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The number of high-risk patients undergoing surgery is steadily increasing. In order to maintain and, if necessary, optimize perioperative hemodynamics as well as the oxygen supply to the organs (DOTo present a stepwise algorithm for a perioperative echocardiography-based hemodynamic optimization in noncardiac surgery high-risk patients. In this context, echocardiography on demand according to international guidelines can be performed under certain conditions (hemodynamic instability, nonresponse to hemodynamic treatment) as well as in the context of a planned intraoperative procedure, mostly as a transesophageal echocardiography.Hemodynamically focused echocardiography as a rapidly available bedside method, enables the timely diagnosis and assessment of cardiac filling obstructions, volume status and volume response, right and left heart function, and the function of the heart valves.Integrating all echocardiographic findings in a differentiated assessment of the patient's cardiovascular function enables a (patho)physiologically oriented and individualized hemodynamic treatment.HINTERGRUND: Die Zahl der kardiovaskulären Hochrisikopatienten, die sich einer Operation unterziehen, nimmt stetig zu. Um bei dieser Patientenpopulation die perioperative Hämodynamik sowie das Sauerstoffangebot an die Organe (DOIm Folgenden wird ein schrittweiser Algorithmus für eine perioperative echokardiographiebasierte hämodynamische Optimierung bei nichtherzchirurgischen Hochrisikopatienten dargestellt. Dabei kann sowohl eine Echokardiographie „bei Bedarf“ entsprechend den internationalen Leitlinien unter bestimmten Bedingungen, wie z. B. hämodynamischer Instabilität, Nichtansprechen einer hämodynamischen Therapie, erfolgen, als auch im Rahmen einer geplanten intraoperativen Anwendung – meist als transösophageale Echokardiographie.Die hämodynamisch fokussierte Echokardiographie erlaubt als bettseitige, schnell verfügbare Methode die Diagnose und Beurteilung von kardialen Füllungsbehinderungen, des Volumenstatus und der Volumenreagibilität, der Rechts- und Linksherzfunktion sowie der Klappenfunktion.In Zusammenschau aller echokardiographischen Befunde sind eine differenzierte Beurteilung der kardiovaskulären Funktion des Patienten und somit eine (patho)physiologisch orientierte und individualisierte hämodynamische Therapie möglich.

Österreichische Zeitschrift für Geschichtswissenschaften, Bd. 29 Nr. 3 (2018): Biographien und Migrationen / Biographies and Migrations

In der Schrittmacher- und ICD-Therapie wird die Vorhofelektrode meist im rechten Vorhofohr („right atrial appendage“, RAA) implantiert. Dies ist zwar einfach, birgt jedoch das Risiko negativer hamodynamischer und elektrophysiologischer Effekte. Atriale Erregungsausbreitung, atriale Kontraktion und atrioventrikulare Uberleitung konnen durch RAA-Stimulation verzogert und desynchronisiert werden. Dies kann zu Vorhofflimmern, einem stimulationsinduzierten langen AV-Block I°, unnotiger rechtsventrikularer Stimulation und Entwicklung einer Herzinsuffizienz fuhren. Eine hochseptale Stimulation nahe dem Vorhofdach, auf dem das Bachmann’sche Bundel verlauft, kann die negativen Folgen einer atrialen Stimulation aus dem Vorhofohr vermeiden und die atriale Erregung synchronisieren, wie die Verkurzung von PQ-Zeit und P‑Wellen-Dauer unter Bachmann-Bundel-Stimulation nahelegt. Einige Techniken zur Implantation atrialer Elektroden am Bachmann-Bundel werden hier vorgestellt, die abgesehen von einer Durchleuchtung in linksanterior obliquer Projektion im Vergleich zur RAA-Stimulation keinen zusatzlichen Implantationsaufwand benotigen. Klinische Studien zur hochseptalen und speziell zur Bachmann-Bundel-Stimulation sind rar. Eigene Daten zeigen einen positiven Effekt bei Patienten mit Sick-Sinus-Syndrom und paroxysmalem Vorhofflimmern, die mindestens 50 % der Zeit atrial stimuliert werden. Die Bachmann-Bundel-Stimulation stellt eine interessante und einfache Option zur optimierten Vorhofstimulation dar. Es ware wunschenswert, wenn diese Technik zur atrialen Elektrodenpositionierung weitere Verbreitung erfahren und zusatzliche Daten uber den klinischen Nutzen generiert wurden.

