[Glucagon, its discovery and description and the work of Max Bürger]. / Das Glukagon, seine Entdeckung und Darstellung und die Arbeiten Max Bürgers.

After intravenous injection of technical insulin (lower degree of purity) already in 1923 Murlin observed transient initial increases of blood sugar. He suggested that this would be caused by another hormone and he gave him the name of glucagon. Nearly from 1928 Bürger dealt with the synergistic effect of muscle work and intravenous application of insulin on the blood sugar. Here he also established the blood sugar increasing principle glucagon. Subsequently by animal experimental and clinical examinations he essentially contributed to the characterization of the substance itself and its mode of action. He always acknowledged the priority of Murlin. The statement of the A-cells of the pancreas as the place of the synthesis of glucagon, the clarification of its structure and its pure preparation caused the fact that nowadays comprehensive knowledge about the second pancreatic hormone is available.

[Anamnesis and clinical examination--also today still principles of sensible diagnosis?]. / Anamnese und klinische Untersuchung--auch heute noch Grundlage einer vernünftigen Diagnostik?

The way to diagnosis goes over many parts, the end of which in each case means testing the obtained facts, critical overthinking and establishing the next steps up to the ascertainment of the real cause of the disease. At the beginning unchangedly stands the obtaining of the anamnesis of the patient and his disease by the physician himself who apart from the spoken word shall recognize, collect and classify plenty of observations at the patient with the help of as many senses as possible. This process is continued in the following physical examination of the patient with an immediate manual contact between the doctor's hand and the patient's skin. New findings are obtained, speculations will be approved or rejected. But finally in most cases the relationship between doctor and patient has become closer. A repeated critical consideration at the end of the physical examination with reasonable inclusion of the anamnestic data leads to the preliminary diagnosis. Only now the statements for further aimed diagnostic steps are done. Thus it is clearly to be stated that the fundaments of a reasonable diagnosis are the results of an integrated and critical synopsis of the objective and subjective findings at the patient by the doctor. History and physical examination are the unalterable condition before using technical possibilities.

[Use of B-image sonography in abdominal vascular diagnosis]. / Die Anwendung der B-Bild-Sonographie in der Abdominalgefässdiagnostik.

The real-time-sonography as an evident non-invasive procedure is of high significance in the vascular diagnostics apart from the usual diagnostic approaches. Taking into consideration methodically conditioned limits the aneurysm of the aorta, the ectasia of the aorta, the elongation of the aorta, the early recognition of arteriosclerotic changes of the wall, the hypertension of the portal vein and the thrombosis of the inferior vena cava are the most important methods for the application of this method. In the aneurysm of the aorta sonography is authoritatively involved in the judgment of the indication for operation. Arteriosclerotic plaques are to be recognized from a size of 5 X 3 mm.

Clinical investigation of the effects of pentoxifylline in patients with severe peripheral occlusive vascular disease.

Pentoxifylline was used in the treatment of 90 patients with atherosclerosis-induced chronic peripheral arterial occlusive disease and diabetic vascular disorders in the lower extremities (clinical Fontaine Stages III and IV) for whom surgical reconstructive treatment was not indicated and who had shown inadequate response to previous therapy. In 20 initially hospitalized patients, treatment was started with pentoxifylline intravenous infusions for 1 week (increased gradually from 500 mg to 1000 mg per day) and afterwards continued for a further 8 weeks by oral administration of the drug (400 mg 3-times daily). In 70 patients, oral treatment (400 mg 2 to 3-times daily) was carried out from the beginning for 3 to 6 months or longer. The majority (74%) of the patients showed good or very good results in respect of the clinical parameters. Pentoxifylline abolished or decreased rest pain and consumption of analgesic drugs, accelerated healing of leg ulcers, produced a statistically significant increase in mean pain-free walking distance (approximately 500%) and reduced concomitant symptoms. Definite improvement was achieved in 16 patients with initial intravenous treatment and in 62 patients on oral therapy alone. Haemodynamic measurements, as well as whole blood viscosity assessment using a middle and high shear rate viscosimeter, revealed only small and insignificant improvements. No essential changes could be found in the chemical blood parameters studied.

[Immunocoagulopathies as a possible cause of acquired hemorrhagic diathesis]. / Immunkoagulopathien als mögliche Ursache erworbener hämorrhagischer Diathesen.

Spontaneous factor VIII inhibitors may be responsible for severe life-threatening haemorrhages. It is reported on two patients with inhibitors directed against factor VIII: C. In one female patient a rheumatoid arthritis could be made evident as basic disease. Diagnostics, therapy and course are reported and discussed.

[Blood rheological changes and their clinical significance in chronic arterial obstructive disease]. / Hämorheologische Veränderungen und ihre klinische Bedeutung bei chronisch-arterieller Verschlusskrankheit.

