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The thyroid gland of 536 patients of a medical hospital in an iodine deficient area was investigated by ultrasound. According to the sonographic pattern and to the scintigraphic imaging the focal lesions were analysed as micro- or macrofollicular adenomas, autonomous adenomas, cysts and chalk. The prevalence of goitres was 37.7%. The prevalence of goitres was higher in women (45%) than in men (30%). Focal lesions could be observed in 27.6%, equally more often in women (36%) than in men (18.9%). The frequency of focal lesions increased with the age of the patients and with the volume of the thyroid gland. Autonomous adenomas were found three times more often in women than in men. Hyperthyroidism was only observed in patients with nodules larger than 4 cm in diameter. Sonographic screening examinations of the thyroid gland seem to be useful in all patients of a clinic of medicine because of the risk (25%) of iodine contamination by diagnostic measures.

The results of preoperative ultrasound investigations were compared with the intraoperative findings in 42 patients (27 women, 15 men) operated on because of tumours of the cecum or colon ascendens. In 34 of 42 patients (i.e. 81%) the tumour could be correctly diagnosed by ultrasound. In 3 cases the investigator was not sure about imaging the tumour. Only in 5 cases (i.e. 12%) the tumour was not identified by ultrasound scanning. 4 out of these 5 patients had attended the hospital to be operated on because of a carcinoma of the rectum and the second carcinoma of the large bowel was found by chance intraoperatively. In 16 patients in whom the diagnosis of a large bowel carcinoma had not been established before, the tumour could be primarily diagnosed by ultrasound.

It is a clinically and experimentally well supported working hypothesis that infection with hepatitis B virus may result in chronic active hepatitis in patients with suspected immune deficiencies. On this basis, a pilot study was performed in order to evaluate the effect of "specific" transfer factor (TF) in the treatment of HBS-Ag-positive chronic active hepatitis. From the leukocytes of 500 ml venous blood each of 40 volunteers that had completely recovered from acute virus hepatitis B within the last 6 months, a unique TF pool (40 units of TF) was prepared according to the method of Lawrence. Preexaminations indicated that this preparation was able to enhance cellular immune reactions in vitro. Thirteen patients with HBS-antigenemia and chronic active hepatitis (i.e., two liver biopsies within the last 6 or more months with the histological criteria of chronic aggressive hepatitis according to de Groote, elevated serum levels of bilirubin, alkaline phosphatase, transaminase activities, and/or gamma-globulines) were randomized: Seven received s.c. injections of two units of TF each on days 1 and 15, the other six saline. Conversion of skin reactions to some ubiquitous antigens occurred in the TF group, but no significant and constant drop of HBS-Ag serum titers was observed. Although some of the biochemical parameters seemed to ameliorate in the TF group, the differences versus the control group did not prove to be significant within the limited number of patients under observation. The in vitro reactivity of patients' lymphocytes to HBS-Ag, tested by means of the 3H-thymidine uptake, was never found enhanced after TF application. In the used doses, "specific" TF was not effective in the treatment of HBS-Ag-positive chronic active hepatitis; unfavorable side-effects were not observed.

Circulating immune complexes (CIC) with a molecular weight (M.W.) of 1.4-1.6 x 10(6) were observed in patients with liver disease. CIC containing abnormal albumin were found in patients with chronic active hepatitis. The abnormal albumin from CIC displayed an apparent M.W. of 105-110,000 on Sephadex G-100 and Sepharose 6B column chromatograph before reduction, and only 50,000 on reduced sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). It is postulated that abnormal albumin contained within CIC may be a dimeric-S-S-linked small albumin (sAlb-S-)2. Immunoglobulins in the CIC containing (sAlb-S-)2 were identified as IgM and IgG. Based on the constituents of CIC and their M.W., the assumed molecular formula of CIC is (IgM)1 (sAlb-S-)2 (IgG)3. Cause and effect of these CIC in liver disease, especially a possible role of altered host components in the initiation of autoimmune reactions, are discussed.

Selective serum IgA deficiency and follicular lymphatic hyperplasia of the terminal ileum were observed in a 30-year-old patient. Due to the relative ileal stenosis he complained of colicky abdominal pains particularly after flatulant food. There was no malabsorption syndrome or lambliasis. Although immunohistochemically IgA producing plasma cells were demonstrated in the intestinal wall, no immunoglobulin could be demonstrated in the intestinal juice, suggesting a secretory defect. The very high percentage of IgE producing plasma cells was noteworthy, these cells having led to the macroscopical picture of follicular hyperplasia. Due to the relative frequency of IgA deficiency (about 1 : 700) and the known increased incidence of malignant disease regular surveillance of these patients is indicated.

