[Influence of pregnancy on HB virus carriers]

Liver function tests (GOT, GPT) were performed on 269 female HB virus carriers during pregnancy and puerperium with the following results: Pregnancy in HB virus carriers did not result in any deterioration in liver function, but was rather associated with its gradual normalization particularly in symptomatic carriers. At 1 month of puerperium, in contrast, the occurrence or rebound flare-up of hepatitis was frequently observed among the virus carriers, notably with overt liver dysfunction being seen in 43% of those positive for e antigen. Of 28 e antigen-positive carriers in whom a follow-up study was extended to the next pregnancy, 12 whose liver function was normal during puerperium had normal liver function during the next pregnancy and was positive for e antigen. In the other 16 carriers showing deteriorated liver function during puerperium, liver function during the next pregnancy was abnormal in 6 and normal in 10, with seroconversion and negativity for e antigen being observed in 2 and 4, respectively, of these 16. It is inferred that fluctuations in liver function and e antigen during pregnancy and puerperium might be consequent on increased secretion of corticoids during pregnancy.

[Pulmonary malignant lymphoma--a case report]

A case of pulmonary malignant lymphoma is reported. A 65-year-old woman had no complaint. But chest roentgenography and CT revealed an infiltrating shadow with marked airbronchogram in the left S3. TBLB revealed marked subepithelial lymphocytic infiltration of the bronchial wall. Because the shadow had gradually enlarged, malignancy was suspected and lobectomy was performed. The resected specimen showed a 60 X 56 X 30 mm greyish-yellow, medullary tumor with intrapulmonary metastasis. Microscopically, well-differentiated small lymphocytic tumor cells severely infiltrated the pulmonary parenchyma, pleura and bronchial cartilage. There was no lymph node metastasis or extrapulmonary involvement. Immunohistochemical study proved the monoclonality of the K chain. She was treated with chemotherapy postoperatively.

Inflammatory effects of acetylglycerylether phosphorylcholine: vascular permeability increase and induction of pleurisy in rats

AGEPC-induced vascular permeability increase in the skins of rats, guinea pigs and rabbits was assessed by the leaked dye method, in which the dye was extracted from the skin sites injected with AGEPC after intravenous injection of pontamine sky blue. The activity was the most potent in the dorsal skin of rats and followed by guinea pigs and then rabbits. The vascular effect in rat skin was not affected by pretreatment with mepyramine and methysergide, but partially reduced by indomethacin and significantly suppressed by dexamethasone. Synergism was observed between AGEPC and bradykinin, histamine, 5-hydroxytryptamine, PGE1, PGI2 or PGD2, when each agent was simultaneously injected with AGEPC into the skin. Pleurisy was induced by intrapleural injection of 1 ug of AGEPC into rats. Pleural fluid accumulation and leukocytes migration were observed. The exudate volume was not suppressed by pretreatment with indomethacin but significantly reduced by intravenous injection of CV-3988, a novel antagonist of AGEPC.

[Experimental-morphologic study of depressed fracture of the skull. Experimental model]

Experimental skull bone models were made and depressed fractures were created. The morphological reactions of the skull bone models were observed to be the same as in human skulls, that is, that the fractures of the inner side were always larger than those of the outer side as a result of the direction of the impacting forces (a so-called classical type of reversed "V" form). The reason for the reversed "V" form of the depressed human skull fractures was discovered by means of these model studies. The reversed "V" form is due to the "HSH" morphological structure. It will be now be necessary to correct the error in textbooks regarding the depressed fractures, especially morphological illustrations.

A case of biliary cystadenocarcinoma with recurrent jaundice. Diagnostic evaluation of computed tomography

A 73-year-old male patient with biliary cystadenocarcinoma and episodes of recurrent jaundice is reported. This very rare tumor was suggested as a possible diagnosis by the computed tomographic findings showing intrahepatic cystic masses with septations and papillary projections. The diagnosis of the mucin-producing tumor was supported by aspiration of mucinous bile with a cannule inserted endoscopically via the major duodenal papilla. The computed tomographic findings and the diagnosis were verified by pathologic studies made on the material obtained surgically. The mucinous bile is assumed to have been responsible for the recurrent jaundice.

Cervical injury from skiing

A retrospective study of 18 patients with cervical spine injuries from skiing accidents is presented. Four patients were treated surgically because of instabilities. Twelve patients had associated head injuries, two of whom were operated on. One patient died from severe craniocervical injury caused by collision with another skier. The causes of the cervical spine injuries are analyzed and the possibilities for preventing them are presented.

[Head injuries in childhood caused by skiing and their optimal prevention]

During the last three skiing seasons we have treated a total of 105 children in our clinical wards for skull-brain injuries caused by skiing accidents. 25 of these cases (25.2%) were operated on, mostly because of a depressed fracture (92%) with or without brain lesion/bleeding, which the children incurred by colliding with various obstacles. Uncontrolled excessive speed and careless skiing methods are the main reasons for these injuries. However, the responsibility for the increasing number of skisport-connected skull-brain injuries does not lie with the children alone, but more so with us grown-ups, i.e. the parents, teachers and physicians, as long as we do not preach and emphatically insist on the implementation of indirect and direct specific measures of accident prevention. Based on an analysis of typical injuries and their many causes we come to the conclusion that, aside from the usual precautions, only one simple, sensible and effective prevention of skull-brain injuries is feasible, namely the "protection helmet". Similar to the existing crash-helmet law for motorcylists and just like for the professional skiracers, whom the children try to imitate more and more with regard to style and speed, we earnestly urge legislation to make the wearing of a protective helmet compulsory for all skiers up to 17 years of age.

