Drug-related superinfection in hospitalized patients. In a series of 14,077 hospitalized medical patients receiving antibiotics, superinfection developed in 95 (0.7%) during drug therapy. The majority were yeast and fungal infections, and serious infections occurred with a frequency of less than one per 1,000 patients treated. Concurrent immunosuppression and impaired renal function increased the risk of new infections.


Contact dermatitis to neomycin sulfate.

Contact dermatitis to neomycin sulfate. The prevalence of contact allergic dermatitis and nonallergic irritant reactions to neomycin sulfate was determined in a large group of young adults who had a noteworthy exposure to topical antibiotics. Only two subjects (0.09%) had contact allergy proved by closed patch testing, while 20 (0.9%) had nonallergic irritant reactions to 20% neomycin sulfate and 17 (0.78%) had nonallergic reactions to one of the hydrophilic ointment bases. In a separate population of 653 children referred for diagnostic patch testing, only one subject had contact allergy to neomycin. All three subjects who had reactions had a history of repeated use of neomycin on chronically damaged skin. These results support the conclusion that intermittent use of neomycin on minor cuts and wounds is not associated with an excessive rate of sensitization.


Antimicrobial selection by a computer. A blinded evaluation by infectious diseases experts. An evaluation of a computer-based consultation system called MYCIN was made. Eight independent evaluators with special expertise in the management of meningitis compared MYCIN's choice of antimicrobials with the choices of nine human prescribers for ten test cases of meningitis. MYCIN received an acceptability rating of 65% by the evaluators; the corresponding ratings for acceptability of the regimen prescribed by the five faculty specialists ranged from 42.5% to 62.5%. The system never failed to cover a treatable pathogen while demonstrating efficiency in minimizing the number of antimicrobials prescribed. The study design may be useful in assessing the performance of other computer-based clinical decision-making systems.


Reye's syndrome in nonpediatric age groups. Reye's syndrome (encephalopathy and fatty liver) is generally considered a disease of children. Four patients, aged 16, 18, 19, and 23 years, with Reye's syndrome were initially seen by internists. A viral prodrome followed by vomiting and encephalopathy without focal neurological signs or jaundice clinically suggested Reye's syndrome. Normal findings of CSF examination (except for increased opening pressure), abnormal findings of liver function tests, and increased blood ammonia further supported the diagnosis. None was hypoglycemic. Reye's syndrome was related to influenza B virus in three patients and to Varicella in another. Three patients survived. Reye's syndrome may be seen intially by general practitioners, emergency room physicians, internists, or psychiatrists. The importance of considering this syndrome in the differential diagnosis of unexplained encephalopathy in adults is stressed.


Energy levels and patient weight in ventricular defibrillation. In a prospective survey employing conventional devices that stored 400 joules or less, direct-current shocks that delivered 194 +/- 11 joules (1.8 joules/kg) to the chest wall terminated 45 of 46 episodes of ventricular fibrillation in 11 of 12 patients weighing 91 to 225 kg. Patients with coronary disease defibrillated more easily than patients without coronary disease. Weight did not determine outcome. The 98% defibrillation efficiency occurred at only half the energy predicted for 50% efficiency from retrospective data. Human defibrillation not only occurred at one third the untested level recommended by proponents of high-energy defibrillation, but also at one fourth the energy, defibrillating 69% of comparably heavy animals. Thus, the costly defibrillators delivering 400 to 800 joules now sold by 11 of 14 American manufacturers are superfluous, untested, potentially lethal devices with which to attempt ventricular defibrillation.


An evaluation of iridology.

An evaluation of iridology. Iridology is an analysis of health based on examination of the iris of the eye. One hundred forty-three patients had photographs taken of both eyes. Nine-five patients were free of kidney disease, defined as a creatinine level of less than 1.2 mg/dL (mean, 0.8 mg/dL), and 48 had kidney disease severe enough to raise the plasma creatinine level to 1.5 mg/dL or greater (mean, 6.5 mg/dL). Three ophthalmologists and three iridologists viewed the slides in a randomized sequence without knowledge of the number of patients in the two categories or any information about patient history. Iridology had no clinical or statistically significant ability to detect the presence of kidney disease. Iridology was neither selective nor specific, and the likelihood of correct detection was statistically no better than chance.


