A C++ framework for developing Medical Logic Modules and an Arden Syntax compiler.

When developing a clinical decision support system that uses knowledge expressed in Arden Syntax, the availability of a robust means of translating Arden Syntax into an executable module becomes critical. This paper describes an approach where Arden Syntax is translated into an intermediate pseudo-Arden language that is in turn compiled and linked to create the executable module. The pseudo-Arden language is defined in C++ using specialized class libraries and preprocessor macros. This approach provides an alternative means of developing the code generator for an Arden Syntax compiler.

[The monoclonal gammapathy of uncertain meaning- a premyelomatosis?]. / Die monoklonale Gammopathie unbestimmter Bedeutung--eine Prämyelomatose?

In three cases of localised multiple myeloma the monoclonal immunoglobulin could be identified even 17, 12 and 8 years prior to clinical manifestation. These observations point again to the question of a possible "history of development" for the plasma cell disease and, thus, to the clinical validity of monoclonal gammopathy of (still) uncertain significance. As even in the relationship of membrane-associated light chains of B-lymphocytes a certain monoclonality begins to appear at an early time, more attention should be devoted to the early diagnosis of malign plasma cell dyscrasia.

[Clinical problems of viral hepatitis B in hematological neoplasms]. / Zur klinischen Problematik einer Virushepatitis B bei hämatologischen Neoplasien.

A virus hepatitis B was observed intercurrently in 8 patients with malignant lymphomas or plasmacytoma respectively. Four of these patients where the therapy of the basic disease was discontinued after manifestations of hepatitis came to death by acute liver dystrophy. The therapy was continued in the remaining four patients without any changes, hepatitis showed a tendency towards an involution with remaining HBsAg carrier status. In our opinion these four cases clearly indicate that, naturally by carefully observing the situation of the liver, a continuation of the envisaged treatment might involve a smaller risk than limiting the treatment.

[First results of in vitro cultivation of stem cells from bone marrow and peripheral blood in an autologous test system of patients with hematological diseases]. / Erste Ergebnisse der In-vitro-Kultivierung von Stammzellen aus Knochenmark und peripherem Blut im autologen Testsystem bei Patienten mit hämatologischen Erkrankungen.

In 17 patients with haematological diseases an autologous test system was elaborated for determining the percentage of unipotent myeloic stem cells in the bone-marrow and peripheral blood and implemented by experiments. In comparing the results obtained by means of the traditional heterologous culture method, differences (diminutions, increase of aggregate numbers) could be found which allow certain conclusions to be drawn on the patient's real bone marrow function. For reasons of standardization, cultivation in the heterologous system cannot be abandoned. The investigations are continued.

[Immunoelectrophoresis--indications and clinical relevance]. / Immunelektrophorese--Indikationen und klinische Relevanz.

In the framework of the analysis of an immunoglobulin fraction and particularly of its monoclonic components the immunoelectrophoresis is the method of choice. It is based on the preliminary examinations of the plasma protein diagnosis, but quantitative establishments are not its task. But notwithstanding its at present practically routine application in this field it increasingly also becomes part of our effort to obtain deeper insight into the orthology and pathology of the lymphoproliferative system also by way of the monoclonic immunoglobulins.

[Unusual course of plasmocytosis. Contribution to the problem of extramedullary and asecretory forms]. / Ungewöhnlicher Verlauf einer Plasmozytomerkrankung. Ein Beitrag zum Problem der extraossären und asekretorischen Formen.

A case of plasmocytosis treated and observed for more than 4 years was characterized by an extraordinarily strong tendency to extramedullary manifestations and by a nearly asecretory course of disease. Its histomorphological explanation with regard to a differential diagnosis towards a possible secondary neoplasia was connected with many problems at the beginning of the disease when it had to be localized in the scull-face area as well as in the final stage. It may be assumed that this is one of those pictures of disease developing in the limiting area of the maturation zone ranging from the lymphoplasmacytoid cell type to the finally differentiated plasma cells and their systemic neoplasia. The term "plasmocytoma with an extra-osseous tumour expansion" will certainly correspond to its clinical picture in the best way.

[Malignant lymphomas: involvement and complications of the gastro-intestinal tract (author's transl)]. / Maligne Lymphome: Manifestationen und Komplikationen im Gastrointestinaltrakt.

