[Available methods to modify primary graft rejection (author's transl)]. / Möglichkeiten zur Beeinflussung der primären Transplantatabstossung.

Primary graft rejection is an immunological reaction. Many modes of preventing, or at least, delaying rejection have already been tested. The present study deals with experiences and possible mechanisms of action of nonspecific immunosuppression caused by different drugs or antilymphocytic sera; furthermore, an account is given of the latest stand of knowledge gained from experimental studies to induce immunological enhancement, as well as immunological tolerance to transplantation antigens.

[Surgical treatment of parenchymal metastases of germinal testicular tumors]. / Operative Behandlung von Parenchymmetastasen germinaler Hodentumoren.

This report concerns 18 patients with germinal testicular tumors in whom the resection of pulmonary metastases was indicated following resection of the primary tumor and combined cytostatic therapy. Nine patients underwent a retroperitoneal lymphadenectomy immediately after semi-castration. Upon follow-up examination, circular pulmonary foci were visualized by conventional films or computerized tomography. These patients developed pulmonary metastases on the average 8 months after the first operation (semi-castration and lymphadenectomy). Since 1978, a combined cytostatic treatment has preceded the lymphadenectomy and resection of parenchymal metastases. No evidence of disease (NED) could be achieved in 9 patients by resection of pulmonary metastases, with an average follow-up period of 30 months. The results in surgery of metastases are judged as the more advantageous, the longer the free interval is between initial disease onset and the occurrence of metastases.

[Indications and results of Y-gastrojejunostomy after gastric resection (author's transl)]. / Indikationen und Ergebnisse der Y-Gastrojejunostomie nach Magenresektion.

The Y-gastrojejunostomy with a long jejunal loop is advantageous in the treatment of recurrent ulcer after gastric resection and in the treatment of persistent peptic esophageal stricture. The peptic damage of esophageal mucosa by gastric juice and bile is thus prevented, and the stricture can heal. In regard to the pathogenicity of duodenogastric bile reflux, the routine Y-technique in gastric resection seems reasonable.

[Traumatic bronchial rupture]. / Der traumatische Bronchusabriss.

Two cases of complete broncho-ruptures are reported. The diagnosis was established after admission to the clinic, the immediate dressing and reanastomosis of the ruptured bronchi had no essential effects on the function of the lungs. All parameters were in the region of the lower standard. The bronchus or tracheal rupture concerns mainly young patients with an elastic thorax. As regards older patients with a rigid thorax, this group is to a large extent prone to a series of fractured ribs and grave injuries of the organs. A series of fractured ribs in juvenile patients can be completely non-existent. It should be noted that the indication for a bronchoscopy is meeting with too great a reserve. Three quarters of all broncho-ruptures thus are not diagnosed. Even if after a number of years a successful reanastomosis is still possible, the functional detriments of delayed anastomoses are not always reversible. In the hands of a skilled surgeon the emergency bronchoscopy with rigid and flexible instruments is also possible in the case of very severely injured patients.

[The value of lung biopsy in the radiological stage of bihilar adenopathy of sarcoidosis (author's transl)]. / Die Bedeutung der Lungenbiopsie im radiologischen Stadium der bihilären Adenopathie der Sarkoidose.

The classification of intrathoracic sarcoidosis into stages is based on radiological criteria. As pulmonary involvement is often considered to be an indication for corticosteroid therapy a comparison was made between the X-ray picture and lung biopsy in stage I sarcoidosis. Non-caseating epitheloid granulomas were found in 9 of 12 patients. The material was obtained by open biopsy in 8 patients and by the transbronchial approach in one case. Open and transbronchial biopsy failed in 3 patients to demonstrate sarcoid granulomas. The results suggest that the presence of mottling in the chest roentgenogram does not provide the rationale for treatment. Further studies will show whether irreversible damage to lung tissue could be prevented if lung biopsies were taken and, consequently, steroid therapy initiated, at an earlier stage of the disease.

[Disease of metalgrinding workers (author's transl)]. / Metallschleiferkrankheit.

It is a specific clinical picture with extensive soft tissue gas and swelling of the forearm. Usually, the clinical course is without any other symptoms. Therapy is not necessary because gas disappears in few days. The etiology of the disease is not clear. Gas can be generated by the chemical reaction between a metallic foreign body and tissue fluid. Spread of benzine evaporation has been considered as a possible source as well. The disease is very rare and its knowledge is important in differential diagnosis of gas gangrene.

[The effect of acute liver damage on inactivation of renin and aldosterone (author's transl)]. / Der Einfluss akuter Leberschädigung auf die Inaktivierung von Renin und Aldosteron.

Plasma renin activity was measured in 5 surgical patients with hydatoid disease of the liver before and after partial hepatectomy. Plasma renin activity rose statistically significantly after surgical operation and remained virtually constant thereafter. This rise was accompanied by a statistically significant rise of plasma aldosterone while urinary excretion of aldo-18oxo-glucuronid remained unchanged. No change of urinary excretion of electrolytes was observed. It is concluded that besides stress after surgical operation decreased hepatic inactivation of renin and aldosterone were the main causes which led to elevation of plasma aldosterone concentration.

