Showing papers in "Wiener Klinische Wochenschrift in 1981"

[Efficacy of specific immunoglobulin against TBE (author's transl)].

Abstract: The efficacy of passive immunization against tickborne encephalitis (TBE) was evaluated in Vienna by means of a telephonic survey. It was learned that in 1979 after a tickbite in endemic areas, of TBE, approximately one out of 1,000 unvaccinated persons came down with the disease. Administration of TBE immunoglobulin after exposure reduced the incidence of the disease to 1:2,500. thus showing a rate of protection of approximately 60%. The survey also showed that in 1979 one third of those at risk (frequent walks in forests) had already undergone active immunization with the Austrian TBE vaccine.

[Subcutaneous Dirofilaria (Nochtiella) repens infection in man--report of the first case in Austria and review of the literature (author's transl)].

Abstract: A 39-year-old female patient developed migratory skin nodules 4 months after a vacation in Greece. The patient observed a total of 17 nodules moving over the trunk to the left thigh, where a subcutaneous lesion was excised, yielding a parasite measuring 0.5 mm X 7 cm. It was classified as Dirofilaria (Nochtiella) repens. Since this is the first case observed in Austria, an exact description of subcutaneous dirofilariasis, its geographical distribution and a review of the literature is presented.

[Ultrasonic diagnosis of acute suppurative appendicitis: a case report (author's transl)]

Abstract: In a patient, 87 years of age, with typical symptoms and clinical signs of acute appendicitis we were able to demonstrate the swollen and fluid-filled appendix by sonography. The suspected diagnosis of a suppurative appendicitis was confirmed at operation. This is the first report, to our knowledge, of the use of sonography in establishing the diagnosis of acute appendicitis.

[Veratrum album poisoning (author's transl)].

Abstract: Ingestion of plant material rarely gives rise to manifest clinical intoxication. This is due to the relatively low toxicity of most of the poisonous plants of Central Europe. Veratrum album is an important exception on account of its highly toxic alkaloids. Seven cases of overt intoxication from veratrum album have been reported to the Austrian Poison Information Centre during the past 5 years. On the basis of these case reports toxicological and clinical aspects of this rare form of poisoning are discussed.

[Causal therapeutic management of aplastic anaemia (author's transl)].

Abstract: Aplastic anaemia is characterized by hypoplasia of haemopoietic tissue. The aetiology of aplastic anaemia is multifactorial, the majority of cases being termed "idiopathic" because of lack of discernible noxious agents. Treatment can include stimulation of haemopoietic stem cells or replacement of stem cells by bone marrow transplantation. Some cases show autoimmune-mediated marrow failure and these patients may respond to immunosuppressive therapy. Pathophysiological subclassification of individual cases is necessary to ensure the correct choice of therapy offering the best chance of success, at minimum risk, from amongst a multitude of therapeutic procedures.

[Is the CO2 laser surgery advantageous? A morphological and experimental study (author's transl)].

Abstract: The great advantages of CO2 laser surgery are the contact-less cutting and the haemostatic effect. An obliteration of blood- and lymph-vessels thus preventing tumour-cell mobilisation and metastatic spread is considered as most advantageous for tumour surgery. Basing on own morphological and experimental investigations, some of these advantages are critically discussed. The morphology of human skin incisions made by a CO2 laser is described, using light microscopy, and the wound healing process of laser incisions in the dorsal skin of rats is compared with incisions made by thermocautery and conventional scalpel. After contamination of laser and scalpel incisions with india-ink, the migration of these particles to the regional lymph-nodes was also investigated. Compared to the scalpel-incisions, the laser- and even more the thermocauter-incisions showed the well known delay in healing, due to the extensive tissue necrosis at the wound margins. This coagulation necrosis, however, was not obliterate the lymphatic drainage. It is concluded from these experiments that the use of the CO2 laser will not guarantee the prevention of metastatic spread and should mainly be recommended where the haemostatic effect is essential.

