[Occurrence of 3 primary carcinomas within 26 months]. / Auftreten dreier Primärkarzinome innerhalb von 26 Monaten.

One case of 3 primary malignant tumors is reported. Having undergone adjuvant polychemotherapy after mastectomy for cancer of the right breast, 2 more primary malignomas were found in a 73-year-old woman within 26 months: malignant melanoma for the right upper arm and scirrhous gastric cancer. Possible induction of secondary/tertiary neoplasms by polychemotherapy with alkylating drugs is discussed. The importance of early detection of secondary/tertiary malignancies and of their delimitation against metastases is underlined as being indispensable for the proper planning of adequate therapy.

[Decrease in arterial PO2 with captopril administration in secondary pulmonary hypertension and right heart failure]. / Abnahme des arteriellen PO2 unter Captoprilgabe bei sekundärer pulmonaler Hypertonie und Rechtsherzschwäche.

The ventilation-perfusion match under therapy with captopril was registered in 14 patients with secondary pulmonary hypertension and right heart failure caused by chronic obstructive lung disease. In none of the cases, changes of cranialisation of the perfusion or increasing ventilation-perfusion mismatch was found, but a significant fall in O2 was seen in all patients. This O2-depression is due to decreasing stroke volume of the right to left shunt.

[Cyclosporin A as a diabetogenic cofactor]. / Cyclosporin A als diabetogener Kofaktor.

Two kidney transplanted patients are reported, who developed an insulin dependent diabetes mellitus after crossing therapeutic Cyclosporine A levels. After stabilisation of the Cyclosporine A levels the insulin dependent diabetes mellitus was completely reversible. The results are indicating Cyclosporine A as the insulin dependent diabetes mellitus initiator.

[Fibronectin in the sputum in malignant and inflammatory diseases of the respiratory tract]. / Fibronektin im Sputum bei malignen und entzündlichen Atemwegserkrankungen.

Fibronectin , a glycoprotein, which is detectable in the pericellular space, can not be found on the surface of malignant transformed cells, but in the surrounding medium in a higher concentration. Which this finding, it was possible to differentiate between inflammatory and malignant genesis of pleural fluid and ascites. In the sputum and in the bronchial lavage different concentrations can be found too: In carcinomas the concentration on the average is much higher but not constant. This glycoprotein can therefore be used as a further tool in the search for neoplasms in the bronchial tree.

[Acute respiratory failure]. / Die akute respiratorische Insuffizienz.

The acute respiratory insufficiency (ARI) is a complicating syndrome in many severe, primarily not the lungs affecting internal and chirurgical diseases. As result of activation of classic cascade-systems, gas diffusion disturbance, right-left shunt and lung restriction occur. The effecting global respiratory insufficiency is only to prevent by polypragmatic therapy but often lung fibrosis terminates medical efforts.

[Endogenous creatinine clearing during cytostatic therapy]. / Die endogene Kreatininclearance unter zytostatischer Therapie.

25 patients with a malign neoplasia were treated with cytostatics. The endogenous creatinine clearance as a parameter of the kidney function was checked. Patients who had no side-effects, did not show important changes in kidney function immediately and 10 days after the treatment. Patients who had hyperemesis and diarrhoea showed an impairment, patients with a hyperkinetic reaction improvement of kidney function. General hyperhydration during a cytostatic treatment is not necessary, it can even be dangerous for patients with a hyperkinetic reaction.

[Modification of the FT4-level and the nonspecific peripheral thyroid parameter by heparin]. / Die Beeinflussung der FT4-Spiegel und eines unspezifischen peripheren Schilddrüsenparameters durch Heparingabe.

Heparin produces changes in FT4-levels both in vivo and in vitro as determined by commercial kits. Methods utilising the principle of equilibrium dialysis show significant increases whereas methods using T4-tracer analogue techniques reveal marked decreases in FT4-values. Possible clinical side-effects of heparin administration such as heparin-induced hyperthyroidism and tachyarrhythmias are discussed. The present results confirm the FT4-decreasing effect of in vivo and in vitro administration of heparin with FT4-RIAs based on the tracer analogue technique; however, the unspecific peripheral thyroid parameter of systolic time-intervals did not reveal any tendency towards hyperthyroidism. Also the discrepant results dependent on the method used, indicate that, following heparin administration FT4-levels do not reflect that hormone concentration is relevant to the metabolism of the whole body.

[The relevance of serum-complement factors in chronic obstructive pulmonary disease (author's transl)]. / Die Bedeutung einer qualitativen und quantitativen Erfasskung des Komplementsystems bei chronisch obstruktiven Lungenerkrankungen.

