Agri-environmental policies from 1960 to 2022

For both research and practice, it is paramount to understand what, where and when agri-environmental policies have been put in place. Here we present a database of 6,124 agri-environmental policies implemented between 1960 and 2022 in about 200 countries. The database comprises a wide range of policy types (including regulations and payment schemes) and goals (such as biodiversity conservation, safer pesticide use and reducing nutrient pollution). We illustrate the application of the database by exploring the association between economic development and agri-environmental policies and between the soil-related, agri-environmental policies of countries and their border discontinuities in cropland erosion. A strong, positive link between economic development and implemented agri-environmental policies is revealed, and it is found that 43% of all global border discontinuities in soil erosion between countries can be explained by differences in their policies.

Lymphopenia and immunoglobulin deficiency in adult patients with a Fontan circulation

Background

Patients with a functionally univentricular heart and a Fontan palliation are prone to a wide range of extra-cardiac complications. Lymphopenia and immunoglobulin deficiency are insufficiently characterized in this population.

Purpose

The aim of this study was to analyze prevalence and associations of lymphopenia and immunoglobulin deficiency in a cohort of adult Fontan patients.

Methods

Ninety-five consecutive patients with a Fontan circulation that were seen at our institution between 2011 and 2021 were screened. Laboratory results and clinical characteristics were extracted from the patient's charts.

Results

Fifty-five patients (47% male) underwent evaluation of lymphocyte and/or immunoglobulin subpopulations at a mean age of 28.9±9.7 years. Baseline characteristics are depicted in the Table. Seven patients (7/55, 12.7%) had immunoglobulin G (IgG) levels below the lower limit of normal (i.e. <7.0 g/l). Patients with IgG deficiency had a higher prevalence of protein-losing enteropathy (43% versus 4%, p=0.001). Fifteen patients (15/52, 28.8%) had lymphocyte counts below the lower limit of normal (i.e. <850/μl). Lymphocyte counts and lymphocyte subpopulations were comparable in groups with and without protein-losing enteropathy. There was a moderately positive correlation between absolute lymphocyte counts and IgG levels (r=0.301, p=0.032). In a subgroup of 24 patients that underwent liver biopsy, there was no difference in terms of absolute lymphocyte counts and immunoglobulin subpopulations in patients with a low (i.e. 1–2) and high (i.e. 3–4) congestive hepatic fibrosis score.

Conclusion

IgG deficiency is present in 13% of patients with a Fontan circulation and seems to be associated with the presence of protein-losing enteropathy. Lymphopenia is more common and occurs in a quarter of all patients with a Fontan circulation; however, its etiology is likely more complex and multifactorial.

Funding Acknowledgement

Type of funding sources: None.

The Metalloprotease-Disintegrin ADAM8 Alters the Tumor Suppressor miR-181a-5p Expression Profile in Glioblastoma Thereby Contributing to Its Aggressiveness

Glioblastoma (GBM) as the most common and aggressive brain tumor is characterized by genetic heterogeneity, invasiveness, radio-/chemoresistance, and occurrence of GBM stem-like cells. The metalloprotease-disintegrin ADAM8 is highly expressed in GBM tumor and immune cells and correlates with poor survival. In GBM, ADAM8 affects intracellular kinase signaling and increases expression levels of osteopontin/SPP1 and matrix metalloproteinase 9 (MMP9) by an unknown mechanism. Here we explored whether microRNA (miRNA) expression levels could be regulators of MMP9 expression in GBM cells expressing ADAM8. Initially, we identified several miRNAs as dysregulated in ADAM8-deficient U87 GBM cells. Among these, the tumor suppressor miR-181a-5p was significantly upregulated in ADAM8 knockout clones. By inhibiting kinase signaling, we found that ADAM8 downregulates expression of miR-181a-5p via activation of signal transducer and activator of transcription 3 (STAT3) and mitogen-activated protein kinase (MAPK) signaling suggesting an ADAM8-dependent silencing of miR-181a-5p. In turn, mimic miR-181a-5p transfection caused decreased cell proliferation and lower MMP9 expression in GBM cells. Furthermore, miR-181a-5p was detected in GBM cell-derived extracellular vesicles (EVs) as well as patient serum-derived EVs. We identified miR-181a-5p downregulating MMP9 expression via targeting the MAPK pathway. Analysis of patient tissue samples (n=22) revealed that in GBM, miR-181a-5p is strongly downregulated compared to ADAM8 and MMP9 mRNA expression, even in localized tumor areas. Taken together, we provide evidence for a functional axis involving ADAM8/miR-181a-5p/MAPK/MMP9 in GBM tumor cells.

