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Kafka first read Kierkegaard’s The Concept of Anxiety in 1922. One can read Kierkegaard’s text as a central element in the poetology of “Der Bau,” which reenacts the relationship between construction, habitation, and thinking against a background of anxiety. “Der Bau” in fact reveals the practice of habitation as a reflection of a state of anxiety. This is the paradox of Kafka’s story: habitation is something that cannot be thought; the more one attempts to ponder the subject, the less one can actually reside. Kafka, as author, is shown to be no more master of his writing than the animal builder is master of his burrow. Creation in this sense is not ruled by the classic opposition of subject and object: the author does not govern his writing but is transformed into what he writes. And this is precisely what Der Bau demonstrates in extenso. Telling about the burrow means postponing the finality of the burrow as well as that of its safety-anxiety-complex. What Kafka cultivated in his late writings is the dystopia of an eternal writing as an equivalent of living and as an alternative to the artistic finality, the rational concept, and the apparent wholeness of works and buildings.

Zusammenfassung: Es wird uber einen 38 jahrigen Patienten mit Aspergillom im rechten Ober-lappen der Lunge berichtet, der wegen schwerem obstruktivem Emphysem inoperabel war. Erfolgreiche Behandlung mit endobronchial appliziertem Amphotericin B. Summary: Report on a male patient, 38, with aspergilloma of the right upper lobe of the lung. Because of severe obstructive emphysema the patient was not fit for surgical treatment Successful therapy was achieved by endobronchial administration of amphotericin B.

Summary This topic problem of a relationship between immunosuppressive measures and the development of mycoses, with the consequent necessity of chemotherapy, has not been studied in detail so far, either experimentally or clinically. As regards the immunological aspects various experimental studies on animals have shown that antibiotics cause a suppression of the antibody reactions. Some data are also available on the influence of corticosteroids. Cortisone increase the sensitivity of mice to Candida or Aspergillus infections. Aspergilloses are much more frequent among treated animals with leukaemia than among untreated animals. Mycosis of the cornea develops much more easily if the defence mechanisms of the macro-organism are depressed by corticosteroids, on account of their marked antiphlogistic effect. From a clinical point of view the typical observation is as follows. A patient in poor condition with neoplastic disease is treated with cytostatics, corticosteroids and antibiotics. Due to a reduction of the leucocytic defence (bone marrow depression from cytostatic therapy) and immunological defence (cytostatics and corticosteroids) a secondary iatrogenic generalized mycosis develops. Therapeutic measures are mostly ineffective in such cases. The pathogenesis of such preterminal mycoses is not entirely clear; the elucidation of certain factors of immunological nature that interfere with treatment is even more difficult. A study of these problems is urgently necessary because the results of treatment to a large extent depend on biological and immunological factors.

In an attempt to characterize a Peanut Agglutinin (PNA) autoantigen widely expressed in common human adenocarcinomas, monoclonal antibodies (MAbs) were made against PNA-affinity purified glycoproteins from pooled breast cancer membrane biopsy materials. Two IgM MAbs, 167H.1 and 167H.4, were found to react strongly with frozen tissue sections of various adenocarcinomas and the antigen was characterized further. By immunoprecipitation, western blotting, and gel filtration, both MAbs were found to react with a 67 kilodalton (kD) antigen. The 67 kD antigen was purified and determined to be specifically PNA reactive and naturally occurring antibodies were demonstrated to the purified antigen. In conclusion, the 167H.1 and 167H.4 MAbs identify a non-mucinous, PNA-reactive autoantigen widely expressed in human adenocarcinomas.

The author presents the most frequently observed pulmonary infections due to some opportunistic fungi (yeasts, Aspergillus, Mucor). He describes the criteria for a correct diagnosis of pulmonary mycosis.

Die Wirksamkeit von Fluor in der Kariesprophylaxe ist allgemein anerkannt. Bis heute wurde hingegen dem Problem der Fluoreinwirkung auf den menschlichen Organismus im allgemeinen und auf die Schilddruse im besonderen sehr wenig Beachtung geschenkt. Ein Fluor-Jod-Antagonismus wurde vielfach angenommen ohne eine Untermauerung mit moderner Schilddrusenfunktionsdiagnostik (Radiojodtest, Jod-Eiweis). Aus diesem Grunde verabreichten wir schilddrusengesunden Individuen uber langere Zeit erheblich hohere Dosen Fluor, als sie dem Prophylaxeoptimum entsprechen, und bestimmten fortlaufend Grundumsatz, eiweisgebundenes Jod im Blut, Radiojodaufnahme und Serumcholesterin. Ferner wurden Ratten, die speziellen Ernahrungsbedingungen unterworfen wurden (jodarm, kalziumarm usw.) mit verschiedenen Fluormengen belastet und hinsichtlich Fluoreinwirkung auf den Gesamtorganismus bzw. die Schilddruse untersucht. Klinische sowie tierexperimentelle Untersuchungsreihen ergeben fur die untersuchten Fluordosen keine schilddrusenspezifische Wirkung. Verschiedene Masnahmen zur Massenprophylaxe mit Fluor (Fluoridierung von Trinkwasser, Milch, Kochsalz, Tablettenverabreichung) und ihre Eignung fur die Schweiz werden diskutiert.