A decrease in fibrin stabilizing factor (Factor XIII) is the most frequent coagulation disorder seen in adults with acute leukemia. Patients with prominent reduction of factor XIII (FSF) (less than 50%) were substituted with a factor XIII concentrate from human placenta, and factor XIII plasma concentration and bleeding tendency were followed up during the course of the disease. After substitution plasma, factor XIII activity went up to normal levels in most of the patients. As compared to the course of 12 patients with distinct factor XIII reduction without factor XIII therapy, there were less bleeding complications in 13 courses of patients with prominent reduction of factor XIII substituted with factor XIII concentrate and in 11 with normal or only slightly reduced factor XIII levels.

49 patients with disseminated bronchogenic carcinoma (small cell, 16;squamous cell, 17;large cell, 12;adeno, 4) were treated with a combination of adriamycin, cyclophosphamide, vincristine and DTIC. In a randomized series (21 patients) chemotherapy alone was compared to chemotherapy plus heparin. Partial remission was achieved in 8 patients with small cell carcinoma, in 5 patients with large carcinoma and in 2 patients with squamous cell carcinoma. The survival of patients who responded to therapy was greater than the survival of patients who did not respond to therapy. The duration of remission and the survival time was not longer in patients who had additional heparin therapy.

In recent studies extrahepatic manifestations of viral hepatitis have been recognized as immune complex diseases. Hepatitis B surface antigen (HBsAg) has been successfully identified in immune complexes, but the pathogenic role of HBsAg-containing immune complexes (IC) remains questionable. The subject of the present study was the antigen-specific determination of IC in the course of hepatitis B virus infection using a new HBsAg-specific IC test (Pernice & Sedlacek, 1978). This test is based on the following principle: rabbit anti-HBs-coated polystyrole test tubes are incubated with the IC-containing test sample. The HBsAg-containing IC bind to the solid phase by their free antigenic determinants. There they can be quantified using a peroxidase-labelled anti-human IgG antibody. A good correlation was found between the level of HBsAg-containing immune complexes and the clinical state of six patients in a follow-up study. IC could be detected simultaneously with HBsAg and either decreased or disappeared before the occurrence of free anti-HBs. In the sera of an additional twenty-eight patient suffering from chronic active hepatitis, HBsAg-containing immune complexes were detected in 85% of cases. One patient suffering from polyarteritis nodosa was also positive. Occasionally, extremely high levels of IC were found in the course of these diseases.

Combination chremotherapy with cyclophosphamide, vincristin, adriamycin and DTIC (CyVADIC") was used from 1974 to the middle of 1977 on 12 patients with various forms of metastisising soft-tissue sarcoma. An objective response was observed in seven of eleven patients. Full, although brief, remission occurred in two of six patients with fibrosarcoma and persists in one with an undifferentiated sarcoma. Partial remission was induced in one patients each with fibrosarcoma and alveolar-cell sarcoma. Mean survival time was 18 months. Those responding to treatment had a longer average survival time than those refractory to it. No statistically significant conclusions can be drawn because of the small number of patients, but these observations suggest that this combined treatment can favourable influence previously therapy-refractory forms of metastasising soft-tissue sarcoma.

Using the 125J-Clq deviation method according to Sobel, the polyethylenglycol precipitation test of Nydegger, and a Sepharose 6B column chromatography in a modification of MacLennan's method, circulating immune complexes (CIC) have been detected in 20--27% of patients with Hodgkin's lymphoma, in 8% of patients with non-Hodgkin lymphoma of low, and in 20--40% with high malignancy. CIC appeared in advanced stages of the diseases and correlated well with the activity of the disease. CIC disappeared in remissions and reappeared during reactivation of the disease. CIC were only found in patients with general symptoms, i.e. B-symptoms. The pathogenetic role of CIC in the initiation of B-symptoms and in tumor spread is still not fully explained. The antibody part of the CIC is IgG, the antigenic component has not yet been characterized.

A new assay for the detection of circulating immune complexes is described. It is based on the same principle as the C1q deviation test: the binding of radiolabelled C1q to a solid phase is inhibited by immune complexes. Trinitrophenylated polyacrylamide beads are used as a stable C1q-reactive solid phase in our test. Aggregated IgG in normal serum could be detected by this method to a minimum concentration of about 10 microgram/ml. The test was used to quantitate circulating immune complexes in sera of patients with glomerulonephritis, liver diseases, lymphoma, and myeloid leukemia. The results are compared and correlated with those obtained by the C1q binding assay for the same sera.