[Determination of the morbidity due to inhalation allergies in Viennese schoolchildren (author's transl)].

Abstract: According to the medical literature there is a huge variation of between 0.4 and 49% of the population reported to suffer from inhalation allergies. In general, however, reference is made time and again to the increasing incidence of allergies, particularly in children. In the present study 3,158 Viennese schoolchildren of three different age groups (8, 12, and 16 year-olds) were tested for inhalation allergy. Precise case histories were elicited and skin tests carried out in all children, and if one of these criteria was positive an immunological examination was performed in addition, in order to detect any specific antibodies in the serum. A point system was used for the diagnosis of allergy. The tests showed that 17.6% of the schoolchildren have an allergic predisposition, 10.1% suffer from clinically manifest allergy and 7.5% show a subclinical form. With advancing age the percentage of children suffering from allergies increases significantly: While among the 8 year-olds only 13.6% show a predisposition to allergy (6.8% manifest, 6.8% latent), the incidence among the 16 year-olds is as high as 22.1% (14.2% manifest, 7.9% latent). Among the allergy patients pollen sensitization was found to exist in 71.7% of cases, sensitivity to household-dust mites in 23.1% and 5.2% reacted to multiple allergens. The results of this study are discussed and compared with internationally obtained data.

[Lead intake with food of young infants in the years 1980/81 (author's transl)].

Abstract: Several studies related minimal cerebral dysfunction in children to environmental lead exposure. We calculated the lead intake of young infants based on measurements of the lead content in their food. There was no significant difference between the lead content of 13 samples of pooled breast milk (50.2 +/- 22.5 micrograms/l), 11 samples of adapted and followup formulas (67.4 +/- 9.9 micrograms/l) and 9 samples of cow milk (59.5 +/- 22.5 micrograms/l). In fruits, commercially prepared strained fruits and juices lead concentrations were between 18.7 and 123.6 micrograms/kg. Based on the mean concentration of all products we calculated the average lead content in an infant's fruit or juice dinner to be 67 micrograms/kg. In plain and creamed vegetables lead concentrations were between 98.2 and 204.0 micrograms/kg, with the highest lead content in potatoes, spinach and carrots. The average lead content in an infant's plain or creamed vegetable dinner was 117 micrograms/kg. The lead intake over the first 6 months of life was calculated from the above-mentioned data and the average amount of food consumed per day. It was found to be below the maximum daily permissible intake from all sources. However, especially after introduction of mixed feeding (vegetables!) at the age of 4 months, the daily lead intake was close to the tolerance limit. There was no evidence of lead contamination during production of commercially-prepared baby food. Environmental contamination seems to be the main reason for the high lead content in infant food, especially in vegetables.

[Shortening of interval between first and second TBE vaccination in asthmatic children (author's transl)]

Abstract: 37 children suffering from asthma had to be vaccinated against tick-borne encephalitis (TBE) with an interval of only 10 days between the first two vaccinations. Sufficient antibodies were detected in samples taken 14 days after the second injection. No differences were found between the results in this group of asthmatic children and in children who were vaccinated with the usual interval of 1 to 3 months elapsing between the first two injections. The asthmatic children tolerated the vaccination very well, moreover the indicence of side reactions was not different from that of the control group.

[Steroid receptor levels in human breast carcinomas in relation to serum hormone levels in postmenopausal patients (author's transl)]

Abstract: Serum levels of LH, FSH, HPRL, oestradiol, progesterone and testosterone were determined by radioimmunoassay in 45 postmenopausal patients in the morning before they were operated on for primary breast cancer. Cytosol oestradiol - (E2R) and progesterone receptor (PgR) levels were estimated by Scatchard plot analysis of saturation assays using the charcoal method. When serum hormone levels and receptor contents were correlated according to the distribution free test of Spearman, all correlations were found to be insignificant, with the exception of E2R/PgR (p less than 0.001).

[Neurological signs in diphenylhydantoin intoxication (case reports and review) (author's transl)].

