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Notes: Summary. In the period of 1 January 1990 to 31 December 1996 the thyroidectomy cases we performed were immediately followed by vocal cord evaluation using a flexible bronchoscope while the patient was still on the operating table. If an obvious cord paralysis was discovered, an exploration of the recurrent laryngeal nerve, to the level of the larynx, was performed. If the nerve was found to be intact, no further measures were taken. A severed nerve underwent suture repair. If an otolaryngologist diagnosed a vocal cord paralysis 1–5 days after surgery, a reoperation was recommended except in the cases where postoperative bronchoscopy had shown an easily mobile cord or the recurrent nerve was completely dissected during the operation. Within this 7-year period, we performed 3492 thyroidectomy operations. The diagnosis of subsequent unilateral postoperative vocal cord paralysis occurred in 48 cases. In 33 of these cases the status of the nerve in the surgical field was known: 4 patients had an intact nerve proved by complete dissection during thyroidectomy, in two patients the lesions of the nerve were detected intraoperatively (1 transsection, 1 partial resection), and 27 cases were followed by reoperation. Of the 33 patients mentioned above, in 19 instances the recurrent laryngeal nerve was found to be intact; 3 displayed signs of local trauma, and 11 were found to be severed with total discontinuity. Those patients with an intact nerve, or local nerve trauma only, went on to develop normal function within 6 months in 20 (91 %) of 22 cases. Of the 11 with a severed nerve, 8 showed “autoparalysis” with good voice within 4–8 months, after suture repair in 10 cases. The patient with partial resection had no repair of the nerve. If immediate postoperative evaluation showed mobility of the vocal cords but a paralysis was detected later by an otolaryngologist and repeat intervention was not done, vocal cord function was spontaneously restored in 9 of 11 patients. Four patients refused reoperation. From 1990 to 1991, the recurrent laryngeal nerve was not always dissected during our thyroidectomy operations. However, this was done routinely from 1991 to 1996. Routine intraoperative dissection of the vocal cord nerve reduced the rate of postoperative cord paralysis from 2.0 % to 1.2 %. It also reduced the frequency of intraoperative nerve injury with total discontinuity from 0.58 % to 0.23 %.

Notes: Summary Thioacetamide-fed rats developed cirrhosis with portal hypertension (P portal = 23.0 ± 5.2 cm H2O, controls: 14.4 ± 1.0 cm H2O). The PO2 of liver tissue was markedly reduced in cirrhosis (PO2 = 7.6 ± 3.4 torr, controls 22.3 ± 5.8 torr), and the aortal pH was significantly lower as well. No correlation was found between portal hypertension, development of large—nodular cirrhosis, and ascites.

Notes: Abstract Histamine concentrations in canine whole blood and plasma were determined under several pharmacological, pathophysiological, and clinical conditions, using fluorometric methods. The specificity of the assay for whole-blood histamine was investigated by comparing 3 purification procedures for the isolation of histamine from whole blood including butanol extraction (Shore), ion-exchange chromatography on Dowex 50 W-X 8, and the combination of these 2 methods (Lorenz). Histamine in whole blood was identified in analytical and preparative samples by fluorescence spectra, thin-layer chromatography, degradation by diamine oxidase from pig kidney and inactivation by histamine methyltransferase from guinea-pig brain as well as by biological tests on the isolated guinea-pig ileum. Since butanol extraction resulted in significantly higher ‘histamine’ values than the other two purification procedures, ion-exchange chromatography on Dowex 50 was recommended as the method of choice for the specific determination of histamine in dog's whole blood. Normal values of histamine concentrations in canine plasma were tentatively estimated. They depended on the time between pretreatment of the animals (anaesthesia, operation) and the collection of blood and showed an approximately logarithmic normal distribution. The median, the lower/upper quartiles and the range of the plasma histamine levels obtained 30 minutes after the end of pretreatment were 0.2, 0–0.4 and 0–1.2 ng/ml, respectively. Nearly 50% of the values were zero (below 0.1 ng according to the sensitivity of the method), only 1% of them exceeded slightly 1 ng/ml. Thus histamine release by drugs or by other medical treatments was only stated, when plasma histamine levels exceeded 1 ng/ml and decreased in a way to give an elimination curve of approximately first-order kinetics (Bateman function). Histamine concentrations in dog's whole blood showed approximately a logarithmic normal distribution. The median, lower/upper quartiles and range were 47, 34/75 and 13–209 ng/ml respectively. The histamine levels in the whole blood of four circulatory regions did not show any significant differences. The plasma histamine concentrations in the portal vein were slightly higher than in the hepatic veins. The injection of exogenous histamine and the concomitant determination of plasma and whole-blood histamine levels in four circulatory regions showed that the plasma histamine determination was the more sensitive method for measuring histamine elimination curves than the whole-blood histamine assay. The elimination of exogenous histamine administered intravenously was influenced by several drugs including inhibitors of histamine inactivation and histamine receptor antagonists. Aminoguanidine and the H2-receptor antagonist burimamide slowed down the disappearance of histamine from the plasma, the H1-receptor antagonist dimethpyrindene enhanced it, but amodiaquine had no significant effects. Dimethpyrindene and burimamide were capable of releasing histamine in dogs, in some cases to a considerable extent. The plasma substitute Haemaccel®, a chemically modified gelatin, released histamine in dogs. Using batch 3000, from 27 animals investigated, 15 animals showed elevated plasma histamine levels and a hypotensive blood pressure response, whereas in 12 of the dogs it did not show an effect on these parameters. The plasma histamine levels at the time of maximum hypotension showed an approximately logarithmic normal distribution. This frequency distribution in combination with the varying incidence of anaphylactoid reactions depending on the batches used seemed very important for the interpretation of clinical reactions to Haemaccel in human test persons and patients. By histamine determinations in plasma and whole blood of several circulatory regions and in various tissues before and after infusion of Haemaccel it could be demonstrated that the sites of histamine release by Haemaccel in dogs were especially the skin of the upper hemisphere of the body and the liver, whereas the gastro-intestinal tract took up histamine from the circulation. These numerous results under various experimental conditions may be considered as an evidence for the high quality and reliability of the method to study histamine release in the whole animal or in human subjects by evaluating histamine elimination curves in plasma.

