[Differential diagnosis of acute arthritis. Quickly assessing infectious etiology]. / Differenzialdiagnostik der akuten Arthritis. Infektiöse Ursachen rasch abklären.

Acute arthritis of abrupt onset producing symptoms showing peak intensity within a matter of hours, have a largely uniform clinical presentation. Urogenital or gastrointestinal infections (= reactive arthritis) or infectious conditions (= septic genesis) in the patient's history may provide further information of relevance for the differential diagnosis, which includes--in particular in the case of the reactive, infectious/allergic forms--direct and serological demonstration of pathogens. In contrast, imaging procedures in the early stages are of little help in clarifying causes.

[Basic therapy of rheumatoid arthritis. Comparison of methotrexate and sulfasalazine]. / Basistherapie der Rheumatoid-Arthritis. Methotrexat und Sulfasalazin im Vergleich.

In a retrospective analysis a total of 167 patients with rheumatoid arthritis (RA) who had been treated with the basic therapy formulas of methotrexate (MTX) or sulfasalazine (SUL) were evaluated with respect to therapeutical result and side effects after a period of 12 months. There was no randomization as to either MTX (n = 87) or SUL therapy (n = 80), but deliberate use of therapy according to prior treatment and activity of the illness. Apart from a significantly higher number of inflammatory joint conditions in the MTX group there was no difference in the two patient groups at the beginning of the study. MTX treatment led clearly to a more conspicuous activity decrease of the illness (ESR, joint index) and a more favourable effect on the locomotor function. Furthermore, the sphygmomanometer readings (for grip strength determination), the dose reduction of the concomitant prednisolone medication as well as the doctor's opinion were in favour of MTX. The portion of patients who had to discontinue the therapy because of side effects (= 11%) and lack of effect (= 9%) was exactly identical in both groups of patients. Both substances have shown to be effective basic therapy formulas for rheumatoid arthritis, while methotrexate has a few advantages.

[Pyruvate and alpha-ketoglutarate levels in the after parenteral fat emulsion (Lipofundin) administration]. / Das Verhalten von Pyruvat, und alpha-Ketoglutarat im Blut nach parenteraler Fettemulsion (Lipofundin)-Gabe.

In various kinds of tests the metabolites pyruvate, lactate, and alpha-ketoglutarate were estimated after a single application of Lipofundin, resp. sorbitol solution. Within 24 hours after infusion significant changes of concentration occurred. The results are discussed. It is emphasized that Lipofundin caused no additional metabolic alterations compared with sorbitol, thus the concentration changes of pyruvate, lactate, and alpha-ketoglutarate after Lipofundin probably being caused by its content of sorbitol. Accordingly, parenteral application of fat during the immediate postoperative period is not necessary. After this period it is indicated in order to meet requirements of essential fatty acids and of energy.

[Routine hip ultrasonography in inflammatory rheumatoid diseases. Results in 119 consecutive patients of a rheumatism clinic]. / Routinemässige Hüftsonographie bei entzündlichen rheumatischen Erkrankungen. Ergebnisse bei 119 konsekutiven Patienten einer Rheumaklinik.

METHOD: In 119 consecutive inpatients with rheumatic diseases--mainly rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis--both hips were routinely investigated by sonography. RESULTS: In 52 of the 119 patients definite or possible pathological findings (in 18 cases bilateral) were observed. The relative frequency of sonographic findings in 223 evaluable hips was 33% and was somewhat higher in patients with rheumatoid arthritis than in those with other diagnoses. Changes were found significantly more often when the patient had joint complaints, limitation of movement, pathological X-ray changes or serological signs of inflammation (elevated ESR, positive C-reactive protein). The relative frequencies were higher than were expected on the basis of data in the literature. Of the pathological sonographic findings, 22% occurred in clinically and radiologically asymptomatic patients. CONCLUSIONS: In view of the therapeutic consequences and the importance of early treatment, routine sonographic examination of the hip joint is recommended.

