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Following 123I-labelling and reinjection of autologous low-density lipoproteins (LDL) to patients with clinically manifest atherosclerosis and/or hyperlipoproteinaemia (HLP), an investigation was carried out of whole body kinetics and local kinetics over atherosclerotic lesions and areas of increased LDL entry identified by "hot spots" in the 123I-LDL scintigram. In patients with HLP the number and frequency of "hot spots" was higher than in normolipaemics. The time course of 123I-LDL influx into atherosclerotic lesion sites until scintigraphic visualization of "hot spots" exhibited three different types of LDL uptake among the patients. In the majority of patients LDL kinetics was characterized by entry into the vessels with the maximal radioactivity measured as early as within 60 minutes after reinjection. In some patients maximal radioactivity over lesion sites was discovered after 20 hours or even later. Morphological evaluation revealed that in comparison to control tissue, fatty streaks and lipid lesions show by far the highest 123I-LDL accumulation. Ex vivo measurement of the deposition of 125I-LDL in de- and re-endothelialized rabbit aortic segments exhibited a significantly (p less than 0.01 - p less than 0.001) higher 125I-LDL retention as compared with endothelialized segments (after i.v.-injection).

In current scientific discussion, increasing importance is being given to the clinical significance of the new formation of vessels (angiogenesis) in the course of physiological, inflammatory and neoplastic processes. Angiogenesis is best studied in the growth of malignant tumors, since cancer may be regarded as the most important angiogenesis-dependent disease in terms of social and economic aspects. The significance of angiogenesis in gynecological oncology is as follows: 1) Intratumoral vessel density is an indicator for the emergence and growth of malignant tumours and their precursor lesions, 2) intratumoral vessel density is an independent prognostic factor for solid malignancies and 3) the inhibition of tumor angiogenesis by means of anti-angiogenetic substances causes tumor growth to be suppressed. Angiogenesis also plays an important role in the regulation of the female menstrual cycle. Proliferation of the endometrium and the formation of the corpus luteum in the second half of the menstrual cycle are examples of angiogenesis in the physiological field. The function of angiogenetic factors in the emergence of endometriosis and in female and male infertility are currently under study. In obstetrics, the new formation of blood vessels is significant for the implantation of impregnated blastocysts and for the development and growth of the placenta. Preeclempsia (gestational toxicosis), for instance, is a typical pregnancy-related disease whose pathophysiological mechanism is attributed to a disturbed development and function of small placental vessels. The present paper is an overview of current knowledge and current approaches of research concerning angiogenesis in the field of gynecology and obstetrics. The paper is focused on the clinical significance of angiogenesis.

The Austrian guideline for prevention and early detection of breast and ovarian cancer in high risk patients--particularly in women from hereditary breast and ovarian cancer families--were established with particular consideration of the most recent position paper of the European Society of Breast Cancer Specialists (EUSOMA) by the authors mentioned above. The guideline is aimed at facilitating and standardizing the care and early detection strategies in women with an elevated life time risk for breast and ovarian cancer.

Toxocara canis and T. cati are not only ubiquitously distributed parasites of dogs, foxes and cats, but may also infest humans, causing a great variety of symptoms and sometimes also severe diseases: the visceral larva migrans syndrome, the ocular larva migrans syndrome, covert toxocarosis, common toxocarosis, neurological toxocarosis, and some other clinical pictures (asthma bronchiale, epilepsy, rheumatoid arthritis) are considered to be induced by Toxocara species. Both Toxocara species are also widely distributed in Austrian dog, fox and cat populations; seroepidemiological studies carried out in Austria revealed seroprevalence rates of 3.7% among the normal human population and up to 44% among persons particularly exposed to those parasites (i.e. veterinarians, farmers). Although many Toxocara infestations do not cause severe clinical manifestations, a few dozens of toxocarosis patients have been registered every year during the last years; in reality, however, we have to assume that several hundreds of patients suffer from toxocarosis. This paper tries to give a synoptic overview of the nosology of this (still) largely almost unknown helminthozoonosis, moreover it summarizes the most important epidemiologic parameters, and presents the diagnostic and therapeutic possibilities available today.

Compared to health services in other countries in the world, the Austrian health care system works relatively well. At the moment it is shaped and dominated by various structures, decision makers and financial backers, which means that it does not work as well as it could under ideal circumstances. The government now wants to develop a national health care plan which, in a concerted action by all those involved in the health service, shall guarantee superior medical care while at the same time taking into account economic aspects. This paper takes a critical look at the idea of an Austrian health care plan from a clinical point of view.

