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The dehydrogenation of (S)-nicotine (1) with mercuric acetate in diluted acetic acid yields no cotinine (3), but reacts only to the iminium stage, resulting far predominant the 5'-iminium structure without affecting the chiral center at 2', therefore the reduction with borohydride nearly quantitatively gives rise to (S)-nicotine (1). For the preparation of cotinine (3) the best method proves the oxidation of (S)-1 with the equimolecular complex Hg(II)-EDTA in pure water. With preliminary alkalization of the preparation an oxidation also of the liberated EDTA to iminodiacetic acid (10) and oxalic acid (15) occurs. This side reaction increase with an excess of chelating agent, which makes the precipitation of mercury as measuring system for control of the dehydrogenation invalid. Surprising is the nearly complete failure of the dehydrogenation to the tertiary carbenium ion and the consecutive reaction of the secondary carbenium ion 5, which in equilibrium with its carbinolamine 5a is again dehydrogenated with Hg(II)-EDTA to the lactam 3 with retention of the configuration.

Within the framework of a project entitled "Observation by Public Health Offices" we discovered a strikingly high mercury concentration of 30 micrograms in the urine of a 10-year old girl from an Albanian family formerly residing in the Kosovo area in Serbia. We investigated into the cause of this mercury load and found that it was also present in other members of the same family. Symptoms of mercury poisoning were evident to varying degrees in individual family members. Ultimately, we traced the source to a bleaching ointment containing mercury. On analysing the same we found a mercury content of 389 mg per g ointment. The use of this ointment with its extremely high mercury content had also contaminated the living-rooms.

Demodex folliculorum has been demonstrated with an elevated frequency in patients with blepharitis, and is thought to cause therapy-resistant blepharitis. This paper presents the germ spectrum of patients with blepharitis and demodex and discusses the efficiency of a specific therapy.In all, 3152 cilia from 139 patients with blepharitis (38% blepharitis, 44% blepharoconjunctivitis, others) and 108 persons with quiet eyes were examined for demodex. Smears n = 125, from the conjunctive of symptomatic patients were investigated for bacteria, 3 weeks of therapy with mercury ointment, 2%: Lindan, cortisone (prednisolone, dexamethasone, hydrocortisone, fluorometholone) or antibiotics after antibiogram (gentamicin, kanamicin, neomicin, erythromicin, ofloxacin, polymyxin-B, colistin) followed in all Demodex-positive blepharitis patients (n = 41).Demodex was found in 52% (62/139) of patients with chronic blepharitis, as against 20% (3/15) of those with acute blepharitis (statistically significant difference, chi 2-test, alpha = 2.5%) and in 29% of quiet eyes (statistically significantly less, alpha = 2.5%, chi 2-test). Gram-positive cocci were isolated from 79% of 57 Demodex-positive patients with blepharitis and 72% of 68 Demodex-negative patients anaerobes in 39% and 37%, gram-negative rods in 11% and 3% (statistically significant difference for gram-negative rods, alpha = 5%, chi 2-test). Of the patients with Demodex, 25% apparently had no more parasites after mercury ointment, 2% (n = 8) and lindan (n = 5) and 15% after cortisone and antibiotics (n = 13). (The best and statistically very significant results (alpha = 1%) were those obtained with mercury ointment, 2%, and lindan: t-test for connected spot checks).Gram-positive and gram-negative bacteria grew more often in patients with Demodex. Demodex seems to be a mediator of chronic blepharitis; we recommend that mites be sought in cilia of chronic blepharitis patients. Mercury ointment, 2% and lindan proved efficient for specific therapy, the main problem being the laborious application and toxicity.

A patient suffering from long-standing pustular psoriasis of the palms was treated for 3 weeks with a mercury-containing drug. Exacerbation into generalized pustular psoriasis developed. Mercury levels in blood and urine were increased. After withdrawal of the mercury preparation, therapy with DMPA (2,3-Dimercapto-1-propane-sulfonic acid), a mercury antidote, was initiated, together with short-term treatment with aromatic retinoids and PUVA. Within a few days mercury levels decreased significantly and the skin lesions practically disappeared.

It was searched for differing effects of homeopathic potencies and equally concentrated conventional dilutions. Activities of enzymes from three different subcellular compartments of the rat liver served as parameters for the evaluation. Especially in the D15/10(-15) range differences proved to be statistically relevant. The series with potentiated carrier substance, necessary from heuristic reasons and related to the homeopathic potencies, resulted in hitherto not understandable findings.

After oral administration of homoeopathically prepared low-dose-amounts of Conium and Mercury phosphate to male Wistar rats enzymatic parameters were investigated in three subcellular compartments of the liver under blind conditions. 1. After seven single application of the substance amount referring to a D8 potency a maximum effect could be detected for both agents. 2. The relation between agent and magnitude of the provoked effect is not linear. 3. The importance of these results is discussed and integrated into a general context.

The presence of bacteria during cataract surgery was studied on 71 consecutive patients. Lid and conjunctival smears were cultured 24 hours preoperatively. Additional conjunctival smears were harvested in the operating room before and after conjunctival disinfection by oxycyanate. Moreover, the whole irrigation fluid was collected under sterile condition and examined microbiologically. 24 hours preoperatively 61 of 71 patients had positive cultures of their lids and/or conjunctivae. 8 of them showed growth of pathogenous bacteria (7 staphylococcus aureus, 1 proteus mirabilis). In the operating room before oxycyanate disinfection 5 patients were positive for staphylococcus aureus and 13 for coagulase negative staphylococci (none for proteus species). After oxycyanate disinfection 4 residual conjunctival smears showed bacterial growth when cultured (3 coagulase negative staphylococci, 1 proteus mirabilis). 22 of 71 collected irrigation fluids content few numbers of bacteria. One was positive for proteus mirabilis, 3 for staphylococci. The patient showing growth of proteus after oxycyanate disinfection and one of the patients with staphylococcus aureus positive irrigation fluid did not show this kind of micro-organism in any smear before. The authors conclude that preoperative cultures do not give real security about the presence or absence of bacteria during the operation.

Heavy metals, including mercury, have recently been in discussion in connection with ecology and therapy. As Meditonsin represents a 0,004% solution of mercury cyanide the following were investigated: absorption, excretion, effect on the kidneys and the chemical behaviour of mercury cyanide and other mercury salts as well as the antimicrobial effectivity in in vitro tests. With the dose recommended for adults neither an increase of mercury ions nor an increased excretion of these could be detected in the blood or the urine respectively. Even in minimal inhibitory concentrations Meditonsin is characterised in the in vitro tests by an excellent antimicrobial effect.

After an accidental injury of the bowel during a hysterectomy, the patients peritoneal cavity was irrigated for disinfection with a solution containing a mercury-compound. The patient died 40 days after this "peritoneal lavage" with a 0.2% solution of mercury-II-oxycanide. The disinfection with the toxic compound during operation can be judged as a medical mistreatment leading to death of the patient. The mercury concentration in blood (0.1 mg Hg per 100 g blood), taken during autopsy, exceeded normal values severalfold. The cause of death was diagnosed as a "multiorgan-failure", caused by an "iatrogenic mercury poisoning". The results of toxicological analysis, histological examination and the findings of autopsy are presented.