Recently, epidemiological data shows an increase of childhood tuberculosis in Germany. In addition to this, drug resistant tuberculosis becomes more frequent. Therefore, diagnosis, prevention and therapy in childhood and adolescence remain a challenge. Adult guidelines do not work for children, as there are age specific differences in manifestation, risk of progression and diagnostic as well as therapeutic pathways.The German Society for Pediatric Infectious Diseases (DGPI) has initiated a consensus-based (S2k) process and completed a paediatric guideline in order to improve and standardize care for children and adolescents with tuberculosis exposure, infection or disease.Updated dosage recommendations take age dependant pharmacokinetics in the treatment of drug sensitive but also drug resistant tuberculosis in account. In addition to this, there is a detailed chapter on perinatal exposure and disease as well as extrapulmonary manifestations.Aktuelle epidemiologische Daten zeigen in den letzten Jahren einen Anstieg der Tuberkulose im Kindes- und Jugendalter. Es findet sich zudem auch in Deutschland ein Anstieg von Infektionen mit gegenüber Tuberkulosemedikamenten resistenten Erregern. In diesem Zusammenhang stellt die Diagnose, Prävention und Therapie der Tuberkulose vor allem im Kindesalter eine Herausforderung dar.Leitlinien für die Diagnostik und Therapie der Tuberkulose im Erwachsenenalter können nicht generell auf das Kindesalter übertragen werden, da hier relevante altersabhängige Unterschiede bzgl. der Krankheitsprogression, Krankheitsmanifestation, Unterschiede in der Anwendung von diagnostischen Maßnahmen und der Therapie bestehen.Unter Federführung der Deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI) e. V. wurde die S2k-Leitlinie für die Diagnostik, Prävention und Therapie der Tuberkulose im Kindes- und Jugendalter verfasst, um die adäquate Versorgung von Kindern und Jugendlichen mit Tuberkulose-Exposition, Infektion oder Erkrankung nach neuesten wissenschaftlichen Erkenntnissen zu sichern.Aktualisierte Dosierungsempfehlungen berücksichtigen die altersabhängige Pharmakokinetik in der Therapie der medikamentensensiblen, aber auch resistenten Tuberkulose. Darüber hinaus werden die Themen perinatale Exposition und Erkrankung sowie die im Kindesalter häufigeren extrapulmonalen Manifestationsformen gesondert behandelt.

Hartmetalle zeichnen sich durch ein einzigartiges Eigenschaftsbild aus. Sie besitzen eine hohe Härte bei einer guten Bruchzähigkeit und kommen wegen ihrer Eigenschaften oft bei Schneid- und Formgebungsanwendungen zum Einsatz. Additive Fertigungsverfahren wie das 3D-Binder-Jetting können helfen, deren Herstellung kostengünstiger zu gestalten.

PURPOSE: To evaluate the volume and changes of human brown adipose tissue (BAT) in vivo following exposure to cold using magnetic resonance imaging (MRI). MATERIALS AND METHODS: The clavicular region of 10 healthy volunteers was examined with a 3T MRI system. One volunteer participated twice. A cooling vest that was circulated with temperature-controlled water was used to expose each volunteer to a cold environment. Three different water temperature phases were employed: baseline (23°C, 20 min), cooling (12°C, 90 min), and a final warming phase (37°C, 30 min). Temperatures of the water in the circuit, of the body, and at the back skin of the volunteers were monitored with fiberoptic temperature probes. Applying the 2-point DIXON pulse sequence every 5 minutes, fat fraction (FF) maps were determined and evaluated over time to distinguish between brown and white adipose tissue. RESULTS: Temperature measurements showed a decrease of 3.8 ± 1.0°C of the back skin temperature, while the body temperature stayed constant at 37.2 ± 0.9°C. Focusing on the two interscapular BAT depots, a mean FF decrease of -2.9 ± 2.0%/h (P < 0.001) was detected during cold stimulation in a mean absolute volume of 1.31 ± 1.43 ml. Also, a correlation of FF decrease to back skin temperature decrease was observed in all volunteers (correlation coefficients: r  = [0.51; 0.99]). CONCLUSION: We found that FF decreases in BAT begin immediately with mild cooling of the body and continue during long-time cooling.

