[Pathogenicity of glomerular hyperfiltration, a question of glomerular tolerance?]. / Pathogenität der glomerulären Hyperfiltration, eine Frage der glomerulären Toleranz?

As an introduction the concept of the hyperfiltration nephropathy is described. Since it was essentially derived from animal-experimental observations on the rat, the question after the importance for human medicine arises. To this is now argued that a comparable nephronal hyperfiltration possesses a species-different pathogenicity, since the glomerular tolerance to among others the mesangial protein load is also species-different. From this the diagnostic demand for the determination of the glomerular filtration reserve for the recognition of the glomerular hyperfiltration and for the investigation of the microalbuminuria for recognizing the glomerular tolerance.

[Status of diabetes in Ethiopia as a contribution to tropical diabetes mellitus]. / Zur Diabetessituation in der VDR Athiopien als Beitrag zum tropischen Diabetes mellitus.

On the basis of own experiences with the care of diabetes in the northern highland of Ethiopia the particularities of the tropical diabetes mellitus are described. In the light of the control score according to Noviks and co-workers the quality of the metabolic management of 100 patients is estimated as above all unsatisfactory, from which the conclusion is to be deduced more than up to now to include the diabetes mellitus into the health care system of Ethiopia and to improve thoroughly the conditions for the diagnostics, the therapy, education and dispensary care.

[A decrease in height as an expression of disordered bone metabolism in hyperthyroidism]. / Grössenabnahme als Ausdruck der Knochenstoffwechselstörung bei Hyperthyreose.

Disturbances of the bone metabolism are only rarely observed in hyperthyroidism. The description of the case demonstrates clinical signs of osteopathy, connections with the duration of the disease and the possibility to be able to treat on the basis of a fundamental diagnosis.

36 months continuous subcutaneous insulin infusion (CSII) in insulin dependent diabetes (IDDM)--influence on early stages of retinopathy, nephropathy and neuropathy--psychological analysis.

UNLABELLED: In extremely unstable (brittle) IDDM patients (n = 11) the metabolic effect of long-term (36 months) CSII proved to be superior to conventional insulin treatment (CIT) (statistical twins, n = 11): HbA1 = 8.6 +/- 0.3 versus 10.4 +/- 0.4, MBG = 5.6 +/- 0.3 versus 8.5 +/- 0.8, M (80)- value = 23.6 +/- 0.6 versus 56.7 +/- 10.2, GCI) = 37.3 +/- 15.6 versus 132 +/- 24.2. In addition, in CSII patients the metabolic control was significantly better than intensified conventional insulin treatment (ICT) before. Retinal morphology improved under CSII in 1 eye, did not change in 10 eyes and deteriorated in 11 eyes. Under CIT retinal findings improved in none, did not change in 16 and deteriorated in 16 eyes. Deteriorations under CSII appeared more frequently during the first than during the second and third year of treatment and seemed to be a consequence of too strict metabolic control and/or too fast decrease of the glycemia at the beginning of CSII. During 36 months of CSII no deterioration but in one case normalization of microproteinuria was observed. Under CIT three cases changed from normal into microproteinuria. Reduced motor nerve conduction velocity (MCV) and/or sensory nerve conduction velocity (SCV) could be normalized in most cases under CSII, but respiratory heart arrhythmia (RHA) at rest could not. Most patients--if highly motivated before starting CSII--remained positively motivated for long-term pump therapy. IN CONCLUSION: Our experiences over three years demonstrate a positive effect of CSII on the metabolism as well as on the course of early stages of microangiopathy and neuropathy. A longer period of observations will be necessary to evaluate this, conclusively.

[Peptide hormones and the "new endocrinology"]. / Peptidhormone und "Neue Endokrinologie".

On the basis of the results found in literature a survey is given of the state of the peptide-chemical research from the point of view of the clinic. The functional mechanisms of the peptide hormones are explained, their effect as hormone and neurotransmitter is demonstrated. Particularly emphasized are the integrative tasks of the peptide hormones, which thus as another regulation principle of the organism are to be put by the side of the nervous and hormonal regulation. By the demonstration of the most frequent endocrine tumour syndromes with formation of adequate hormones the clinical importance of these substances is dealt with. The infrequency of these diseases is emphasized by the small number of own observations. It is referred to the growing importance of the peptide hormones in the diagnostics and therapy of internal and surgical diseases.

