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Ritual circumcision in males is regarded as one of the oldest surgical procedures. Whereas their medieval illustrations are mostly interpreted within a religious context, this study tries to prove the influence of the political and social situation of the above-mentioned period.Selected iconography of ritual male circumcision in the Middle Ages from Germany, France, Italy, and the Byzantine Empire was critically examined. Special attention was paid to the stained glass windows recently returned to St. Mary's Church in Frankfurt/Oder, where circumcision of the so-called Antichrist is also shown. Up to now we could not find any medical historical information about this subject. Clerical fine art of the fifteenth and sixteenth centuries shows more frequently than before illustrations of ritual circumcision, which evidently demonstrate the political, economic, and social tensions and controversies of that period. In many cases this iconography indicates a rejection of this old Jewish tradition and its confessors. Also the stained glass image of the Antichrist posthetomy could be interpreted as criticism or aversion.This study expands our approach to medieval illustrations of ritual circumcision that have hitherto mostly been interpreted in religious terms. The influence of changing political and social situations in the Middle Ages is evident.

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The first thermally robust Ge(II) -Sn(II) compound 1 and the structurally characterized Sn(II) -Sn(II) analogue 2, which maintain their structural integrity in solution, were obtained by treating MAr2 (M=Ge, Sn; Ar=2,6-(Me2 N)2 C6 H3 ) with Sn[1,8-(NR2 )2 C10 H6 ] (R=CH2 tBu). On the basis of structural and spectroscopic data, the M-Sn bond is regarded as the interaction of a MAr2 donor with an Sn[1,8-(NR2 )2 C10 H6 ] acceptor.

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Determination of blood flow is essential for monitoring rotary blood pumps. However, accurate measurement directly adjacent to the pump housing is difficult because of the highly irregular flow profiles near the fast spinning rotor. Therefore, a specially adapted flow probe based on the ultrasound transit time (USTT) principle was designed to evaluate the flow in centrifugal blood pumps. The probe can be directly mounted at the housing and creates 2 crossed measuring ultrasound beams. The mean value, Qm, of the 2 output signals corresponds to the blood flow and the difference, Qd, correlates to the vorticity of the flow profile in the pump outflow tract. In vitro measurements obtained an accuracy for mean flow values of better than +/-0.6 L/min in extreme working points and for vorticity values even as high as Qd = 3.5 L/min. Because of vorticity, however, the output signal contained considerable noise, and that required the application of a 10 Hz filter. Positioning of the ultrasound (US) beams parallel to the axial direction of the pump was superior to radial positioning. Additional measurement of the flow profile demonstrated that a large vorticity occurred (up to Qd equal to 3.5 L/min), and this vorticity was highly dependent upon the afterload of the pump. In vivo experiments demonstrated the reliability of the method. We concluded that USTT flow measurement can determine blood flow immediately adjacent to the pump housing with sufficient accuracy, and these measurements are superior to those from US-Doppler systems (which cannot handle the vorticity accurately enough) and electromagnetic devices (which lack zero stability).

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In addition to part 1 of the study, the present paper investigated more than 25 resin/conditioner combinations with respect to their bond strengths to porcelain and composite resin. For that purpose stainless steel lingual buttons were bonded with the various adhesives and their shear bond strengths and types of bond failure were determined after 24 hours. All specimens were air-abraded with 50 microns Al2O3 for 2 or 4 seconds by means of a Microetcher before bonding. Results show that, on the porcelain, and composite under investigation, several materials yield bond strengths which are similar to or higher than what is achieved with the conventional acid etch technique on enamel. Maximum adhesive strength is not always desirable, however, for bonding brackets. The type of bond failure and the risk of irreversible damage to the bonded material have also to be taken into consideration.

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Adult patients often have fillings, artificial crowns and/or bridges that make fitting of conventional bands difficult or even impossible. In such cases bonding rather than banding would be preferable. The present paper presents the investigation of more than 25 resin/conditioner combinations with respect to their bond strength to different metals as well as to amalgam. For that purpose stainless steel lingual buttons were bonded with the various adhesives and their shear bond strengths and types of bond failure were determined after 24 hours. All specimens were air-abraded with 50 microns Al2O3 for 2 or 4 seconds by means of a Microetcher before bonding. For comparison, buttons were also bonded to bovine enamel after air-abrasion or conventional etching with 37% H3PO4. Results show that, on all metals investigated, several materials yield bond strengths which are similar to or higher than what is achieved with the conventional acid etch technique on enamel. Maximum adhesive strength is not always desirable, however, for bonding brackets. The type of bond failure and the risk of irreversible damage to the bonded material have also to be taken into consideration. Al2O3 abrasion may cause considerable damage to enamel within 4 seconds. Since the bond strength on air-abraded enamel is about the same as on acid etched enamel, conventional etching with H3PO4 is preferable to the sandblasting of enamel.

