A comparison of language samples elicited at home and in the clinic. One of the most common methods of obtaining diagnostic information about a child's language production is to collect and analyze a spontaneous language sample. Usually, this sample is collected in a clinical setting by a speech-language pathologist. Because children's language production seems very sensitive to situational variables, there is some question about the representativeness of language samples obtained in clinical settings. This study compared language samples obtained in the home by the mothers with those obtained in the clinic by speech-language pathologists. Subjects were three- to five-year-old children who had been referred for speech and language diagnostics. Results were that the children's mean-length-of-utterance (MLU) scores were better for the home sample, although there was no difference between their Developmental Sentence Scores (DSS) for the home sample and the clinic sample. The home samples yielded higher MLU stage placements (Brown, 1973) and higher estimated language ages on the DSS (Lee, 1974) for most of the children. Clinical implications of the results are discussed.


Talker effects on word-discrimination scores of adults with sensorineural hearing impairment. Speech discrimination testing was completed on 30 adults with varying degrees of sensorineural hearing impairment. Tape recordings of four talkers' utterances of CID W-22 word lists served as the stimulus materials. Listeners' responses were scored independently by three experienced judges. For 26 of the 30 subjects, the difference between the lowest and highest word-discrimination score was 8% or greater. Variations in scores could not be attributed to a single talker but were spread across all talkers. A moderate negative correlation was found between each listener's average word-discrimination score and amount of variability among his or her individual scores. The statistical analysis indicated that talker differences were responsible for only a small portion of the variability in scores and suggested that a factor of greater importance is the talker-listener interaction.


Management of palilalia with a pacing board. Palilalia is a speaking disorder that has been likened to the festinating gait of Parkinsonian patients. This report describes a pacing device developed as a means of controlling the severely palilalic output of one patient. The device is a modeled after Luria's suggestion that a treatment program for such patients can be developed successfully by transferring automatic motor acts to a conscious, reactive level.


Effects of four noise competitors on the California Consonant Test. Thirty-five normal-hearing listeners' speech discrimination scores were obtained for the California Consonant Test (CCT) in four noise competitors: (1) a four talker complex (FT), (2) a nine-talker complex developed at Bowling Green State University (BGMTN), (3) cocktail party noise (CPN), and (4) white noise (WN). Five listeners received the CCT stimuli mixed ipsilaterally with each of the competing noises at one of seven different signal-to-noise ratios (S/Ns). Articulation functions were plotted for each noise competitor. Statistical analysis revealed that the noise types produced few differences on the CCT scores over most of the S/Ns tested, but that noise competitors similar to peripheral maskers (CPN and WN) had less effect on the scores at more severe levels than competitors more similar to perceptual maskers (FT and BGMTN). Results suggest that the CCT should be sufficiently difficult even without the present of a noise competitor for normal-hearing listeners in many audiologic testing situations. Levels that should approximate CCT maximum discrimination (D-Max) scores for normal listeners are suggested for use when clinic time does not permit the establishment of articulation functions. The clinician should determine the S/N of the CCT tape itself before establishing listening levels.


A comparison of children's performance on two tests of articulation. This study compared children's performance on two tests of articulation. Children ranging in age from five years, four months to eleven years, six months were administered the Deep Test of Articulation and the Arizona Articulation Proficiency Scale: Revised. Comparisons between the tests were made of performance on individual sounds, total test performance, and differences in children identified as potentially in need of remediation. Results revealed differences in performance across tests on 15 of 21 sounds tested. Performance of almost 83% of the subjects varied across tests on at least one sound. Although some individual sounds displayed considerable variation between tests, total test performance and conclusions were similar. The data indicated, however, that the AAPS may fail to identify some children with consistent errors on relatively few sounds. The results are related to previous research, and clinical implications are discussed.


Bilateral cord dysfunctions: abductor type spastic dysphonia. Unlike cord approximation disorders such as adductor type spastic dysphonia and vocal cord paralysis, which have been well defined, abductor type spastic dysphonia has received limited attention. This report presents voice symptoms, spectrographic data, indirect laryngoscopic observations, and case histories of two cases. Questions are raised as to whether there is a spastic component to this disorder, and if there is a specific age group affected.


Mirror, mirror on the wall...?

Mirror, mirror on the wall...? This study was designed to determine the value of using a mirror for speech teaching. Data derived from manner, place, voicing, and blend errors produced by 27 hearing-impaired children while imitating consonant-vowel syllables under three conditions (audition alone, audition plus direct vision, audition plus vision using a mirror) were analyzed to determine whether the use of a mirror enhances or detracted from the accuracy of their responses relative to the other two conditions; whether different types of errors were made under any of the conditions; and whether error types under each condition were related to age or hearing level. Although more place errors occurred under the auditory condition, the difference between the numbers of errors made under the two auditory-visual conditions was not significant. The use of a mirror neither enhanced nor detracted from the accuracy of responses of subjects in this study. This finding cast doubt upon the value of using a mirror as a general aid in speech teaching.


An examination of variables involved in tympanometric assessment of eustachian tube function in adults. Eustachian tube function was assessed tympanometrically in a group of normal adults. A pressure-swallow technique of assessing Eustachian tube ventilatory function was administered with positive and negative induced pressures in the range of +/- 200 mm to +/- 400 mm H2O. This study indicated the relative efficiency of measurement of Eustachian tube function under each of the experimental conditions. Recommendations of procedures for further clinical data collection are presented.


Comparison of DES vs DES + chlorambucil in women with first recurrence of breast cancer. Thirty-four women with first recurrence of breast cancer were randomized into two groups, and received either Diethylstilbestrol (DES) 5 mg orally (PO) t.i.d. alone, or in combination with Chlorambucil (CB) 0.1--0.2 mg/kg/day PO. All patients randomized were greater than 5 years postmenopausal at the time of the study and had no prior chemical or hormonal therapy. Estrogen receptors were not available. There was no significant difference between Groups A and B with respect to frequency of objective response or mean duration of that response, with the values for Group A being 46.2% and 4.8 months, respectively, and for Group B, 46.7% and 4.8 months (P greater than 0.05). The most common toxicities noted for both groups were nausea and vomiting, edema, weakness, and thrombophlebitis. The risk of major toxicity necessitating withdrawal from the study was greater in Group B due to the added danger of thrombocytopenia/pancytopenia. The addition of CB to DES does not appear to offer any significant advantage over DES alone in women with first recurrence of breast cancer.


Fibrosarcoma of the mediastinum.

Fibrosarcoma of the mediastinum. Fibrosarcoma is a rare primary malignant tumor of the mediastinum. Three cases are presented with different presenting symptoms and clinical manifestations. Thoracotomy with biopsy of the mass is the only method for arriving at a definitive histologic diagnosis.


Adjuvant chemoimmunotherapy following regional therapy for isolated recurrences of breast cancer (stage IV NED). A combination of 5-fluorouracil, Adriamycin, cyclophosphamide, and BCG (FAC-BCG) was evaluated as adjuvant treatment in breast cancer patients following surgical excision and/or radiation of first site of recurrent disease. In a group of 68 patients treated with FAC-BCG, the estimated proportion remaining free of disease at 2 years from first recurrence was 69%, compared to 24% in 60 historical control patients (P less than 0.01). Estimated 2-year survival rate from first recurrence was 85% for the FAC-BCG patients and 78% for the controls (P = 0.07). This regimen has significantly prolonged the disease-free interval from the first recurrence, but additional follow-up is needed to determine its effect on long-term survival.


Tumorlytic activity of autochthonous blood fractions upon spontaneous murine mammary carcinomas. Autologous blood fractions of mice bearing spontaneous mammary carcinoma were assessed for their autotumorlytic capability. In the 180 animals evaluated, it appears that in the blood of these tumor animals there coexists at least two types of biological antagonists ie, one which is capable of inducing tumor breakdown and necrosis and the other which apparently nullifies this action. These results seem additive to the growing body of evidence that the tumorous host has the capability of destroying its own neoplasm but some negative homeostatic mechanism seems to favor the tumor rather than the host.


Non-specific and specific active immunotherapy in a B16 murine melanoma system. Conflicts amongst reports concerning the efficacy of both nonspecific and specific attempts at immunotherapy may be ascribed to different animal models utilizing tumors of different immunogenicity. We have selected the B16 mouse melanoma model as the example of a spontaneously occurring neoplasm that is histocompatible with the host and does have tumor-associated antigens. Attempts to alter tumor growth or survival with nonspecific active immunotherapy as well as with specific active immunotherapy were not successful. Nonspecific active pre-immunization failed to alter tumor take or growth. Specific active immunotherapy both with and without adjuvant did decrease tumor take and prolong host survival. The effects were increasingly documented at lower tumor cell inoculums and became less apparent with increase in the tumor cell challenge.


Repair of double-outlet right ventricle. An analysis of 62 cases. Sixty-two patients with double-outlet right ventricle (DORV) underwent complete intracardiac repair between 1967 and July, 1978. Five patients (three deaths) with DORV and complete atrioventricular (AV) canal are the subject of a separate report and are not discussed further here. Twenty-eight patients had relatively uncomplicated DORV (subaortic ventricular septal defect [VSD], doubly committed VSD, or 1-malposition of the aorta with subaortic VSD) with or without pulmonary stenosis. Two (14%) of 14 died after a completely intraventricular repair, and one (12%) of eight after repair including use of a valved external conduit. Use of a transannular patch in this group was an incremental risk factor, five (83%) dying among six treated in this way. Anterior enlargement of a restrictive or unfavorably located VSD did not increase risk. A noncommitted VSD was an incremental risk factor, two (50%) of four dying after repair. No instances of complete heart block occurred in these groups. Two late deaths occurred in the uncomplicated group, from persisting servere pulmonary hypertension. The late results were good in the remainder and in the two surviving patients with noncommitted VSD. After repair of the Taussig-Bing type of DORV, eight deaths (32%) occurred among 25 patients. Complete heart block developed in two patients. In the Taussig-Bing type of DORV, the 6 year actuarial survival rate was only 38%. Most late deaths were related to improtant pulmonary vascular disease. The surgical technique that has evolved for the basic tunnel repair in the various types of DORV is described.


