Base-exchange reactions of the phospholipids in cardiac membranes.

Canine cardiac microsomes were shown to incorporate the nitrogenous bases, serine, ethanolamine, and choline, into their respective phospholipids by the energy-independent, Ca2+-stimulated base-exchange reactions. The optimal Ca2+ concentration was 2.5 mM. Metal ions other than Ca2+ either inhibited or had no effect on the activities. La3+ and Mn2+ were both potent inhibitors. The pH optimum for the reactions at 2.5 mM Ca2+ was approx. 7.8 and depended upon Ca2+ concentration. Apparent Km values at 2.5 mM Ca2+ were 0.06 mM for L-serine, 0.13 mM for ethanolamine and 0.49 mM for choline. The kinetic and metal ion inhibition studies suggest that the choline-exchange reaction is a separate process from the serine and ethanolamine reactions. The ATP-stimulated Ca2+ binding system of the cardiac membranes was not related to the base-exchange reactions; however, the energy-independent Ca2+ binding to the membranes appears to be related to the exchange reactions.

[Problems of the so-called spontaneous intestinal perforation]. / Zur Problematik der sogenannten spontanen Darmperforationen

Among 250 cases of perforation of the large and small bowel during the past 5 years there were 11 patients in whom the cause of the perforation was not clear at first and which were labeled spontaneous. After thorough investigation a satisfactory explanation for the perforation of the apparently normal bowel could be given for all patients. The most frequent causes were distention of the bowel wall, particularly of the cecum, and ischemic enterocolitis. We consider the incidence of really spontaneous bowel perforations very unlikely.

[Enteral feeding following resection of the colon]. / Enterale Ernährung nach Colonresektionen.

14 male patients with cancer of the colon were enterally fed for 2 days preoperatively, on the day of the operation and 5 days postoperatively with a high-caloric oligopeptide diet without the additional enteral administration of calories. All the anastomoses (5 rectal and 5 sigmoid colon resections as well as 4 hemicolectomies ) healed without problems; no complications occurred . The nutrition was well tolerated without exception and the jejunal tube tolerated without discomfort. The short-lived function proteins fell during postoperative metabolism. However, the means for total protein, albumin, prealbumin, transferrin and the immunoglobulins (IgM, IgG, IgA und IgD) were still within the lower part of the normal range. Only retinol-binding protein fell to values up to 30% below normal.

[Immunologic localization of primary tumors]. / Immunologische Primärtumorlokalisation.

Specificity of cellular immune reactivity was tested in 115 cancer patients. The electrophoretic mobility test was used as in vitro test for cellular immunity, KCl extracts from various human carcinomas were used as antigens. For each tumor a typical lymphocytic reaction was noted: the most pronounced migration inhibition in cancer patients was caused by corresponding tumor extracts. Lymphocytic reactions to extracts from tumors of different histogenesis were weaker or negative. A total of 158 tests in 54 healthy control persons with the same antigenic substances showed negative results in 139 cases. Demonstrated specificity of sensitized lymphocytes could prove to be a valuable aid in immunological tumor recognition.

[Congenital esophageal cysts]. / Congenitale Oesophaguscysten.

Congenital cysts of the esophagus are rare tumors of the mediastinum. They are classified as foregut-cysts. Most of them are found accidentally on routine chest X-ray. They are seldom diagnosed preoperatively. Exstirpation of the cysts presents no major problems. Five patients with congenital esophageal cysts are presented.

[Immune reactivity in colorectal cancer--clinical value from a surgical viewpoint]. / Immunreaktivität beim colorectalen Carcinom--Klinische Wertigkeit aus chirurgischer Sicht.

Specificity of cellular immunity was verified by the cell migration inhibition test in 36 patients with colorectal cancer and 15 with colorectal adenomas. The electrophoretic mobility test is considered as an indirect method for demonstrating cellular immunity against malignant tumors. Soluble potassium chloride tumor extracts from various human carcinomas were used as antigens. In 31 of 36 tumor patients, a specific lymphocytic sensitization against antigens of colorectal carcinomas could be shown. Lymphocytic reactions to antigens from histologically different tumors (cross-reactions) were weaker or negative. This reaction, verified for carcinomas, was also noted in cases with precancerous lesions. Measurements in 54 healthy control persons with the same antigenic substances showed negative results in 48 cases. Acute inflammatory lesions of the colon reduce the reliability of the test.

[Space occupying mediastinal processes]. / Raumbordernde Mediastinalprozesse.

About 1-2% of all tumors are found in the mediastinum. Any space-occupying swelling of the mediastinum has to be exstirpated. Even if a carcinoma cannot be completely removed, the tumor mass should be reduced as much as possible. The operation must not be delayed by any diagnostic uncertainties.

