The magnitude of exercise-induced ST segment depression and the predictive value of exercise testing. The assess whether the magnitude of exercise induced ST segment depression improves the predictive values of symptom limited exercise tests, and helps in the recognition of patients with more severe coronary heart disease, 90 consecutive patients with positive treadmill tests who also underwent selective coronary arteriography were reviewed. The predictive value improved progressively with the increasing ST depression and was most reliable in a select group of patients with normal electrocardiographic baseline who were not receiving digitalis (73% with ST depression greater than or equal to 1 mm to 100% with ST depression greater than or equal to 4 mm). The incidence of 2 and 3 vessel disease increased from 61% with ST depression greater than or equal to 1 mm in the overall population to 100% with ST depression greater than or equal to 4 mm in the select group, and the incidence of left main trunk lesions increased, respectively from 6 to 30%. The prediction of 2 and 3 vessels disease was found to be significantly greater when patients were dichotomized into those with ST depression greater than or equal to 4 mm compared to less than 4 mm. It is concluded that the magnitude of ST segment depression definitely improves the predictive values of exercise tests as well as the ability to recognize the patients with more severe disease. However, the markedly positive exercise tests cannot be utilized to accurately predict the presence of 2 or 3 vessel disease in individual cases unless ST depression attains 4 mm or more in patients with normal electrocardiographic baseline who are not taking digitalis. In this group, the ability to predict left main trunk lesion is approximately 30%.


Concealed accessory pathway and dual AV conduction: drug-dependent reentrant tachycardia. Electrophysiological studies were performed in a patient with paroxysmal supraventricular tachycardia and a normal surface ECG at the time of the study. Premature atrial stimulation revealed dual AV conduction and an echo zone during AV conduction over the fast and the slow pathway. The prolongation of the AV conduction time by a calcium antagonist, Ro 11-1781, permitted the induction of tachycardias via both pathways. Premature ventricular stimulation yielded constant VA conduction times with activation of the low right atrium before the high right atrium before the left atrium. During the tachycardia, premature right ventricular beats conducted to the atrium at a time when the AV node and the His bundle would be refractory. The study suggests the simultaneous occurrence of an occult accessory bundle connecting the right ventricle to the right atrium and dual AV conduction.


Notation of physical equations no longer a problem. Physical quantities and equations are used to define the laws of natural and engineering sciences. Clarity has been brought in equal measure into the the theory of physical quantities and the SI-system of units due to the basic work of Wallot and that of national and international institutions. For practical use in this paper, the most important rules and definitions for the formulation of physical equations are treated in an elementary form and the ease of their use is demonstrated in the following examples: speed of a car, capacitance of a plate capacitor, thermal emission of the cathode of an x-ray tube, oxygen uptake in cardiology, mole concentration and mass concentration of a substance in a solution. In addition, some important quantities and units of cardiology were summarized in a table.


The definition and identification of need for health care. Some definitions of need for health care as a basis of planning health services are discussed. A model proposed by Donabedian (1974) relating need to resources is used to consider the problems faced by the Resource Allocation Working Party (RAWP) (Department of Health and Social Security, 1976). The paper concludes that need should be defined in relation to the procedures available to meet it and the resources that permit those procedures to be used. The procedures include the whole gamut of prevention and screening, cure and care, research and development. This necessarily raises moral and ethical issues which stretch beyond the limits of medicine and concern patients, their relatives, and the public in general. Neither the medical profession nor the lay public can be expected to help define need for health care unless they understand the underlying issues. This is a challenge to those responsible for professional and public education.


Subregional resource allocations in the National Health Service. The Resource Allocation Working Party in its report Sharing Resources for Health in England proposes a formula for the identification of both regional and district financial targets (Department of Health and Social Security, 1976). In this paper it is argued that the national formula is not a valid instrument for the latter purpose. Furthermore, research into medical needs and outcomes will not be adequate to bring about real changes in resource distribution at local levels unless it is recognised that the health authorities can meet needs in different ways and that a change in resource management from institutional to service budgeting is required.


Resource allocation. Some problems in applying the national formula to area and district revenue allocations. The inadequacy of the current national formula in dealing with flows of patients across administrative boundaries is illustrated. In particular, the problems of dealing with varying admission rates for inpatients and in allocating revenues for outpatient services are discussed. We draw attention to an oversight in the recommendations concerning psychiatric services and criticise the general approach to the allocation of revenue under this heading. It is concluded that the national formula should not be applied for revenue allocation at district level in an unmodified form.


Association of childhood mortality with housing status and unemployment. The association between mortality at the ages of 0-4 and 5-14 years in the county boroughs of England and Wales for 1971, using Kendall's correlation technique, and a variety of socioeconomic indicators, was computed. Kendall's partial correlation technique was used to determine whether any association remained when the effect of social class and unemployment was kept constant. At ages 0-4 years there was a significant and positive association between mortality and low socioeconomic position, high density housing, inadequate housing amenities, and the unemployment rate (P less than 0.001). A significant association with the housing variables remained when the effect of socioeconomic status and unemployment was kept constant. Between the ages 5-14 years there was a statistically significant association (P less than 0.001) between mortality and housing density which was eliminated when the effect of social class was held constant. There was no association between unemployment and mortality in this age group.


Principles of allocation of health care resources. The methods and principles of allocating centrally provided health care resources to regions and areas are reviewed using the report of the Resource Allocation Working Party (RAWP) (Department of Health and Social Security, 1976) and the consultative document (Department of Health and Social Security, 1976a) as a basis. A range of practical problems arising from these papers (especially the report of the RAWP) is described and traced to the terms of reference. It is concluded that the RAWP misinterpreted aspects of social and administrative reality, and it failed to recognise clearly that the several principles on which it had to work conflicted with each other and demanded decisions of priority. The consequential errors led to (a) an injudicious imposition of 'objectivity' at all levels of allocation, (b) an unjustified insistence that the same method be used at each administrative level in an additive and transitive manner, (c) the exclusion of general practitioner services from their considerations, (d) a failure to delineate those decisions which are in fact political decisions, thus to concatenate them, inappropriately, with technical and professional issues. The main requirement in a revised system is for a mechanism which allocates different priorities to different principles at each appropriate administrative and distributive level, and adapts the working methods of each tier to meet separately defined objectives.


Living conditions in childhood and subsequent development of risk factors for arteriosclerotic heart disease. The cardiovascular survey in Finnmark 1974-75. Several studies in Norway have shown large differences in risk factors for arteriosclerotic heart disease among municipalities. Today it is difficult to show specific differences in the standard of living between the various municipalities to explain these findings. However, such differences have previously existed, and were expressed by, for example, the variations in infant mortality from one municipality to another. In this work a significant positive correlation is shown between the cholesterol values among men and women aged 35-49 years and the infant mortality rate previously present in the municipalities for the same cohort. The findings indicate that poverty in childhood and adolescence, followed by later prosperity, results in high cholesterol values. The findings are related to previous work where a significant positive correlation was shown between infant mortality rates and later mortality rates from arteriosclerotic heart disease.


Bed usage and disease specific mortality within ICD chapters. Using Hospital In-Patient Enquiry (HIPE) data (Department of Health and Social Security and Office of Population Censuses and Surveys, 1974), the relationship between mortality and bed usage was examined for a number of disease categories within 10 chapters of the International Classification of Diseases (ICD) (World Health Organisation, 1967). There was found to be significant correlation within six chapters for males and within six chapters for females. The use of standardised mortality ratios (SMRs) in the formula of the Resource Allocation Working Party (RAWP) (Department of Health and Social Security, 1976) for certain chapters where no correlation could be demonstrated is questioned. It is suggested that separate SMRs for urinary disease and genital disease should be used and that the SMRs for Chapter XVII (accidents, poisoning, and violence) should either be omitted from the formula or determined separately for subdivisions of the chapter.


Relationship of mortality to socioeconomic status and some other factors in Sydney in 1971. In Sydney in 1971 low socioeconomic status was found to be associated with high mortality and this became more marked with increasing age; it was not statistically significant in relation to infant mortality. Mortality was higher among those born in Australia than among immigrants. A more varied pattern in the differences in cause specific death rates was noted in those born in Australia compared with those born overseas. Socioeconomic status was characterised by an area-type index applied to the results of 1971 census and calculated for local government areas in the Sydney Statistical Division.


Seasonal variation in admissions of psychiatric patients and its relation to seasonal variation in their births. Inpatient admissions to all psychiatric hospital beds in England and Wales in 1970-73 were studied by month of admission for eight diagnostic groups. The admission rates for schizophrenia showed a pronounced seasonal variation, with a maximum in summer. The seasonal pattern for schizophrenia was very similar to the one shown for mania, although somewhat less marked. The admission rates for neurosis and for the large group of 'all other non-psychotic mental illness' showed little evidence of seasonal variation as there was could largely be explained by social factors. In schizophrenic and manic patients, the pattern of seasonal admissions (peak months July and August) is similar to the pattern reported for their births (peak months February and March). This is consistent with the hypothesis of an abnormal seasonal pattern of parental conception as the cause of the abnormal birth pattern.


Cigarette smoking among secondary schoolchildren in 1975. Prevalence of respiratory symptoms, knowledge of health hazards, and attitudes to smoking and health. A questionnaire relating to smoking habits, respirator symptoms, and health attitudes was administered to 10 498 secondary schoolchildren in 1975. The results reported in this paper indicate that children who smoke regularly have a higher prevalence of upper respiratory tract infections and a higher incidence of the respiratory symptoms, cough, phlegm production with a cold, and shortness of breath, compared with non-smokers. Children are aware of the risks of lung cancer when smoking, but less aware of the other more immediate health risks, and this is particularly so in the younger age groups. It is suggested that health education should be directed towards younger children and that more use should be made of the fact that smoking clearly makes them less healthy.