Results of treatment with continuous subcutaneous insulin infusion (CSII) in insulin-dependent (type I) diabetics.

10 labile insulin-dependent diabetic patients treated with CSII were followed up for 6 to 16 months under conditions of everyday life. The mean blood glucose (MBG), glycosylated haemoglobin (HbA1), motor nerve conduction velocity (MCV), and respiratory heart arrhythmia at rest (RHA) were investigated. A significant improvement of metabolic control was observed (MBG 8.03 +/- 1.40 vs 5.18 +/- 0.87 mmol/l, p less than 0.01; HbA1 10.7 +/- 1.3 vs 8.7 +/- 1.6%, p less than 0.05) in comparison with the control values under intensified conventional therapy. MCV increased gradually but the average RHA remained unchanged. The psychological examination employing a questionnaire reflects that all patients selected were highly motivated and that their positive attitudes were further stabilized during pump treatment. An average of three mild hypoglycaemic episodes occurred per month per patient; these were no more than under intensified conventional treatment. Other minor clinical and technical complications occurred at a total frequency of one per month per patient and did not achieve therapeutical relevance.

[Side effects of hormonal contraceptives from an internal medicine viewpoint]. / Nebenwirkungen hormonaler Kontrazeptiva aus internistischer Sicht.

Only little, partly reliable data are present concerning the frequency of impairing side-effects of hormonal contraceptives. These data are burdened with subjective opinions, do often not take into consideration the compound of the preparations, neglect prerequisites for epidemiological recognitions, overestimate individual descriptions and do not take into consideration the comparison with the moments of danger in the interruption of undesired pregnancies. Under this aspect the value of disturbing effects and contraindications are demonstrated from the point of view of the internist. At present there is no secure clue to genetic and endocrine long-term effects, also not for short-term lesions. Taking into considerations subjective complaints, the frequency of disturbing effects is relatively high. Cardio- and cerebrovascular complications must be seen in connection with associated risk factors. Women of the 35th to 45th year should take hormonal contraceptives only when they finish smoking and under careful control.

[Surgical aspects of the treatment of malignant thyroid gland tumors]. / Chirurgische Aspekte bei der Behandlung maligner Schilddrüsengeschwülste.

95 cases with primary malignant thyroid tumours underwent surgery from 1965 to 1977. In view of the interdisciplinary character of treatment and independent of histological differentiation, total thyroidectomy should be performed. Differentiated carcinomas should be treated by selective dissection of suspected cervical lymph nodes. Surgical intervention of undifferentiated and medullary carcinomas should be followed by unilateral or bilateral neck-dissection. The survival rate is shown to depend on histological stage and extension of the tumour.

[Mass screening for goiter under a public x-ray program]. / Strumareihenuntersuchung durch Volksröntgenaktion.

The photofluorograms obtained during the 1976 public x-ray screening programme in the urban region of Rostock were scrutinized for dilations of the mediastinum and displacements of the trachea which might indicate strumae. Suspicious x-ray findings were verified scintigraphically in 42 of 117 cases. Tracheal constriction and displacement were found in 28 patients. Except for two suffering from hyperthyroidism, all patients were euthyroid on the basis of the in vitro diagnosis. 14 of 18 "cold" nodes and regions were clarified cytologically. Altogether, 21 patients were treated by hormone substitution, 4 by surgery and 1 (female) by radio-iodine therapy. This shows that public x-ray screening programmes are a suitable tool for identifying treatable strumae regardless of age for little additional cost.

Studies on liver function under the influence of oral contraceptives.

The effects of two sequential therapies using mestranol as an estrogen and chlormadinone acetate and norethisterone acetate, respectively, as a gestagen on the aminotransferase (GOT and GPT), alkaline phosphatase and alpha-amylase activities, the cholesterol, total bilirubin and total protein contents and the indocyanine green (Ujoviridin, VEB Chemiekombinat Bitterfeld) half-life were studied in two groups, each comprising 12 women of fertile age. The serum protein was separated by paper electrophoresis and both the thymol turbidity and zinc sulphate tests were performed during the first treatment cycle. An estrogen-induced rise in alanine aminotransferase (GPT) activity from 6.31 U/liter to 12.14 U/liter was observed during application of the mestranol/chlormadinone acetate therapy. The value dropped to 5.34 U/liter when chlormadinone acetate was administered as a gestagen in addition to the estrogen. No significant changes were noted in the other biochemical parameters. Sequential therapy involving application of mestranol and norethisterone acetate produced only statistically secured rises in the alpha 1-globulin content and the GPT activity. All other changes in the different parameters remained within the normal range and were statistically insignificant.