Abstract: Five patients who were treated with long-term diphenylhydantoin for epilepsy developed neurological signs of poisoning. In 4 cases the symptoms appeared following treatment of status epilepticus with additional phenytoin medication. All patients had an acute symptomatic psychosis and a diffuse slowing of the curves in the EEG. All 5 patients showed cerebellar signs and two of them complained additionally of objective polyneuropathy, a third case complaining of itching only. An axonal polyneuropathy with minimal reduction in motor nerve conduction and a considerable extension of distal latency and diminution of compound action potential was found. In one case the biopsy showed concentric lamellar bodies coming from the axon, with intact myelin sheaths. All alterations were reversible. The pathogenesis of toxicity is discussed. Cumulation of toxic products in the plasma arising from delayed elimination of DPH metabolites is pointed out. However, one case with cerebellar signs had normal DPH levels.

[Lactate acidosis in the cerebrospinal fluid as a prognostic parameter of malacic cerebral insult (author's transl)].

Abstract: The concentrations of lactate and pyruvate were determined in 111 CSF and blood samples. The CSF and blood chemistry of 43 patients with a lateralized ischaemic cerebral insult was compared with that of a control group of 18 patients. The first tests were carried out within 24 to 48 hours and 50 follow-up determinations were undertaken in the cerebral insult group. The patients were classified according to their level of consciousness (lucid-somnolent-soporous-comatose). Covariance analysis revealed a distinct relation between the CSF chemistry and the level of consciousness of the insult patients; accordingly, a continuous increase in the lactate level from 1.54 mmol/l to 3.48 mmol/l and in the pyruvate level from 0.11 mmol/l to 0.21 mmol/l was noted. Spearman's correlation analysis also pointed to a statistically significant correlation between decreasing levels of consciousness and the CSF lactate/pyruvate quotient. The increase in the CSF/blood quotient of lactate from 1.17 to 2.14, corresponding to the decrease in the level of consciousness, also indicates that during the early stages of the disease, cerebral tissue hypoxia is reflected in the CSF rather than in the blood. Further subdivision of the groups according to whether the patients survived or died, showed that the critical maximum concentrations from the prognostic point of view are 2.74 +/- 0.19 mmol/l in the case of CSF lactate, 0.186 +/- 0.017 in the case of CSF pyruvate and 1.92 +/- 0.65 for the CSF/blood quotient of lactate. None of the patients with a CSF lactate level of 3.1 mmol/l or more survived the ischaemic cerebral insult. Thus, the above-mentioned parameters are to be regarded as important indicators of the threat to the patient's life.

[The serum uric acid level in the Viennese population (author's transl)]

Abstract: Serum uric acid determinations were made in 2,626 subjects (males and females) within the framework of the "Wiener Gesundheitsstudie 1979", at three distinct age levels (25, 40 and 60 years). The serum uric acid level in male subjects was found to have an arithmetic mean of 6.25 mg/dl, whereas in female subjects the serum uric acid levels, with an arithmetic mean of 4.66 mg/dl, were considerably lower. Levels of more than 7 mg/dl occurred in 3% of the female subjects, whereas hyperuricaemia was detected in 25.4% of the males. In addition, hyperuricaemia was correlated with other risk factors. A relation between hyperuricaemia and coronary heart disease and myocardial infarction was found in the subgroup of the 60 year-old men. There is, furthermore, a pronounced association between hyperuricaemia and a tendency to overweight. The "protective effect" of diabetes mellitus on hyperuricaemia was confirmed only in the subgroup of the 60 year-old men.

[Human fascioliasis in Austria (author's transl)].

Abstract: Two cases of human fascioliasis in Austria (a 3-year-old boy and a 4-year-ond girl) are reported. A description is given of the clinical picture and the diagnostic procedures employed in the two cases. The importance of the serodiagnosis of fascioliasis is demonstrated, especially in the case of liver flukes; 4 different serological tests, partly of high sensitivity, were performed. After unsuccessful therapy with Resochin both children were treated with dehydroemetine; after a 4-week interval during which no eggs of Fasciola were found in several stool samples from either child, ova were yet again detected in the faces of the boy. The problems concerning the chemotherapy of fascioliasis are discussed.