1. Ubersicht uber die komplexen Wirkungen des Adrenalins und seiner Derivate auf die Respirationsorgane an Hand der Literatur. 2. Beschreibung des vonRossier undMean 1936 angegebenen Adrenalinversuches, bei dem die Atemreserven vor und nach einer Injektion von Adrenalin spirometrisch gemessen werden. 3. Die Bearbeitung des umfangreichen Materials der Medizinischen Poliklinik Zurich zeigt, das die wesentliche Adrenalinwirkung beim Vorliegen von Bronchialspasmen in einer deutlichen Zunahme der dynamischen Atemreserven, die im Atemgrenzwert charakterisiert sind, besteht. 4. Mit dem Adrenalinversuch lassen sich Spasmen nachweisen, die klinisch nicht immer erkennbar sind, z.B. bei der Silikose und bei der Bronchitis inapercepta. 5. Die detaillierteren Untersuchungen der Lungenfunktion zeigen, das Adrenalin bei lungengesunden Versuchspersonen und bei Patienten mit chronischen Bronchialspasmen neben einer Grundumsatzsteigerung eine massive Zunahme der Ventilation bewirkt. Ist die Lungenfunktion durch solche Spasmen gestort, so ist nach der Adrenalininjektion meistens keine wesentliche Besserung des alveolaren Gaswechsels und vor allem keine Okonomisierung der Atmung festzustellen. Ist die Lungenfunktion normal, so wird unter der Wirkung des Adrenalins die Atmung verflacht und unokonomisch. 6. Es wird auf die Rolle der Spasmen fur die verschiedenen Bronchitisformen und fur die Silikose hingewiesen.

Vor Einleitung einer spezifischen antimykotischen Therapie mussen die anamestischen Angaben, die Grundkrankheit und die moglichen therapeutischen Komplikationen uberpruft werden, da Mykosen der inneren Organe uncharakteristische Krankheitsbilder darstellen. Besonders bakteriologische Superinfektionen und die Tuberkulose mussen ausgeschlossen werden. Die Chemotherapie der generalisierten Mykosen hat in letzter Zeit grose Fortschritte gemacht. Als grose Bereicherung des therapeutischen Rustzeuges ist das 5-Fluorocytosin anzusprechen, das relativ wenig Nebenwirkungen aufweist. Aber auch das gefurchtete Amphotericin B kann bei entsprechend sorgfaltiger Handhabung beim gleichen Patienten wahrend Jahren immer wieder mit Erfolg eingesetzt werden, ohne das betrachtliche Nebenerscheinungen auftreten. Im Gegensatz zur bakteriellen Infektion spielt das Terrain bei der mykotischen Infektion eine weit grosere Rolle. Die In-vitro-Resultate mussen mit groster Vorsicht interpretiert werden, da bei den tiefen Mykosen infolge schlechter Vaskularisierung so hohe Blutspiegel erreicht werden mussen, das die Substanzen zu viele toxische Nebenwirkungen aufweisen. Oft ist der Arzt dafur verantwortlich, das sich das Terrain so verandert, das sich eine Mykose entwickeln kann. Wir empfehlen deshalb strengere Indikation fur kombinierte Langzeitbehandlungen, ferner bessere Uberwachung von Kathetern, Infusionen und medizinischen Geraten, ferner die prophylaktische lokale Anwendung von Mycostatin im Bereiche von Kontaktstellen, um eventuelle Eintrittspforten abzuriegeln.