Measuring kinetics and metastatic propensity of CTCs by blood exchange between mice

Existing preclinical methods for acquiring dissemination kinetics of rare circulating tumor cells (CTCs) en route to forming metastases have not been capable of providing a direct measure of CTC intravasation rate and subsequent half-life in the circulation. Here, we demonstrate an approach for measuring endogenous CTC kinetics by continuously exchanging CTC-containing blood over several hours between un-anesthetized, tumor-bearing mice and healthy, tumor-free counterparts. By tracking CTC transfer rates, we extrapolated half-life times in the circulation of between 40 and 260 s and intravasation rates between 60 and 107,000 CTCs/hour in mouse models of small-cell lung cancer (SCLC), pancreatic ductal adenocarcinoma (PDAC), and non-small cell lung cancer (NSCLC). Additionally, direct transfer of only 1-2% of daily-shed CTCs using our blood-exchange technique from late-stage, SCLC-bearing mice generated macrometastases in healthy recipient mice. We envision that our technique will help further elucidate the role of CTCs and the rate-limiting steps in metastasis.

Rituximab in routine care of severe active rheumatoid arthritis : A prospective, non-interventional study in Germany

OBJECTIVE

To assess safety, effectiveness and onset of effect of rituximab (RTX) in routine clinical treatment of severe, active rheumatoid arthritis (RA).

METHODS

Prospective, multi-centre, non-interventional study in rheumatological outpatient clinics or private practices in Germany. RTX-naïve adult patients were to receive RTX according to marketing authorisation and at their physician's discretion. Also according to their physician's discretion, patients could receive a second cycle of RTX (re-treatment = treatment continuation). Major outcome was the change in Disease Activity Score based on 28-joints count and erythrocyte sedimentation rate (DAS28-ESR) over 24 weeks and during 6 months of re-treatment.

RESULTS

Overall, 1653 patients received at least one cycle RTX; 99.2% of these had received disease-modifying antirheumatic drugs (DMARD) pre-treatment and 75.5% anti-tumor necrosis factor(TNF)‑α pre-treatment. After a mean interval of 8.0 months, 820 patients received RTX re-treatment. Mean DAS28-ESR decreased from 5.3 at baseline to 3.8 after 24 weeks (-1.5 [95% confidence interval, CI: -1.6; -1.4]), and from 4.1 at start of cycle 2 to 3.5 at study end (change from baseline: -1.8 [95% CI: -2.0; -1.7]). Improvements in DAS28-ESR and Health Assessment Questionnaire (HAQ) score occurred mainly during the first 12 weeks of RTX treatment, with further DAS28-ESR improvement until week 24 or month 6 of re-treatment. Improvements in DAS28-ESR and EULAR responses were more pronounced in seropositive patients. RF was a predictor of DAS28-ESR change to study end. Safety analysis showed the established profile of RTX.

CONCLUSION

RTX was safe and effective in a real-life setting with rapid and sustained improvement in RA signs and symptoms.

[The first biologic for rheumatoid arthritis: factors influencing the therapeutic decision]

BACKGROUND AND AIMS

Biologics (disease modifying antirheumatic drugs, bDMARD) have been in use in Germany for the treatment of rheumatoid arthritis (RA) since 2001, usually after failure of at least one conventional synthetic (cs)DMARD. We analyzed temporal changes in factors that influence the decision for either a first bDMARD or a further csDMARD.

MATERIAL AND METHODS

We analyzed data from 9513 bDMARD-naive RA patients in the German biologics register RABBIT who switched to a new therapy. For three recruitment periods (2001-2003, 2004-2006 and 2009-2015) factors influencing the therapeutic decision were analyzed by means of machine learning methods and logistic regression analysis.