[Report on the results achieved over the past 10 years in the neuro-orthopaedic out-patient department (author's transl)].

Abstract: A short abstract of the pathophysiology of pain and its conduction is followed by a discussion of the importance of neurological-orthopaedic cooperation for the diagnosis and the treatment of pain syndromes arising from the locomotor apparatus. The examination of the spine from the functional, i.e. segmental point of view is pointed out. The main reflex answer of the spine to irritation is the restriction of movement or hypermobility. Therefore, neuro-orthopaedic reflex treatment consists of so-called "test treatment" by means of manipulation to overcome the restriction of movement or by local curative anaesthesia, or by a combination of both methods. The results over the past decade of treatment in 1008 patients suffering from various pain syndromes are presented and differentiated.

[Herpes zoster oticus -- neuropathologic contribution to the genesis of concomitant facial paralysis (author's transl)].

Abstract: A woman of 71 years suffered from herpes zoster oticus, 7th and 10th nerve paralysis, vertigo and hearing loss; she died after 5 weeks. Neuropathologic examination revealed intensive inflammation in the pons and medulla oblongata and necrotizing arteritis in the cerebello-pontine angle, predominantly on the clinically affected side. The adjacent facial nerve was severely damaged. For the first time, necrotizing arteritis appears as important cause of facial paralysis in the Ramsey-Hunt syndrome.

[Results of a questionnaire issued to expectant and delivered mothers (author's transl)].

Abstract: At the Department of Obstetrics and Gynaecology, Wilhelminenspital der Stadt Wien, Vienna, 98% of all deliveries are continuously monitored. 30% (1979) received epidural anaesthesia. The presence of the husband in the delivery room and partial rooming-in is available to all mothers. To find out if the service to expectant and delivered mothers is according to the requirement of our patients, questionnaires were distributed indiscriminately over a two-month period to 350 pregnant women and to 240 women in the puerperium. Fetal monitoring was valued positively in the majority of cases, the presence of the husband during delivery is requested in a minority of cases only, but would be welcomed by a higher proportion of puerperal women for the next delivery. Expectant mothers wished epidural anaesthesia in 50% of cases. Not only pregnant, but also delivered women demanded rooming-in, the latter group agreeing in the main with our partial form of rooming-in. Nearly 90% of mothers with rooming-in felt well prepared for baby care on leaving the hospital. We believe in the possibility of a synthesis of continuous monitoring to achieve optimum safety of delivery and family-orientated obstetrics in the hospital management of labour and the puerperium.

[Studies on the effect of the alpha-receptor stimulant, gutron, in the orthostatic syndrome (author's transl)].

Abstract: 20 patients, aged 17 to 35 years, with static, labile circulatory disturbances were selected on the basis of an orthostatic test for inclusion in a double-blind trial of Gutron, an alpha-receptor stimulatory drug. The duration of the trial was third weeks and 5 mg Gutron twice daily or placebo was randomly administered in the second week. Venous capacity and circulatory performance under orthostatic conditions (upright) and also under ergometer stress were evaluated. Changes in general well-being objectified by means of a self-assessment scale. Gutron achieved a lowering of the decrease in venous capacity during orthostatis, whereby the systolic blood pressure was raised and the diastolic blood pressure decreased. These features, in conjunction with a broadening of the amplitude and a decrease in pulse rate, point to an essential economisation of the circulation. The results were generally similar during ergometer work. The improvement in well-being was manifest by the decrease in negative entries in the self-assessment scale.

[Multiple sclerosis and chromosomal aberrations (author's transl)].

