Venous Obstruction in Asymptomatic Patients Undergoing First Implantation or Revision of a Cardiac Pacemaker or Implantable Cardioverter-Defibrillator: A Retrospective Single Center Analysis.

PURPOSE: To investigate the incidence and possible risk factors of upper deep vein obstruction in patients both prior to first cardiac device implantation and before device revision. MATERIALS AND METHODS: Records of asymptomatic patients undergoing contrast venography prior to implantation or revision of a cardiac device from 09/2009 to 04/2012 were reviewed. Venograms were used to determine the presence of venous obstruction. Interrelations between the incidence of venous obstruction and patient- or device-related parameters were identified using Fisher's exact test and univariate logistic regression. Multivariate logistic regression was used to identify independent predictors of venous obstruction. RESULTS: 456 patients met the inclusion criteria (330 males, 126 females, 67.8  ±â€Š 12.9 years). 100 patients underwent first implantation, and 356 patients underwent device revision (mean time since implantation 82.5  ±  75.3 months). Venous obstruction was present in 11.0 % and 30.1 % before implantation and revision, respectively. Only presence of ventricular escape rhythm was significantly related to venous occlusion (p < 0.001) prior to first implantation. Prior to revision, significant predictors were male sex (p = 0.01), time since implantation (p < 0.0001), presence of escape rhythm (p = 0.02), compromised coagulation (p = 0.02), phenprocoumon (p = 0.005), and peripheral arterial disease (p = 0.01). CONCLUSION: Although several risk factors could be identified, reliable prediction of venous obstruction was not possible. Therefore, we advocate performing venography in all patients prior to device revision or upgrade to avoid complications. In cases of first device implantation, the risks associated with venography should be weighed against the surprisingly high rate of deep upper vein obstruction.

[Urogenital trauma associated with pelvic ring fractures]. / Urologické poranení pri zlomeninách pánevního kruhu.

PURPOSE OF THE STUDY: To evaluate, in a retrospective study, injuries to the urogenital tract in patients with pelvic ring fractures. MATERIAL In the years 1998-2007, a total of 308 patients with pelvic ring fractures were treated. The study did not comprise patients with low-energy fractures, such as apophyseolysis in children, osteoporotic bone fractures or pathologic fractures. It also did not include patients with multiple injuries who died within 6 hours of admission to the hospital. The group consisted of 186 men and 122 women with an average age of 34 (range, 6 to 76) years. RESULTS: The fractures sustained were classified as type A in 5 %, type B in 57 % and type C in 38 % of the patients. The average follow-up was 71 (range, 13 to 121) months. A primary injury to the urogenital tract was recorded in 50 (16 %) patients. Injury to the urethra was found in 23 (7.5%) and urinary bladder trauma in 18 (6%) patients, vaginal injury was in four women (1%), and penis injury in three (1%) and lacerated testicles in two men (1%). Injury to the urogenital tract was associated with a pelvic ring fracture type A in 5 %, type B in 34 % and type C in 61 % of the patients. Out of the 23 patients with urethral trauma, only six (26 %) were free from functional and subjective complaints; eight (35 %) continued to receive therapy for urethral stenosis seven (30 %) reported urinary incontinence, and seven men (30 %) had erection problems. In six patients (26%) the lasting sequelae were combined. The 18 patients with injury to the bladder reported no subjective complaints at a one-year follow-up. Two patients with penis root injury had erectile dysfunction. Two patients with the loss of both testicles were in the care of a psychiatrist. The patients' satisfaction was evaluated on a 0-to10-point scale. The average value for the whole group was 4.1 points. In the patients with erectile dysfunction, the value was 0.8, and in those with isolated injury to the urinary bladder it was 9.4 points. DISCUSSION: The increasing number of injuries to the urogenital tract associated with permanent sequelae is caused by a growing number of pelvic ring fractures as well as, and this is more important, by decreasing mortality in patients with severe trauma to the pelvic ring The extent of urogenital injury is related to the degree of dislocation of the pelvic skeleton. Injury to the male urethra is the most frequent urogenital trauma because of the male anatomy. It occurs most often in unstable C type fractures when the pelvic ring is disrupted with bone displacement due to shear force at the site of urethra attachment. The consequences are related to the quality of treatment of urogenital tract injury as well as to how the skeletal injury is managed. The lasting effects of the primary injury to nerve structures are beyond repair by therapy. CONCLUSIONS: Injury to the urethra results in erectile dysfunction in 50 % of the injured patients it is often associated with urinary incontinence that has a strong effect on the patient's life quality. Isolated trauma to the urinary bladder has a good prognosis. The incidence of post-traumatic incontinence is not high, but reduces the patient's personal and social comfort. A prerequisite for a successful therapeutic outcome is a good cooperation of the orthopaedic surgeon and urologist. Key words: pelvic ring fractures, urogenital injury.

