Search

We studied the concentration of angiotensin-converting enzyme (ACE) in 80 respiratory and hepatologic healthy patients aged 4 months to 35 years. The normal values ranged from 9.4-38.8 U/ml with a tendency of lower ACE-concentrations in the older patients. In the follow up of 16 patients with hypersensitivity pneumonitis a decrease of initially elevated values of ACE was observed in 12 cases. In two patients with a recurrent course of hypersensitivity pneumonitis ACE rose to levels above 30 U/ml. These findings suggest that ACE-concentration in serum is an additional parameter to evaluate the acute stage of disease in patients with hypersensitivity pneumonitis.

Present-day procedures for the sterilization of women are discussed. In particular, the possibilities of inpatient and ambulant treatments and their efficacy and risks are gone into. The hypsteroscopic transuterine tubal sterilization is reported as a new method which is still in the experimental stage. If the same sucessful results are achieved as with the sterilization methods already known, its advantages would be: a short ambulant procedure; local anesthesia, therefore no risk from the anesthetic point of view; avoiding the abdominal cavity, consequently no complications involving the peritoneal space such as are usually encountered with all other sterilization procedures; low risk of morbidity; the patients are not disabled; very low cost factor.

In 78 children (4 to 17 years of age) with moderate or severe asthma who were additionally treated with sustained-release theophylline preparations, different ways of drug monitoring were examined. Analysis of plasma and saliva theophylline was performed by means of high performance liquid chromatography. Saliva theophylline turned out to permit a reliable prediction of plasma theophylline, if an individual regression is calculated for each patient, basing on 3 simultaneously performed measurements of theophylline levels in saliva and plasma within the therapeutic range of 8 to 20 mg/l. In 25 patients theophylline levels were determined in venous and capillary blood. There was an excellent agreement (r = 0.97). Thus, a convenient monitoring of theophylline treatment in children is possible.

The blood pressure of patients who underwent surgical correction of coarctation of the aorta are usually controlled at rest in the upper and lower extremities. The assessment of the success of the operation is then based on these blood-pressure readings. It is, however, more important to control the blood pressure during standardized exercise so that assessment of the capacity for work in daily life could be made. This is best realized with the bicycle ergometric examination with simultaneous blood-pressure readings 40 patients who had undergone surgical correction of the coarctation of the aorta, using the Vossschulte indirect patch aortoplasty method, were examined. The examination results were compared with those of 35 healthy children. The bicycle-ergometric exercise was carried out in stepwise increasing loads of up to 2 Watt/kg body weight. The blood-pressure, were compared based on the age of the patient at the time of the operation, in relation to the time between the operation and the ergometric examination and the age of the patient at the time of the operation. The W170 (Physical working capacity at a heart rate of 170) and the maximum oxygen intake of the subjects were also used as parameters for comparison. It could be seen that the initial blood pressure at rest was, on the average, relatively higher than those of the control subjects. This tendency was also observed during the bicycle-ergometric examination. In some subjects, the blood pressure rose to dangerously high values particularly at 2 Watt/kg body weight. The blood pressures of the patients remained on the average higher than those of the control subjects during the resting phase after the exercise (control after 1' and 5') and normalized relatively slowly. 45% of the patients showed pathological blood-pressure values. The W170 of the patients, a parameter for precise assessment of the cardiorespiratory fitness, was measured. The findings in the patients showed only very slight difference compared to those of normal subjects in all the assessment parameters. This applies also to the maximum oxygen supply, particularly when one considers the standard deviation. It is advisable to consider limitation of activities, for example sport, in the special cases where there are dangerously high blood-pressure rises during exercise even though no subjective complaints are made by the patients and the blood pressures at rest are normal. It is, on the whole, interesting to note that the operated patients compare very favourably with the control subjects in the W170 and the maximum oxygen-intake values.

The use of hysteroscopy has been restricted a.o. by the need for general anesthesia. This applies in particular to the pre- or post-partum period, because the hyperemic atonic uterus is easily over-inflated to a dangerous level. Over-inflation did not occur following 50 aspirotomy D & E procedures in the second trimester, using a para- and intracervical block with lidocaine 1% with adrenaline 1:200,000 only. The uterine cavity was always thoroughly evacuated in these cases in which final check suction had been performed. We recommend that postabortum hysteroscopy should be performed preferably under local anesthesia.

90 hysteroscopies using CO2 were performed to evaluate differences in effectiveness between the customary curettage and the suction methods in terminating pregnancy during the first trimenon. Following suction, the uterine cavity was nearly always thoroughly evacuated. Very seldom is there any residual tissue seen. On the contrary, the uterine cavity following termination by customary curettage was almost never completely evacuated. Very often rest tissue of decidua, usually chorionic, in some cases with villous structures, were found. Tissue remnants following termination by either method were removed by target biopsy or curettage and examined histologically. Having made the above observations and comparison, it must be concluded that the suction method is clearly the more advantageous. If applied correctly, it becomes unnecessary to perform curettage right after the suction.

A new electrical apparatus for CO2 hysteroscopy is described. It adds an electric suction pump to the insufflator to fix the cervical cup securely and maintain the seal indefinitely. The apparatus was used in 257 patients without any untoward effects.

Sparing termination of pregnancy with a low incidence of complications, using the drainage method in local anaesthesia, can be effected on an outpatient basis. Carticain, which is a rapidacting anaesthetic with good analgesic effect, enables practically painless dilatation of the cervical channel with subsequent evacuation, when combined with good psychological guidance of the patient. When questioned postoperatively, practically all patients were in favor of local anaesthesia. Another positive aspect, in their opinion, was the fact that they could be discharged after brief hospitalization. Furthermore, treatment on an outpatient basis is cost-saving.

The acute toxicity, lethal dosage and mechanical effects of carbon dioxide gas were studied in the waking dog by intravenous and intra-arterial insufflation. The threshold dosage for toxicity was 400 ml per minute in the dog. The important factor in the toxicity was not the total volume of carbon dioxide but the volume per unit of time. Metabolic acidosis was responsible for changes in the EKG, the heart rate and the respiratory rate. These findings are discussed in relationship to the usage of carbon dioxide gas for hysteroscopy in the human female. During carbon dioxide gas hysteroscopy blood gas analyses were done in 40 patients. 28 patients had a hysteroscopy under general anaesthesia and 12 patients under local anaesthesia. It was found that the volume of carbon dioxide used for the creation of a pneumometra in hysteroscopy has no side effect. The necessary gas flow is too small for toxic side effects or mechanical side effects such as a gas embolisation.

Various pathomechanisms are responsible for the development of pulmonary arterial hypertension (PAH) in cystic fibrosis (CF). Main factors are chronic hypoxia and the loss of peripheral vessels caused by recurrent infectious lung disease and lung fibrosis. Measurement of pulmonary artery pressure and pulmonary resistance provide reliable information on PAH. Many non invasive procedures, including echocardiography, myocardial and pulmonary imaging by radionuclide, proved to be not sensitive enough to diagnose PAH. Arterialized pO2 (taken from the hyperemized ear lobe), however, measured during standardized submaximum work load, seems to be a valuable parameter to estimate PAH (r = 0.92). Treatment of PAH in CF-patients is, at the moment, predominantly based on the improvement of the general therapeutical regimen of CF and on long-term oxygen insufflation, which should be initiated as soon as there are first signs of PAH.