The results are summarized as follows: 1) The administration of synthetic ACTH-Z in a dose of 0.25 mg or 0.5 mg q.d. was followed by a gradually declining tendency of the daily urinary excretion of 17-KGS. More particularly, after 1.5 months of synthetic ACTH-Z medication at either of these dosage levels, the response of urinary 17-KGS was found to have decreased to about 1/2 of its level at the beginning of medication. 2) The responsiveness of urinary 17-KGS was well maintained even after 3 months of intermittent doses of 0.25 mg of synthetic ACTH-Z (3 times a week, or every other day). 3) Synthetic ACTH-Z, when used in a smaller dose of 0.125 mg daily, produced a minimal stimulating effect on the adrenal cortex. When administered in a less frequent (twice weekly) dose of 0.25 mg, synthetic ACTH-Z failed to prevent or counterbalance atrophy of the adrenal cortex induced by small doses of steroid drugs (average total dose equivalent to 12.2 mg of prednisolone). 4) With the purpose of activating the steroid-atrophied adrenal cortex, synthetic ACTH-Z was administered in a daily or intermittent (every other day, or 3 times a week) dose of 0.25 mg. With the daily dosage regimen, the atrophied adrenal cortex temporarily exhibited a good response, but its responsiveness soon decreased again, and in the end, synthetic ACTH-Z administered in this mode failed to activate the adrenal cortex. With the intermittent dosage regimen, on the other hand, a tendency toward recovery of adrenocortical responsiveness was observed in half the cases studied. In the remaining half receiving steroids over a prolonged period of time, recovery of adrenocortical responsiveness was not attained to any appreciable extent. These results might be interpreted as suggesting that the administration of synthetic ACTH-Z in an intermittent dose of 0.25 mg or 0.5 mg is advisable for the activation of the atrophied adrenal cortex. If this therapeutic regimen fails to initiate a tendency to recovery of adrenocortical responsiveness in a matter of a month or two, this implies that there is atrophy of the adrenal cortex severe enough to invalidate the therapeutic use of synthetic ACTH-Z. 5) The response of the adrenal cortex of 0.25 mg doses of synthetic ACTH-Z was distinctly suppressed by the concomitant use of steroids in 10 mg doses (as calculated on a prednisolone basis). Likewise, the response of the adrenal cortex of 0.5 mg doses of synthetic ACTH-Z was suppressed to 78%, 46% and 16%, respectively, by the conjoined use of steroids in doses of 20 mg, 30 mg and 40 mg or above...     

The effects of ordinary provocation on the power density spectrum. A clinical electroencephalographic study (author's transl)]

In the search for methods which might increase the discrimination of the EEG, the power density spectra of a random sample of patients during different conditions were analysed. Power density spectra were made during eyes closed, eyes open, after hyperventilation, during photic stimulation, and during auditory stimulation. It proved that the spectra may change under different provocation tests, sometimes in a rather peculiar way. The conclusion was, that these analyses improve explicit the EEG diagnosis, a problem however is the time required for spectra interpretation.     

A comparative study of three procedures used for studying bronchopulmonary bacterial flora (author's transl)]

Three methods of taking samples of bronchopulmonary secretions; transtracheal aspiration (TT), sputum collection, and fibro-aspiration, were compared in 43 patients with severe pneumopathies. There was no significant difference in the number of times a pure or dominant germ was isolated by using the three procedures in these 43 cases. In contrast, however, there was a significantly lower number of polymorphous flora and more sterile samples observed when using TT than with the other two methods. When antibiotics are given 1 to 7 days before taking the samples, there is a significant reduction in the number of cultures having a germ in the pure state.