Collagen peptidase and type III procollagen peptide serum levels in chronic liver diseases.

The concentration of the N-terminal peptide of procollagen III and the activity of collagen peptidase (PZ-peptidase) were measured in sera from 92 patients with chronic liver disease. In patients with liver cirrhosis and chronic hepatitis with transformation of liver structure, high values were found for both variables compared with hepatoses and chronic hepatitis without transformation. The concentration of procollagen III peptide and the activity of collagen peptidase in serum increased with increasing degrees of fibrosis and, even more markedly, with increasing degrees of mesenchymal activity in the liver.

[Diploma of continuing education from the Society of Physician of Thüringia]. / Fortbildungsdiplom der Landesärztekammer Thüringen.

The diploma of continuing medical education (DCME) gives the possibility to describe and document the effort of the physicians to accomplish continuing medical education and quality assurance which is a claim of the professional rules for physicians. Stimulation of the physicians to participate lectures is a further goal of the DCME. The DCME which can't be used as a title, is supposed to be for physicians, who finished their specialisation. Acquisition of DCME is voluntary. For the DCME, the candidates have to participate 100 hours of continuing medical education with given theme setting for 3 years. The DCME represents an useful proof for the fulfilling of the duty of continuing education as well as for evaluation of given lectures.

[The internist--generalist or specialist?]. / Der Internist--Generalist oder Spezialist?

Also after the elimination of certain subjects and after the development of subspecialisations internal medicine has remained the central clinical basic speciality. The synoptic medical thinking and acting with a coordination of all special examinations to a coherent view and treatment of the patients is incumbent on the internal specialist as "general internal specialist" or so-called "generalist". The central point of the intermedical care of the population lies in the work of the internal specialist. This has consequences also for the education and further training. In the auditory and at the patient we must be able to show the students and physicians trustworthy how internal medicine as general internal medicine is organised in its full extent and is practised by a medical superintendent who is qualified to do this.

[The internist--responsibilities, professional practice and self concept. An introduction]. / Der Internist--Aufgaben, Tätigkeit und Selbstverständnis. Eine Einführung.

An analysis of claim and reality causes doubt about the fact whether the internal medicine as a basic clinical subject may at present fully meet its commission. The working group "ethics" of the GDR Society of Internal Medicine has worked out a material concerning the questions of the tasks, the activity and the self-appreciation of the internal specialists and puts it under discussion.

[Early detection and follow-up of solid tumors]. / Früherfassung und Verlaufskontrolle solider Tumoren.

The early recognition of solid tumours as presymptomatic diagnostics is only reasonable, when it leads to a gain of survival time and survival rate. The evidence of effectiveness by randomized studies (apart from carcinoma of the cervix) was proved up to now only for the carcinoma of the breast (mammography) and the carcinoma of the colon (occult blood in the stools). The target-specific screening within well defined risk groups is to be recommended, when the subsequent chain of investigations and the therapy chain is ascertained. For the control of the course increasingly tumour markers are used including monoclonal antibodies against tumour-associated antigens.

[Panmyelopathy and myeloproliferative syndrome]. / Panmyelopathie und myeloproliferatives Syndrom.

From the viewpoint of a territorial haematological centre with a certainly preselected number of patients the initial symptom of bi- or pancytopenia in 3/4 of the cases proves as first reference to a myeloproliferative or myelodysplastic syndrome. Of these cases 62.5% transferred into a crisis of blasts; that is, they must be regarded as real preleukemia. The morphology of the bone marrow as well as the stem cell cultures obtained from this give important references to the diagnostic classification of the early changes as well as to their prognosis.

[Experiences in organization of medical graduate and continuing education in the new German country (Thüringen)]. / Erfahrungen beim Aufbau der ärztlichen Fort- und Weiterbildung in einem neuen Bundesland (Thüringen).

The switch from a state controlled to a self responsible continuing medical education could be completed in Thuringia within the first years after the reunification. Higher performances demonstrated by the just mentioned analyses can be observed quantitatively as well as qualitatively. This concept of our academy concerning a professional and regional decentralization in combination with centralized offers for further education has been proved. A good teamwork between the organizers and participants succeeds more and more in finding out the kind of teaching needed. Medical education can be planned globally and according to the needs. New ways of training can be searched and may go beyond country borders.

Epidemiology of chronic liver diseases.