[Seat-belt and chance fractures of the thoracolumbar spine]. / Sitzgurt- (Seat-belt) und Chance-Frakturen der thorakolumbalen Wirbelsäule.

INTRODUCTION: The authors have attempted to elucidate the differences between Chance, seat-belt, and flexion distraction fractures. Chance and seat-belt fractures have more common features, while flexion distraction fractures differ, in particular, due to the mechanism of injury. A difficult diagnosis is sometimes a common characteristic, while therapy is always the same. PATIENTS AND METHODS: During the period from 1997 to 2005, the authors treated 23 seat-belt fractures, and only three "genuine" Chance fractures. All patients had normal neurological findings. The mechanisms of injury were a car crash in 20 cases, and a fall associated with flexion in 6 cases, such as a rolling fall while skiing. According to the localisation, Chance fractures were found at the L 1 level twice and at the L 2 level once. Seat-belt injury was found once each in the areas of T 7, L 4, L 5, -twice at L 2 and L 3, and 16 times at the T / L spine transition, respectively. All patients were operated on using instrumented posterolateral spondylodesis. RESULTS: All fractures healed by spondylodesis as confirmed by X-ray images. All patients returned to their original job or school. 14 patients were evaluated 6 months after removal of the metallic implants. The mean subsequent kyphotisation was 1.4 degrees with the largest deviation of 4 degrees in a patient with a pure ligamentous variant of a seat-belt fracture. CONCLUSION: The objective of this work is to illustrate the various types of spinal distraction injuries of a seat-belt character and Chance fracture, when the vertebral body is not compressed. X-rays and often also CT scans show a "benign" character. Interpretation of the findings is very important for the development of further chronic instability of the spine and all consequences. If the diagnosis of a distraction injury is made the operative stabilisation is essential. That is why all our patients were tretaed by operation.

[Osteosynthesis of hip and femoral shaft fractures using the PFN-long]. / Osteosyntéza zlomenin horního konce diafýzy femuru pomocí PFN-long.