New knowledge about the physiology and pathophysiology of the flowing properties of blood, particularly in the area of microcirculation, led to a better understanding of the pathogenesis of the arterial obstructive disease. When the vasomotor reserve is kept, the blood fluidity authoritatively determines the flow-time-volume depending on the conditions of flow. An increase of the blood and plasma viscosity as well as a decreased fluidity of erythrocytes and an increased aggregation of erythrocytes lead over an impairment to the nutritive capillary blood supply to hypoxic tissue damage. Physico-chemical changes of the milieu, such as lactacidosis and hyperosmolarity may additionally cause local rheological disturbances and contribute to a reduced perfusion. The improvement of the flowing properties of the blood takes at present place essentially by haemodilution and reduction of fibrinogen. The possibly most hopeful way to the reduction of blood viscosity consists in the immediate improvement of the fluidity of erythrocytes. Here up to now the xanthine derivative pentoxifylline showed good results in the clinical practice.

[Preliminary studies on iodine administration during parenteral nutrition]. / Orientierende Untersuchungen zur Frage der Jodzufuhr bei parenteraler Ernährung.

Iodine deficiency is the main cause of endemic goiter. To estimate the iodine supply during parenteral nutrition, the iodine content of some important solutions used for infusions and routine parenteral nutrition has been assessed. It varied from 21 micrograms I/l to 68 micrograms I/l and is considered to be sufficient to supply the daily iodine requirement.

[Poststenotic systolic pressure and blood flow measurements during intra-arterial and vasoactive therapy]. / Poststenotische systolische Druck- und Blutflussmessungen unter intraarterieller und vasoaktiver Therapie.

In 34 male patients with peripheral arterial occlusive disease of the lower extremities the individual responsibility to an intraarterial adenosine triphosphate infusion was tested with the help of Doppler-sonographic poststenotic measurements of the systolic blood pressure as well as comparatively to this by determination of the arterial blood-flow in rest in the region of the calf. While the greater part of the patients with occlusive disease reacted with a significant increase of the blood supply, nearly with the same frequency a decrease of pressure or no change could be established concerning the behaviour of the peripheral pressure. For the judgment of the efficacy of an intraarterial infusion treatment in the acute experiment plethysmographic measurements of the blood-flow are, therefore, more suitable and should be preferred to Doppler-sonographic pressure parameters. As to the controls of long-term therapy under conservative treatment as well as for the judgment of the success in the reconstructive surgery of vessels, however, the post-stenotic measurements of the pressure stood the test apart from further methods in clinical practice.

[Growth hormone secretion in growth retarded children and adolescents]. / Untersuchungen zur Wachstumshormonausschüttung minderwüchsiger Kinder und Jugendlicher.

In 119 children and adolescents with restricted growth whose secretion of growth hormone (hGH) was investigated in the insulin hypoglycaemia test, different hGH-secretion patterns were found. 52.1% of the investigated persons showed a prestimulatory stress-conditioned hGH-secretion. There were no relations to age or to sex. The hypoglycaemia-conditioned secretion of hormone following this spontaneous release has quantitatively no relation to the size of the decrease of blood sugar. However, it is also determined by the trend of secretion in the pretest-phase. Different modes of synthesis and release are the cause for this behaviour. High spontaneous hGH-levels decrease the hypoglycaemia effect of the intravenously applied insulin. In 33.9% of the cases the levels of the growth hormone are lower during the proper test phase or only as high as in the preparation time. Twelve times the poststimulatory values simulated a hyposomatotropism. The eventual importance of the secretion patterns remains up to now unclear for the longitudinal growth.

[Differences and similarities of Crohn disease and ulcerative colitis]. / Unterschiede und Gemeinsamkeiten von Colitis ulcerosa und Morbus Crohn.

Sometimes the demarcation of a colitis granulomatosa Crohn from an ulcerous colitis renders diagnostic difficulties. Also when certain communities of the two clinical pictures are recognizable, nevertheless the differences prevail. The judgment of the success of various forms of therapy and the further clarification of etiology and pathogenesis demand the differentiation in every case. Anamnesis, clinic, radiological findings, endoscopic and bioptical signs are building stones which in their totality render possible the findings of the diagnosis. Bioptical investigations in various stages of activity and after the beginning of the treatment are suited further to restrict the number of the non-classifiable colitides.

[Early diagnosis of stomach neoplasms]. / Zur Früherkennung von Magenkarzinomen.

The primary prevention of the carcinoma of the stomach promises little success in near future. Therefore the effort is directed to early recognition and healing (secondary prevention). The optimum method for this is the combination of X-ray-examination, gastroscopy and aimed biopsy. But also by early diagnosis and therapy in the invasive carcinoma the chances of survival are to be improved. At present only 5-6% of the patients with gastric carcinoma survive longer than 5 years. The author adopts a definite attitude to the groups with risk of carcinoma. The search for further factors of persons endangered by carcinoma (habit of nutrition, kind of constitution and preparation of food, other exogenous factors) must be continued intensively in order to get selected groups which may be controlled consequently.