RESULTS

In all recruitment periods the number of previous csDMARDs, high dosages of glucocorticoids (>7.5 mg/day) and a higher DAS28 (>5.1) were significantly associated with the decision for a first bDMARD. Over time, the chance of receiving a bDMARD increased in patients with moderate disease activity, moderate glucocorticoid dosages (5-7.5 mg/day) and those with comorbidities, such as congestive heart failure or prior malignancy. Men had a higher chance of receiving a bDMARD than women only in the first recruitment period. Private health insurance, high education and gainful employment were significantly associated with more frequent prescription of bDMARDs in all recruitment periods.

DISCUSSION

The time-dependent changes in the impact of disease activity, concomitant drugs, gender and comorbidity on the prescription of bDMARDs mirror the increasing therapeutic options and the growing experience in the application of the new substances in patients at higher risk. The influence of demographic and social factors may reflect safety concerns in patients at increased risk of adverse events but also the need to economize drug costs..

[Treatment results and complications after PFN osteosynthesis]

Intramedullary implants, such as the proximal femur nails (PFN), are inserted for the treatment of per-, inter- and subtrochanteric fractures. The initial experiences with these PFN, carried out by AO/ASIF in 1996, have been published.

PATIENTS AND METHODS

This study makes a systematic examination of the complications and clinical treatment results from 133 patients treated at our clinic from December 1997-2001 with 139 PFN in per-, inter- and subtrochanteric femur fractures. The mean age at the time of surgery was 78.4 years. All fractures were classified according to the AO system. The most frequent injuries were 31 A2.3 fractures (61.2%). All intraoperative image-converter images and all radiographs from the total period of treatment were evaluated retrospectively in accordance with 28 criteria. The degree of osteoporosis was estimated using the Singh classification.

RESULTS

A total of 44 (31.7%) complications arose in 31 (23.3%) patients. On 11 occasions, hip screw cut-out was observed. Of these, two cases involved a Z-effect and one an inverted Z-effect. Two patients suffered a femoral neck fracture following removal of the hip screws. There were 38 (27.3%) reoperations required with 13 changes in procedure. In autumn 2002, clinical follow-up examinations were carried out on 65 (48.9%) patients who were assessed according to the Merle d'Aubigné score. A total of 51 (38.3%) patients had died at the time of follow-up. Normal ambulation was achieved by 33.8% of patients, while 64.6% were free of pain.

CONCLUSIONS

The PFN is an appropriate implant in cases of per-, inter- and subtrochanteric femur fractures. Anatomical resetting and correct implant positioning are the keys to successful osteosynthesis. The risk of implant failure is highest in the case of multi-fragmentary per- and intertrochanteric fractures in which medial strengthening has been degraded in patients aged over 80 years. The clinical results in elderly patients are unsatisfactory.

ACE inhibition does not exaggerate the blood pressure decrease in the early phase of spinal anaesthesia

BACKGROUND

This study investigates whether long-term treatment with an angiotensin converting enzyme inhibitor (ACEI) impairs the hemodynamic regulation during the early phase of spinal anaesthesia.

METHODS

Forty-two patients undergoing minor surgery were studied. Twenty-one patients were long-term treated (ACEI group), while the other patients served as controls (nonACEI group). All patients received a balanced electrolyte solution (6 ml kg(-1)) 20 min before spinal anaesthesia.

RESULTS

Mean arterial blood pressure decreased 19% in both groups within 20 min after spinal anaesthesia. Heart rate did not change in either group. Plasma renin concentration increased from 7.3 +/- 2.1 to 12.8 +/- 4 pg ml(-1) during spinal anaesthesia in nonACEI patients (P < 0.05), whereas an elevated plasma renin level remained unchanged in the nonACEI group. The angiotensin II concentration increased in both groups during spinal anaesthesia (P < 0.05). The vasopressin concentration did not change during spinal anaesthesia in the ACEI group, but increased from 1.2 +/- 0.3 to 2.2 +/- 0.5 pg ml(-1) in patients with ACEI treatment (P < 0.05). The norepinephrine concentration increased transiently 5 min after spinal anaesthesia in both groups, and returned to baseline levels within 15 min.