Abstract: Chromosomal investigations were performed after peripheral lymphocytes taken from 25 healthy females and from 35 female patients suffering from various types of multiple sclerosis had been cultured for 48 hours. The incidence of cells with chromosomal breaks in multiple sclerosis patients (2.0%) was significantly higher than in controls (1.1%): Chi2 = 7.26; DF = 1; p less than 0.01. Furthermore, chromosomal rearrangements (dicentric chromosomes, translocation chromosomes, chromatid exchange figures) were observed more frequently in the MS patients than in the controls. Analysis of the interchromosomal distribution of breaks found in the patients revealed a relative surplus in chromosome A2 and D-group chromosomes.

[Laboratory diagnosis of viral diseases of the skin (author's transl)].

Abstract: In order to establish the diagnosis of viral diseases with clinical manifestations in the skin, frequently the help of a virus laboratory is needed. Not even classical childhood diseases such as measles and rubella can safely be diagnosed by the clinician. Today, in many cases diagnosis is possible within hours after the arrival of clinical specimens in the laboratory. Only in cases of enterovirus infection and tropical diseases has the virologist to resort to the classical time-consuming methods of direct (virus isolation) or indirect (serologic) diagnostic virology.

[An unusual case of repeated self mutilation (author's transl)].

Abstract: An unusual case is presented of repeated, life-threatening self mutilation, elicited by the topical application of sodium hydroxide, which necessitated several operations, including amputation of the left lower leg. Histological examination revealed colliquation necrosis and a striking eosinophilia. The latter feature, which was not reproducible in an animal experiment, may be related to a defect of leucocyte locomotion in the present case. Language: de

[Penicillamine-induced elastosis perforans serpiginosa and pulmonary cyst in Wilson's disease (author's transl)].

Abstract: A large air cyst was removed from the right lung of a 29-year-old female patient with Wilson's disease and penicillamine-induced perforating elastosis, the cyst first appearing after 9 years of treatment with penicillamine. Since, on the one hand, the microscopic and ultrastructural changes in the elastic tissue of the lungs were identical to those observed in the skin, both in areas of clinically-demonstrable elastosis perforans serpiginosa and clinically unaffected skin and, on the other hand, no other pulmonary disease was demonstrable to account for the development of the cystic lesion, it is concluded that penicillamine is the causative factor by means of extensive alteration of the elastic tissue. The morphological changes in the elastic fibres are so characteristic that it is easy to distinguish penicillamine-induced elastosis perforans serpiginosa from the idiopathic variant.

[Multidisciplinary diagnostic approach to Fahr's syndrome, a familial disease (author's transl)].

Abstract: Fahr's syndrome is characterized by idiopathic non-arteriosclerotic, symmetric, intracerebral vascular sclerosis. On the basis of relevant literature and our own research, the necessity of multidisciplinary diagnosis is reviewed: psychiatric, neurological, medical, paediatric and radiological approaches are discussed. The early onset of diverse psychological alterations is regarded as significant. Extensive diagnosis seems justified by the at least theoretically possible means of prophylaxis and treatment in cases of Fahr's syndrome associated with hypoparathyroidism, pseudo-hypoparathyroidism and pseudo-pseudo-hypoparathyroidism. This condition otherwise irreversibly leads to dementia.

[Serum alpha-1-fetoprotein and serum lactic dehydrogenase isoenzymes in liver tumours (author's transl)].

Abstract: Serum alpha-1-fetoprotein (AFP) and serum lactic dehydrogenase isoenzymes (LDH I-V) were evaluated in healthy subjects as well as in 10 patients with primary liver carcinoma, in 10 patients with metastatic liver cancer and in 10 patients with cirrhosis of the liver. The diagnosis was established histologically in all cases. The upper limit of the normal AFP range was 9 ng/ml. Four out of all the patients with hepatocellular or cholangiocellular carcinomas had normal AFP values, 3 showed slightly increased AFP values, whilst a serum AFP concentration exceeding 174 ng/ml - limit which is statistically highly suggestive of hepatoma - was found in only 3 patients. Three out of the patients with metastatic liver cancer and 3 with cirrhosis showed moderately increased AFP values. In primary liver cancer LDH V is increased significantly and 8 out of all patients showed higher values of LDH V than LDH IV. By contrast, patients with metastatic liver cancer had significantly increased LDH IV, which was higher than LDH V in 9 out of all cases. Cirrhotics showed normal LDH isoenzymes. Combining these results, a definitive diagnosis could be made in 9 patients with primary carcinoma of the liver and in 9 patients with metastatic liver cancer.