Preoperative prediction from cineangiograms of postrepair right ventricular pressure in tetralogy of Fallot. To aid preoperative decision-making, we have related the ratio of postrepair peak pressure in the right and left ventricles (PRV/LV) to preoperative cineangiographic measurements in a retrospective study of 135 patients undergoing complete repair of tetralogy of Fallot or tetralogy of Fallot with pulmonary atresia. Postrepair PRV/LV was related to the preoperative diameter of right (DRPA) and left (DLPA) pulmonary arteries normalized to the descending thoracic aorta (DescThAo) in patients undergoing repair with transannular patching or a valved external conduit by the dquation: PRV/LV = 0.4840/(DRPA/DescThAO + DLPA/DesThAo) + 0.2007. Stenosis of the right pulmonary artery orifice and pulmonary artery arborization abnormalities incrementally increased postrepair PRV/LV. When a transannular patch was not used in classical tetralogy of Fallot, an increment of postrepair PRV/LV usually resulted, depending upon the size of the "anulus" measured intraoperatively: Incremental PRV/LV = 0.09437 . exp(-0.6344 . Z) where Z is a normalized expression in circumference terms of the diameter of the pulmonary arterial outflow tract (DPAOT) measured intraoperatively after infundibular dissection and valvotomy. DPAOT is itself related to the cineangiographically measured pulmonary valve anulus diameter (DPVA): DPAOT = 3.357 . DPVA0.5789 . BSA0.1551. In toto, these relations allow postrepair PRV/LV without transannular patching to be estimated from preoperative cineangiographic measurements. This allows preoperative predictiom in classical tetralogy of Fallot of the need for transannular patching, and in infants this can determine the choice between primary one-stage repair and two-stage repair. Prediction of postrepair PRV/LV when transannular patching or an external conduit is planned allows identification of patients in whom right and left pulmonary arteries are too small for safe complete repair, and in them an initial palliative operation should be done to enlarge the arteries.


Sinus venosus type of atrial septal defect with partial anomalous pulmonary venous return. This report describes our method of repairing the sinus venosus type of atrial septal defects. The superior vena cava is compartmentatlized by means of a single double-armed suture. Caval catheters are used as temporary internal shunts, and a vertical U-shaped patch is incorporated into the atriotomy suture line. The experiences with 27 cases are presented.


Coronary sinus septal defect. Surgical considerations. The coronary sinus septal defect is an uncommon anomaly. If it is not suspected, found, and repaired at operation, a residual intracardiac shunt will result. The defect usually is associated with a left superior vena cava (LSVC), which necessitates special consideration in the conduct of cardiopulmonary bypass. Our recent treatment of three cases of coronary sinus septal defect stimulated us to review the embryology, anatomy, diagnosis, and surgical treatment of this malformation.


Surgical repair of inferior sinus venosus atrial septal defect. A 9-year-old girl presented for cardiac evaluation with symptoms of dyspena, fatigue, and cyanosis with exercise. Cardiac catheterization demonstrated an atrial septal defect; an anomalous right superior pulmonary vein was suspected but not confirmed. Operation disclosed anomalous drainage of the right superior and inferior pulmonary veins into the right atrium, an intact fossa ovalis, and an inferior sinus venosus defect. Repair was accomplished by detaching the posterior edge of the atrial septum and suturing it to the right of the pulmonary veins, so that the defect was closed and all the pulmonary venous blood was directed to the left atrium.


Successful surgical correction of symptomatic cor triatriatum dexter. An unusual case of cor triatriatum dexter is presented. Abnormal embryologic development of the eustachian valve caused nearly complete septation of the right atrium in a 67-year-old woman. Multiple supraventricular arrhythmias prompted clinical evaluation and diagnosis. Surgical excision of the anomalous membrane resulted in complete relief from arrhythmias and a clinical cure. Cor triatriatum dexter is rare and is infrequently diagnosed before postmortem study; however, once the diagnosis is extablished, the condition is amenable to a relatively simple surgical correction. Supraventricular tachycardia has not previously been reported to be associated with cor triatriatum dexter. We believe this is the first case in which such arrhythmias led to early diagnosis and successful surgical correction.


Calculation of systemic blood flow with pulmonary artery thermistor probe. A simple thermodilution technique is described for determining systemic blood flow with right atrial and left atrial catheters and a pulmonary arterial thermistor probe. Injections of cold water into the atrial catheters provide computer display readings that permit direct calculation of systemic blood flow. The method is convenient for determining systemic blood flow in postoperative patients with a residual left-to-right shunt.


Congenital tracheoesophageal fistula without esophageal atresia. Congenital tracheoesophageal fistula (TEF) without esophageal atresia, commonly referred to as H-type fistula, comprises only 4.2% of all TEF's. Four infants with this entity were surgically treated at Santa Rosa Children's Hospital during the period of 1974 to 1977, and their diagnosis, surgical management, and hospital course are described in detail. H-type TEF is characterized by a clinical triad consisting of paroxysms of coughing precipitated by feeding, gaseous distention of the gastrointestinal tract, and pneumonitis. Demonstration of H-type TEF can be difficult and may be accomplished only by repeated examinations. The esophagogram using cinefluoroscopy and image intensification is the primary diagnostic technique utilized. If this is nondiagnostic, then tracheobronchoscopy should be performed in conjunction with ancillary techniques which improve endoscopic yield. Surgical correction can be accomplished through a cervical approach in 80% of cases. Preoperatival treatment of H-type TEF is dependent upon a high index of suspicion, an aggressive diagnostic approach, and prompt surgical correction. Our series of patients demonstrates that early diagnosis is feasible.


Gas exchange after pulmonary fat embolism in dogs. Gas exchange following moderately severe experimental pulmonary fat embolism was studied in nine dogs. A new method designed to describe the distribution of ventilation-perfusion ratios in the lung was applied before and after intravenous injection of homologous neutral fat. The dose of fat (0.75 ml/kg) was low enough to produce a small but significant decrease in arterial PO2 (mean change of 10 mm Hg) in the first 15 minutes after the embolism but high enough to result in the death of two of the four dogs that were allowed to survive the initial postembolism period. Pulmonary artery pressure and pulmonary vascular resistance both rose significantly within 5 minutes of the fat injection and remained elevated for the 2 hour experimental period. Immediately after the embolism there was an increase in the percentage of the total ventilation going to areas of the lung with ventilation-perfusion ratios between 10 and 100, which usually appeared as a discrete mode in the ventilation distribution. This mismatching of ventilation and perfusion partially resolved within 2 hours after the embolism, as indicated by the gradual disappearance of this population of gas exchanging units with relatively decreased blood flow. At no time within 2 hours after the embolism was there a significant increase in shunt or in ventilation to totally unperfused lung. The gas exchange pattern in the two dogs that subsequently died was indistinguishable from that of the other seven in the immediate postembolism period.


Surgical implications of pulmonary actinomycosis. Four cases of pulmonary actinomycosis are presented. Resection was necessary in three cases before the diagnosis was established. A high index of suspicion for this disease is advised for the thoracic surgeon involved in the treatment of lung masses.


Thoracoscopy: new method of early diagnosis of cardiac herniation. Cardiac herniation is an uncommon but rapidly fatal complication of radical pneumonectomy. Although operative correction is simple, a successful clinical outcome requires early diagnosis and thoracotomy. A patient is described in whom a left-sided cardiac herniation through a pericardial defect occurred following radical pneumonectomy. The diagnosis was suspected by persistent hypotension and radiographic changes. Confirmation of the diagnosis was achieved by thoracoscopy, performed with local anesthesia in the operating room. Immediate thoracotomy resulted in a successful outcome.


Clinical application of a new endoscopic technique for detection of in situ bronchial carcinoma. Hematoporphyrin is preferentially concentrated by cancer tissue and therefore is a potentially useful chemical marker. This report demonstrates the effectiveness of a photoelectric hematoporphyrin fluorescence detector used simultaneously with flexible fiberoptic bronchoscopy as a means of detecting and localizing bronchogenic carcinoma. The detector generates an audio signal when fluorescence is within the visual field of the bronchoscope. Of interest is that an audio signal was generated which indicated hematoporphyrin fluorescence in areas where no mucosal abnormality had been seen. These areas proved to be carcinoma in situ.


The continent ileostomy: a viable alternative. The continent ileostomy is one of the alternative techniques in managing patients who require a proctocolectomy. Although previously plagued with up to 30% revisions, the continent ileostomy appears to contribute significantly to the social and psychologic well-being of these patients. Our experience suggests that improved surgical techniques make this procedure a safe and favorable alternative to the traditional Brooke ileostomy.


Effect of elective induction on birth weight. The 1,250 Mayo Clinic obstetric deliveries for 1976 were reviewed and 73 elective inductions were identified. Sixty-three of these mothers were successfully matched by gravidity, parity, and age within 5 years with healthy women in whom delivery was spontaneous at term. The mean birth weight for the electively delivered infants was greater than that for the controls, but the difference was not statistically significant. Mean gestation and 1-minute Apgar scores were similar for both groups. The neonatal problems observed, with the exception of elevated bilirubin levels, did not seem to point to any special hazard of induction. Even though pregnancy is interrupted, elective induction, as practiced at the Mayo Clinic, was not shown to produce a systematic reduction in birth weight.


Arteriovenous malformation affecting the transverse dural venous sinus--an acquired lesion. Dural arteriovenous malformations of the transverse sinus are relatively well localized to the occipitomastoid regions and occur predominantly in women who are more than 40 years of age. The signs and symptoms, except for pulsatile tinnitus, vary and apparently depend on the presence of impaired venous drainage, which may produce increased intracranial pressure, papilledema, and transient or persistent neurologic deficits. Eight of the 14 patients described had occlusion of one or both transverse or sigmoid sinuses. Two patients had angiographic demonstration of sigmoid or transverse sinus occlusion (one 1 year and the other 4 years) before the development of an arteriovenous malformation in the appropriate sinus. Dural sinus occlusion may precede the development of a dural arteriovenous malformation, and the pathogenesis may be partial recanalization of a thrombus.