Breast cancer is the most frequent type of cancer in women. The therapeutic approaches to breast cancer have developed rapidly over the past 20 years, due to the increasing knowledge about the biology of breast cancer. Therefore it was possible to increase response rates as well as the duration of response and survival in neoadjuvant, adjuvant, and palliative treatment. This paper gives a review of the current breast cancer trials. Effective new cytotoxic chemotherapy and hormonal therapy agents, as well as the identification of specific molecular abnormalities (HER2/neu) led to the development of targeted therapeutic interventions in the neoadjuvant, adjuvant, and palliative treatment of breast cancer. Increased understanding of the biology of breast cancer led to the development of rational therapeutic interventions, which are currently under active clinical development.

Even though there is no convincing evidence that eating disorders in general are on the rise, there has been an enormous increase in "treated" cases of patients with eating disorders. This review will cover important aspects of diagnosis and treatment of eating disorders. Psychotherapeutical and pharmacological treatment strategies in anorexia and bulimia nervosa will be discussed. For both eating disorders, psychotherapy is the treatment of choice. Drugs with a serotonergic function, e.g. serotonin-reuptake-inhibitors (SSRI), have demonstrated significant results in the treatment of bulimia nervosa and eating disorders with comorbid depression. In clinical practice "treatment packages" are offered because of the complexity of the disorders. The paper also deals with medical complications of eating disorders, motivational interviewing in anorexia nervosa and treatment with self-help manuals in bulimia nervosa.

The rapidly growing interest in sports climbing in recent years among young climbers raises the question about the risk of injuries and overstrain syndromes in this group. This paper investigates injuries and overstrain syndromes of 99 adolescent climbers aged between 8 and 19 years. The authors interviewed climbers from Austria, Germany and Switzerland. Besides the type and pattern of injuries and overstrain syndromes, the level and duration of climbing, intensity of training and gender were recorded as potential risk factors. 47 climbers were asked about setting up fingers on small holds, which is considered a main reason for epiphyseal injuries of fingers in the literature. Injuries and overstrain syndromes, as well as their frequency and pattern are reported and classified. Descriptive data analysis and statistical models are used to assess the influence of risk factors. Among the potential risk factors only the climbing level has a significant influence on the risk of injuries and overstrain syndromes (p = 0.0427). Furthermore the risk of injuries and overstrain syndromes in the area of the fingers is significantly higher for climbers who reported setting up fingers on small holds (OR = 8.24, p = 0.0022). Finally we found a higher frequency of injuries and overstrain syndromes in lower extremities (43% of all injury and overstrain occurrences) and a lower frequency of injuries and overstrain syndromes in general (43% of all the climbers under investigation) compared to other studies. As a result special guidelines for training and competition are given. In order to increase the accuracy of the reports and to investigate long-term effects we recommend a study with clinical assessment and a longer period of observation.

The article summarizes the first results of an attempt to reconstruct the destinies of the Jewish pediatricians of Vienna after the German occupation of Austria in March 1938. Traditionally pediatrics in Vienna were characterized by a high percentage of Jewish specialists. In 1938 they were confronted with abrupt humiliations and persecutions by the sudden introduction of the Nazi racial laws. The paper describes the foregoing, developments in Germany since 1933 and analyses the fates of 96 pediatric specialists of Vienna, who were affected by these events.

Forty years of epidemiological research have shown that physical activity as well as physical fitness are inversely related to cardiovascular and all-cause mortality in men and women. This association is likely to be causal. The moderate and most active or fit individuals experience mortality rates that are approximately one-third to one half lower than the rates among those least active or fit. Furthermore, moderate or high levels of physical activity or cardiorespiratory fitness seem to protect against the influence of other potential predictors on mortality. There appears to be a dose-response curve. The greatest benefit is registered when the least active become moderately active or fit. In western societies the prevalence of physical inactivity has been found to be as high as 40%. Exercise guidelines, as traditionally prescribed for disease prevention and improvement of aerobic capacity, unfortunately have failed to enhance the level of physical activity. Currently, exercise training is being extended to include broader physical activity. This new paradigm emphasizes the potential effectiveness of moderately intense activities of daily life (lifestyle activity) for achieving health benefit, and aims at improving levels of general energy expenditure throughout the day. This paper analyses the actual epidemiological evidence for these new recommendations and discusses approaches at different levels of physical activity intervention including individual, community, organisational, environmental and policy-level strategies to increase the activity levels of inactive population groups as well as across the population as a whole.