Expanding psychiatric service in a hospital emergency room. Senior medical residents were used to extend psychiatric coverage in a busy hospital emergency room. Their service was supported by the backup consultation of senior psychiatric physicians. The medical residents worked in conjunction with psychiatric residents to provide 24-hour daily emergency psychiatric service to more than 350 patients during a 12-month period. There were no significant differences in the demographic composition of the patient population seen or in the disposition of individual patients made between the medical and psychiatric residents. The hospital was able to expand its psychiatric service in the emergency room without major increases in cost. The medical residents benefited by experiencing a more diversified patient care training program, and they earned a modest supplement to their houser officer salary.


Appendectomies during physicians' boycott. Analysis of surgical care. The 1975 San Francisco physicians' boycott caused major changes in patterns of providing surgical care, but there was no appreciable change in the number of appendectomies performed during the boycott month when compared with a six-month baseline period. The ratio of normal to inflamed appendices removed was no different during the boycott than it was during the control period, and no differences were noted in the percentage of cases perforating in the boycott month when compared with the control period. In addition, patients seeking care for appendicitis during the boycott month did not experience delays. The lack of change in the standard direct and indirect indicators used to monitor quality of care suggests no major lapses in appendicitis care occurred in San Francisco during the boycott.


Aspergillosis and other systemic mycoses. The growing problem. To measure the incidence in the United States of systemic mycoses necessitating hospitalization, we reviewed discharge records of 1,875 hospitals participating in the Professional Activity Study of the Commission on Professional and Hospital Activities. Projected incidence rates in 1976 ranged from 23.0 per million for histoplasmosis to 0.2 per million for blastomycosis. High prevalences of leukemia or lymphoma (5.9% to 10.2%) or of other malignancies (9.9% to 13.2%) were recorded in patients with aspergillosis, candidasis, or cryptococcosis. High prevalences of chronic obstructive lung disease (9.6% to 9.9%) were recorded in those with aspergillosis or histoplasmosis. Marked increases from 1970 to 1976 were found in the incidence of aspergillosis (158%), actinomycosis (92%), cryptococcosis (78%), and coccidioidomycosis (74%). Increasing numbers of persons with immunosuppressive conditions, migration of susceptible persons into hyperendemic areas, and aging of the population contributed to the increases.


Postoperative ulnar neuropathy.

Postoperative ulnar neuropathy. Although compressive ulnar neuropathy developing during surgical procedures under general anesthesia has been recognized, clinical and electrophysiological features of this neuropathy have been incompletely described. During the past two years, we have seen eight patients with this complication, mainly following intra-abdominal or intrathoracic operations. Neuropathy was associated with a persistent severe deficit during a mean follow-up of 23.5 months (range, six to 96 months) after operation. Electrophysiological studies verified substantial Wallerian degeneration in the majority of patients. Clinical and electrophysiological data, as well as intraoperative findings in some patients, suggest that compression occurred at the cubital tunnel. These patients with ulnar neuropathy had a particularly poor prognosis, whether treated surgically (decompression or transposition) or medically. Prevention of ulnar nerve compression during major operations therefore assumes paramount importance.


The need for epidemiologists.

The need for epidemiologists. The increasing need for epidemiologists in biomedical research has been studied by polling organizations with present and potential needs for epidemiologic services. The research institutes of the National Institutes of the National Institutes of Health and the schools of medicine reported the greatest estimated need among the respondents. They and others polled indicated a substantial need for master's and doctoral level epidemiologists that cannot be fulfilled by current training programs in epidemiology. Broad, sound methodological training applicable to all health problems, and increased funding for support of epidemiologic trainees and training programs in institutions, which would make epidemiology training competitive with that in other fields, are strongly recommened.


Primary lymphomas of the thyroid gland.

Primary lymphomas of the thyroid gland. Twelve patients with primary lymphoma of the thyroid gland were reviewed. Based on clinical observations of this group of patients and a review of the literature, a composite clinical picture can be drawn of the patient at high risk of having primary lymphoma of the thyroid gland. This condition should be considered in the differential diagnosis in patients with a history of lymphocytic thyroiditis and an enlarging neck mass, tender or nontender. The mass may be cold or cool with areas of patchy uptake shown on scintillation scanning. The patient has a greater than 50% chance of having hoarseness with or without vocal cord paralysis. We also review the pathogenesis and prognosis of primary lymphoma of the thyroid gland.