Digitalis glycosides.

Digitalis glycosides. The digitalis glycosides number among the most commonly used cardiovascular drugs. Despite 200 years of investigation, much new information regarding their mechanisms of action and clinical use continues to be developed. Clinicians dispensing these potent drugs need to be aware of thes advances if they are to make the best possible therapeutic decisions.


Demyelination of the brain in tuberous sclerosis: computed tomography evidence. Two patients with tuberous sclerosis are described in whom computed tomography of the head revealed areas of diffuse diminution of density suggestive of demyelination. Computed tomography is a sensitive test for the detection of intracerebral lesions in tuberous sclerosis, and the finding of areas of diminished density in the absence of evidence for tumor or ventricular obstruction correlates with the common histologic finding of diffuse demyelination. Serial studies with computed tomography are likely to determine whether such demyelination precedes the growth of hamartomas and calcification that characterize tuberous sclerosis.


Neuronal involution during ageing. Ultrastructural study in the rat cerebellum. Involutive phenomena have been investigated by electron microscopy in the Purkinje Pk neuron of the cerebellar cortex of the aging rat. The still limited number of specimens available to date, however, suggest an age-related progression of morphological and functional deteriorations involving particularly the intraneuronal "nucleus-ribosome system" (NRS). The impairments are characterized by changes in the nucleolar texture. These alterations are accompanied by modifications in the repartition and relative proportion of RNP components of the nucleolus. In addition, other nuclear elements such as interchromatin and perichromatin granules may vary in importance with age. Recognizable changes in the ribosomal constituents of the NRS are evidenced by modifications in the density and distribution of free ribosomes. An altered structure and organization of GER cisternae are also evident. Furthermore, "light" cytoplasmic areas, an increased evidence of neurotubules and the gradual congestion of the pericaryon by age pigments are other valuable ultrastructural features that may be regarded as part of the sequence of morphologic events occurring during neuonal ageing. The above ultrastructural data will subsequently form the basis of a model of ageing in the nerve cell, which will complete the previously proposed model of neuronal maturation. Therefore, this long-term study essentially purports the investigation of subcellular events taking place in the Pk neuron all along the normal life span in rats. This model will also be used to evaluate the changes in the sequence and the reinforcement of the processes of evolution versus involution as affected by certain xenobiotics, such as abused drugs(alcohol and narcotics). The intraneuronal modifications found in the nuclear and cytoplasmic structures of the NRS could possibly reflect the molecular dysfunction related to the production of various types of RNA and neuronal proteins. This hypothesis is supported by biochemical data obtained from analysis of the brain of aged animals. Ultrastructural and biochemical data appear to be in good agreement with the neurophysiologic interpretation of a slow-down and reduced efficiency of the CNS during the progressive development of senescence in human and animal subjects.


Age-dependent gene induction in quail oviduct. IX. Age-dependent alterations of DNA-bound amino acids. DNA-amino acids (and DNA-protein) complexes were isolated from oviducts of immature, mature and senescent quails by a procedure which does not involve proteolytic enzymes. The content of DNA-amino acids in the complexes, isolated from animals belonging to three different age classes is almost identical and it amounts to about 10 micrograms/mg DNA. However, the fraction of DNA-amino acids which is resistant to pronase is twice as high in lysates from senescent quails as in those from immature and mature animals. The amount of DNA-bound amino acids is strongly dependent on hormone-induced physiological effects in immature quails. If immature animals were treated with estrogen hormone, which causes in induction both of DNA and RNA synthesis, the level of DNA-bound amino acids increases by 220%. This material has been found to be pronase sensitive which might indicate that the amino acids are present as peptides. Treatment of estrogen-stimulated animals with progesterone or inhibitors of DNA and RNA synthesis antagonizes the estrogen-envoked formation of DNA-associated amino acids. From the data we propose that the amount of proteins and/or amino acids, bound to DNA,is not only age-related but also correlated with the physiological state of DNA in immature and mature animals.


Influence of diet on chromatin organization in insect mid-gut cells, and its implications for the understanding of aging in this model system. Female Sarcophaga bullata were fed on three different dietary combinations: liver/water; sugar/water; and sugar/liver/water. These diets resulted in different survival patterns for the insect, with the longest lifespans being expressed on the last treatment. The Feulgen-DNA values for mid-gut cell nuclei were determined using a scanning and integrating microdensitometer. The cell nuclei of the mid-gut reacted to the presence of nutrients by an increase in the extinction values for Feulgen-DNA when compared to the unfed state. There were also significant differences between the various treatments in the extent of the activation shown by the mid-gut cells. The dietary regimes resulting in the longest lifespan showed a complete and uniform activation of the mid-gut epithelium, whereas other treatments did not. These observations suggest that changes in the chromatin organization occur with diet, and that maximum Feulgen-DNA extinctions occur (i.e. chromatin uncoiled and supporting transcription) on the sugar/liver/water diet. Nuclei showing maximum extinctions do not show an age-related change between 3 and 12 days of life. However, if the nuclear activation is partial, or incomplete, then age-related reversals in chromatin condensation take place.


Measuring components of children's health status. Measures of physical, mental and social components of health status and general health ratings were studied for children ages 0-4 (N = 679) and 5-13 (N = 1473). Questionnaires were completed by adult proxies (usually mothers) in three generally healthy populations. Hypothesized multi-item scales were tested; reliability was estimated and preliminary attempts at validation were undertaken. Items in ten scales pertaining to mental health (Anxiety, Depression, Positive Well-Being, Mental Health Index), social health (Social Relations), general health ratings (Current Health, Prior Health, Resistance/Susceptibility to Illness, General Health Rating Index), as well as parental satisfaction with child development satisfied Likert-type and discriminant validity criteria. Because functional limitation items were endorsed for very few children, scales to measure physical health could not be tested. Almost all scales were sufficiently reliable for group comparisons; reliability coefficients were lower in the most disadvantaged population. Interrelationships among scales and validity variables generally supported their construct validity and supported a multi-component model of children's health status.


The effect of length of membership upon the utilization of ambulatory care services. A comparison of disadvantaged and general membership populations in a prepaid group practice. The relationships between duration of membership and the use of outpatient medical care services for disadvantaged and general membership groups in a prepaid group practice were analyzed. The effects of duration of membership upon utilization rates during a six-year study period were estimated by retrospective cohort analyses. Rates were computed for successive three-month intervals. There were no significant start-up effects on use for new enrollees in either study population. This finding is in contrast to what has been reported in other studies. New HMOs or existing HMOs with many new members may not require the additional resources previously thought necessary. Average cohort utilization rates were higher for the disadvantaged cohorts, with the exception of young males 0 to 14 years old. We also examined the persistence of utilization patterns over time. Consistently high users and nonusers were found in both populations. In general, these findings suggest that length of time does not affect ambulatory care use. Age, sex, socioeconomic background and health status are more important than duration of membership in accounting for differences in utilization.


The relationship between utilization of mental health and somatic health services among low income enrolees in two provider plans. Mental health services were included in comprehensive benefits available with no out-of-pocket expenses to enrollees in the Seattle Prepaid Health Care Project. This study was designed to examine the characteristics of users as compared to nonusers of mental health services and to examine the possibility of lower use of somatic health services attributable to the availability of mental health services. Two enrollee groups were studied: one group included enrollees with at least one mental health service (MH-U) and the other included those with some somatic utilization but without mental health utilization (MH-NU). Results indicated that mental health users were different from nonusers based on sociodemographic, health status, and prior utilization measures. Further, the mental health utilizers consumed more somatic services than other enrollees, even controlling for background variables. The visit and admission rates for the MH-U group were 2.4 times that of the MH-NU group, and total inpatient and outpatient costs were three times as high. On all three comparisons, approximately 60 per cent of the difference was accounted for by mental health utilization and by differences in sociodemographic and health status characteristics. The remaining 40 per cent could not be explained, but there is a suggestion that the higher utilization occurred for conditions where medical care is discretionary.


The effect of delay rules in controlling unscheduled visits to hospitals. The increased demand of unscheduled visits to hospital outpatient facilities, and particularly to walk-in clinics, necessitates the consideration of means to control this flow and to reduce in-hospital waiting times. A model is developed in which a percentage of the unscheduled visits are assumed to be delayable, e.g., patients with non-urgent complaints who call may be asked to delay their arrivals for specified lengths of time. A simple rule for determining, dynamically, the length of this delay was examined by computer simulation. The results demonstrate significant reduction of in-facility waiting times while only marginally increasing the time patients wait from their initial contact with the clinic until seen by a practitioner.


[Classification of the disease and pathologic type of bronchogenic carcinoma (III) (author's transl)]. The classification of bronchogenic carcinoma according to its extension and evolutive stages is useful in order to be able to organize epidemiologic and therapeutic studies, as well for exchanging information. At the present time, however, it is very difficult to establish a common classification for all of the groups working on bronchogenic carcinoma. The Bronchogenic Carcinoma Cooperative Group classified the cases following parameters such as operability, resectability, localized or generalized disease, and do not completely agree with the value of the TNM classifications. In the same way in respect to the different pathologic type of bronchogenic carcinoma, the traditional decision not to operate that follows the presentation of the undifferentiated types comes under discussion. This is due to the wide diagnostic variability in the evaluation of the different pathologic types according to the experience of various pneumopathologists published in the literature.


[Pulmonary nocardiosis. A case report (author's transl)]. Within the genus Nocardia three species are at present considered to have human pathologic interest: N. asteroides, N. brasiliensis, and N. caviae. These species are usually the etiologic agents of at least two clinical pictures: nocardiosis and actinomycetoma. A case of pulmonar nocardiosis in a 62-year-old male is reported. The patient had asthmatic episodes and on several occasions received treatment with corticoids. The clinical picture basically consisted of an impairment of the general condition with respiratory symptomatology and fever of 38 to 39 degrees C. An opaque pleuropulmonary image was observed on the chest X-ray film, and the diagnosis of tuberculosis was initially established. The correct diagnosis was confirmed through the bacteriological examination of the transtracheal aspirate with the isolation of N. asteroides. Treatment with streptomycin, sulfamethoxazole and trimethoprim achieved the clinical and roentgenologic cure of the patient. After 2 months of treatment the clinical manifestations had disappeared and after 5 months the chest X-ray was normal. Some epidemiologic data are reviewed.


