[Role of protease activation in pathophysiology of acute pancreatitis]. / Die Rolle der Proteasenaktivierung in der Pathophysiologie der akuten Pankreatitis.

For over a century it has been assumed that acute pancreatitis represents an autodigestion of the pancreas by its own, physiologically inactive proteases. Whether, how and where digestive proteases are being activated in the pancreas has remained the topic of much controversy and speculation. We review a number of recent studies that have been undertaken to elucidate the mechanisms and identify the initial subcellular localization of this process. These studies suggest that a premature and intrapancreatic protease activation does, indeed, occur early in pancreatitis and can be experimentally induced in vivo and in vitro. Activation begins within minutes of the induction of pancreatitis and is initially confined to cytoplasmic vacuoles at the apical pole of acinar cells. From here trypsin activity as well as its activation peptide are transferred to the cytosol of acinar cells where autodigestion may begin.

Immunohistochemical detection of lactoferrin in different human glandular tissues with special reference to the exocrine pancreas.

The immunohistochemical detection of lactoferrin was carried out with the PAP technique on pancreatic tissue samples of 23 patients, operated for acute (13) or chronic (4) pancreatitis as well as for adenocarcinomas (6). In order to control our immunohistochemical technique and the antisera produced by us we studied some tissue samples of human mammary gland and parotis. We detected lactoferrin in the glands of parotis and mammae as well as of their secretions. In the pancreatic tissue we found a positive reaction only in granulocytes of inflammatory areas with the exception of a luminal reaction on the surface of acinar cells in one case of pancreatic adenocarcinoma. We would like to interpret our results with the hypothesis of granulocytic origin of immunochemically detectable lactoferrin in the pancreatic juice of patients, especially in cases of chronic pancreatitis.

[The quantitative determination of resistance factors in the saliva of patients with very high caries involvement]. / Quantitativer Nachweis von Abwehrfaktoren im Speichel von Patienten mit sehr hohem Kariesbefall.

The unstimulated and stimulated whole saliva of patients with a very high caries experience were used for the determination of the flow rate, total protein, and the antibacterial proteins lysozyme, S-IgA and lactoferrin as well as the peroxidase and thiocyanate being components of the salivary peroxidase system. The concentration, the specific concentration and the secretion rate were calculated.

Immunohistochemical localization of trypsinogen and trypsin in acute and chronic pancreatitis.

Immunoreactive trypsin was localized with the peroxidase-antiperoxidase technique in normal human pancreatic tissue and in the glands of patients suffering from acute or chronic pancreatitis. In the normal pancreas and in the histologically normal areas of the inflamed pancreas, trypsin was detected in the zymogen granules of acinar cells and in ductal secretory material. During acute pancreatitis, three characteristic changes were observed: (1) separate acinar cell fragments in early lesions; (2) decreased and evenly dispersed staining in necrotic acinar cells, and (3) intensive reaction in plugs in acinar lumina in advanced lesions. In chronic pancreatitis, the localization of trypsin in acinar cells was similar to that in normal pancreas. Some proteinaceous plugs in dilated pancreatic ducts were weakly immunoreactive. The results show that the tissue distribution of immunoreactive trypsin is altered in acute pancreatitis.

[Quantitative determination of immunoglobulins in chronic obstructive bronchitis]. / Quantitative immunglobulinbestimmungen bei chronicscher obstruktiver Bronchitis.

In a systematic series of examination the quantitative determination of the immunoglobulin IgG, IgA and IgM in patients with advanced chronic obstructive bronchitis and formation of emphysemas was performed without a spastic component. In the result is to be stated: 1. a highly significant increase of the IgA concentration, 2, a significant decrease of the IgG-concentration, 3. no change of the IgM-concentration. Thus the IgA shows the behaviour known in chronic unspecific inflammation of the bronchial wall. The decrease of IgG proved might be an expression of a general decreased function of the organ due to a chronic hypoxia. The results show that there are apparently no relation between the IgM-concentration in the serum and the chronic obstructive bronchitis.