Primary osteoporosis is common, with significant sociomedical consequences. This paper studies the prevalence of risk factors and risk behavior for osteoporosis in women of four different occupational groups: housewives, blue collar workers, white collar workers/civil servants and farmers. We analyzed risk factors and risk behavior associated with osteoporosis in the scientific literature. The sample comprises 9,939 women. The data set is based on a health survey conducted in 79 selected rural communities of Styria (Austria) between 1989 and 1993. Sociodemographic data, lifestyle, health complaints, chronic conditions and utilization of preventive and treatment services were surveyed by means of standardized personal interviews. The results show that the women of the four occupational groups were subjected to very different stresses. White collar workers/civil servants had the lowest risk with regard to osteoporosis. Our results suggest that efficient intervention programs to prevent osteoporosis need to specifically focus on the different social life styles of women.

The introduction of thrombolysis has reduced the mortality of acute myocardial infarction (MI) by 25%. Large-scale studies have revealed that especially patients over 65 benefit from this therapy. Nevertheless, many centers apply an age limit for thrombolytic therapy due to the higher risk of stroke or bleeding in elderly patients. In 1993 181 patients suffering from acute MI were admitted to the intensive care unit of the University Clinic of Internal Medicine, Graz, and 54 (29.4%) of them were treated with fibrinolytic drugs. In this paper we report on the successful thrombolytic management of acute MI in two male patients (87 and 88 years old) who were treated with 100 mg recombinant tissue-type plasminogen activator complex. As a sign of successful reperfusion a rapid increase in plasma creatinine kinase levels and fast amelioration of the ischemia-related ECG changes were observed. In the follow-up examination after four months the first patients showed only minimal exertional dyspnea and was otherwise well. The second patient died one month after MI following a laparotomy for ileus. We draw the conclusion that patients of advanced age also benefit from thrombolytic treatment of acute myocardial infarction, but the indications and contraindications have to be carefully observed.

This paper reviews the mechanisms leading to the commencement of labor in the presence of intrauterine infection. It is postulated that induction of preterm contractions represents an escape mechanism of the fetus from a hostile environment. Bacterial toxins provoke an immunological response (macrophages) of the fetomaternal compartment. Liberation of cytokines (IL-1, IL-6, IL-8) stimulates prostanoid synthesis in the decidua and amnion, as well as migration of granulocytes into the cervix. Additional still unknown factors may determine whether this process leads to cervical dilatation, effacement and finally preterm delivery. The role is discussed of other cytokines, i.e., colony-stimulating factors, transforming growth factor beta, and interleukin receptor antagonists as potential, clinically useful tocolytics in this labile equilibrium.

Gastric epithelioid leiomyosarcoma (epLMS), which generally occurs in mid- or late adult life, is a rare smooth muscle tumor of the stomach. Out of 25 soft tissue tumors of the stomach operated at the Department of Surgery, University of Graz, two epLMS were diagnosed. This paper presents the case of a 67-year-old male with an epLMS in the corpus and of a 80-year-old female with an epLMS in the fundus of the stomach. The tumors were not diagnosed by gastroscopy; they were localized by sonography and CT-scan. In both cases the tumor was completely removed surgically, using a TA 90 4.8 mm respectively a TA 55 4.8 mm stapler. Diagnosis was reached by histological and immunohistochemical examination of the tumor tissue. Surgical excision with wide tumor-free resection margins is the therapy of choice in this tumor group.

This paper describes the development of a new instrument for measurement of craving in alcohol dependent patients. Craving is measured by self-statements. 146 alcoholics were examined. The results show that craving depends on situational factors, varying with the time of day and place. The severity of craving 30 days before inpatient treatment is shown. Four empirically substantiated subscales of psychological craving are presented. In the discussion the quality of the new questionnaire is assessed and connections to research on relapse are established. Finally, the importance of coping with craving in the prevention of relapse is pointed out.

To date, investigators have relied on hysterosalpingography, hysterosalpingoscintigraphy, and laparoscopic chromopertubation for the diagnosis of tubal disease causing infertility. With the development of the "linear everting catheter" system it may now be possible to evaluate the tubal lumen and to diagnose changes in the tubal wall or the tubal mucosa by direct visualization. This paper describes our initial clinical experience with 14 women who underwent evaluation for infertility. The new catheter system allowed both inspection of the tubal ostium without cervical dilation or concomitant hysteroscopy and virtually atraumatic access to the tube by means of an endoscope measuring half a millimeter in diameter and a magnification of 40. Given adequate experience with this technique it may also be performed in an outpatient setting. Ultimately, tuboscopy may come to play a major part in the diagnosis of sterility. Other potential applications of this new technology are the tubal transfer of embryos, intratubal insemination and the conservative treatment of tubal pregnancy.

