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From 1973 to 1978 in the dissection material of the Medical Clinic in 78 deceased a stenosis of the aortic valve was diagnosed. Clinically diagnosed was the failure of the aortic valve, however, only in 33 cases. The retrospective analysis of the dissection material showed from the clinical point of view that the old age of the patients at admission (x = 70 years), the short stay in the ward and the reduced general condition were factors which rendered difficult the diagnosis of a stenosis of the aortic valve. On the basis of our results we are of the opinion that when a systolic murmur is present above the basis in connection with signs of the load of the left heart in the ECG in every case the diagnosis of the stenosis of the aortic valve is to be included into the diagnostic considerations also when a picture of heart complaints is not present in older persons.

Clinical and morphological findings of 406 patients who fell ill from a virus hepatitis were established according to the data and statistically evaluated to find relations between clinical, serochemical and histological criteria. The results were tested statistically. Clinical and paraclinical findings at the end of the hospital treatment give no evidence concerning the histological degree of cure of the acute virus hepatitis. In normalised clinical and serochemical findings we could morphologically prove an acute hepatitis still in 27.4%. Anamnestic data and severity of the clinical course have no relation to the histological diagnosis at the end of the hospital treatment with clinical and serochemical recovery. Therefore, at the end of the hospital treatment we recommend the liver biopsy as final examination. The most favourable date of the liver biopsy would, however, be between the 6th and 12th week after discharge.

The basis of the results are histological investigations of the preparations of liver biopsy of 134 donors who were evident in the SGPT-screening and of 100 patients with viral hepatitis after normalisation of the clinical and the laboratory-chemical findings. The liver casts were got by means of Menghini's method. In patients with hepatitis we found in 43% and in donors in 44% a small-droplet to medium size droplet fatty change in the liver cells. A large-droplet fatty change in the liver cells occurred in the patients with hepatitis only in 2% of the cases, in the donors, however, in 25%. Factors which favour the fatty change in the liver cells, such as adiposis, alcohol and prednisone therapy, were excluded. Our results increase the suspicion that in one part of the clinically healthy donors who are evident in the SGPT-screening we have to do with persons who are in the healing phase of a viral hepatitis with abortive course. Therefore, these persons should be excluded from blood donation. Donors and patients with the findings of a large-droplet fatty change in the liver cells must be investigated systemically. Blood donors with the findings of a fatty liver may remain in the team of donors.

The clinical findings of 28 diabetic females with suspicion of diabetic nephropathy were compared with the findings of 27 decreased female diabetics with ascertained diabetic glomerulosclerosis. In the two groups above all elderly female diabetics were concerned with an average duration of diabetes of more than 10 years. Of the parameters examined duration of diabetes and diabetic retinopathy still possessed the greatest diagnostic certainty. All the other symptoms (particularly proteinuria, hypertension) were only signs of reference. On account of the difficult differential diagnosis of the diabetic nephropathy an undiscriminating use of the notion should be avoided, above all then when a bioptical clarification is not possible.

It is reported on a 79-year-old female patient who died from coma hepaticum. As evoking cause an immunesuppressive treatment with cyclophosphamide or prednisolone, respectively, on account of chronic lymphadenosis with excessive thrombocytopenia is discussed. An accessible preliminary lesion of the liver after an infectious jaundice with persistence of the HBs-antigen from which the patient formerly suffered is probable. It is referred to the combination of the chronic aggressive hepatitis with malignant systemic diseases and immunopathy, taking into consideration the decision of therapy.

n the basis of clinical case reports on liver disintegration comata in foudroyant virus hepatitis the coma therapy was explained which was performed in the clinic for infectious and tropic diseases of the County Hospital St. Georg Leipzig in 1981 and this therapy was compared with the possibilities mentioned in literature. The aim of the article was to determine the present position of a county hospital in the great number of forms of therapy proposed. The basic therapy aimed at the reduction of neurotoxic protein metabolites and the application of intensive-medical therapeutic methods in interdisciplinary cooperation of internal specialist, specialist in dialysis and haemostaseologist are valuated as successful. The combined haemoperfusion/haemodialysis--two out of three patients treated survived--as a constituent of the present concept of therapy is assessed positively.

Prerequisite of a scientific and rational liver diagnostics is the knowledge of the physician of function and structure of the liver. The laboratory demand should always be an accomplishment of the physician and should be performed only upon such a scale that it is also followed by therapeutic consequences and/or consequences concerning the expert's opinion. The biochemical blood analysis gives information about the size of the injury to the parenchyma and about the disturbance of the various partial functions of the liver. In this case is to be taken into consideration that biochemical and histological parameters are no concurrent, but supplementing diagnostic methods. A progress in liver diagnostics is the use of the isoenzymes of the aspartate aminotransferase and the lactate dehydrogenase as well as of the enzymes of the metabolism of the connective tissue. With the entering into selected parameters of the liver diagnostics possibilities to the establishment of the disturbed liver metabolism by means of markers are shown and at the same time recommendations for the praxis of the liver diagnostics are derived.

37 patients with clinically and histologically ascertained acute virus hepatitis (51% virus hepatitis B) underwent a bicycle-ergometric load a short time after admission to hospital and 17 of them were subsequently submitted to a training from twice a day to 30 minutes with 70% of the submaximal steady state effect. After their discharge from hospital all patients were repeatedly examined in the outpatient department for on an average 2.7 years; 20 patients (8 in the load group, 12 in the comparative group) were submitted to a liver biopsy on an average after one year. In 11 of the other patients the result of a histological examination of the liver from the end of the clinical treatment was present. The comparison of the training group and the control group showed nearly the same percentage of cures for the two groups as well as no transitions into chronic hepatitis in the training group. Also clinical and biochemical relapses did not appear in the load group. In a follow-up observation up to five years in the training group did not appear any disadvantage concerning the complete cure of virus hepatitis so that we apparently do not fear any negative sequels of physical activity in the acute phase of virus hepatitis. A forced immobilisation of the body--after proved ineffectiveness of diet and medicamentous treatment last support of the therapeutic regime--thus seems no more be indicated, since it is also accompanied by impairing reduction of the bodily function.

It is reported on a 46-year-old woman who died of a haemorrhage of the cerebral matter in renally fixed hypertension and severe arteriosclerosis of the arteries of the basis of the brain. The possible connection between hypertension, arteriolosclerosis of the kidneys and arterioclerosis of the arteries of the brain basis and an intake of ovulation inhibitors lasting 10 years is critically discussed.A 46 year old woman who used oral contraceptives (OCs) for 10 years developed severe arteriosclerosis of the base of the brain and renally fixed hypertension. She subsequently died of cerebral hemorrhage. The relationship between o.c. use and hypertension is discussed. A thorough family and personal anamnesis must be taken for women who want to use o.c.s; hypertension, kidney ailments, obesity, or diabetes mellitus require particular attention. Blood pressure should be checked for the first 3 months of o.c. use and every 6 months thereafter. Weight gain during o.c. use may serve as a warning symptom. Hypertension or several other difficulties require discontinuation of o.c. use to determine whether they may be caused by o.c.s.