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Background and Objective: The periodontal region is a source of gram-negative bacterial infection. The pathogens involved have recently also been demonstrated in atheromatous plaques. They may increase the risk of myocardial infarction. In this study a strategy for eradicating periodontal bacteria and thus healing in patients with periodontal pockets and advanced destruction of alveolar bone was examined., Patients and Methods: Initial periodontal status was documented in 36 patients with periodontitis (24 women, 12 men) who were then randomly assigned to one of three groups. Those in two of the groups were given either metronidazole or doxycycline orally as adjuvant treatment, while the third group received no antibiotics. Patients in all groups were treated according to a two-step procedure. In step 1, extensive supra- and subgingival plaques and concrements were removed. In step 2, root debridement and/or closed curettage of all pockets was undertaken in one visit, and the antibiotic given to the patients in groups 1 and 2. Results were assessed 3 weeks after the first step and 6 months, 2 and 4 years after step 2., Results: The initial examination at 3 weeks revealed significant changes in all three groups with regard to the incidence of plaque and sulcus bleeding, but not regarding probing depth and attachment level. However, there were significant changes in probing depth and attachment level in all groups after step 2. Periodontal attachment was significantly improved at 2 and 4 years in the patients on metronidazole, but not those on doxycycline or no antibiotics. The greatest decrease in bleeding tendency was recorded in the metronidazole group. This group also had the greatest gain of new alveolar bone compared with the other two groups. Complete eradication of Porphyromonas gingivalis and Actinobacillus (Hemophilus) actinomycetemcomitans, important pathogenic bacteria that may have an atherogenic action, was obtained only in patients on metronidazole., Conclusion: The tissue-sparing two-step procedure brought about good clinical and radiological results, which can be significantly bettered by the addition of metronidazole, achieving eradication of pathogens involved in periodontal disease.

Purpose: Retrospective evaluation of postoperative long-term results after surgery of inflammatory aortic aneurysms (IAAA) with computed tomography (CT). Findings in CT were analysed with particular attention to the development of inflammatory tissue adjacent to the aneurysm site., Material and Methods: Of 2101 patients operated on an aortic aneurysm 5.4% (114 patients) presented typical intraoperative features of inflammatory aortic aneurysms. 54 of these 114 patients (47%) were examined via computed tomography pre- and post-operatively. On an average the follow-up-study was performed 2.5 years postoperatively., Results: All follow-up-studies revealed a correct location of the aortic prostheses. In 85.1% of the cases there was either no or negligible persisting inflammatory tissue with a diameter of less than 2 mm. 10.6% of the patients demonstrated remaining but reduced inflammatory tissue. In 4.3% of the cases the extent of the inflammatory tissue had not changed. Aneurysms of the anastomoses (n = 4), morphologic renal changes (n = 7) and an aorto-enteric fistula were demonstrated by CT as postoperative complications., Conclusions: In evaluating recurrence of the aneurysm and possible complications as well as the development of the inflammatory tissue, postoperatively performed computed tomography proved a reliable diagnostic method.

Physiologically, an influence of sex steroids on the antioxidative capacity can be seen at least as a short-term effect. First of all the steroid effects are due to the estrogen component rather than the progestin component. The antioxidative potential of natural estrogens is several times higher than that of vitamin E. Long-term studies should be performed to verify this in perimenopausal hormone replacement.

Antiandrogens or progestins with an antiandrogenic component usually have only a weak antigonadotropic activity. It is thus possible that the antiandrogenic effect on the cellular level is cancelled or at least reduced by an increased ovarian androgen production. The aim of the four submitted clinical studies of the progestin and antiandrogen dienogest alone (0.5-2 mg/day) or of a combined regimen of ethinylestradiol (0.03 mg) plus dienogest (2 mg) (EE/DNG) was to examine the influence on the serum androgen and SHBG concentrations as well as on the serum FSH, LH, progesterone and 17 beta-estradiol concentrations in young women. Like the progesterone derivatives, dienogest has a relatively low antigonadotropic activity. Inhibition of ovulation is mainly produced by peripheral mechanisms such as the reduction of preovulatory 17 beta-estradiol secretion. Dienogest alone has no significant effects on the serum SHBG and androgen concentrations. Unlike this, the combination of EE plus DNG markedly increases SHBG concentrations (to 2.1-3.7 fold the basal levels). The decrease in serum androgens with total testosterone (by 17 and 40%), free testosterone (by 48 and 54%) and dehydroepiandrosterone sulfate (by 51%) corresponds to the values shown in the literature for other oral contraceptives with modern progestins. EE/DNG does not affect the serum concentrations of 5 alpha-dihydrotestosterone (DHT), although the marker of the peripheral transformation from T to DHT, androstanediol glucuronide, is distinctly reduced (by 38%). In a double-blind comparison no differences are found between EE/DNG and a regimen combining 0.02 mg of ethinylestradiol and 0.150 mg of desogestrel. Solely the SHBG concentrations, with EE/DNG, as expected, are significantly higher. In a sequential regimen, dienogest, chlormadinone acetate and desogestrel (progestins without binding to SHBG) enhance the inhibitory effect of ethinylestradiol sulfonate on free testosterone, whereas norethindrone acetate and levonorgestrel (progestins with a strong binding to SHBG) reduce this effect of the estrogen significantly. These results exclude the possibility that the very distinct antiandrogenic effect of dienogest on a cellular level is neutralised or reduced by an increased systemic supply of androgen.