An epidemiological study of rheumatic fever and rheumatic heart disease in Lagos. In Lagos 12 755 schoolchildren aged between six and 12 years were screened for evidence of rheumatic heart disease and showed a prevalence rate of 0.03%. Group C (27.7%) and group G (47.3%) predominated in the throat and in cases of pharyngitis, while group A predominated on the skin. Two hundred and sixty-six cases of pharyngitis were recorded, 70 (26.4%) were positive for beta-haemolytic streptococci. Half of the cases of streptococci while 28.2% and 21.1% were caused by groups C and G respectively. A diversity of serotypes of group A streptococci, which included types 49 and 55, and C and G streptococci were isolated from impetiginous skin lesions. The main point of interest is the association of group C and G streptococci with sore throat and skin infections. The pathogenicity of C and G in such circumstances merits further investigation. The present study also showed that prophylactic benzathine penicillin (Penadur) given to patients with rheumatic heart disease or rheumatic fever had been effective with no recurrent attack of acute rheumatic fever.


Variations in the response of sheep to experimental magnesium deficiency. Hypomagnesaemia was induced in adult sheep by changing their diet from chaff given orally to a milk diet, low in Mg, infused via the abomasum. All sheep given the milk diet developed hypomagnesaemia and four out of 19 developed nervous convulsions similar to the natural disease grass tetany. Analysis of the sequential changes in plasma Ca, P and Mg revealed a striking positive correlation between Ca and Mg and hypocalcaemia thus appeared to be a general response to Mg deficiency. Many sheep appeared to adapt to the deficiency since after a period of about 11 days the decline in plasma Mg (and Ca) was either alleviated or reversed. However the four sheep which developed convulsions all showed a rapid and substantial decline in plasma Mg associated with a decline in plasma Ca.


The influence of breed on the susceptibility of sheep of Haemonchus contortus infection in Kenya. The relative resistance of six breeds of sheep to Haemonchus contortus infection was investigated under field conditions on two stations situated in a semi-arid zone in Kenya. As judged by faecal egg counts, monitored throughout a two-year period, it was found that there were consistent differences between the breeds. The breeds studied in order of increasing susceptibility were Red Masai, Blackhead Persian, Merino, Dorper, Corriedale and Hampshire. Post mortem findings confirmed that the differences in faecal egg count were related to the establishment of worms rather than larval inhibition or the suppression of worm egg production. There was also evidence that the Red Masai showed self-cure more frequently than the other breeds.


The influence of haemoglobin phenotype on the susceptibility of sheep to Haemonchus contortus infection in Kenya. Two flocks of Merino sheep were set-stocked on pastures known to be endemic for Haemonchus contortus. Both flocks included sheep with the three common haemoglobin types (HbAA, HbAB, HbBB). The results of regular monitoring over a two-year period showed a clear relationship between haemoglobin types and susceptibility to haemonchosis. The HbAA sheep experienced fewer deaths, had consistently lower egg counts and exhibited a more frequency and effective self-cure than the HbAB or the HbBB types. Post mortem findings demonstrated that this phenomenon was due to differences in the establishment of adult H contortus and not to suppression of egg laying capacity or an alteration of male to female adult worm ratio.


Genital lesions in experimental chronic Trypanosoma brucei infection in rams. Rams inoculated intravenously with Trypanosoma brucei developed scrotal oedema and a nonsuppurative granulomatous periorchitis resulting in testicular degeneration, atrophy, calcification and sclerosis. The tunica vaginalis was the seat of an intense granulomatous inflammation and focal necrosis, which extended to the epididymis and spermatic cord. Lesions in the seminal vesicles were suggestive of diminished testosterone production even though Leydig cells were discernible in the sclerotic testicular intertubular tissue. In areas where there was inflammation or focal necrosis, there was also extravascular localisation of trypanosomes. It is suggested that genital lesions in human sleeping sickness may have a similar pathogenetic mechanism involving tissue localisation of the trypanosomes and associated inflammatory and degenerative changes.


Clinical, virological and serological response of the West African dwarf sheep to experimental infection with different strains of Rift Valley fever virus. West African dwarf sheep were inoculated with three different strains of Rift Valley fever virus (RVFV). Using infective mouse serum as the source of virus classical RVFV disease characterised by sudden onset, a sharp but transient febrile response, viraemia, abortions and the development of specific RVFV antibodies in surviving animals was observed. The severity of clinical response was, however, dependent on the strain of virus used, with animals inoculated with Smithburn's neuroadapted strain showing a milder response than those inoculated with either the Nigerian or Lunyo strain. The inoculation of sheep with RVFV infective mouse brain material of the three different strains resulted in a mild febrile response with low level viraemia. Immune sera from sheep inoculated with both the Nigerian and Smithburn's neurotropic strains did not neutralise the Lunyo virus strain in a mouse intracerebral neutralisation test; the reverse, however, was not the case. The findings indicate that the West African dwarf sheep is highly susceptible to RVFV infection and that previous reports of only a mild clinical response following inoculation with the Nigerian strain were due to infective mouse brain rather than infective mouse serum.


Immunological reactions of Rift Valley fever virus strains from East and West Africa. Three strains of Rift Valley fever virus, namely Nigerian (NIG), Smithburn's neurotropic (SNT), and Lunyo variant (LUN) were compared by complement fixation (CF), neutralisation (N), haemagglutination/haemagglutination-inhibition (HA/HI) and agar gel diffusion (AGD) tests. They showed reciprocal cross-reactivity in CF tests. In N tests, using immune sheep sera, there was reciprocal cross-neutralisation between the NIG and SNT strains, but not with the LUN strain, the antiserum of which neutralised both NIG and SNT antigens whereas the reverse was not the case. When hyperimmune mouse ascitic fluid was employed in N tests, there was cross-reactivity between the three strains. Both the NIG and SNT strains yielded haemagglutinins, but not the LUN strain. Furthermore, by the antibody absorption and AGD techniques, the NIG and SNT strains were found to be identical and distinct from the LUN variant strain. The techniques found most useful in distinguishing between the three strains were HA and AGD. Laboratory neuro-adaptation of the classical pantropic virus did not appear to affect its haemagglutination activity.


Structure of the epidermis in Ayrshire bullocks. The living epidermis and stratum corneum of cattle, when measured on cryostat sections, were both found to be approximately 30 micrometer thick. However, the corneum contained about 30 cell layers, whereas the living epidermis was composed of only four. Histological processing involving fixation, dehydration and paraffin embedding, resulted in the loss of half of the stratum corneum and proved to be unsuitable for study of this layer. Lipid derived mainly from the sebaceous gland was present between the squames in the outer two thirds of the corneum probably in the form of an emulsion with sweat.


Structure of the sheep epidermis.

Structure of the sheep epidermis. The stratum corneum measured on fresh frozen sections was found to be considerably thicker than previously reported. It was uniformly permeated with sebum, which also formed an intact film over the skin surface and it could readily be divided into two zones. The living epidermis was approximately half as thick as the stratum corneum.


Ultrastructural alterations of the myocardium of rats fed rapeseed oils. Ultrastructural studies were conducted on the myocardium of rats fed corn oil, Tower RSO (0 . 88 per cent EA), 1788 RSO (3 . 6 per cent EA) and Target RSO (38 . 9 per cent EA) supplemented diets for 18 weeks. Cardiac myocytes of Tower RSO-fed rats showed some loosening of myofibrils and a slight increase in the number of mitochondria, few of which had lost their cristae. Large intravascular lipid droplets were observed in the myocardium of rats fed the 1788 RSO diet, as well as some small lipid droplets which were seen in close association with mitochondria. There was an apparent increase in the number of mitochondria of both normal and giant size. Many of the mitochondria exhibited distortion of shape and degeneration of cristae. The matrix of megamitochondria contained vesicles and electron-dense floccular inclusions and at times electron-lucent lipid-like material. The degenerative changes of mitochondria were most pronounced in the Target RSO group, where some megamitochondria showed a complete loss of cristae and a replacement of matrix with lipid-like material. These observations suggest that both intravascular lipid globules and the mitochondrial alterations are possible contributory factors involved in the development of cardiac lesions in RSO-fed rats.


Termination of arrested development of the trichostrongyles of sheep in northern Nigeria. Monthly worm counts of groups of ewes and lambs that grazed continuously and tracer lambs revealed that under the conditions existing in northern Nigeria, most of the Haemonchus contortus in sheep between November and March were arrested larvae. During the months of April and May, almost equal proportions of adults, developmental stages and arrested larvae were recovered and, by June, only adults and developmental stages were recovered in high numbers. The proportion of arrested larvae had diminished considerably. A similar pattern was recorded for Trichostrongylus spp, except that fewer larvae were involved in arrested development and very large numbers of adults were recovered throughout the duration of the study. Maturation of arrested larvae occurs in April.


Resistance of chickens to challenge with the virulent Herts 33 strain of Newcastle disease virus induced by prior infection with serologically distinct avian paramyxoviruses. Results indicate that some degree of protection from challenge by Newcastle disease virus (NDV)/Herts 33 was conferred on chickens by prior infection with PMV/turkey/Wisconsin/68, PMV/turkey/Ontario/6661/68, PMV/Netherlands/449/75 and PMV/parakeet/England/39/78 viruses, all of which are serologically related but distinguishable from NDV. Except for one bird which survived challenge three weeks after infection with Robin/Hiddensee/19/75, no protection was seen in chickens infected with other unrelated avian paramyxoviruses. In contrast to infection with NDV-B1, birds protected by infection with avian paramyxoviruses showed large increases in NDV haemagglutination inhibition (HI) titres after challenge. In these birds considerable increases in the homologous HI titres were also seen after challenge.


Field observations on the epidemiology of abomasal parasites in young sheep during winter and spring. A flock of spring born lambs was continuously exposed to natural parasite infection from birth until selected for slaughter in groups of two or three, at monthly intervals throughout winter and spring for abomasal worm counts. Meteorological data were recorded and regular estimates of infective pasture larval availability were made. Parasite population changes and inhibition patterns for Ostertagia spp, Haemonchus contortus and Trichostrongylus axei were recorded. Ostertagia spp were found to survive well both on the pasture and within the host, principally as arrested larvae. H contortus overwintered almost entirely in the host in the inhibited form and T axei overwintered mainly in the host, but in the adult stage.