CONCLUSION

Long-term ACEI treatment does not further exaggerate the blood pressure decrease in the early phase of spinal anaesthesia. The increase in vasopressin concentrations in ACEI treated patients seems to be sufficient to compensate for the inhibited renin-angiotensin system. In addition, the transient increase in plasma norepinephrine, which occurs independent of preoperative ACEI treatment, seems to be involved in blood pressure regulation during spinal anaesthesia.

[Kirschner wire transfixation of syndesmosis rupture--an alternative treatment of type B and C malleolar fractures]

After completing ORIF of the lateral malleolus, the standard technique for fixation of the syndesmosis involves placement of a 3.5 mm locking screw across the fibula to the tibia. Alternative there is a possibility to make the transfixation with two 1.6 mm Kirschner wires introduced obliquely across the distal tibiofibular syndesmosis. No early removing of the implant is necessary. This retrospective study was conducted on a total of 50 cases of Weber type B or C malleolar fractures with syndesmotic rupture between 1988 and 1996. In 45 patients (90%) there is no complication seen for the transfixation, but in five patients a Kirschner wire dislocation was observed. We were able to review 36 of these patients after a median follow-up of 8.3 years (range 5-12 years). The results were evaluated using objective, subjective and roentgenographic criteria. Subjective rating had 29 patients (81%) with very good or good results. Good radiological results were found in 29 patients (81%). Concluding of this results the Kirschner wires transfixation is a technical simple method with good or very good results.

Vasculitis of the female genital tract with clinicopathologic correlation: a study of 46 cases with follow-up

Forty-six cases of vasculitis affecting the female genital tract are described; only 41 similar cases have been previously reported, either as case reports or small series. The age range of the patients was from 22 to 80 years, and most of them presented with abnormal bleeding or were being treated conditions unrelated to the vasculitis. There were 39 hysterectomy specimens (26 of which were derived from total abdominal hysterectomies) and seven specimens of the cervix only. The vasculitis was confined to the cervix in 30 of the 46 cases; in 24 of these, the entire uterus was available for examination. In 23 cases, only a single vessel was involved, and in the other 23 there was more extensive vessel involvement. In all cases, the involved vessels were arterioles and small arteries. In 42 cases, the arteritis was of the polyarteritis nodosa (PAN) type, and in four, of the giant cell type (GCA). Follow-up ranged from < 1 year to 23 (mean, 3) years. Systemic manifestations were previously diagnosed or subsequently developed in only four patients, three with PAN and one with GCA; in each of them, the genital tract vasculitis was found only in the cervix (in one of these, however, the specimen was a loop excision of the cervix and the rest of the uterus was not assessable). The three patients with PAN subsequently developed extragenital PAN (one case), PAN and rheumatoid arthritis (one case), or PAN and polymyalgia rheumatica (one case). The patient with GCA had previously documented temporal arteritis and temperomandibular arthritis. The findings in this series and in previously reported cases indicate that vasculitis of the female genital tract is only rarely associated with systemic vasculitis.

HLA-DR/DQ interaction in patients with erosive rheumatoid arthritis presenting articular and extraarticular disease manifestations

In the present study we have analysed the effect of HLA-DRB1 and -DQB1 alleles on disease progression and genetic predisposition among 201 RA patients. We clearly confirm the association of RA with HLA class II alleles sharing the (Q)R/KRAA amino acid (AA) cassette in the third hypervariable region (HVR3) of the DR beta-chain. The HVR3 (Q)R/KRAA motif was significantly overrepresented among RA patients (79% vs. 40%, P < 0.001), with one third of the patients homozygous (28% vs. 6.7%, P < 10(-9)) and the number of rheumatoid factor positive (RF+) patients was significantly increased among HVR3 (Q)R/KRAA homozygous in comparison to HVR3 (Q)R/KRAA negative individuals. Erosive disease defined by the Larsen Score and personal disability determined using the Health Assessment Questionnaire (HAQ) was significantly increased among patients positive for the HVR3 motif with the worst outcome among HVR3 (Q)R/KRAA homozygous patients. In contrast, there was no association of the shared HVR3 AA cassette and disease severity in the majority of patients presenting systemic (extraarticular) disease. Homozygosity for the shared HVR3 motif was only marginally increased among patients presenting 'severe' extraarticular disease in comparison to patients with articular disease (33% vs. 43%, P = ns). Similarly, patients with nodular disease were not more often homozygous for the HVR3 (Q)R/KRAA motif. Furthermore, we observed no HLA-DR independent association of DQB1 alleles among HVR3 (Q)R/KRAA positive patients and controls. Our analysis supports the predominant role of HLA-DR for genetic susceptibility to RA. In the clinical setting, however, HLA-DR typing may be limited to assess the individual risk of patients for disease progression.