PURPOSE OF THE STUDY: A group of 79 patients with ipsilateral fractures of the hip and femoral shaft treated with the use of a long proximal femoral nail (PFN-long) was retrospectively evaluated. MATERIAL: From January 1998 to February 2005, 79 patients were treated surgically. The group included 42 men and 37 women at an average age of 56.6 years. In 47 patients (37 men and 10 women; average age, 38 years; range, 18-72 years) the fractures were due to a high-energy trauma. In the remaining 32 patients (six men and 25 women; average age, 77.6 years), the cause of fracture was a low-energy trauma, most frequently an ordinary fall. The fractures were categorized according to the Dousa, Bartonícek and Krbec classification. Type IV fractures, i. e., subtrochanteric fractures involving the whole upper half of the femur, were most frequent. METHODS: The Synthes PFN-long is based on the PFN and partly also UFN implants. The nail is matched to femoral shaft antecurvation, and femoral neck screws have a 10 degrees anteversion. The nail is cannulated, is 10 mm thick and is available in three lengths with a distal dynamic opening. RESULTS: The results are based on the evaluation of 65 patients followed up for at least 12 months. At 12 months bone union was achieved in all patients; in 38 patients (58 %) it occurred by 6 months and in 59 patients (91 %) by 9 months. The outcomes were excellent in 42 (64 %), good in 18 (28 %) and satisfactory in 5 patients (8 %). Thirteen intra-operative complications (27 %) in nine patients were recorded, with the necessity of repeat surgery in four cases. Two problems were involved: incomplete reduction (nine fractures) and incorrect implant insertion (four fractures). Early complications included hematoma in the wound in five cases and one infected wound.A late complication was delayed union in two cases. DISCUSSION: The management of ipsilateral fractures of the hip and femoral shaft is still associated with a high percentage of complications, mostly due to reduction being difficult. The PFN-long is an implant combining the advantages of the short PFN and UFN systems. Our results are in agreement with the literature data on similar fractures treated with second-generation reconstruction nails and have a lower percentage of complications, even though our group had different characteristics in terms of a higher average age and nearly equal numbers of men and women. CONCLUSIONS: The PFN-long is a high-quality implant that increases our options of treatment. Of all the reconstruction nails, it has most advantages. The availability of only three sizes (in three lengths with one thickness) is a certain disadvantage.

[Hip joint arthroplasty following surgical treatment of acetabular fracture]. / Aloplastika kycelního kloubu po operacním lécení zlomenin acetabula.

PURPOSE OF THE STUDY: A group of 49 patients treated by total hip arthroplasty after previous surgery for an acetabular fracture are evaluated in this retrospective study. MATERIAL: In the period from 1997 to 2004, 49 patients, 35 men and 14 women, with posttraumatic arthritis following acetabular fracture were treated in our department. The average age was 42 years, with 67 % of the patients being younger than 40 years. The average follow-up was 42 montsh (range, 18 to 92). The acetabular fractures evaluated by the AO classification included type A1 in 17 patients, type A2 in seven, type B1 in nine, type B2 in six, type B3 in seven, type C1 in three and type C2 in two patients. METHODS: In 11 patients with aseptic necrosis of the femoral head without acetabular deformity, cementless Zweymüller Bicon or Spotorno CLS acetabular components were used. Twenty-nine patients with acetabular defects of type I and II, according to the American Academy of Orthopedic Surgeons (AAOS) classification, underwent acetabular reconstruction with the bone impaction grafting technique, using allogenic grafts and cementless Zweymüller Bicon acetabular components. Four patients with AAOS type III acetabular defects were treated with impacted morsellized bone allografts, using titanium mesh and cemented polyethylene acetabular cups. Three patients were treated with solid bone grafts fixed with osteosynthetic material. In two patients with type IV defects, osteosynthesis using a plate completed with allogenic bone graft, a mesh and a cemented cup were used. RESULTS: The patients were evaluated with the use of Harris hip scores. In 20 patients (43 %) the outcomes were excellent, and very good in 18 (37 %), satisfactory in six (12 %) and poor in four (8 %) patients. DISCUSSION: Hip joint arthroplasty following the surgical treatment of acetabular fracture is indicated in patients with post-traumatic hip arthritis. This frequently occurs due to complications associated with surgery for acetabular fractures, or the cause remains unknown. Some types of these fractures show a high proportion of poor results. The group can be divided into two different subgroups: the patients with a spherical, healed acetabulum and the patients with acetabular deformity or defect, of which the most serious condition is pseudoarthrosis of one or both columns. In the first subgroup, the surgical technique of acetabulum replacement is the same as in cases with arthritis due to degenerative disease. In the other subgroup, the procedure for cup implantation resembles revision arthroplasty for acetabular loosening. The options for treating defects or deformities and the implants used are identical in both situations. Therefore the results should be compared with those of revision arthroplasty and not primary implantation. Scars, fibrotic changes in muscles, para-articular ossification, bone defects, residual deformities of the acetabulum, devitalized bone fragments or hindering previous implants make the surgical procedure more difficult and interfere with good results. CONCLUSIONS: Total hip arthroplasty carried out after acetabular fracture is technically demanding. The prerequisite for a good result is to achieve primary stability of the acetabulum. Acetabular reconstruction is based, in the first place, on replacement of the missing bony tissue, and on providing conditions for correct alignment of the acetabulum and reliable primary and early secondary osteointegration. THA after acetabular fracture achieves poorer results than when it is indicated for degenerative disease. Key words: acetabular fracture, post-traumatic hip arthritis, total hip replacement.