[Hormonal contraceptives and high blood pressure (author's transl)]. The aim of this report is to offer an explanation for the high incidence of arterial hypertension in women taken hormone contraceptives. The real incidence of this association has been considered in women initially having a normal blood pressure and in others who had high blood pressure before using these contraceptives. The estrogen and progestogen components in hormone contraceptives were analyzed individually in various studies. The most recent investigations seem to indicate that progestogen is the main cause of high blood pressure. Different mechanism that could link hormone contraceptives to high blood pressure were investigated. The renin-angiotensin-aldosterone axis involving the action of estrogens and progestogens on the renin substrate, plasma renin, angiotensin II and aldosterone were analyzed. Another possible mechanism could involve glucocorticoids, altering the metabolism of glucose, pyruvate, cholesterol, and triglycerides, Kidney disease involving renal function, microangiopathic anemia, and renal thromboembolism; hyperactivity of the sympathetic nervous system (noraepinephrine and dopamine-beta-hidroxylase blood levels); prostaglandins; genetic mechanism; and individual mechanism were all taken into consideration. Lastly the priorities of the different systems linking high blood pressure to hormone contraceptives and the relationships between them are analyzed.


[Plasma B12 vitamin and folic acid during chronic renal failure and hemodialysis (author's transl)]. Thirty-one patients suffering from very advanced degrees of chronic renal insufficiency were studied. Ten received a hypoproteic diet as the only treatment and the remaining 21 were on a program of hemodialysis with a free diet and no vitamin supplements. Basal and pre- and post-dialysis plasma determinations of B12 vitamin and folic acid were carried out on them. Looking at the results it was verified that there was a significant reduction in the plasma values of both B12 vitamin and folic acid in the cases of low protein intake. In dialysis we saw that although folic acid was lost during sessions the free dietetic intake was enough to compensate for these losses. As for B12 vitamin, although it is described as dialyzable, we did not observe that its post-dialysis values disminished. Our conclusions indicate that a supplementary vitamin contribution is not necessary for patients who are on a program of hemodialysis.


[Association of VCR-5FU-CYCLO-PDN in the treatment of disseminated carcinoma of the breast (author's transl)]. A group of 32 patients with disseminated breast cancer were submitted to polychemotherapy following Cooper's protocol. Vincristine, cyclophosphamide, 5-fluorouracil, and prednisone were administered. The fifth drug used by Cooper, methotrexate, was not included in the therapy program because of difficulties in obtaining it. Both the objective and subjective results were similar to those of other authors using similar drug associations, while toxicity was moderate. Although this treatment is effective to some degree, the authors feel that further research should be carried out on more potent drugs, or in different combinations, in order to get a more definite chemotherapeutic effect in patients with breast cancer.


[A new pathology: unstable urinary bladder (author's transl)]. Thirty-five cases of incontinence of urine due to hyperactivity of the detrusor as a result of unstable urinary bladder were found among 100 patients with incontinence. The cause of the hyperactivity was established after a thorough urological and neurological screening with intravenous urography, seriated mictional cystoureterography, cystoscopy, and urine culture. The diagnosis was considered definite if uninhibited contractions of the detrusor were detected by electrocystomanometry. The primary clinical symptom was an imperious urge to mi-turate, with or without leakage of urine. Diurnal and nocturnal frequency was exacerbated in cold weather and in contact with water. There were some instances of a history of late enuresis and association with cystoceles. Anticholinergics (propantheline bromide) are the treatment of choice. Surgery should be indicated only after all medical attempts have failed.


[Pulmonary function differences in healthy subjects according to postural changes (author's transl)]. The total lung capacity (TLC) and its subdivisions along with the forced spirometric values (FEF25-75 and FEV1) were determined in a group of 44 healthy subjects, composed of 29 women and 15 men. The determinations were carried out in a sitting position and in supine position, breathing air. All the pulmonary volumes diminished when the subject lay down, but the functional residual capacity (FRC) was that which underwent a greater reduction. The residual volume decrease was the only one which did not reach statistically significant levels. Women always showed smaller pulmonary volumes than men. It has been demonstrated that FRC can be exactly measured by means of the closed helium technique. The regression figures of FRC in supine position were determinted for both sexes, with a r = 0,33 (p less than 0,1) in women and r = 0,95 (p less than 0.001) in men. The forced spirometric tests did not undergo any important changes although the reduction of the FEV1 was significant in both sexes. The results obtained were compared with those published by other authors.


[Aspiration biopsy cytology of the diseases of the mammary gland (author's transl)]. A detailed report is given on the results of aspiration cytology used in 612 patients. On the basis of his own experiences he speaks high of cytodiagnostics in the complex of cyto-radio-clinical triplet, where its value may reach 98-100% to the contrary of 60-88% of the other two components. It is rapid, trustful, undangerous, in everyday practice is suggested at every place, where the personal and objective conditions are guaranteed.


[Critical study on dead cases in recurrent early stomach cancer (author's transl)]. 35 deaths of 299 operated early stomach cancers have been studied retrospectively. These cases can be grouped in the following categories: 2 deaths directly due to operation, 7 due to recurrence of carcinoma, 19 due to other diseases including cancer in other sites and 7 cases in which the real causes of death could not be elucidated. Special attention was paid on the 7 recurrent cases: In 4 of 7 patients the histological study revealed lymph and blood vessels invasion in their resected stomachs, lymphnodes metastases in 5 patients and positive cut-end in 2 patients. 5 of 7 patients died within 3 years after operation.


[Resection of the valvula bauhini and its effect on the metabolism. An experimental study in animals (author's transl)]. In animal experiments (20 mongrel dogs) malabsorption was induced by resection of 100 cm ileum. Subsequently the influence of the ileocoecal valve (Valvula Bauhini) in absorption was studied. In one group of animals intestinal continuity was reestablished by ileoileostomy, in a second by ileocolostomy. The results of the absorption studies were compared with a healthy control group. After ileoileostomy animals do not lose weight, serum cholesterol and protein remain normal. Oral tolerance tests with Triolein-iodine-131 and Cyanocobalamine show results identical with those of the control group. After ileocolostomy all these parameters are lowered--partially to a pathological level. It is concluded that in all operations in the area of the terminal ileum and colon the Valvula Bauhini should be retained if possible.


[The oxygen tension in the gastric fundus wall in relation to arterial blood supply. Experimental study with intramural pO2-measurement (author's transl)]. Animal experiments in dogs were performed in order to measure oxygen tension in the gastric fundus. For this purpose an intravasal oxygen catheter electrode was inserted into the gastric submucosa. The probe recorded pO2 in an area about 2 cm in length. The oxygen tension was measured in relation to the respective blood supply of stomach. The method is suitable for determining the tendency of oxygen supply of the tissue intraoperatively as well as after implantation postoperatively. The clinical interpretation of the trend of pO2-measurements depends on further experiences.


[Paravasal sclerotherapy: experimental study on the effect of sclerosing agents (author's transl)]. Sclerosing and side effects of three solutions mostly used for paravasal sclerotherapy were studied by subcutaneous injections in lower legs of rats. The results demonstrate that of the three examined sclerosing agents 5 p.c. phenol in almond oil has the lowest toxocity in tissue besides a sufficient production of collagen fibres.


[On microsurgical treatment of vocal cord carcinomas with CO2-laser (author's transl)]. The follow up of a few patients with cancer of the vocal cords treated with CO2-Laser microsurgery is described. This new technique seems to be suitable not only in the treatment of benign lesions of the larynx, but also for malignant tumors of determined localisation and extension. Owing to a relatively short observation time a final judgment of the recurrence rate is not yet possible.


[Five-year-cure rate of laryngeal cancer in the Kiel clinic. Report of 216 cases from 1960 to 1967 (then director: Prof. Dr. E. Müller) with special reference to indications for surgical or orthovolt x-ray therapy]. Report about the five-years-cure of all cases of carcinoma of the larynx, the Kiel-University-ORL-Department had to engage in with diagnostical and therapeutical treatment within a period of 7 years. Out of the total of 216 patients the absolute survival rate was 144 (= 66,7%) after five years. Cure rate was the best with carcinoma of the true vocal cord (72,8%), less satisfactory with carcinoma of the supraglottic region (61,1%), only 5/14 with carcinoma of the marginal region, and only 2/8 with advanced and widespread tumours of undefinable origin. After comparing the distribution of the total of our patients with those of other authors, our system of diagnosis, staging, and classification is described in detail being the basis for a skilful choice of primary surgical therapy on the one hand or primary irradiation on the other hand (in our cases orthovolt-X-ray). Both the primary treatment and treatment of recurrence-cases are described in detail, differing from descriptions and claims of other authors for "modern" therapy in many items. Nevertheless we have comparatively very good results, they demand a critical standpoint towards new therapeutical methods. In our opinion close collaboration between laryngologists and radiotherapists concerning classification of tumours, staging and choice of therapy, treatment and post-clinical observation is the fundamental condition for obtaining good and better results in treatment of laryngeal carcinoma.


[Some reasons for failure in tympanoplasty (author's transl)]. The reasons for failures in tympanoplasty are classified and discussed as anatomical or pathological ones and those, that rise from method and technique. A main cause insists in the pathopolymorphism of the chronic purulent otitis media and the discrepancy of clinical impression and pathological reality. The author wishes to encourage the surgeons to a more radical technique by these examples and to the use of new methods in the field of reconstructive surgery of the middle ear.


[Investigation of the problem of safety of computer models in automatic analysis of nystagmus (author's transl)]. The aim of the investigations was to demonstrate by means of statistical methods, that there was no signifikant difference between manual calculation and automatical computer analysis of ENG.