Bone metastases and bone pain in breast cancer. Are they closely associated? One hundred ninety patients with breast cancer were prospectively evaluated for bone pain and had technetium Tc 99m-methylene diphosphonate bone scintigraphy for bone metastases. Of the 66 patients showing evidence for bone metastases, 21 (32%) did not have bone pain. There were 155 sites of skeletal metastases, but pain was found only in 50 sites. The age of the patient or involvement of weight-bearing bones did not seem to affect the association between bone metastases and pain. We discuss the need for periodic bone scintigraphy, even when the clinical state does not seem to warrant it.


Hemagglutination-inhibiting antibodies in vaccinated children with renal disease. One year after immunization with a single 0.5-mL dose of influenza virus vaccine, serum samples from 30 children with renal diseases were tested for serum hemagglutination-inhibiting (HI) antibody titers to A/New Jersey/76, A/Victoria/75, and A/USSR/77. Eleven  unvaccinated children with renal diseases formed a comparison group. In contrast to the comparison group (0/11), 53% (16/30) of the vaccinated group had a protective level of serum HI titers (greater than or equal 1:40) against A/New Jersey. A protective level of serum HI titer against A/Victoria was noted in 83% (25/30) of the vaccinated group, while 54% (6/11) of the unvaccinated group had similar HI titers. None had a detectable HI titer against A/USSR. A minor common cold-like illness occurred in seven of the 30 vaccinated children; one of these had exacerbation of nephrotic syndrome. The data suggest a good protection against influenza one year after vaccination in children with renal disease.


Nonfluorescent tinea capitis in Charleston, SC. A diagnostic problem. Statistics gathered at the Medical University of South Carolina from 1973 to 1978 indicate a dramatic change in the etiologic agents of tinea capitis in Charleston since the 1950s. The preponderant agent is now Trichophyton tonsurans, which produces lesions that are not fluorescent in a Wood's lamp examination (long-wave ultraviolet). Trichophyton tonsurans caused 90.6% of 265 culture-proved cases of tinea capitis in the 1970s, but in the 1950s it was responsible for only 1.6% of 378 cases. The study emphasizes that cultures are necessary because the increase in nonfluorescent tinea capitis throughout the United States presents unsuspected diagnostic problems to physicians who are not aware of the change in etiologic agents.


Cytotoxic-induced ovarian failure in women with Hodgkin's disease. I. Hormone function. Forty-one women with advanced Hodgkin's disease were studied to determine the effect of combination chemotherapy on fertility and ovarian function. Histories and pretreatment ovarian biopsy specimens indicated normal fertility before therapy, thus implying no adverse effect of Hodgkin's diseases on female gonadal function. Ovarian activity was assessed after therapy by menstrual history, serial basal body temperatures, and hormonal levels. Each case was assigned to one of three categories: primary ovarian failure (failed ovary), irregular ovarian activity (failing ovary), and normal cyclic ovarian activity (functioning ovary). After therapy, 20 of 41 patients (49%) were categorized as failed, 14 (34%) as failing, and only 7 (17%) as functioning. In 16 months of further observation, progressive loss of ovarian function occurred that was clearly age related but not statistically dose related. Induction of premature, irreversible menopause presents a need for effective hormonal replacement and patient counseling.


Cytotoxic-induced ovarian failure in Hodgkin's disease. II. Effects on sexual function. Chemotheraphy for Hodgkin's disease produces ovarian failure in young women. The consequences of this are emotional distress, sexual dysfunction, and the disruption of families and friendships. These previously unappreciated side effects of cytotoxic therapy had developed in 25 of 41 patients, among whom we conducted a retrospective study.


Sulindac in ankylosing spondylitis. Double-blind evaluation of sulindac and indomethacin. Ankylosing spondylitis affects about 1% of the population. In the past, evaluation of therapy in the management of this disease has been hampered by the lack of availability of objective criteria for following the condition. By using recently developed measurements of spinal mobility and other variables we have compared sulindac, a recently introduced nonsteroidal antiinflammatory drug, and indomethacin in a double-blind six-month parallel study of 30 patients. Sulindac and indomethacin have comparable efficacy and tolerance. Advantages of sulindac include a twice-a-day dose regimen.


