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The activity of plasminogen activators and plasmin inhibitors in articular capsules of the hip and knee joints in rheumatoid arthritis, chronic traumatic inflammation, arthrosis and aseptic loosening of prosthesis was determined histochemically and correlated with the degree of mobility in osteoarthrosis of the hip. Microscopically unchanged articular capsules were employed as reference sites. In inflammatory articular diseases the plasminogen activator activity was significantly reduced, whereas it remained unchanged in arthrosis and necrosis of the heas of the femur, and significantly enhanced in aseptic loosening of prosthesis. Plasmin inhibitor activity was established in joint capsules with inflammatory changes only; in case of rheumatic inflammation, it was higher than with traumatic inflammation. In osteoarthrosis of the hip there is a positive correlation between joint mobility and plasminogen activator activity. The results point towards involvement of the local fibrinolytic system in joint diseases; however, no definite statement can be made with regard to possible causative linkups.

Whole body hyperthermia was produced in 14 patients with conventionally incurable malignant disease. The technique consisted of arteriovenous shunting involving extracorporeal circulation with heat exchange during general anaesthesia. A temperature of 41.8 degrees C was maintained for periods of 6 hours. After achieving hyperthermic temperatures treatment was enlarged by administration of 5-fluorouracil (1000 mg) in patients with colorectal carcinoma and by dacarazine (200 mg/m2) in patients with malignant melanoma. In 5 out 6 patients with stage IV colorectal carcinoma stabilisation of the disease was seen for an average of 10 months. In contrast, progression of the disease was seen in patients with malignant melanoma and mean survival was only 5 months. These preliminary results in a small number of patients indicate that 1. induction and maintenance of whole body hyperthermia is clinically possible, 2. technical requirements are considerable, however feasible, 3. different tumours react differently to treatment.

198 Phonoarthrographic examinations of the knee joint are reported on. An analysis was then carried out on the noise in knee joints with clinically and operatively demonstrated gonarthritis, chondromalacia of the patella, meniscus lesion and complex ligament injuries of the knee joint. Our results show that statistically, due to the division of the noise peaks into frequency groups, the four examined conditions could be separately identified. A practical use is possible now, in diagnosis as well as in examining the progress in knee joint disease. The representation of pathological-anatomical changes by phonoarthrograhy allows the effectiveness of therapeutical measures to be checked. This simple painless examination method provides an additional aid to diagnosis.

Discussing the causes of aseptic loosening mechanism of total hip replacement shear forces resulting from friction between cup and head are often mentioned. Therefore measurements of friction torque in explanted endoprostheses were performed in a new hip simulator to evaluate the influence of friction on the loosening. Differing from other simulators the physiological deformation of the hip bones was imitated by a bending beam. The measured values were compared with mathematically and experimentally found limit loads of the cup fixation. It was shown that the only influence of the shear forces transferred by friction was no significantly dangerous factor for the interface between bone and bone cement of a primarily fixed cup.

The use of composite materials in orthopaedic surgery permits the design of implants with varying degrees of stiffness. A system of carbon fibre reinforced epoxy hip stems was investigated and compared to the mechanical safety of metal ones. Special attention has been paid to the fact that torsional moments are the common failure mechanism of composite materials. In total 74 hip stems (three different sizes) have been tested under static and dynamic loading conditions according to ISO 7206. A group of 27 implants was pre-conditioned for 75 days in 80 degrees C Ringer's solution to discover potential degradation effects of absorbed fluids. The carbon fibre hip stems proved to reach run-out loads higher than conventional metal ones. Moisture absorption didn't influence the mechanical properties within the range of the experimental accuracy. The calculated fatigue stress of 750 MPa permits further optimization of stiffness parameters without the risk of implant fracture.

The closure of conjunctival wounds by means of the fibrin adhesive technique has been reported by several authors; however, the clinical results were only partially satisfactory. Premature clot lysis resulted in disturbances of wound healing. These observations were corroborated by our the present authors' findings. Investigations of the proteolytic and fibrinolytic activity of aqueous humor and the lacrimal fluid revealed no activity in the aqueous humor, but significant activity in the lacrimal fluid. These findings indicated that proteolytic activity is responsible for the rapid dissolution of the fibrin clot after contact with tears. Stimulated by these findings, the present authors developed a topically applicable antifibrinolytic postoperative treatment based on eye drops containing Aprotinin (Trasylol). This technique has been applied in 3 patients so far and has resulted in stabilization of the fibrin clot until the wound has healed sufficiently. This cure is recommended for closure of conjunctival fistulas following glaucoma surgery, as well as for conjunctival wounds and partially dehiscent corneoscleral sections. It is noted that suturing of the latter is often complicated by scars or atrophy of the tissue.