[Electrical and pharmacological strategies for early cardioversion of atrial fibrillation]. / Elektrische und pharmakologische Frühkardioversion von Vorhofflimmern.

Cardioversion of atrial fibrillation as an element of rhythm control strategy is indicated in patients with first episode of atrial fibrillation, hemodynamic instability, recurrent atrial fibrillation with low probability of spontaneous conversion, or severe symptoms. Early cardioversion is performed within 48 h of onset of atrial fibrillation. The best point in time is still unknown. It can be performed by pharmacological, or, preferentially, by electrical cardioversion. The advantages of electrical cardioversion are higher efficacy and no proarrhythmic risk, however, short time general anaesthesia is needed. Electrical cardioversion is most effective when biphasic shocks are delivered. For pharmacological cardioversion, several antiarrhythmic drugs are available which have to be considered individually. Thromboembolic risk does not differ between the two methods. Early cardioversion and maintenance of sinus rhythm is most effective in atrial fibrillation of short duration, normal left atrial size and no or only mild structural heart disease.

[Personal experience with treatment of acetabular fractures]. / Nase zkusenosti s lécením zlomenin acetabula.

PURPOSE OF THE STUDY: The article presents a retrospective evaluation of a group of 119 patients treated for acetabular fractures between 1996 and 2002. MATERIAL: In the monitored period 119 patients, (89 men, 30 women) average age 35 years, were hospitalized with an acetabular fracture. Surgically treated were 91 patients (70 men, 21 women), average age 29 years. Prevailing in this group were Type A fractures which accounted for 45%, Type B was represented by 35% and Type C included 19%. Twenty-eight patients were treated conservatively. METHOD: Indication for surgical treatment was instability, hip incongruence or combination of both. Conservative treatment was chosen in the fractures without displacement, in fractures with secondary congruency and in case of contraindication of surgical treatment. The indication was always based on CT examination with a three-dimensional reconstruction. The surgery was performed within 24 hours in 42%, within 48 hours in 64%, within 72 hours in 87%. Posterior Kocher-Langenbeck approach was used in 54%, anterior ilioinguinal approach in 22% and the combination of both approaches in 24%. Posterior approach was indicated in A1, A2, B1 fractures, ilioinguinal approach in A3, B3, C1 Types, the combination of both approaches in B2, C2, C3 fractures. Osteosynthetic material was chosen according to the fracture type, bone quality and fragment size. RESULTS: The evaluation was based on subjective complaints, radiograph and clinical examination using Harris Hip Score. In the group of 91 patients treated surgically we achieved excellent result in 41 cases (45%), very good result in 28 cases (31%), fair result in 7 cases (9%) and poor result in 13 cases (15%). We recorded 17 peroperative complications--11 times inadequate reduction, 5 times nerve injury, once vascular injury. Early complications included infect--twice and loosening of implant--once. Late complications occurred in 26 cases--paraarticular ossification in 17 cases, aseptic necrosis of the femoral head in 8 cases. DISCUSSION: The treatment of fractures of the acetabulum as any intraarticular fracture is based on a precise anatomical reduction, stable fixation and early mobilization. Difficulties of the treatment of the acetabulum arise from the anatomical relations. Decisive for the indication, the method of treatment and prognosis is the type of the injury of the weight-bearing area of the acetabulum. In order to understand the type of the fracture it is necessary to make a careful preoperative examination based particularly on CT examination with a three-dimensional reconstruction. The indication and treatment strategy--surgical approach, method of reduction, type of fixation--is selected accordingly. Each surgical approach has its limits and also the possibilities of fixation are limited by the type of the fracture. The outcomes depend directly on the quality of the reconstruction of the articular surface and the incidence of complications, caused either by the injury or preoperatively. CONCLUSION: The treatment of displaced fractures of the acetabulum is on principle surgical. Satisfactory results are produced only by anatomical reconstruction of the weight-bearing area of the acetabulum. Surgical treatment is highly demanding and the long-term results not always correspond to the efforts made.