Some studies revealed that psychiatrists have more negative attitudes than psychologists towards patients with schizophrenia. This raises the question of whether different models of the aetiology of schizophrenia and the amount of personal contact influence the attitudes of mental health professionals.Explicit and implicit attitudes towards schizophrenia were assessed in medical and psychology students (n=60 and n=61, respectively) as well as their familiarity with the disorder and their subjective models of its aetiology.Medical and psychology students showed a substantial level of negative attitudes. Personal contact was negatively associated with stereotypes among medical students and positively associated among psychology students. Positive attitudes were related to biogenetic causal beliefs among medical students and to psychosocial causal beliefs among psychology students.The results emphasise the need to adapt antistigma campaigns to target groups. They also indicate the superiority of a multidimensional aetiology over monocausal aetiological models in reducing stigma.

Venous leg ulcers (ulcera crurum venosa) are frequently seen in elderly patients. It has been suggested that low level laser irradiation has a biostimulative and wound healing effect; however, this has not yet been clinically verified by controlled studies.The difference in size reduction of leg ulcers with and without low level laser or placebo laser treatment was measured in 44 patients randomised into two treatment groups (685-nm low level laser and placebo laser) or a control group which served to quantify the effect of laser application. All patients received standardized wound care.The aim of the study was to compare the effectiveness of low level laser irradiation with that of a placebo "light source". The size of the ulcers was planimetrically measured at baseline (day 1), at the end of therapy (day 28) and 2 months later (day 90). The difference in wound size was evaluated.There were no statistically significant differences in reduction of wound size between the three groups, thus suggesting that low level laser light does not have any stimulatory effect on wound healing in ulcera crurum venosa.

Cerebral microdialysis is an invasive technique for neurochemical monitoring that has been established for neuro-critical disorders such as subarachnoid hemorrhage and severe brain injury. We present data on cerebral microdialysis in stroke patients which were obtained in an ongoing study supported by the German Ministry for Education and Research. So far, 50 patients have been included who required critical care due to massive stroke of the middle cerebral artery territory. By correlating the microdialysis results with follow-up CT scans, we could define the neurochemical characteristics of three different brain compartments: (1) noninfarcted brain tissue with normal microdialysis values, (2) brain areas adjacent to the infarct core which were not hypodense in CT scans but caused reversible neurochemical alterations, and (3) the infarct core with massive concentration changes which did not normalize over the measuring period of 3 to 5 days. Microdialysis values averaged over time and correlated with initial PET scans helped to describe neurochemical predictors of a malignant, i.e., life-threatening, space-occupying course of the ischemic stroke. We discuss the value of this method in guiding therapy and predicting clinical outcome in the context of other neurological critical care disorders and describe the pros and cons of cerebral microdialysis as an invasive monitoring technique.

Infectious mononucleosis (IM) is the manifestation of primary infection with Epstein-Barr virus (EBV). EBV persisting after infection for a life-time infects90% of the adult population. Primary infection mostly asymptomatic in young children manifests in teenagers and young adults in about 50% as IM with fever, sore throat, generalized lymphadenopathy, frequently hepatosplenomegaly and blood lymphocytosis with the characteristic atypical lymphocytes. Clinical presentation, typical lymphocytosis and heterophile antibodies are diagnostic. Atypical cases may need to be confirmed by specific serology. IM is a self-limiting lymphoproliferation regressing within 2-3 weeks. Complications are rare and may involve many different organs. Severe cases are very uncommon, except in patients with inborn or acquired immunodeficiency carrying a substantially higher risk for severe courses, pogredient lymphoproliferation and lymphoma.