All healthy mammalian organisms are characterized by an equilibrium between the occurrence of highly reactive oxygen species and their destruction by anti-oxidants. Numerous diseases go hand in hand with a disturbance of the homoeostatis. In order to avoid or minimize the destructive effect of the oxidant stress on biological structures, therapies utilizing drugs with anti-oxidant effects are increasingly being applied. Preconditions for these therapies are a characterisation and a follow-up of the anti-oxidant status in the diseased organism. In the course of the present study selenium, glutathione peroxidase and malondialdehyde were determined in patients with various clinical pictures (terminal renal insufficiency, septic shock, high-risk gravidieties, arterioscleroisis, pulmonary carcinoma, acute myocardial infarction, test patients taking the contraceptive pill). Patients with terminal renal insufficiency and those suffering from septic shock syndromes clearly show a selenium decrease in serum and whole blood as well as a drop in the GSH-Px-activity, and increased malondialdehyde concentrations in the serum. Both are a reflection of an increased lipid peroxidation. First results of a selenium therapy are available for patients with therminal renal insufficiency and post-traumatically induced renal failure. The interpretation of the findings in the categories "high-risk gravidity" and "women on the contraceptive pill", which show a normal GSH-Px-activity and significantly increased malondialdehyde concentrations, seems problematic. The organism counteracts an increased lipid peroxidation with a normal plasma-GSH-Px-activity, clearly a sign of a still normal anti-oxidant potential.

Periodontology is a young department and has developed in Jena in the last 25 years; since 1982 it is a part in state examination. Maintenance of teeth is possible until old age and requires periodontology as a part of therapy. Biochemically, microbiologically and immunologically methods make it possible to differentiate unlike forms of periodontitis and their special therapy.

At present diagnosis and therapy of rapidly progressive periodontitis is still difficult in the daily practice. It is possible to define this form of periodontitis by suitable clinical and paraclinical characteristics. In searching a practical therapeutic concept, including effective motivation, first results of a sufficient therapy confirm the possibility of a successful strategy in the treatment of patients with rapidly progressive peridontitis.

In 8 female sports students (runners) aged 20 and 21 years and 10 women between 20 and 40 years of age, who regularly underwent body building training, serum levels of ethinylestradiol (EE2) and levonorgestrel (LNG) have been determined under conditions of exercise as well as in rest, prior to and following the intake of 1 tablet of Gravistat (0.05 mg EE2, 0.125 mg LNG). Blood samples were obtained at points 0, 2, 6 and 24 hours. Exercise (5000 meter running and intensive body building training of one hour duration, respectively) was started immediately after intake of the steroid combination. There were no significant differences in the serum concentration levels obtained during exercise and rest. But exercise consistently resulted in a slight decrease of EE2 and LNG serum concentrations and the area under curve values.

Caffeine is mainly metabolized by 3-methylcholanthreneinducible cytochrome P-450, whereas metamizol (Analgin) is probably mainly metabolized by the phenobarbital inducible cytochrome P-450 family. Therefore the elimination of caffeine from serum and the elimination of the main metabolites of metamizol in urine reflect the activity of these two cytochrome P-450 families. Sex hormones can influence the activity of cytochrome P-450. Intake of levonorgestrel (0.125 mg) daily for 14 days reduced the metabolism of caffeine slightly, but the elimination of metamizol-metabolites is not influenced. Longterm administration of levonorgestrel (0.250 mg daily) for three months did not change the metabolisms of both model substances tested. In contrast, ethynylestradiol (0.050 mg) alone and also the combination with levonorgestrel markedly retarded the elimination rate of caffeine and metamizol-metabolites. This fact should be taken into consideration in drug therapy.