[Osteosynthesis of proximal femoral fractures using short proximal femoral nails]. / Osteosyntéza zlomenin proximálního femuru krátkým proximálním femorálním hrebem.

PURPOSE OF THE STUDY: A group of 147 patients with proximal femoral fractures treated with the use of the proximal femoral nail, manufactured by the Synthes company, in the period between October 1997 and June 2001 were retrospectively evaluated. MATERIAL: The group of 147 patients whose average age was 69 years consisted of 59 men (average age, 59 years) and 88 women (average age, 75 years). The most frequent fracture occurring in 54% of the patients was an unstable pertrochanteric fracture (Kyle III); persubtrochanteric and subtrochanteric fractures were treated in 27% and 19% of the patients, respectively. METHODS: In 1997, a new implant, the proximal femoral nail manufactured by the Synthes company (PFN), was introduced in the Czech Republic. In addition to all advantages of a nail to be implanted intramedullary, it has several other favorable characteristics: its length is 240 mm, pre-drillings is not necessary, it can be dynamically locked, it has a high rotation stability, and mechanical stress concentration on the implant-bone interface is low. This evaluation is based on the type of fracture, the duration of healing, the duration of surgery and X-ray exposure. RESULTS: The patients were followed up at 6 months, 3, 6 and 12 months, and once a year. The fracture healed in the anatomical position by 6 months in 95% of them. The average operative time was 56 min and X-ray exposure lasted on average 1 min. We recorded 14 intra-operative complications in nine patients, which included incomplete reduction in four cases, fixation in distraction in two, incorrect length of screws in one, fracture at the site of distal locking in two and incorrect insertion of femoral neck screws in five cases. Early post-operative complication involved seven cases of hematoma in the operation wound with the necessity to re-operate in five cases. Late complications occurred in two patients and included pseudoarthrosis and necrosis of the femoral head after healing. Most of the complications were found in subtrochanteric fractures. DISCUSSION: The treatment of unstable fractures of the proximal femur is still associated with some failures. The reasons are: disregard for biomechanics, overestimation of the potentials of new surgical techniques or new implants or poor adherence to established procedures. PFN is a novel, modern implant based on experience with the gamma nail. Since relevant literature data are very few, any comparison of our results is very difficult. The lower average age of our group was due to the intentional selection of our patients for this type of surgery. CONCLUSIONS: PFN is an excellent implant for the treatment of unstable fractures of the proximal femur. The terms of successful outcome include a good understanding of fracture biomechanics, correct indication and exactly performed osteosynthesis.

[Purulent Salmonella arthritis of the ankle joint]. / Purulentní salmonelová artritida hlezenného kloubu.

In the case study the authors focus on Salmonella enteritidis which caused purulent osteoarthritis of the ankle and sepsis. Salmonella osteoarthritis is one of the nidal forms of the salmonella infection. The authors briefly present etiology, pathogenesis, diagnosis and principles of the treatment of infectious osteoarthritis. They analyze a case of a 56 years old immunocompromised patient who was treated at the authors' department for a late diagnosis with an already developed septicemia. They describe the course of the disease, complications and the result of the treatment and discuss the pitfalls of the diagnosis and treatment. Only a timely diagnosis followed by a sufficiently vigorous surgical intervention with drainage of the joint and combined with a timely, targeted and long-term antibiotic therapy leads to the management of this severe nosologic unit.

