[The role of free fatty acids in the pathogenesis of arteriosclerosis]. / Die Rolle der freien Fettsäuren in der Pathogenese der Arteriosklerose.

Several diseases and functional disturbances (e.g. diabetes mellitus, obesity, phaeochromocytoma, chronic renal functional disturbances, psychosocial stress) marked by a disturbed metabolism of free fatty acids (FFA) and a hyperlipacidaemia correlate with a premature occurrence of arteriosclerotic alterations of the vessels. The FFA do not play an unimportant role as a link in the causal chain between the above-mentioned diseases or functional disturbances on the one hand and the atherogenesis on the other. Therefore an overview is given of the influence of a hyperlipacidaemia on important partial processes of the atherogenesis. In this connection the role of FFA in the lesion of the endothelium and in the formation of foam cells is depicted.

[Metabolism of free fatty acids in muscles]. / Der Stoffwechsel der freien Fettsäuren in der Muskulatur.

The skeletal muscle and the myocardium (musculature) are involved in the turnover rate of free fatty acids (FFA) with a third. Disturbances of the FFA metabolism of the musculature result in a restriction of the function which appears as a diminished contractility and, as far as the myocardium is concerned, additionally as arrhythmias. Moreover the restriction of the FFA utilization by the muscles plays a role in the origin of hyperlipacidaemias participating in the pathogenesis of various acute and chronic extramuscular functional disturbances (e.g. thrombophilia, disorders of the capillary circulation, hyperlipoproteinaemia, postnatal hypoglycaemia). With regard to its clinical relevance a survey is given of the FFA muscular metabolism. The author deals with the factors affecting the FFA netto bilance of the muscles and in this connection the regulation of the lipolysis, the triglyceride synthesis and the fatty acid oxidation. Finally the relation between the FFA and glucose metabolism in the muscles is described.

[The metabolism of free fatty acids in the liver]. / Der Stoffwechsel der freien Fettsäuren in der Leber.

The liver participates in the turnover rate of free fatty acids (FFA) with a third. A severe disruption of liver function that occurs in cirrhosis leads therefore to a pathogenetic relevant hyperlipacidaemia respectively increases that. With regard to its clinical relevance a survey is given of the FFA metabolism of the liver. The factors are described which influence the FFA uptake by this organ. In this connection the metabolic fate of the FFA in dependence on the hormonal nutritive state is depicted. The author deals with the relation of the hepatic FFA metabolism to that of triglycerides, cholesterol, ketone bodies, carbohydrates, amino acids and insulin. The importance of these relatons for the caloric homeostasis and for the pathogenesis of various acute and chronic functional disturbances (ketoacidosis, negative nitrogen-balance, hyperlipoproteinaemia, hyperinsulinism, atherosclerosis) is described.

[Metabolism of free fatty acids in fatty tissue]. / Der Stoffwechsel der freien Fettsäuren im Fettgewebe.

Hyperlipacidaemias play a role as etiological partial factor in the pathogenesis of various acute and chronic functional disturbances and are essentially the sequel of a disturbed metabolism of the free fatty acids of the fatty tissue. With regard to its clinical relevance a survey is given of the free fatty acid metabolism of the fatty tissue and its free fatty acid net balance as resultants from lipolysis and triglyceride synthesis is described. The author deals with the regulation of the lipolysis by cyclic mononucleotides, adenosine triphosphate, adenosine, fatty acids, ions, beta-hydroxybutyrate, lactate as well as hormones and finally with the control of the triglyceride synthesis.

[Lipid parameters in newly detected type II diabetic patients and relations to coronary heart disease]. / Lipidparameter bei neuerfassten Typ-II-Diabetikern und Beziehungen zur koronaren Herzkrankheit.

In a prospective study 192 new manifested type 2 (noninsulin dependent) diabetics were checked in view of prevalence of coronary heart disease (CHD) and hypertension in relation to concentration of lipids in serum. CHD was found in 49%, hypertension in 53% dominating females. Increased triglycerides (1.98 mmol/l) and decreased HDL-cholesterol i.s. (1.28 mmol/l) were characteristically, cholesterol (6.6 mmol/l) were within references, the lipoprotein-screening test was pathologically. Prevalence of CHD was associated with age, sex, hypertension, partly with triglycerides and weight and inverse with HDL-cholesterol i.s. but not with the concentration of blood glucose and insulin i.s. basal as well as stimulated (75 g oGTT). In conformity with other studies the differences in lipids alone would'nt be allowed to explain the high prevalence of CHD in new manifested type 2 diabetics.

[Metabolism of free fatty acids in the intravascular space]. / Der Stoffwechsel der freien Fettsäuren im Intravasalraum.

With regard to the clinically relevant pathogenetic significance of hyperlipacidaemias a survey of the metabolism of the free fatty acids in the intravascular space is given. The transport of the free fatty acids by albumin and lipoproteins is demonstrated and the importance of the non-protein-bound fraction of the free fatty acids is emphasized. The dynamics of the metabolism of the free fatty acids is characterized with the help of the fractional and absolute turnover rate. Furthermore, the author deals with the participation of individual organs in the total metabolism and the metabolic fate of the free fatty acids as well as with the sources of this lipid fraction. Finally the regulation of the plasma concentration of the free fatty acids and its significance for the maintenance of the caloric homoeostasis is described.

[Management of diabetes during operative procedures]. / Diabetesführung bei operativen Eingriffen.

The described basic scheme for the peroperative care of patients with diabetes mellitus which was for many years successfully used proved to be very efficient and improves the interdisciplinary care. On the basis of a standardized infusion programme in which the carbohydrates are given in combination as glucose and sorbite in many type II diabetics administrations of insulin and tolbutmide may be avoided. Modern anaesthesia techniques have a sedative effect on the postaggression syndrome. The change to oral fluid and food supply takes place as early as possible with adequate good results and advantages also after abdominal interventions. The diabetic and postoperative metabolism have both a common disturbed utilization of glucose which lead to catabolism with increased gluconeogenesis and lipolysis and additionally evoke complications. The necessary therapeutic measures may also be used in other non-postoperative postaggression syndromes without presence of diabetes mellitus. It is particularly referred to the dangers of a too schematic approach.

[Problems with the abortive Pickwickian syndrome]. / Zur Problematik des abortiven Pickwick-Syndroms.

In one year among 16 male patients and 24 female patients who were admitted on account of a considerable obesity and the connected with complaints in order to reduce the weight in the hospital, thrice the diagnosis abortive Pickwick-syndrome was made. Apart from the characteristic symptoms of obesity, hypersomnia, periodical breathing in sleep in all three patients smaller anatomical changes in the nasopharyngeal space were found. Secondary cardiopulmonary or cerebral sequels, as they are described in full pictures and late forms of the Pickwick-syndrome, could not be registered. The diagnosis of abortive Pickwick-syndrome, which we made ex juvantibus (reduction of weight), is perhaps more frequent than up to now assumed. Since the pathological disposition for sleep among others is of great importance in the field of transport and occupational medicine and may be prevented only by reduction of weight, which could be confirmed also in our three cases, it is referred to the necessity of an early recognition and treatment.