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The aim of this study was to systematically review the literature on antibiotic prophylaxis in gynaecologic surgeries to prevent inflammatory complications after gynaecological operations. The study was carried out as a systematic review. Only randomised controlled trials of women undergoing gynaecological surgery were included. The Medline and the Cochrane library databases were searched from 1966 to 2016. The trials must have investigated an antibiotic intervention to prevent an inflammatory complication after gynaecological surgery. Trials were excluded if they were not randomised, uncontrolled or included obstetrical surgery. Prophylactic antibiotics prevent inflammatory complications after gynaecological surgery. Prophylactic antibiotics are more effective in surgery requiring access to the peritoneal cavity or the vagina. Cefotetan appears to be more capable in preventing the overall inflammatory complication rate than cefoxitin or cefazolin. No benefit has been shown for the combination of antibiotics as prophylaxis. No difference has been shown between the long-term and short-term use of antibiotics. There is no need for the primary use of an anaerobic antibacterial agent. Antibiotics help to prevent postoperative inflammatory complications after major gynecologic surgeries.

MedAustron, das Zentrum fur Ionentherapie und Forschung in Wiener Neustadt/Osterreich, wird Ende 2016 den Patientenbetrieb aufnehmen. Die Behandlung mit Protonen und Kohlenstoffionen stellt eine Erweiterung des radioonkologischen Therapiespektrums dar. Bedingt durch das physikalische Verhalten der Ionen bezuglich der steuerbaren Eindringtiefe und Energiedeposition in Materie ist eine verbesserte Schonung der umgebenden gesunden Organe und Gewebe moglich. Die Radiologietechnologen konnen in enger interdisziplinarer Zusammenarbeit mit Radioonkologen und Medizinphysikern entscheidend zur erfolgreichen Behandlung von Tumorpatienten beitragen.

Akute Vergiftungen sind haufige Probleme in der Akut- und Notfallmedizin. Im Erwachsenenalter uberwiegen hierbei Intoxikationen mit Arzneimitteln. Eine subtile Anamnese sowie sorgfaltige klinische Untersuchung sind die Grundlage der Diagnostik. Anhand des klinischen Erscheinungsbilds lassen sich typische Toxidrome abgrenzen. Als zusatzliche diagnostische Masnahmen sind ein Drogenscreening im Urin sowie eine Blutalkoholbestimmung schnell und breit verfugbar. Als wichtigste therapeutische Masnahme steht die Sicherung der Vitalparameter im Vordergrund. Der fruhzeitige Kontakt mit einem Giftinformationszentrum ist fur die Einschatzung der Gefahrdung und das weitere Prozedere hilfreich. Primare und sekundare Eliminationsverfahren bedurfen einer kritischen Indikationsstellung und zeichnen sich durch eine meist geringe Evidenz aus. Nur in sehr wenigen Vergiftungsfallen ist ein spezifisches Antidot verfugbar.

Summary Objectives Scientific databases index numerous references related to the treatment of Kienbock's disease; yet little is known about the nature of the disease and its pathognomonic features. This study provides a cross-sectional analysis of the pattern and extent of osteonecrosis in a large cohort and a longitudinal analysis to determine the spontaneous disease progression in single patients who have not had surgical management until fragmentation of the lunate. Methods In a prospective case series, the pattern and extent of osteonecrosis were correlated with the duration of symptoms in all patients with Kienbock's disease confirmed using high-resolution 3-T magnetic resonance imaging (MRI) and ultra-thin section computed tomographic (CT) scan since 2009. Furthermore, a retrospective consecutive case series study was conducted to determine the rate of spontaneous evolution in all consecutive patients treated conservatively in our university hospital since 1990. Results Among the 35 consecutive patients with Kienbock's disease diagnosed in high-resolution 3-T MRI and ultra-thin section CT, 46% (16/35) presented degeneration of lunate cartilage on CT scan in the first 12 months following the onset of symptoms. Median wrist pain duration of patients presenting a fracture of the lunate was 14 months. Thirty-one percent (11/35) of the patients had arthritis of the lunate, yet no fractures at the time of examination. Of 106 consecutive patients with Kienbock's disease and complete records, who did not have surgical intervention until fragmentation of the lunate, three cases were identified with well-documented spontaneous courses from apparently intact lunate morphology until fragmentation within 6 months. Conclusions Kienbock's disease progresses substantially faster than previously described and, contrary to current classifications, the articular cartilage of the lunate degenerates in early stages. Level of evidence : Diagnostic accuracy, Level IV.

BACKGROUND: Multiple hypotheses regarding the cause of Kienbock disease have been proposed in seemingly contradictory small case series and cohort studies with inadequate statistical power. A prospective case-control study was conducted to analyze frequently discussed risk and causal factors. METHODS: Eighty-one consecutive patients with Kienbock disease and 198 patients with wrist ganglia were referred to the authors' clinic between 1990 and 2012, and 2003 and 2011, respectively. Patients with wrist ganglia were chosen as a control group because of the similar age distribution compared with the general population and because the common etiopathologic features of wrist ganglia and Kienbock disease can be excluded. Demographic, occupational, and medical information, including age, sex, handedness, ethnicity, education, occupation and employment status, prior treatment, and medical history were collected. Associated conditions and medication were assessed at a follow-up examination. RESULTS: Sixty-five of 81 patients with Kienbock disease and 70 of 198 controls were included in the study. Both groups were comparable with respect to age distribution and handedness. Employment status and job characteristics were similar in both groups. Hand-arm vibration during work or leisure activity over a period of 2 years was present in 23 percent with Kienbock disease and in 24 percent of 70 controls. Cortisone was used in six of 65 cases with Kienbock disease [controls, zero of 70] for an average duration of 46 months. CONCLUSIONS: Trauma, hand-arm vibration, heavy manual labor, and comorbidities were not associated with Kienbock disease. Steroid-associated Kienbock disease in six of 65 cases is consistent with the findings reported for osteonecrosis of other parts of the skeleton. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Background and Purpose— Strokes have especially devastating implications if they occur early in life; however, only limited information exists on the characteristics of acute cerebrovascular disease in young adults. Although risk factors and manifestation of atherosclerosis are commonly associated with stroke in the elderly, recent data suggests different causes for stroke in the young. We initiated the prospective, multinational European study Stroke in Young Fabry Patients (sifap) to characterize a cohort of young stroke patients. Methods— Overall, 5023 patients aged 18 to 55 years with the diagnosis of ischemic stroke (3396), hemorrhagic stroke (271), transient ischemic attack (1071) were enrolled in 15 European countries and 47 centers between April 2007 and January 2010 undergoing a detailed, standardized, clinical, laboratory, and radiological protocol. Results— Median age in the overall cohort was 46 years. Definite Fabry disease was diagnosed in 0.5% (95% confidence interval, 0.4%–0.8%; n=27) of all patients; and probable Fabry disease in additional 18 patients. Males dominated the study population (2962/59%) whereas females outnumbered men (65.3%) among the youngest patients (18–24 years). About 80.5% of the patients had a first stroke. Silent infarcts on magnetic resonance imaging were seen in 20% of patients with a first-ever stroke, and in 11.4% of patients with transient ischemic attack and no history of a previous cerebrovascular event. The most common causes of ischemic stroke were large artery atherosclerosis (18.6%) and dissection (9.9%). Conclusions— Definite Fabry disease occurs in 0.5% and probable Fabry disease in further 0.4% of young stroke patients. Silent infarcts, white matter intensities, and classical risk factors were highly prevalent, emphasizing the need for new early preventive strategies. Clinical Trial Registration Information— URL: http://www.clinicaltrials.gov .Unique identifier: NCT00414583