[Is pyodermia fistulans sinifica of clinical importance?]. / Ist die Pyodermia fistulans sinifica von klinischer Bedeutung?

Pyodermia fistulans sinifica is a retention dermatopathy. We report on 12 men and 2 women with this disease, and our radical surgical treatment. The prognosis is favourable.

[Morphological studies on swine livers after extracorporeal perfusion]. / Morphologische Untersuchungen an Schweinelebern nach extrakorporaler Perfusion.

Morphologic examination of 6 porcine livers after extracorporeal perfusion showed toxic damages of parenchyma with and without necrosis, dilatation and distension of sinusoids with and without hemorrhage and accumulation of inflammatory cells, activated stellate cells, different distributions and loss of glycogen. These findings in the liver could be caused as well by inflow of toxins and cells from the patient, as by increasing damage of the livers under the unphysiological conditions of extracorporeal circulation. The authors point at possible immunologic responses and give their opinion on the question of "vitality" of extracorporeally perfused porcine livers.

[Behçet's syndrome. Possible differential diagnosis in multi-system symptoms]. / Das Behçet-Syndrom. Mögliche Differentialdiagnose bei multisystemischer Symptomatik.

Behçet's syndrome was described as a triad with recurrent ulcers of the mouth, aphthae of the genitals as well as changes of the eyes. A fourth later added main criterion comprises multifarious dermatological symptoms. Facultative signs of a disease, which, however, occasionally may stand also in the centre of the clinical picture are vascular, gastrointestinal and central-nervous participations, arthritic pains and swellings as well as an epididymitis. On account of the infrequency of the disease outside the endemic regions and the development of the individual manifestations over larger periods it is often recognized very late. Out of the six casuistics described three of them fulfilled the criteria of a complete Behçet's syndrome with evidence of all four main criteria, in the remaining casuistics the incomplete clinical picture was present with three main and one to four side criteria. In all cases the course was relatively benign. Recently, streptococcal antigens were considered to be etiological factors; correlations with the HLA-system are ascertained for patients from endemic regions. In phases of clinical activity the combination of immunosuppressive agents with cortisonoids is the therapy of choice.

[Indications and surgical therapy of thyroid gland diseases--analysis of 725 operated patients]. / Indikation und operative Therapie von Schilddrüsenerkrankungen--Analyse von 725 operierten Patienten.

Diseases of the thyroid gland are an important part of elective surgical procedures. The adequate surgical therapy is at present standardized and requires a permanent qualitative control to reduce avoidable complications. The relation between men and women in our patients (n = 725) was 1 to 5. The mean age was 51.2 years. 10% (n = 79) of the patients were hyperthyroid. 646 patients had benign disease; and 79 patients were found to have malignancy of the thyroid gland. The most common indication for an operation was bilateral multinodular goitre (n = 325) in combination with a cold nodule (n = 123), in 79 patients latent hyperthyroidism or Morbus Basedow (n = 22). Struma nodosa with retrosternal extension (n = 49), recurrence of goitre (n = 34), thyroiditis (n = 12) and dystopic goitre (n = 2) were rare in these patients. Patients with malignancy of the thyroid gland were always treated by thyroidectomy or completed thyroidectomy with lymphnode dissection. In the cases of benign disease the surgical methods were variable, although the bilateral subtotal resection (n = 413) predominated. While doing so the radical resection of parenchyma with a persistent functioning remnant of goitre of 5 cm3 was favoured. The resulting postoperative complications are discussed. An endocrinological appropriate follow-up of the patients is necessary.

[Incidence of damage to the recurrent laryngeal nerve in surgical therapy of various thyroid gland diseases--a retrospective study]. / Zur Häufigkeit der Schädigung des Nervus laryngeus recurrens bei der operativen Therapie verschiedener Schilddrüsenerkrankungen--eine retrospektive Untersuchung.