Evaluation of a live Salmonella choleraesuis vaccine by intranasal challenge. Weaned pigs were immunised with a live attenuated Salmonella choleraesuis vaccine. The protective immunity induced was compared with that of unvaccinated pigs by intranasal challenge with a field strain of S choleraesuis. Of 18 unvaccinated pigs, three died as a result of challenge from S choleraesuis and 10 of the survivors developed chronic lung lesions. None of the vaccinated pigs died as a result of challenge and two only showed macroscopic evidence of salmonellosis on autopsy three weeks after challenge. It was concluded that subcutaneous vaccination of pigs prevented death and clinical illness but did not prevent invasion of tissues following intranasal challenge with S choleraesuis.


Babesia divergens: the immunisation of splenectomised calves during irradiated piroplasms. Groups of three splenectomised calves were inoculated with 1 . 2 x 10(10) Babesia divergens-infected erythrocytes irradiated at 24, 28, 32, 36 and 40 kilorads. Control calves were inoculated with 1 . 2 x 10(7) or 1 . 2 x 10(4) non-irradiated parasites. While control animals all experienced severe reactions, animals receiving blood irradiated at 24, 28 and 32 kilorads had mild reactions and were solidly immune to an homologous challenge of 1 . 1 x 10(4) Babesia-infected erythrocytes. Animals receiving parasites irradiated at 36 and 40 kilorads had limited ability to resist the challenge.


Stressor effects of handling on the immature fowl. Chicks were handled for 5 min twice daily for five consecutive days per week over a three-week period. The control birds were not handled once they had been allotted to their brooders. The growth rate of the treated birds was significantly decreased. There was no adrenal hypertrophy; the concentration, but not the content, of adrenal cholesterol was significantly increased. Plasma glucose, FFA and cholesterol concentrations were similar in the groups at the end of the experiment. The lipolytic response of the handled birds to a further stimulus of handling was significantly greater than that of unhandled birds experiencing novel handling stimulus. There was also a significant decrease in the concentration of corticosterone in the plasma of the handled birds but not in the unhandled group. There was thus no evidence of habituation.


Studies on the ultrastructural morphology of Bacteroides nodosus. The morphology of Bacteroides nodosus was examined with the electron microscope. B nodosus stained with solium phosphotungstate and uranyl acetate possessed fimbriae and in addition organisms negatively stained with sodium phosphotungstate often possessed rings on their surface. Phage-like particles were also observed in negatively stained preparations. In thin sections, B nodosus had a multilayered cell envelope and the type of cell division characteristic of Gram-negative bacteria. The cytoplasmic region contained a diffuse nucleoid area, ribosomes and, sometimes, concentrically arranged membranous lamellae. Fimbriae and capsular material were also seen in sections of B nodosus fixed with glutaraldehyde-osmium. Their visualisation appeared to be enhanced when ruthenium red was incorporated n the glutaraldehyde-osmium fixative but only when sections were stained with heavy metal salts, indicating that the fimbriae and capsule were not predominantly polysaccharide in nature.


Serological studies with the virus of peste des petits ruminants in Nigeria. It was possible to distinguish separate serological responses when experimental goats were inoculated with either rinderpest virus or peste des petits ruminants virus. Examination of field samples established that peste des petits ruminants occur commonly in Nigerian sheep and goats although some villages have escaped recent infection. There was no evidence of infection with rinderpest in these animals.


The blood volumes and erythrokinetics of Ndama and Zebu cattle experimentally infected with Trypanosoma brucei. The responses of susceptible Ndama and Zebu cattle to experimental infection with Trypanosoma brucei were compared using haematological, parasitological and radioisotopic methods. Animals of both breeds became anaemic, but this was more severe in the Zebu cattle, one of which died. Although the prepatent period was the same in animals of both breeds, the levels of the first and subsequent peaks of parasitaemia were higher in the Zebu. The anaemia was due to an accelerated rate of red cell break-down which was more marked in the Zebu cattle. Haemodilution was not a feature. There was no evidence of dyshaemopoiesis but iron reutilisation from degraded erythrocytes was impaired. The greater resistance of the Ndama to T brucei infection could not be attributed to the capacity of this breed to mount a more effective erythropoietic response than the Zebu.


The effects of some surface sampling procedures on the stratum corneum of bovine skin. Clipping and shaving remove cell and lipid layers from the stratum corneum and also modify the effects of subsequent lipid collection and microbiological sampling techniques. The damage to the epidermis caused by solvents indicates that further evaluation of some sebum collection procedures and of the effects of dips and dressings applied to the skin is required.


A note on the transmission of Babesia bovis (syn B argentina) by the one-host tick, Boophilus microplus. Boophilus microplus infected with Babesia bovis were transferred artificially from one splenectomised calf to another during each moult in the parasitic life cycle of the tick. Eggs from the engorged female ticks recovered at the end of the cycle were incubated and the resulting larvae used to infest more splenectomised calves. Babesia bovis was transmitted only by the original larvae used at the commencement of the experiment and it was concluded that the protozoan parasite did not persist in an infective form in the ticks beyond the larval stage.


The period between birth and first suckling in dairy calves. The period between birth and first suckling was recorded for 82 dairy calves. 11 per cent of heifers' calves and 46 per cent of cows' calves had not suckled by 6 h after birth. All calves, whether suckling spontaneously or put to the teat at 6 hr, had adequate 48 h total serum immunoglobulin levels.


The effects of implanting jugular catheters on plasma glucose concentrations in wethers fed two extremes of diet. Although de novo glucose synthesis was 47 per cent higher in wethers fed hay plus barley than in wethers fed hay alone, the plasma glucose concentrations were similar. When two chronic jugular vein catheters were implanted, plasma glucose concentrations rose by 17 per cent and 5 per cent after 4 h in those fed hay alone and hay plus barley respectively. Levels subsided after 24 to 30 h post catheterisation.


Attempts to immunize rats against infection with Fasciola hepatica using in vitro culture antigens from newly excysted metacercariae. Attempts were made to immunise rats against Fasciola hepatica using the culture products obtained from the in vitro cultivation of newly excysted metacercariae. Three culture regimes were chosen: (1) medium NCTC 135 for 48 h (2) NCTC 135 + 20 per cent fetal calf serum (FCS) for 48 h (3) NCTC 135 + 20 per cent FCS for 14 days. The used culture medium from each of these regimes was concentrated, mixed with adjuvant and injected subcutaneously into rats. Similarly treated unused culture media was used in control rats. The rats were challenged with an oral dose of 20 F hepatica metacercariae 35 days later and autopsied 96 days after the start of the experiment. The fluke burdens in those rats which had received the culture antigens did not differ significantly from those in the control groups.


A test for early pregnancy in sheep.

A test for early pregnancy in sheep. The rosette inhibition test has been used to detect an early pregnancy factor (EPF) in the serum of ewes. EPF was shown to be to be present within 72 h of mating and was still detectable after one month of gestation and in some cases after four months' gestation. The detection of EPF could be of value in the diagnosis of pregnancy in the ewe during the first month of gestation.


Some haematological data for the European kestrel (Falco tinnunculus). The mean packed cell volume and haemoglobin concentration of blood samples taken from a colony of captive European kestrels were found to be 45.9 per cent and 17.3 g per cent respectively. No evidence of protozoal parasites was found in smears from 13 birds examined.


[Radioactive isotopes in the diagnosis and therapy of tumors]. The Author, after some historical accounts, widely deals with physics and chemistry of the atom that are the necessary presupposition to the knowledge of the mechanisms of action of radio-isotopes. He hence exposes the radio-isotopes applications with special consideration to the action of radiations on the organism and the possibility of diagnosis and therapeutics with radioisotopes in oncology. The Author concludes that radio-isotopes must not be considered separately in the therapeutics of tumours, but as main component of the whole anti-tumour armament (surgical, consentional radiological, chemi-therapeutic) in which the immune-therapeutics is proving itself with fascinating possibilities.


Development of individual differences of cardiovascular regulation in the Bailey recombinant inbred mice. Previous research has demonstrated that the cardiovascular system (CVS) is not completely developed in the rat until 20 days of age. Prior to this age the sympathetic nervous system (SNS) is dominant during resting conditions and the stress response is vagally mediated, which is the opposite of most adult rats. In the present research, using the Bailey recombinant inbred strains and their progenitor strains (C57BL/6By and BALB/cBy), we determined the developmental period for the CVS in mice. The CVS was controlled by a high SNS tone and the stress response was vagally mediated at 8 days of age. By 12 days of age, the mice had much slower baseline heart rates which were vagally controlled. Significant strain differences were also found with a polygenic model accounting for these differences. The stress response of the 12-day-old mice was not interpretable because of individual differences in the adult coping strategies. These differences were accounted for by a different polygenic model than was found in the baseline condition.


Genetic analysis of lines selected for wing vibration in Drosophila melanogaster. Selection for the wing vibration component of courtship in the Oregon-R stock of D. melanogaster was practiced for 44 generations. Selection was successful, indicating that there is genetic variation for the trait in the Oregon-R stock. The mean realized heritability of the trait, based on the first 11 generations of selection, was 15%. Biometrical analysis showed that there is some additive genetic variance for the trait with the possibility of some ambidirectional dominance. No maternal effects for the trait were found.


Reduction of testosterone to 5 alpha-dihydrotestosterone by human and rat uterine tissues. Incubations of adult rat uterine tissue and human endometrial and myometrial homogenates with [1,2,6,7-3H]testosterone resulted in the formation of 5 alpha-[3H]dihydrotestosterone. The rat uterine homogenates showed higher activity than the minced tissue. The activity in human tissue was found to be less than rat tissue on a per unit weight basis. The human endometrium has been found to possess significantly higher activity than myometrium. These results support the hypothesis that androgens may exert their effect on uterus via 5 alpha-reduced metabolites.


