[Psychogenic twilight states in children and adolescents].
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Biomedical subjects
Publications and source records attributed to E Müller.
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A 6-year-old boy is reported who was operated upon with a pre-operative diagnosis of a recurrent right incarcerated inguinal hernia. As green-brown fluid appeared from the suspected hernial sac, a laparotomy was performed which showed a duplication of the ascending colon with a prolongation into the inguinal canal. The duplication and the relative intestinal segment were excised (right-sided) and because of the close relationship between the intestinal wall and the wall of the cyst, and the shared blood supply, an organ procedure was technically not possible.
In 591 appendectomies a repeat laparotomy was necessary in 19 children (3.2%). 12 of these children had had perforated appendicitis. After a so-called "chronic appendicitis" we have never seen an indication for a second operation. The most important indications requiring relaparotomy were the post-operative ileus and the septic complications. We found intra-abdominal infections mainly after perforated appendicitis, the re-laparotomy was never carried out before the eighth post-operative day.
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Surgical measures in the lymphedema of the extremities require precise establishment of the indication. The current surgical techniques (tissue reduction, Thompson's operation, lympho-venous anastomosis) are of some benefit but also have disadvantages. For that reason, the choice of surgical method depends entirely on the individual case and the edema (primary or secondary) present. Primary lymphedema preferentially calls for the performance of tissue reduction or Thompson's operation. In secondary lymphedema, we prefer as a primary surgical measure the so-called lympho-venous anastomosis; this technique can be applied as long as the subcutaneous lean and fatty tissue is not fibrotic. We formerly applied the technique according to Degni and found that the results in terms of reduction of the edema were more promising in the lower than the upper limbs.
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Cholinesterase activity was investigated in the heart of the developing chick from the 6th to 20th day of incubation. The earliest cholinesterase-positive nerve cells and fibers could be demonstrated between the 7th and 9th day. On the 13th day the nervous structure attained full development comparable with that seen in the hatched chicken. The number of ganglia increases up to the 15th day, and remains constant thereafter. The right ventricle is associated with the largest number of ganglia.
The changes in thymus, spleen and lymph nodes of the mouse after a single cortisone application or a single whole body x-irradiation were investigated morphologically and histochemically. During 24 h the alterations following the cortisone application are at all stages examined indistinguishable from those following the x-irradiation. The first signs of lymphocyte destruction can be observed already in the first two hours after treatment. Almost at the same time macrophages accumulate at the sites of cell death in the lymphatic organs studied. The eosinophils display a different behaviour. While they accompany the macrophages in the thymus already at the first stages, they appear in the spleen and lymph nodes with a latency of 6 and 8 h, respectively. The highest amount of necrotic cells is found ten hours after both treatments. At the same time the accumulation of macrophages and eosinophils reaches its maximum. The cholinesterase in the lymphatic organs is largely the true cholinesterase. The enzyme-activity increases in the cortex of the thymus gradually 6 h after treatment, showing the highest deposit of reaction product at 10 h. In spleen and lymph nodes the cholinesterase shows only slight variations. The possible role of the cholinesterase-activity in these non-cholinergic tissues is discussed.
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Local free cell (eosinophils and macrophages) and extracellular (acid mucopolysaccharides) reactions were studied by histochemical techniques in 72 primary lung cancers (Group A), 17 pulmonary metastases and 5 lung tumours of unknown origin (Group B). Strong cellular reactions were more frequent in Group A than in Group B, whereas extracellular reactions were more frequent in Group B than in Group A. In both groups the degrees of eosinophilic infiltration and accumulation of acid mucopolysaccharides tended to be negatively correlated. In contrast, macrophages and eosinophils showed a positive correlation in the primary cancers, but none in the other tumours. The extracellular material had physical and chemical properties (solubility, affinity to stains and degradability by enzymes) of the sulphated acid mucopolysaccharides. From its distribution it appeared to be derived from fibroblasts and/or tumour cells.
