[The significance of urinary tract infections in patients with cerebrovascular diseases during clinical rehabilitation]. / Die Bedeutung von Harnwegsinfekten bei Patienten mit zerebrovaskulären Erkrankungen während der klinischen Rehabilitation.

In 361 patients with cerebral stroke a study of medical and neurological complications was undertaken. Among a total of 131 complications (36.2%) a striking incidence of urinary tract infections was seen: 83 cases (22.9%). Patients without complications had an average stay of 61.2 days in hospital, those with urinary tract infections had 77 days (p < 0.05). In patients with cerebrovascular accidents voiding dysfunctions are common. Great care must be taken to prevent complications: indwelling catheters should be used only over short periods of time. In case urinary drainage is needed over a long period of time, suprapubic catheterization should be preferred.

[Scintigraphy studies of lymph flow in paralyzed upper extremities]. / Szintigraphische Untersuchungen des Lymphtransportes in gelähmten oberen Extremitäten.

BACKGROUND: In paralysed limbs quite often edemas are seen, which might pose problems during rehabilitation. The origin of these edemas is not fully understood. METHODS: 48 patients with hemiplegia and edema of the paralysed arm were studied; in 40 patients lymphoscintigraphic studies (static and dynamic lymphography) were performed. RESULTS: In 80% of these cases lymphatic flow in the paralysed arm was increased compared to the healthy arm. If there was marked edema in the paralysed arm, the increase of lymph flow was considerable (p < 0.01). CONCLUSIONS: Edemas in hemiplegic extremities are not due to lymphedema, as in lymphedema the lymph flow usually is very slow. They most likely are caused by disorders of filtration and reabsorption, due to a dysfunction of the autonomic nervous system.

[Value of nuclear magnetic resonance tomography in leg edema of unknown origin. Preliminary report]. / Stellenwert der Kernspintomographie bei unklaren Beinödemen. Vorläufige Mitteilung.

Edemas of the leg sometimes pose problems for diagnosis. Invasive procedures like lymphography or phlebography are either difficult to perform or might endanger the lymphatics. The value of magnetic resonance imaging was assessed in 20 patients with lymphedema, lipedema and phlebedema. Images of patients with lipedema showed homogenous enlarged subcutaneous tissue. In lymphedema a honeycomb pattern in the subcutaneous tissue was observed; in phlebedema there was an increase of fluid within the muscle. Magnetic resonance imaging is useful in differentiating lymphedema, lipedema or phlebedema.

Prevalence of serological markers for viral hepatitis and AIDS in rural Punjab.

PIP: Sera from 385 healthy people aged 1-76 years from rural Punjab, India, were assayed in 1985-1986 for antibodies to hepatitis A, hepatitis B virus (anti-HBc) and hepatitis B serum antigen, and 175 of these sera were screened for HIV antibodies by ELISA. Commercial kits Havab, Ausrah II, and Ausab Test, (Abbott Laboratories, North Chicago, Ill, USA) were used. In cases of positive HBsAG, HBe-Antigen and HBV-DNA were determined by radioimmunoassay. over 98% of persons 20, 89% of those 10-19 and 88% of children 1-9 had hepatitis A antibodies. Markers for hepatitis B virus, anti-HBc, ranged from 3.12-36.9% over the age groups, with a total of 100 or 30% positive. HBsAG positives averaged 3.37%. These data are typical of Indian populations in which everyone 10 years has been exposed to hepatitis A. None of the sera were positive for HIV.^ieng

Prevalence of serological hepatitis A and B markers in a rural area of northern Zaire.