Gene therapy was tested for inducing functional angiogenesis in the superficial rat epigastric island flap to allow earlier pedicle division. Autologous rat fibroblasts were grown, harvested, cultured and retrovirally transfected to produce PDGF-AA, an angiogenetically active protein. Stable gene expression was monitored by PDGF-AA ELISA. 180 animals were divided into 3 groups (I-III) and a bilateral flap created in each animal. In all experiments, the rightsided flap was subjected to experimental treatment and the left-sided flap served as control (1 ml saline 0.9%). During flap elevation, group I received 5 x 10(6) GMFB (genetically modified fibroblasts) plus 1 ml DMEM as medium. Group II was treated with 5 x 10(6) NMFB (non modified fibroblasts) plus 1 ml medium and group III received 1 ml medium alone. The flaps were sutured back and the vascular pedicle was bilaterally ligated and divided in each 10 animals during the following 6 days. 7 days later, the flaps were harvested, the amount of necrosis measured and histologically examined. The GMFB produced up the 560-times more PDGF-AA than the NMFB, measured by ELISA. The GMFB-treated flaps tolerated surgical division of the vascular pedicle significantly earlier than groups II and III. Histologically, fibroblasts persisted in all flaps of groups I and II without major inflammatory reaction. In all GMFB-treated flaps, massive angiogenesis could be demonstrated. By means of retroviral gene transfer autologous rat fibroblasts can be genetically modified for stable expression of the PDGF-A gene to produce high amounts of PDGF-AA, which is angiogenetically active. After injection into the panniculus carnosus, these cells induce functional angiogenesis to permit earlier division of the vascular pedicle in this flap model.

Advances in gene technologies have meanwhile reached plastic surgery. Important contributions in this field (which are not all included in the paper) come not only from plastic surgeons, but also from neighboring specialities like dermatology, trauma surgery, orthopedics and vascular surgery. The uniting principle for all this work is improving wound healing and reconstructing tissue defects taking into consideration functional and aesthetic aspects. Gene-therapy is gaining further importance in the clinical field of plastic surgery. In this regard, every clinician has to be aware of the fact that progress in experimental and experimental-clinical work will be achieved only with the help of basic science. On the other hand, basic science needs the clinical input to get relevant patient-oriented studies started. Further intensive cooperation between clinicians and basic scientists is therefore mandatory. In plastic surgery, 2 years ago we founded a forum called ECSAPS (European Conference of Scientists and Plastic Surgeons), which takes place in European city every year.

This article describes experiences of parents of sexual abused children and their evaluations of institutional interventions on sexual child abuse. Results are presented of a study investigating 'individual and institutional reactions on sexual child abuse'. The number of contacted institutions, personnel experiences with these institutions and resulting requirements are described. The results are based on a sample of 47 (82.5%) girls and 10 (17.5%) boys (range 6-18 years) and interviews with their 'non-abusing' parents. 28 (49.1%) of these children were abused by a member of the family, 29 (50.9%) children by non-familiar persons. It could be shown that 70.2% of the children had contacted four or more different institutions soon after the sexual abuse had been revealed. In cases of sexual abuse by a family member the first contacted institution was the Youth-and-Health-Care-System whereas in cases of sexual abuse by non-familiar persons mostly the police was contacted. Nevertheless in most cases both judicial and supporting approach were chosen. Additionally to concrete advices and professional competences the interviewed parents reported that emotional warmth was a very helpful aspect of the professional intervention. Generally the perspective of the parents seems to give some interesting informations about 'consumer satisfaction'.

A review of the literature reveals that with conventional treatment alone or in combination with secondary muscle/tendon transfer, about 4-43% of cases show incomplete recovery with severe functional and/or aesthetic impairment (group III). If these patients undergo early microsurgical brachial plexus revision, regeneration without significant functional and/or aesthetic impairment (shift from group III to group II) can be achieved in 80-90% of cases. Moreover, microsurgical reconstruction of the brachial plexus increases the possibilities of secondary muscle/tendon transfers. Therefore, provided patient selection is good, severe obstetrical brachial plexus injuries should be scheduled for early microsurgical revision. There is no need to wait for a frustrating spontaneous recovery. Our concept is based on our experience with more than 1100 patients presenting with brachial plexus lesions between 1981 and 1996 and treated in our institution. There were 217 obstetrical brachial plexus lesions, 133 of which were treated conservatively. In 84 cases operative treatment was necessary. Fifty-one cases underwent early revision of the brachial plexus, and secondary tendon transfer was done in 33 patients.