Lipasebestimmungen im Serum sind Amylasebestimmungen an Empfindlichkeit weit, an Spezifitat deutlich uberlegen. Unter etwa 1400 Lipasebestimmungen fanden sich 230 pathologische Werte, die sich auf 193 Patienten verteilten. Diese 193 Patienten liesen sich leicht in mehrere Krankheitsgruppen unterteilen, welche im einzelnen besprochen werden. Lipase-Erhohungen gehen immer auf ein Pankreopathie zuruck. Eine Ausnahme stellt die Niereninsuffizienz dar. Die chronische Pankreatitis ist eine haufige Erkrankung, die durch Lipasebestimmung im Serum in zahlreichen Fallen, erfast werden kann. Nur etwa 25% aller Patienten zeigten auch pathologische Amylasewerte. Wichtigste Ursache chronischer Pankreatitiden sind Alkoholismus und Gallenwegserkrankungen. In neun von insgesamt elf Fallen mit operativ oder autoptisch gesichertem Pankreaskarzinom war die Lipase-Aktivitat erhoht. Bei acht Patienten mit begrundetem Verdacht auf Myokardinfarkt lies sich mit Hilfe der Lipasebestimmung eine leichtere Pankreatitis nachweisen. Der Herzinfarkt als Fehldiagnose einer Pankreatitis durfte nicht selten sein. Akut auftretende Herzinsuffizienz kann nicht nur zu ausgepragter anoxamischer Leberzellschadigung, sondern auch zu einer deutlichen Pankreasparenchymschadigung fuhren. Erwahnenswert sind Lipase-Erhohungen im Laufe einer Hepatitis und bei Niereninsuffizienz. Zwischen Reststickstoffanstieg und Lipase-Erhohungen besteht eine auffallend gute Korrelation. Determination of serum lipase activity is far more sensitive and more specific than that of amylase. Among some 1400 examinations of lipase, 230 gave abnormal values (193 patients). The patients with abnormal serum lipase activity could be grouped into several types of disease. Increased serum lipase activity was always due to pancreatic disease, if renal failure could be ruled out. Serum lipase abnormalities were often found in chronic pancreatitis, in which it proved a useful diagnostic test, while only 25% of cases had abnormal amylase values. Alcoholism and biliary tract disease are important causes of chronic pancreatitis. — In nine of a total of 11 cases with proven carcinoma of the pancreas there was a definite increase in serum lipase activity. In eight patients with proven myocardial infarction mild pancreatitis was demonstrated by abnormal lipase values. Pancreatitis is often misdiagnosed as myocardial infarction. Acute heart failure may not only cause anoxaemic damage to liver cells but also damage to pancreatic parenchyma. Lipase activity may also be increased in hepatitis and renal failure. There was a good correlation between a rise in nonprotein nitrogen and lipase activity. La demostracion de las pancreopatias mediante la determinacion de la lipasa serica gracias a un nuevo micrometodo Las determinaciones de la lipasa serica son mucho mas precisas e indudablemente mucho mas especificas que las de la amilasa. En un total de aproximadamente 1.400 determinaciones de la lipasa se encontraron 230 valores patologicos, correspondientes a 193 pacientes. Estos pacientes pudieron clasificarse facilmente en unos cuantos cuadros patologicos que son discutidos de uno en uno. Las elevaciones de la lipasa se deben siempre a una pancreopatia. La unica excepcion es la insuficiencia renal. La pancreatitis cronica es una enfermedad frecuente, que puede diagnosticarse en muchos casos mediante la determinacion de la lipasa serica. En cambio, solo un 25% de los pacientes mostraron, asimismo valores alterados de amilasa. Las causas mas importantes de pancreatitis cronica son el alcoholismo y las afecciones de las vias biliares. En nueve casos de un total de once de carcinoma pancreatico (comprobado quirurgica o autopsicamente) se hallaba aumentada la actividad de la lipasa pancreatica. En ocho casos en los que se supuso con motivo un posible infarto miocardico pudo comprobarse una ligera pancreatitis gracias a la determinacion de la lipasa. Por lo visto, no es raro diagnosticar un falso infarto miocardico en caso de pancreatitis. La insuficiencia cardiaca aguda puede determinar no solo lesiones celulares hepaticas anoxemicas intensas, sino tambien una evidente lesion del parenquima pancreatico. Deben mencionarse las elevaciones de la lipasa en el curso de la hepatitis y en la insuficiencia renal. Existe una llamativa relacion entre el aumento del nitrogeno residual y el de la lipasa.

Vom therapeutischen Standpunkt aus ist zu unterscheiden zwischen einheimischen und tropischen Systemmykosen.

The clinical course and morphological findings are reported of visceral paracoccidioidomycosis or South American blastomycosis with lung involvement in a 47-year-old male after specific antimycotic treatment for 11 years. The patient had been infected during a stay in São Paulo, Brazil, from 1950 to 1954. The diagnosis was established in 1959 after his return to St. Gall, Switzerland, in tissue from buccal mucosa and cervical lymph node biopsy and in fungus cultures. The patient was treated with Fungizone (amphotericin B) and with the sulfonamide Fanasil. He died in 1970 from acute right heart failure. Autopsy revealed multiple encapsulated mycotic foci in both lungs, together with healed foci and pulmonary fibrosis. Histological examination showed a large amount of Paracoccidioides brasiliensis in the mycotic foci, but cultural proof was no longer possible. In the buccal mucosa and lymph nodes, only fungus-free scars were observed. There are only a few effective antimycotic agents. With a thorough knowledge of their side effects and dosage modalities, it is possible to achieve highly satisfactory results.