Purpose This prospective clinical study examined standard wrist magnetic resonance imaging (MRI) examinations and the incremental value of computed tomography (CT) in the diagnosis of Kienbock's disease (KD) with regard to reliability and precision in the different diagnostic steps during diagnostic work-up. Materials and methods Sixty-four consecutive patients referred between January 2009 and January 2014 with positive initial suspicion of KD according to external standard wrist MRI were prospectively included (step one). Institutional review board approval was obtained. Clinical examination by two handsurgeons were followed by wrist radiographs (step two), ultrathin-section CT, and 3 T contrast-enhanced MRI (step three). Final diagnosis was established in a consensus conference involving all examiners and all examinations results available from step three. Results In 12/64 patients, initial suspicion was discarded at step two and in 34/64 patients, the initial suspicion of KD was finally discarded at step three. The final external MRI positive predictive value was 47%. The most common differential diagnoses at step three were intraosseous cysts (n = 15), lunate pseudarthrosis (n = 13), and ulnar impaction syndrome (n = 5). A correlation between radiograph-based diagnoses (step two) with final diagnosis (step three) showed that initial suspicion of stage I KD had the lowest sensitivity for correct diagnosis (2/11). Technical factors associated with a false positive external MRI KD diagnosis were not found. Conclusion Standard wrist MRI should be complemented with thin-section CT, and interdisciplinary interpretation of images and clinical data, to increase diagnostic accuracy in patients with suspected KD.

Background – In patients with acute middle cerebral artery (MCA) occlusion, recanalization rates with intravenous (IV) recombinant tissue plasminogen activator (rtPA) are limited. Aim– We evaluated the feasibility and safety of combined IV thrombolysis with abciximab and reduced dose rtPA in a 3- to 6-h time window. Methods – We prospectively (March 2002 to February 2005) studied patients with symptomatic MCA occlusion on computed tomography (CT) angiography and absence of major early ischemic changes (EIC) on non-contrast CT (NCCT) within 3–6 h from symptom onset. Patients were treated with IV abciximab and half-standard dose rtPA. Outcome parameters were symptomatic intracerebral hemorrhage (sICH), early clinical improvement and functional independence at discharge (modified Rankin Scale score ≤ 2). Results – Of 13 patients, mean age was 62 ± 11 years, onset-to-treatment time 4.8 ± 0.9 h and median baseline National Institutes of Health Stroke Scale score 11 (interquartile range 6.5–13.5). sICH occurred in one patient (8%). We observed early clinical improvement in four patients (31%). Six patients (46%) were functionally independent at discharge. Conclusions – In patients with acute symptomatic MCA occlusion and absence of major EIC on NCCT, combined IV thrombolysis with abciximab and half-standard dose rtPA was feasible and seemed to be safe if applied within 3–6 h from symptom onset.

PURPOSE: The purpose of this study was to evaluate the results and complications of percutaneous nephrolithotomies performed within 5 years in our patients. MATERIALS AND METHODS: From 2001 to 2005 in our department 158 percutaneous nephrolithotomies (PNL) in 131 patients and 138 renal units were performed. The indications for PNL were calculus greater than 2 cm, failed ESWL, and when there is additional urinary obstruction which was not caused by the stone itself. Data concerning past medical history, about the procedure including complications and the postoperative course were collected and evaluated. RESULTS: 87 (63 %) of the patients had a history of prior stones. The main symptoms were flank pain, recurrent renal colic and urinary tract infection. The stones treated had a size from 5 to 60 mm. In 40 patients (29 %) relief of urinary obstruction (double-J-ureteral stent or percutaneous nephrostomy) or ESWL was performed prior to PNL. Mean operating time was 83 (30 - 235) minutes including retrograde placement of a ureteral catheter and nephrostomy. Complications occurred in 26 (16.5 %) procedures. Severe complications were: one fatal pulmonary embolism, one septicaemia, three open revisions (including one nephrectomy) and four blood transfusions for blood loss. In 94 patients (68 %) there was no residual stone or gravel after the first PNL. No further therapy was necessary in 17 (39 %) of the 44 patients with incomplete stone removal. 19 patients underwent a secondary PNL. In these procedures the efficacy decreased. 102 of 131 patients (138 renal units = 73.9 %) were discharged without residual stone after 158 procedures. CONCLUSIONS: PNL is an efficient and rarely complicated procedure for larger stones of the upper urinary tract. Even so, the occurrence of severe complications must be considered. Complications can be minimised by the use of a standardised therapeutic pathway.

