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Ein Großteil der Industrie 4.0-Konzepte weist Berührungspunkte mit Verfahrensweisen, Strukturen und Protokollen im IT-Bereich auf. Gerade für KMU (kleine und mittelständische Unternehmen), deren Möglichkeiten oft hinter denen großer Konzerne zurückstehen, sind viele der Industrie 4.0-Entwicklungsansätze und -Anwendungsfälle zu abstrakt und bedürfen daher einer entsprechenden Erläuterung. Um speziell die Möglichkeiten und Potentiale einer „Smart Factory“ greifbar darstellen zu können, wurde ein Demonstrator entworfen und umgesetzt. Most of the industry 4.0 strategies involve IT procedures, structures and protocols. Especially for SMEs with often limited options compared to large corporations, many of the industry 4.0 development approaches and applications are too abstract and therefore require further explanation. To present the possibilities and opportunities of a Smart Factory, a demonstrator was designed and implemented.

Zur Untersuchung moglicher durchblutungsfordernder Effekte niederfrequent gepulster schwacher Magnetfelder, die bei gestorter Frakturheilung seit Jahrzehnten erfolgreich eingesetzt werden, wurde im placebokontrollierten Experiment bei pAVK-Patienten der Stadien IIb bis IV ein mit 4 Hz gepulstes Magnetfeld mit einer Intensitat von 5 μT uber eine Ganzkorper-Magnetfeldmatte appliziert. Nachweisen lies sich in der Verumgruppe (n=30) unter einmaliger einstundiger Anwendung eine signifikante Steigerung des Laser-Doppler-Fluxes um uber 50% und des tcpO2 um 17% (Messung am Fusrucken), wobei der Anstieg der Werte umso groser ist, je niedriger die Ausgangswerte sind. Fur Puls und Blutdruck sowie cAMP und cGMP (im Venenblut) liesen sich keine Veranderungen feststellen. Es wurden keinerlei unerwunschte Wirkungen beobachtet.

Usual ICU monitoring of patients with abdominal pathology provides no detailed information about hepatosplanchnic haemodynamics or intestinal metabolism. In our animal experiment, the effects of systemic hypoxia on microdialysis measurements of the peritoneum in comparison with the ischiocrural muscle as reference were investigated in 7 rats. The parameter of interest was the course of glucose metabolism reflecting sympathoadrenergic activity during the experiment. Measurements were obtained at timed intervals at baseline, under hypoxia, and during reoxygenation. After induction of systemic hypoxia, the peritoneal microdialysis showed significantly higher levels of glucose in comparison with the ischiocrural muscle. The results indicate hypermetabolic activity or a hypersympathetic response of the bowel in response to hypoxic stress. In the clinical setting, the bowel has an important role in the development of multiorgan failure. Microdialysis may therefore be an interesting tool for the early detection of hypoxic metabolism during and after abdominal procedures.

Per Simulation von Operationstechniken haben Weiterbildungskurse in der Viszeralchirurgie zum Ziel, Naht-, Resektions- und Rekonstruktionstechniken am Gastrointestinaltrakt zu vermitteln. Vor, nach und 5 Jahre nach erstmaligem Stattfinden des Weiterbildungskurses fur gastrointestinale Chirurgie in Norderstedt wurde eine Befragung der Teilnehmer hinsichtlich der Ausbildungssituation, des Lernerfolges und der Umsetzung des Erlernten in der eigenen Klinik durchgefuhrt. Wahrend bei gut 1/3 der Teilnehmer die Ausbildungssituation als unzureichend beschrieben wird, ist die Zufriedenheit mit diesem Kurs mit 94% sehr hoch: 27% der Teilnehmer trauten sich nach dem Kurs zu, selbststandig eine Anastomose zu nahen. Grunde fur die Ablehnung neuer Techniken waren in nur 7% bei den Teilnehmern selbst zu finden, in 41% konnten die Vorgesetzten nicht uberzeugt werden. Mehr noch als die Vermittlung neuer Techniken liegt die Bedeutung eines solchen Kurses in der Ubung von Fahigkeiten, die im Operationssaal aus verschiedenen Grunden zu kurz kommen.

