78. Die Verwendung automatischer Nahtger?te in der Lungenchirurgie

Zusammenfassung Anhand von 678 bis Ende 1979 operierten Patienten mit Lungenerkrankungen wird die technische Anwendung automatischer Nahtgeräte demonstriert. Sie eignen sich zum Bronehusverschluß, für Keilexcisionen sowie zum Verschluß von Lungenvenen. Technische Modalitäten sind zu beachten. Der Vorteil liegt bei sachgemäßem Vorgehen in der Sicherheit der Anwendung, der Effektivität und in der kürzeren Operationszeit. Die Insuffizienzquote beträgt einschl. der Anfangszeit 4,4% in der Spätphase 3,2%. Komplikationen bei Keilexcisionen treten ebensowenig auf wie beim Verschluß der Lungenvenen.     

Acute leukaemia in a defined geographic area – Incidence,clinical history and prognosis

A consecutive series of patients (1978–1981) comprising all patients with acute leukaemia from a population of 475000 inhabitants was reviewed. Thus, 94 patients were diagnosed as having acute leukaemia. No patients were lost from follow-up. The incidence figures of ALL and AML differed significantly from those of Sweden as a whole. 9 patients were < 15 years old. The median age of adult patients was 64 years, 60.8% being ≥ 60 years old. Of adult patients with AML, 20% had a preleukaemic history (chronic myeloproliferative disorders, myelodysplastic syndromes and others). None of 6 patients with leukaemia as a metamorphosis of a chronic myeloproliferative disorder achieved a complete remission. The overall remission rate of the remaining adult patients was 25%. Treated patients, 15–39 years old, with AML without any preleukaemic history, had a complete remission rate of 80% compared to 12% for patients ≥ 60 years old with the same diagnosis. Of 60 patients with ‘primary’ AML, 14 were not treated, mainly because of advanced age and complicating diseases. Most of these patients died within a week of admission.     

Serotonergic interhemispheric asymmetry: Neurochemical and pharmaco-EEG evidence

1. Postmortem neurochemical investigations revealed interhemispheric asymmetry in the mediofrontal region of human brain. Significantly higher right hemisphere serotonin metabolite (5HIAA) content as well as increased maximal imipramine binding (IB) were found in the right hemisphere than in the left side.

2. IB did not show a gender difference in the mediofrontal area. However, women had higher IB in the right orbital frontal cortex than did men.

3. In vivo pharmaco-EEG results tend to support the postmortem neurochemical data. Intravenous chlorimipramine resulted in an asymmetric topographic distribution of the P300 auditory evoked potential, peak amplitudes were shifted to the right hemisphere.     

Widespread serum amyloid P immunoreactivity in cortical amyloid deposits and the neurofibrillary pathology of Alzheimer's disease and other degenerative disorders

Amyloid P (AP) component is present in all types of systemic amyloid deposits. Recently, it has been shown to be also present in cerebral amyloid lesions of Alzheimer's disease (AD). In this study, we used immunocytochemical methods to extend these findings at the electron microscope level and characterize the spectrum of AP immunoreactivity in neurofibrillary pathology (NFP) of AD and other neurodegenerative disorders including Down's syndrome (DS), Creutzfeldt-Jakob, Parkinson's, Pick's and diffuse Lewy body diseases and progressive supranuclear palsy. In AD and DS, AP immunoreaction product was evident in all the classical amyloid lesions and NFP in a large sample of all cortical areas examined. The distribution and relative intensity of immunostaining was similar to that of thioflavin S staining in serial sections. In many cases, however, plaques and vessels stained by anti-AP serum were not apparent with thioflavin S. Serial sections immunostained with antiserum to amyloid A, C-reactive protein or to other proteins involved in systemic amyloidoses and the acute phase response showed no evidence of staining in any of the cerebral lesions. Electron microscopy confirmed that AP immunoreactivity was associated with the abnormal filaments characteristic of NFP as well as amyloid fibrils found in plaques and vessels showing congophilic amyloid angiopathy. Plaques of Creutzfeldt-Jakob disease, Pick bodies of Pick's disease, tangles and Lewy bodies in Parkinson's disease and a subpopulation of Lewy bodies in the diffuse Lewy body disease coexistent with AD were also stained. With the exception of vessels in two of the five cases, AP was not detected in age-matched controls. Our observations indicate AP to be a consistent feature of cerebral NFP and amyloid deposits.     