[Immunobiological fundamentals of primary graft rejection (author's transl)]. / Immunbiologische Grundlagen der primären Transplantatabstossung.

Graft rejection caused by genetic differences between donor and recipient is an immunological reaction of transplantation antigens with mechanisms of primarily cellular immunity, and later on even of humoral immunity. For initiating the immune response of the recipient three stages have to be distinguished: 1. Recognition of determinant groups of transplantation antigens by menbrame receptors at the surface of immunologically competent lymphocytes. 2. Differentiation and proliferation of immunologically activated lymphoid cells into cellular antibodies and plasma cells, the receptor molecules of which could be identified as immunoglobulins and which are sent into the blood as circulating humoral antibodies, , partially as complement fixing ones. 3. Effector phase, in the course of which the lysis of the graft is caused by target cell destruction. Many problems still remain unsolved, but now as ever, the basis of most experimental studies is still formed by Burnet's clonal selection theory.

[Liver cirrhosis and duodenogastric reflux--on the problem of the hepatogenic ulcer]. / Lebercirrhose und duodenogastrischer Reflux--Zum Problem des hepatogenen Ulcus.

Patients suffering from liver cirrhosis and patients showing no signs of liver or stomach disease (control group) were quantitatively examined for duodenogastric reflux. The duodenogastric reflux was measured by means of bile tracers. The bile tracer used in this study was the tricarbocyanin dye indocyningreen (ICG). The intra-gastric concentration of ICG was photometrically measured after gastric acid was suctioned through a stomach tube. The duodenogastric reflux was calculated in percent in terms of the infused and the biliary secreted ICG amount respectively. Bromthalein was used as an additional tracer in order to control the efficiency of peptic acid removal. A total of 15 patients suffering from liver cirrhosis and 6 patients who showed no signs of stomach or liver disease (control group) were examined. The patients with liver disease showed a reflux of 2.85% +/- 0.76%, the control group (n = 6) showed a reflux of 0.45% +/- 0.39%. The difference is statistically significant (P less than 0.05). Bromthalein aspiration by all patients with liver cirrhosis was 87.95 +/- 2.78% of the amount infused.

Atrophic gastritis after Billroth I gastrectomy.

The gastric mucosa of a stomach resected according to Billroth I operation is subject to a process of aging twice as intense as that of a non-resected one. Atrophy after Billroth I gastrectomy increased by 3% on an average per annum. As a result, a typical distribution of degrees of inflammation in the region of the greater curvature became evident. Atrophic gastritis occurres especially near the anastomosis and decreases in the direction of the fornix. The possibility is discussed that resected patients--in contrast to non-resected--are afflicted with stomach cancer primarily on account of the more intense and earlier mucosal atrophy.

[About the comparison of closely related species chimpanzee-man and fox-dog in respect of the possibility of xenotransplantation (author's transl)]. / Uber die Vergleichbarkeit der Spezieskombinationen Schimpanse-Mensch und Fuchs-Hund im Hinblick auf xenogene Transplantationen.

Although the transplant combinations chimpanzee-man on one hand and fox-dog on the other hand have nearly the same phylogenetic development within their zoological family, it is not quite correct to compare the immunological reactions and patterns of rejection of xenogeneic transplants within these systems. The differences in immunochemistry of serum proteins between these two systems confirm that chimpanzee and man are more closely related than fox and dog concerning their genetic disparity. This and other mentioned examples demonstrate the possibility of obtaining qualitative informations of genetic constellations between xenogeneic species combinations by comparing immunochemistry of serum proteins.

[Quantification of duodenogastric reflux in patients with different gastric resections (author's transl)]. / Quantitative Bestimmung des duodenogastrischen Refluxes bei verschiedenen Magenresektionsverfahren. Eine experimentelle Untersuchungen.

The duodenogastric reflux was measured quantitatively in patients with classic gastric resections (Billroth I, Billroth II with and without enteroanastomosis) as well as in patients without gastric operations. A total of 43 patients with gastric resection and 6 without gastric operation were studied. Patients operated according to B II without Braun's enteroanastomosis (n = 10) had a bile reflux of 50.4 +/- 4.1% (SEM) during the study. Patients having been operated according to B II- and Braun's-enteroanastomosis (n = 15) and those having undergone B I-operation (n = 17) had a duodenogastric reflux of 21.5 +/- 3.7% (SEM) and 23.1 +/- 3.5% (SEM), respectively. In 6 control subjects without gastric operation bile reflux into the stomach averaged 0.5 +/- 0.4% (SEM).

[Bioavailability of cimetidine after partial gastrectomy (author's transl)]. / Bioverfügbarkeit von Cimetidin nach Magenteilresketion.

Absorption characteristics of cimetidine were studied in 10 patients after Billroth I and 12 patients after Billroth II gastrectomy and compared with 9 patients without gastric disease. The onset of absorption after 400 mg cimetidine was identical in all groups, but peak plasma concentrations occurred somewhat (18%) later in B I and significantly (42%) later in B II patients (p less than 0.05). Plasma half life was not different between the 3 groups. The area under the plasma level curve as a measure for bioavailability was significantly increased in the two gastrectomy groups (17% and 23%, resp.). In addition, the duration of effective plasma concentrations above 0.5 microgram/ml was significantly prolonged in the two groups.