[Using interaction-intensive therapeutic nursing measures and "home remedies" in nursing care. An explorative study as a plea for integrated nursing practice]. / Der Einsatz von interaktionsintensiven pflegetherapeutischen Massnahmen und von "Hausmitteln" in der Pflege. Eine explorative Studie als Plädoyer für eine integrierte Pflegepraxis.

BACKGROUND: Until today there existed no major studies about the wide range of currently utilized methods or potential sociodemographic and institutional influences on utilization despite an immense interest among nurses in alternative nursing methods (in this study referred to as home remedies). METHODS: In this study, from standardized questionnaires with a convenience sample of three different settings of nursing practice, i.e. acute-care, nursing homes, and home health care were analyzed using the statistical program SPSS. RESULTS: Our analysis showed that a wide range of traditional home remedies is being utilized, e.g. application of heat and cold or herbal infusion (herbal teas). Furthermore, lay approaches such as aromatherapy were also commonly used. The statistical analysis revealed complex influences of age, duration of nursing practice and institutional setting in the utilization of home remedies. CONCLUSION: There is need for more systematic studies to further examine the alternative methods or home remedies so popular among nurses and their patients. Regarding a more consistent naming of the variety of different methods coming from naturopathy, folk and lay medicine, the authors suggest the term "integrative nursing care".

[Work satisfaction and working conditions of the nursing staff as the basis of internal interventions]. / Arbeitszufriedenheit und Arbeitsbedingungen des Pflegepersonals als Grundlage betriebsinterner Interventionen.

Satisfaction and working conditions of nursing staff as a basis for internal interventions Can analyzing the working situation of nursing staff by means of a questionnaire contribute to improving working conditions and thus reduce fluctuation and increase work-satisfaction? This was the basic question of this investigation and aimed at creating an instrument that could help work out existing resources and strategies for possible interventions. Therefore, an anonymous questionnaire containing 114 questions concerning the current situation was presented to the nursing staff in two departments of internal medicine and one surgical department of a university hospital in southern Germany in April 1993. Analysis of the data of the different working fields (ordinary/intensive care, clinics) showed individual differences regarding resources and possible interventions. Furthermore, the assumption could be confirmed that by means of such a project the nursing management gains specific starting points for the preparation of change. The prospects of improving working conditions seem quite good, as these findings are based upon the statements of the staff concerned. It has to be emphasized that the nursing staff were able to identify themselves with the conclusions when the results were presented to them.

Tissue polypeptide antigen in bronchogenic carcinoma.

Serum concentrations of tissue polypeptide antigen (TPA) were examined by an immunoradiometric technique in 114 patients with bronchogenic carcinoma and in 55 patients with noncancerous lung diseases. The sensitivity of TPA examination in bronchogenic carcinoma was 67.5% and was increased in advanced stages of the disease. No statistically significant differences were observed between histologic types of bronchogenic carcinoma. In nonmalignant lung diseases, elevated levels of TPA were observed in 21.8% of patients. TPA is of little value in the diagnosis of bronchogenic carcinoma; however, it may be useful as an auxiliary criterion for staging.

Evaluating statistical analyses and reproducibility of microbial mutagenicity assays.