Markku Kaste ja Filip Scheperjans työryhmän jäsenenä. Background: The kidney-brain interaction has been a topic of growing interest. Past studies of the effect of kidney function on intracerebral hemorrhage (ICH) outcomes have yielded inconsistent findings. Although the second, main phase of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) suggests the effectiveness of early intensive blood pressure (BP) lowering in improving functional recovery after ICH, the balance of potential benefits and harms of this treatment in those with decreased kidney function remains uncertain. Study Design: Secondary analysis of INTERACT2, which randomly assigned patients with ICH with elevated systolic BP (SBP) to intensive (target SBP 90, 60-90, and Outcomes: The effect of admission eGFR on the primary outcome of death or major disability at 90 days (defined as modified Rankin Scale scores of 3-6) was analyzed using a multivariable logistic regression model. Potential effect modification of intensive BP lowering treatment by admission eGFR was assessed by interaction terms. Results: Of 2,623 included participants, 912 (35%) and 280 (11%) had mildly and moderately/severely decreased eGFRs, respectively. Patients with moderately/severely decreased eGFRs had the greatest risk for death or major disability at 90 days (adjusted OR, 1.82; 95% CI, 1.28-2.61). Effects of early intensive BP lowering were consistent across different eGFRs (P = 0.5 for homogeneity). Limitations: Generalizability issues arising from a clinical trial population. Conclusions: Decreased eGFR predicts poor outcome in acute ICH. Early intensive BP lowering provides similar treatment effects in patients with ICH with decreased eGFRs. Am J Kidney Dis. 68(1): 94-102. (C) 2016 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc. This is an open access article under the CC BY-NC-ND license.

Hintergrund: Die Lyme-Borreliose wird als eine mogliche Ursache fur die akute Innenohrschwerhorigkeit und den akuten peripheren isolierten Vestibularisausfall diskutiert. Uber die Notwendigkeit einer serologischen Diagnostik und deren therapeutische Konsequenzen gibt es gegensatzliche Auffassungen. Patienten und Methoden: In der vorliegenden Studie wurden 344 Patienten mit akuter Innenohrschwerhorigkeit sowie 66 Patienten mit akutem peripherem isolierten Vestibularisausfall retrospektiv betrachtet. Die Ermittlung der spezifischen Pravalenzen von IgG- und IgM-Antikorpern im Serum gegen die Spirochaten erfolgte mittels ELISA (Enzygnost® Borreliosis, Dade Behring Marburg). Die Haufigkeiten beider Erkrankungen wurden mit den Literaturangaben verglichen. Neurootologische Befunde von seropositiven Patienten wurden denen von seronegativen Patienten gegenubergestellt und statistisch analysiert. Ergebnisse: Bei 15,7 % der Patienten mit einer akuten Innenohrschwerhorigkeit konnten IgG-Antikorper gegen Borrelia burgdorferi nachgewiesen werden. Der IgM-Titer war bei 4,7 % der Patienten erhoht. Die Seropravalenzen fur IgM und IgG lagen leicht uber den in der Literatur beschriebenen Prozentsatzen fur die klinisch unauffallige Bevolkerung. Erkrankte mit IgM-Antikorpern zeigten gegenuber den IgG-positiven ofter apikocochlear betonte Horstorungen. Patienten mit akutem peripheren isoliertem Vestibularisausfall hatten haufiger IgG-Antikorper gegen Borrelien (18,2 %) als Gesunde. Der IgM-Titer lag bei ihnen mit 1,5 % im Rahmen der Literaturangaben fur scheinbar Gesunde. Die seropositiven Erkrankten zeigten bei beiden Krankheitsbildern keine bedeutsamen neurootologischen Befundunterschiede im Vergleich zu den seronegativen Erkrankten. Schlussfolgerungen: Die leicht erhohten Seropravalenzen konnten dafur sprechen, dass Borrelieninfektionen eine mogliche, seltene Ursache fur die akute Innenohrschwerhorigkeit sowie den akuten peripheren isolierten Vestibularisausfall sind. Horstorungen im Tieftonbereich scheinen ein neurootologisches Kriterium darzustellen, das auf eine Borreliose hinweisen kann, wenn seropositive Titer vorliegen. Beim Nachweis von IgM-Antikorpern ist eine orale Antibiotikatherapie (Doxycyclin, Cefuroxim) zu empfehlen. Auch eine isolierte IgG-Titererhohung kann fur eine prasente Infektion sprechen. Bei Patienten mit akutem peripherem isolierten Vestibularisausfall sollte eine Neuroborreliose mittels Lumbalpunktion ausgeschlossen werden. Background: Lyme disease has been described as one possible cause of sudden sensorineural hearing loss and vestibular neuronitis. The necessity of serological diagnosis and its therapeutic consequences have been discussed controversially. Patients and Methods: 344 patients with acute sensorineural hearing loss and 66 patients with vestibular neuronitis were examined in retrospect. By means of ELISA (Enzygnost® Borreliosis, Dade Behring Marburg) the specific prevalences of IgG- and IgM-antibodies against borrelia in serum were evaluated. The frequency of seroprevalences for both diseases were compared to those given in the literature. Neurootological findings of the seropositive patients were compared with those of seronegative and analysed statistically. Results: 15,7 % of the patients with sudden sensorineural hearing loss had positive levels of IgG-antibodies. IgM-titers were elevated in 4,7 % of the patients. The seroprevalences for IgM and IgG were above those described by other investigators for the healthy population. Patients with positive IgM-antibodies showed more often low frequency hearing loss than IgG-positive patients. 18,2 % of the patients with neuronitis vestibularis had IgG- and 1,5 % IgM-antibodies against Borrelia. Whereas IgG occurred more often than known for the healthy population, IgM was within the limit for the healthy population. The seropositive group did not show any remarkable neurootological signs compared with the seronegative group. Conclusions: Because of the elevated seroprevalences Borrelia infections may be one possible but very rare cause of sudden sensorineural hearing loss and vestibular neuronitis. Low frequency hearing loss may be a sign for an infection with Borrelia as an etiological factor especially in combination with seropositive titers. In case of the presence of IgM-antibodies, patients may be treated with oral antibiotics (Doxycyclin, Cefuroxim). In patients with neuronitis vestibularis a neuroborreliosis should be excluded by means of lumbar puncture.