Introduction We investigated the influence of resterilized polypropylen meshes (Prolene(R)) on proliferation and apoptosis of human fibroblasts in an experimental in vitro study. Method Human fibroblasts were seeded into six-well culture dishes in a density of 3 x 10 (4) cells/well. After resterilization of meshes (steam autoclave, 121 degrees C, 20 min.) according to the manufacturer's recommendations (Ethicon, Norderstedt) square sheets of 2 x 2 cm were incubated with fibroblasts over a period of 6, 12, 18, 24, 30, 36, 42 and 48 h. Preparations of fibroblasts with non-resterilized meshes and without meshes served as controls. Proliferation index and apoptotic index were estimated by flow cytometry after cell staining with an FITC-conjugated antibody against the Ki-67 antigen or with FITC-conjugated Annexin-V and propidium jodide, respectively. Results A significant reduction of the proliferation index from 86 % to 42 % was found after 48 h incubation of cells with resterilized meshes, whereas only a slight decrease was found in the group with non-resterilized meshes (75 %) and in controls without meshes (80 %). Apoptotic index increased significantly from 2 % to 48 % after 48 h incubation with resterilized meshes in comparison to both control groups, where only a slight increase could be observed: non-resterilized meshes to 19 % and without meshes to 10 %. Conclusion Resterilized meshes inhibit growth of human fibroblats in vitro significantly, demonstrated by a reduced proliferative activity and an increased apoptotic index. This could be caused by a release of toxic substances from the meshes, which have a negative influence on cell growth. Therefore, resterilization cannot be recommended.

Intestinal Obstruction as Cause of Acute Abdomen Intestinal obstruction is one of the most common causes of acute abdomen. Successful therapy depends on the correct diagnostic ass

Introduction Neo-angiogenesis, of great importance for tumour growth and nutrition, is preferentially mediated by the cytokine vascular endothelial growth factor (VEGF), which has a direct effect on vascular endothelial cell proliferation and migration. This study was designed to clarify whether VEGF is a suitable tumour marker in sera of patients with a colorectal cancer, and whether VEGF concentrations in sera and tumour tissues are correlated with tumour extension (pTNM) and especially with tumour volume or size. Furthermore, the influence of VEGF levels on patients» prognosis was examined. Methods VEGF serum concentrations of 122 patients with colorectal cancer and 65 controls were determined with an ELISA kit. Additionally, VEGF concentrations of tumour and normal tissue were measured in 38 patients using the same ELISA. Results Our results demonstrate that VEGF is not a suitable diagnostic tumour marker in patients with colorectal cancer due to its low sensitivity (36%). However, a combination of the serum tumour markers CEA and VEGF can significantly increase the pre-operative diagnostic sensitivity to 62%. VEGF serum levels differed significantly between patients (mean 438 pg/ml) and controls (mean 203 pg/ml), and also between tumour and normal tissue (984 vs 89 pg/mg protein). Serum concentration showed a significant correlation to tumour volume and size. Patients with VEGF serum levels greater than cut-off had a poorer prognosis than those less than or equal to cut-off. For this reason VEGF could be used as a predictor of patients» outcome.

The intravesical instillation of BCG (Bacillus Calmette-Guerin) in cases of relapsed superficial bladder cancer is an acknowledged kind of prophylaxis. It is uncertainly up to now whether a verification of the immune systems competence is necessary. The recommendations in this problem are very different. In conclusion to the recent literature we think that a verification of the immune system before BCG installation in the urinary bladder has not a prognostic value. Additionally, the legal obligingness of this immunotest is doubtful.

Usual ICU monitoring of patients with abdominal pathology provides no detailed information about hepatosplanchnic haemodynamics or intestinal metabolism. In our animal experiment, the effects of systemic hypoxia on microdialysis measurements of the peritoneum in comparison with the ischiocrural muscle as reference were investigated in 7 rats. The parameter of interest was the course of glucose metabolism reflecting sympathoadrenergic activity during the experiment. Measurements were obtained at timed intervals at baseline, under hypoxia, and during reoxygenation. After induction of systemic hypoxia, the peritoneal microdialysis showed significantly higher levels of glucose in comparison with the ischiocrural muscle. The results indicate hypermetabolic activity or a hypersympathetic response of the bowel in response to hypoxic stress. In the clinical setting, the bowel has an important role in the development of multiorgan failure. Microdialysis may therefore be an interesting tool for the early detection of hypoxic metabolism during and after abdominal procedures.

Es fehlen in der Literatur Langzeitergebnisse zur Prognose von Patienten mit rupturiertem Bauchaortenaneurysma. Ziel der vorliegenden Untersuchung war es, die Prognose von elektiv und notfallmasig operierten Patienten mit infrarenalem Bauchaortenaneurysma zu vergleichen.