Notes: Conclusion Due to the large number of parameters in this communication only one dose of histamine was investigated. This dose (6 μg/kg) was chosen because it caused short-acting but remarkable effects in the circulatory system and induced plasma histamine levels as high as found after administration of histamine releasers [8]. With this dose of histamine it could be shown that several effects of histamine in the circulatory system of dogs depended on the actual plasma histamine levels. H1- and H2-receptor antagonists applied separately from each other are able to block only few histamine effects in the circulatory system. They influence the circulatory reactions to histamine not only by acting on the receptors, but also by altering the actual plasma histamine levels.

Notes: Abstract The effects of the H1-receptor antagonist dimethpyrindene and the H2-receptor antagonist burimamide on circulatory and respiratory parameters and on plasma histamine levels were tested in 21 mongrel dogs. Both drugs released histamine. The incidence for this effect was 10/11 in the case of dimethpyrindene and 5/10 in the case of burimamide. Following dimethpyrindene all animals showed arterial hypotension, pulmonal hypertension, decrease in peripheral resistance and hyperventilation. The portal venous pressure was increased in dogs reacting by a histamine release. Following burimamide both an initial arterial hypertension and a subsequent hypotension were observed the latter being more pronounced in the group with histamine release. In this group the portal venous pressure raised considerably. In the non-reacting animals cardiac output was elevated, probably due to a release of catecholamines. It seemed remarkable that the effect of exogenous histamine on portal venous pressure was completely blocked by dimethpyrindene, but not the action of histamine released by the drug itself. It is concluded that the effects of antihistaminic drugs on possibly histamine-induced physiological and pathophysiological processes should be interpreted very carefully as far as their specificity is concerned.

Notes: Summary After oesophagectomy for oesophageal carcinoma and retrosternal colonic interposition, a benign stenosis developed at the collar anastomosis. Bouginage was unsuccessful. Therefore, a prothesis was placed endoscopically, which enabled the patient to swallow without problems until his death as a result of diffuse metastasis 9 months later.

Notes: Summary Analysis of retrospective evaluation of case histories in 88 lung cancer patients showed grave faults in documentation. Quantitative knowledge of parameters of history, diagnostic findings, therapy and follow-up was reduced up to 17% (knowledge of adjuvant cytostatic therapy). Prospective data collection (n=44) had an evaluability of more than 95% in all parameters. The value of a retrospective study is reduced therefore, and should be considered in the conclusions.

Notes: Summary Retrospective chart analysis of 88 operated patients with bronchial carcinoma showed grave deficiencies. In 15 % the reason for admission to hospital was not available and the exact smoking habits of 74 % were not known. Retrospective TNM-classification was possible in only 59 %. It was known in 67 % whether a radiotherapy and in 17 % whether a cytostatic therapy was additionally performed. Only 13 of the 20 surviving patients participated in the follow-up. In contrast with these figures, a prospective collection of data (44 patients) has an effectiveness of 95 % or more for all parameters.

Notes: Summary In 16 patients operated on for mechanically caused ileus and in 12 control patients (cholecystectomy) localPO2 of the small bowel wall was determined by means of a multiwire Pt surface electrode constructed by Kessler and Lübbers. The ileus patients showed an increased pulse rat of 110 (90–115) vs 90 (80–110) beats/min and creatinine levels of 1.06 (0.79–1.45) vs 0.80 (0.70–0.88) mg%. ( $$\tilde x$$ , 1.–3. quartile,P 〈 0.05). Local PO2 values of the serosal site of the small bowel were significantly reduced in patients with ileus compared to the control group [22.5 (12.5–35) vvs 61.2 (53.0–71.0) torr.] Hypoxia of the bowel in mechanically caused ileus could be demonstrated by localPO2 determination and underlines the demand of early decompression.