Ziel: In der vorliegenden Studie erfolgte die statistische Evaluierung klinischer Befunde auf der Grundlage der spezifischen Prävalenzen von IgG-, IgM- und IgA-Antikörpern gegen Herpes-simplex-Viren (HSV) und Varicella-zoster-Viren (VZV) in Serum bei Patienten mit akuter Innenohrschwerhörigkeit und akutem isoliertem peripherem Vestibularisausfall. Patienten und Methoden: Untersucht wurden Patienten mit akuter Innenohrschwerhörigkeit (HSV: n = 150, VZV: n = 104) und Vestibularisausfall (HSV: n = 60, VZV: n = 45), die sich zwischen 1996 und 2000 in stationärer Behandlung an der Universitäts-HNO-Klinik Jena befunden hatten. Die Seroprävalenzen wurden mittels ELISA (Dade Behring Enzygnost®-anti-HSV und -anti-VZV) ermittelt. Anamnestische Angaben und klinische Befunde von seropositiven wurden denen von seronegativen Patienten gegenübergestellt und statistisch analysiert. Ergebnisse: Der Grossteil (87,3%) der Patienten mit einem «Hörsturz» hatten erhöhte IgG-Titer gegen HSV, 9,3% waren gleichzeitig IgM-positiv. Die IgG-Prävalenz für VZV betrug 98,1%. Gut 4,8% waren IgM-positiv, 24% hatten eine erhöhte IgA-Konzentration, 2,9% waren IgM- und IgA-positiv. Bei Patienten mit Vestibularisausfall waren 90% HSV-IgG-positiv und 3,3% gleichzeitig IgM-positiv. Bei 100% war das VZV-IgG erhöht; 15,6% waren VZV-IgA-positiv, darunter 2 auch IgM-positiv. Die Altersverteilung der Patienten mit serologischem Hinweis auf eine HSV- oder VZV-Reaktivierung war zweigipfelig. Patienten mit eine «Hörsturz» mit möglicher HSV-Reaktivierung zeigten signifikant öfter Rezidiverkrankungen (36 versus 12%) sowie Ohrschmerz und Ohrdruck (21 versus 7%). Bei anti-VZV-IgA-positiven Erkrankten mit Vestibularisausfall lag häufiger eine Rezidiverkrankung (14 versus 5%) sowie ein vollständiger Erregbarkeitsausfall in der kalorischen Prüfung (71 versus 45%) vor. Schlussfolgerungen: Das Vorliegen einer Rezidiverkrankung und Ohrdruck bei akuter Innenohrschwerhörigkeit können Hinweise für eine HSV-Reaktivierung sein, Kopfschmerzen und ein Rezidivereignis bei Vestibularisausfall können für eine VZV-Reaktivierung sprechen.

Because of their frequency, non-opioid analgesics (NOA) single drug exposures registered by Poisons Information Centre (PIC) Erfurt have been studied over a decade.A retrospective analysis of frequencies, circumstances of exposure, symptom severity, and age groups in NOA single drug exposures received by the PIC Erfurt from the beginning of 2003 to the end of 2012 was undertaken.Of all 4749 NOA single drug exposures, the 10 most frequent were caused by paracetamol (n=1 686), ibuprofen (n=1 439), acetylsalicylic acid (n=456), dipyrone (n=274), diclofenac (n=267), flupirtine (n=138), naproxen (n=41), etoricoxib (n=36), indomethacin (n=24), and dexketoprofen (n=19). Paracetamol single drug exposures increased from 158 in 2003 to 216 in 2007 and fell afterwards to 133 in 2012. Ibuprofen single drug exposures continously rose from 57 in 2003 to 258 in 2012. Adults were more often involved in NOA (53.8%) and all single drug exposures (54.1%) than children (45.9% and 45.6%, respectively). Suicidal attempts were more frequent in NOA (43.1%) than in all single drug exposures (34.2%), whereas accidental exposures or exposures in abuse were less often (33.4 and 0.2%, 46.0 and 0.9% respectively). NOA single drug exposures resulted mostly in none to minor symptoms (77.0%) and rarely in moderate (2.1%) or severe symptoms (1.0%). One adult was found dead after probable ingestion of 32 g of acetylsalicylic acid in suicidal intention.Because many NOA are over-the-counter drugs, it is difficult to obtain data on their use. PIC data could provide information on the NOA use in the population.

The morphology of blood cells in the kidney and spleen of Xiphophorus helleri was characterized by electron microscopy. Erythrocytes, thrombocytes, lymphocytes, granulocytes and monocytes/macrophages were identified. Thrombocytes were elongate and contained bundles of microtubules and a canalicular system. Lymphocytes were heterogeneous in morphology. Granulocytes were divided into two types, based on the light microscopic results, which were extended by the present electron microscopic study. Neutrophils and eosinophils differed in abundance, cell shape, morphology of the nucleus and granula. Neutrophils displayed a spherical to three-lobulated nucleus and different types of granula. Several intermediate forms of granula were observed. The complement of granules displayed a different composition in the cells. These findings suggest a maturation process of a single type of granulum rather than several types. Eosinophils also contain different types of granula, described as G1–G4. The cell shape was variable and nuclei were small and eccentric. Monocytes and macrophages frequently showed autophagocytotic figures. A peroxidase reaction was observed only in the granula of neutrophils.

The purpose of this study was to get information on all human exposures to veterinary medicines (HEVM) reported to the Poisons Information Centre (PIC) over a 10-year period.A retrospective analysis of all HEVM was undertaken and a comparison was made to all human exposures (HE) registered by the PIC from the beginning of 2003 to the end of 2012 according to frequencies, circumstances of exposure, symptom severity, age groups, and substances involved in HEVM.In total, 389 cases of HEVM with 409 veterinary medicines were registered (0.30% of all HE, 360 monoexposures). The relative frequency of children and adults in HEVM (children: 52.4%, adults: 46.0%) and all HE (children: 48.7%, adults 48.7%) was the same with significant (p0.05) differences in some age subgroups. The portion of accidental exposures was significantly (p0.05) higher in HEVM (83.3%) than in all exposures (59.3%), whereas the portion of suicidal exposures was significantly (p0.05) lower (HEVM: 6.4%, all exposures: 23.6%). Most frequent veterinary medicines (ATCvet) in HEVM were antiparasitic substances, insecticides and repellents (n=185), substances for the nervous system (n=48), substances for the cardiovascular system (n=35), and immunologicals (n=35). HEVM mostly resulted in no or mild symptoms (83.8%) and rarely in moderate (10/389, 2.6%) or even severe symptoms (5/389, 1.3%). In 4 of 5 cases of HEVM with severe symptoms, veterinary surgeons used products for animal euthanasia (n=3) or methadone (n=1). Once, self-medication with anthelmintics for several days by a goatherd resulted in transient blindness.In comparison to other HE, HEVM are rare. Most accidental HEVM in laymen result only in none to mild symptoms. If veterinary surgeons, however, swallow or inject products for animal euthanasia or opioids in suicidal intention, severe symptoms can be expected.