[Slow cortical evoked potentials after noise exposure]. Human cortical evoked potentials under conditions of stimulation are registrated in the post-stimulatory phase of a five minutes lasting equally masking white noise (90 dB HL). Changes of the evoked potentials during to adaptation, possible analogy with high tone losses after noise representation and the origin of tinnitus are examined. Stimulation was started 3 sec after the off-effect of the noise. For five minutes periodically tone bursts were represented. Each train of stimulation consists of tone bursts of three frequencies: 2 kcs, 4 kcs, 8 kcs. The 0.5 sec lasting tones were separated by pauses of 2 sec. During the experiment stimulation and analysis were controlled by a computer. Changes in latency and amplitudes of the cortical evoked potentials were registered. Changes of the adaption patterns as a function of the poststimulatory time are discussed.


[Acoustic evoked potentials in presbycusis]. Investigations concerning presbyacusis indicate that the ageing process of the hearing organ is mostly influenced by changes in the sensory-neural pathways. Psychoacoustic measurements give only reduced information on the peripheral and central part of the hearing organ. To verify changes of transport processes in the hearing organ caused by age we examined different evoked potentials. Occurrence probability of positive wave-complexes, input-output functions of amplitude and latency and particular changes in response pattern are analyzed. The results are controled by a signal-analyzer-system using the classical t-test. Thus we could prove data of three age groups and of sex-differences. Our examination partically confirm morphological and histological data of reduced transport processes in most regions of the auditory pathays.


[Inhalation therapy of sinusitis with the Breathing Mask 500]. The subject of this analysis are the results of treatment of sinusitis in its varying forms and degrees with the "Climate Mask 500" in conjunction with antrum puncture. Either dry or humit warm-air inhalations with coniferous oil additives were prescribed depending on the type of sillness. In 100% of the cases so treated normalisation or improvement of the subjective complaint could be observed. The objective findings normalised or improved in 80% of the cases. Because of its therapeutic value, its simplicity, the reduction in medication and the lack of side effects, inhalation treatment with the "Climate Mask 500" can be said to be a useful aid in a causal therapy of sinusitis.


Sudden hearing loss in divers and fliers. Many papers have been written about sudden sensory hearing loss and the effect of barotrauma on the inner ear. Fistulae of the round and oval window membranes have been implicated in the great majority of these cases. It has usually been recommended that the patient be treated with conservative therapy, such as bed rest, for a period of as long as 30 days and that the final hearing results are as good or better than those that have been surgically explored and corrected. In our experience immediate surgical exploration and correction of sudden severe or profound sensorineural deafness in the diver or flier is absolutely essential and the excellent results of hearing improvement in this select group certainly corroborates this theory. Other cases with the hearing loss limited to the high frequencies most notably have tinnitus and surgical exploration does not improve the hearing but may improve vertigo if present. Numerous cases are presented to support these supositions.


Pediatric vocal cord paralysis.

Pediatric vocal cord paralysis. Pediatric vocal cord paralysis accounts for approximately 10% of all congenital laryngeal lesions. Early detection of these neurogenic disorders is based upon a high index of suspicion and is important to prevent catastrophes during periods of acute respiratory embarrassment. This paper reviews the symptoms, etiology and management of unilateral and bilateral vocal cord paralysis as it pertains to this age group. A case is presented of a neonate with vocal cord paralysis and associated hydrocephalous and meningomyelocele to illustrate many of the problems associated with pediatric laryngeal paralysis.


Percutaneous embolization to control intractable epistaxis. Recurrent epistaxis is a common manifestation of patients with a bleeding diathesis. Two patients with epistaxis secondary to a bleeding diathesis managed by local conservative techniques are reviewed. (A case of polycythemia vera and a case of liver failure secondary to hepatoma are reviewed.) Recently bilateral, percutaneous carotid angiography examination was performed on a patient with a bleeding diathesis and intractable epistaxis. At the time of the angiographic examination, embolization of both internal maxillary arteries with Gelfoam particles was accomplished and dramatic control of the epistaxis was achieved. In a patient with severe epistaxis secondary to a bleeding diathesis that is unresponsive to local measures, percutaneous Gelfoam embolization offers substantial advantages over surgical intervention.


Rehabilitation of the face following traumatic injury to the facial nerve. Etiology, diagnosis, and surgical management of facial paralysis due to traumatic injury of the VIIth cranial nerve are discussed. Sixty patients are reviewed who underwent some type of surgical procedure for the repair of the facial nerve. These cases are categorized according to etiology, which includes temporal bone fractures, iatrogenic injuries, and penetrating wounds of the head and neck. The results of a poll of eight leading otologists on their approaches to several aspects of the surgical management of these injuries are presented in the Discussion section. The diagnostic and prognostic studies associated with facial paralysis, as well as the more common surgical procedures available for repair of the facial nerve, are briefly reviewed.


Schwannomas of the parapharyngeal space and jugular foramen. Schwannomas or neurilemmomas are among the most common neoplasms occupying the parapharyngeal space, yet only 107 cases have been previously reported. Neurilemmomas involving the jugular foramen are extremely rare. Only 55 cases have been reported in the world literature. The neoplasm occurred in the parapharyngeal space in three of our patients and in the jugular foramen in another patient. Of the tumors located in the parapharyngeal space, the nerve of origin in one of them was the glossopharyngeal, which is extremely rare. Adequate exposure for complete excision of parapharyngeal space tumors is best obtained through an external incision and should not be attempted transorally. In the jugular foramen case, the neoplasm arose from the vagus nerve high in the neck and extended intracranially in a "dumbbell" shape into the posterior cranial fossa. Total removal was successfully accomplished in one stage, by using a subtotal temporal bone resection--upper neck--posterior cranial fossa approach. Surgical removal is the treatment of choice. Schwannomas rarely recur following complete excision.


The grand biopsy for the "cold" thyroid nodule. A lobe and isthmusectomy is our standard surgical management for the cold nodule of the thyroid. Experience indicates that the great majority of cold nodules prove benign. It is manifest that the attendant morbidity for this surgery be extremely low. Our experience reviewing thyroid surgery for only benign disease indicates that complications are indeed uncommon. Our surgical management of the cold nodule includes resection of a lobe and isthmus with exploration and palpation of the opposite side. The nerve is routinely identified and preserved. In the past 18 months, we have experienced two minor postoperative complications in 36 consecutive cases of the lobe and isthmus resection for benign disease.


Bilateral longitudinal temporal bone fractures: a retrospective review of seventeen cases. The types of temporal bone fractures, longitudinal and transverse, are reviewed. All cases of bilateral temporal bone fractures at Parkland Memorial Hospital in Dallas over a 10-year period from 1968 to 1978 are reivewed and discussed by the authors. One hundred sixty patients with the diagnosis of base of skull fractures were studied. Fifty-nine of these were temporal bone fractures and 17 of the 59 were bilateral. Of all the base of skull fractures, 10% were bilateral temporal bone fractures and 29% of all temporal bone fractures were bilateral. For each case the method of injury, the extent of damage to hearing and facial nerve function, presence of CSF otorrhea, X-ray findings, and additional complications are summarized and the results discussed. The operative findings of facial nerve decompressions are carefully reviewed. The authors' method of caring for temporal bone fractures is presented.


Sinus complications of frontal craniotomy. Frontal sinusitis, or inflamatory complications of sinusitis, may occur as a consequence of frontal craniotomy when the sinus has been entered during the craniotomy. This may happen particularly during surgery to treat an aneurysm or to excise a tumor in the sellar area. These complications may also occur if the sinus is entered during routine craniotomy when the sinus is high or asymmetrical, or during reduction of frontal bone fractures. This presentation describes the etiology of such inflammatory complications and describes the approach to treatment of such complications, as well as outlining their prevention.


Acoustic and perceptual comparison of chronic and incipient spastic dysphonia. Vocal symptoms of patients with chronic and incipient spastic dysphonia were compared on a number of acoustic and perceptual parameters. Patients with incipient spastic dysphonia displayed less severe strain-strangle phonation, effort, rhythm, and stress. Harshness was the only perceptual parameter on which incipient spastic dysphonics were rated higher than chronic spastic dysphonics. Changes in the acoustic measures of laryngealization, harmonic change, mean vowel duration, and duration ratio between stressed and unstressed vowels accompanied changes in listeners' perception of strain-strangle phonation and effort. The variation in acoustic characteristics such as laryngealization and harmonic change as well as normal phonation indicated that both groups were characterized by a variety of phonatory modes.


Progressive sensorineural hearing loss and cochlear otosclerosis: a prospective study. The association of otosclerosis with reduced bone conduction is well known but no experimental or valid clinical relationship has been established to confirm this relationship. The purpose of this presentation is to demonstrate a clinical relationship between otosclerosis and sensorineural hearing loss. Experimental proof will await the accumulation and study of temporal bones of those individuals who, in life, exhibited the clinical relationship to be developed in this dissertation.


[Rational combined X-ray examination of gallbladder and stomach (author's transl)]. X-ray examination of patients with upper abdominal symptoms has been performed up to now mostly as a sequence of separate procedures; instead, an integrated procedure is recommended: a plain film of the upper abdomen should be taken first; a routine oral cholecystogram in the lying position 12 hrs after intake of the contrast medium should be omitted-instead the gallbladder should be visualized fluoroscopically with the patient remaining in the standing position or lying, and films should be taken during visualization. X-ray examination of the stomach and duodenum may follow immediately thereupon, eventually as well during pharmacologically induced hypotony. Then a fatty meal may be given in order to stimulate contraction of the gallbladder; if spasmolytics have been given before, contraction however might be hampered. The diagnostic significance of fatty meals applied as a routine procedure in X-ray diagnosis of gallbladder function is considered to be limited; on the other hand this procedure may improve the diagnosis of the morphological situation.


[Endoscopic polypectomy in the colon, a calculated risk (author's transl)]. 5774 colonoscopies were performed in 5 years, --including 2877 total colonoscopies and 1338 polypectomies. This confirms the diagnostic and therapeutic value of this method. Increasing experience of the endoscopist, better techniques as well as adequate pre-and postoperative care contribute to decreasing the risk of the polypectomy. If coagulation current is used exclusively the risk of bleeding can be lowered considerably.