Pharmacokinetic investigations (c0h, c2h, c6h, c24h, AUC24) were carried out both in the first and last four days of a treatment cycle in patients of different ages, who used oral contraceptives at least for 12 months. 57 women took the preparation Trisiston (three-step-formulation with the components 0.03 mg ethinylestradiol (EE2) + 0.05 mg levonorgestrel (LNG), 0.04 mg EE2 + 0.075 mg LNG, 0.03 mg EE2 + 0.125 mg LNG), 23 subjects used Gravistat (0.05 mg EE2 + 0.125 mg LNG) and 17 patients were under Certostat, a preparation still in clinical evaluation (0.05 mg EE2 + 2.0 mg Dienogest (DNG)). The levels of EE2, LNG and DNG were measured by means of radioimmunoassays. Between the concentrations obtained after administration of a first and single tablet (earlier investigations) and those determined in long-time users during the first 4 days following the tablet-free interval no qualitative and quantitative differences were observed. Between the levels of EE2 and LNG determined in the first and last days of the treatment cycle, marked differences were found in patients under the formulations Trisiston and Gravistat, but not in those taking Certostat. It is concluded that a cyclic and reversible cumulating effect emerges under the influence of LNG-containing contraceptives, the mechanism of which cannot be explained solely by the increase of carrier protein capacity. It seems possibly due to an alteration of steroid metabolism resulting from the interaction between both components.

Serum levels of ethinylestradiol (E2) and levonorgestrel (LNG) have been determined in 10 volunteers of similar age after administration of 1 tablet of the oral contraceptives Gravistat and Ediwal, respectively, each containing 0.05 mg E2 and 0.125 mg LNG, using a cross over design. The studies were carried out at intervals of 4 weeks, within the follicular phase of the menstrual cycle and under standardized conditions. Wide variations were observed between the women in the calculated pharmacokinetic parameters, while there was a relatively close correspondence between the intra-individually obtained values, except for one case.

It was the aim of this clinically longitudinal study to find out the consequence of the removal of calculus with hand- and roto-pro-instruments of the periodontium in 50 patients suffering from periodontal diseases. There are no clinically provable differences between the two methods of the removal of calculus. Both methods cause a statistically significant effect on the inflammatory factors of the periodontium.

250 patients in long-term treatment (about 12, 4 years) were examined concerning their oral symptoms (DMF/T, CPITN, GPM, Plaque-index, Sulcus-bleeding-index of Mühlemann and Son), number of teeth, number of extracted teeth and teeth with endodontic treatment during the treatment period. These patients were compared with 250 patients, who were not under regularly treatment. There are clear differences between both groups. It can be concluded that long-term treatment with exact fillung therapy, endodontic and periodontic treatment is able to maintain teeth until a high age of life.

Preventive measures, continuously realized in children of dentists cause significantly lower values of Plaque index, Sulcus-bleeding-index, CPITN and caries in all groups of age in comparison to other groups.

The slight therapeutic breadth involved means that manic depressive lithium prophylaxis may call for life-long routine management. The lithium/serum-level checks required hitherto are here compared with a non-invasive method, that of determining the lithium level from a mixture of the patient's saliva, a method involving no danger that will eventually assume considerable importance.

A radioimmunoassay for ethinylestradiol (EE2) which was developed in the pharmacological department of VEB Jenapharm has been modified and fully validated. It was the purpose of the present study to extend the still limited data concerning EE2-serum levels after a single and repeated ingestion of combination pills with different doses of EE2. 10 volunteers aged 17-25 years with normal body weight and length received a single tablet of either Gravistat (0.05 mg ethinylestradiol + 0.125 mg levonorgestrel) or Minisiston (0.03 mg ethinylestradiol + 0.125 mg levonorgestrel). 11 other women were involved into the study after ingestion of the 21st tablet of a contraceptive cycle. Peak serum levels which were significantly higher in the Gravistat- than in the Minisiston-group were observed 90 to 120 minutes after the oral administration. Detectable EE2 levels were determined in all volunteers after 24 hours. Pharmacokinetic data showed pronounced interindividual variations. Whereas the mean 24 hours levels of EE2 increased progressively during the treatment cycles, kinetic values obtained at the end of the cycle exhibited a significantly higher level than those after ingestion of a single dose. Area under curve (AUC) was calculated by the trapezoidal rule with the aid of a compartment free model.