Because of their importance for clinical toxicology, developments of sub-stance abuse reported to the Poisons Information Centre (PIC) Erfurt were investigated and compared to other reasons of human exposures.A retrospective analysis of all human exposures (exposures of humans to substances in abuse, accidental and unknown circumstances, and suicide attempts) (n=125,130) from the beginning of 2002 to the end of 2011 was undertaken according to substance classes, reasons of exposures, symptom severity, age groups, and gender.Cases of substance abuse (3,760, 3.0% of all exposures) continuously increased from 252 (92 with one and 160 with multiple substances) in 2002 to 507 in 2011 (239 with one and 268 with multiple substances). In relation to all exposures, only the abuse of multiple substances rose significantly (p0.001). In comparison to all substances of exposure, ethanol, amphetamine-type stimulants, benzodiazepines/analogues, and liquid ecstasy abuse significantly (p0.005) increased while cannabis and Brugmansia/Datura species abuse significantly (p0.05) decreased. Substance abuse significantly (p0.001) more often caused moderate (23.7%) and severe symptoms (6.1%) than in suicide attempts (9.6%; 4.4%). First legal highs exposures were registered in 2010 and led significantly (p0.001) more often to moderate symptoms (50%) than cannabis exposures (19.4%).The clinical significance of substance abuse is shown by the fact that it resulted more often in moderate and severe symptoms than suicide attempts. Data on substance abuse from PICs could supplement official annual drug reports in aspects of clinical toxicology.

Negative ulnar variance has been associated with Kienböck disease, both supporting a causal link and providing a basis for therapeutic recommendations. The aim of this study was to determine whether there is a causal relationship between Kienböck disease and negative ulnar variance.The causal relationship between Kienböck disease and negative ulnar variance was assessed using three methodologies: (1) an analysis of the quantitative and qualitative distribution of ulnar variance in a case-control study of 81 patients with Kienböck disease and a control group of 212 healthy wrists; (2) a systematic literature review and meta-analysis of six case-control studies (including the case-control study presented in this article) to test for an association between Kienböck disease and negative ulnar variance; and (3) a determination of causal relationship by using the Bradford Hill criteria.The case-control study indicated that when Kienböck disease is associated with negative ulnar variance (59 of 81), in 75 percent of the cases negative ulnar variance was equal (29 of 59) or less (15 of 59) pronounced on the contralateral healthy side. The odds ratio generated from the meta-analysis demonstrated a significant association between Kienböck disease and negative ulnar variance (OR, 3.58; 95 percent CI, 1.59 to 8.06; p = 0.002, random effects method). Six of nine Bradford Hill criteria do not support a causal relationship.The significant association between Kienböck disease and negative ulnar variance can be well explained by selection bias because magnetic resonance imaging, which may detect and allow exclusion of a potential ulnar impaction syndrome, was performed in only the Kienböck disease group in all six case-control studies. The application of the Bradford Hill criteria does not provide sufficient scientific evidence to support a causal relationship between Kienböck disease and negative ulnar variance.Risk, III.

En cas de malformation de l'innervation colorectale, les decouvertes histologiques et histochimiques sont susceptibles de permettre une classification de l'etat morphologique et d'indiquer aux chirurgiens pediatres la direction therapeutique. Les limites de ces faits resultent de malfacons techniques, de la localisation des structures morphologiques dependant de l'âge et de la subjectivite de l'examen. Une investigation quantitative biochimique des activites cholinesterasiques dans des specimens de muqueuse rectale homogeneisee ou des segments intestinaux reseques, a ete pratiquee. Les valeurs standard biochimiques de la AChE-activite depassent 3-6×10 -7 mol Ach/min/g qui sont des valeurs normales et le pourcentage d'esterases specifiques/esterases non specifiques qui est de 1,1 a 1,3. Le pourcentage de AChE par rapport a l'activite enzymatique totale etait de 47,5%. La distribution standard des differentes structures cholinesterasiques globulaires et asymetriques est precisee par la proportion des types moleculaires G1/G2/G4 et A12. Ces types principaux determinent la nature biochimique du rectum humain. L'hypertrophie des fibres nerveuses cholinergiques dans les segments intestinaux aganglionnaires est correlee par les examens biochimiques avec l'augmentation de la cholinesterase entrainee par le tetramer G4 a haut pouvoir moleculaire. Cependant la maladie de Hirschsprung ne peut pas etre differenciee par le pourcentage de l'activite AChE par rapport a l'activite ChE a cause de l'augmentation permanente de BChE dans le tissu aganglionnaire. Les dysplasies intestinales neuronales avec l'hyperplasie des fibres nerveuses cholinergiques sont caracterisees par des perturbations du dualisme et de l'interrelation des differentes cholinesterases. Par le moyen des investigations biochimiques, les facteurs subjectifs dans la determination des etats histochimiques peuvent etre evites et le diagnostic mieux precise. Le traitement correspondant s'est toujours montre satisfaisant dans notre Clinique

The sulphhydryl group containing drug N-(2-mercaptopropionyl)-glycine (MPG) was tested as a cytoprotective substance for storage of human platelets for transfusion. Autologous platelets stored for 48 h at 21 ± 1°C in the absence (control-platelets) or in the presence (MPG-platelets) of MPG, respectively, were labelled with Indium-III oxine and retransfused into the healthy donors. Significantly higher survival and a higher spleen/liver-ratio were obtained using stored MPG-platelets compared to stored control-platelets. Additionally, a very strong correlation was found between the percentage of discocytes counted after incubation of stored platelets in fresh plasma in vitro and the survival of stored platelets after retransfusion in vivo.

Zusammenfassung Ein 15-jahriges Madchen trank in einer Diskothek eine unbekannte Flussigkeit. Nach 3-stundigem Klinikaufenthalt erwachte sie ohne Nachwirkungen. Es standen 2 Blutproben (Abnahme ca. 6 h und 8,5 h nach Ingestion) und 2 Urinproben (Abnahme ca. 6 h und 9,5 h nach Ingestion) fur die toxikologischen Untersuchungen zur Verfugung. Das Drogenscreening auf Kannabinoide, Opiate, Kokain und Amphetaminderivate und das Arzneimittelscreening mit HPLC/DAD verliefen im Blut und im Urin negativ. Mit GC/MS wurde γ-Hydroxybuttersaure nachgewiesen. Folgende Konzentrationen wurden ermittelt: Etwa 6 h nach Ingestion im Serum: 4,1 µg/ml. Etwa 8,5 h nach Ingestion im Serum: Konzentration unter der Nachweisgrenze von 1 µg/ml. Etwa 6 h nach Ingestion im Urin: 365 µg/ml. Etwa 9,5 h nach Ingestion im Urin: 176 µg/ml. Die relativ niedrige Konzentration in der 1. Blutprobe und das Nichtauffinden von γ-Hydroxybuttersaure (GHB) in der 2. Blutprobe sind auf die kurze Halbwertszeit (durchschnittlich 27 min) zuruckzufuhren. Die Konzentration in der 1. Blutprobe lasst aber den Ruckschluss zu, dass diese zum Ingestionszeitpunkt oberhalb des therapeutischen Bereiches lag (50–120 µg/ml). An GHB als Noxe sollte immer gedacht werden, wenn trotz einer fur Opiate typischen Symptomatik das Drogenscreening und das mit HPLC/DAD durchgefuhrte Arzneimittelscreening negativ verlaufen.

