[Acute management of myocardial infarct patients in Austria (cross-sectional study of 8 intensive care units)]. / Akutversorgung von Herzinfarktpatienten in Osterreich (Querschnittsuntersuchung an 8 Intensivstationen).

8 Austrian Intensive Care Units provided data from 6,317 cases (including 1,667 cases with acute myocardial infarction) admitted during 1990 and 1991 for a documentation system offered by the Austrian Heart Foundation. Significant differences were observed between the units concerning admission policies and the use of diagnostic methods. 71% of the AMI cases were first infarctions, 10% were Non-Q-infarcts. The median of the prehospital period varied between 2.5 and 6.5 hours. The evaluation of the admission mode showed that on average 42% of the AMI cases had contact to their G.P. before hospital admission, this figure varying, however, between 24 and 90% in different areas. It seems that this contact takes place to a much lower extent in big cities. On average G.P. contact before hospital admission in AMI resulted in doubling of the duration of the prehospital period. Thrombolytic treatment was applied in 24.7% of AMI cases with a variation between 13.9 and 48.4% in the different centers. It is suggested that regular use of this kind of quality control should offer means for optimizing the acute care of infarct patients on a regional and on a national level.

[Punctate cytology of benign and malignant changes in the thyroid gland (author's transl)]. / Punktatzytologie benigner und maligner Schilddrüsen-veränderungen

80 thyroid gland aspirates obtained post-operatively were compared with 69 clinically punctured cases. The results suggest that the vast majority of cytological misdiagnoses are caused by a faulty withdrawal technique. As a contribution to the differential diagnosis of "follicular neoplasia" an attempt was made to introduce the diameter of the nucelus obtained morphometrically as a parameter of malignancy. In aspirates of highly differentiated follicular carcinomas a significantly higher percentage of thyrocytes with larger nuclear diameters are found than in benign nodular changes in the thyroid gland.

[Morphological and cytokinetic studies of the arterial wall following x-ray irradiation. I. Results with 3000 rad. focal irradiation dose in rabbits]. / Morphologische und zelkinetische Untersuchungen an der Arterienwand nach Röntgenbestrahlung. I. Ergebnisse bei 3000rad. Herdbestrahlungsdosis am Kaninchen

The arterial wall (abdominal aorta, splenic artery) has been investigated after irradiation with 3000 rad (3 X 1000 rad within 3 weeks) in rabbits. In addition to light microscopic techniques semi-thin sections, electron microscopic sections, permeability staining and autoradiographic techniques have been applied. These studies revealed typical lesions in the media (elastic degeneration, cellular proliferation of the smooth muscle cells) and lesions of the endothelial cells using ultrastructural techniques especially. The intima showed an increasing permeability in the irradiated area, while autoradiographically a higher mitotic activity in the media was demonstrable. The results are discussed in the light of similar atherosclerotic and X-ray induced lesions of human blood vessels.

Humoral immunodeficiency to bacterial antigens in patients with juvenile onset diabetes mellitus.

Humoral immunity to bacterial antigens was tested in 49 tissue typed patients with juvenile onset diabetes mellitus (JOD) and in 50 healthy controls. The number of patients with agglutinins to E. coli and staphylococci was significantly lower compared to controls (p less than 0.001, p less than 0.01 respectively). Missing antibody formation to pertussis and diphtheria toxoid could also be detected in a higher percentage of JOD patients than of controls (p less than 0.05; p congruent to 0.05, respectively). By contrast heteroagglutinins to sheep and rabbit erythrocytes were found in similar proportion in both groups and the values of immunoglobulin serum concentrations showed no difference between patients and controls. In addition no correlation between antibody formation and genes of the HLA complex was found. It is suggested that the severely reduced agglutinin formation to bacteria antigens might be partly responsible for susceptibility to bacterial infections in juvenile diabetics.

[Migration inhibition of mononuclear cells in idiopathic adrenal insufficiency. Inhibition of migration of mononuclear cells with adrenal microsomes and blocking of the reaction by adrenal antibodies (author's transl)]. / Untersuchungen über die Migration mononucleärer Zellen bei Patienten mit idiopathischer Nebennierenrindeninsuffizienz. Hemmung der Migration mononucleärer Zellen durch Nebennieren-Mikrosomen und Blockierung der Reaktion mit Nebennierenriden-Antikörpern

In 19 patients with idiopathic adrenal insufficiency and in 19 controls, cellular (as measured by the migration inhibition test) and humoral (by means of immunoflourescence) immune reaction to adrenal antigens were investigated. Significant inhibition of migration was observed in 12 patients with adrenal microsomes; migration of mononuclear cells was however within normal range in 18 out of 19 controls. Adrenal antibodies could be detected in 11 (53%) of the patients. In a further series of investigations adrenal microsomes have been preincubated with specific antibody and used in migration inhibition tests. The migration indices observed with microsomes were compared to those obtained with microsomes preincubated with adrenal antibody. Migration inhibition with microsomes could be blocked by antibody in almost all antibody-positive patients. No uniform trend on the migration of mononuclear cells was found in the antibody-negative patients. A blocking of the cellular immune reaction by specific antibody seems likely. Possible mechanisms which could lead to such phenomena as well as the biologic significance of adrenal antibodies are discussed.