Three weeks after commencing oral contraception for the first time, a 26-year-old woman with a history of rheumatic carditis and chorea minor presented with sudden recurrence of hyperkinesis. Withdrawal of the contraceptive agent was followed by rapid remission of the hyperkinesis, which suggests a casual relationship between the contraceptive and this condition and an analogy between this case and so-called chorea gravidarum. A young non-pregnant woman presenting with chorea minor should be specifically questioned by ingestion of oral contraceptives. If there is a past history of rheumatic fever with or without chorea, oral contraceptives are contraindicated.3 weeks after commencing oral contraception (Ovulen) for the 1st time, a 26-year-old woman with a history of rheumatic carditis and chorea minor presented with sudden recurrence of hyperkinesis. Withdrawal of the contraceptive agent was followed by rapid remission of the hyperkinesis, which suggests a causal relationship between the contraceptive and this condition and an analogy between this case and so-called chorea gravidarum. A young nonpregnant woman presenting with chorea minor should be specifically questioned about ingestion of oral contraceptives. If there is a past history of rheumatic fever with or without chorea, oral contraceptives are contraindicated.

In the differential diagnosis of gastrointestinal disturbances the possibility of laxative abuse is considered either too late or not at all. The sequel is a protracted course of illness with a series of expensive and fruitless investigations. On the basis of three recently observed cases of laxative-induced diarrhea the problems of diagnosis and management are discussed. Methods of securing early diagnosis are mentioned. The overall prognosis must be considered unfavorable. The importance is stressed of long-term follow-up of these patients at community level, to ensure timely intervention should complications arise and to prevent further unnecessary investigations.

The author presents the most frequently observed pulmonary infections due to some opportunistic fungi (yeast, Aspergillus, Mucor). He describes the criterial for a correct diagnosis of pulmonary mycosis.

An 85-year-old female diabetic was admitted in coma, having been on antidiabetic treatment with the biguanide derivative "Silubin retard", 600 mg/d, for one-and-a-half months. The anion deficiency was 57 mmol/l, pH 6.9, suggesting the diagnosis of lactic acidosis in the absence of other causes of metabolic acidosis. Blood lactic acid levels of more than 16.65 mmol/l (150 mg/100 ml) confirmed the diagnosis. Administration of 875 mmol sodium bicarbonate over 12 hours corrected the deficiency. On admission to hospital there had been slight pre-renal failure. Myocardial infarction developed as a result of tissue hypoxia but did not prove clinically important. On the second day there were signs of a compensated disseminated intravascular coagulopathy with upper gastro intestinal haemorrhage. The woman died suddenly 18 days later of pulmonary embolism.

A 47-year-old man who had undergone gastrectomy for duodenal ulcer required repeated hospitalization due to recurrent fistulas in the region of the laparotomy scar and increased cholestasis and cachexia. An intrahepatic and subphrenic abscess was diagnosed clinically and by liver scan and confirmed by laparotomy. The histologic findings revealed actinomycosis. Through early surgical drainage and administration of 20 million units penicillin G daily it proved possible to discharge the patient completely cured after 2 months. The pathogenesis of liver actinomycosis is discussed.

The relatively high lethality of meningitis is due to the delay in beginning treatment (usually caused by nonrecognition of the disease) and to the greater age of the patient (associated diseases). New aspects of the improvement of the prognosis were not obtained by comparison of various patient collectives a decade apart in our clinic, although an improvement in additional measures such as artificial respiration occurred. The reason lies in veiling by antibiotic premedication. Before beginning antibiotic therapy an exact etiological diagnosis should be made. This objective can only be attained by better training of the physician, including neurology.

In a retrospective study the serological results from 1494 patients with community-acquired pneumonia were evaluated. An infectious etiology was found in about 40% of the cases. The majority of pneumonias was caused by Mycoplasma pneumoniae and by influenza virus type A, whereas Legionella pneumophila was the fifth most frequent pathogen. In the second part of the study, 13 hospitalized patients with community-acquired pneumonia were investigated by the whole panel of routinely used microbial methods. The etiological agent was found serologically in 3 cases and in one case by cultivation. These results suggest that the determination of serum antibodies against pathogens is frequently more useful than is generally assumed, although the yield of positive results is dependent on the epidemiological situation. The detection of elevated complement-fixing titers or specific IgM antibodies often leads to diagnosis from the first serum examined.