In patients with acute middle cerebral artery (MCA) occlusion, recanalization rates with intravenous (IV) recombinant tissue plasminogen activator (rtPA) are limited. Aim- We evaluated the feasibility and safety of combined IV thrombolysis with abciximab and reduced dose rtPA in a 3- to 6-h time window.We prospectively (March 2002 to February 2005) studied patients with symptomatic MCA occlusion on computed tomography (CT) angiography and absence of major early ischemic changes (EIC) on non-contrast CT (NCCT) within 3-6 h from symptom onset. Patients were treated with IV abciximab and half-standard dose rtPA. Outcome parameters were symptomatic intracerebral hemorrhage (sICH), early clinical improvement and functional independence at discharge (modified Rankin Scale scoreor = 2).Of 13 patients, mean age was 62 +/- 11 years, onset-to-treatment time 4.8 +/- 0.9 h and median baseline National Institutes of Health Stroke Scale score 11 (interquartile range 6.5-13.5). sICH occurred in one patient (8%). We observed early clinical improvement in four patients (31%). Six patients (46%) were functionally independent at discharge.In patients with acute symptomatic MCA occlusion and absence of major EIC on NCCT, combined IV thrombolysis with abciximab and half-standard dose rtPA was feasible and seemed to be safe if applied within 3-6 h from symptom onset.

The effect of halothane on the regulation of blood platelet free cytosolic calcium was investigated in Quin-2-loaded cells from patients susceptible to Malignant Hyperthermia (MH) and healthy controls, respectively. The resting level of free cytosolic calcium was slightly, but statistically significantly, enhanced in platelets from patients (90 ± 10 nM vs 110 ± 35 nM). Halothane induced a dose-dependent, rapid Ca 2+ release from intracellular stores both in normal and in MH derived cells, but the resulting increase in cytosolic calcium was significantly higher in the latter (2 mM halothane: [Ca 2+ ] i = 117 ± 12 nM vs 218 ± 117 nM; 4 mM halothane: 225 ± 35 nM vs. 417 ± 201 nM). Whereas in platelets from healthy donors a complete reversibility of the halothane effect could be observed within 30–45 min, the cytosolic Ca 2+ transients in platelets from patients were different from those in normals either in a higher initial peak or in a diminished decline velocity or in both. The basal Ca 2+ permeability of the platelet plasma membrane was very low. Generally, halothane caused a dose-dependent increase in Ca 2+ permeability. However, the influx of external calcium was significantly higher in platelets from patients than in controls (2 mM halothane: Δ[Ca 2+ ] i = 69 ± 12 nM vs 135 ± 63 nM; 4 mM halothane: 127 ± 33 nM vs. 258 ± 111 nM). Combining the results, the suggestion can be made that susceptibility to MH is characterized by a generalized membrane defect. A fast halothane-induced intracellular Ca 2+ release and an increased Ca 2+ permeability of the plasma membrane seem to be of particular importance for adverse cellular reactions on exposure to the anaesthetic.

1,2,3-Triazabutadienes. XXII. Photochemistry of 1-(Carbmethoxy-aryl)- and 1-(Carboxy-aryl)-3-(3-alkyl-benzthiazolinyliden-(2))-triazenes as potential CEL-dyes 1-(Carbmethoxy-aryl)-3-(3-alkyl-benzthiazolinyliden-(2))-triazenes (ester-triazenes) (1) were synthesized by coupling of substituted 3-alkyl-2-imino-benzthiazolines-(1,3) with 2-, 3- and 4-carbmethoxy-benzenediazonium salts. The Z-isomers obtained can be transformed into the E-isomers 2 photochemically or by heating. In the presence of acids the E-ester-triazenes are protonated. From the E-ester-triazenes the potassium-salts (4) can be produced by alkaline ester hydrolysis. With hydrochloric acid the E-triazene-potassium salts (4) can be transformed into the protonated (at the N(1)-Atom) E-acid-triazenes (5). Their photochemical properties are identical with those of the protonated E-ester-triazenes (3). The 1-(carboxy-aryl)-3-(3-alkyl-benzthiazolinyliden-(2))-triazenes (E-acid-triazenes) (6) can be obtained from the protonated derivates by deprotonation in the presence of water. The photochemical behaviour of the E-acid-triazenes (6) and of the E-triazene-potassium-salts (4) depends on the position of the carboxy-group (2-position: photolysis, 3- and 4-position: photoisomerization). The uv/vis-spectroscopical and photochemical properties of the triazene-derivates in solution and in polymeric layers are discussed.

The purpose of this study was to evaluate the results and complications of percutaneous nephrolithotomies performed within 5 years in our patients.From 2001 to 2005 in our department 158 percutaneous nephrolithotomies (PNL) in 131 patients and 138 renal units were performed. The indications for PNL were calculus greater than 2 cm, failed ESWL, and when there is additional urinary obstruction which was not caused by the stone itself. Data concerning past medical history, about the procedure including complications and the postoperative course were collected and evaluated.87 (63 %) of the patients had a history of prior stones. The main symptoms were flank pain, recurrent renal colic and urinary tract infection. The stones treated had a size from 5 to 60 mm. In 40 patients (29 %) relief of urinary obstruction (double-J-ureteral stent or percutaneous nephrostomy) or ESWL was performed prior to PNL. Mean operating time was 83 (30 - 235) minutes including retrograde placement of a ureteral catheter and nephrostomy. Complications occurred in 26 (16.5 %) procedures. Severe complications were: one fatal pulmonary embolism, one septicaemia, three open revisions (including one nephrectomy) and four blood transfusions for blood loss. In 94 patients (68 %) there was no residual stone or gravel after the first PNL. No further therapy was necessary in 17 (39 %) of the 44 patients with incomplete stone removal. 19 patients underwent a secondary PNL. In these procedures the efficacy decreased. 102 of 131 patients (138 renal units = 73.9 %) were discharged without residual stone after 158 procedures.PNL is an efficient and rarely complicated procedure for larger stones of the upper urinary tract. Even so, the occurrence of severe complications must be considered. Complications can be minimised by the use of a standardised therapeutic pathway.