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Although there is convincing evidence that prophylactic administration of high doses of the monoclonal antibody OKT3 predisposes patients to an increased prevalence of early posttransplantation malignancy, particularly posttransplantation lymphoproliferative disease, it is indeterminate whether polyclonal antilymphocyte globulin poses a similar hazard. We reviewed the outcome of 112 consecutive cardiac transplant recipients who received uniform immunosuppression, including induction therapy with antilymphocyte globulin, and were prospectively followed-up for a median duration of 41.5 months (range 1 to 81 months). No patients had posttransplantation lymphoproliferative disease. Nine malignant neoplasms (8%) were detected from 6 to 70 months after transplantation. Four patients with cutaneous neoplasms were alive and well at the time this article was written. Three patients died of disseminated adenocarcinoma 6 months, 17 months, and 60 months after transplantation. One patient was undergoing treatment of Kaposi's sarcoma at the time this article was written, and another was undergoing treatment of transitional bladder cell carcinoma. Actuarial survival for all patients was 88% at 1 year and 79% at 5 years. Moderate doses of induction antilymphocyte globulin may facilitate rapid reduction of maintenance cyclosporine and steroid doses, thereby decreasing the duration of intense immunosuppression and lowering the risk of posttransplantation lymphoproliferative disease. Testing this hypothesis would require the development of reliable and reproducible in vivo assays to prospectively assess immune status.

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Allograft coronary artery disease (ACAD) is the major factor limiting long-term survival of cardiac transplant recipients (CTRs). Although cyclosporine based triple drug immunosuppression has not decreased the occurrence of ACAD, some preliminary data suggests that prophylactic antilymphocyte preparations may reduce the incidence of this problem. All CTRs at Henry Ford Hospital have uniformly received prophylactic Minnesota Antilymphocyte Globulin (ALG), thereby providing a unique opportunity to investigate this hypothesis. One hundred three CTRs were followed for a median duration of 34 months with annual angiograms begun one year after transplant. Patients who died without an angiogram were considered to have ACAD based on autopsy results or if their death was clinically suspicious. Ninety-two patients underwent at least one angiogram. Fourteen patients had abnormal angiograms. Nine patients were identified as having ACAD by non-angiographic criteria. Five had autopsy proven disease, 3 died suspiciously, and 1 underwent successful re-transplantation for ACAD. By Kaplan-Meier analysis, the risk of developing ACAD was 12% in 1 year, 16% in 2 years, 22% in 3 years, 26% in 4 years, and 29% in 5 years. Risk of ACAD increased with older recipient's age, higher triglyceride levels, and diabetes, but was not affected by active CMV infection, number of acute rejection episodes, and HLA mismatching. These results suggest that prophylactic ALG reduces the occurrence of ACAD.

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Fifty-six patients undergoing orthotopic cardiac transplantation were given Minnesota ALG prophylactically or therapeutically for acute cardiac rejection. During a follow-up period of 0-28 months (mean follow-up period, 11.9 months), the actuarial survival for the entire group was 96% and 86% at 30 days and 1 year, respectively. Actuarial freedom from rejection was 60% and 28% at 30 days and 1 year, respectively. All but seven rejection episodes responded to initial steroid pulses or a modification of a maintenance cyclosporine and azathioprine regimen. The seven failures were rescued with further Minnesota ALG therapy. Few serious hematologic or allergic reactions to Minnesota ALG were observed, and no new malignancies occurred during the follow-up period. We conclude that Minnesota ALG is safe and effective in cardiac transplantation.

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Fifty six patients undergoing cardiac transplantation were immunosuppressed with a multi-drug induction regimen in which Cs administration was delayed postoperatively until satisfactory hemodynamics and renal function were achieved. The advantage of this approach is the absence of acute renal dysfunction in the early postoperative period. This immunosuppressive regimen was well tolerated and without significant detrimental effects on patient survival, graft rejection, or infection.

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Data obtained from a thermal system capable of measuring changes in organ temperature as well as tissue thermal clearance in the uterus and vagina have been compared with blood flow measured continuously with a transit-time ultrasound volume-flow sensor placed around the common internal iliac artery and intermittently with radioactive microspheres in the chronically instrumented nonpregnant sheep. Temperature changes in both the uterus and the vagina correlated well with blood flow changes measured by both techniques after intravenous administration of estradiol or norepinephrine. Thermal clearance did not correlate well with blood flow in the vagina or uterus. These methods may have value in the investigation of blood flow patterns in various clinical situations such as the pelvic pain syndrome and early pregnancy.

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The circular and longitudinal muscle coats of equine "midcolon" were found to be directly electrically coupled. They appear to act in concert, in healthy animals, as a pacemaker in the area of the large colon pelvic flexure, for retropulsive-propulsive myoelectrical events. The retropulsive events keep the cecum and right ventral and left ventral divisions of the colon filled, imposing a delay time for fermentation of cellulose and for bacterial protein synthesis. Point-to-point involvement of adjacent colon sections was slowed by cooling the intestinal contents with no adverse clinical signs. Diminution of the blood flow to this regulatory area was achieved in 12 weanling foals (raised parasite-free) by parasitic cranial mesenteric arteritis, using Strongylus vulgaris larvae. Four of the 12 developed clinical signs of abdominal pain, but on necropsy 3 of these 4 had no gross lesions in the gastrointestinal tract. Dissociation of the left ventral and left dorsal colon divisions, as regards intraluminal pressure events and their antecedent myoelectrical action potentials, was induced in 7 of 8 adult animals given an acaricide which under field conditions is associated with progressive large colon obstruction and colic.

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