ZusammenfassungIn tierexperimentellen Studien wurde histochemisch untersucht, inwieweit Pharmaka, die in der Gynäkologie bei Frühgeburtsgefahr prophylaktisch gegen die Entstehung eines akuten Atemnotsyndroms verwendet werden, einen Einfluß auf die fibrinolytische Aktivität der Lunge haben. Hierbei wurde nach Gabe von Betamethason eine Abnahme der gewebeständigen Fibrinolyse und eine Zunahme von Plasmininhibitoren in maternalem und fetalem Lungengewebe der Ratte gefunden, was nach Gabe von Ambroxol nicht der Fall war. Daraus ergibt sich im Hinblick auf eine nicht iatrogen verminderte fibrinolytische Aktivität der Frühgeborenenlunge ein Vorteil von Ambroxol.In einer weiteren Untersuchungsreihe wurde geprüft, welchen Einfluß Aprotinin auf die gewebeständige Fi im Rahmen des traumatischen Schockgeschehens hat. Bei narkotisierten Ratten mit bilateraler Oberschenkelfraktur blieb nach 20000 KIE Aprotinin pro kg KG die fibrinolytische Aktivität des Lungengewebes erhalten, was für den Kliniker zeigt, daß im Falle einer sekundären Hyperfibrinolyse beim Schockpatienten keine Kontraindikation für Aprotinin besteht. Synthetische Fibrinolysehemmkörper dagegen, wie z. B. Tranexamsäure-Derivate, interferieren mit der Wirkung gewebeständiger Plasminogenaktivatoren und bewirken u. U. die Bildung von lyseresistenten Gerinnseln. Diese Substanzen dürfen deshalb bei keinem Zustand mit vermehrter Fibrinbildung gegeben werden.

The fibrin adhesion technique is the imitation of the last step of the coagulation system. Fibrinogen is converted by thrombin into fibrin and stabilized by factor XIII. Fibrin sticks to the tissue and the tissue is adapted by syneresis. Local application of aprotinin to the thrombin solution is necessary in order to inhibit premature lysis of the fibrin film. This technique is now used in some selected cases in man such as fixation of cartilage, tendon, sealing of colonic anastomoses and preclotting of vessel grafts. An excellent hemostyptic effect of the fibrin glue in combination with absorbable collagen tampons was found. This combination technique is now used to seal parenchymatous organs and to stop hemorrhage in patients with defective hemostasis particularly those undergoing open heart surgery.

ZusammenfassungDas Verhalten des Plasmakininogenspiegels wurde während und nach einer Substitutionstherapie bei Patienten mit Hämophilie A untersucht.Es zeigten sich deutliche Unterschiede bei der Anwendung von AHP, CohnFraktion I und AHG »500«. Die in allen Fällen beobachtete Abnahme des Plasmakininogenspiegels bei AHP konnte durch Gabe von natürlichen Proteinaseninhibitoren verhindert werden.Zur Klärung dieses Verhaltens wurden Untersuchungen durchgeführt, welche auf die Möglichkeit einer gesteigerten Plasmakininfreisetzung durch Thrombozyten und Leukozyten hin weisen.

Summary1. Blood clots are lysed by SK before the beginning of retraction. Retracted clots are only very little lysed.2. Recalcified citrated blood is easily lysed since the excess of added calcium ions inhibits the retraction.3. The determination of the water content of the clots gives information on their retraction state.4. The determination of water content made it possible to prove that thrombus retraction takes place in vivo. Already one day after thrombosis the water content is clearly lower than in fresh clots. Later the water content increases again slightly.5. Clots formed in vitro and in vivo are lysed by SK after retraction if they come into contact with fibrin or fibrinogen containing plasminogen.6. Heated fibrin plates or heated fibrin tubes both with SK, casein degradation and an immunological method allowed to prove that whole blood clots loose their activable plasminogen during retraction. One assumes that plasminogen is expressed during retraction.7. The possibility of a therapeutical fibrinolysis with SK is due to the fact that SK can penetrate into the clot and the SK containing thrombus continuously comes in contact with circulating blood rich in plasminogen. The importance of these results for thrombolysis with SK is discussed.

SummaryIn vitro whole blood clots were incubated in SK, washed several times in Ringer-solution and then introduced into plasminogen solution. These clots showed marked signs of lysis surpassing those observed in clots that had only been incubated in SK. There was a correlation between the duration of the SK incubation and the clot lysis in the plasminogen solution. We deduce from these findings that SK enters the clots by diffusion and that this process lasts several hours.If SK-incubated clots are placed into an SK-free environment, the SK slowly diffuses out of the thrombi.Even in contact with very slight plasminogen concentrations, SK-incubated clots undergo distinct degrees of lysis.

Conventional and recently developed hysterectomy clamps were examined with respect to sure, nonslip grip and minimum resulting tissue trauma. Slippage was appraised by means of the tenacity testing device, tissue damage on the basis of macroscopic, histologic, and scanning-electron-microscope findings. The new clamp (Zeppelin) comes closest to meeting the demands set for sure grip and gentleness to tissue as compared to the conventional clamps (Wertheim, Rogers, Masterson) and best satisfies requirements for the use in hysterectomies today.

ZusammenfassungDie Technik der lokalen Applikation von Gerinnungsfaktoren hat in den letzten Iahren zunehmend Eingang in die Medizin gefunden. Die sog. Fibrinklebung ist aufgrund der bisherigen Erfahrungen nur zur Fixierung gering belasteter Gewebestrukturen einsetzbar. Durch die lokale Anwendung von Gerinnungsfaktoren in Kombination mit resorbierbaren Tragern auf der Basis von Kollagen wird die Blutgerinnung beschleunigt und bei Patienten mit hereditären wie iatrogenen Blutungskomplikationen die Hamostase erleichtert. Von Vorteil ist ferner der initiale gas- und fliissigkeitsdichte Wundverschluß.Im Gegensatz zu Cyanoacrylatklebstoff wird keine Fremdkörperreaktion ausgelöst. Vergleichbar einem intaktern Gerinnungsfaktor stimulieren die lokal applizierten Gerinnungsfaktoren Fibrinogen und Thrombin in Gegenwart eines polyvalenten Proteinaseninhibitors wie Aprotinin die Wundheilung.