Among 100 patients with malignant lymphomas we found 7 with primary involvement of the gastrointestinal tract and 2 with secondary affection. 2 patients suffered from M. Hodgkin and 7 from non-Hodgkin-lymphoma. The absence of characteristic diagnostic data may lead to incorrect results, as shown. There false diagnoses cannot be excluded neither by endoscopy nor by histology of biopsy material. Every operation on the gastrointestinal tract under the suspicion of a malignant lymphoma should be improved used for the staging. A radio- and/or polychemotherapy has stage depending to follow. On the other hand these are followed by a high percentage of gastrointestinal complications (6% incomplete ileus) which require a gastrointestinal intensive care.

[Problems of immunoglobulin analysis in IgD-plasmacytoma]. / Zur Problematik der Immunglobulinanalyse beim IgD-Plasmozytom.

We succeeded in proving the specific monoclonal immune globulin in a case of IgD-plasmocytoma only relatively late after generalisation of the disease. The immunoelectrophoretic findings changed under the antineoplastic system therapy in such a way that the specific line of immune globulins was demonstrated much weakened and a new strong precipitation line for free easy chains of type L appeared. When the findings were not carefully inspected without doubt an easy chain plasmocytoma might have been diagnosed. The findings can earliest be explained by a further increase of the spontaneous readiness for decay which already exists in the immune globulin D under the cytostatic therapy.

[Rare monoclonal immunoglobulins, and analysis of their biological and clinical value]. / Seltene monoklonale Immunglobuline, eine Analyse ihrer biologischen und klinischen Wertigkeit.

Under rare monoclonal immunoglobulins we understand double or multiple formations in the same patient and above all the appearance of fragments, semimolecules or free heavy chains. Among our material of 309 cases of monoclonal immunoglobulins we could five times establish such findings. The cases in question were twice the combination of complete molecules, in three cases we saw fragment formations, partly in combination. By evaluation of literature and on the basis of an own observation we come to the determined result that these anomalous formations of fragments--which by all means may be called real paraproteins--must represent products of an incomplete synthesis. This anomaly is the functional expression of the structural changes concomitant with the cancerisation of the cell. Double and multiple formation is by no means at the same time bi- or oligoclonality. Our findings are discussed under these aspects.

[Diagnosis and therapy of plasmacytoma and Waldenstrom's disease]. / Diagnostik und Therapie des Plasmozytoms und des Morbus Waldenström

Plasmocytoma and Waldenstroem's disease together with some other very rare diseases form the group of paraproteinaemic haemoblastoses. In these cases the plasmocytoma as a neoplasia of the plasma cells is quite likely to define by the sum of the cytomorphological, radiological and immunological findings in form of the plasmocytosis of the bone-marrow, the destructions of the skeleton and the formation of monoclonal immunoglobulins as cardinal symptoms. Waldenstroem's disease, however, becomes more and more a special form of the IgM-forming malignant lymphomas. In its classical expression apart from the formation of lymphomas, hepato-splenomegaly and haemorhages it above all exhibits the excessive formation of a monoclonal, macromolecular immunoglobulin. In this disease the prognosis is in many cases by far more favourable than that one of the plasmocytoma which, apart from its solitary-multiple form of the course, is a disease with high malignity. Cyclophosphamide and sarcolysin are the remedies of choice in the plasmocytoma, procarbazine in waldenstroem's disease. Nowadays, the inclusion of the two diseases into the large spectre of neoplasias of all cells of the immuno-competent system which finally are structurally derived from the immunocyte and are functionally differentiated renders a special way of description unnecessary.

[The clinical valency of monoclonal immunoglobulins. Attempt at a determination of their importance]. / Zur klinischen Wertigkeit momoklonaler Immunglobuline. Versuch einer Standortbestimmung

The classification of the protein bodies which Apitz in his time called paraproteins into the large spectre of the immunoglobulins has had a decisive influence on the clinical valency of these findings. Nowadays it is possible to estimate these proteins from the point of view of their development as the functional evidence of a monoclonal proliferation as well as issuing from the part of their immunological effect. 218 cases of monoclonal immunoglobulin are distributed according to the clinical diagnosis. Here it is shown that also a not unconsiderable proportion of benign diseases reveals these findings. Monoclonal immunoglobulins are of special interest when diseases of the group of nosological forms of the lympho-plasma-cellular reticulum and particularly of the paraproteinaemic haemoblastoses are in question. The analysis of the monoclonal macroglobulinaemias has led to a new orientation concerning Waldenstroem's disease which absolutely might be regarded as a nosological entity and no more as a morphological one. A special quality of the protein, the formation of cryoprotein, has close structural relations to the easy chain type kappa, which possibly in general must closely be correlated with reactions of immunoglobulins dependent on temperature.