[Fulminant course of a leptospira grippotyphosa infection].
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Biomedical subjects
Publications and source records attributed to H Köhler.
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A combined familial study of multiple sclerosis (MS) in England and in the Rostock area of the GDR using the macrophage electrophoretic mobility (MEM)-LAD test embracing 132 relatives has revealed a closely similar pattern of distribution of "anomalous" LAD (Linoleic Acid Depression) values in relatives (77% type of reaction) to that originally reported in the British study. The anomaly in predominantly associated with females--all mothers of MS patients being affected, whilst daughters and sisters are also represented. In addition unusual full MS type of reaction (90% reduction) has been found in some children related to patients. There is clearly a genetic element in the development of MS probably mainfested in the inborn mishandling of unsaturated fatty acids suggested by Thompson; no recognizable pattern of inheritance is noticeable even within the combined material. There is evidence that the metabolic anomaly alone does not inevitably lead to MS, and the full abnormality may be present at an early age. A survey about the examinations and a selection of characteristic family trees of MS are given, illustrating the manner in which the 77% type anomaly is distributed with occasional omission of a generation.
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In terminal renal insufficiency thrombosis occurs almost exclusively in the arteriovenous shunt. The management of this acute, life threatening thrombosis is hardly contested. On the other hand, few results are available concerning effective thrombosis prophylaxis. In addition to the effectiveness, the pharmacokinetics of a substance and also possible bleeding complications must be taken into account. The parenteral administration of heparin and its short half life restrict it to use in thehospital. Oral anticoagulants, because they are difficult to dose, should be avoided when possible. Dextrans (Rheomacrodex) and acetylsalicylic acid (Colfarit) appear to be best suited for thrombosis prophylaxis in renal insufficiency. Dextran has the disadvantage of volume overload, and acetylsalicylic acid that of stomach intolerance. Sulfinpyrazone (Anturano) also appears to be effective, although its pharmacokinetic behaviour in renal insufficiency is still not known. Dipyridamole (Persantin), whose effectiveness for this purpose has not yet been demonstrate, should be administered even more cautiously.
After infusion of 500 ml of 6% hydroxyethyl starch into fifty-four patients an increase of serum amylase was observed which in fifty-one cases exceeded the upper limit of normal (190 U/l). In most cases serum amylase reached twice the basal value. Renal function influenced the duration of the increase in serum amylase, but not the maximum increase (201+/-15 U/l; mean+/-SEM). In patients with advanced renal failure (glomerular filtration rate (GFR) = 2-10 ml/min) serum amylase was still markedly elevated after 72 h (298+/-24 U/l; mean+/-SEM). In patients with normal renal function (GFR greater than 90 ml/min) serum amylase decreased to 183+/-40 U/l (mean+/-SEM) within 72 h without reaching basal values. After infusion of HES no changes were observed in serum lipase or in amylase or lipase activities in duodenal secretion. Amylase excretion in the urine decreased. The assumption of a macroamylasaemia caused by formation of an HES-amylase complex was confirmed by gel filtration. The elimination from plasma of this high molecular enzyme-substrate complex is slow and causes hyperamylasaemia. In no case was the macroamylasaemia associated with signs or symptoms. An awareness of this causal relationship seems to be important, to avoid the erroneous diagnosis of a pancreatic disease.
Lymphocytes from MC sarcoma-bearing mice were exposed to a soluble tumor antigen. The lymphokine-containing supernatant thus obtained was fractionated on Sephadex G-75. Fractions were tested for their activity to reduce the surface charge of indicator macrophages by cell electrophoresis technique. When unseparated spleen or lymph node cells were used the charge-reducing activity of the supernatant was found in three regions according to molecular weights of about 100,000, 60,000 - 35,000 and 13,000 Daltons. The appearance of activity was found to be time-dependent. As indicated by tests with separated lymphocytes both B and T cells appear to release charge-reducing activity.
Five patients had persistent, pulling pain in the sternum, clavicles, and upper ribs that was exacerbated by cold and dampness. Clublike, symmetrical enlargement of the clavicles was seen and, in two patients, venous congestion of the upper half of the body. All patients had a constantly elevated erythrocyte sedimentation rate. Radiologically there was symmetrical hyperostosis of the sternal and middle portions of the clavicles, synostosis of the sternoclavicular joints, a widened and thickened sternum, and varying degrees of involvement of the upper ribs. X-ray findings did not change over several years. Phlebography showed bilateral subclavian vein occlusion in three patients and unilateral occlusion in one. Biopsies of the clavicles showed a characteristic hyperostotic sclerosis of the spongiosa. The cause of this sternocostoclavicular hyperostosis is unknown, but clinical, radiologic, and histologic findings indicate that it may represent a distinct, hitherto undescribed entity.