Baby hamster kidney cells fixed in acetone on glass slides were used as antigen for demonstration of antinuclear antibodies. Where certain storage conditions were observed (drying agent, 4 degrees C) they have kept for 12 months up to now. As regards specificity, sensitivity, reproducibility, and differentiation of fluorescent types the baby hamster kidney cell test appears superior to other immunofluorescence methods used (chicken erythrocytes, rat liver sections, and crithidiae). These results were obtained in 73 sera from patients with disseminated lupus erythematodes, drug-induced lupus erythematodes, discoid erythematodes, allergic vasculitis, progressive scleroderma, dermatomyositis, and 36 control sera.

During the course of acute viral hepatitis A and B, several humoral and cellular immune phenomena have been observed, part of which is predominantly or even exclusively associated with hepatitis B: 1. Relative and absolute counts for T-lymphocytes depressed and for "null" -cells elevated; 2. mild elevation of serum globulin levels; 3. IgM augmentation occurring fastly, pronounced, and long lasting in typical cases; 4. IgG augmentation occurring later, less pronounced, and for a shorter period in typical cases; 5. autoantibodies to smooth muscles and mitochondria in low titers in some patients; 6. specific antibodies to "e" -antigen (early) and HB-Ag (later in the course) in part of the cases with hepatitis B; 7. immune complexes including HB-Ag, IgG and probably IgM (and IgA) as well as complement in some cases; 8. depressed levels of the fourth component of complement and - in cases complicated by "allergic" symptoms - of C3, C4, and total complement; 9. occurrence of activated lymphocytes ("virocytes") in peripheral blood; 10. enhanced spontaneous lymphocytic DNA-synthesis; 11. enchanced phytohaemagglutinin stimulation of lymphocytes; 12. mild lymphocyte proliferation to HB-Ag in part of the acute and convalescent cases of hepatitis B; 13. production of migration inhibition factor to liver specific protein (and HB-Ag) or lymphocytes in different percentages of patients with hepatitis B. Origin, diagnostic and prognostic importance, as well as pathogenetic revelance of the described immune phenomena are discussed.

A 30-year-old Turk was admitted with signs of exudative enteropathy together with malabsorption. There was no improvement on a gluten-free diet. Immunological investigations demonstrated atypical IgA-immunoglobulin in the serum which did not precipitate with antisera against L-chains. Peroral ileal biopsy and surgical biopsy material showed a diffuse proliferation of plasma cells in an altered ileal mucosa and in the mesenteric lymph nodes. Skeletal X-rays showed no osteolysis and the bone marrow showed no evidence for multiple myeloma. Treatment with melphalan and steroids resulted in a three year remission. In the terminal stage an intra-abdominal malignant lymphoma developed.

Lymphocytes from patients with HBs-Ag-positive and -negative acute, chronic-persistent, and chronic-active hepatitis, from healthy controls and from patients with alcoholic liver cirrhosis were tested under standardized conditions. These included use of a single charge of Phytohemagglutinin (PHA-P) dissolved and diluted in one operation, of a single pool of homologous serum of the major blood group AB found free of HBs-Ag and cytotixic factor, and elaboration of PHA dose response curves in the presence of autologous and homologous serum in each case examined. During the early phase of acute virus hepatitis B and non-B, and in HBs-Ag-positive chronic persistent and active hepatitis, hyperresponsiveness of lymphocytes to PHA was observed independently of the source of the serum present in the culture. Lymphocyte responsiveness returned to normal in the later phase of acute hepatitis and depressed in alcoholic liver cirrhosis and in cases of HBs-Ag-positive chronic active hepatitis in which cirrhosis had developed. Although the cause of these alterations in lymphocyte responsiveness is not completely understood, the central role of a primary change of the lymphocytes themselves affecting their ability to react to PHA seems probable.

Using Laser nephelometric measurement a method is described to detect immune complexes, which seems to be suitable for routine studies as well as for specific complex characterisation. Tetanus-Antitetanus complexes are used as standard thus the result is expressed as tetanus complex units (TCU). The method is simple and permits the direct measurement of complexes in native sera. Furthermore it is possible to characterise the complexes either by the immuno-globuline class of the antibody involved or the antigen respectively. Complexes were found with this method in various frequency in all but one group of patients under study (SLE, RA, other connective tissue diseases, malignomas, myelomas, thyroiditis, Grave's disease and healthy controls). Their was a high correlation with two other common techniques to measure immune complexes, e.g. C1q-deviation and C1q-PEG precipitation.