This paper presents personal experience of 169 percutaneous transluminal angioplasties (PTA) and more than 1,000 worldwide published results of angioplasty on supraaortic stenoses especially of the carotid artery. The technique of the angioplastic procedure, essential pretherapeutic diagnostic methods and indications of PTA are described and discussed. Results of published and own experience indicate that PTA is an effective and alternative method to vascular surgery in the treatment of symptomatic carotid artery stenoses. With strict definition of the indication, the complication rate for PTA is not likely to be higher than that for vascular surgical treatment. PTA of carotid artery stenosis should be used exclusively in medical centers in which a cooperation by vascular surgeons, internists, neurologists and interventional radiologists or neuroradiologists comes true.

This paper presents the results of a combined endoscopic-surgical approach with management of acute biliary pancreatitis in 91 patients. The diagnosis was always made by means of endoscopic-retrograde cholangiography. Papillary or bile duct stones, or unmistakable signs of previous stone passage, and in exceptional cases flow obstruction due to preiampullary diverticuli were considered criteria for a positive diagnosis. All 91 patients were subjected to endoscopic sphincterotomy with/without stone extraction subsequent to the diagnostic cholangiogram. Endoscopic intervention was performed as soon as possible after admission to hospital, but by 48 hours at the latest. Cholecystectomy was carried out in all patients who were free of risk factors and without previous cholecystectomy, during the disease-free interval. The complication rate of this combined endoscopic-surgical approach amounted to 10.9%; the mortality rate was 3.3%. The achieved results suggest that endoscopic sphincterotomy with stone extraction in the acute phase of biliary pancreatitis is the method of choice in order to interrupt the process of this disease. In combination with the final surgical treatment of gallstone disease by cholecystectomy to avoid recurrences, the prognosis of acute biliary pancreatitis can be significantly improved by using this combined endoscopic-surgical management.

A survey was performed in 1989 by the Institute of Social Medicine and the Austrian Workers Compensation Board(AUVA) to investigated the alcohol problem in 277 factories in which the workers were exposed to hot and dusty atmospheres. As a result of the findings, a further study was undertaken by the same research team to investigate one possible solution to the problem of alcohol consumption at work in a paper-producing factory, predominantly under hot and dusty conditions. The study was well prepared by many activities in the field of health promotion. In this trial, an electrolyte drink especially suited for heat-burdened work places, was introduced for three months as alternative drink to alcohol. Before and after this period the employees answered a questionnaire regarding their alcohol consumption and any changes in consumption habits. One of the main results of the study was the significant increase in electrolyte drink consumption and decrease in wine consumption although that of beer remained practically unchanged. The offered electrolyte drink was accepted as alternative drink by many workers and represents a practical example of health promotion at the place of work. This study should encourage other factories and businesses to experiment with electrolyte drinks especially suited to their particular conditions in an attempt to overcome the problem of alcohol consumption during working hours.

Some papers report that the effect of heparin-mediated extracorporeal LDL less than cholesterol, LP(a), triglycerides, fibrinogen greater than precipitation (H.E.L.P.) in cardiovascular disease may results from an influence on the above-mentioned parameters. Hence, this method has been applied in multi-infarct dementia (MID), where fibrinogen, whole blood and plasma viscosity and red cell transit time (RCTT) are increased. The selection of patients was based on DMS-3, on NINCDS/ADRDA criteria and on the Hachinski Ischemic Stroke Scale. All the patients (n = 14) were examined magnet resonance imaging. Fibrinogen, cholesterol, LDL-cholesterol, HDL-cholesterol, LP(a), RCTT and plasma and whole blood viscosity were determined prior to, and after each two H.E.L.P. procedures. Fibrinogen was lowered (in a comparison of the data prior to the first and following the second plasmapheresis) from 526.4 +/- 114 to 314.1 +/- 80.1 mg/dl (p less than 0.01), cholesterol from 210.8 +/- 76.8 to 131.3 +/- 38.2 mg/dl (p less than 0.01), LDL from 125 +/- 53 mg/dl to 63.6 +/- 25.7 mg/dl (p less than 0.01), LP(a) from 26.2 +/- 13.2 to 12.0 +/- 9.5 mg/dl (p less than 0.01), HDL from 31.7 +/- 6.3 to 29.7 +/- 5.6 mg/dl (no significance), RCTT from 14.4 +/- 2.8 to 10.9 +/- 0.9 (p less than 0.01), whole blood viscosity (low shear rate) from 11.64 +/- 1.7 to 8.74 +/- 1.4 mPa/sec (p less than 0.01) and (high shear rate) from 5.38 +/- 0.58 to 4.28 +/- 0.83 mPa/sec (p less than 0.01). Plasma viscosity decreased from 1.51 +/- 0.12 mPa/sec to 1.25 +/- 0.1 mPa/sec (p less than 0.05). In cases of MID the implementation of H.E.L.P. therefore enabled an alteration of the hemorheological profile which has so far not been achieved by any hemorheologically active substance to a comparable degree and in comparable time.