The course in Gastrointestinal Surgery (GISC) aims at teaching and training resection, reconstruction and suture techniques of the upper gastrointestinal tract. Prior to, after and 5 years following the first course, participants were asked to answer a questionnaire requesting information regarding the adequacy of surgical training in their residency program and how much they had benefited from the GISC. While 1/3 of the participants described the surgical training during their residency as inadequate, more than 90% benefited from the GISC. Although the single-layer-continuous suture technique was implemented by only 8% of the participating surgeons, other techniques such as cross-section gastroenterostomy were accepted by 38%. Only 7% of the participants rejected these new techniques, while 41% of the senior surgeons at home could not be convinced. Besides the teaching of new techniques, participants benefited above all from the repetitive training in surgical procedures.

We investigated the influence of resterilized polypropylen meshes (Prolene(R)) on proliferation and apoptosis of human fibroblasts in an experimental in vitro study.Human fibroblasts were seeded into six-well culture dishes in a density of 3 x 10 (4) cells/well. After resterilization of meshes (steam autoclave, 121 degrees C, 20 min.) according to the manufacturer's recommendations (Ethicon, Norderstedt) square sheets of 2 x 2 cm were incubated with fibroblasts over a period of 6, 12, 18, 24, 30, 36, 42 and 48 h. Preparations of fibroblasts with non-resterilized meshes and without meshes served as controls. Proliferation index and apoptotic index were estimated by flow cytometry after cell staining with an FITC-conjugated antibody against the Ki-67 antigen or with FITC-conjugated Annexin-V and propidium jodide, respectively.A significant reduction of the proliferation index from 86 % to 42 % was found after 48 h incubation of cells with resterilized meshes, whereas only a slight decrease was found in the group with non-resterilized meshes (75 %) and in controls without meshes (80 %). Apoptotic index increased significantly from 2 % to 48 % after 48 h incubation with resterilized meshes in comparison to both control groups, where only a slight increase could be observed: non-resterilized meshes to 19 % and without meshes to 10 %.Resterilized meshes inhibit growth of human fibroblats in vitro significantly, demonstrated by a reduced proliferative activity and an increased apoptotic index. This could be caused by a release of toxic substances from the meshes, which have a negative influence on cell growth. Therefore, resterilization cannot be recommended.

The aim of our study was to investigate the influence of polypropylene meshes on the proliferation and apoptosis of human cell cultures in vitro.Human fibroblasts and HeLa cells were incubated in different densities (10(4), 3.10(4), 10(5) cells/well) together with polypropylene meshes (Prolene, 2 x 2 cm) in six-well culture dishes over a 48-h period. Cells without meshes served as controls. Cells were spun on slides and stained with the monoclonal antibody MIB-1. To calculate the proliferation indices, stained nuclei were counted. Apoptotic indices were determined by flow cytometric analysis, using FITC-conjugated Annexin-V and propidiumjodide for staining.Fibroblasts showed only a slight reduction of the proliferation index (PI) from 64% (controls) to 60% (meshes). Increasing cell density leads to a decrease in the PI of both groups. The PI of HeLa cells was similar in mesh groups and controls and independent of cell density. The apoptotic index (AI) of fibroblasts was significantly higher in the mesh group (3.7%) in comparison with the controls (1.9%). The same was observed for HeLa cells (AI mesh group: 4.5%, AI controls: 1.2%). Furthermore, an increase of AI was found with increasing cell density in both cell lines.Whereas meshes did not influence the proliferation of the cell lines examined, they seem to have a marked influence on apoptosis, as a significant increase of AI was observed in the mesh group in contrast to controls.

Fur die radiofrequente Thermoablation inoperabler Lebermetastasen ist eine exakte Plazierung der Ablationssonden im entsprechenden Zielareal entscheidend. Das percutan e aber auch intraoperativ offene und insbesondere laparoskopische Positionieren der Sonden ist jedoch auf Grund ungenugender Zuganglichkeit oft erheblich eingeschrankt, so dass eine in-plane-Punktion unmoglich ist. Freihandpunktionen mit signifikanten Abstand zwischen Ultraschalltransducer und Einstichstelle sind mit einer erheblichen Ungenauigkeit verbunden. Zugleich steigt die Invasivitat, da unvermeidliche Fehlpositionierungen erst nach Eintritt der Sonde in die Schallebene verfolgt und korrigiert werden konnen.