[Premedication of esophago-gastro-duodenoscopy with a neuroleptanalgesic drug and a tranquillizer--a controlled clinical study (author's transl)]. In a controlled double-blind randomized study Thalamonal and Valium were compared in 498 esophago-gastro-duodenoscopies. Both drugs were injected intravenously immediately before the procedure. Satisfactory sedation which made additional injection of the drug during the endoscopy superfluous could be achieved in 66% of the patients with Thalamonal and in 52% with Valium respectively. The difference between the two preparations is statistically significant (p less than 0,005). In 95 patients catamnestic studies were performed in order to evaluate second episodes of fatigue after the endoscopy. A good effect of the preparation during endoscopy and a lack of second attacks of sedation following discharge was observed only in 23% of the patients after Thalamonal and in 21% of the patients after Valium injection, respectively. Therfore a good premedication was achieved in only one fifth of the patients receiving one of the two drugs.


[Percutaneous cholangiography with the Chiba method (author's transl)]. In 92 patients with cholestasis a percutaneous cholangiography was performed. The bile duct could be visualized in 75 cases (81.5 percent). When the bile ducts were dilatated, the investigation succeeded in 94 percent, whereas in patients with normal bile ducts the rate was 65 percent. Complications occurred only in 2 cases. In one patient surgery was necessary due to biliary  peritonitis. In another patient a discrete hemobilia without clinical symptoms could be found during laparotomy.


[Biliary peritonitis after percutaneous transhepatic cholangiography with the Chiba technique (author's transl)]. The Chiba technique of percutaneous transhepatic cholangiography (PTC) can be easily learned and does not require much technical equipment; it is thus widely used now in the diagnosis of suspected obstructive jaundice. The procedure is generally regarded as safe; thus standby availability of a surgical outfit is not considered to be necessary. However fever, cholangitis, septicemia, biliary peritonitis and bleeding have been reported in patients who underwent PTC. A case report is given of a patient who had biliary peritonitis following PTC, in order to demonstrate the need for careful selection of patients undergoing this procedure. PTC should not be done in patients with coagulopathy, cholangitis and known allergic reactions against the cntrast medium to be injected. If a dilated duct can be visualized bile should be aspirated and only small amounts of contrast medium be injected. If extrahepatic biliary obstruction has been diagnosed or if the patient complains about pain after the procedure surgery should be done within 24 hours.


[Exploration of pancreaticojejunal anastomosis by postoperative endoscopic pancreaticography (author's transl)]. Endoscopic pancreaticography (EP) was performed in 9 patients after pancreaticojejunal anastomosis had been established surgically; in 2 of these patients EP was not successful. The anastomosis could be demonstrated in 5 cases to be functioning 1-6 years after operation; in 3 cases the duct system was found to be dilatated, in 2 cases diameters were normal. EP and clinical symptoms correlated well in 4 of 5 cases.


[Hemobilia after liver biopsy (author's transl)]. Colicky pain in the gallbladder region, hematemesis, melena and jaundice are symptoms of hemobilia. The underlying cause can be an arterio-biliary or a porto-biliary fistula, resulting in hemorrhage into the duodenum. Shunting may be intra- or extrahepatic and may originate from trauma, or from biliary, pancreatic or vascular lesions. Since 1976 liver biopsies were done in 2221 patients; in 3 of these hemobilia occurred. In one case the artery involved could be obturated by transarterial placement of Ivalon particles; the two other cases recovered without special treatment. A review is given of 23 cases of hemobilia after liver biopsy, and treatment is discussed.


[Ultrasound-guided needle biopsy of malignant liver cyst (author's transl)]. A liver cyst was detected during a routine ultrasonographic examination. Needle biopsy of the cyst was performed using ultrasound as a guidance device during puncture. Malignant cells could be demonstrated on cytological examination. Needle biopsy of circumscribed lesions of the liver is a low risk procedure, causing no strain for the patient. Needle biopsy should be done, when a hepatic cyst is detected by ultrasound, when there is suspicion of malignancy, and when a parasitic lesion has been excluded.


Phospholipid exchange between subcellular organelles of rabbit lung. A soluble protein fraction (PLEP) prepared from rabbit lung can catalyze the exchange of phospholipids between subcellular organelles of the lung and between these subcellular organelles and synthetic liposomes. Phospholipid exchange between microsomes and synthetic liposomes and between mitochondria and synthetic liposomes was stimulated 8-fold and 2.5-fold, respectively, in the presence of the protein fraction. Lung exchange protein could also catalyzed phospholipid exchange between subcellular organelles of the liver and synthetic liposomes. Phospholipid transfer between microsomes and lamellar bodies of the lung was stimulated 2-fold by the exchange protein. Both radiolabeled phosphatidylcholine (PC) and phosphatidylinositol (PI) were transferred from 32P-labeled microsomes to lamellar bodies, but the exchange protein exhibited no transfer activity for phosphatidylglycerol (PG) and that for phosphatidylethanolamine (PE) was insignificant compared to the transfer activity for phosphatidylcholine and phosphatidylinositol. While the physiological role of the phospholipid exchange proteins in the lung is unknown, it is possible that they participate in the distribution of the newly synthesized phospholipids from the site of synthesis to lamellar bodies and other membrane compartments of cells.


The effect of clofibrate on heart and plasma lipids in rats fed a diet containing rapeseed oil. The effect of clofibrate on heart and plasma lipids in rats fed a diet containing 30% of the calories as peanut oil (PO) or rapeseed oil (RSO) (42.7% erucic acid and 0.5% eicosenoic acid) was studied. A decrease of erucic acid content to one-third and concomitant increase in the content of 18:1, 16:1 and 16:0 fatty acids in plasma triacylglycerols were observed after administration of clofibrate to rats fed the RSO-diet. It is suggested that these changes reflect the increased capacity of the liver to chain-shorten very long chain length fatty acids. The extent of lipidosis in the heart of rats fed the RSO-diet was decreased by 50% by clofibrate. However, the concentration of erucic acid in heart triacylglycerols decreased much less (30%) than the concentration of all other fatty acids (50-65%). It is concluded that the clofibrate administration increased the oxidative capacity of the heart mitochondria and that the heart cell does not have an efficient system to handle very long chain length monounsaturated fatty acids as does the liver.


The metabolic fate of cholesterol-5 alpha, 6 alpha-expoxide in vivo. [14C] Cholesterol-5 alpha, 6 alpha-expoxide, administered to mice by either gastric intubation or skin painting, was rapidly and primarily excreted in the feces. Residual amonts of the epoxide and its metabolites were found in a wide variety of organs, and persisted for at least 72 hr. At some sites (principally the liver, the small intestinal contents and the combined stomach/duodenum and their contents), the labeled compound existed in a water-soluble form which could not be extracted with chloroform/methanol. Treatment of the small intestinal contents with a preparation of beta-glucuronidase/sulfatase produced a marked increase in the amount of organic-solvent-extractable cholesterol-alpha-epoxide and other polar metabolites. Unchanged epoxide was found mainly in the feces and the skin at the site of application. On the basis of these results, stool specimens, and not blood samples, should be analyzed to detect the presence of this compound and/or its metabolites in vivo.


Epoxides as products of lipid autoxidation in rat lungs. The nature and content of lipid epoxides in rat lung were examined in air-breathing control rats and those exposed to nitrogen dioxide. Exposure to 6.5 ppm NO2 for 24 hr resulted in significantly greater epoxide content in a number of lipid classes. It is proposed that lipid autoxidation in lung tissues may contribute to the levels of epoxide-containing lipids. Furthermore, the processes involved in epoxide formation may be predicted from autoxidation studies utilizing a system of unsaturated fatty acid monolayers on silica gel which serves as a model for biomembranes. The findings indicate that exposure to oxidizing gases can lead to an accumulation of lipid epoxides in both lung parenchymal tissue and on the alveolar surface.


Studies on cell proliferation in inguinal adipose tissue during early development in the rat. [2-14C] Thymidine was injected into rats aged 3,5 and 10 days, and incorporation of the precursor into deoxyribonucleic acid (DNA) of the inguinal fat tissue was measured for short time periods. Using chromatographic procedures to measure the distribution of thymidine and its metabolites in the soluble fraction of the tissue, degradation of the precursor was found to be similar at all ages. The data indicate that thymidine was more rapidly utilized for DNA synthesis in 3-day-old rats than in older animals. When 14C-thymidine was injected in vivo and adipocytes and stromal cells were then separated from the inguinal tissue of 3-and 5-day-old rats, the incorporation into DNA was significant in both types of cells already 30 min after pulse labeling. Stromal cells took up twice as much of label as the adipocytes. Furthermore, real incorporation into DNA was found in the adipocytes when incubated in vitro in a culture medium supplemented with 14C-thymidine. The possibility is discussed that early in postnatal life adipocytes might synthesize DNA for further cell division.


Stimulation of lipid absorption in young rats by cholesterol: early time changes and effects on pentobarbital sleeping time. Four groups of young male and female rats were fed a chow diet (O), chow plus 10% corn oil (F), chow plus 1% cholesterol (C), or chow plus 1% cholesterol plus 10% corn oil (CF) for 1, 2, 4 and 8 days. After 2 dats, male F, C and CF rats exhibited a shorter anesthesia period (-20 to -30%) when given pentobarbital. By 4 days, male F and C rats had pentobarbital sleeping times (PB-ST) 20% less than O rats. These effects were additive and CF rats had 40% shorter PB-ST. Reduction of PB-ST by cholesterol and corn oil was similar but slightly less in female rats. Liver lipid content doubled in 4 days in CF rats, and liver cholesterol was 4 times than of O rats. These changes and the increases in metabolism of barbiturate suggested changes in liver microsomal enzyme activities. Serum glutamic oxaloacetic and glutamic pyruvic transaminase, two enzymes reflective of liver damage, did not increase after 8 days on C, F or CF diets. Our results suggest that consumption of an animal sterol and a high lipid diet by laboratory rats, normally consuming a diet low in fat (3-4%), increase the ability of the animal to detoxify a barbiturate. Storage of absorbed dietary cholesterol in the liver may represent a major mechanism for maintaining extra hepatic cholesterol homeostasis.