In regard to quality-control studies concerning strabismus surgery we were interested in a comparison of subjective and objective parameters after squint surgery.In a questionnaire 175 patients were asked for their evaluation of the functional and cosmetic results 1 week and 6 weeks after squint surgery. Parallel, objective parameters like reduction of the squint angle and quality of stereopsis were documented.Overall 94.2% of patients with esotropia (n = 52) were satisfied cosmetically and 5.8% were not 1 week after squint surgery was performed. In the group of a patients with exotropia (n = 36), 91.7% of the patients were satisfied cosmetically and 8.3% were not. Even in cases of esotropia or exotropia no changes in the quality of stereopsis were noted by some patients or they could not be mentioned in the questionnaire. Some patients did not appreciate the improvement of binocular function found in our examination.Good congruence between objective and subjective results 1 week after squint surgery was found.

A broad spectrum of very different institutions is confronted with the problem of sexual child abuse. So far, only a few systematic descriptions of institutional interventions and their impact on sexually abused children exist. In this article, first results are presented of a study investigating "individual and institutional reactions on sexual child abuse'. In dealing with this problem legal provisions are of special importance. The results presented are based on data obtained from questionnaires and qualitative interviews with experts (median of vocation experience: 8 years) in two german cities (berlin/cologne). Questionnaires were filled in by 195 experts from the entire institutional spectrum (counselors, clinical centres, youth welfare departments, public prosecutors, courts of justice, police), of whom 40 additionally took part in a detailed interview. This article focuses on the question, how different institutions handle legal provisions. The use of criminal law exemplarily shows the different impact of legal provisions on the interventions of counselors. The close connection between the assessment of legal interventions and counseling concepts could be shown at the example of the allegedly homogeneous group of specific counselors.

From the beginning of their lifes children are involved in many different kinds of social relations, that influence the development of children's personality. With the "Soziales Beziehungsverfahren" (SOBEKI), a method for the clinical diagnostic of children is available, that allows of determining the social network of six- to twelve-year-olds as well as specific distributions of functions in the children's systems of relations and beyond, making conclusions about cohesion and hierarchical structures of children's networks in- and outside their families. In this article a study will be presented, in which the social relations of eight- to eleven-year-old primary school children were investigated with the SOBEKI.

The Social Relationship Procedure for Children (Soziales Beziehungsverfahren f¿ur Kinder, SOBEKI), a technique employing figure tasks and interviewing, is a new clinical psychology assessment instrument for use with children. With this instrument it is possible to (a) determine the significant others (social network) of 6- to 12-year-old children, (b) measure how specific functions are divided among members of a child's social networks, and (c) visualizing cohesion and hierarchical structures of the children's networks within and outside their families. In the present paper the theoretical foundations, administration and assessment of the procedure are outlined. In addition, the results of a comparison of children with psychiatric disorders and a healthy control group are presented.

The question arising from this subject, could be answered with "Yes" and "No", since this issue is interpreted differently by footwear manufacturers. During the last 10 years the scientists have achieved essential knowledge concerning the requested standards of children's footwear. These results verify that children's footwear needs to have other characteristical features than adult's footwear. The requested standards on a healthy children's shoe result from the exceptional function (intensity and many-sided motor activity) and the anatomy (elasticity, shape and state) of a child's foot, which is, in contrast to an adult's foot, still developing. Due to these facts there are special requirements and features regarding the fitting, the flexibility and the information. This is explained on some examples.

Acute rupture of the ulnar collateral ligament (UCL) of the metacarpophalangeal joint of the thumb (skier's thumb) is a common skiing injury in adults. Do we find this injury in children? Of the 302 skier's thumbs during the last 4 years we found 24 (8%) injuries in children (mean age 13.4 years) with open growth plates. They had the following diagnosis and consecutive treatment: 5 partial ruptures of the UCL, 3 Salter I and 6 Salter II fractures with radial fragment of the proximal phalanx I; all these had conservative treatment. In addition one had a Salter III fracture with open reduction and fixation, 6 avulsion fractures, which were treated twice operatively and 4x conservatively and 3 ruptures of the ligament which needed reconstruction. Supposing the trauma mechanism in adults, we see a different, age-dependent injury pattern in children. The younger had Salter-I- and Salter-II-lesions of the proximal phalanx, where as the adolescents showed avulsion fractures and ruptures of the UCL as seen in adults. The follow-up of 17 cases minimally 1 year after the accident showed in 12 a full recovery, in 4 cases small subjective symptoms but full function and in 1 case an ankylosis of the MCP-joint following a postoperative infection.