In the GDR mortality from liver cirrhosis decreases in contrast to most other countries though the alcohol consumption of the population is continuously increasing. In Capital Berlin and in the industrialized districts mortality from cirrhosis is higher than in the rural areas. Within a period of 6 years the number of inpatients with chronic liver diseases has risen from 11.600 to 14.200. From the epidemiologic point of view, virus hepatitis is not the main source of liver cirrhosis. The total recovery rate of acute hepatitis has increased from 80% to 94% over a period of some 8 to 10 years, liver cirrhosis was found to have developed only in 0.3%. 70% of cirrhotic patients did never suffer from virus hepatitis, as their anamnesis revealed. 73% of 1.8 million blood donors that were subjected to SGPT and HBAg-screening tests showed histologic changes of the liver. With the use of these screening methods it has been possible to register 7% persons with liver diseases among these blood donors. Early recognition and treatment of chronic liver diseases seem to result in a reduction of mortality from liver cirrhosis.

Contributions to the epidemiology of liver cirrhosis and chronic hepatitis.

The real prevalence of liver cirrhosis within the total population is unknown. Our own statistic evaluations of the mortality from liver cirrhosis in relation to the death rate and investigations in fatal accidents may suppose a real prevalence of nearly 1% in the population of the GDR. Investigations of trends have shown a rising rate of incidence and mortality from liver cirrhosis in the GDR, mainly caused by alcoholic cirrhosis. There are positive correlations with the increasing alcohol consumption and negative ones with hepatitis incidence. Liver cirrhoses are accompanied by a high percentage of secondary diseases especially by gastroenterologic, cardiologic and metabolic disorders. The increase of alcoholic cirrhoses in the age group 20-40 years from 35% 1970 to 63% 1978 with the peak for men between 30-50 years will be of economic importance. Main topics for the epidemiologic research of liver cirrhosis have been discussed.

[Hairy cell leukemia. Light and microscopic and electron microscopic examinations (author's transl)]. / Die Haarzell-Leukämie. Lichtmikroskopische und elektronenmikroskopische Untersuchungen.

Two cases of a typical hairy cell leukemia are presented. The light microscopic findings within the bone marrow, lymph nodes and spleen are documented. The hairy configuration of tumor cells can best be seen in semithin sections of white cells of the peripheral blood. Electron microscopically, the organelle composition of hairy cells (including the characteristic ribosome lamellae complex) is demonstrated. The significance of morphological observations for the diagnosis of hairy cell leukemia and the differential diagnosis of this tumor disease are discussed. From the electron microscopic observations of intercellular cross-banded structures it seems possible that the increase of intercellular material demonstrable light microscopically by silver impregnation is the consequence of synthesis of collagen type IV. The conclusion is drawn from findings in our cases and from reports in the literature that hairy cell leukemia is a clinically and structurally defined syndrome rather than a pathological entity.

[Platelet spreading in diabetes mellitus]. / Untersuchungen der Thrombozytenausbreitung bei Diabetes mellitus.

In 162 test persons divided into healthy control persons and diabetics of type I and type II the thrombocyte spreading was investigated according to the method of Breddin. Age, sex, degree of seriousness of retinopathy, duration of diseases, present level of blood sugar and HbA1 concentration were taken into account. Spread thrombocyte forms were increasingly found in old age, in diabetics of both types and a close relation to the extent of retinopathy was evident. As diabetic retinopathy became evident and with growing degree of seriousness, spread forms of thrombocytes were increasingly found, so that the increased spreading capacity may be interpreted as a disturbed metabolic and blood vessel situation in diabetes mellitus.

[Experience and results in the evaluation of documentation-oriented medical records in the German Democratic Republic]. / Erfahrungen und Ergebnisse bei der Auswertung des dokumentationsgerechten Krankenblattes der DDR.

At the instance of the chronic liver diseases (Nr. 571 and 573 IKK) is shown in form of a model which high value of information the process of the stored data of the headline of a medical record suited for documentation. Thus informations concerning the clinical morbidity/mortality, analyses according to age and sex, residence and admitting institution, comparison of admission, treatment and post-mortem diagnoses, ascertainment of the diagnosis and finally economic data may be got. From this result the epidemiological conclusions and the statements for analyses of factors.

[Biotransformation in liver damage]. / Zur Biotransformation bei Leberschäden.

Xenobiotics may produce liver damages. Vice versa primary liver diseases influence metabolism and elimination of drugs. The activity of the isoenzymes of the monooxygenase system which catalyze biotransformation reactions in the liver can be tested by model substances (Cyt P-450Pb: Metamizol, Cyt P-450MC: Caffeine, Cyt P-450db1: Debrisoquine). It can be influenced by estrogens, gestagens, smoking, alcohol. Only severe stages of liver diseases reduce the biotransformation of drugs. Thus in liver cirrhosis the excretion of unchanged furosemide is increased. The bioavailability of propranolol is changed by a reduced first pass effect in liver cirrhosis. In patients with drug hepatitis after dihydralazine 15 out of 17 patients are genetically slow acetylators and they show also a lower activity of phase I cytochrom P-450 catalyzed biotransformation reactions. The same holds true for patients with haemochromatosis. Determination of the 7-ethoxycoumarin-O-deethylase (ECOD) in liver biopsy samples allows the correlation of the decrease in biotransformation with the increase of liver cell necrosis, intraacinous fibrosis and structural changes. Possibly the changes in biotransformation caused by liver diseases are connected with a disturbed regeneration of the liver corresponding to the concept of the "streaming liver".