Preparation of cupric palmitate membrane, its characterization and evaluation of thermodynamically effective fixed charge density. Membrane potentials have been measured across parchment-supported cupric palmitate membrane separating various 1:1 electrolytes at concentrations C1 and C2 such that C2 = 10 C1. Membrane potential data have been used to calculate transference number of ions, permselectivity and also to derive the thermodynamically effective fixed charge density which is an important characteristic governing the membrane phenomena by utilizing the generally accepted and most widely used theory of Teorell-Meyer and Sievers as well as the recent theories for membrane potential of Kobatake et al. and Nagasawa et al. based on the principles of nonequilibrium thermodynamics. The values of charge densities derived from different theories were almost the same, confirming thereby the validity of the recently developed theories of membrane potential.


Cardiac output differences in males and females during mild cycle ergometer exercise. To study sex differences in cardiac output during submaximum exercise, eight male and eight female subjects were matched on max Vo2 (1 min-1 and ml kg-1 min-1). Each subject performed one, eight minute submaximum bicycle ergometer test at 35% of Vo2max (300 kpm min-1). At a steady state mean Vo2 of 0.96 1 min-1, cardiac output was determined. Significant differences between men and women were observed (p less than .05) in cardiac output, stroke volume and (a-v) O2 difference. The males had a lower cardiac output (1.75 1 min-1) and stroke volume (17.2 ml beat-1) and a higher (a-v) O2 difference (2.01 vol %). When these variables were expressed independent of lean body weight the above differences were non-significant. It was suggested that cardiac output differences between the sexes during mild exercise are due, in part, to differences in lean body weight.


Characteristics of national and world class female pentathletes. Nine national and world-class female pentathletes were assessed for body composition, maximal aerobic power (Vo2max), strength, and speed. The subjects averaged 175.4 cm in height, 65.4 kg in weight, 11.0% relative body fat, 45.9 ml kg min-1 in Vo2max, and 8.35 m/sec for maximal running speed. When compared with other athletic females, this group was tall and lean with good, but not exceptional, maximal aerobic power. Group means for one-repetition maximum lifts were 59.7 kg (power clean), 61.5 kg (horizontal bench press), 60.0 kg (pull down), 87.9 kg (squat), 44.9 kg (include bench press), and 36.3 kg (leg curl). Within this elite group the most successful performers were stronger and possessed a greater lean body weight which together suggest the importance of muscle mass for success in the pentathlon.


Prediction of maximal oxygen uptake in boys, ages 7-15 years. Predictions of Vo2max (1 min-1 and ml kg-1 min-1) were obtained via multiple regression procedures from a sample of 100 boys, ages 6.7-14.8 years. Prediction equations for Vo2max (1 min-1) were obtained from the subjects' height, and the Vo2 (1 min-1) and heart rate observed during the third min of a treadmill walk (R = 0.95; CV = +/- 9.3%). A similar prediction was obtained when the subjects' age, height and weight were used (R = -0.94; CV = +/- 9.7%). Vo2max (ml kg-1 min-1) was predicted with similar accuracy (CV = +/- 8.4%) from age, and heart rate, VCO2(1 min-1), Vo2 (ml kg min-1), or from simply age, height and weight (CV = +/- 9.2%). Cross-validation of the equations with another sample of 39 boys demonstrated that the prediction equations based on laboratory data were quite stable, % errors approximately 1-2 +/- 9%. However, the equations based on age, height and weight underestimated the Vo2max slightly, both in 1 min (X = -0.091 min) and ml kg min (X = -2.2 ml kg min, P less than 0.05). The results indicate that reasonably reliable and accurate estimates of Vo2max for children may be obtained from either laboratory data, or simply from their age, height and weight.


Control of sweating rate while exercising in the heat. All of the heat produced during exercise in a hot environment is either stored in the body or dissipated to the environment by evaporation of sweat. In order to minimize the storage of heat, thereby resisting circulatory strain, the body must be able to effectively increase sweating rate in these conditions. This paper characterizes the physiological control of sweating as a proportional control system, with increases in internal temperature having the greatest effect upon increasing the sweating rate. Factors which modify the threshold and gain of the sweating response, such as occur with dehydration or physical training, affect the storage of heat and therefore the steady state internal temperature during exercise in the heat.


Control of skin circulation during exercise and heat stress. At any given environmental and mean skin temperature, exercise brings about an increase in internal body temperature and skin blood flow. At high environmental temperatures, when skin temperature is elevated, skin blood flow at any given internal temperature reaches higher levels than at cooler skin temperatures. Increased cutaneous blood flow serves to deliver metabolic heat from the core to the skin, where the heat is lost to the environment by convective, radiative, and evaporative mechanisms. However, at high levels of skin blood flow, peripheral vascular pooling and fluid losses by filtration lead to reduced central venous pressure. This lowers cardiac stroke volume, and requires a higher heart rate to maintain a given cardiac output. Mechanisms which alleviate some of the cardiovascular strain produced by exercise in the heat include the following: acutely, reflexes which arise from receptors in working muscles produce vasoconstriction in a number of central and peripheral vascular beds. Other reflexes, arising from cardiac baroreceptors, produce additional peripheral vasoconstriction when cardiac filling is impaired. In the long term, physical conditioning and heat acclimation lead to increases in sweat output during thermal stress, leading to cooler skin and core temperature during exercise, and decreasing the level of skin blood flow needed for regulation of body temperature.


Effects of exercise in the heat on body fluid distribution. Experimental findings as to body fluid shifts during exercise appear to be greatly influenced by the mode of exercise (bicycle ergometer, treadmill, etc) and by the state of subject hydration. Endurance training has been shown to increase resting plasma (blood) volume. Also, endurance training results in modification of vascular volume dynamics during exercise, i.e. for a set task, plasma volume becomes stabilized. In the untrained individual, heat exposure exaggerates body fluid shifts during exercise. With training, stability of vascular volume is attained during heat exposure, but maximum protective responses towards exercise in heat is only gained upon heat acclimatization. Two items benefit the individual: an increase in the capacity of the sweat mechanism and an expansion of plasma volume. Benefits of training as to body fluid shifts are probably a result of metabolic changes within the active muscle mass.


Heat tolerance and aging.

Heat tolerance and aging. Although children and older adults appear more susceptible to heat stress, the mechanisms responsible for their lower tolerance are not fully understood. Many studies dealing with the effect of age on temperature regulation have concluded that an inadequate sweating response is primarily responsible for the low tolerance of children and the elderly to exercise in the heat. However, the dependence of core temperature on relative exercise intensity and sweat rate on absolute exercise intensity makes it difficult to avoid the confounding effects of exercise on thermoregulation when aerobic power (Vo2max) varies across age groups. When 38 non-acclimatized females, ages 12 to 68 years, exercised at 30-35% Vo2max in the heat, the degree of cardiovascular stability was the primary predictor of tolerance time. Age was not a significant predictor. However, it was evident that individuals at either end of the age continuum were more likely to be at risk. For children this risk was associated with the instability of an immature cardiovascular system; for older women, a marked decrement in aerobic power. Sweat rate added significantly to the prediction of tolerance time for all subjects regardless of age. Whether the decrease in responsiveness of sweating noted for some older individuals is an age related change or a reflection of their lower fitness levels is not known.


Relationships among training, heat acclimation, and heat tolerance in men and women: the controversy revisited. For more than a decade there has been a controversy over the beneficial effects of physical training in a cool environment on exercise-heat tolerance. The issues include (a) inadequate controls regarding the physical characteristics of subjects, (b) marked variability in the conditions of the standard heat tolerance tests and (c) differences in the intensity and duration of the training programs employed. Intense training in a cool environment cannot serve as a substitute for exercise in the heat if acclimation is desired within a 2 week period. However, a substantial improvement (50%) in heat tolerance can be derived from 8-11 weeks of training under temperate conditions (21 degrees C) and thermal equilibrium can be maintained for at least 4 hours during mild work (200 W/m2) in dry or wet heat by endurance runners. These adjustments occur in both men and women and appear to be independent of aerobic capacity. The key to improved thermal tolerance with training in a cool environment is maintenance of an elevated core temperature for a sufficient duration of time to produce an adaptive response.


Influence of caffeine and carbohydrate feedings on endurance performance. Nine trained cyclists were studied to determine the effects of caffeine (CAF), and glucose polymer (GP) feedings on work production (kpm) during two hr of isokinetic cycling exercise (80 rpm). Ingestion of 250 mg of CAF 60 min prior to the ride was followed by ingestion of an additional 250 mg fed at 15 min intervals over the first 90 min of the exercise. This treatment significantly increased work production by 7.4% and Vo2 by 7.3% as compared to control (C) while the subjects' perception of exertion remained unchanged. Ingestion of approximately 90 g of GP during the first 90 min (12.8 g/15 min) of the exercise had no effect on total work production or Vo2. It was, however, effective in reducing the rate of fatigue over the last 30 min of cycling. Although GP maintained blood glucose and insulin levels (P less than or equal to 0.05) above those of the C and CAF trials, total CHO utilization did not differ between treatments. During the last 70 min of the CAF trial, however, fat oxidation was elevated 31% and appeared to provide the substrate needed for the increased work production during this period of exercise. These data, therefore, demonstrate an enhanced rate of lipid catabolism and work production following the ingestion of caffeine.


[Determination of the law of radiation source motion in intracavitary moving and multipositional irradiation]. The intracavital moving and multipositional irradiation with portable sources in gamma-therapy of extended pathologic foci offers more possibilities for the formation of dose distribution in accordance with the patient's individual features. A method is proposed to calculate the movement law for the point and linear irradiation sources following the preset dose distribution. The authors show possible formation of dose fields with a practically rectilinear isodose portion.


[Analog model of the interaction of the human body-temperature sensor-environment system]. A simple analog model of interaction in the system of human body and temperature sensor is described. It can be employed as an imitator in the development and adjustment of thermometric devices. Analytical expressions which describe this model operation and results of determining the real parameters of the system are reported.