90 patients suffering from chronic skin diseases-mainly psoriasis vulgaris-were treated in a double-blind-study for two weeks with topical Clobetasol-17-propionate compared with other topical corticoids. In 81% was seen a better therapeutical effect on the Clobetasol-17-propionate treated skin area.

Candida krusei is a rarely isolated opportunistic yeast which we observed in 12 immunocompromised patients over a four-month period. Epidemiologic investigations identified the source of the organism in a bottle containing contaminated lemon juice in the hospital kitchen. Since elimination of the source we found the yeast in only 3 additional cases (4% vs. 0.4% of all patients with positive yeast cultures) over 11 months. Upper respiratory tract was the most common site of colonization. 6 of 15 patients developed infections with C. krusei (4 pneumonia, 1 disseminated infection and 1 localized). 4 died from fungal infections. - The importance of infection control institutions for efficient epidemiologic investigation of nosocomial infections is discussed.

Prevention of urinary tract infections (UTT's) in female patients with postoperative indwelling catheter was investigated by applying a single dose of cotrimoxazole on the day of removal of the catheter, and the results compared to the morbidity from perioperative urinary tract infections in the years 1978-1979. Hence, it was the aim of this open study to establish whether the incidence of postoperative nosocomial UTT'S could be lowered and development of clinical symptoms prevented. Bacteriological problem and the diagnostic value of urinary sediment were also investigated. A single dose of Cotrimoxazole proved to be significantly effective in preventing or treating nosocomial UTT's. Urinary sediment in preventing or treating nosocomial UTT's. Urinary sediment is a simple, cheap and effective screening method for detecting uncomplicated urinary tract infections. However, interpretation of the sediment is doubtful if analysed in the early phase following gynaecological operations.

In a prospective trial, 67 women (outpatients and inpatients) with acute symptomatic infection of the lower urinary tract were randomly selected to receive either a single dose of oral co-trimoxazole or conventional five-day therapy with the same drug. Diagnostic and bacteriological problems were investigated. Both regimens showed similar effectiveness with 91% (five-day therapy) and 100% (single-dose therapy) clinical and bacteriological cure. There were no co-trimoxazole-resistant species in vitro and no therapy side effects. As in other studies, we found that in more than one-third of the cases enterococcus was the responsible bacteria for the infection. This is an important finding because of its resistance to cephalosporins.

The authors have studied in retrospect 36 cardiotocographic registrations of women who had given birth to foetus affected by congenital cardiac disease. Emphasis is placed on antepartum diagnosis for appropriate postpartum management of newborns with congenital cardiac anomaly in which such diagnosis is possible.

Basing on a study of 205 "matched pairs", it is shown to what extent peridural anesthesia (PA) influences the course of parturition, the type of termination of birth, and the intrapartal and post-partal condition of the child. The method of PA application is accurately described in the section "Material and Methods". The first stage of labor, or period of dilatation (PD) is not in any way effected by PA. However, PA will almost double the expulsion period (EP). Hence, elective termination of birth via technically simple, complication-free outlet forceps is usually propagated and employed significantly more often. Emergency sections or delivery by forceps due to mandatory indication, are not more frequent under PA than otherwise. The intrapartal condition of the child, measured with the cardiotocogram employing in the score according to Hammacher et al. (6) before and after application of PA, as well as during the last 30 minutes of birth (final score), is influenced only irrelevantly. The Apgar scores one minute and five minutes post partum, as well as the arterial umbilical cord pH values, do not differ significantly between the peridural and the control groups. The authors agree with the widespread opinion that, at the present moment, PA is the best obstetric analgesic method with simultaneous maximum possible safety for the fetus.

