Positive sign of the stenocardia syndrome as a criterion of myocardial ischemia during the treadmill test

Diagnostic validity of the criteria of myocardial ischemia in coronary patients exposed to the treadmill test is assessed. The risk of a false diagnosis of coronary insufficiency on the basis of the pain syndrome was 5 times as high as that of diagnosis based on ischemic electrocardiographic ST depression. In subjective assessment of walking tolerance, patients with severe angina were particularly prone to mistakes. Limitations of angina classifications by severity, based on subjective sensations of coronary patients, are considered.     

Role of immediate versus delayed nephrectomy for failed renal transplants

The role of timing of transplant nephrectomy after renal transplantation has not been well defined. This report compares the morbidity, mortality, and hospitalization costs of 37 patients undergoing transplant nephrectomy within 14 days after graft failure and return to dialysis, with 31 patients undergoing delayed transplant nephrectomy (less than 14 days after graft failure and return to dialysis). This analysis revealed that there were no significant (P greater than .05) differences in patient morbidity and mortality between these groups. There was, however, a substantial increase (P less than .05) in the cost of hospitalization in the delayed nephrectomy group. For this reason, we recommend early nephrectomy after renal transplant failure in order to minimize the cost of health care for these patients undergoing failed cadaver donor transplant nephrectomy.     

303. Orientierungshilfen in der diagnostischen und operativen Schulterarthroskopie

Zusammenfassung Zu Beginn des Videofilms wird die Problematik der Rectumcarcinomdiagnostik mit genauer Bestimmung der Wandinfiltration dargestellt. Als zusätzliches diagnostisches Verfahren wird sodann die endorectale Sonographie und deren Prinzip erläutert. An einer Falldarstellung (Patient mit ulcerierendem Rectumcarcinom und Rectumpolypen) wird die sonographische Methode im Vergleich mit der Rectoskopie und weiteren bildgebenden Verfahren sowie dem Operationspräparat und dem histologischen Schnitt verglichen. Eine weitere Anwendungsmöglichkeit der endorectalen Sonographie liegt in der Verlaufskontrolle operierter Patienten mit Rectumcarcinom. Dies wird an einer weiteren Falldarstellune erläutert.     

Renal Aspergilloma--A Case Illustrating the Problems of Medical Therapy

The second documented case of renal aspergilloma due to Aspergillusflavus is presented. The merits of the medical therapy thatfailed are discussed. Pathological examination showed a nidusof aspergillus around suture material persisting from a pyelolithotomyoperation 2 years before in India. We argue that this was thereason for the failure of the medical therapy. This is the firstcase of its kind reported.     

Traumatology of the alar ligaments

A postmortem study of craniocerebral traumas of varying severity was done to determine the pattern of injury of the alar ligaments. It was found that in the entire group of patients (n = 30) the alar ligaments were ruptured or suffused with blood 11 times. No close relationship was found between the massive nature of the cranial trauma and the severity of the injury of the alar ligaments. In some cases the alar ligaments were not at all involved even though the skull had suffered extensive osseous lesions, whereas on the other hand the ligaments were injured even though only soft parts had been involved (e.g., haematoma or dehiscent wounds of the scalp). Ruptures of the alar ligaments were typically involved in extended ruptures of the ligamentous apparatus (see Figure 6a involving the ligamentum apicis dentis, ligamentum transversum atlantis, m.atlanto-occipitalis anterior, m.tectoria, m.atlanto-axialis anterior et posterior). In some cases the pattern of injury of the alar ligaments was found to be decisive in enabling reconstruction of the course of the accident. Damage to the alar ligaments near the dens axis represent rotation injuries. On the other hand, insertion tears out of the condyli occipitales must be related to a lateral thrust tendency in indirect fracture of the skull (bursting fracture). Within this overall framework a new mechanism of fracture of the condylus occipitalis is described. As a matter of principle, the alar ligaments can become involved in consequence of rotation, traction and compression of the cranium.     

Evidence for dopaminergic innervation on kitten retinal ganglion cells

Effects of iontophoretically applied dopamine and its receptor antagonists on physiologically identified retinal ganglion cells were studied in the optically intact eye of pentobarbitone anaesthetised kittens (7-9 weeks of age) and the results were compared with the effects obtained from adult cats (18-22 weeks of age). In both the adult and the kitten, dopamine had an inhibitory effect on visually evoked and spontaneous activity of the retinal ganglion cells, irrespective of cell type. However, unlike in the adult, the effects of dopamine in kittens were variable and not dependent on retinal eccentricity. In adult cells, only L-sulpiride (a potent D2 receptor antagonist) reduced the inhibitory effect of exogenous dopamine, whereas in kitten cells, both alpha-flupenthixol (a potent D1 receptor antagonist) and L-sulpiride did so. When applied alone, neither alpha-flupenthixol nor affected the activity of ganglion cells in adults, but in kittens both antagonists produced an excitatory effect in some cells. Physiologically active dopaminergic innervation seemed, therefore, to be present on the immature ganglion cells, but was subsequently 'eliminated' during the course of postnatal development. Furthermore, in immature cells, both D1 and D2 type receptors are present but only D2 receptors remain in adult. Therefore, there is a mismatch between dopamine receptors and dopamine in the adult retina and this mismatch may be the consequence of a developmental event.