[NMR research on blood plasma for tumor detection--a method for mass screening?]. / NMR-Untersuchungen an Blutplasma zur Tumordetektion--Eine Methode zum Massenscreening?

Recently, a simple NMR test was proposed to distinguish patients with and without malignant diseases by line-width analysis of methyl and methylene lipoprotein resonances in human plasma (4). We have reevaluated this proposed cancer detection technique at 250 MHz (magnet field strength 5.9T). The mean line width for 11 controls was 31.2 Hz (SD 4.1 Hz). For 8 patients with untreated malignant tumors, the line width was 27.5 Hz (SD 3.9 Hz). The data confirm the reported lower line widths of human plasma NMR resonances for patients with malignant tumors compared with controls (4). However, the statistical significance (P greater than 0.07) does not justify to use this technique for individual differential diagnostic purposes without further improvements of the method.

[Studies on the frequency and diagnostic value of hepatomegaly]. / Untersuchungen über Häufigkeit und diagnostische Bedeutung von Lebervergrösserungen

In 4 groups of patients (I = 1 621 internistic in-patients, II = 2 073 donors with increased SGPT-values, III = 2 619 after-examined patients with hepatitis, IV = 514 patients of a sanatorium for liver diseases) frequency and diagnostic validity of the symptom enlargement of the liver are tested. The most frequent cause of hepatomegalia is in group I an insufficiency of the right heart. The highest percentage, however, is to be found in liver diseases, then come heart insufficiency, diseases of stomach and gall-bladder, diabetes, rheumatic diseases. In these diseases liver biopsy detects additional changes in many cases. The validity test in the 4 groups yields very different results, dependent on the number of patients and the diagnostic questioning. The symptom hepatomegalia cannot be used as a screening test, but it is of high diagnostic value in the clinical diagnostics.

[Testing of granulocyte function after gravity leukapheresis]. / Testung der Granulozytenfunktion nach Schwerkraftleukophorese.

In a laboratory model granulocyte concentrates are produced by a procedure of gravitational leukopheresis. Hydroxyaethyl starch (HAS) served as an accelerator of sedimentation. In a parallel test arrangement a preparation of hydroxyaethyl taken from the industrial production of the GDR and a control preparation (Plasmasteril) was used. The regaining rate of this method amounts to about 70 per cent with 98 per cent of living cells in the concentrates. Vitality, performance of phagocytosis and ability of migration will only reduce to a slight degree during the first 4 hours, after that time, however, they will decrease significantly. There are no essential differences between the results of both preparations.

[Behavior of fibrinogen in diabetic patients in comparison with objective vascular measurements in the ocular fundus]. / Fibrinogenverhalten bei Zuckerkranken im Vergleich mit objektiven Gefässmessungen am Augenhintergrund.

Objective measurements of vessels were performed in vivo in 10 patients affected with diabetes mellitus, the fibrinogen concentrations in the venous blood being determined simultaneously. Whereas the ensured correlations with fibrinogen concentration could be recognized from the diameter of arteries and veins and from the flow velocity, a linear correlation could be found to exist between the fibrinogen level and the volume flowing through a retinal artery. These findings prove that the very existence of a hyperfibrinogen anemia does not justify the assumption of the blood volume flow being decreased. In patients with diabetes mellitus the enhanced volume flowing through retinal arteries is rather connected with an increased fibrinogen level.

Results of treating stage III and IV malignant non-Hodgkin's lymphomas (NHL).

Malignant non-Hodgkin's lymphoma (NHL) patients were enrolled and analyzed retrospectively in 2 successive study groups. The first group consisted of 57 patients divided into low- and high-grade malignant NHL according to the Kiel classification, the second one included 104 patients divided into low-, intermediate-, and high-grade malignant NHL. The more individualized and more intensive polychemotherapy of the 2nd group yielded clearly better treatment results compared to the first group, especially in high-grade malignant NHL. The complete remissions rose from 32% to 59%, the recurrence rates fell from 62% to 20%, the 5-year survival time of patients under age 30 increased from 0 to 48%. In intermediate-grade malignant NHL, intensive therapy yield results that are as beneficial as those of mild therapy in low-grade malignant NHL (5-year survival rate 62% and 65%, respectively).