This paper presents a new method for measuring intracranial pressure (ICP), which is completely non-invasive by using an isolated "headband electrode". The head itself - as a dielectric--forms a capacitor. A high frequency alternating voltage field is applied to this system (1-1.5 MHz) whereby a measuring signal is obtained which depends on the dielectric properties of the head. These, in turn, primarily depend on the filling status of the intracranial space. In addition, a pulse wave can be plotted as a result of cardiac and respiratory cycles. This combined information permits the calculation of actual ICP values with the help of a simple Basic PC programme. The measuring system was tested in 20 patients with intracranial space-occupying lesions. Their ICP values were known from invasive measurement and the obtained correlation was R = 0.983.

The successful cloning of the von Willebrand (vW) gene in 1985 and the production of gene probes stimulated a number of molecular genetic patient studies. It turned out that even in the case of patients with severe vW syndrome gross delections were only rarely found. We could not identify a deletion in the eight severe vW patients studied. Thus, at the moment it is not possible to directly demonstrate the genetic defect in vW patients. However, a number of restriction fragment length polymorphisms (RFLPs) within the vW gene were identified. They cosegregate with the gene and can be used for segregation analysis of the disease. These RFLPs should help to achieve better diagnosis of the vW syndrome in the future. This paper shows the data obtained in two families. They demonstrate the usefulness of RFLP analysis for diagnosis of carriers of the vW syndrome.

According to the literature and on the basis of the case reported in this paper of rhinocerebral mucoraceae mycosis we summarize the characteristic features as follows: mucoraceae--mycoses--common, but wrong term: "mucormycoses"--are a group of infections caused by members of the family mucoraceae (Mucor, Rhizomucor, Rhizopus, Absidia species)--most frequently by Rhizopus species. Primarily the fungi enter the pharynx or nose, local infections or trauma being a prerequisite. The most important predisposing factor is diabetes mellitus. Invading the tissue and causing vascular thrombosis the infection frequently takes an acute, often fulminating and fatal course. Acute sinusitis accompanied by swelling of the cheek and protrusion of the eye in a diabetic, particularly with acidosis, are pathognomonic. Diagnosis is confirmed by microscopic examination of infected tissue (unstained smear or histologically). Since systemically administered antifungals have not proved very effective in these myoses, mainly because an adequate tissue level can hardly be achieved, the most effective and curative treatment is surgical removal of infected tissue, simultaneous control of diabetes being mandatory.

Freedom and compulsion are burning questions in psychiatry, and often unsatisfactorily resolved. In this paper general aspects are discussed in the light of data obtained at the Innsbruck University Department of Psychiatry and the Mental State Hospital of Hall in Tyrol. From 1976 to 1986 364 (1.99%) patients required compulsory admission following certification by police (or civil service) doctors out of 18,207 admissions to the University Department of Psychiatry over this 11-year period. Of these patients 90 had to be jugded by a court commission with regard to further compulsory hospitalization. Most frequent reasons for compulsory admission were alcohol-related psychiatric diseases in men and endogenous psychoses in women. The data collected at the University Department are compared with the situation in the Mental State Hospital of Hall in Tyrol. Results are discussed in the light of recent literature.