Thyroid hormone and thyrotropin levels in patients placed on colestipol hydrochloride. Bile acid sequestrant resins can bind T4 in vitro and in the gut. Therefore, the effect of colestipol HCl on thyroid function was studied prospectively in 17 subjects with type II hyperlipoproteinemia. Serum T4, T3, T3 resin uptake, and TSH levels were measured before and during therapy. No change in T4 levels and only small transient, but significant, decreases in T3 were noted in a minority of patients; TSH levels did not change. Small increases in T3 resin uptake were noted. We conclude that no major alterations in thyroid function occurred with colestipol therapy.


LATS-protector activity in thyrotoxicosis measured by thyroidal intracellular colloid droplet formation. A modified assay method of LATS and LATS protector (LATSP) was devised employing murine thyroidal intracellular colloid droplet formation. This method is 4- to 8-fold more sensitive to stimulators than is the regular McKenzie bioassay. For the assay of LATSP, IgG to be tested was incubated with human thyroid homogenate, then LATS-IgG was added and it was further incubated. The potency of LATS in the mixture was assayed. The adequacy of the present method for the assay of LATSP was supported by the facts that the LATSP activity was roughly related to the dose of IgG tested and that the inactivation of LATSP was observed when the IgG was pretreated with human thyroid particulate fraction and then assayed. With this method, 7 out of 32 patients with thyrotoxicosis showed LATS and 18 showed LATSP. Changes in LATSP were followed up in 7 cases out of the 18. LATSP activity decreased and then disappeared in 6 out of the 7 cases, when they had been euthyroid for a certain period of time. At 12-20 months after the treatment either by thionamide medication or by subtotal thyroidectomy. LATSP and 131I-thyroid uptake were measured in these 6 patients. In all of the 6, LATSP was negative regardless of thyroid suppressibility.


Coagulation and fibrinolysis in multiple trauma after early heparinizing. In 27 multiple trauma patients receiving standard shock management and intensive care, coagulation and fibrinolysis were investigated after early heparinization. The general coagulation tests did not imply any impaired clotting function. Platelets and factors I, II, and V decreased without induction of hypocoagulability. There was considerable decrease in plasminogen, whereas FDP ranged within normal; thus, a hyperplasminemia can be excluded. Antithrombin III remained within normal range; even in nonsurvivors there was no depletion, although their antithrombin III activity was significantly lower. In comparison to 50 trauma patients - a comparable group with regard to trauma patterns, shock management, and intensive care - there were no significant differences in volume requirements or mortality rate. Whether early heparinization is effective in preventing disseminated intravascular coagulation (DIC) related organ failure remains to be seen.


Impairment of reticuloendothelial system function with sepsis and its improvement with ATP-MgCl2 plus glucose administration. Peritonitis in rats was produced by cecal ligation and puncture. Sixteen hours following cecal ligation and puncture, the gangrenous cecum was removed and the animals received either 4 ml saline (nontreated), 0.75 ATP-MgCl2 (100 mumoles ATP plus 50 mumoles MgCl2), and 2.0 ml of 50% glucose or 2.0 ml of 50% mannitol and 1.25 ml saline. Two hours after the removal of the cecum, RES function was evaluated by measuring the intravascular clearance of a 131 I triolein-labeled gelatinized test lipid emulsion. The intravascular half-time (t1/2) in the nontreated animals was double that of sham-operated animals, suggesting that significant depression in RES function occurred during sepsis. Administration of ATP-MgCl2 plus glucose following sepsis resulted in t1/2 values similar to those of sham-operated animals, indicating that the impairment of pagocytic activity of the RES was reversed with treatment. The beneficial effect of treatment following sepsis does not appear to be due to hypertonicity, since administration of 50% mannitol failed to decrease the t1/2. The precise mechanism of the beneficial effect of ATP-MgCl2 + glucose on restoration of RES function is not known.


Gram-negative sepsis in thermally injured sheep. Burn wound sepsis was studied for four days in awake, unanesthetized sheep. Each of the animals was given a 40% third-degree burn, and the wound was infected with Pseudomonas aeruginosa. According to their cardiopulmonary response, the animals were divided into three groups: hyperdynamic, normodynamic, and hypodynamic. The hyperdynamic group had an increased cardiac index and a decreased total peripheral resistance index. The hypodynamic group was characterized by the following: decreased cardiac index, increased total peripheral resistance index, increased hematocrit, decreased PaO2, increased pulmonary vascular resistance index, and decreased neutrophils (P less than or equal to 0.05). The hypodynamic group was inoculated with more P aeruginosa, had more positive cultures for P aeruginosa, and had a greater mortality rate than the other two groups. It is suggested that the hypodynamic group was hypovolemic as a result of a fluid shift from the vascular compartment, that this fluid shift may be important in preventing the animals from responding to sepsis with an elevated cardiac index, and that the derivation of the cardiovascular response to sepsis is related to the severity of the initial septic insult.


Evaluation of glucocorticoids during resuscitation of injured patients. This study evaluates the effects of 30 mg/kg methylprednisolone (MP) administered to eight trauma patient over a 30-minute period during initial resuscitation. Vascular pressures, cardiac index (CI), left ventricular stroke work index (LVSWI), systemic (SVR) and pulmonary (PVR) vascular resistance, oxygen delivery (OD), oxygen consumption (VO2), physiological shunt (shunt), limb blood flow (LBF), limb-oxygen delivery (LOD), and limb oxygen consumption (VLO2) were calculated at control and 1, 2, 4 and 6 hours following MP administration. At 1 hour there was an increase in CI from 2.9 +/- 0.3 to 3.5 +/- 0.3 liters/min/m2 (P less than 0.01), in OD from 961 +/- 172 to 11067 +/- 148 ml/min (P less than 0.05), in VO2 from 178 +/- 16 to 220 +/- 16 ml/min (P less than 0.01), in shunt from 25 +/- 3% to 33 +/- 3% (P less than 0.05), and a decrease in SVR from 1187 +/- 98 to 1945 +/- 87, and in PVR form 222 +/- 22 to 178 +/- 18 dyne sec/cm5 (P less than 0.05). These values returned to control by 4 hours. In spite of a pulmonary wedge pressure (PWP) that did not increase form a control of 5 +/- 2 mm Hg, and a mean arterial blood pressure (MABP) that did not decrease from a control of 86 +/- 5 mm Hg, LVSWI increased significantly at 1 hour (P less than 0.01). LBF, LOD, and VLO2 decreased at 1 hour (P less than 0.05). Since increased cardiac output was associated with increased stroke volume and left ventricular stroke work index, but without an increase in preload (PWP) or a decrease in afterload (MABP), methylprednisolone(MP), in pharmacologic dosage appears to have a positive inotropic effect on the myocardium of trauma patients during resuscitation.


Early cardiorespiratory prognostic patterns in multiple trauma patients. Hemodynamic parameters were monitored for one week ( in greatest detail during the first 24 hours) in 50 severely injured people who had been admitted to the hospital for treatment within one hour after the accident and, as judged by the type of injury, had probably lost more than 1 1/2 liters of blood. The estimations included not only blood pressure, heart rate (HR) and shock index but also the cardiac index (CI), pulmonary arterial pressure (PAP), pulmonary capillary pressure (PCP), and parameters of oxygen transport were determined with the aid of Swan-Ganz catheters, CI, SI, and left ventricular stroke work index (LVSWI) were decreased, PAP, total pulmonary resistance (TPR), and total systemic resistance (TSR), were increased from the very beginning in the nonsurviving group, with a high prediction of vital outcome. The Swan-Ganz catheter is valuable in such cases in obtaining early prognostic evaluation and in controlling therapy - ie, volume replacement, vasodilation, and adrenergic therapy.


Effect of reticuloendothelial blockade on the development of hypotension after trauma, sepsis, and intravascular coagulation. Numerous studies have demonstrated that reticuloendothelial system (RES) depression induced by colloid blockade increases susceptibility to circulatory shock following trauma and sepsis. Recent data have suggested that this may relate to the failure of the RES to clear potentially embolic material derived from activation of the hemostatic system. The present study thus compared the hypotensive response precipitated by trauma or sepsis with that resulting from induction of intravascular coagulation. Mean arterial blood pressure (MABP) was monitored for 120 minutes after sublethal NCD trauma and after intra-aortic injection of live E coli (approximately 10(10) organisms per rat), E coli endotoxin (0.1 mg/100 gm), or bovine thrombin (10 units/100 gm) in 400-500 gm rats 30 minutes after RE blockade (50 mg/100 gm gelatinized lipid colloid) or saline injection. All rats were anesthetized with sodium pentobarbital. No hypotension was observed in blockaded control rats. After trauma, MABP decreased by 20 minutes after injury and recovered to normal levels by 1 hour post-trauma. MABP decreased in blockaded rats after trauma and remained diminished through 2 hours. After live E coli endotoxin or thrombin, both the normal and the blockaded groups underwent an initial hypotension of similar magnitude. A second period of hypotension was much more pronounced in the RE-blockaded animals. Reduced MABP persisted in these animals through 2 hours. These data indicate that RE blockade enhances the hypotensive response to intravascular coagulation and that resulting from trauma or sepsis. This effect was especially apparent during the second phase of hypotension during sepsis and intravascular coagulation. It was suggested that the RES manifests some protective effect against the agents inducing this secondary hypotensive response.


Immunoreactive serum opsonic alpha 2 sb glycoprotein as a noninvasive index of RES systemic defense after trauma. Reticuloendothelial system (RES) depression has been correlated with diminished resistance to trauma, shock, and sepsis in man and animals. Previous studies have related the depression of RES hepatic Kupffer cell phagocytic function after trauma to diminished bioassayable opsonic activity. The present study determined if the loss of biological activity and RES alteration correlated with immunoreactive serum opsonic alpha 2 SB glycoprotein levels after trauma. Serum opsonic activity was measured by liver slice bioassay, and immunoreactive opsonic protein was measured by rocket electroimmunoassay. RE function was determined by colloid clearance over a 24-hour post-trauma period. Anesthetized rats (250-300 gm) subjected to sublethal or severe (greater than LD50) whole-body NCD trauma were the shock models investigated. Immunoreactive levels in 63 rats prior to injury were 518 +/- 24 microgram/ml. Neither biological nor immunoreactive levels were altered over 24 hours in anesthetized sham-traumatized controls. Temporal alteration in the initial decrease and recovery pattern of biologically active and immunoreactive opsonic protein levels significantly correlated following both sublethal and severe injury. Moreover, the patterns of immunoreactive levels of the opsonic protein correlated with the functional phagocytic activity of the RES as determined by vascular clearance of a test dose of blood-borne radiolabeled particulates. This glycoprotein falls after trauma, and the magnitude and duration of the decline increases with severity of injury. Immunoreactive opsonic alpha 2 SB glycoprotein appears to be an accurate measurement of circulating opsonic activity and RE Kupffer cell function after trauma, especially with respect to clearance. Thus, immunoreactive opsonic protein warrants clinical consideration as a noninvasive measure of reticuloendothelial systemic defense in patients after trauma and burn.