[Liver function studies under the influence of hormonal contraceptives (sequential preparations)]. / Leberfunktionsuntersuchungen unter dem Einfluss hormonaler Kontrazeptiva (Sequenzpräparate).

20 fertile women who were treated with mestranol as oestrogen and both gestagenes chlormadinonacetate and norethisteronacetate were investigated. Alkaline phosphatase, ASAT, ALAT, alpha-amylase, cholesterol, bilirubin, serumproteins, indocyanine green half time, paper electrophoresis of serumproteins, thymol and zinc sulfate turbidity tests were examined during the first therapy cycle. Elevation of ALAT activity (6,3 I U/l to 12,14 u/l) was found during treatment with mestranol/chlormadinonacetate. A depression of ALAT (up to 5,34 u/l) was observed under additional therapy with gestagene chlormadinonacetate. Statistical significance was noted only for ALAT and alpha 1 globuline under sequential therapy with mestranol/norethisteronacetate.

PIP: 2 different sequence preparations were administered to 2 groups of 20 women, 17-41 years of age. Several biochemical parameters, including Ujoviridin ICG tests, were taken 2 days before o.c. use, on the day that the gestagen component was begun, and on the final day of sequential preparation use. In the group takine .08 mg mestranol and 2 mg chlormadinon acetate, a significant increase of the GPT values was observed during the first phase of the sequential preparation. After the gestagen component was introduced, the GPT fell significantly to below initial levels. In the group taking .08 mg mestranol and 1 mg norethisterone acetate, significant increases in the chi-one-globulin levels and the GPT were observed during the first phase of treatment. All other values remained within normal levels, and no significant difference was found between the results obtained from the 2 preparations.

[The clinical significance of the risk factor hyperlipoproteinemia. Study on 2700 patients]. / Zur klinischen Bedeutung des Risikofaktors Hyperlipoproteinämie. Untersuchungen an 2700 Patienten.

In a clinical study on 2,700 inpatients of the medical clinic of Rostock University systematic examinations of the lipids and lipoproteins were carried out. 2.5% of the examined patients showed a primary hyperlipoproteinemia, 14,8% disturbances of the lipid metabolism of different degree of severity, taking into consideration borderline regions of 300 mg/100 ml for cholesterol and of 250 mg/100 ml for triglycerides. In coronary sclerosis and myocardial infarction the frequency of hyperlipoproteinemia was, as we expected, very high, it was about 63 and 77%, respectively. In part groups in primary hyperlipoproteinemia as additional examinations the triglyceride content in the material of liver punction, various coagulation parameters, such as function and kinetics of the platelets were determined and examinations of the secretion of the exocrine pancreas were carried out. In patients of the programme of chronic dialysis, apart from this in temporary dependence on the treatment determinations of the heparin-induced lipoprotein lipase were performed. The consequences resulting from the mutual relations of the factor of risk hyperlipoproteinemia to the diseases of various organic systems are shown.

[Diagnosis and therapy of malignant thyroid neoplasms]. / Zur Diagnostik und Therapie maligner Schilddrüsentumoren.

On 155 patients (114 women and 41 men), who from 1965 to 1975 underwent a combined operative, radiological and hormonal treatment, the advantages of a planned interdisciplinary therapeutic procedure in malignant tumours of the thyroid gland are demonstrated. The histological classification was performed according to the nomenclature of the WHO. In 94 cases we had to do with differentiated epithelial tumours, 61 times with undifferentiated tumours. 36 patients were younger than 40 years, in general the 6th to 7th decennium was preferred. In clinical and nuclear-medical suspicion to malignoma the aspiration biopsy was carried out with a thin needle. 252 biopsies brought 39 times findings suspicious to tumour, in 20 cases the suspicion was confirmed by operation. The mean survival time after the complex therapy described was 2 1/4 years in the undifferentiated tumours, in differentiated carcinomas 4 years. Up to now 25 patients reached the 5-year-limit. The lethality was loaded above all by late stages. The planned interdisciplinary proceeding in suitable centres is able to improve the chances of success in early diagnosing including the punction cytology.