Activity of high-dose cyclophosphamide in the treatment of childhood malignant gliomas

Seventeen patients less than or equal to 20 years of age with newly diagnosed (n = 10) or recurrent (n = 7) malignant gliomas (anaplastic astrocytoma and glioblastoma multiforme) were treated with cyclophosphamide in association with hematopoietic cytokines (GM-CSF or G-CSF). Cyclophosphamide was given at a dose of 2 g/m2 daily for 2 days at 4-week intervals. Toxicity consisted of grade IV neutropenia and thrombocytopenia in 95% and 48% of cycles, respectively. There were no cyclophosphamide-related cardiac, pulmonary, or urothelial toxicities observed. Four of 10 patients with newly diagnosed disease demonstrated responses (three complete and one partial responses; one CR was only of 2 months duration). None of the seven patients with recurrent tumors demonstrated a response. We conclude that high-dose cyclophosphamide warrants further evaluation in children with newly diagnosed malignant glioma.

Treatment of patients with pineoblastoma with high dose cyclophosphamide

The outcome for patients with pineoblastoma has historically been very poor, with most patients dying of disseminated disease despite irradiation. Furthermore, the low incidence of this tumor has hindered progress toward defining better treatment strategies. Here we report the activity and toxicity of cyclophosphamide administered as a single agent at a dose schedule of 2 g/m2/day for 2 successive days at monthly intervals for a maximum of four courses. Eight patients were evaluated, six newly diagnosed and two recurrent. Amongst the six newly diagnosed patients, there were three patients demonstrating partial responses, and three had stable disease throughout the cyclophosphamide treatment period. All six patients are alive and disease free after further therapy. One patient with recurrent disease demonstrated tumor progression on cyclophosphamide, and the other had stable disease throughout the cyclophosphamide treatment period. Both patients subsequently died of progressive disease. The major toxicity of high dose cyclophosphamide was hematopoietic, with one patient requiring a dose reduction after three courses due to prolonged thrombocytopenia. One patient was also withdrawn from treatment with cyclophosphamide due to impaired pulmonary function. This study demonstrates the activity of high dose cyclophosphamide in the treatment of pineoblastoma and may serve as basis for the design of future studies of this tumor.

Response of recurrent medulloblastoma to low-dose oral etoposide

PURPOSE

The outcome for patients with recurrent medulloblastoma has historically been poor, with most patients dying of disseminated disease. Here, we report on seven patients with recurrent medulloblastoma, most heavily pretreated with a variety of chemotherapeutic agents, including parenteral etoposide (VP-16), who showed responses to the administration of repeated courses of low-dose oral VP-16.

PATIENTS AND METHODS

Seven patients age 4 to 16 years were treated with VP-16 after neuroradiographic and clinical evidence of tumor progression. Six had received prior irradiation. All seven had been pretreated with a variety of chemotherapeutic agents and schedules, including parenteral VP-16. VP-16 was administered orally as repeated 21-day courses at 50 mg/m2/d with a 7-day interval between courses. Evaluation consisted of neuroradiographic and clinical examination after completion of every two courses of therapy. Complete blood cell counts were performed weekly.