Are microcomputers appropriate for your practice? The overly simplistic view of the process of automation widely presented to physicians needs to be counterbalanced. Computers are becoming cheaper, easier to program, and simpler to operate. However, the physician must be aware of the gap between personal computing and serious use of computers in his practice. To bridge this gap, the physician must analyze his needs to identify appropriate applications to automate, plan the implementation of these applications, and choose the necessary hardware and software resources. To do so it may be valuable for him to seek the help of an expert. Although the physician can certainly perform the necessary tasks, he should be aware that to perform them efficiently there are a number of aspects he should seriously consider.


Esophageal motor dysfunction in systemic lupus erythematosus. Two cases with unusual features. Two patients with systemic lupus erythematosus had intermittent episodes of dysphagia associated with severe nonpleuritic chest pain. Esophageal manometry disclosed abnormalities characteristic of diffuse esophageal spasm. The findings suggest that diffuse spasm should be considered in the differential diagnosis of unexplained chest pain and dysphagia in patients with lupus.


Cytotoxic chemotherapy and gonadal function in patients with Hodgkin's disease. Facts and thoughts. Castration commonly appears to be the price of "cure" in patients treated with chemotheraphy for Hodgkin's disease. Awareness and anticipation by the physician, with appropriate counseling of the patient on the profound psychological and emotional changes occasioned by chemotherapeutic treatment, may provide benefit both in terms of acceptance of therapy and in adjustment of changes in interpersonal relationships. From this point, attention should be directed to (1) replacement of evident hormonal deficiency, (2) artificial preservation of viable germ cells, and (3) means of avoidance of germ cell damage by chemotherapy.


Prophylaxis of recurrent urinary tract infection in female patients. Efficacy of low-dose, thrice-weekly therapy with trimethoprim-sulfamethoxazole. Thirty-two women with recurrent urinary tract infections were treated after eradication of existing infections with a mixture of 40 mg of trimethoprim and 200 mg of sulfamethoxazole thrice weekly at bedtime for six months. Six preadolescents received one half this dose. During 21.3 cumulative patient-years of prophylaxis, one infection due to Streptococcus faecalis and one due to a sulfamthoxazole-and trimethoprim-sensitive Escherichia coli occurred--an infection incidence of 0.1 per patient-year. During prophylaxis, 61 of 72 periurethral cultures and 24 of 51 anal canal cultures failed to yield Enterobacteriaceae. One patient had transient colonization with a trimethoprim-resistant E coli during prophylaxis. Twenty-one patients had recurrent infection within six months of discontinuation of prophylaxis, with a mean time to recurrence of 2.6 months. One infection recurred 26 weeks following prophylaxis with a Proteus mirabilis. Thrice-weekly trimethoprim-sulfamethoxazole therapy was effective for prophylaxis of recurrent urinary tract infections and did not predispose to colonization or infection with trimethoprim-resistant Enterobacteriaceae.


Yersinia enterocolitica enteritis in children. Five patients were admitted to Children's Hospital National Medical Center with manifestations of Yersinia enterocolitica infections. Four of five had primarily enteric illness, while the fifth had associated ocular and joint involvements. In three of five cases, the disease was self-limiting. Two of the patients (No. 1 and 2) may have had their disease improved by antibiotic therapy. Increased alertness to the potential of Y enterocolitica to cause a variety of syndromes is necessary to make an accurate bacteriologic diagnosis and to expedite medical treatment.


Antibiotic usage in a pediatric medical center. Antibiotic usage in a large pediatric teaching hospital was evaluated during a three-month period. A total of 1,067 patients received antibiotics and 295 patient records were reviewed. One hundred sixty-nine courses of antibiotics were administered to surgical patients, 77% for surgical prophylaxis. One hundred forty-seven antibiotic courses administered to medical patients were therapeutic in 61.2% and in 35.3% were given because of suspicion of infection. Ampicillin was the most commonly used antibiotic; cephalosporins were used for surgical prophylaxis. Aminoglycosides were used commonly for suspected infection in medical patients. Antibiotic management was inappropriate in 66% of surgical patients and in 21% of medical patients. Not obtaining appropriate studies prior to and during therapy were common infractions on all services. Surgical prophylaxis was freqently inappropriate by reason of no indication, wrong drug or dose, or inappropriate timing.


Brain death--an opposing viewpoint.