Oxygen consumption in canine skeletal muscle following massive saline infusion. To study the effect of interstitial edema on tissue oxygen transport, we infused buffered isotonic saline solution at a rate of 200 ml/kg/hr into mongrel dogs for two hours, measuring oxygen delivery and consumption in a skinned, innervated hindlimb. Hematocrit dropped gradually to 10.8 +/- 3.9%. Muscle water content increased 13% (P less than 0.05). However, oxygen consumption did not change significantly from control of 0.228 +/- 0.029 ml/min/100 gm. Femoral venous oxygen tension fell from control of 62.6 +/- 2.6 mm Hg to 31.4 +/- 2.3 mm Hg. Mean arterial flow increased to nearly twice the control level of 12.5 +/- 1.1 ml/min/100 gm and fell gradually, with the sustained 50% drop in vascular resistance largely explained by expected decreases in blood viscosity. We conclude that interstitial edema did not cause a significant defect in canine skeletal muscle oxygen utilization.


[Vectorcardiographic manifestations of supraventricular ectopic rhythms]. In the presence of low right atrial rhythms, the eight-shaped PF loop is located in the first quadrant, the PH loop is rotating in a counterclockwise direction and PS can rotate in either course. When the rhythm originates in high left atrial regions, PF and PH loop loops can be found in the third quadrant of both planes and should have a clockwise rotation. When the pacemaker is located in low left atrial regions, the PF loop rotates in a counterclockwise direction, or with its branches superposed, and located in the second quadrant; PH is rotating clockwise in the third quadrant; PS with either a clockwise or a counterclockwise rotation, is situated above and slightly ahead of the E point. In the presence of a nodal rhythm, the P loops show a counterclockwise rotation or an eight-shaped configuration. In the absence of atrial enlargements, the PF loop can be seen in the first quadrant and the PH in the first or the fourth quadrant.


[Vectorcardiographic manifestations of left intraventricular conduction disorders]. Both, the vectorcardiographic changes produced by the various degrees of left bundle branch block and these observed with the different types of left distal block, are described. When a "wave jumping" phenomenon exists, the vectorcardiographic changes are more characteristic in the horizontal plane than in the frontal plane and can be interpreted satisfactorily in basis of the ventricular activation sequence. The normal counterclockwise rotation of the horizontal vectorcardiogram persists in the presence of left bundle branch block of slight and moderate degrees, since the electromotive forces of the free left ventricular wall are still predominant. In the majority of intermediate degree blocks, the middle portion of the RH loop develops with a clockwise rotation and general aspect with a clockwise rotation and the general aspect of the ventricular loop resembles an eight figure. This is due to the electromotive forces originated by the delayed depolarization of the left septal mass that starts to predominate. With advanced degrees of block, the largest portion of the RH loop shows a clockwise rotation, as well as marked notchings and slurrings. The initial anterior portion of the horizontal vectorcardiogram does not disappear, but is situated to the left of the anterior-posterior axis with a counterclockwise rotation (first right septal vector). Otherwise, the direct electrical sign of left distal block emphasized: evidence of delayed activation in a limited zone of the homolateral ventricle. This local delay gives rise to an asynchronism of the activation phenomenon between the upper and lower regions of the ventricle. The diagnosis of left bifascicular block is based essentially on the evidence of unequal delay of the activation sequence in the basal regions and in the inferior ones of the homolateral ventricle and also on the frequent persistence of the first left septal vector.


[Preliminary studies on the immune response to tetanus antitoxin: use of dried blood on filter paper]. The tetanus antitoxin titers of blood obtained by venepuncture and those of finger-blood absorbed on filter paper are compared when the titration techniques use fresh or formalinized erythrocytes sensitized by the bis-diazotized benzidine (BDB) method. The results show that the antitoxin titers are closely similar with the two methods of sampling and storage.


[Bovine brucellosis in Algeria. Results of serological detection from 1969 to 1976]. The results of the 1969-1976 serological detection of bovine brucellosis in Algeria carried out in the "domaine autogérés" show a stabilization of the level of infection around 12% despite prophylactic measures. Other measures are advocated.


[Practical methods for rabies control in Algeria]. Control measures currently in use in Algeria have not given the results expected. Suggestions are made of the eradication of rabies in rural areas as well as in urban ones by concentrating on the dog and adapting the legislation.


[Management of a suspect bite].

[Management of a suspect bite]. Ignorance of the indications or unsuitable treatment are the most common causes of mistakes in the vaccinal or serovaccinal treatment of rabies. The physiological, clinical and epidemiological bases are brought to mind and a simple management scheme is suggested taking into account the W.H.O. recommendations.


[Stool culture. Evaluation of technics of salmonellosis diagnosis]. With a view to standardizing diagnostic methods in our country, we have attempted to evaluate the techniques for isolating Salmonella, more particularly S. typhi, by stool culture. The various factors influencing the isolation rate of these organisms are studied, i.e.: the mode of sampling, the components of media for both isolation and enrichment, and subcultures. A scheme for isolation of Salmonella from stools is proposed.


[Epidemiology of rabies in Algeria].

[Epidemiology of rabies in Algeria]. An epidemiological study on rabies in Algeria has been carried out on data provided by the "Institut national de Santé publique" and the "Institut Pasteur d'Algérie". It showed that no region is unhurt. The animal reservoir is of the domestic type, essentially the dog. In 40% of cases, bites are due to stray dogs.


[National survey on pulmonary tuberculosis treatment. Bacteriological results]. A survey concerning the out come of the pulmonary tuberculosis treatment has been carried out in algeria. 11 districts were concerned. Patients received treatment in sanitary centers from January to March 1977. Smears were done before any treatment and after 12 months cure; Ziehl-Neelsen staining was performed at the local laboratory and sputum samples were sent to the central laboratory for fluorescence examination and culture. Positives cultures were tested to antituberculosis drugs. Bacteriological results obtained before and after 12 months treatment are reported.


[Survey on tuberculosis treatment in the Sahara. Preliminary bacteriological results]. The preliminary bacteriological results of a survey carried out in the Sahara desert and concerning antituberculosis treatment are reported. Two regimens were compared ; a twelve-months regimen SHE/HE and six months regimen RHEZ/RH. Out of 370 patients admitted in one year, 292 had a positive smear, whereas 40 had not any bacteriological proof. 275 strains were isolated and 205 were tested to antituberculosis drugs; 15% showed a resistance to a least one drug. The 15% rate was in fact very different from one sanitary district to another. The search for INH metabolites in the urines of patients before treatment showed 67 positive cases out of 341. The follow up was carried out at the 5th, 6th, 9th and 12th month after admission, smears and cultures of sputum and detection of INH metabolites in urines were used.


[Absorption and urinary elimination of pyrazinamid administered alone or in combination with isoniazid and rifampicin]. The aim of this work to study the PZA absorption in man its urinary excretion. The PZA was administered alone and in association with INH or/and Rifampicin. The PZA dosage in blood and urine and pyrazinoic acid in urine were performed in a sample of 80 patients divided into 4 groups. PZA dosage was also performed in blood from mice in the same experimental conditions. Our results showed that in man, the titres in serum gave higher peaks when PZA was given alone. Titres were significantly lower when PZA was associated with the two other drugs. The comparative study of PZA seral rates in men and women in one side and mice in the other, showed that the seral concentration was proportional to the body weight. Urinary excretion of Pyrazinamide and pyrazinoic acid showed a relation between the seral concentration and the urinary concentration. However, there was no correlation between the maximum seral concentration and urinary excretion of pyrazinoic acid.


[Description of 173 cases of cutaneous leishmaniasis]. The authors present 173 cases of cutaneous Leishmaniasis observed in the Biskra area. Sidi Okba is the biggest focus of this disease which mainly affects children from 1 to 5 years. Lesions are dry and often multiple (2 or 3). The authors have observed that 73% of girls are affected on the face and point out the aesthetic damage caused by the oriental sore.


[Phage types of Vibrio cholerae and non agglutinable Vibrio isolated in Algeria from 1975 to 1977]. 1 285 strains of Vibrio cholerae and 556 strains of non agglutinable Vibrio were isolated either from stool specimens or water in Algeria from 1975 to 1977. These strains were phage-typed with Basu and Mukerjee's 5 phages for the Vibrio biotype El Tor and with Mukerjee's phage IV for the Vibrio biotype cholerae. The results obtained are discussed in terms of choleraphages used for the diagnosis and epidemiological study of cholera.


[Modification of the strain Flury HEP after its adaptation to cell culture. Development of experimental vaccine for veterinary use]. The rabies strain Flury HEP, adapted in our laboratory to BHK21 cells, shows, after 20 passages on this cell, an important modification of its pathogenic characteristics on adult mice, guinea pigs and hamsters. An experimental vaccine made with this adapted strain gives a good sero-conversion rate when injected by the intramuscular route to a group of dogs.