The NCI/NTP has completed the first phase of a 4-laboratory study on the reproducibility of testing chemicals for mutagenicity in the Salmonella/microsome assay. This paper is a report of the statistical analysis of some of that data. This analysis involved (1) identifying and removing spurious data; (2) determining the adequacy of the remaining data in making a decision on the mutagenicity of the test chemical; (3) performing the statistical tests; and (4) interpreting the results. Using this procedure, 7 approaches were used to determine the mutagenicity of a test. These approaches were the (1) 2-fold rule, (20 modified 2-fold rule, (3) one-way analysis of variance (homogeneity test), (4) test for linear trend, (5) combination of 3 and 4, (6) 97.5th percentile threshold rule and (7) confidence interval threshold rule. The conclusions drawn by each rule were compared to the microbiologists' interpretation, and the results of these comparisons were presented. In addition, the strengths and weakness of each rule were discussed. The reproducibility of the assay in this study was examined, and a discussion of the significance of these results was presented.

In vitro information system for collection and analysis of experimental data.

The In Vitro information System (IVIS) provides for the collection, maintenance, analysis and reporting of mutagenesis data for the In Vitro Carcinogenesis Program of the Carcinogenesis Testing Program in the National Cancer Institute. Initial development or IVIS focused on the microbial mutagenicity assays conducted in a collaborative study in four laboratories. Information is collected about contract management, chemicals, microorganisms strain checks, preparation of activation enzymes, test results, and confirmation of mutation. IVIS provides for editing and maintenance of the information on computers at the National Institutes of Health. Analysis and reporting features were designed to assist both laboratory investigators and NCI staff in evaluating the mutagenic activity of test compounds. The analysis has focused on two principal goals: using the computer to examine the results of each test to determine if the test was adequate for a further statistical analysis; and secondly, if the plate counts are adequate, developing statistics that indicate whether there is a positive or negative trend. Reports have been developed for tabular displays of test results, frequency distributions, dose response graphs and statistical computations.

Neoplastic and nonneoplastic lesions in aging (C57BL/6N x C3H/HeN)F1 (B6C3F1) mice.

Neoplastic and nonneoplastic lesions in untreated (C57BL/6N x C3H/HeN)F1 (B6C3F1) mice used as controls in carcinogenesis tests were tabulated and evaluated. The most common neoplasms in 2,543 male mice were hepatocellular adenomas and carcinomas. In 2,522 female mice, common tumors were lymphomas, leukemias, pulmonary adenomas and carcinomas, hepatocellular adenomas and carcinomas, and pituitary adenomas. The risk of developing most neoplasms increased with the age of the mouse. Hepatocellular carcinomas metastasized in 12% of the animals with these tumors. Other than lymphomas and leukemias, few other tumors metastasized. Nonneoplastic lesions included cystic hyperplasia of the uterus, nephritis, ovarian and uterine cysts, inflammatory lesions of the lung, mineralization in the brain, and focal hyperplasias in several tissues. The focal hyperplasias in lung and pituitary, adrenal, and thyroid glands were suggestive of the early stages of neoplasia. Comparative aspects of lesions in aging mice and their interpretation in carcinogenesis tests are discussed.

[On the contamination of the citric acid fermentation. II. Sodium 5-nitrofurylacrylate as an antiseptic against representatives of the Enterobacteriaceae (author's transl)]. / Uber Kontaminationen der Zitronensäuregärung. 2. Mitteilung: natrium-5-nitrofurylacrylat als Antiseptikum gegen Vertreter der Enterobacteriaceae.

In context with the first communication which deals with the characterization of the so-called brown contamination called forth by Enterobacteriaceae in the citric acid fermentation of molasses, the present paper describes the screening of antiseptic substances able to suppress the contamination mentioned without damaging the normal growth of the producing mould Aspergillus niger and its ability of producing citric acid. Among the substances tested the sodium salt of 5-nitrofurylacrylic acid (5-NFA) excelled partly because of its antiseptic effect in relatively small concentrations and partly because the mould tolerates appreciable amounts of this antiseptic. Therefore there may be applied, in the presence of a heavy contamination, relatively high concentrations of the antiseptic without fear of damaging the producing mould. Usually a dose of 10 to 15 mg 5-NFA in 11 of medium was sufficient to suppress the brown contamination.