Brain death--an opposing viewpoint. Recent and proposed legislation to establish "brain-related" criteria of death has uniformly confounded irreversible cessation of total brain function with the death of the human person. Much of the confusion comes from widespread misunderstanding of how the word "death" is used and what it means. Cessation of total brain function, whether irreversible or not, is not necessarily linked to total destruction of the brain or to the death of the person. Further, to take vital organs or to otherwise treat people as though they were dead already on the basis of these recent criteria is morally unacceptable to most Orthodox Jews and Christians.


An algorithm for the operational assessment of adverse drug reactions. III. Results of tests among clinicians. To determine how practicing clinicians use a recently developed algorithm for the diagnostic assessment of suspected adverse drug reactions (ADRs), eight clinicians--four board-certified, practicing physicians and four interns--rated the likelihood of 30 suspected ADRs. Each physician reviewed the case summaries, first using implicit clinical judgment and two months later by means of the ADR algorithm. The algorithm significantly improved the reproducibility of the senior clinicians' assessments as compared with their implicit assessments; however, the improvement in the interns' assessments with the algorithm was not significant. The validity of the physicians' assessments, which was measured by comparing their ratings with a consensus rating of the three algorithm developers, was also significantly improved by the use of the algorithm. When used by practicing clinicians, the algorithm improves the reproducibility and validity of their assessments of ADRs and should provide a more precise diagnostic approach to these complex clinical phenomena.


Evaluation of carcinoma of the uterine cervix before radiotherapy. In 1974 the Patterns of Care Study began a prospective nationwide survey of radiotherapeutic cancer care in the United States. Cancer of the uterine cervix was one of the diseases surveyed. Pretreatment evaluation data were collected from 170 randomly chosen radiation therapy facilities. The frequency of use of tests in workup varied substantially according, for example, to the severity of disease and the availability of tests. For carcinoma of the uterine cervix, we found that the following tests were used routinely: physical examination, including taking a history; complete blood cell count; serum chemistry analysis; chest roentgenogram; and intravenous pyelogram. Frequent but not routine tests included dilation and curettage and evaluation of the involvement of the bladder and rectum. Other test were used infrequently.


Rickettsialpox. Case report and epidemiologic review. In recent years, rickettsialpox was infrequently reported: one case per year was recorded by the Public Health Service during the past 15 years. We observed a case of rickettsialpox in New York City and reviewed the clinical, diagnostic, and epidemiologic features. Records of the New York City Health Department showed that serum samples from only six patients were submitted for serological testing for rickettsialpox during the past ten years, suggesting that although the disease is uncommon now, clinicians may be failing to recognize and diagnose rickettsialpox, as it may occur more frequently than is presently recognized.


Lymphocyte transformation in patients with breast cancer and the effect of surgery. Lymphocyte response to phytohemagglutinin (PHA) in vitro was subnormal in forty of fifty-one patients with breast cancer. After apparently successful surgery, lymphocyte response improved significantly in most of those in whom it had been previously impaired. It remained markedly subnormal in only five patients, two of whome subsequently died of metastases. This finding indicates that depressed cell mediated immunity in patients with breast cancer is the result of the malignant disease. Failure of the PHA response to revert to normal postoperatively may indicate a poor prognosis.


Longitudinal study on Schistosoma japonicum infections in the Philippines. Incidence and prevalence among school children in Dagami Area, Leyte. The annual incidence of Schistosoma japonicum infection was calculated from the record of the yearly examination among school children of Dagami Area, Leyte, Philippines. Data were processed mainly by the computer. Children were examined for eggs by the merthiolate formalin concentration technique and by the circumoval precipitin test (COPT) once a year in 3 consecutive school years (SY), SY 1974/75, 1975/76 and 1976/77. About 600 to 700 children were examined yearly and the ratios of cases rechecked after 1 year were about 30%. A method to calculate the overall incidence in children who were examined at different intervals, was newly established. The incidence appeared to rise rapidly in the survey period, being 25.59% and 41.30% by fecal examination and 10.74% and 21.27% by COPT in SY 1975/76 and 1976/77, respectively. From the combined results of fecal examination and COPT, the reliable values of incidence, however, were shown to be stable during 2 years such as 22.06% and 24.21%, respectively. The incidence estimated by the age prevalence data was 20.25% in SY 1976/77 by the combined results and was found to be lower than the directly calculated value.