[Evolution of the repartition of enteropathogenic enterobacteria serotypes isolated in Algeria from 1974 to 1977]. The authors survey the enteropathogenic enterobacteria studied from 1974 to 1977 and draw the following conclusions : S. typhi is still the predominant serotype. Among Salmonella, other than S. typhi and S. paratyphi, S. wien remains the most frequently reported serotype while progressively decreasing from 1974 to 1976 and is supplanted by S. infantis in 1977. Among the 847 strains of Shigella examined, a high frequency of Shigella flexneri is noted with Shigella sonnei following by a wide margin. As regards the enteropathogenic E. coli the serotypes 0111 : K 68 (B4) and 0125 : K 70 (B15) were isolated, frequently from 1974 to 1976 but the serotype 0119 : K 69 (B14) became the most frequent in 1977.


[Problems of variability of Mueller-Hinton medium for sensitivity testing. Some parameters and an attempt to standardize sensitivity of Salmonella typhi]. The incidence of some so-called "Mueller-Hinton Medium" for sensitivity testing on the growth of bacteria (especially S. typhi) and on the drug activity are evaluated here. The role of the quality and amount of ingredients : peptone, agar and starch are emphasized. An improved medium is proposed : tryptophane is added to compensate the casein hydrolysate deficiency for S. typhi growth.


[42 cases of subacute sclerosing panencephalitis hospitalized at the Ait Idir hospital in Algiers]. In this report of 42 cases hospitalised at "Hopital Neurologique" in Algiers during 1967 though 1975, 0,32 cases per year per 100,000 persons under 20 years old were reported in the province of Algiers where 21 cases resided. However, in the same province, a figure of 0,82 cases per 100,000 persons under 20 years old was found for the year 1973 when an intensive search for cases was carried out. Other findings are indicated.


[Some aspects of the evolution of cholera in Algeria from 1971 to 1975]. Taking as a basis information collected in their laboratory, the authors study certain aspects of the evolution of cholera in Algeria during the different outbreaks from 1971 to 1975. 6 301 strains of vibrio-cholerae (mainly serotype Ogawa) were isolated either from cholera patients or carriers. All but two of strains were sensitive to all antibiotics tested. Most of the Wilayate (districts) were affected during these outbreaks which took place from June to December; the majority of cases were observed from August to October but principally in September.


Depressed cell-mediated immunity in chronic dermatophytic infections. The immune response was studied in ten patients with benign dermatophytosis, and in five patients with a severe affection. At the humoral level no deficiencies were observed in both groups. However, all patients showed a marked and constant increase in IgE level. Skin test response in various concentrations of antigens as well as studies of activation of lymphocytes by specific and non-specific mitogens in vitro have demonstrated a depressed cell-mediated immunity. This anergy, however, is not an "all-or-none" phenomenon; it varies and there seems to be a direct relationship between the state of anergy and the severity of the cases. Furthermore, certain discrepancies were observed between the in vivo and in vitro responses suggesting that defective cellular immune reactions in dermatophytosis may be symptomatic of a lack of some humoral factor and do not necessarily reflect an intrinsic cellular defect. Finally, among these 15 patients, 7 were brothers and sisters from 3 separate and unrelated families, suggesting an autosomal hereditary influence.


The stages of recovery from severe head injury with special reference to late outcome. Ten years research into the physical and psychosocial consequences of severe brain damage in adults has revealed substantial information about the process of recovery. The main features are evidence that the greater part of physical and mental recovery occurs within six months of injury and that in most cases the mental consequences of injury outweigh the physical ones and place the greater burden upon the injured person's relatives. Impairment of memory is the most common cognitive disorder and alterations in personality often occur also and are the most taxing of the mental deficits for all concerned. The process of recovery has three stages, in the first the patient is unconscious, in the second he or she regains full consciousness signified by the end of the period of post traumatic amnesia and continues to show evidence of rapid improvement in basic physical and mental functions. The rate of recovery shows within six months of injury in most cases and this represents the end of the second stage. In the third stage, which may last for many months, both the patient and his or her relatives adapt to the residual disabilities of the former. Methods of managing the three stages should include physical, psychological and social techniques and the way in which they may be linked to the patients' differing physical and psychosocial needs during the three stages of recovery are briefly discussed.


Psychological consequences of blunt head injury. 89 severely closed head injured cases were tested on measures of verbal learning, and verbal and nonverbal intelligence, and their performance was compared with that of 30 orthopaedic cases. Head injured cases had severe deficits on all the tests. Severity of injury (judged by post-traumatic amnesia duration) was significantly related to poor performance on the learning and nonverbal intelligence tests, but not on the verbal intelligence test. The effect of injury on the family was studied in a further group of 35 head injured cases, showing that family burden within six months of injury was related to the presence of childish behaviour and loss of interest in the patient, together with other behavioural and affective changes. Physical deficits were not significant in this respect.


Cognitive recovery during the first year after severe blunt head injury. Cognitive recovery was examined in 24 severe closed head injured patients tested at 3, 6 and 12 months after injury, and 12 patients tested, in addition, at one month. A retested non-head injured control group was used, and where appropriate, alternative test forms were employed to control for practice effects. Tests of intellectual, perceptual/constructional skills, linguistic and memory functions were used, showing that by 12 months the only statistically significant differences between head injured and control patients were on learning and constructional tasks. Individual patients showed widely varying recovery patterns which made prediction of recovery difficult.


Recovery curves in a visual search task. A visual search task was administered to eighteen neurosurgical patients and fourteen control subjects on four occasions over a period of six months. Improvement occurred during the first five postoperative weeks but there was evidence of persistent impairment when patient performance was compared to control performance - the comparison makes use of a simple mathematical model.


An examination procedure for cavo-adducto-varus. This examination is used in cava-adducto-varus feet to determine the primary areas producing the secondary forefoot pathology. Table I is a compilation of the data and shows by means of an asterisk those pathologies possible with an additional primary deformity. The fold face test parts, when indicated in the exact order, are diagnostic. Once the primary areas have been elucidated, the remaining components are secondary, and the prognosis of biochemical and specific surgical treatment can be made. The specific treatment procedures and their rational use will be discussed in a future presentation.


Compression screw fixation in proximal first metatarsal osteotomies for metatarsus primus varus: initial observations. Many methods of fixation have been used after proximal abductory metatarsal osteotomies for the correction of metatarsus primus varus. The methods include external immobilization and the application of devices such as stainless steel wire, Kirschner wires, staples, and compression plates. We have combined external immobilization with compression screw fixation across the osteotomy site. Two different types of screws were used: 1) an AO screw 3.6 mm. wide and 26 to 28 mm. long and 2) a standard Woodruff screw 3.5 mm. wide and 31.8 to 44.4 mm long. Twenty-two procedures were reviewed. When we compared the results, we found the AO screw to be superior in the degree of rigid fixation which it provides, as judged by the extent of postoperative callus formation.


Congenital metatarsus adductus: clinical evaluation and treatment. Congenital metatarsus adductus, a deformity at the tarsometatarsal joints in which the metatarsals are deviated internally in relation to transverse plane, predisposes to "pigeon-toed" gait. Treatment is aimed at achieving normally balanced foot by overcorrection at the deformity sites. The most common problem after treatment is pronation deformity, which can be avoided by carefully positioning the heel at the time of casting. The sooner conservative measures are instituted, the more easily and rapidly the deformity will be corrected. If conservative casting does not result in improvement, then soft tissue surgery is indicated.


Frostbite: its diagnosis and treatment.

Frostbite: its diagnosis and treatment. The treatment, diagnosis, and outcome of frostbite victims is by no means an exact science. As this presentation shows, most authors agree that the key to control and treatment of cold injury comes from a reversal of the damage to the microvasculature (19). The methods of diagnosis of the extent of damage are all based on determination of vascular status whether it be tissue or bony structures. Treatment varies widely but rapid rewarming of the affected tissues is by far the most successful treatment to minimize tissue loss. As in the case study presented here, when surgical amputation is necessary, one must take mechanical function into account as well as the line of demarcation in order to give a functional limb for rehabilitation and to prevent the possibility of subjecting the patient to unnecessary repetitive surgical procedures.


Surgical correction of metatarsophalangeal joint dislocation and arthritic deformity: the partial head and plantar condylectomy. The partial head and plantar condylectomy has been presented as a procedure indicated in the correction of dislocated metatarsophalangeal joints. Although there may be a number of causes of dislocation, the surgical correction is the same. A skin plasty is useful in preventing a cocked-up toe, and this is performed at the plantar aspect of the base of the toe. A V-osteotomy, or other metatarsal dorsiflectory procedure, is recommended when the neighboring metatarsal is only slightly plantar flexed or greater. This prevents the occurrence of transfer lesions so commonly associated with this procedure. Two case studies have been presented demonstrating successful results when the procedure is performed on both the second and third metatarsophalangeal joints. We contend that the partial head and plantar condylectomy is a valuable procedure in reconstructive surgery of the foot.


Non-joint destructive procedure for long great toe with abductus deformity (a retrospective study). Excessive great toe length may be attributed to an unusually long first metatarsal, proximal phalanx, distal phalanx, or a combination of two or all three components. The procedure proposed here is not recommended for deformity existing in conjunction with a long first metatarsal or a pathologic first metatarsophalangeal joint. It has been used in mild to moderate hallux abductus or abductovalgus associated with intact first metatarsophalangeal joint cartilage and a long great toe.


Omental transplantation for chronic occlusive arterial diseases. Problems of surgical indication and technique for the treatment of chronic occlusive arterial diseases remain unresolved, especially in the cases which show poor angiogram run-off. To establish the surgical technique of omental transplantation, anatomical findings of the omental vessels were studied. The anatomical findings of the omentum were classified into two types. Type I (single layer) and Type II (double layer), and subdivided into seven subtypes according to the number of omental arterial branches. Omental transplantation was performed in our clinic in 19 cases (20 limbs) and surgical results were satisfactory. The examination of microscopic findings of the implanted omentum and the ischemic muscle of the implanted limb by consecutive serial sections suggested that the vessels of the omentum might invade the ischemic muscular tissue and supply blood to the muscle. Omental transplantation should be considered one of the most useful surgical techniques in cases with poor angiogram run-off.