The aim of this paper is to propose a new key for the use of hormonal contraceptives. With respect to the complaints about side effects, it is possible to adjust the treatment with the aid of 3 tables and to find the pill of choice for nearly every patient. (author's modified)

Ten consecutive bone marrow transplant recipients were assigned alternatively to receive either a high dose polyspecific intravenous immunglobulin (HDIVIG) 0.5 g/kg weekly X 14, or a conventional dose of a CMV specific intravenous immunglobulin (CMVIG) 0.1 g/kg every three weeks. Before and after each application we determined the levels of total IgG, IgG subclasses, IgG 1, IgG 2, IgG 3, IgG 4, total IgA and IgM and of specific IgG and IgM antibody concentrations against endotoxin, lipid A, streptococcus A, hemophilus, EBV and CMV. In the HDIVIG, total IgG rose from 11 (median, range 2-11) g/l to 25 (22-32) g/l by day 89, in the CMVIG group, IgG dropped from 11 (10-15) g/l to 9 (6-12) g/l. In the same period the mean levels of IgG subclasses expressed as % of normal plasma pool increased in the HDIVIG group in all subclasses, not in the CMVIG group. The differences were significant, however, only for IgG 1 and IgG 2. IgG-antibodies against CMV, EBV, endotoxin, streptococcus and hemophilus did increase significantly in the HDIVIG group, but not in the CMVIG group. No increase was seen in both groups in lipid A antibodies and in specific IgM antibodies. Each application of CMVIG induced a transient increase of anti-CMV antibodies. We conclude that HDIVIG induces reproducibly an increase of specific and non-specific IgG antibodies. No attempt was made to assess clinical outcome. However, these results provide a rational basis for further therapeutic studies.

32 patients in an early state of coronary sclerosis were investigated in connection with diagnostic angiography. 8 patients received 2 mg gallopamil (G) and for every 12 patients 0.1 mg/kg propranolol (P), respectively, 0.12 mg/kg Atenolol (A). All medications were injected intravenously over 4 min. The angiograms were repeated in identical projections before (control) as well as 5, 10, 15, and 20 min after G and 2, 4, 6...up to 20 min after P and A. All angiograms were analyzed using a quantitative computerized contour detection system. 10 min after infusion of G 34 measured coronary segments showed a significant (p less than 0.05) medium dilation of 21 +/- 4.3% and after a further 10 min an insignificant increase in coronary diameter was observed up to 25 +/- 4%. After infusion of P and A a distinct vasoconstriction could be seen. Especially P showed a decrease in diameter of almost 25% in small coronary segments (less than 2.0 mm diameter). The dilatative effect of G i.v. seems to be important in the therapy of acute ischemic situations, for instance, for unstable angina, acute myocardial infarction, or during PTCA. The acute coronary vasoconstriction after infusion of P and A should be considered when used in acute ischemic events.

It was the aim the present study to evaluate maternal morbidity and fetal outcome of 832 pelvic outlet forceps deliveries during the years 1974 through 1977 with special reference to the method of anesthesia (Epidural anesthesia (EA) with Bupivacain 0,5% or general anesthesia (GA) with Methohexital-Na and Succinylcholin). Maternal vaginal and/or cervical injuries were seen significantly (p less than 0,001) more often in the forceps group than in spontaneous, vacuum, or breech deliveries. Vaginal injuries occurred less often (p less than 0,01) in the EA- than in the GA-group. Forceps deliveries were not associated with increased maternal morbidity in fetuses weighing 3750gr or more. The cardiotocography scores (Hammacher et al. 1974) of the 30 minutes preceeding delivery (final scores) were better with EA than with GA (p less than 0,01). Arterial cord pH and 1 minute Apgar values were similar in both groups. The same was true for fetuses with a birthweight of 3750gr or more. The time for cervical dilatation from 7 to 10 cm and duration of the second stage of labor did not influence maternal morbidity or fetal outcome, regardless of the method of anesthesia.

The value of abdominal Electrocardiogram (abd. ECG) for cardiotocography has been studied prospectively in 183 ante- and 93 subpartum patients. The indications for using abd. ECG have been worked out and the influence of various factors on the quality of registration were tested. It was found that neither location of the placenta nor obesity nor the state of the membranes influenced the quality of abd. ECG-records. Furthermore abd. ECG was used successfully in cases with advanced labor.