Local infiltrates of eosinophilic leucocytes and macrophages and the deposition of acid mucopolysaccharides (AMPS) in 72 operable primary lung cancers and 17 isolated pulmonary metastases of known origin were correlated to tumour stage (radically or non-radically operable) and clinical course, by following the patients for 2-3 1/2 years. Half of the primary lung cancers showed strong local eosinophilia which, in combination with either strong macrophage infiltration or absence of AMPS reaction, characterized a very good prognosis in radically operable patients. No eosinophils, together with a strong AMPS reaction, indicated a very poor prognosis, irrespective of tumour stage. 16/17 metastases (7 different histologies) had either no local eosinophilia (13), strong AMPS deposition (12) or both (9). This suggests that malignant clones with great metastatic potential in general are characterized by absence of local eosinophilia and/or a strong AMPS reaction. These observations taken together indicate that local eosinophilia expresses an immune reaction which is, houl metastatic clones. It if does, metastatic success may be due to an escape mechanism based on the elaboration of AMPS.
The occurence of Neisseria meningitidis in the urogenital tract is a rarity but nevertheless this may lead to a false diagnosis of gonorrhea, even when the Thayer-Martin-selective-medium is used and oxidase-reaction is performed. This is demonstrated in our case. A complete diagnosis, including sugar-fermentation, is necessary, when gram-negative diplococci are isolated from urogenital swabs. In the case Neisseria meningitidis is isolated, it is not required by law to report it to the public health authorities.
Electromyographic measurements of the activity of the lips were performed on 101 children with dental malocclusions. It was stated that the intensity of the tetanic activities depended on the type of malocclusion. On mouth closing the lower lip was in general more active than the upper lip. Electromyographic examinations before and after treatment with the function regulator showed a considerable decrease in muscular activity compared to the initial values. These results permit to conclude that the function regulator as a training tool in the oral vestibule exerts a beneficial effect on incorrect positions and parafunctions of the muscles of the lips.
Residual volume and the relative RV/TLC (total lung capacity) were measured in 632 men and 191 women aged 15 to 70 years. The residual volume showed a significant correlation to age and body height, but not to the relative body weight (Broca-Index). The values of RV/TLC showed a correlation to age and Broca-Index, but not to the body height. The regression formular to calculate the normal range are given; they comply with the data of other authors.
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Examinations of psychic and intellectual development were made in 9 girls with idiopathic precocious puberty. The question was, whether precocious somatic maturation corresponds with an accelerated development of intellectual efficiency and psycho-social behaviour. Whereas psychodiagnostic investigations and questionnaires to parents and teachers suggested age-related, normal results, there was found a remarkable tendency to elevated IQ values, averaging 123. Complex influences as increased general vitality, elevated pression towards psycho-social achievement and accelerated maturation of certain brain areas are discussed as conditional factors.
Approximating the cumulative cross section of the terminal airway structure by a single parabolic exponential term with the unknown parameters initial cross section a, exponential steepness b and external dead space VDE, calculations of the stationary concentration front F along airway length L, raising during constant flow inspiration, were done, solving the gas transport equation for stationary conditions numerically and integrating the distribution of dF/dL. The conversion to the expiratory F-V profile was done neglecting pulmonary inhomogeneity and expiratory front deformation. Calculations were applied on a scale of different a and b enclosing normal and some pathological lung models. Applying different inspiratory flows, there is a linear correlation between the reciprocal steepness dV/dF of expiratory F-V diagrams and the flow diffusion ratio V/D*, where D* is the effective diffusivity of gases. Compared to normal, the model of nonobstructive emphysema shows higher values of dV/dF and the general obstruction lower ones; all three have the same increase of dV/dF along V/D*. The peripheral obstruction type has the highest slope of regression along V/D* and the obstructive emphysema the lowest one. Mathematical approximations of the regression between dV/dF of the expiratory F-V diagram at certain intervals of F and V/D* were used to present a procedure calculating airway parameters a, b, VDE and the effective diffusivity D* from a sequence of F-V diagrams applying different inspiratory flows.