In 42 patients with malignant and benign diseases of the kidney, the urinary bladder and the prostate the sensitization of the lymphocytes was investigated in the cell electrophoresis mobility test. In these cases human encephalitogenic protein and tumour-associated antigens from malignomas of kidney, urinary bladder and prostate were used as antigen. When using human encephalitogenic protein 3 "falsely positive" and 2 "falsely negative" results were got, whereas, when using the corresponding tumour-associated antigens in the cell electrophoresis mobility test in every case the histologically ascertained tumour diagnosis could be confirmed.
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Cytopherometry in neurologic diseases is discussed with regard to antigenic reactivity, the formation of cytokines and the direct changes of electrophoretic mobility of immune-competent cells. The Macrophage-Electrophoresis-Mobility (MEM) test, the variants of the method and additional techniques produced some results of diagnostic and immunpathologic value. A general and unspecific sensitization during cellular immune reaction in lesions of the nervous parenchyma was detectable. Using adequate antigens and extended methods of characterisation in the test system, differentiated reactivity, mainly of the inflammatory diseases and in some pathogenetic processes - including a defect of cell-membrane - was found. Typical findings were shown with the MEM-LAD (linoleic acid depression) test in M.S. This technique led to novel pathogenetic, family-genetic and therapeutic aspects. Similar diagnostic progress in various types of brain tumors was shown by using tumorassociated antigens. Analysis of specific factors of cellular immunity was extented by developing a thymosine assay and direct assessment of cytokines, especially fo the MSF (macrophage slowing factor) in the MSF assay. The thymosine assay may prove valuable for the cellular basis of immunologic processes (in particular myasthenia and therapeutic thymectomy). With the direct MSF assay a differentiated high MSF activity in the CSF in chronic neuroimmunologic processes and particularly in M.S. was shown which led to novel aspects of the immunology of the CSF. The characteristics of the MSF, found after column-chromatographic fractionation, showed identical zytokine activity in CSF and the supernatants of lymphocyte-antigen-incubation which lay in the lower range of molecular weight of migration inhibitory lymphokines.
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A Trypanosoma cruzi-like strain was isolated from marmoset monkeys originating from Columbia. The frequency of affected monkeys was up to 32.7%. The parasite density was 10-40 trypomastigote forms per mililiter. Monkeys, rats, mice and other small Rodentia were found to be susceptible. Clinical symptoms or histopathological findings could not be acertained with these trypanosomes even after a 2 1/2 year observation period. The strain behaved as an apathogen in experimental animals. The parasitaemia in animals was sparse (1-10 trypanosomes/ml) and without any conspicuous periodic fluctuations. Trypanosomes could be detected microscopically up to 2 1/2 years after infection in the blood of infected animals. With a positive blood finding, the blood passage could be carried out in animals with regularity. The serum from infected reacted positively in Chagas Latex test as well as in Chagas CFT. The trypomastigote forms injected into cultures of human embryonal thyroid gland and in cells of other origin, showed higher or lower multiplication with a marked cytopathogenic effect between the 9th and 11th day post infection, depending on the type of tissue culture. There was a cyclical development in Rhodnius prolixus or Triatoma infestans. The so-called metacyclic or trypomastigote forms from the faeces of Reduviidae or from tissue culture could again infect animals.
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The substantiation and the indications and contraindications for the physical training of patients who have had myocardial infarction are discussed on the basis of the experience gained at the Clinic of Internal Diseases of the Medical Department of K. Marx University in Leipzig (DDR) and the First Chair of Hospital Therapy of the N.I. Pirogov Second Moscow Medical Institute. On the strength of their own findings and the information in the current literature, the authors name, among other precoditions for training, diminution of capacity for muscular work, psychologic instability and the persisting threat of the progression of ischemic heart disease. The methods of functional diagnosis, which is also a necessary precondition for the physical rehabilitation of the patients are bicycle ergometry, auxiliary tests for the gaseous composition of blood and exhaled air, determination of the heart volume by means of X-ray, catheterization of the pulmonary artery with a floating catheter, ventriculography, and coronarography.
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