[Clinical experience with occult blood test in 8784 patients (author's transl)].

Abstract: The faeces of 8784 patients were tested for occult blood, using the "Haemoccult-II" method. 347 (4.0%) gave at least one positive result. Endoscopic examination of the gastrointestinal tract was performed in 301 patients. In 62.8% of cases the lesion responsible for the bleeding was located in the lower gastrointestinal tract, in 17.6% in the upper gastrointestinal tract. In 19.6% no cause was found for the positive test. In 133 out of 301 haemoccult-positive patients (44.2%) tumours were identified as sources of bleeding. Our results were compared with the findings obtained with other screening programmes for colorectal carcinomas. Haemoccult-II test are recommended as a yearly routine procedure for early detection of colorectal tumours.

The conservative treatment of stress incontinence in women with midodrine

Abstract: This paper describes the aetiology and symptoms of stress incontinence in women and reports on the conservative therapy of this condition with midodrine, an alpha-sympathomimetic drug. Successful results were obtained in 80% of the cases, the side effects produced by midodrine were negligible.

[Encouraging results with cytostatic therapy in metastasizing breast cancer (author's transl)].

Abstract: 58 women with metastatic breast cancer, non-responsive to hormone therapy, were treated with a modified CMF regimen After progression the combination of adriamycin and vincristine was used With CMF the response rate was 41% (10% complete remissions, 31% partial remissions), 38% showed no change, whilst progression of the disease was observed in only 21% of patients The median duration of remission was about 8 months Progression of the disease was treated by a combination of adriamycin and vincristine and remissions were obtained in 24% of cases The median survival time of our patients from the time of tumour metastasis was 186 months and was dependent on the results of treatment

[Development and results of adrenal autotransplantation (author's transl)].

Abstract: 56 cases of adrenalectomy and autotransplantation of human adrenal tissue have been reported in the literature since 1955. The most common indication was bilateral adrenal hyperplasia. A reduction in postoperative corticosteroid substitution and a return to almost physiological function on discontinuation of long-term substitution can be achieved. Recurrent disease is easily cured by partial excision of the transplanted tissue, situated usually in small muscle pockets, under local anaesthesia. The loss of adaptation to circadian rhythm and stress are adverse effects. Further development of this technique, which is still relatively rarely implemented, may make it more universally applicable for a wider indication of bilateral adrenalectomy, without loss of adrenal function.

[Granulomatous placentitis in toxoplasmosis (author's transl)].

Abstract: A case is reported of granulomatous placentitis due to Toxoplasma infection, which led, like two similar cases reported in the literature to abortion within the first half of pregnancy. The author tries to interpret the pathogenesis of this rare type of reaction. In view of the early onset of infection a complete immune response of the fetus in this state of development appears unlikely. The question arises whether maternal immuno-competent cells might be responsible for this mature immune reaction, which took the form of granulomatous inflammation of the placenta. A prerequisite for this type of reaction is considered to be prolonged retention of vital placental tissue in the uterus in intra-uterine death of the fetus or complete abortion.

[Fungal infections -- always dangerous for immunosuppressed patients (author's transl)].

Abstract: Four renal transplant recipients, treated with the immunosuppressive combination of azathioprine-prednisolone, developed organ or systemic mycoses caused by Candida albicans and, in one case, additionally by Trichophyton rubrum. Ketoconazole, a new wide-spectrum antimycotic drug, was successfully used in the treatment of the fungal infections in these patients. The oral route of administration, good tolerance and excellent results are good recommendations for this drug.