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Aims and Methods: While CD40 is a costimulatory molecule of utmost importance for B-cell proliferation and Ig class switch its role has not been elucidated in the human thymus and in thymic epithelial tumors. To investigate, whether CD40 is functionally active there, we investigated the proliferative response by 3H-Thymidin incorporation of primary normal and neoplastic thymic epithelial cell cultures to CD40 triggering by soluble CD40 ligand (CD40L)., Results: Normal thymic epithelial cells exhibited proliferation in response to CD40 ligand in a dose dependent manner, while a CD40 ligand specific monoclonal antibody prevented this effect. This response was not significantly different from the response of neoplastic thymic epithelial cells derived from myasthenia gravis-associated thymomas., Conclusion: Our data demonstrate that CD40 is expressed on the surface of normal and neoplastic epithelial cells of the thymus and is a functional molecule in terms of epithelial cell proliferation in vitro. Given the differential expression of CD40 in the various histological thymoma subtypes in vivo, the finding suggests a role of CD40 in the different mechanisms of tolerance breakdown in thymomas.

Expert judgement of selected gastro-intestinal disorders, as well as of pancreatic and liver disease and of the status after gastric surgery is discussed. The group of liver disease commented upon includes virus hepatitis as a disease caused by professional activity, fatty liver, chronic hepatitis and cirrhosis of the liver. A causal relationship between progressive liver disease and peptic ulcer has to be accepted; a causal relationship between most types of liver disease and cholelithiasis however has not yet been established. In conclusion, the advantages are stressed of an early mobilisation of patients with chronic liver disease as well as the positive effects of physical therapy upon the course of the disease, the psychological and general status of the patient.

The technique of sequential scintigraphy in investigating newborn infants in order to exclude or detect cyanotic congenital heart disease has been improved. The primary scintigraphic data are recorded digitally (list mode, 1 ms, 128 by 128 pixels) and evaluated automatically as a sequence of 1/2 s frames in 1/8 s increments. A 35 mm film is exposed to a scanning pulsed light spot on a CRT-screen with quantitative correspondence between local count density and the local number of light pulses. A series of highly resolved images of the rapidly changing scintigraphic pattern is achieved in 30 min. The results of 3 investigations are discussed. They prove the importance of adequate spatial resolution and definition in time in nuclear angiocardiography in infancy. Three case results are discussed in detail. In one case cardiac catheterisation and angiocardiography had been omitted, since the radioisotopic findings excluded cyanotic congenital heart disease. Two further investigations are discussed with reference to the findings at cardiac catheterisation.