Lyme disease has been described as one possible cause of sudden sensorineural hearing loss and vestibular neuronitis. The necessity of serological diagnosis and its therapeutic consequences have been discussed controversially.344 patients with acute sensorineural hearing loss and 66 patients with vestibular neuronitis were examined in retrospect. By means of ELISA (Enzygnost Borreliosis, Dade Behring Marburg) the specific prevalences of IgG- and IgM-antibodies against borrelia in serum were evaluated. The frequency of seroprevalences for both diseases were compared to those given in the literature. Neurootological findings of the seropositive patients were compared with those of seronegative and analysed statistically.15.7 % of the patients with sudden sensorineural hearing loss had positive levels of IgG-antibodies. IgM-titers were elevated in 4.7 % of the patients. The seroprevalences for IgM and IgG were above those described by other investigators for the healthy population. Patients with positive IgM-antibodies showed more often low frequency hearing loss than IgG-positive patients. 18.2 % of the patients with neuronitis vestibularis had IgG- and 1.5 % IgM-antibodies against Borrelia. Whereas IgG occurred more often than known for the healthy population, IgM was within the limit for the healthy population. The seropositive group did not show any remarkable neurootological signs compared with the seronegative group.Because of the elevated seroprevalences Borrelia infections may be one possible but very rare cause of sudden sensorineural hearing loss and vestibular neuronitis. Low frequency hearing loss may be a sign for an infection with Borrelia as an etiological factor especially in combination with seropositive titers. In case of the presence of IgM-antibodies, patients may be treated with oral antibiotics (Doxycyclin, Cefuroxim). In patients with neuronitis vestibularis a neuroborreliosis should be excluded by means of lumbar puncture.

The Department of Clinical Pharmacology in Jena is a pharmacovigilance center in a study on intensified spontaneous adverse drug reaction reporting. Physicians specialized in clinical pharmacology screen admissions to the Department of Internal Medicine for possible adverse drug reactions. Because of the collaboration between the Pharmacology Department and the nearby Poison Information Center (PIC) in Erfurt the question occurred whether the latter might contribute to adverse drug reaction monitoring. We compared the ADR registered by the intensified spontaneous reporting system in 1999 with those of the PIC during the same period. Each symptom observed was regarded as 1 case. Every suspected drug was also treated separately. The symptoms were classified using adverse reaction terminology. The drugs were classified according to the WHO Anatomical Therapeutic Chemical (ATC) classification index. The causality assessment was based upon bibliographic data and the method of Bégaud et al. [1985]. Only possible, probable or very probable ADR were compared. The PIC registered mainly psychiatric and nervous system disorders sedation and extrapyramidal disorders were the most frequent reactions - unlike the pharmacovigilance study which registered primarily gastrointestinal and heart rate disorders. The PIC registered mainly drugs used in the therapy of disorders of the central nervous system, i.e. mostly psycholeptics and drugs acting on the alimentary tract, mostly anticholinergics. Drugs for the therapy of sensory organs disorders were frequent owing to the systemic and local adverse drug effects of anticholinergic mydriatics. The PIC and pharmacovigilance centers can benefit from co-operation. The PIC provides easy access to qualified drug information and is thus a useful tool in ADR evaluation. Although the number of adverse reactions assessed was small, their evaluation revealed problems in drug usage which would not otherwise be reported. The evaluation has enlarged the pool of ADR data which is the basis for signal detection.

In literature, cases of nutmeg abuse have been described repeatedly, but only one fatal case of poisoning was reported [1]. In the present case, myristicin (4 microg/ml) was detected for the first time in the postmortal serum of a 55-year-old woman. Identification was achieved with the aid of UV-VIS spectroscopy and TLC; for quantification, HPLC was used. Because also flunitrazepam (0.072 microg/ml) was found, death had probably been due to the combined toxic effect of both substances. From 1996 to 1998, in a series of cases, seven poisonings with nutmeg were recorded by the Erfurt Poison Information Centre. Even where higher doses (20-80 g of powder) had been ingested, a life-threatening situation was never observed. In one of these cases, a myristicin blood level of 2 microg/ml was measured 8h after ingestion of two to three tablespoonful of nutmeg powder (approx. 14-21 g, or 280-420 mg/kg).

Proximal tubule segment PII cells of marine elasmobranch fish were studied by transmission electron microscopy of thin sections, and X-ray microanalysis was performed with freeze-dried cryosections. Epithelial cells of PII are characterized by high and dense brush border at the apical side, elaborate folding of the lateral cell membrane and large basal extracellular labyrinth confined by a system of meandering cell extensions. Basal cytoplasmic zone, apical cytoplasmic zone, nuclei, mitochondria and apical small vacuoles were accessible for X-ray microanalysis. Concentrations of Na, Mg, P, S, Cl and K were different in the cytoplasmic zones along the basal-apical axis of the cell and in the organelles. PII cells lacked an apical tubulovesicular apparatus, instead they displayed an apical zone of smooth clear vesicles and small apical vacuoles. After freeze-drying, the small apical vacuoles and the smooth clear vesicles contained flocculent mass-dense material. Small apical vacuoles showed high concentrations of Mg (229 mmol/kg water), Na (132 mmol/kg water) and Cl (148 mmol/kg water). Sequestration of Mg in vesicles and small apical vacuoles and subsequent exocytosis between the microvilli of the brush border are supposed to be important steps in the transepithelial transport (tubular secretion) of magnesium by PII cells of marine fish.