RESULTS

The major toxicity of oral VP-16 was hematologic, with two patients requiring platelet transfusions due to thrombocytopenia and two requiring RBC transfusions. All seven patients developed treatment-related neutropenia. Two patients were supported with granulocyte colony-stimulating factor (G-CSF) between courses. One patient developed infectious epididymitis after course 2 and required intravenous antibiotics; this illness was complicated by Clostridium difficile colitis. There was one episode of fever associated with neutropenia. There were no treatment-related deaths. Of seven patients assessed, six have demonstrated partial responses (PRs) and the remaining patient had stable disease (SD).

CONCLUSION

This report demonstrates the activity of oral VP-16 in the treatment of a small cohort of pretreated patients with recurrent medulloblastoma. This form of administration of oral VP-16 was well tolerated and produced modest toxicity.

[Management of lateral type B malleolar fracture with penetrating wires, cerclage and hemicerclage]

In this retrospective study 52 cases of malleolar fractures type B, that were treated with Kirschner wires, cerclages and hemicerclages, between 1981 and 1991 at the Männedorf Hospital, were compiled and completed with the corresponding synopsis. The results show that the osteosynthesis technique, in certain cases, is absolutely justifiable and represents a reliable alternative to tensile screw osteosynthesis. This procedure of osteosynthesis is a good method in comminuted fractures as well as osteoporotic bone, in which the screws grip badly. A minimum of osteosynthesis material is implanted in precarious soft tissue conditions. As in the tensile screw osteosynthesis, the removal of the material can be done ambulatory under local anaesthetic with stab incision. The functional after-treatment is not recommended. We suggested a postoperative plaster of Paris treatment for 6 weeks (2 weeks without and 4 weeks with strain). As the postoperative course shows comparable results, osteosynthesis of the lateral malleolar fracture type B with Kirschner wires, cerclages and hemicerclages represents a good variation to plate osteosynthesis and tensile screw osteosynthesis.

[Necrosis of the terminal ileum after drug poisoning. Case report]

In an attempt to commit suicide, a 32-year-old women swallowed a vast amount of psychiatric drugs, i.e. tranquilizers, amphetamines, hynotic and antidepressant agents. By intensive care, using high doses of catecholamines and appropriate antidota, satisfactory circulation and oxygenation could be maintained. 3 days after admission a peritonitis became apparent. A 50 cm long section of the distal ileum was found to be completely necrotic and had to be resected. However, circulation of the correspondent mesenterium was not disturbed at all. A drug-induced non-occlusive intestinal ischemia was postulated to be the pathophysiological mechanism of intestinal necrosis. Non-occlusive intestinal ischemia is rare; it has been reported in young adults intoxicated by cocaine or phenobarbital, in children with high overdosage of iron compounds, in elderly individuals suffering from low-output congestive heart disease and in patients treated with digitalis drugs, with or with or without overdosage.

[Complications of diverticuli of the proximal small intestine. 3 case reports and review of the literature]

Three cases of small bowel diverticula are presented. In the first patient perforation of a congenital diverticulum in pars II of the duodenum occurred, the second case is the first description of bezoar in a duodenal diverticulum with bleeding of the diverticulum at the same time and the third patient suffered from ileus due to unusually large jejunal diverticulum. Up to 20% of all autopsied patients present duodenal diverticula. In other parts of small bowel diverticula are not as frequent. Most cases are asymptomatic and require no treatment. As soon as ailments occur, further investigations and probably surgical treatment is necessary. Perforation, bleeding and obstruction are indications for surgical interventions. The symptomatology is unspecific, therefore preoperative diagnosis is difficult. At least during the operation the possibility of small bowel diverticula and their complications should be considered. Till today complications of small bowel diverticula are affected with a mortality of 33-48%. More awareness of their existence could possibly improve this unfavourable outcome.

[Ten cases of rare breast tumors. Review and surgical management]

Ten cases of rare breast tumors are reported along with review of the literature. Three of the patients had cystosarcoma phylloides, one a primary carcinoid of the breast, two metastasis to the breast (bronchus carcinoma and carcinoma of the maxillary sinus), two malignant lymphoma and two Hodgkin lymphoma of the breast. We present a discussion of diagnostic and therapeutic procedures of breast tumors. Specially in rare breast tumors an exact histological diagnosis is important in order to avoid unnecessary surgical treatment and to guide further therapy.

