[Hyperparathyroidism must not be an indication for surgery].
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Biomedical subjects
Publications and source records attributed to G Baldauf.
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The hereditary hemorrhagic teleangiectasia, commonly known as "Rendu-Osler-Weber" disease, is a relatively seldom found affection manifesting itself by the formations of localized arteriovenous capillary connections which are tiny arteriovenous fistulas. They are found in the skin, the mucous membranes and in nearly all organs of the body. The diseases is transmitted by a dominant character. Affections of the lung can be seen in 89% of the cases (1). In the following paper five exemplary cases are to show that the simple radiological method of the roentgenogram of the thorax taken in the frontal projection and in the lateral view, assisted by the conventional tomography in most cases will bring the last diagnosis. In the differential diagnosis nodules in the lung can be delimited by the connecting arteries and veins.
An acquired partial pituitary insufficiency of unknown origin with selective ACTH and STH deficiency was demonstrated in a 44-year-old patient. The clinical course over many years corresponds to subclinical Addison's disease with occasional acute crises. Ossification of both auricular cartilages and anhidrosis were outstanding signs. There is possibly a connection between the glucocorticoid deficiency over many years with normal mineralocorticoids and the auricular cartilage ossification.
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In all affected members of a family with Gardner's syndrome the complete triad of skin tumours, osteomas and polyps of the colon has developed since 1968 when examination revealed an apparently bisymptomatic variant of Gardner's syndrome. In this family bony changes consisting of circumscript osteomas, diffuse sclerosing zones within certain bones, and ridge-like widening of the corticalis were noted, having developed during puberty but remaining constant thereafter. Similarly, no significant new skin tumours appeared after puberty. Most colonic polyps however, occurred in adolescence or thereafter, with malignant transformation after a variable interval of several years. The necessity of long-term observation of the colon, also in patients presenting with a bi- or monosymptomatic form, is stressed. Coloscopy has proven to be more useful diagnostically than radiological methods.
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Several substances with anticonvulsent activity can lead to hypovitamenosis D after prolonged use through their effect on vitamen D metabolism in the liver. This results in abnormal bone mineralisation and produces rickets or osteomalacia. Radiological examination of the skeleton should be performed on patients receiving prolonged anticonvulsent therapy, in order to arrive at an early diagnosis. This requires an accurate knowledge of the types of bone abnormality and of their most frequent localisation. Pathological findings such as Looser's zones, epiphyseolysis or delayed development must be considered in this context. Radiological examination provides an accurate diagnosis if combined with clinical findings and important biochemical results: reduced calcium and raised alkaline phosphatase. Treatment with vitamen D must then be instituted. Healing may be complete or leave residual changes, depending on the severity of the bone changes.
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The investigations have shown that it is possible to predict the breakthrough behavior of complex mixtures in a pilot-plant filter. The aim of future studies will be to predict the breakthrough behavior of waterworks filters in the same way as discussed here. This seems to be fairly simple if the filters are working with adsorption only. If, in addition, biological processes occur in a filter (as is generally observed), these processes have to be taken into account because an additional mechanism exists for removal of organic substances in the activated carbon filter. Investigations in a new research program will also need to consider the influence of ozone on biodegradation. Use of the methods already discussed, can help to optimize existing plants, as well as a proper control of the efficiency of the regeneration processes.
The distribution of common and erosive changes in advanced polyarthrosis is radiologically demonstrated in the hands of 32 patients. 23 of them showed erosive destructions in at least one joint. In general the alterations were symmetrical. Most of the destructions were seen in the distal and proximal interphalangeal joints, especially in DIP II, III, V and PIP III. Usually the thumb was spared. Most emphasis has been put on the differential diagnosis to rheumatoid arthritis and arthritis in psoriasis and gout. A recent concept concerning mechanical factors in the pathogenesis of so called primary osteoarthritis in the small finger joints is discussed.