Bile duct anastomoses are still associated with a high failure rate. Although following iatrogenic bile duct transection only a positive selected group of patients get a primary end-to-end reconstruction, long-term results demonstrate an incidence of postoperative strictures up to 78%. Also in orthotopic liver transplantation biliary tract complications remain a significant cause of morbidity with an incidence of up to 49%. Since these complications can also be seen under optimal circumstances, the methodically based disadvantages of the conventional hand suturing like perforating needle injury of the choledochal wall with intraluminal suture material, the suboptimal approximation of the mucosal edges and an inhibited blood flow in the choledochal stumps caused by a suture related tissue strangulation may also responsible. Thus there is a search for alternative anastomosis techniques.To test extramucous placed titanium clips for biliary reconstruction after complete division of the bile duct we performed an end-to-end-anastomosis in 9 pigs. Therefore we used the VCS (Vascular Closure Staples)-instruments (Auto Suture).The application of the VCS-clips (medium size) permitted the technical realization of a tension free, everted anastomosis with an exact approximation of the mucosal edges. One of the animals died from aero embolism intraoperatively. All the others showed a complication-free postoperative period without any signs of anastomotic leakage or stenosis (follow-up: 6 months). At histological examination there were smooth and intact mucosal surfaces in all pigs and--especially important for the development of strictures--only a very mild fibrosis and inflammation.The potential advantage of the VCS-clip-technique is the non-penetrating tissue approximation with optimal contact of the mucosal layers that does not compromise the blood flow in the choledochal stumps. Before clinical use can be recommended further studies are required.

Zur Evaluierung der operativ-technischen Eignung extramucos platzierter Metallclips (Vascular Closure Staples, Fa. AutoSuture®) im Vergleich zur konventionellen Handnaht wurden insgesamt 36 Schweine randomisiert und der D. choledochus nach Durchtrennung mit VCS®-Stapler bzw. Handnaht End-zu-End anastomosiert. Die VCS®-Clip-Technik bietet als nichtpenetrierende und evertierende Gewebeadaptation mit optimalem Mucosakontakt nicht nur potentielle Vorteile fur die Gallenwegsrekonstruktion, sondern erweist sich im Tierversuch bezuglich der Anastomosendurchblutung (laserdopplerflowmetrisch signifikant hohere Perfusionswerte als nach Handnaht) und Bindegewebsbildung (mediane Wandstarken im Anastomosenbereich 6 Monate p.o. in der Clip-Gruppe: 510 um versus 660 (μm in der Naht-Gruppe, p

Introduction: Non-resorbable meshes are routinely used for surgical hernia repair to reinforce and stabilize the abdominal wall. Recently, criticism of uncontrolled use of these meshes arose, because the knowledge of foreign-body reactions and neoplastic formation is insufficient. The aim of our study was to investigate the interaction of meshes with human HeLa cells and fibroblasts in vitro. Methods: HeLa cells or human fibroblasts were seeded and cultured over a 48 h period in six-well culture dishes (104,3 x 104,105 cells/well) in an appropriate growth medium on polypropylene meshes (square sheets of 2 x 2 cm2). Controls were seeded without meshes. The cells were treated with trypsin, washed, fixed on slides by cytocentrifugation, followed by immunocytochemical staining with the monoclonal antibody MIB-1 and the StreptABC method (Dako, Glystrup, Denmark). The proliferation index was determined by counting MIB-i stained nuclei. To determine the apoptotic index, washed cells were stained with Annexin V-FITC and propidiumjodide followed by flow cytometric analysis. Results: In comparison to the controls, the proliferation index of fibroblasts incubated with meshes was reduced by only about 6% (64% versus 58%). Interestingly, the proliferation index was increased with decreasing density of the cells: from 46% at 105 cells/well to 71% at 104 cells/well (samples with meshes) and from 55% at 105 cells/well to 78% at 104 cells/well (controls). The apoptotic index of fibroblasts grown with meshes was doubled in comparison to the controls (3.7% versus 1.7%). Additionally, in the mesh group the apoptotic index was elevated with increasing density of the cells: from 2.3% at 104 cells/well to 6.0% at 105 cells/well. The proliferation indices of the HeLa cells were generally higher (90% – 99%), but we could not find any difference between cells grown with or without mesh. The apoptotic index of HeLa cells grown with meshes was elevated by a factor of 7 in comparison to that of the controls (0.5% versus 3.4%). Discussion: Within the selected 48-h period polypropylene meshes had no significant influence on the proliferation index of the investigated cell cultures. However, our results demonstrate that polypropylene meshes have the tendency to increase the apoptotic cell number of the investigated human cells in vitro.