In a seroepidemiological study of the population of a rural area in northern Zaire, markers of hepatitis A and B were determined. Examinations of serum specimens (n = 142) showed that hepatitis A is acquired early in childhood; virtually all persons beyond 20 years of age are immune. Capillary blood dried on filter discs (n = 352) gave accurate results only in childhood; in older individuals a high percentage of positive results was missed (approximately 20%), presumably due to lower anti-HAV titers in older persons. The dried-blood method showed similar limitations regarding the detection of hepatitis B markers. In the 5-7 year age group there was already a high prevalence of anti-HBc (59%) as determined by the dried blood method. In the 10-19 year age group the prevalence was 94% as determined by examination of serum specimens. In all age groups the percentage of HBsAg positive persons was 20.7%, as demonstrated in capillary blood specimens and 31.7% in serum specimens.

[Tetanus immunity in an urban population: gaps in the vaccination of senior citizens and foreign guest workers]. / Tetanusimmunität einer Grossstadtbevölkerung: Impflücken bei Senioren sowie bei ausländischen Gastarbeitern.

Immunity against tetanus in an urban population: gaps of immunity among elderly persons. In a sero-epidemiological survey we investigated the immunity against tetanustoxoid in an urban population. Children and adolescents born in Germany (n = 193) showed an excellent immunity, negative findings being the exception. Among soldiers of the army (n = 136), negative findings were rare too. In these both groups the antibody titiers averaged 4,5 IU/ml. It is generally agreed that an antibody titer of 0,01 IU/ml protects against tetanus. Adults born in Germany (n = 295) had a good immunity: 84% showed antibody - titers against tetanus. Among elderly persons, however, above 60 years of age (n = 1576) there was a striking incidence of negative findings: in 1043 persons (65%) no antibodies could be detected. The remaining 533 persons with positive findings (35%) had antibody-titers in the lower range (average 0,482 IU/ml). Also among foreigners and immigrant labourers from mediterrean countries (Greece, Turkey, Yugoslavia) the frequency of negative findings was high: 183 persons were examined, 70 (39%) were negative 113 (61%) were positive. The incidence of negative findings was highest among women from the mediterrean countries. Several small studies published in Switzerland show a similar tendency. Our paper will encourage further seroepidemiological studies.

[Epidemiology of hepatitis A and B and yellow fever in Zaire]. / Epidemiologie der Hepatitis A und B und des Gelbfiebers in Zaire.

In a sero-epidemiological study, clinically healthy persons from a rural area of Zaire were tested for antibodies against hepatitis A, B and yellow fever. There was a high prevalence of antibodies to hepatitis A-virus in early life: 90% of all children at the age of ten had antibodies in their sera. Similarly up to the age of 19 years almost 90% of all persons investigated were positive for hepatitis B (anti-HBc). The incidence of the hepatitis B-surface antigen in all ages was high. According to the method used, it totalled to 21% (capillary blood) or 32% (serum specimens). All these persons were asymptomatic HBsAg carriers. A carrier-rate of 20-30% is extremely high; it has been reported only in a few studies in tropical countries. 138 serum specimens from all age groups were tested for antibodies to yellow fever virus; 59 of them (43,4%) were positive. None of these persons reported a history of yellow fever; evidently they had undergone subclinical infections. Our findings show that yellow fever still is endemic in Central Africa. It may be concluded that all persons visiting Central Africa should be vaccinated against hepatitis A (passive prophylaxis), yellow fever and, if possible, against hepatitis B.

[Tetanus immunity in old age]. / Tetanusimmunität im Alter.

Among 1546 elderly persons (above 60 years of age) from a large town the immunity against tetanus was tested. 1043 persons (66.18%) had no antibodies against tetanus-toxoid in their serum. Almost half of the remaining positive sera (33.82%) showed antibody titers between 0.01 and 0.1 IU/ml. It is open to discussion if these titers warrant complete protection against the disease. On the contrary, children or young men serving in the army showed good immunity with high antibody titers. Tetanus has become a rare disease in the western countries, but cases still occur. The disease affects nowadays mainly adults. The older the patient the higher is its mortality. According to our study, many old people are not protected against tetanus. The risk of infection is widespread. It is strongly recommended to immunize also elderly persons at regular intervals. The vaccination against tetanus is cheap, well tolerated and yields a good immunity even in old age.