[Immunostaging of patients with chronic pancreatitis. I. A study of humoral and cell-mediated immunity (author's transl)]. / Immunstatus bei Patienten mit chronischer Pankreatitis. I. Eine Querschnittsstudie der humoralen und zellulären Immunität.

Immunostaging was performed in patients with chronic pancreatitis of different etiologic groups. Immune responifveness was assessed by immunoglobulin serum levels, non specific autoantibody formation, C3 levels, antistreptolysin reaction, antibody titer against Toxoplasma gondii, E. coli, Herpes simplex-, Mumps- and Cytomegalovirus and screening for soluble immune-complexes (PEG precipitation assay), number of T- and B-lymphocytes, lymphocyte responsiveness to PHA, PPD, tetatoxoid and mumps-antigen in a whole blood assay, skin testing with candidin, trichophytin, tuberculin and streptokinase and HLA-typing. In some cases we found a depressed cell-mediated immune responsiveness. Patients were divided into two groups based on this main finding. Cellular hyporesponsiveness was correlated to the severity of the disease and a high incidence of HLA-B5 but not to any etiologic factor of the disease.

Serum complement and protein metabolism in chronic dialysis patients.

1. Patients receiving regular hemodialysis treatment who are permitted to select their own diets are in danger of a protein deficiency manifested by a significant reduction in serum transferrin and in complement C3c. 2. Correlation analysis within the dialysis group revealed no secure connexion between the complement C3c and total hemolytic activity respectively, and transferrin levels. 3. Analysis of diets showed that protein intake and the serum transferrin level correlate. No such correlation was found for the complement C3c or total hemolytic activity. 4. Low transferrin levels in the serum appear to result in more severe anemia among dialysis patients. 5. Knowledge of the serum transferrin level permits much more exact assessment of the protein metabolism in regular hemodialysis patients than knowledge of the total hemolytic activity or the level of the complement C3c.

[Serum complement and protein metabolism in chronic dialysis patients]. / Serumkomplement und Eiwissstoffwechsel bei chronischen Dialyse-patienten.

1. When a so-called free diet is granted there is the danger of a protein deficit, which can be proved in a significant decrease of the serum transferrin and of the complement factor E3c, in patients in the chronic haemodialysis programme. 2. Within the group undergoing dialysis a correlation analysis did not result in a statistically ascertained connection between the complement factor C3c and the total haemolytic activity and the transferrin, respectively. 3. On the basis of a diet analysis a connection between the protein supply and the serum transferrin level could be established, which was not to be proved for the complement factor C3c and the total haemolytic activity, respectively. 4. Low transferrin values in the serum seem to be followed by a deterioration of the anaemia situation of the patient undergoing haemodialysis. 5. Compared with the total haemolytic activity and the complement factor C3c the determination of the serum transferrin allows an essentially exacter information about the protein metabolism of the patient undergoing a chronic haemodialysis.

[Serum transferrin in chronic kidney failure with conservative treatment and hemodialysis]. / Serumtransferrin bei chronischer Niereninsuffizienz unter konservativer Therapie und Hämodialyse.

1. Serum transferrin is a sensitive indicator for the establishment of a subclinical protein deficit. 2. When a diet moderately poor in protein was given (0.5-0.6 g/kg body weight/daily) was given the transferrin values (243 +/- 61 mg/100 ml) were significantly lower than in the control group (284 +/- 61 mg/100 ml), but they were altogether still in the lower normal region.

[Drug-induced]. / Medikamentös induzierte Thrombozytopenien

The rare clinical picture of the thrombocytopenia caused by drugs is described using own histories of diseases and data from literature. The questions of diagnostics and therapy are discussed. Despite the as a rule benign course it is referred to the fact to withold the noxa once diagnosed consequently from the patient for prevention of possible complications (cerebral haemorrhage).