[Hygienic and economic significance of sewer drainage in hospitals. Architectural changes in the guidelines of the Federal Health Office]

The hygienic importance of barrier zoning in hospitals has been evaluated on the basis of the relevant international literature between 1970 and 1989. There have been only a very few pertinent publications and in none has there been any pointer which would support the hypothesis of barriers having an infection-preventing effect. Using four University Hospitals in Baden-Würtemberg as paradigms, a model was prepared for calculating what space and cost savings were possible, if a simpler system could be installed, instead of the one demanded under federal regulations and already planned for the four hospitals. It was found that it would save a realizable area of 319,5 m2 at a potential cost saving of DM 1,138,335. By dispensing with hygienically not justifiable building work at the planning stage of new hospitals considerable greater costs could be avoided.

Humeral mobility after treatment with hanging cast

A retrospective review of 23 patients after treatment of humeral fractures with hanging cast was performed. The average followup time was 8.59 years (range, 1.0 to 15.5 years). Functional results were good in eight (34.8%) and excellent in 15 patients (65.2%). To assess the flexibility of shoulder and elbow joints 24 parameters were measured on each body side using the neutral-zero method of Debrunner. A cumulative comparison of each parameter revealed decreased flexibilities of the upper limb after treatment with hanging cast: reduced abduction without moving shoulder blade (84.08 +/- 7.53 vs. 77.34 +/- 11.38; p less than 0.05), reduced free abduction (166.09 +/- 14.4 vs. 158.22 +/- 19.28; p less than 0.01), reduced anteelevation (155.26 +/- 10.12 vs. 149.35 +/- 3.22; p less than 0.01), reduced external rotation with hanging arm (48.96 +/- 19.05 vs. 41.18 +/- 16.75; p less than 0.01), increased flexion of the shoulder (25.65 +/- 10.37 vs 27.3 +/- 10.0; p less than 0.05) and reduced extension of the elbow (0.86 +/- 6.92 vs. -2.68 +/- 9.63; p less than 0.05). These findings show that longterm deficiencies of humeral mobility after treatment with hanging casts exist.

[Surgical treatment of diabetic malum perforans by ray resection]

The main cause of the diabetic perforating ulcer is peripheral neuro- and angiopathy. Trivial injuries of the foot, wounds (chiropody), bacterial or mycotic infections often lead to tissue defects in the form of a perforating ulcer (in which neuropathy predominates) or of gangrene (in which angiopathy predominates). The deeply penetrating trophic ulcer with secondary development of osteitis in the foot bones often present us with difficult therapeutic decisions. Several measures for its treatment are given in the literature. We report on 5 patients in whom a plantar perforating ulcer was present beneath the 2nd an 3rd metatarsal heads with radiologically confirmed osteitis. The entire ray, including the corresponding toe, is excised as a wedge from the plantar and dorsal aspects, and the wound left open to heal. The indications, the course of healing, the duration of hospital admission and the complications are described.

[Abdominal actinomycosis--ileo-vaginal fistula as clinical manifestation. Case report and literature review]

In 1985 sigmoid resection was performed in an 81-year-old patient with recurrent sigmoid diverticulitis. Due to adenomyosis uteri, hysterectomy was performed at the same time. Approximately one year after an uneventful recovery fetid leukorrhea occurred. Radiograms revealed a fistula between the terminal ileum and vagina. Adhesions between the terminal ileum and vaginal stump were surgically resolved and an ileum segment resection was performed. Postoperative recovery was uncomplicated and the patient has been symptom-free since. The histological findings of Actinomyces microorganisms, thread-like foreign material and detritus drew our attention to a rare instance of abdominal actinomycosis. Publications of purely historical interest dealing with therapeutic measures before the antibiotic era are not taken into consideration. The clinical picture, incidence and therapy of abdominal actinomycosis are described in the light of the literature.

[Semiquantitative lipase determination--a useful screening test for pancreatitis?]