Psychosexual attitudes in the female following sterilization. This study represents a three year follow-up, summarizing the psychosexual attitudes of 120 patients who were sterilized with tubal occlusion by one of three methods: culdoscopy, laparoscopy or postpartum laparotomy. The results indicate that most patients had a favorable impression of the procedure with little significant change in their sexual habits. Eight per cent of patients expressed regret at not being able to have more children. The frequency of coitus remained largely unchanged.


Sequelae of mid-trimester abortions induced by extra-amniotic drip infusion of normal saline. The results of a survey conducted in a group of 60 women, three years after they underwent induction of mid-trimester abortion by extra-amniotic infusion of isotonic saline solution, are presented. The aim of this method for induction of abortion can affect the patients' fertility and the outcome of their subsequent pregnancies and deliveries. In the group we recorded 39 pregnancies, of which 9 were undesired. Of the 30 women who wished for another pregnancy, 29 became pregnant without difficulty and one after treatment for intrauterine adhesions. Twenty-four (80%) of the pregnancies ended with spontaneous deliveries, five of which (16.6%) were premature deliveries, 4 (13.3%) by spontaneous abortions and in one case (6.7%) a cesarean section was performed. The results obtained using our procedure are similar to those reported for other methods for induction of abortion, and especially by the intra-amniotic infusion of hypertonic saline. In our series we have recorded no immediate complications. All patients received preventive antibiotic treatment and in all of them a manual exploration of the uterine cavity was performed in order to avoid the formation of intrauterine adhesions.


Wertheim hysterectomy: a ten year experience. This study covers 230 Wetheim operations. Sixty-seven patients had Stage II carcinoma (29.17%), and 163 patients had Stage I carcinoma (70.80%). Until 1968, x-ray treatment was used after the Vienna Wertheim operation, but since then the approach has changed. Tele- and brachio-cobalt therapy is now included. The operative death-rate was 0.96%. One patient died of peritonitis, another of renal uremia. In the Vienna Wertheim group, ureteric fistulae occurred in 7.23% of patients. With the introduction of mesentery and the ureter roof into the Wertheim procedure, ureteric fistulae have currently disappeared from the material examined (133 cases), although the operation was more radical than the classical Vienna Wertheim technique. Urography examination shows that changes are twice are frequent, and later anatomical changes in the urinary system are more than twice as frequent, with the Vienna Wertheim technique. A considerable number of early hydronephroses were found to have disappeared during the first year. Urography examination has shown that the mesentery of the ureter also has a beneficial effect on the flow of urine. It serves in the prophylaxis of fistulae, and prevents greater displacement of the ureter in the parametrial vacancies.


Post-hysterectomy morbidity after previous punch cervical biopsy plus diagnostic curettage. The post-operative morbidity of 70 patients who underwent total abdominal hysterectomy five to thirteen days after punch-biopsy of the cervix uteri and diagnostic curettage was compared of that of a control group of patients, with hysterectomy alone. It was observed that the sequence punch-biopsy hysterectomy presented a significantly higher post-operative morbidity. This increase was mainly due to higher parametritis, excessive vaginal discharge and wound infections rates. The interval between the two operations was also found to influence the post-hysterectomy morbidity, which seems to decrease with longer intervals.


Multicentricity of breast carcinoma: a case against partial mastectomy. One hundred and seventy-three mastectomies for carcinoma of the breast during a two-year period were reviewed for multicentric foci in the pathologic specimen. There was a total of 38 cases of multicentric carcinoma, comprising 22%. Sixty-two percent of all carcinomas presented as clinical Stage A and B, of these, 21% were multicentric. It is our opinion that except for certain extenuating circumstances, the procedure of choice for carcinoma of the breast is either a modified or standard radical mastectomy.


Pulmonary resections with staplers.

Pulmonary resections with staplers. The use of mechanical stapling devices for closure of the bronchus, pulmonary arteries and veins and lung parenchyma in twenty-six consecutive patients undergoing various types of pulmonary resection is presented. There have been no complications.


Traumatic ventricular septal defect: a case of early repair and review of the literature. We present a case of traumatic ventricular septal defect following a stab wound of the heart. The patient was operated on within the first 24 hours after being injured, because the hemodynamic situation had deteriorated; he is well 31 months postoperatively. From the literature reviewed, it is apparent that most of such lesions should be corrected early, since these patients are exposed to the continued risk of symptomatic cardiac dysfunction, and repair offers an excellent prognosis with minimal morbidity.


Colonic cancer and associated diverticulitis. In a total group of 385 cases of colonic cancer, there was evidence of associated diverticulitis in 42 cases. Of these, 92% of the patients were over 60 years of age. In 45% of the cases the coexisting lesions were located in the sigmoid colon. It is suggested that cancer of the colon contributes to the development of diverticulosis and diverticulitis; this is confirmed by the finding of 52.8% of the total group of diverticulosis (98 cases) complicated by diverticulitis. Signs of diverticulitis may mask the presence of cancer, and the diagnosis of associated lesions is sometimes difficult. The patient's history and repeated radiographic studies play an important role in the detection of associated cancer. The final diagnosis is confirmed by pathologic examination.


Surgical treatment of thrombotic occlusion of pelvic veins. During a three-year period, 20 patients were operated on for acute thrombosis of the pelvic veins. Seventeen of them underwent a thrombectomy and the remaining three had a femorofemoral bypass after Palma. As regards long-term results in 18 patients, between one and four years postoperatively, phlebography in the thrombectomized group revealed ten open and five occluded vessels. Two patients died. In the group with bypass, two grafts were open. The relatively good results in spite of delayed intervention (in some cases eight or nine days after occlusion) suggest that even if performed after the generally accepted six day deadline, it is worthwhile to attempt an operation. The importance of an early diagnosis is stressed; among the many characteristic symptoms "heaviness" of the affected limb is an early complaint which aids diagnosis.


Adrenalectomy for disseminated breast cancer. Forty-three patients (two males and 41 females) were submitted to bilateral adrenalectomy for disseminated mammary carcinoma. Several factors were considered for their prognostic value in predicting the response to endocrine ablation. The age of the patients, the treatment of the primary lesion, the free interval, the location of metastases and the involvement of regional lymph nodes did not affect the response to adrenalectomy. Response to therapeutic castration was directly correlated to the response to adrenalectomy (P less than 0.01); this is a valuable predicting factor that should be taken into consideration before proceeding to bilateral adrenalectomy. A statistically significant variation in survival between the responders and nonresponders was found (P less than 0.05). Finally, the high response rate to the operation (53.4%) can be attributed to the complete removal of the adrenal tissue during the operation.


Use of labor graphs in a community hospital. The large series reported by Friedman have established the importance of the time factor in relation to cervical dilatation and station of the presenting part during labor. Variations of the rate of dilatation and descent may be evident using a graph with the upper values of normal. This study was conducted in a Community hospital with an average of 200 deliveries a month. The attending physician followed labor as usual, unaware of the graphic recordings. The outcome of the labors with normal and abnormal graphic patterns were compared. There was a correlation between the abnormal labor pattern, arrest of cervical dilatation, with abdominal deliveries and lower apgar scores. The recognition of abnormal labors does not require a profound understanding of labor nor the range of normalcy.


Keratoacanthoma: case presentation and discussion. Keratoacanthomas are rather common, rapid growing skin tumors, in which may occur as solitary lesions or in the form of multiple lesions. Multiple forms involve the palms of soles, and their source is unclear. On area where hair grows, these lesions originate from the infundibular areas. Many environmental and traumatic influences are implicated as potential etiologic factors. Keratoacanthomas should be differentiated clinically and histologically from squamous cell carcinomas, prurigo nodularis, and chronic paronychia. Treatment varies according to the type of lesions, but solitary lesions should be excised in toto.


Surgical correction of severe hammer digit syndrome: a case report. Survivors of a stroke are forever in a battle for complete recovery. Signs and symptoms of the initial stroke may remain. Patients who has had a stroke may retain some of their initial manifestations, e.g., hemiparesis. Limbs that were initially paralyzed will usually retain signs of upper motor neuron damage. This patient demonstrated such a situation, and we felt that the proper treatment in this case of severe hammer digit syndrome was modified Lambrinudi fusions.


Prevalence of HBs-Ag in schistosomiasis. (A) general aspects. Nine hundred and sixteen schistosomal patient together with 97 non-schistosomal controls were examined for the presence of HBs-Ag and anti-HBs in their sera by counter-immunoelectrophoresis (CIEP). The results are reported and statistically analysed. HBs-Ag, anti-HBs and the exposure rate were found significantly higher in schistosomal patients than in controls. The frequency of HBs-Ag was not significantly different in the active and inactive schistosomal groups, while the anti-HBs was significantly higher in the inactive group. S. mansoni-infected cases showed significantly higher frequency of HBs-Ag and anti-HBs than cases with S. haematobium. The prevalence of HBs-Ag was highest between 20-39 years of age in the schistosomal group, while the anti-HBs was maximum at the age of 30-39 years. There were no sex differences in the prevalence of HBs-Ag and anti-HBs in both schistosomal and control groups. However, a significantly higher frequency of anti-HBs was found between male patients and male controls. The same was true for females. Patients with history of parenteral anti-bilharzial treatment and blood transfusions were accompanied with significantly higher percentage of HBs-Ag and anti-HBs. The importance and significance of the results are discussed.


Prevalence of HBs-Ag in schistosomiasis: B-frequency in various stages of schistosomiasis. The study included 916 schistosomal patients and 97 controls. The prevalence of HBs-Ag and anti-HBs was significantly higher in the bilharzial patients compared to controls. Their frequency was higher in the ascitic than the hepatosplenic group, and the difference between each and the simple group was highly significant. Cases with current jaundice showed highly significant frequency of both HBs-Ag and anti-HBs compared to those with no history or manifest jaundice at the time of study. In addition, cases with raised bilirubin, SGPT and SGOT showed significantly higher frequency of HBs-Ag and anti-HBs compared to cases having normal levels. On the other hand, the frequency was not affected by the level of serum alkaline phosphatases. As regards liver pathology, cases with mixed pathologic picture showed significantly higher frequency of both HBs-Ag an anti-HBs compared with those having pure schistosomal lesions.