Urinary 3-methoxy-4-hydroxyphenylglycol (MHPG) excretion in depression. Twelve acute depressed patients were studied in the course of antidepressant treatment. Three-day-24-hour urine samples for 3-methoxy-4-hydroxy-phenylglycol (MHPG) were collected both before and after a five week treatment schedule. MHPG were estimated by spectrophotometry. Initial MHPG excretion did not reflect the severity of pretreatment depression and final MHPG showed no specific correlation with post-treatment improvement. No specific or uniform influence of different anti-depressant treatments or changes in MHPG was evident. Depressed patients with bipolar affective disorder tend to have initially lower MHPG levels than patients with unipolar depression. Urinary MHPG excretion measurements may prove not to be a useful index in the diagnosis and choice of treatment in patients suffering from primary depression.


Effects of 24-hour unilateral ureteral obstruction on glomerular hemodynamics in rat kidney. Glomerular hemodynamics were studied, by micropuncture, in Munich-Wistar rats submitted to 24-hour unilateral ureteral ligation (UUL). Glomerular capillary pressure (PG), intratubular pressure (PT) and pressure in the first-order peritubular capillaries (EAP) were measured with a servonulling device. Single nephron filtration fraction (SNIFF) was calculated fmom arterial and peritubular blood protein concentration. SNGFR was both measured by conventional micropuncture techniques and calculated from efferent arteriole blood flow (EABF) and SNFF. Afferent arteriole blood flow (AABF) and resistance of afferent (Ra) and efferent (Re) arterioles were calculated. Measurements were repeated 1 to 2 hours after the release of the ureter. Sham-operated rats were used as control. UUL caused a marked increase in Ra (from 4.9 +/- [SD] 2.4 to 12.7 +/- 5.1 dynes/sec/cm-5). The fall in SNGFR (from 111.9 +/- [SD] 23.9 to 34.4 +/- 23.1 nl/min/kg body wt) was secondary to a decrease in both PG and AABF. A further increase in Ra (16.0 +/- 6.7 dynes.sec.cm-5) occurred after releasing the ureter. SNGFR, however, was unaltered (33.7 +/- 16.6 nl/min/kg body wt) since PG decreased parallel to PT, but AABF did not significantly change. Conclusion. Ureteral obstruction determines, in 24 hours, a marked cortical ischemia that is not promptly reversed by ureteral release.


Medullary collecting duct function in the remnant kidney before and after volume expansion. The role of the medullary collecting ducts (CD) in the regulation of water and electrolyte excretion by the remnant kidney has not been determined. Medullary CD function was therefore studied by the microcatheterization technique during hydropenia and after volume expansion with an isotonic saline load in rats with sham-operated normal kidney (stage I), remnant kidney (stage II), remnant kidney after contralateral nephrectomy (stage III), and sham-operated normal kidney after contralateral nephrectomy (stage-III control). Sodium, potassium, water, and solute reabsorption along the medullary CD were not altered in stage II during hydropenia when compared to normal control (stage I), but water reabsorption proximal to the medullary CD was decreased. In stage III, where the uremia was mild (BUN, 41 mg/dl), the fractions of the filtered load of sodium (72%) and water (62%) which were reabsorbed along the medullary CD were reduced in comparison to stage II (94% and 83%, respectively), stage I, or stage-III control. The fraction of filtered potassium entering the medullary CD was increased to 53% in stage III, compared to 16% in stage II, and 10 or 11% in stage I or stage-III control. No change in the fraction of filtered potassium remaining along the collecting ducts was observed. After volume expansion, there was no significant change in the fraction of filtered sodium and water remaining along the medullary CD in stage I, II, or III. The greater fractional excretion in stage III resulted from decreased reabsorption in more proximal nephron segments. The results indicate that (a) during hydropenia, fractional reabsorption of sodium and water is decreased along the medullary CD of the stage-III remnant kidney in the presence of mild uremia, (b) the increased fractional excretion of potassium in the remnant kidney with uremia is not determined by altered potassium handling in the medullary CD but occurs proximal to this nephron segment, and (c) extracellular fluid volume expansion with isotonic saline results in similar inhibition of fractional sodium and water reabsorption in the collecting ducts of both remnant and normal kidneys.