We have studied changes in peripheral tissue thickness with a novel hand-held ultrasound device during the perioperative course of 60 healthy surgical patients in three different intraoperative body positions. The nil-by-mouth period led to a significant decrease in forehead tissue thickness. Standardized infusion therapy with Ringer's solution at a rate of 8 ml kg-1 h-1 resulted in a gradual increase in tissue thickness, which was significantly different from preoperative baseline values after 90 min. Packed cell volume decreased significantly after the start of infusion and remained low over the rest of the observation time. Different body positions did not influence changes in tissue thickness. We conclude that changes in perioperative tissue thickness in healthy patients can be detected easily by ultrasound, independent of body position. This method may prove useful for the non-invasive assessment of fluid balance state.

The peritoneal lavage in peritonitis can be studied in a standardized manner only in animal models, because peritonitis is too variable and dependent on too many patient related factors. In this article answers are given to questions on the influence of different lavage substances on survival, local and systemic concentrations of bacteria, endotoxin, and TNF as well as on mesothelial adherence of bacteria. These data refer to results from acute models of infection published in the literature. Furthermore, we show from our own chronic peritonitis model the influence of the peritoneal lavage on abscess formation and translocation. After inoculation of a Bacteroides fragilis suspension, a chronic abscess forming peritonitis was induced. At day 3/7/14 intraabdominal abscesses were found in 2/4/6 of 8/5/6 animals in an untreated, in 1/3/5 of 5/5/5 animals in a saline lavaged, and in 5/0/2 of 5/5/5 animals in a Taurolidin lavaged group, respectively. Both, the intraabdominal and the systemic bacterial dissemination were more effectively inhibited by the Taurolidin lavage than by the saline lavage.

The intravesical instillation of BCG (Bacillus Calmette-Guérin) in cases of relapsed superficial bladder cancer is an acknowledged kind of prophylaxis. It is uncertainly up to now whether a verification of the immune systems competence is necessary. The recommendations in this problem are very different. In conclusion to the recent literature we think that a verification of the immune system before BCG installation in the urinary bladder has not a prognostic value. Additionally, the legal obligingness of this immunotest is doubtful.

Vascular infections after percutaneous endovascular procedures are rare. We report a case of bacterial arteritis following PTA and stent implantation into an iliac artery. It was complicated by septic embolization, ipsilateral empyema of the knee joint and formation of an infected false aneurysm. Contamination of the stent with Staphylococcus aureus is likely to be the cause. The treatment included resection of the infected arterial segment, removal of the stent, and autologous reconstruction.

Fifty-seven patients with abdominal and retroperitoneal malignancies were examined by laparoscopy mainly to establish operability (n = 29), to gain histology (n = 20), or to carry out laparoscopic (assisted) palliative procedures. Early explorative laparoscopy is recommended if large tumours, ascites or metastases are suspected because of the high sensitivity in confirming inoperability.

Bei 40% der Tumorpatienten entwickeln sich im Krankheitsverlauf schmerzhafte Knochenmetastasen, die mit einer Stabilitatsgefahrdung der befallenen Skelettabschnitte und im Wirbelsaulenbereich mit einer Kompression des Spinalkanals einhergehen. Die Lebensqualitat wird durch diese Symptomatik erheblich beeintrachtigt, so das eine schnell wirksame und nebenwirkungsarme Therapie erforderlich ist. Die Strahlentherapie stellt eine hochwirksame Behandlung zur Schmerzpalliation bei Knochenmetastasen dar. Eine Besserung der Schmerzen geben 90% der Patienten an. Als nicht-invasive Masnahme tragt sie auch bei Stabilitatsgefahrdung oder Kompression des Spinalkanals zur Restabilisierung bzw. Besserung der neurologischen Symptome und damit zur Verbesserung der Lebensqualitat entscheidend bei.