Distal splenorenal shunts (Warren's operation) B-mode and real time ultrasonographic assessment. B mode and real time ultrasonography have been used in a trial to demonstrate the patency of distal splenorenal shunt done in Warren's operation. Thirty seven patients with portal hypertension, and bleeding oesophageal varices were the subject of this study. Using B-mode ultrasonography in 70% of cases (26 patients), the splenic, left renal vein and the site of anastomosis were demonstrated. In 8% (3 patients), both splenic and left renal veins were seen patent, but the site of anastomosis was not detected. In the remaining 22% (8 patients), neither the left renal vein nor the site of anastomosis could be demonstrated. Using the Real-time two dimensional ultrasound, 9 of the 37 patients were examined. The patency of both veins and the site of the shunt was demonstrated in 90% (8 patients).


Serum calcium, magnesium and phosphate in bilharzial hepatic fibrosis. Serum calcium, magnesium, phosphate and albumin were estimated in 74 bilharzial patients and 14 normal individuals as control. A significant hypocalcaemia and hyperphosphataemia was found in bilharzial patients with liver fibrosis and ascites. The authors suggest that these changes may be due to hypoparathyroidism. Both ascitic and non ascitic patients showed hypomagnesaemia. This hypomagnesaemia was more obvious in the ascitic group. The hypomagnesaemia is probably due to excess aldosterone secretion in these patients, combined with hypoparathyroidism in the cirrhotic patients with ascites.


Delayed hypersensitivity to specific antigen and hetrologous PPD antigen in patients infected with Schistosoma mansoni and/or Schistosoma haematobium. 181 cases with schistosomiasis were skin tested with S. mansoni antigen and tuberculin (PPD) after complete clinical and parasitological examination. Their results were compared to a control group of 89 non bilharzial cases. The positivity of tuberculin reaction was found to be less frequent in schistosomiasis (37.5%) when compared to non schisto. controls (55.0%). This low reactivity was more manifest in the advanced stages of the disease. The delayed skin reaction with S. mansoni antigen was seen in 52.4% of schisto. cases while non of the control showed any positivity. There are more delayed skin test positives with the advance of the disease.


Interstitial-implant radiotherapy in upper-aerodigestive-tract malignancy. In the treatment of upper-aerodigestive-tract malignancy, interstitial-implant radiotherapy differs in several physical and biologic respects from conventional external-beam therapy: unlike external-beam therapy, it can deliver a high central dose with a rapid fall-off, which overcomes the central hypoxic resistance effect and yet greatly improves normal tissue tolerance. External-beam and interstitial-implant therapy can also be combined to the patient's benefit; in many cases, this combination offers advantages over external-beam therapy alone, preoperative external-beam therapy, or aggressive surgery. The recent upsurge of interest in this modality has come about because of three developments: more suitable radioactive sources, after-loading, and computerized dosimetry. The early results in upper-aerodigestive-tract malignancy, both as primary and as salvage therapy, are promising; but the precise role of this treatment in our therapeutic armamentarium remains to be established.


Laryngeal keratosis and subsequent carcinoma. The frequency with which carcinoma develops in laryngeal keratoses is a controversial subject. A study of 92 cases of laryngeal keratosis with a minimum of five years' follow-up resulted in identification of three patients (3.26%) who developed laryngeal carcinoma. A reviews of the literature reveals that, in series of keratoses defined by stringent pathologic criteria, subsequent laryngeal carcinoma develops in 3.33%-4.31%. These findings support a low but predictable frequency of conversion to malignancy in laryngeal keratosis. A grading system for keratosis is presented and discussed with reference to clinicopathologic correlation.


Thyroid and associated polyglandular neoplasms in patients who received head and neck irradiation during childhood. One hundred fifty-one patients with a history of childhood irradiation to the head, neck, and thorax had neck explorations (142 for "cold" thyroid nodules and 9 for hypercalcemia). Fifty-nine of the patients had thyroid carcinoma, and associated glandular tumors were found in 20 others. In addition, 6 female patients developed breast carcinoma; 4 of these women also had thyroid carcinoma. In this series, 48.6% of the patients irradiated for acne and 36.4% with tonsil and adenoid irradiation developed thyroid carcinoma, but only 10.5% with thymic irradiation did so. It is suggested that the workup on these patients include not only complete thyroid and parathyroid testing, but also a careful examination of all salivary glands, both major and minor. Women should have thorough breast examinations and should perhaps be followed as if they were in the potentially high-risk breast group. When thyroid surgery is performed, a total thyroidectomy is recommended.


Computed tomography of the normal larynx. A computed tomographic analysis of normal laryngeal anatomy was undertaken using cadaver larynxes. This was part of a larger project in which patients with laryngeal carcinoma were routinely evaluated in the computed tomographic (CT) body scanner. The appearance of normal laryngeal anatomy had to be delineated before disease processes of the larynx were evaluated, and this was accomplished using a computed tomographic technique with 5-mm slice thicknesses and a 3-mm overlap. The scan slices were then compared with anatomic sections taken at the same levels. The comparisons demonstrate an ideal level of accuracy that can be approached in the in-vivo larynx only with use of the latest-generation scanners. However, CT scanning is of immediate usefulness in the diagnosis of laryngeal pathology.


Importance of the columellar-labial junction in rhinoplasty. Concentration on tip positioning may draw a surgeon's attention away from modifying positions of the nasofrontal angle and of the columellar-labial junction. All three landmarks are, however, vital to the establishment of desirable profiles. This article emphasizes that changes in the positioning of the columellar-labial junction may (1) eliminate certain hazards involved in changing tip position, (2) make it possible to produce aesthetic effects that cannot be achieved with tip positioning alone, and (3) make rhinoplasty safer and more predictable in certain difficult cases. Also presented are techniques that have been found to work most satisfactorily in changing angle and position. A few patients selected from among several thousand rhinoplastic cases are analyzed to underscore the significance of this area in rhinoplastic planning. Follow-up varied from several months to several years.


Embolization techniques in vascular tumors of the head and neck. Surgical excisions of vascular tumors of the head and neck are frequently associated with difficulties because of the potential of operative blood loss. The technique of selective percutaneous embolization before surgery has emerged as a valuable adjunct-and even alternative-to surgery in the management of such lesions. By reducing the blood flow to a vascular tumor or arteriovenous malformation, embolization techniques can be greatly facilitate surgical excision. The participation of a qualified invasive radiologist is essential. If cases are carefully selected and procedural details strictly adhered to this technique can be quite valuable to surgeons treating vascular lesions of the head and neck.


Trichoepithelioma: report of an unusual case and review of the literature. Trichoepitheliomas are benign and uncommon skin tumors presenting in the head and neck region. Although they can be solitary, they occur more frequently as multiple lesions with an autosomal dominant inheritance. To the surgeon, they often present the problem of clinical differentiation from basal-cell carcinoma. An unusual case is described, and experience in the treatment of 19 patients is reviewed.


Diagnosis of infratemporal fossa tumors using percutaneous core needle biopsy. Three patients with infratemporal fossa carcinomas presented with severe, unrelenting facial pain, weight loss, and 5th cranial nerve deficit. Erosion of the base of the skull at the foramen ovale was present in two of these patients. Histologic diagnosis of infratemporal fossa malignancy was obtained by needle biopsy of the foramen ovale region; the technique is described. This approach to the infratemporal fossa is preferred to the more complicated external surgical approach with its greater risk of morbidity. Surgical approaches to the infratemporal fossa are also reviewed. Two of the patients were treated with radiotherapy; the third refused further therapy. Supravoltage radiotherapy with curative intent is the recommended treatment because of the difficulty of an en bloc tumor resection in the infratemporal fossa. Radioactive gold seeds may be implanted through an external surgical approach to boost the local dose.


Embryonic development of the head and neck: part 2, the branchial region. The embryology of the branchial (pharyngeal) region is reviewed in terms of the embryonic pharynx, branchial apparatus and derivatives, tongue, larynx, and trachea. Derivatives of the branchial pouches, grooves (clefts), and arches are analyzed in relation to each other and to the first arch syndrome. Other common head and neck defects attributable to abnormal development of the branchial region are also discussed, particularly those defects involving the incomplete degeneration or the abnormal migration of branchial tissues.


Mandible stabilization between ablative and reconstructive surgery. The biphase external skeletal-fixation splint (Morris splint) for mandibular stabilization has been used in cases of ablative surgery. It is a practical approach to stabilization for patients whether or not they undergo reconstruction, either immediate or delayed. The Morris splint can be applied without increasing the time required for major resection. It can be left in place for prolonged periods, but it still allows easy surgical access and easy postoperative care and observation. While not a new tool, it has been little used by the head and neck cancer surgeon, probably because it has not been presented for this purpose but rather for treating fractures. A practical approach to the use of the Morris biphase splint is presented, as well as the indications for its use and some results of our experience with this tool.


The pansigmoidoscope: one year's experience in a gastrointestinal diagnostic unit. Since May 1976, the Olympus pansigmoidoscope has been available for routine use at the University of Oregon Health Sciences center. Two hundred sixty-five examinations were performed over the next year. The average distance examined was 49 cm. Time per examination ranged from 3 to 15 minutes, with an average of 8 minutes. Preparation consisted of one or two tap water enemas, except in known inflammatory bowel disease where no preparation was given. No patient received sedation and there were no complications. Small biopsy (2.8 mm), large biopsy (4.0 mm), "hot biopsy" and polypectomy were performed when indicated. The procedure was most helpful for the following indications: 1) differential diagnosis and follow-up of inflammatory bowel disease, 2) hematochezia, 3) evaluation of abnormal barium enema, 4) left-sided polypectomy, 5) diarrhea with normal barium enema, and 6) guaiac-positive stools. It was of no value in patients with abdominal pain with normal barium enema. Comparing the frequency of examinations this year with last year we found a 50% decrease in use of the rigid (25 cm) sigmoidoscope (538 to 270 exams) and a 98% decrease in use of the MB2 (100 cm) colonoscope (80 to 2 exams).