Evidence that 3α-hydroxy-5α-pregnan-20-one is a physiologically relevant modulator of gaba-ergic neurotransmission

3α-Hydroxy-5α-pregnan-20-one (HPO) is a progesterone metabolite which exhibits narcotic properties at high concentrations by interactions with the receptor for gamma-aminobutyric acid (GABA). The present investigation characterized low-dose effects of HPO on GABA_A receptor binding, by determining the allosteric properties of HPO on the in vitro binding of ³H-muscimol to membrane fractions from the cerebella of ovariectomized rats. A newly developed method for tissue preparation was used to wash out endogenous ligands interfering with the assay. HPO reduced the affinity of ³H-muscimol to GABA_A receptor sites by 52% and enhanced the number of accessible binding sites from 5.5±0.5 to 7.5±1.3 pmol/mg protein at subnanomolar (0.1 nM) HPO concentrations. The modulatory effects of HPO on GABA_A receptor binding provide evidence that this pregnane steroid might be a physiologically relevant modulator of GABAergic neurotransmission.     

Epidemiology of acute diarrhea in children living in Sicily

A longitudinal survey (February 1984 - January 1985) on the incidence of acute diarrhea episodes in a sample of 8,164 children (aged 0–12 years) living in southeastern Sicily was carried out by means of weekly telephone interviews with doctors practising in the territory. The incidence rate was 0.479 (0.472–0.485 95% C.I.) per child per year and the frequency of episodes was significantly higher (p < 0.001) in children aged 0–4 years (0.86). Diarrhea was more frequent in industrial areas than in rural ones, and almost half (45.1%) of the total episodes had a mild course. No death from diarrhea occurred and admission to hospital was reported for 8.4% of all cases.Corresponding author.     

Bone loss and forms of tibial condylar fracture

Summary Bone loss and fracture type were determined in 358 tibial condylar fractures. Degree of osteoporosis at the knee was defined by analogy to Singh's grades of osteoporosis at the hip and to Jhamaria's classification of osteoporosis at the calcaneum: grade V — normal; grade IV — slight reduction of trabecular bone; grade III — osteoporosis, predominantly of trabecular bone; grade II — osteoporosis of trabecular and cortical bone. Five fracture types were distinguished, with the component of trabecular bone compression increasing from a to e: a — pure split fractures; b — split fractures with displacement of a piece of the articular surface; c — split compression fractures; d — local compression fractures; e — compression of a whole condyle. There was a highly significant rank correlation between the two sets of ordered categories. Fractures in osteoporotics tended to involve the lateral condyle; this is explained by the fact that crush fractures occurred more frequently at the lateral condyle. The influence of bone loss on fracture type was demonstrated to be independent of age. A clear understanding of these associations concerning three variables at a time was reached by the use of log-linear-model analysis for cross-classified qualitative data.

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Zusammenfassung Bei 358 Frakturen der proximalen Tibia wurden der röntgenologisch erkennbare Knochenschwund und die Frakturform festgestellt. Entsprechend dem Singh-Index zur Bestimmung der Osteoporose am proximalen Femur und der Klassifikation der Trabekelstruktur am Fersenbein nach Jhamaria wurden folgende Osteoporosegrade am Knie definiert: Grad V — normal, Grad IV — Spongiosastruktur leicht vermindert, Grad III — Osteoporose betrifft vorwiegend die Spongiosa, Grad II —Osteoporose von Spongiosa und Kompakta. Fünf Frakturformen wurden unterschieden, wobei das Ausmaß der Spongiosakompression von a bis e ansteigt: a — reine Spaltfrakturen, b — Spaltfrakturen mit Abscherung eines Gelenkflächenteiles, c —Spaltkompressionsfrakturen, d — Frakturen mit lokaler Kompression, e — Frakturen mit Kompression eines ganzen Kondyls. Zwischen diesen beiden Merkmalen, deren Ausprägungen Rangklassen bilden, war eine hochsignifikante Rangkorrelation nachzuweisen. Brüche osteoporotischer Knochen betrafen vermehrt den lateralen Gelenksknorren, was dadurch statistisch zu erklären war, daß dieser sich für Kompressionsfrakturen als anfälliger erwies. Die Beziehung zwischen Osteoporose und Frakturform war nicht abhängig vom Lebensalter. Solche Zusammenhange zwischen je drei Variablen konnten übersichtlich dargestellt wurden, indem die Häufigkeitstabellen durch Log-lineare Modelle interpretiert wurden.