The effects of two sequential oral contraceptive preparations, Sequostat (6 days ethinylestradiol 0.05 mg, 15 days ethinylestradiol 0.05 mg + norethisterone acetate 1.0 mg) and Sequence-Ovosiston (9 days mestranol 0.1 mg, 12 days mestranol 0.08 mg + chlormadinone acetate 2.0 mg) on triglycerides, total cholesterol, HDL- and LDL-Cholesterol, glucose tolerance, total plasma proteins, plasma protein fractions, plasma transaminases, gamma-glutamyl-transferase, alkaline phosphatase and antithrombin III were studied in two groups of 46 and 29 young women respectively. Investigations were performed prior to the hormonal intake and after treatment for 3, 6 and 12 months. In nearly all parameters studied significant but minimal changes could be demonstrated which in most cases showed a minor degree in the Sequostat-group, while Sequence-Ovosiston exerted a less effect on glucose tolerance. A significant increase of HDL-cholesterol and a reduction of LDL/HDL-cholesterol relation could be demonstrated at least in the first six months, resulting from the estrogen dominance of the contraceptives.

Caffeine is mainly metabolized by 3-methyl-cholanthrene-inducible cytochrome P-450, whereas metamizol (Analgin) is probably mainly metabolized by phenobarbital inducible cytochromes P-450. Therefore the elimination of caffeine from serum and the amount of the main metabolites of metamizol excreted into urine reflect the activity of these two cytochrome P-450 families. Sex hormones can influence the activity of cytochrome P-450. Dienogest is a new gestagen, used for temporary contraception. We investigated the effect of this new sexual hormone alone and in combination with ethynylestradiol on the elimination of both testdrugs. In 10 healthy volunteers dienogest 2 mg daily for 14 days have no effect on the metabolism of model drugs whereas the combination with 0.05 mg ethynylestradiol has an influence on the elimination of caffeine and metamizol.

Karyopycnotic and keratinisation indices were determined in buccal smears which had been taken from newborns. An assessment was made of 239 smears which had been obtained from newborns in their first eight weeks of age, with the probands being subdivided into two groups, depending on breast feeding and feeding on powdered milk (Ki-Na).--Both indices were extremely high on the first day after birth, but they declined up to the eighth or 14th days of age which was attributed to postnatal reduction of high foetal oestrogen levels. Both indices then went up, with some difference being recordable between the two groups, depending on the modes of feeding. The keratinisation index of the breast-feeding group was much higher than that of the Ki-Na group, on account of very high oestrogen levels in breast milk, between the fourth and seventh days from delivery, with consequences on mucous membrane proliferation. The keratinisation index declined gradually along with oestrogen drop of breast milk and turned to be equal to that of the Ki-Na group, eight weeks after delivery.--Proliferation of buccal mucous membrane and its importance to efficient defence against infection during the first four weeks of age are discussed.

48 women complaining of climacteric disorders were treated with an estrogen preparation for 1 year. Before an intervalls of 2 month during the treatment period studies of the Kupperman index, the vaginal karyopcnotic index and 3 neurovegatative (hemodynamic) tests were carried out: The orthostase-test according to Schellong, the cold-pressor-test according to Hines and Brown, the Pholedrin (Veritol-)test. During estrogen substitution the following alterations could be stated: A significant decrease of systolic and diastolic blood pressure values, a tendency of adjusting the systolic blood pressure values after standing up to the values in rest (Schellong-test I), a shortening of the interval needed to establish stable values of blood pressure and heart frequency, a tendency to reduce the increase of blood pressure in the cold pressor test, and a significant amplification of the increase of blood pressure and blood pressure amplitude in the Pholedrin test. These results are believed to indicate an alteration of vegetative reactivity in the parasympathicomimetic direction. Estrogens seem to exert a favourable influence on the mechanism of blood pressure regulation.

Intravenous administration of gonadotropin-releasing hormone (GnRH) induces not only a rapid release of pituitary LH and FSH stored, but also stimulates biosynthesis of these hormones by a long acting process. Repeated injection of GnRH after an interval of 90 to 120 minutes evokes an increased response compared with the first period of stimulation. This pattern of reaction is principally maintained on therapy with steroidal contraceptives. The twofold stimulation provides additional information on hypothalamic-pituitary reactivity exceeding the results yielded by the simple GnRH stimulation test. On the contrary examination of prolactin response to twofold TRH-administration gives no increased diagnostic aid.

The present paper deals with the effects of the hormonal contraceptives Deposiston and Gravistat on the digestibility of dietary crude protein and on the urine excretion of nitrogen. The substances under test were given to nine women aged between 18 and 25 years. The faecal and the urinary nitrogen were determined in the first two cycles during which no contraceptives were used, and also in the subsequent three cycles during which Deposiston and Gravistat were taken by mouth. The preperiod extended over 3 days; and the sampling period, over 4 days. The apparent digestibility of the dietary protein was but slightly increased by the contraceptives. In case of Deposiston for example, it amounted to 85.0% (1st cycle), 86.0% (2nd cycle), 87.3% (3rd cycle), 87.1% (4th cycle), and 88.2% (5th cycle). Deposiston and Gravistat did not affect the urine excretion of nitrogen and the nitrogen balance.