[Exeresis in occipital neuralgia]

31 patients, suffering from an occipital neuralgia, were treated surgically by section of the n. occipitalis major or minor. The retrospective study of these cases extends over a period of one to nine years. In 26 patients (84%) a good result was achieved initially, and 16 patients (52%) are completely free of any complaint up to the present. In five patients (16%) no improvement has occurred. In two of these five patients an epipharyngeal cancer was discovered later; in one of the patients trigeminal neuralgia was established later on. Contrary to earlier published intradural rhizotomy this operation is simple and without risk (it is performed under local anaesthesia), and in long-standing, obstinate and tormenting cases very good results can thus be achieved. The unclear aetiology of the neuralgia was observed anatomically by the atypical course of the nerves. Other methods for the treatment of occipital neuralgia were not considered here.

Clinical and experimental morphological study of depressed skull fracture

Ninety-eight cases of depressed skull fractures, caused by various accidents, were treated. The morphological structures of the fractures were studied. Thirty-four depressed fractures were established experimentally, and a comparable study was performed. Clinically and experimentally I confirmed the same morphological reactions, that is, that the fractures of the inner region were always larger than those of the outer side, as a result of the direction of the impacting forces. The human skull suffers depressed fractures only because it has "HSH" (hard-soft-hard) histological structures. It is naturally disadvantaged.

Effective extraction and radioimmunoassay of chorionic gonadotropin in human urine

A single-step procedure for extracting and concentrating hCG from 24hr urine samples was developed. The procedure involves the adsorption chromatography with Vitachange (Permutit). Its hCG recovery was improved to be more than 90% compared with about 50% of a standard kaolin-acetone method. Nonspecific urinary protein concentration in extracts was also reduced. Thus, partial purification and concentration of urinary hCG by this procedure with subsequent RIA using antisera against the unique carboxyl-terminal peptide of hCG beta subunit provides a sensitive and specific method for detecting hCG in urine. In urine samples obtained from normal persons, the upper limit of hCG-immunoreactivity detected by this new system was 1.1 IU/24hr. However, 93% of subjects gave values lower than 0.5 IU/24hr. The urinary hCG level of lower than 1.1 IU/24hr may be designated as normal. This new assay system now provides reliable potentiality in the strict management of patients who are undergoing treatment for gestational trophoblastic neoplasia.

Depressed skull fracture in skiing and its experimental study

During the last seven skiing season, 57 patients were treated surgically for head injuries caused by skiing accidents. A typical type of injury was observed, namely the "depressed fracture" in 84% of the cases, accompanied by brain contusions or hematomas. The mechanism of the accidents was analyzed. A depressed fracture is caused by direct local force application, often as the result of high or not properly adjusted speed. Through this impressive observation of depressed fracture with or without brain damage, experimental impact mechanisms of human skull depressed fractures were studied. In the present study, a tolerance threshold of about 1 to 2 kN (can be compared to an impact of about 16 km/h) was observed for a depressed fracture in the temporal region, which often is the area of severe damage in skiing. This clinical and experimental examination should aid in preventing head injuries in skiing accidents because head injuries are mostly the result of depressed fractures, accompanied by brain contusions or hematomas. From these analyses, it can be shown that the wearing of helmets is in fact an effective possibility for the prevention of head accidents in skiing. It should be recommended particularly for children and young people.

[A study on luteal function during consecutive cycles (author's transl)]

It is conceivable that luteal function is varied with different menstrual cycles. A study was therefore undertaken to investigate for changes in luteal function during consecutive menstrual cycles.

METHODS

From those women receiving ambulatory treatment at the hospital 30 displaying a biphasic basal body temperature (BBT) curve were chosen for the study. BBT records were obtained from each of these women for at least 3 consecutive cycles and a total of 194 cycles thus rendered available were evaluated for the pattern of BBT, the duration of high phase (DHP), high phase score (HPS) and planimetric luteal index (PLI). Twenty of these 30 women were subjected further to endometrial dating at the 7th-8th day of high phase with simultaneous determinations of serum estradiol (E2), progesterone (P) and prolactin (PRL) during 2 consecutive cycles.

RESULTS

The incidences of abnormal values of the parameters for at least one of the consecutive cycles studied were: DHP; 13.3% pattern; 50-100%, HPS; 40.0%, PLI; 13.3%, E2; 25%, P; 25%, PRL; 30%, endometrial dating; 65%. These results indicate a considerable variability of luteal function.

Acrylic fixation in displaced dens fractures

Non-union of odontoid process fractures with displacement in old patients have been treated operatively stable acrylic fixation. Immediate mobilization without external fixation was achieved.

[Classical low back pain and sciatica syndrome caused by a melanotic nerv sheath tumour of the first sacral root (author's transl)]

This is the description of the case of a 22 year old patient with low back pain and sciatica on the right side investigated by lumbar Dimer-X-Myelography. The result of the examination was an impression in the contrast column at the L5/S 1 level on the right. At operation an intradural tumour, plum-sized, well-defined, and blue-black in colour, was found and removed. Histologically the tumour was melanotic and of high cellular density, with spindle-shaped cells as well as giant cells, with round nuclei, considerable polymorphism, and atypical mitoses. On the basis of the operation finding, the clinical course, and the histology, the diagnosis is melanotic nerve sheath tumour of the first sacral root. For two years following operation the patient has experienced no discomfort.

[Stablization of destructive processes in the cervical spine by means of acrylic prostheses (author's transl)]

Stabilization of destructive processes in the cervical spine by means of acrylic prostheses has hitherto been carried out either by an anterior approach or by a posterior approach. With progressively destructive lesions the stability achieved by either of these methods is unsure, and therefore the author has employed a combination of both approaches. The first two patients treated with this new technique have now been followed up for two years. The position and stability of the prosthesis in each case has remained excellent.