[Acute appendicitis]. / Akute Appendicitis.

The appendectomy rate in the Federal Republic of Germany has decreased considerably over the past 20 years; in Hannover it has declined by 50%. The number of patients not undergoing operations after hospitalization has increased from 20% to about 65%. Mortality has decreased by 80%, now reaching 0.7 for 100,000 of the population. More than 80% of the deceased are over 65 years old. The main cause of death is advanced appendicitis including perforation. In the North German Patient Appeal Office 10% of all complaints in general surgery concern appendicitis, mostly because of delayed diagnosis. A considerable number of appendectomies is carried out simultaneously in gynecological operations.

Ultrastructure and visceral distribution of lipopigments in infantile neuronal ceroid-lipofuscinosis.

After an uneventful psychomotor development, a Jordanian boy developed increasing blindness, deafness, myoclonic jerks, tetraspasticity and dementia beginning at the age of 8 months and finally resulting in coma during which he died at the age of 3 years and 4 months. Two of his older siblings had possibly suffered from the same disease, but one of them had died in the Near East without adequate diagnosis. Autopsy revealed infantile neuronal ceroid-lipofuscinosis (NCL). Lipopigments showing typical autofluorescence and PAS staining granules were abundant in the markedly atrophic brain and numerous visceral organs, especially in cells of the reticulo-endothelial system, intestinal tunica propria, the bone marrow and hepatic von Kupffer cells. Ubiquitous accumulation of these NCL-typical lipopigments were found in adventitial mesenchymal cells of small vessels, particularly in lungs, liver and lymphatic organs. Lipopigments had accreted to a lesser degree in podocytes of renal glomerula and Sertoli cells, and in striated muscle fibers only around nuclei. Lymphocytes, smooth muscle cells and stratified epithelial cells did not contain lipopigments. The ultrastructure of the membrane-surrounded osmiophilic cytosomes consisted predominantly of finely granular lipofuscin although short membranous profiles were occasionally embedded within this granular matrix. These morphological findings emphasize the diagnostic importance of lymph node, rectal and bone marrow biopsies and, to a lesser degree, of liver biopsy in infantile neuronal ceroid-lipofuscinosis. The nosology of infantile NCL, independent of the ethnic background, was further clarified by our studies on ultrastructure and visceral distribution of these lipopigments. Morphological damage to parenchymal cells of visceral organs, contrary to the widespread loss of cortical neurons in the brain could not be demonstrated.

[Diagnosis and therapy of hepatoblastoma. Successful treatment of an inoperable hepatoblastoma and review of the literature (author's transl)]. / Zur Diagnose und Therapie des Hepatoblastoms. Erfolgreiche Behandlung eines inoperablen Hepatoblastoms und Literaturübersicht.

A review of the literature shows minimal success in relation to the treatment of hepato-blastoma. Recent improvements have been related to better techniques of liver resection. No final therapeutic recommendations can be made but prophylactic chemotherapy is indicated. The authors present a surprisingly successful patient who had a non-resectable hepato-blastoma and who is alive 8 years later without symptoms. In spite of radiotherapy, and chemotherapy there have been no obvious somatic changes which could be attributed to the treatment. The effect of treatment on the gonads is a feature that will have to be considered at a later date.

[Enophthalmos with limitation of bulbar motility as a rare clinical symptom of metastasizing carcinoma of the breast (author's transl)]. / Enophthalmus mit Motillitatsstörung als seltenes klinisches Symptom metastasierter Mammakarzinome.

A 57-year-old woman presented with a ptosis of her left eye four weeks prior to surgery for scirrhous carcinoma of the breast. Six months later she had blurred vision in her left eye, and double vision occurred three months subsequently. The diagnosis was enophthalmus and ophthalmoplegia. The suspected diagnosis of a distant metastasis of the scirrhous carcinoma of the breast was confirmed by biopsy. The orbital symptoms were a rare first sign not only of a metastatic process, but also of the carcinoma itself.

Human brain growth in the 19th and 20th century.

Data of 2399 brain weights and ages from populations before 1880, 1885 to 1900 and 1966 to 1976 were obtained from German anatomical and pathological institutes, analyzed with non-linear and multiple linear regression analyses and the results compared. The influence of the absolute age (sample period) on brain weights of adults (age of at least 10 years of ontogenesis) could not be verified. Different averages in the different samples seem to be stipulated by inhomogeneities of the age distributions. Sex differences were confirmed for the different periods. There is an accelerated degree of maturity of brain weights between the population sampled from 1966 to 1976 and the two older populations. The growth rate of the degree of maturity reveals the same fact, i.e., the growth rate is more rapid than 100 years ago. These differences may be explained by changed causes of death in the autopsy samples, but it is possible that they are at least partly caused by an acceleration of brain development in the early postnatal period. In all populations analyzed brain weights in females develop faster than in males. The development of the brain weight in 6 more samples is compared with the results for the Medical School Hannover sample.

Ultrastructural aspects of bubble formation in human fatal accidents after exposure to compressed air.

Electron microscopic investigations were performed on samples of human tissue obtained from subjects following fatal decompression sickness, associated with hyperbaric air-therapy. Intra- and extracellular gas bubbles of varying size were identified throughout the entire body. Each bubble was covered by an osmiophilic non-homogeneous coat of cloudy and flocculent material, native to its specific locality. This envelope measured from 30 to 560 Angstroem-units in thickness. Association of this covering with an electrokinetic zonal activity, detected biophysically by Lee and Hairston (1971) is assumed. We consider this surface coat prevents nitrogen from being eliminated via the blood-lung barrier.

[Fatal decompression sickness following therapeutic hyperbaric environment (author's transl)]. / Letale Dekompressionskrankheit nach therapeutischer Uberdruckbehandlung.

In Hannover/Germany in 1976 a so called "Society for Regenerative Hyperbaric Therapy" (Gesellschaft für Regenerative Uberdruck-Therapie) subjected 20 patients within two coupled multi-place chambers to a simulated hyperbaric environment, equivalent to a maximum of 4 ata, followed usually by gradual reductions of the pressure. The patients were of an average age of 67.2 years and were afflicted by various disorders. During one of the "dives" a patient developed air embolism of the central nervous system. During ensuing confusion of the chamber was opened suddenly, with resultant explosive reduction of the high pressure. This resulted in five letal accidents of decompression sickness. Post mortem examination revealed diffuse distribution of gas bubbles throughout the entire body. By elecronmicroscopy each bubble was covered by an osmiophilic coat. Post mortem findings are discussed and correlated with well-known and new clinical symptomes. These observations present for the first time fatal accidents of decompression sickness in humans, associated with hyperbaric air-therapy.