In a search for host factors predisposing for chronic obstructive pulmonary disease we have correlated in 20 patients the function of complement with the findings in functional lung exploration. Thereby we found no interrelationship between these two biological parameters.

[Blood glucose abd hormonal counterregulation in juvenile type I diabetics during exercise (author's transl)]. / Blutzuckerverhalten und hormonelle Gegenregulation bei jugendlichen Typ-I diabetikern unter körperlicher Belastung.

A decline in blood glucose is observed in juvenile insulin-treated diabetics after an exercise test. Though a prompt rise in counter regulatory hormones is seen, a compensation of the lowered glucose level did not take place. This is the result of a more rapid absorption of the s.c. injected insulin during and after physical activity.

Pulmonary function studies in long-term survivors with artificial ventilation in the neonatal period.

Lung function tests in 11 children aged 2.5--5.5 years who required intermittent positive pressure ventilation (1--624 hrs) in infancy were obtained. The conditions necessitating artificial ventilation were hyaline membrane disease, neonatal apneic spells, aspiration of milk, and birth asphyxia. On examination the probands were in a good healthy state and without any subjective signs of dyspnea. Lung volumes could be measured in all of the probands. They did not show any statistically significant deviation from standards for height and correlated with the age of the probands. Time related flow rates were sufficiently measurable in 7 probands only, who cooperated adequately. In 6 of them the expiratory flow showed a decrease of the effort independent portion with a slight increase in the total airway resistance. There was no correlation between the condition requiring artificial ventilation, the former therapeutic characteristics and the degree of the pathological lung function tests. The results of this investigation suggest damage of the smallest airways which could be the reason for the obstructively impaired expiratory patterns seen in 6 of the probands.

[Influence of a highly purified D-thyroxine medication on thyroid iodine uptake and in vitro tests of thyroid function (author's transl)]. / Beeinflussung laborchemischer und nuklearmedizinischer Schilddrüsenparameter unter der Behandlung mit einem hochgereinigten D-Thyrosin-Präparat.

25 euthyroidal patients with elevated serum cholesterol levels were treated with 4 mg of D-thyroxine daily for 4 weeks; controls were made after this period and after a withdrawal period of another 4 weeks. At the end of the treatment period there was a significant decrease of the serum cholesterol level, of the basal and TRH-stimulated serum TSH and of the thyroidal radioiodine uptake. The radioimmunologically determined values of total T 3 and Free Thyroxine index and of the serum iodine level rose significantly without being accompanied by clinical hyperthyroid symptoms. These changes can be explained on one hand by the well known cholesterol lowering effect of D T-4 and by the inclusion of D-isomeres of thyroid hormones in the radioimmunoassay, and, on the other hand, by the fact that the above-mentioned medication causes an uptake of iodine, and, possibly, by a direct inhibitory effect of D T-4 on the pituitary gland.

[The influence of a beta-adrenolytic premedication on cardiovascular parameters and plasma free fatty acids during esophago-gastro-duodenoscopy (author's transl)]. / Uber den Einfluss einer beta-adrenolytischen Prämedikation auf Herz-Kreislaufparameter und freie Fettsäuren bei der Osophago-Gastro-Bulboskopie.

Three groups of patients with different premedications were examined for changes of blood pressure, heart rate, ECG and plasma free fatty acid levels during esophago-gastro-duodenoscopy: Group A was premedicated with Bunitrolol, group B was premedicated with Hyoscin-N-butyl-bromide and diazepam, group C was endoscopied without premedication. The pulse rate rose significantly less in group A than in groups A and C; the same phenomenon was observed with regard to the systolic blood pressure. Premature beats occurred in all 3 groups: 32 per cent of the patients in group A, 43 per cent in group B and 60 per cent in group C had at least occasional premature beats; an accumulation of premature beats however occurred significantly less frequently in group A than in groups B or C. A drop of the ST-part of the ECG occurred with about the same frequency in each group. An increase of the plasma free fatty acids, which was noted in groups B and C, could be observed in Group A. A pre-endoscopic medication of beta blocking agents could be a useful measure in patients with labile arterial hypertension, vegatative dysregulation and a hyperkinetic heart syndrome.

[The distribution of ventilation and perfusion in the obstructive syndrome during nitroglycerin and bronchospasmolytic therapy]. / Die Verteilung von Ventilation und Perfusion beim obstruktiven Syndrom unter Nitroglyzerin und gleichzeitiger bronchospasmolytischer Therapie.

In chronic obstructive lung disease and pulmonary artery hypertension a cranialisation of both ventilation and perfusion can be observed. Nitroglycerine induces a decrease of tension and peripheral resistance. A ventilation-perfusion mismatching induces arterial hypoxemia. If bronchospasmolytic agents are added, hypoxemia can be prohibited.