Submandibular saliva from 111 persons was collected and the secretion rate was determined before and after stimulation with Ascorvit. Analyses from Na, K, Ca, Mg and Zn were carried out by atomic absorptions spectroscopy respectively by flame emission analysis.

50 healthy women (mean age 29.9 +/- 6.4 years) with early unwanted pregnancy (mean duration 39.3 +/- 2.9 days post menstruationem) received a single oral dose of 600 mg of Mifepristone. Uterine bleedings occurred in all patients within 8 to 110 hours (43 +/- 23.3 hours) after the application, but its duration was very different and correlated with the results of treatment. 39 patients reported on an amount of bleeding exceeding by far the menstrual strength. But in most cases this heavy bleeding lasted only 1-3 days. Frequency of complete abortion was 80% (40 women). 4 patients had an incomplete abortion, and in 6 women the pregnancy was unaffected by the treatment. "Medical abortion" provides a novel alternative to the surgical procedure and is fairly accepted by the patients. Its efficacy, however, should be improved by focusing on early pregnancies not exceeding 10 days after the expected menstrual period and, perhaps, the additional usage of low doses of prostaglandin E derivatives.

In this study 300 women (100 pregnant women, 100 women taking contraceptives and 100 women without contraceptive medication) were examined, recording the periodontal condition (using a computer-orientated chart) and the periodontal index according to Kötzschke. The values for the total index and the superficial and deep components of the index according to Kötzschke, the pocket depth and the degree of tooth mobility (determined for each tooth) were significantly higher in women under contraceptive medication than in the control subjects.

The partial pressure of oxygen (pO2) in the inflamed gingiva was measured in 24 patients before and after the application of Gingivox. The Gingivox treatment led to a significant increase in pO2 from 72.2 mm Hg to 94.6 mmHg. The arterial pO2 values of all patients, measured on the hyperaemic ear-lobe, lay within the range of normal values. The measurements were performed by means of the micro-Astrup equipment of the firm of Radiometer, Copenhagen.

Progesterone as the main representative of gestagen-effective sexual steroide does not cause allone a statistically significant dilation of the lumina of the ureters compared with the adequate values of the control urogrammes. The fact that in pregnant rabbits no dilation of the ureters and of the renal pelvis was to be found allows the suspicion that during the pregnancy of the animal species used there are other mechanical conditions than during the human gravidity.

The total level of N-acetylneuraminic acid in serum was found to be affected by long-time application of hormonal contraceptives. That effect appeared to depend on oestrogen. The problem of reversibility is discussed.

The results obtained from the cytological examination of gingival smears taken during one cycle demonstrate that the effect of the depot contraceptive Deposiston on the gingivae is measurable.

In 10 women serum FSH- and LH-concentrations (radioimmunoassay) were measured daily throughout a complete cycle. 2 patients exhibited untreated biphasic menstrual cycles. 2 women were under the treatment of a combined estrogen - progestagen preparation, 1 woman was taking a sequential preparation, and 5 patients were treated with a weekly dose of a recently developed depot - estrogen (ethinylestradiolsulfonate). While the untreated women showed typical serum FSH-and LH-patterns characteristic of the biphasic menstrual cycle, patients on combined therapy were found to have a continuous low FSH- and LH-level except in the postmenstrual phase of the cycle, in which the values were slightly elevated. Serum-FSH-concentration in the woman on the sequential preparation remained constant throughout the treatment peroid, while serum LH-pattern showed multiple peaks. In the same manner, serum LH-patterns in women on the weekly depot- estrogen regimen were characterized by nearly regularly appearing LH-peaks, which seemed to be correlated with the estrogen intake. The cause and clinical significance of these findings are discussed.

Excretion of synthetic sexual steroids in parotid saliva was investigated by means of thin-layer chromatography. Oestrogens and gestagens were detectable, depending on doses, within one hour from application.

The influence of a long-term application of 4 different hormonal contraceptives on the excretion of various constituents of the urine was examined. A reverse effect after stoppage of the medication is to be established in none of the other parameters with the exception of calcium.

The effect of hormonal contraceptives administered for 24 months on the hydroxyproline content in urine was investigated. -- The results suggest an increase of hydroxyproline by application of sexual steroids. The reversibility is discussed.