Magnetic resonance imaging (MRI) was evaluated for its potential in assessment of acute pancreatitis compared to computed tomography (CT). 15 patients with acute pancreatitis were examined using a routine protocol including T1- and T2-weighted sequences and a fat-suppressed T1-weighted spin-echo sequence. Gadopentant-Dimeglumin (Gd-DTPA) was given. For comparison, plain and contrast-enhanced CT was performed prior to MRI. MRI proved to be superior to CT in detection of bleeding, duodenitis and ascites. MRI failed to detect concrements. These first results show that, considering the latest development in technology, MRI is not inferior to CT in diagnostic imaging of acute pancreatitis.

Pilze sind Organismen von groser Vielfalt. Von den humanpathogenen Mykosen haben die differenten Candida-Spezies die groste pathogene Bedeutung. Candida albicans ist ein kommensaler Besiedler des Gastrointestinaltraktes, wobei die Besiedlung von oral nach rektal in der Regel abnimmt. Bei lebensbedrohlichen tiefen Mykosen im chirurgischen Krankengut liegt in 70 % der Falle eine Lasion des Gastrointestinaltraktes vor [2]. Dies gilt besonders fur das perforierte Ulcus duodeni und ventriculi [3]. Zwischen Keim und Wirt ist die Immunitatslage von ausschlaggebender Bedeutung. Verstandlich, das das bei vermehrt Schwerstkranken die Zahl der tiefen Mykosen zunimmt. Aus epidemiologischen Studien ist bekannt, das Mykosen bei den Risikofaktoren Nikotin, Alkoholismus, Immunsuppression, hohem Alter, Antazida und Antibiotika gehauft auftreten [4]. Zudem konnen Pilze Zucker direkt verstoffwechseln und treten bei Diabetikern gehauft auf.

Hauptverantwortlich fur die relativ schlechte Prognose der mesenterialen Ischamie ist neben dem schlechten Allgemeinzustand der meist alteren Patienten eine verzogerte Diagnostik. Die klinische Symptomatik ist oft nur diskret, v.a. im sog. stummen 2. Intervall. Als erste wertvolle laborchemische Hinweise gelten zwar erhohter Hamatokrit, rasanter Leukocytenanstieg, Thrombocytensturz und zunehmende Lactatkonzentration im peripheren Blut. Insgesamt sind diese Parameter jedoch als relativ unspezifisch zu bewerten, sodas der eindeutige Beweis fur eine mesenteriale Ischamie zur Zeit nur mit Hilfe der Mesenterikographie moglich ist.

Die einzelne EEG-Ableitung hat fur die Diagnose einer Enzephalitis und zur Beurteilung ihrer Prognose nur wenig Aussagekraft. Zusammen mit anderen Kardinalsymptomen aber kann die im EEG registrierte Allgemeinstorung die Diagnose stutzen. Die Beachtung des Ablaufs der hirnelektrischen Befunde wahrend der Erkrankung last Beziehungen zur Symptomatik erkennen und kann prognostische Aussagen ermoglichen. Das gilt nicht nur fur den Wandel der Allgemeinstorung, sondern im besonderen auch fur die hypersynchrone Aktivitat: Bleibt sie auch nach Uberstehen der Krankheit nachweisbar oder tritt sie einige Zeit spater auf, so entsteht nicht selten ein zerebrales Anfallsleiden; diese Patienten hatten haufig auch neurologische und psychische Defektsyndrome. Bei einem Vergleich der EEG-Befunde von Kindern mit Defektsyndrom und anderen, welche die Erkrankung ohne sichtliche Folgen uberstanden hatten, wurden Herdveranderungen und hypersynchrone Potentiale dann haufiger gesehen, wenn ein Defektsyndrom bestehen blieb (13,2% im Vergleich zu 10,8%; 15,5% im Vergleich zu 5,4%). The E.E.G., taken by itself, is of little value in the diagnosis and prognosis of encephalitis. However, taken with other cardinal signs the E.E.G. can be of diagnostic importance. Serial E.E.G.s in the course of the disease can be related to signs and symptoms and be of prognostic significance. This is true not only of changes in general abnormalities but especially also for hypersynchronous activity. If the latter remains after the clinical phase of the disease is over or occurs some time later, the development of cerebral seizures is not rare and such patients frequently show neurological and mental defects. Comparison of E.E.G.s of children with such defects and others who have overcome the disease without manifest sequelae showed a higher incidence of focal changes and hypersynchronous potentials if defects remained (13.2% compared with 10.8%; 15.5% compared with 5.4%).