This paper addresses the problems which have arisen in connection with the improved intensive care of neonates and the possibility of prenatal diagnosis and therapy. Medical problems consist of difficulties in determining the indications. Ethical problems result from the right of decision of the pregnant woman, of her family and of the society beyond the normal physician-patient relationship and there are expert and legal questions, too. A more public evaluation of the patient material may lead to solution of the problems. Ethical and legal principles can be derived from these basic considerations. No new morals and ethics must evolve even if damage to the fetus or malformations can now be recognized antenatally instead of only postnatally as before. Malformations incompatible with life are indications for termination if the pregnant woman so desires. Every other type of malformation is something which the pregnant woman, her family and society must come to terms with. Prenatal medicine is able to soften the consequent burdens for the family and society.

Acute, febrile, neutrophilic dermatosis (Sweeet's syndrome) is an uncommon, distinct disease of unknown origin. It is characterized by typical skin lesions and systemic symptoms such as fever and leucocytosis. Ultrastructural data suggest a primary vascular process as the initial pathogenic mechanism. In this paper two patients are described and the clinical variability, incidence and pathogenesis of this syndrome are discussed.

In cases of rapidly increasing androgenism, virilism and androgenetic cycle disturbances it is essential to exclude the presence of an androgen-producing tumour. Serum levels of testosterone above 1.5 ng/ml and dehydroepiandrosterone sulphate values above 6700 ng/ml are suggestive of tumour. Functional tests, laparoscopy and imaging modalities are often less efficient. Selective vein catheterisation enables the diagnosis and localisation of such hormone-producing neoplasms (Kirschner and Jacobs, 1971). This paper presents the case report of the diagnosis of a Leyding cell tumour of the right ovary by means of selective vein catheterisation. The tumour was not palpable and had not been detected on laparoscopy. The procedure is extensively described and discussed.

Between 1/7/1974 and 30/6/1979 we analysed 532 amniotic fluid cell cultures. In 402 cases a genetic indication for amniocentesis was given; 57 prenatal diagnoses were carried out for gynaecological and other medical indications. We also analysed 73 amniotic fluid test samples. Altogether 19 pathological results (3.6%) were found. We observed 16 abnormal findings in 459 diagnostic amniocenteses and 3 pathological results in the test cultures. The transmission of parental chromosomal polymorphisms to the fetus is discussed here. The importance of prenatal diagnosis in genetic counselling, along with cost-benefit reflections, are stressed in this paper.

This paper reports the findings in 22 primigravidae in whom Caesarian section was performed because of impaction of the head in mid-pelvis. 100 women who had normal deliveries served as controls. The routinely-determined external measurements of the pelvis were within the normal range in all women, whereas the distances between symphysis and the 3rd or 5th sacral vertebra were reduced in comparison with the conjugata externa in patients requiring Caesarian section. For an exact diagnosis ultrasound and X-ray pelvimetry was performed post sectionem. A reduced distance between the symphysis and the 3rd or 5th sacral vertebra was ascertained by both methods. Hence, a channel pelvis might be the main reason in these women for standstill in labour. The ultrasound and X-ray pelvimetry results were comparable.

This paper reviews the technique of nuclear placental flow-rate determination developed in 3 stages at the I. Department of Obstetrics and Gynaecology, University of Vienna. It particularly highlights the diagnostic potential of the most recent development, which is based on iterative regression, by quoting pertinent figures. In 153 females with type I flow-rate patterns the diagnosis proved to be correct in 82.2% of cases. 26 patients had pathological flow-rate patterns and 20 of the infants born to this group of mothers had moderate to severe dystrophy due to reduced placental function. The placental perfusion test, another recent development, is of particular significance in differentiating between the causes underlying reduced placental blood flow. These two techniques have internationally conquered a firm position in the battery of placental perfusion studies designed to assist in the diagnosis and treatment of placental insufficiency.

Microtia is a rare malformation. Reconstruction of microtia is not a routine operation because of its rarity of occurrence and the complex deformity. In this paper the indication for surgical treatment, technique, results and complications are discussed. Two different operation methods were used in our patients. A multiple-stage and a single-stage reconstruction procedure. We used autogenous rib cartilage. Five of the seven treated patients came to the follow-up examination. Reconstruction was performed 2 years ago in two cases and between 4 and 12 years ago in three cases. Our patients were content with the result in so far as they would be prepared to undergo treatment again. Carefully built rib framework is an essential prerequisite for a successful postoperative result. Microtia represents a greater psychological problem than a cosmetically imperfect result after reconstruction.