In 233 sera, taken from 112 patients and 20 healthy blood-donors, we have compared RapiTex-Lipase, a semi quantitative immunochemical latex test for the determination of the lipase, with the conventional quantitative method of determination in order to establish its diagnostical value as a screening test for acute pancreatitis. It appeared that, with a positive result of the test increased values of lipase were found in 98% of the cases, but that a negative result of the test did not exclude an increased lipase. The sensitivity of the test as to the quantitative determination of the lipase depended directly on the activity of the lipase and turned out to be acceptable at 88% only with values 4 X higher than the upper limit of the normal range. With values 5 X higher and more, it reached 100%. Even if the test, due to its very high level of discrimination, did not show a reaction in every case of unspecific extrapancreatic hyperlipasemia, its organ-specificity for the pancreas was reduced and came to 80 to 96% in patients with renal insufficiency, diseases of the liver, abuse of alcohol and in various non-pancreatic intra- or extra-abdominal affections. In 16/18 patients with acute pancreatitis the test used for screening turned out positive (sensitivity 89%), two patients with values between 2 and 4 X the upper limit of the norm had a negative test.(ABSTRACT TRUNCATED AT 250 WORDS)

[Ectopic kidney tissue in the inguinal canal. Case report and review of the literature]

We report a unique case of isolated ectopic tissue associated with an undescended testis. The pathological findings are outlined, and the embryology of renal and testicular development is reviewed.

The incidence and natural history of thrombus in the portal vein following distal splenorenal shunt

The incidence of thrombus formation in the portal vein following distal splenorenal shunt was 4% occlusive and 14% nonocclusive from 1974 to 1977, and 6% occlusive and 22% nonocclusive in 1980. The increased incidence was probably due to more aggressive ligation of collaterals on the portal vein. Ten patients with this complication were evaluated prospectively with clinical and biochemical parameters, angiography, and nutrient hepatic perfusion. In this group, one thrombus was occlusive immediately after operation, and nine were nonocclusive: eight of the latter resolved by six months, but one progressed to total thrombosis. There were no demonstrable adverse clinical or biochemical sequelae. Angiography showed continuing portal perfusion in the face of nonocclusive thrombus, but at six months there was increased collateral formation and significant (p less than 0.05) reduction in portal vein diameter, from 20 +/- 4 mm to 14 +/- 5 mm. Nutrient hepatic perfusion at six months, 896 +/- 257 ml/min, was not significantly different from that seen prior to operation, 848 +/- 92 ml/min. It is concluded that the natural history of nonocclusive portal vein thrombus after distal splenorenal shunt is resolution, and management should be expectant.

Stimulation of corneal differentiation by interaction between cell surface and extracellular matrix. I. Morphometric analysis of transfilter "induction"

The present study was undertaken to determine whether or not physical contact with the substratum is essential for the stimulatory effect of extracellular matrix (ECM) on corneal epithelial collagen synthesis. Previous studies showed that collagenous substrata stimulate isolated epithelia to produce three times as much collagen as they produce on noncollagenous substrate; killed collagenous substrata (e.g., lens capsule) are just as effective as living substrata (e.g., living lens) in promoting the production of new corneal stroma in vitro. In the experiments to be reported here, corneal epithelia were placed on one side of Nucleopore filters of different pore sizes and killed lens capsule on the other, with the expectation that contact of the reacting cells with the lens ECM should be limited by the number and size of the cell processes that can tranverse the pores. Transfilter cultures were grown for 24 h in [3H]proline-containing median and incorporation of isotope into hot trichloroacetic acid-soluble protein was used to measure corneal epithelial collagen production. Epithelial collagen synthesis increases directly as the size of the pores in the interposed filter increases and decreases as the thickness of the filter layer increases. Cell processes within Nucleopore filters were identified with the transmission electron microscope with difficulty; with the scanning electron microscope, however, the processes could easily be seen emerging from the undersurface of even 0.1-mum pore size filters. Morphometric techniques were used to show that cell surface area thus exposed to the underlying ECM is linearly correlated with enhancement of collagen synthesis. Epithelial cell processes did not pass through ultrathin (25-mum thick) 0.45-mum pore size Millipore filters nor did "induction" occur across them. The results are discussed in relation to current theories of embryonic tissue interaction.