Glomerular filtration dynamics in the dog during elevated plasma colloid osmotic pressure. To determine if the glomerular filtration coefficient (Kf) of the dog is influenced by changes in plasma colloid osmotic pressure (COP), we conducted micropuncture experiments in dogs given concentrated albumin solutions. In one group (N = 9), filtration dynamics were evaluated following infusion of 450 to 600 ml of a 25% bovine albumin solution. To minimize the effects of acute volume expansion, we also achieved high COP levels in another group (N = 7) by albumin loading on the day prior to the experiment. In all experiments, renal arterial pressure was reduced to approximately 90 mm Hg to minimize potential errors that might lead to overestimation of single nephron filtration rate (SNGFR) and glomerular pressure (GP). In the acutely expanded dogs, COP increased to 23.0 +/- (SEM) 0.9 mm Hg, SNGFR was 59 +/- 6 nl/min, estimated GP was 61.0 +/- 2.0 mm Hg, proximal tubule pressure (PTP) was 23.0 +/- 1.6 mm Hg, and superficial filtration fraction (SFF) was 0.13 +/- 0.02. A similarly reduced whole kidney filtration fraction was also observed, due almost entirely to a marked increase in renal blood flow. When compared to noninfused control dogs (N = 13), Kf was significantly higher in the dogs with elevated COP, being 5.3 +/- 0.6 nl/min/mm Hg as compared to 3.4 +/- 0.3 nl/min/mm Hg. Average effective filtration pressure (EFP) was 12 +/- 1mm Hg, and EFP at the efferent end of the glomerular capillaries was 8.9 +/- 1.2 mm Hg. In the group infused on the prior day, COP was 20.0 +/- 0.8 mm Hg, SFF was 0.26 +/- 0.01, SNGFR was 70 +/-8 nl/min, GP was 59 +/- 2 mm Hg, and PTP was 19.0 +/- 1.5 mm Hg. Average EFP was 15 +/- 1 mm Hg, and EFP at the efferent end of the capillaries was 7.5 +/- 0.7 mm Hg. kf was 4.85 +/- 0.66 nl/min/mm Hg, a value significantly higher than that obtained in control dogs having a COP of 15.0 +/- 0.6 mm Hg. Furthermore, one group of control dogs (N = 4), expanded with an isooncotic albumin solution, did not exhibit significant changes in Kf even though the degree of plasma volume expansion was similar to the group expanded with concentrated albumin solution. These experiments are consistent with previous findings obtained in the rat that Kf is influenced by the COP, although the changes in Kf appear to be less than they are in the rat. The data indicate that even under these conditions of elevated COP, the filtration process in the dog is characterized by positive filtration pressures throughout the length of the glomerular capillaries.


Effects of metabolic acidosis and alkalosis on sodium and calcium transport in the dog kidney. Clearance and micropuncture studies have been performed in dogs to examine the effects of acute and chronic metabolic acidosis and acute alkalosis on tubular sodium and calcium transport. Acute metabolic acidosis, induced by the infusion of hydrochloric acid, decreased proximal fluid reabsorption and increased the fractional delivery of sodium and calcium to the distal tubule, but not to the final urine. In comparison with normal dogs, dogs with chronic metabolic acidosis (induced by feeding ammonium chloride) showed an increase in proximal fluid reabsorption and a dissociation of calcium from sodium reabsorption more distally, leading to an increased delivery of calcium relative to sodium at the distal tubule and in the final urine. The infusion of sodium bicarbonate to correct chronic metabolic acidosis, both in intact and thyroparathyroidectomized (TPTX) dogs, reduced proximal fluid reabsorption and caused a selective enhancement of calcium reabsorption relative to sodium in the more distal nephron, resulting in a reversal of the dissociation observed in acidosis, both at the distal tubule and in the final urine. By contrastin fusion of sodium chloride in parathyroid-intact acidotic dogs did not reduce proximal fluid reabsorption or enhance tubular calcium reabsorption. In nonacidotic dogs, both intact and TPTX, infusion of sodium bicarconate to induce acute alkalosis resulted in selhese data demonstrate the presence of a component of tubular calcium reabsorption situated beyond the proximal tubule, which is inhibited by chronic (but not acute) metabolic acidosis and enhanced by metabolic alkalosis (or bicarbonate infusion) independently of parathyroid hormone.