We compared the anti-proliferative effects of natural interferon p (nlFN p) and recombinant interferon y (rlFN y) on 2 human melanoma cell lines, IGRl and SK-Me128, grown in 2-dimensional monolayer and in 3-dimensional spheroid culture. In monolayer culture, growth of both lines was inhibited in a dose-dependent manner by 5-day treatments with IFN in concentrations ranging between I and 5,000 IU/ml. Incubations with 120 IU/ml nlFN p or 25 IU/ml rlFN y led to a 50% growth inhibition of IGRl cells. A 50% growth inhibition of SK-Me128 cells was obtained with 60 IU/ml nlFN p, whereas even 5,000 IU/ml rlFN y inhibited the growth of this line by only 30%. Growing these melanoma cell lines in 3-dimensional spheroid culture for 5 days reduced their sensitivity to interferon. Growth inhibition values of 50% were achieved with 3,000 IU/ml rlFN y or 9,000 IU/ml nlFN p for IGRl spheroids and 10,000 IU/ml nlFN p for SK-Me128 spheroids, while 10.000 IU/ml rlFN y reduced the growth of SK-Me128 spheroids by only 25%. Outgrowth tests showed that the proliferative capacity after 5-day incubations with IFN was only reduced in IGRl spheroids treated with high doses of nlFN p. The macroscopically observed increased density of interferon-treated spheroids could be confirmed by light microscopy as corresponding to reduced intercellular space in these spheroids. Scanning electron microscopy furthermore showed variations on the surface of IFN-treated spheroids as well as in cellular organization and structures between cells, hinting at a possible involvement of extracellular matrix substances in the reaction to interferons. These findings show that the high anti-proliferative sensitivity of the melanoma cell lines in

Content and distribution of diffusible ions in epithelial cells were studied by scanning transmission electron microscopy and energy dispersive electron probe X-ray microanalysis of freeze-dried cryosections from trout kidney, rat liver and Malpighian tubules of Drosophila larvae. Cryofixation of small excised kidney and liver samples by rapid immersion into liquid propane resulted in intracellular K/Na-ratios1. In contrast, K/Na-ratios7 were obtained after in situ cryofixation by means of a cryopunching device which allows tissue pieces to be frozen during excision from the intact organ. Isolated hepatocytes cryofixed in a small droplet of culture medium had a K/Na-ratio of 3.7. After culturing the hepatocytes, the K/Na-ratio increased to 24. Effects of extracellular media of different composition on the intracellular element content were studied. Malpighian tubules of Drosophila larvae were cryofixed by rapid immersion into liquid propane, and the distribution of K across the cells forming the tubules from the basal to the apical cell membrane was measured. An increasing K gradient was found from the intermediate to the apical cytoplasm. The intracellular K distribution was dependent on ions and transport inhibitors present in the fluid surrounding the Malpighian tubules within the larvae. Content and distribution of ions in epithelial cells sensitively depend on the physiological state immediately before cryofixation. Thus, electron probe X-ray microanalysis of cells and cell functions requires careful selection and control of the cell system to be studied.

The ultrastructure of renal tubule cells was studied in the European lesser spotted dogfish by the evaluation of thin sections and freeze fracture replicas. Computer-assisted three-dimensional reconstruction of entire nephrons was performed. The distinction of nephron segments and collecting tubule was made using results of previous histological work. The first proximal tubule segment (PI) consists of two subsequent portions, PIa and PIb. PIa is a component of the lateral countercurrent bundle, and PIb, which displays an apical tubulovesicular apparatus and an extended lysosomal compartment, is located in the vicinity of the glomeruli. Rod-shaped intramembrane particles were detected in PIa. The second proximal tubule segment (PII) is a special segment in elasmobranch and teleost fish. PII differs largely from PI in cell morphology and function. The apical cytoplasm was filled with small clear vesicles, and an apical endocytic apparatus was lacking. In the apical cell membrane, rod-shaped particles were revealed by freeze fracture. The apical tight junctions of PI and PII consisted of seven to ten meandering strands. The distal nephron was subdivided into two major segments: early distal tubule (EDT) in the lateral countercurrent bundles and late distal tubule (LDT) in the mesial tissue. The EDT showed marked amplification of basolateral cell membranes. The tight junctions displayed a low number of continuous parallel strands, which is also characteristically found in the diluting segments of other vertebrates. LDT cells showed cytoplasmic studs and rod-shaped intramembraneous particles at the apical cell membrane, thereby resembling type A intercalated cells of collecting duct. The collecting tubule (CT) emerged from the LDT and was part of the countercurrent arrangement inside the lateral bundles. Tight junctions of LDT and CT consisted of many meandering strands in a honeycomb pattern. With immunohistochemistry, binding sites of a polyclonal antibody against an extraplasmic portion of rat gastric H(+)-K(+)-adenosine triphosphatase (ATPase) were observed at the apical cell membrane of PIa, PII, and LDT. From the colocalization of binding sites for the antibody against the transport enzyme with rod-shaped intramembrane particles, we assume that these might be the morphological correlate of gastric H(+)-K(+)-ATPase-like enzyme in the renal tubule.

The kidney is a complex zonated organ with a variety of different cell types. For the study of the functional and morphological features, the precise localization in the zones is relevant, which requires the evaluation of rather large portions of tissue. Transmission electron microscopy of replicas of tissue is limited by difficulties to obtain sufficiently large specimens. In order to overcome this problem cryopreparation methods and high resolution field emission scanning electron microscopy (SEM) were used.1 mm3 cubes of perfusion fixed rabbit kidneys cryoprotected with glycerol were frozen by plunging into liquid propane. For further preparation two different methods were employed.1: Samples were fractured in liquid nitrogen with a scalpel, freeze substituted using methanol with glutaraldehyde and osmiumtetroxid, warmed to room temperature, critical point dried, and coated by electron gun evaporation with 2 nm of platinum at an angle of 45°, and 10 nm of carbon perpendicularly.

Severe glomerular changes in the kidney of rainbow trout suffering from presumptive chronic viral haemorrhagic septicaemia are described. The pathological changes, as revealed by light- and electron microscopy, resembled those of membranous glomerulonephritis in mammals. Large electron-dense subendothelial-mesangial deposits were present in most glomeruli. A lattice-like arrangement of macromolecules was observed. Monocytes and macrophages were observed in the capillary convolute. The possibility of post-infectious disease nephropathy with aggregation of immunocomplexes in the capillary wall in fishes is discussed.

Perfusion fixation of trout kidney with picric-acid: formaldehyde: acetic acid: ethanol mixture was compared with other methods as a fixative for staining with the alcian-blue PAS technique. Perfusion fixation gave conspicuously better results for light microscopical purposes.

1. 1. Homogenates of tissues which participate in osmoregulation of fishes were assayed for N-acetyl-neuraminic acid (NANA). 2. 2. The kidneys were found to contain considerable amounts of NANA, in addition to well known sites of sialoglycoprotein production (e.g. gills, intestine, skin). 3. 3. The epithelia of freshwater fish (Carassius auratus, Cottus gobio) exhibited higher concentrations of NANA as compared with saltwater fish (Myoxocephalus scorpius). 4. 4. The biochemical results are discussed, for their functional significance.