H. U. Zollinger

Toxoplasmosis is a ubiquitous infection, contracted by at least a third of the population in most areas of the globe. Clinical disease arises rarely, usually unexpectedly, but sometimes with disastrous effects on the patient. Humans, pets, farm and zoo animals may contract toxoplasmosis, possibly involving any clinical laboratory in its diagnosis. Pathologists must ponder the clinical significance of a hyperplastic l. ymph node, a cyst found at autopsy, or a serologic titer. Serving as scientific physicians, pathologists are asked: How is toxoplasmosis diagnosed? 'What is the treatment for ocular toxoplasmosis, for congenital infection, or for toxoplasmosis in the immunologically compromised host? vVhy does disease develop in as diverse areas as the eye, lymph nodes and placenta? How is Toxoplasma transmitted? This review proposes to survey recent advances, providing a scientific background to diagnose and manage the clinical problems of toxoplasmosis. Reviews are available which emphasize other aspects, such as serologic pro- cedures, resistance and immunity (REMINGTON, 1970), the clinical syndromes (DESMONTS, '1969; FELDMAN, 1968) and comprehensive presentations (JACOBS, 1967; FRENI{EL, '1970). Transmission and Prevalence The recent discovery of the coccidian stages of Toxoplasma in the cat intestine and the Toxoplasma oocyst excreted in cat feces, considerably broadens our understanding of Toxoplasma and its transmission (FRENKEL, DUBEY and MILLER, 1970).

The patriarch of experimental pancreas research is REIGNIER DE GRAAF (1641-1673). He carried out the first experiments with dogs in order to ob­ tain fistular secretion (1664). But only few years later, the just arisen interest in the physiology of the pancreas was severely set back by remarks of CONRAD BRUNNER. In 1682, BRUNNER expressed his belief that on the basis of experi­ ments he had carried out the pancreas was a vitally unimportant organ. He overlooked that after ligation of the main duct (discovered in the turkey by HOFMAN in 1641 and in a human cadaver by WIRSUNG in 1642), in the dog an accessory duct (described by SANTORINI in 1724) usually maintains an adequate flow of secretion. EBERLE in his monograph (1834) confirmed the emulsifying capacity of the pancreatic juice which had already been suggested by SYLVIUS (FRAN­ CISCUS DE LE BOE, 1614-1672) and he dealt with the essential enzymatic functions of the pancreatic juice such as amylolysis, lipolysis and proteolysis. Since HEIDENHAIN (1875), we know that for example trypsin (largely isolated by KUHNE in 1867) is situated in the acinar epithelial cells as zymogen in inactive form; it is thought that the action of "acid" on the glandular tissue is needed for inducing the "enzymatic activity". According to what we know now about the central role of acidosis in the activation of zymogen this topic is, of course, of topical interest.

Von E. WILDBOLZ In den letzten Jahren ist die Pyelonephritis, vor allem die chronische Pyelo­ nephritis, immer mehr in den Brennpunkt des medizinischen Interesses gerückt. Klinische und anatomische Arbeiten zeigen ihr außerordentlich häufiges Vor­ kommen. Sie ist heute die bedeutendste Gruppe der Nierenerkrankungen, ja sie hat sogar die Infektionen der Atemorgane von ihrem ersten Rang in der Häufigkeitsskala aller Infektionskrankheiten bei Spitalpatienten verdrängt. Auch der langsam Reagierende muß sich Rechenschaft davon ablegen, daß hinter der harmlosen Etikette einer chronischen Pyurie, einer chronischen Cystitis, einer Cystopyelitis, einer "empfindlichen Blase" sich oft eine Erkrankung verbirgt, die sich über Jahrzehnte hinzieht, progredient ist und schließlich, aller Therapie trotzend, zum Tode führt. Die pyelonephritische Schrumpfniere übertrifft an Zahl bei weitem alle anderen Schrumpfnieren. Diese Untersuchungen haben ferner ergeben, daß die atypischen Formen der chronischen Pyelonephritis ebenso häufig wie die typischen Formen sind, bei denen die chronische Pyurie auf den Ursprung der Erkrankung hinweist. Wir müssen also nicht nur diese Pyurien richtig deuten und auslegen, sondern wir müssen auch bei Erkrankungen wie Anämie, Adynamie, Neurose, an den renalen Ursprung der Allgemeinstörungen denken. Durch alle Studien, die sich etwas ausführlicher und eingehender mit der Klinik der chronischen Pyelonephritis befassen, zieht sich wie ein roter Faden die Verzweiflung über die Ohnmacht unserer Therapie. Die Therapie mit Anti­ biotica, die in akuten Fällen so viel Gutes zeitigt und die bei ihrer Einführung die Ausmerzung aller Infektionskrankheiten erwarten ließ, versagt.

Vor die Therapie setzten die Gotter die Diagnose. Otto NiigeJi Renal biopsy has decisively enriched renal diagnostics. Kidney diseases may be monitored during their entire course, and new techniques - such as immunofluorescence and electron microscopy - may be systematically applied, resulting in novel insights into the morphogenesis, pathogenesis, and etiology of kidney lesions. These insights, in turn, have served as new starting points, in the spirit of the quotation above, for the institution of causal therapy by the clinician. This work presents our findings based on 20 years of experience in evaluating renal biopsies. As of the end of 1974, our computer-supported, systematic clinical, morphologic, and follow-up evaluation of case material consisted of over 2000 biopsies, including 679 examined by electron microscopy and 400 by immunofluorescence microscopy. The subsequent 500 biopsies (400 studied by electron microscopy and 300 by immunofluorescence) were con­ sidered qualitatively only. In order to enhance qualitative findings with quantitative data, it was necessary to devise new methods for quantifying electron-microscopic findings. Additionally, we attempted to correlate cyto­ logic and immunofluorescent observations to integrate the isolated findings of electron microscopy into a vital cytologic pattern of reactions. We also attempted to evaluate the almost overwhelming flood of publications, especially those appearing within the last 10 years. The idea for this book was conceived a decade ago. At that time, however, our own experience in renal biopsy diagnostics seemed insufficient to sup­ port such a major undertaking.