This paper concerns the treatment schedules employed and their outcome in 90 pregnancies in women with insulin-dependent clinical diabetes between 1962 and 1977. During the period 1962 to 1970, during which time diabetic control was still mostly carried out externally, the perinatal mortality rate (pnm) was 23.8%. As from 1971 the patients were put under control by the clinic as soon as possible on an interdisciplinary basis and the pnm dropped to 4.1%. The case history of these patients revealed that the pnm in previous pregnancies supervized elsewhere was 65%. No correlation was found between the pnm and the severity and duration of diabetes according to White's classification. Rigorous metabolic control is essential for an improvment in the pnm. This involves striving for mean blood glucose levels of under 100 mg% during the last trimester. Fetal weight gain above normal levels was sometimes detected by ultrasonic methods in spite of satisfactory metabolic regulation. The daily intake of carbohydrates should be reduced in these cases from 150-200 g to 100 g. Other important aspects include treatment of frequently-occurring complications (toxaemia, urinary infection, etc.), as well as measures to lower the rate of premature birth. The date of delivery was flexible and dependent on the response to metabolic control and the appearance of critical situations. On average, delivery took place at the end of the 38th week of gestation.

This paper first reviews the relatively abundant literature on crystallization phenomena in human secretions, then our experiments, aimed at artificial imitation, are discussed. Threadlike crystals appear when the inorganic share of the solution shows 530mg% NaCl and 70mg% KCl and the organic one either 34mg% hyaluronic acid or 200 to 500mg% glucose. By overstepping the concentration limit of glucose or human albumin, crystallization can be prevented. The prevention of crystallization by proteins might gain some significance in diagnostic cytology as a primitive method to analyse colloid semiquantitatively.

This paper presents the case report of a 2 year-old boy in whom a grade II fetal alcohol syndrome was diagnosed at 17 months. At 21 months, an embryonal rhabdomyosarcoma of the urinary bladder trigone was found, and the tumour excised. Polychemotherapy was initiated, but bone-marrow depression and death in septicaemic shock followed. The main autopsy findings included the demonstration of tumour remnants in the urinary bladder and prostate, and a severe acute purulent pyelonephritis. This is the fifth case of fetal alcohol syndrome in conjunction with a malignant tumour to be reported in the international literature. These cases do not show any uniformity as to tumour type. No conclusion can as yet be drawn as to whether there is a pathogenetic connection between the fetal alcohol syndrome and the occurrence of malignant tumours (as is the case with the fetal hydantoin syndrome and neuroblastoma), or whether these findings are purely coincidental. Clinicians and pathologists should, however, be advised to look more closely for even minimally pronounced forms of the fetal alcohol syndrome in children with embryonic tumours.

Brief mention is made of previous attempts at the formation of an artificial vagina after Wertheim's operation with amnion and freely-transplanted omentum, which did not, however, yield good long-term results. This paper deals with a technique of artificial vaginal reconstruction by means of a stalked segment of the sigma, immediately after completion of the Wertheim procedure, as described and recommended by Novak, Ljubjana. Six women aged from 30 to 33 years have been operated on by this procedure. A follow-up examination one year after the operation revealed an excellent result, because all patients had normal intercourse without any difficulty. Hence this technique of operation is recommended in young women with cancer of the cervix.

The answer to the question which we are frequently asked as to whether there is a "good" cholesterol is most probably negative. There seems to be little doubt about the fact that a high serum level of cholesterol, irrespective of whether it is transported by HDL or LDL is undesirable. However, prospective studies have clearly shown that the risk of atherosclerosis is inversely proportional, at a given serum cholesterol concentration, to the HDL-transported fraction. On the other hand it must be borne in mind that HDL represent a very heterogeneous mixture of lipoprotein classes and families and generalizations should be avoided. Lp(a), for example, which is mostly found in the HDL density class may, even, represent an independent risk factor for atherosclerosis and vascular diseases. Thus, the present paper attempts to review current concepts of HDL structure, chemical and immunochemical composition and metabolism. Furthermore, factors are listed which are known to influence the serum HDL concentration. Finally, the most widely used methods for analysis and determination of HDL, alpha lipoprotein and LpA are listed and mean values obtained in our laboratory are given.

This paper reports two cases of neurosarcoidosis . Initially the clinical picture involved only the nervous system. Later on manifestations pertaining to other systems were detected by interdisciplinary investigations. The resulting diagnostic problems, the value of additional investigations and the therapeutic management are discussed on the basis of the two presented cases.