Osteoclastoma-like giant cell tumor of the lung.

Rare extraskeletal locations of osteoclastoma-like giant cell tumors have been found in thyroid, pancreas, breast, skin and heart. In our case, a 40-year-old male patient, such a tumor was found in the left upper lobe bronchus with atelectasis due to bronchial obstruction. Upper lobe resection was done. As far as we know, this has not been reported.

[Tracheal and bronchial ruptures (author's transl)]. / Die Problematik der Tracheal- und Bronchusruptur.

Rupture of the major airways is rare. Open injuries usually involve the trachea; injuries to the airways in closed chest trauma are in 80-90% of the cases located at the bifurcation or the main bronchus. Rupture of the bronchial system may cause an immediate threat to life, but may also produce few symptoms. The possibility of such an injury should always be taken into consideration, even if at first the clinical signs only point to damage of the lung parenchyma. Intubation and continuous suction drainage are life-saving emergency measures to be followed as soon as possible by bronchoscopy to establish the diagnosis. Treatment is by prompt suture or anastomosis. Failure to diagnose rupture of a bronchus results very soon in stenosis and, later on, in damage to the lungs and jeopardizes the success of subsequent reconstructive surgery. The repair of extended stenoses presents particularly difficult technical problems. Alloplastic grafts may be the answer. During 1961-1978 7 persons with injuries to the trachea and bronchi were treated at the Department of Surgery, Giessen. 3 persons were saved by immediately performing an anastomosis.

Lung phosphatidate phosphatase: activity during altered physiologic states.

Phosphatidic acid phosphatase (PAPase) which catalyzes the conversion of phosphatidic acid to 1,2-diacyl-sn-glycerol was studied in fetal, neonatal, and adult rat lung microsomal fractions from whole lung under normal and altered physiological states. The maximal activity was obtained at pH 7.0 with 1.0 mM phosphatidic acid as the substrate. Twenty-one-day-old fetal rat lung averaged 20.3 +/- 0.6 SE nmol/min/mg microsomal protein compared to 9.9 +/- l.0 nmol/min/mg in liver. Following birth there was a dramatic 53% increase in the PAPase activity. Twenty-one-day-old fetal rat lungs from diabetic mothers (streptozotocin-induced) and from mothers fasted the last four days of gestation did not show altered PAPase activity. Premature breathing for 3-6 hr on day 21 of gestation also did not affect the PAPase activity. These data demonstrate that the microsomal PAPase activity (l) increases dramatically only after birth (2) is not responsive to altered physiologic state (maternal diabetes, maternal fasting, and premature breathing) and (3) may not be an important regulatory enzyme in lung surfactant phospholipid production.

[Therapeutic principles and priorities of polytrauma in general surgery (author's transl)]. / Behandlungsgrundsätze und Prioritäten des Polytraumas in der Allgemeinchirurgie.

The absolutely prior task in patients with multiple injuries is to maintain the cardiac and pulmonary functions. Furthermore a quick decision is needed regarding additional life-saving operations. Apart from a careful clinical investigation simple diagnostic procedures are necessary (chest x-ray, peritoneal lavage). The life of the injured person is endangered through hemorrhages. The most effective therapy is to recognize and to stop these bleedings. The surgical repair of intestinal ruptures, injuries to the pancreas, ruptures of the diaphragm and other problems can be postponed. The same applies to most of the thoracic injuries, except to the tension pneumothorax. Mediastinal injuries require the use of the heart-lung-machine, if the heart and the big vessels are involved. The extent of an operation and the intraoperative procedure are determined by the injury.

[Continence of anus praeter -- a problem solved? Erlangen magnetic stoma seal (author's transl)]. / Der kontinente Kunstafter -- ein gelöstes Problem? Der Erlanger Magnetverschluss.

Primary or secondary implantation of the Erlangen magnetic stoma seal in case of colostomy or ileostomy is technically simple, although it requires a critical selection of patients and careful surgical technique. The best follow-up of the operated cases should be in the special protological clinics in the hands of stoma therapists. About 15% of the cases meet local complications and therefore the magnet-ring is explanted. An ideal continence is not always achieved. We hope that these patients can be better helped with magnetic stoma seal through further development.

[Alloplastic tracheal prosthesis with biocarbone. A study of animal experiments (author's transl)]. / Alloplasticher Trachealersatz mit Biocarbone. Eine tierexperimentelle Studie.

Animal experiments have shown bicarbone to be a suitable material for alloplastic tracheal replacement. So far survival rates have been limited by connective tissue stenoses and by loosening prostheses. Although the transplants are not lined by bronchial mucosa, the movement of secretions is not seriously impaired due to the smooth surface. It is still a matter of speculation as to whether modifying the suture technique with a more elastic transistion from the trachea to the prosthesis would produce better results.