[HL-A system and diabetes mellitus]. / HLA-System und Diabetes mellitus

In 19 families of juvenile diabetes patients intravenous glucose tolerance was tested and HLA antigens were determined. A total of 68 first degree blood relations (siblings, parents, children) was studied. Taking the age dependent variabilities of the glucose assimilation coefficient (k-value) into consideration, glucose intolerance was found in 35.5% of the blood relations. Particularly in blood relations (above all in siblings) aged under 35 and with glucose intolerance, a trend to increased frequencies of those HLA antigens (B8, BW15, CW3) associated with juvenile diabetes was found, but it is not yet clear whether this association will be of practical significance.

[Study of age and sex dependance in renal clearances with radioisotopes (author's transl)]. / Untersuchungen zur Alters- und Geschlechtsabhängigkeit der renalen Clearance mit Hilfe von Radioisotopen

In 85 patients between 15 and 95 years of age (40 male patients and 45 females) without any signs of renal disease (concentration of serum creatinine below 1,4 mg/100ml, normal diastolic blood pressure and normal urine analysis) a highly significant negative correlation was found between glomerular filtration rate (GFR, determined by 51Cr-EDTA - slope-clearance) and renal plasma flow (RPF, determined by 131J-oJHS-iodinehippuricacid-totalclearance) on one side and age on the other. Beginning with a basic value of 160 ml in males and 144 ml in females for GFR, the average decrease per year was 1,2 ml/1,0 ml respectively. The basis value of RPF was 854 ml for males and 673 ml for females, the decrease per year was 5,4 ml in men and 2,9 ml in women. The importance of physiological diminution of clearance values in elderly patients and its consequences for therapy are discussed. The more exact and methodically simpler 51Cr-EDTA-slope-clearance without urine collection should be used instead of the somewhat inaccurate determination of endogenous creatinine clearance especially in older patients.

Alterations of the internal elastic membrane in the coeliac trunk and its branches.

Changes in the internal elastic membrane of the coeliac trunk and its branches begin in the foetus. Usually these changes increase with advancing age. The intensity of involvement varies in different arteries, localized swelling is of particular importance as a measure of atherosclerotic involvement. There is a close relationship between morphology and chemical structure.

[Eosinophilic granuloma (histiocytosis-X) with lung and bone manifestations]. / Eosinophiles Granulom (Histiozytosis-X) mit pulmonaler und ossärer Manifestation

A 26 year-old male presented with a spontaneous pathological fracture of the right femur caused by an osteolytic lesion. A chest X-ray demonstrated the coexistence of interstitial pulmonary fibrosis. Fibrocaseous tuberculosis and widespread malignancy were ruled out by appropriate investigations. The differential diagnosis, as based on the histological examination of the bone tumour, rested between hyperparathyroidism complicated by pulmonary disease and eosinophilic granuloma with lung manifestations. Hyperparathyroidism was ruled out by the absence of clinical and biochemical evidence of a disturbance of calcium metabolism. The diagnosis of histiocytosis-X was established by the histological appearance of the lung biopsy.

HL-A antigens in idiopathic Addison's disease.

The frequencies of 36 HL-A antigens of the SD-1, SD-2 and SD-3 locus have been determined in 20 patients with idiopathic Addison's disease and compared with those of 450 controls. No significantly different HL-A antigen frequencies could be observed in both groups. These findings are in contradiction to data reported by a Copenhagen group. Possible mechanisms which might have led to this discrepancy are discussed.

[Clinical and immunological studies in idiopathic adrenal insufficiency]. / Klinische und immunologische Untersuchungen bei der idiopathischen Nebenniereninsuffizienz

The application of 2 special methods to the pathogenetic elucidation of idiopathic Addison's disease is discussed in the light of a clinical case. In accordance with the literature, this patient with idiopathic Addison's disease showed a normal adrenomedullary response (as gauged by the catecholamine excretion and the increase in plasma renin activity) to 2-deoxy-D-glucose administration. Moreover, IgG antibodies were demonstrable in the patient's serum with respect to adrenocortical antigens of the cytoplasmic components of the endocrine cells of the zona glomerulosa and zona fisciculata.

[Thyreotoxic crisis triggered by stimulation of the adrenal gland medulla]. / Thyreotoxische Krise ausgelöst durch Nebennierenmarkstimulation

Thyroid storm was observed in a patient with Grave's disease after stimulation of release of epinephrine and norepinephrine with 2-DG. Measurements of catecholamine secretion before and during onset of thyrotoxic crisis suggested the important bearing of increased activity of the sympathetic nervous system on pathogenesis of thyroid storm.

[Serum concentration of triiodothyronine in autonomous thyroid gland adenoma]. / Serumkonzentrationen des Trijodthyronins beim autonomen Adenom der Schilddrüse

Serum Concentration of T3 was measured in 14 patients with autonomous thyroid adenoma using a chromatographic method. 9 patients had increased levels of T4, 5 were normal. In both groups serum-T3-concentration was significantly elevated. In patients with normal T4-values hypertriijodothyroninemia seems to be the biochemical base for clinical signs of hyperthyroidism. The pathogenetical importance of elevated T3-levels is discussed for T3-secretion and T4/T3 conversion.