This paper presents four unusual variants of blue naevus: a giant-sized blue naevus, a blue naevus assuming the clinical and histological appearance of a histiocytoma, a plaque-type blue naevus, and a pedunculated cellular blue naevus. Two of these lesions were studied at the ultrastructural level: in one case the dermal melanocytes contained malanosomes of all stages, thus documenting active melanin synthesis. In the other lesion, melanocytes of identical appearance were found in the superficial portions, whereas inactive melanocytes, densely packed with mature melanosomes, predominated in the deeper portions. It is concluded that blue naevi may vary considerably, both clinically and in histological appearance, as well as in regard to melanin synthesis activity.

This paper--by reviewing the relevant medical literature--investigates whether at all and under which circumstances ultrasonic screening in pregnancy can be an efficient and cost-effective health policy measure. The author looks into the question of long-term side effects, as well as the effectiveness of screening for the assessment of intra-uterine growth retardation, the gestational age and congenital malformations. Cost-effectiveness of routine screening for all pregnant women is also discussed. The author concludes that screening should only be carried out in selected groups of patients, according to strict criteria of indication. On the basis of current knowledge screening for all pregnant women is neither an efficient nor a cost-effective health policy measure.

Breast cancer is the most common cause of cancer death in women. The probability of being cured of this disease is below 50%. However, for certain stages of disease prognosis can be improved by the application of modern therapeutic strategies. The present paper deals firstly with the relationship between prognosis, staging, and tumour cell characteristics (receptor status and cell kinetic findings). Thereafter, selection and efficacy of cytotoxic chemotherapy and endocrine treatment is discussed and related to the prognostic different entities. The current therapeutic regimen of our group is outlined.

This paper presents the case report of a woman with a third Fallopian tube, a rarity in the world literature. The occurrence was confirmed by X-ray (hysterosalpingography) and histological examination of the adnexae after hysterectomy 10 years later.

The infiltration of the ureters, bladder or urethra by recurrent colorectal carcinoma raises both urodynamic and surgical problems. These include the question of whether reconstruction or urinary diversion is indicated. The present paper describes the surgical procedures carried out in 19 patients with tumour extention of recurrent colorectal carcinoma to the urinary tract. In the majority of cases the treatment of choice can be decided only intraoperatively. It is important to choose the procedure which guarantees both surgical radicality and minimal discomfort to the patient.

The nasal resistance and the temperature were measured in both nasal lumina immediately before and 20 minutes after an allergological skin test in 75 patients admitted to the allergy ward because of suspected allergic rhinitis. The measurements were carried out by means of a passive anterior rhinomanometer according to van Dishoeck and the results served as parameters of the reaction of the nasal mucous membrane. In order to secure the allergy diagnosis, the skin tests were supplemented by a carefully taken case history as well as by RIST and RAST. The 100 skin test series carried out in this investigation showed an increase in the resistance and in the temperature in most of those patients whose positive skin test result corresponded to the final diagnosis. These reactions were most pronounced in the screening tests, and were also confirmed by the herb, tree and mould tests. Furthermore, the temperature in the nasal lumen increased sooner than the resistance. Thereby it was possible to prove that in allergological skin tests the shock organ, i.e. the nasal mucous membrane in the cases discussed in this paper, shows a marked concomitant reaction if there is a manifest allergy to the allergens used in the test.

Symphalangism is the partial or complete bony fusion of phalanges in the fingers and toes due to an autosomal dominant gene, with inherited failure of development of one or more interphalangeal joints. Two patients--a newborn baby and his mother--both revealing this rare malformation, are presented in this paper and the clinical and radiological features are described and discussed.

A 10-year-old girl suffering from post-hepatitic aplastic anaemia received 21 x 10(10) (5 x 10(8)/kg body weight) nucleated cells from her brother, whose HLA typing, but not his blood group, was identical with the patient's. Conditioning had been carried out with cyclophosphamide according to the Seattle protocol (50 mg/kg body weight on four successive days). On day 9 she showed signs of early engraftment by the appearance of granulocytes and their precursor cells in the peripheral blood. The new blood group of the patient's erythrocytes and the male karyotype of her leucocytes demonstrate successful engraftment. The child is now in excellent health 18 months after transplantation and requires no treatment of any kind. This paper reports the first bone-marrow transplantation in Austria.

This paper reports the occurrence (10 occasions) of fragmentation of the guide-spiral during catheterization of the superior vena cava in 9 patients according to the Seldinger method. Reasons for this severe complication are faults in the material, technical inadequacy or lack of supervision. Such complications are dangerous for the patient and have a high mortality. Better results can only be achieved by early diagnosis and--if possible--removal of the foreign body.