UNLABELLED: We investigated the incidence of the recurrent laryngeal nerve (RLN) palsy after thyroid gland surgery in 725 cases. The incidence was correlated to the different diseases of the thyroid gland, to the operative procedure (subtotal resection, lobectomy, thyroidectomy), to the intraoperative exploration of the nerve and to the surgeons' state of training. RLN palsy was found in 7.6 per cent (4.8 per cent nerve at risk) five days after surgery. A permanent RLN damage was defined as a persisting paralysis of the vocal cord six months after surgery. Permanent nerve damage occurred in 2.1 per cent for euthyroid nodular goitre, for recurrent goitre in 11.7 per cent and for thyroid carcinoma in 10.1 per cent. There was a statistically significant difference between the number of RLN pareses occurring after nerve exposure with 4.2 per cent and that occurring after non-exposure with 1.1 per cent for subtotal lobectomy. 67.7 per cent of these pareses at day five were transient. The RLN palsy rate for Senior House Officers was 6.7 per cent but there where none for registrars and consultants. CONCLUSIONS: The RLN damage five days after thyroid gland surgery is mainly caused by the great number of recurrent goitre and thyroid cancer (16.1 per cent), the rate of procedures performed by younger surgeons and the near total resection of euthyroid goitre. The exposure of RLN is important for the training to manage thyroid gland surgery.

[Antigen-specific rosette inhibition test with autologous serum--a possibility for the detection of blocking factors in chronic rejection of allogeneic orthotopic kidney transplants]. / Der antigenspezifische Rosettenhemmtest mit autologem Serum--Eine Möglichkeit zum Nachweis blockierender Faktoren bei der chronischen Rejektion allogener orthotoper Nierentransplantate.

After allogeneic renal transplantation in 26 female pigs the kinetics of the immunological reactivity have been investigated in order to diagnose a rejection crisis. The animals were not treated with immunosuppressive substances. The antigen specific rosette test is an useful parameter for estimation of immune reactions against a graft. Moreover, the inhibition of this test by autologous serum taken in the course of a chronic graft rejection is caused by blocking factors. Therefore this inhibition test would be suitable for an exact determination of specific immune reaction against the graft. By exclusion of false positive results by means of the rosette reaction test a high significant correlation between the antigen specific rosette formation and the clinical symptoms of the rejection could be observed. As long as blocking factors are protecting the graft against activities of immunocompetent cells respectively their effector molecules, recipient serum is able to inhibit the rosette formation. On the other hand a strong increase of rosette forming cells in a pig whose serum does not show an inhibitory activity is correlated with clinical symptoms of a rejection.

[The importance of active rosette-forming cells and specific antigen-binding cells in the diagnosis of rejection after allogeneic orthotopic kidney transplantation]. / Die Bedeutung aktiv rosettenbildender Zellen und spezifisch antigenbindender Zellen bei der Rejektionsdiagnostik nach allogener orthotoper Nierentransplantation.

After allogeneic renal transplantation in 26 female pigs the kinetics of the immunological reactivity against the graft have been investigated with a specific test, the antigen specific rosette test and an unspecific test, the active E-rosette test. In acute and chronic rejection the level of antigen specific rosette forming cells reflects very well the clinical signs of rejection. Because of early occurrence of immunological reactivity in the case of frequent (daily) testing this test is suitable for a relative sure prediction of rejection episodes. In spite of their relative good correlations to the increase of serum creatinine, posttransplant increase and decrease of active rosette forming cells are not always in an uniform temporal relation to the rejection process. For that reason this test alone is not suitable for diagnosis of rejection. However, high preoperative values (greater than or equal to 18% active T cells) refer to an increased readiness to immunological reactivity of recipient against the graft and reflect contraindication to transplantation. If active rosette forming cells (greater than or equal to 18%) and antigen specific rosette forming cells show maxima at the same time, than follow in high significance strong cell mediated rejections. On this way the active E-rosette test completes the values of the antigen specific rosette test.