[Effect of high-amplitude electrical impulses on the strength of the coagulative adhesion of the blood vessels]. Strength of coagulative commisure of the blood vessel tissues in their coagulation with high-frequency current can be increased after additional action of high-amplitude electrical pulses. A comparative test of commisures tensile strength confirmed its possible increase by 1.6--1.7 times when vascular tissues were preliminarily subjected to the action of short high-amplitude electrical pulses.


[Gipospast-1 thermoelectric apparatus for local hypothermia]. A possibility of providing local hypothermia for human extremities over the area from 6.25 cm2 to 37.5 cm2 with temperature level up to 10 degrees C is shown. "Gipospast-1" is designed for accomplishing the local hypothermia. It was revealed that at such conditions the human organism reaction ensures a specific heat flow on the cooling surface to 0.02+/-0.04 W/cm2. The clinical trials of the apparatus confirmed its efficacy for removing the contractures of the facial muscles and for decreasing the spastics in paretic extremities of neurosurgical patients.


[Manufacture of control knobs for medical devices and apparatus]. Control knobs having rigid projections in the setting port which incise into the shaft of the control element possess operating advantages over the knobs of other constructions. But they are unprofitable in production because of the mechanical treatment method. Considerably technical and economical higher profit can be attained by casting the knobs according to melted models.


[Electrode for the pickup of bioelectrical potentials]. Three versions of surface multipoint electrodes are described providing electrical contact with the body surface without any electrode paste. The electrical contact is achieved through numerous metal pins being electrically connected with each other. One electrode has all its pins fixed rigidly on a common base-plate. In two other versions the pins are movable by means of special springs and volumetric elastic (springy) materials which allows to ensure electrical contact with uneven body surface.


[Design and production problems with stethophonoendoscopes]. The existing stethophonendoscope models with separate stethoscopic and phonendoscopic heads fail to give adequate reproduction of processes under investigation within the auscultation frequency range with intensity sufficient for reliable diagnosis. The Leningrad industrial association "Krasnogvardeets" offers a new stethophonendoscope design with a head reproducing acoustic signs at a necessary intensity level within a wide frequency range. These stethophonendoscopes can be manufactured serially because their most complicated and functionally responsible elements are strictly unified for different models.


[Reinforcement of the operating elements of medical instruments]. Reinforcement processes were analysed to assess the possibility of their use for the medical apparatus production. It was shown that one of the ways to make medical instruments more durable is the reinforcement of their operating surfaces with wear-proof, corrosion-resistant and hard materials by means of soldering, sputtering and fuse on.


[Evaluation of the force loads on the elements of artificial heart valves from the results of processing echocardiograms]. Approaches to further improving the valve prosthesis construction greatly depend on the knowledge of the physical load affecting the elements of artificial cardiac valves that operate in the human organism. An analysis of echocardiograms is given. They were recorded in the patients with implanted artificial ball heart valves, type MK4-2.25. The design values for the force of the ball impact against the valve shell are presented. The echocardiogram analysis revealed a phenomenon of the fibrotic ring deformation under the ball action on the valve shell and the degree of this deformation has been determined.


[Value of liver needle-biopsy in Djibouti (1.1110 specimens) (author's transl)]. Liver diseases, specially hepatomegalies and hepatosplenomegalies are very frequent in Republic of Dijibouti. Needle-biopsy of the liver is a good approach of this pathology as demonstrated by controlling 1.110 specimens within a period of 9 years, leading to very different diagnosis.


[Distribution of HBs antigen in Tananarive (author's transl)]. This survey has been conducted among blood donors and patients with hepatitis, cirrhosis, liver carcinomas and various causes of liver dysfunction or enlargement. The frequency is 5,4 p. 100 among blood donors and 50 p. 100 among cases of hepatitis.


[Chatelguyon thermal springs and amoebiasis (author's transl)]. Châtelguyon thermal springs are an effective treatment of chronic post amoebic colitis and its side effects on gastroduodenal tract and autonomic nervous system. The high level of magnesium of these waters is the main therapeutic agent; after the cure, the intraerythrocytic magnesium level is above the standard while the Mg seric level is below. The waters might reactive the amoebiases, increasing in the same time the specific amoebic antibodies. Parasiticidal treatment must be prescribed before any cure, if patient is proved to be Entamoeba minuta or cyst carrier.


[Rheumatoid polyarthritis in Madagascar (author's transl)]. Report of 11 cases of rheumatoid arthritis observed in Malagasy. Frequently, a single joint is concerned at the on-set period and this may raise some questions to differetiate rheumatic fever, gout and osteo-articular tuberculosis, as these three diseases are of high and almost equivalent frequency in the country. Clinical, biological and radiological features are the same as observed in Europe. Evolution is often severe as a consequence of requently delayed diagnosis and difficulties encountered in treatment of out-patients.


[Cancerized phagedenic ulcers. A study about 19 cases observed in Dakar "Hôpital Principal" from 1961 to 1976 (author's transl)]. Cancerization is the main complication of phagedenic ulcers which are frequent in tropical areas. The detection of the turn towards cancer is generally too late because of social and psychological conditions. Patients of this study were civil servants and had beneficial of a comparatively early detection. The clinical, radiological and pathological features are described and the importance of the control of lymph nodes is emphasized. The surgical tactic is discussed according to each situation but it must be as conservative as possible, even if the amputation is only delayed since lymphatic dissemination is late and amputation eminently dramatic in the african context.


[Reaginic allergy to mold in Djibouti].

[Reaginic allergy to mold in Djibouti]. 16,7 P. 100 OF RESPIRATORY ALLERGIC DISEASES IN Djibouti are caused by years, as demonstrated by the utilization of M. and M2 compounds prepared by Institut Pasteur. The role of air-conditionners appears important. Cultures of dust collected from filters reveale a much greater number of positive yeast cultures than front air.


[Retinopathy due to amino-4-quinoleines group of the synthetic antimalarial drugs (author's transl)]. The use of overdoses of amino-4-quinoleines in non-malarial diseases has demonstrated various toxic actions on eyes. The most severe is retina lesion. Metabolism of these drugs and pathogeny of the lesions are discussed. With regard to aetiology, the main factor is overdose and duration of treatment. Clinical aspects are classified in three phases; the third one is divided in 5 stages. Treatment is only prophylactic.


[Basophilles degranulation test. Its value in an overseas allergologic dispensary (author's transl)]. Specific Ig.E fixed on basophilic leucocytes and mastocytes give way to a release of cytoplasmic granulations when antigen is present. This is the base of a clinical laboratory test easy to perform and consequently of great value in tropical areas. Report of first results in Republic of Djibouti.


[Cerebral malaria with renal insufficiency in a 5 months pregnant woman. The use of prostaglandines for delivery (author's transl)]. Report of a typical case of cerebral malaria with coma during 3 days, pneumopathy and renal insufficiency with failure of concentration. The delivery of a dead foetus has been started by prostaglandines.


[Test tube technique for field diagnosis of hemoglobin S (author's transl)]. Laboratory diagnosis of sickle-cell anemia requires expensive equipment often too sophisticated for rural dispensaries. Therefore haemoglobin precipitation in solutions of neutral salts appears to be a specific and reliable test, as valid as Emmel test, and easily performed during mass campaigns or within the technical and financial limitation of rural medicine.


[Loco-regional anesthesia in remote medical units: II.--Anesthesia of the upper limb: plexic blocks (author's transl)]. The anesthetic block of the upper limb plexus may be realized by either sus-cladications and possible complications.


[Diagnosis of jaundices in tropical practice (author's transl)]. Diagnosis of jaundices in tropical medicine complies with the same rules as in Europe. Some etiologies occur more frequently than in Europe; others, specific to tropical areas require peculiar investigations. Most jaundices observed overseas are hemolytic or hepatitic. Their diagnosis is generally easy. However, chronic viral hepatitis, a frequent infection, requires liver needle-biopsy for a valid diagnosis. The diagnosis of cholestatic jaundice must be conducted in a systematic fashion: if abdominal echotomography is not available, laparoscopy with or without liver needle-biopsy and percutaneous lateral transhepatic cholangiography (OKU-DA's technique) are easily performed in tropical countries and give a certain diagnosis.


Adult hypophosphatasia. Clinical, laboratory, and genetic investigation of a large kindred with review of the literature. Investigation of the kindred of a 58-year-old woman with all of the features of "adult" hypophosphatasia revealed 12 individuals in 3 generations with subnormal circulating total alkaline phosphatase (AP) activity. The pattern of inheritance suggested autosomal dominant transmission, with incomplete penetrance of the trait particularly in the young males. Hypophosphatasic individuals other than the proposita were clinically well but had loss of permanent teeth, showing that dental abnormalities could be the only clinical manifestation of the disorder. Radiographic investigation of the proposita revealed that completion of stress fractures was necessary for healing; maturation of incomplete fractures resulted in stable Looser zones. Skeletal survey and radionuclide bone imaging were unremarkable in hypophosphatasic individuals without fracture. Subclinical osteopenia was found in several affected women by metacarpal cortical width and bone densitometric measurements. Laboratory studies showed increased plasma and urinary phosphoethanolamine levels in affected individuals. Phosphoethanolamine and phosphoserine appeared to be natural subtrates for AP since a negative correlation existed between each substrate and circulating total AP activity. Phosphoethanolamine and phosphoserine levels were greatest in the clinically affected proposita; furthermore, only she showed absence of leukocyte AP activity. Heat fractionation of her total circulating AP activity suggested severe reduction in the bone isoenzyme. Hypophosphatasic children had higher levels of total circulating AP than affected adults; the increase was apparently secondary to increased bone isoenzyme. Iliac crest bone biopsies showed greater abnormality in affected women. Osteoidosis was particularly pronounced in the proposita's younger affected sister and hypophosphatasic daughter. Histomorphometric analyses of the biopsies revealed a paucity of osteoblasts despite increased quantities of unmineralized matrix. The finding that hypophosphatasic children in this kindred had higher circulating total AP activity than adults and were able to model their skeleton normally, together with observations that the bone biopsy in adults had a paucity of osteoblasts, suggests that some factor(s) during growth is able to induce both AP activity and osteoblast function, or, that this disorder is an "abiotrophy" with deficient osteoblastic formation and/or accelerated destruction in adult life.