Effect of various protein diets on growth, renal function, and survival of uremic rats. The effects on growth, renal function, and survival of three isocaloric diets of various protein content (14, 27, and 37 g/100 g in diets I, II, and III, respectively) were compared in uremic rats and in controls. Diet I provided the minimal requirements in all amino acids for gorwing rats. In controls fed ad lib, weight and length gain were better with high protein diets, whereas they were inversely related to the diet protein content in uremic rats. The higher the protein intake, the higher the progressive elevation of BUN and serum creatinine and the mortality rate. Because proteins were supplied by fish flour, their increase was associated with increased mineral content, and the conclusions are restricted to the use of natural proteins: a moderately restricted protein diet securing only the minimal requirements had a beneficial effect on growth and survival of rats with reduced kidney mass. Avoiding any excess in proteins from the early stage of renal disease is suggested.


Amino acid-mediated stimulation of renal phospholipid biosynthesis after acute tubular necrosis. The mechanism by which amino acid infusion stimulates membrane physpholipid biosynthesis during renal regeneration after mercuric-chloride-induced acute tubular necrosis was studied in the rat. Amino acids can act directly on regenerating renal tissue to enhance net phospholipid synthesis because preincubation of cortical slices with amino acids induced an increase in [14C]-choline incorporation into phospholipid without altering the rate of breakdown. This amino acid stimulation of phospholipid biosynthesis was studied further by measuring [14C]-choline accumulation and its sequential conversion to phosphorylcholine, cytidine diphosphocholine (CDP-choline), and phosphatidylcholine via the Kennedy pathway in regenerating renal tissue. [14C]-Choline accumulation was increased after amino acid infusion, compared to glucose infusion. There were also increments in the Vmax of the choline kinase reaction, which converts entering [14C]-choline into [14C]-phosphorylcholine, and of the cholinephosphotransferase reaction in which [14C]-CDP-choline is incorporated into [14C]-phosphatidylcholine, whereas the apparent Km of each reaction was unchanged. Thus, amino acids infused after tubular necrosis can act directly on regenerating renal cells to increase precursor availability and augment two reactions of the phospholipid biosynthetic pathway.


Prognostic importance of vascular lesions in acute renal failure with microangiopathic hemolytic anemia (hemolytic-uremic syndrome): clinicopathologic study in 20 adults. Renal biopsies obtained from 20 adult patients within 30 days after onset of acute renal failure with microangiopathic hemolytic anemia ("the hemolytic-uremic syndrome") were studied. Lesions were graded independently by two observers without knowledge of the clinical history. All patients who did not have refractory hypertension were treated with heparin. Ten of the patients died, and four developed end-stage renal failure requiring chronic dialysis. Six patients, however, had a relatively good outcome: two recovered completely and four developed mild-to-moderate chronic renal failure not requiring dialysis. The six patients with a good outcome had significantly less severe arterial intimal thickening on biopsy compared with the remaining patients with a poor outcome. The patients with a good outcome and those with a poor outcome did not differ in the severity of glomerular lesions. The clinical features did not allow a prediction of late outcome. These results suggest that early renal biopsies may be helpful in predicting prognosis in the "hemolytic-uremic syndrome." This clinical syndrome may occur either in apparently healthy people, or may complicate the course of a chronic essential hypertension.


[The crescent sign in childhood urography]. The crescent sign is a rare roentgenological symptom in excretory urography of infantile hydronephrosis. The orign is a presence of contrast material in the collecting renal tubule of the atrophic renal parenchyma. That is displaced at the renal circumference. The disappearance of the crescent sign represents the prognostic for the reparative potence of the renal parenchyma after the therapy of the obstructive uropathy in two own case.


[Behavior of serum concentrations of immunoglobulins G, M and A in the 1st week of illness in children with bacterial and viral diseases]. The serum concentrations of the immune globulins in children with acute infection of the upper respiratory tract, angina lacunaris, mumps and acute infection of the urinary tract within the first week of illness were analysed. In the adequate age group the values (altogether 540) of healthy and diseased children were confronted and statistically compared. Here the following characteristic changes were shown: the acute infection of the upper respiratory tract was characterized by an increase of IgG. In mumps a decrease of IgA was stated. As to the infections of the urinary tract in the younger age group an increase of IgM existed, in the older age group a decrease of IgA. The results refer to the dynamics of the immune globulins in the initial phase of the individual diseases.


[Social environment of the puerpera and her attitude towards the child]. The mother's attitude towards the newborn child is influenced considerably as well by the number of children, the respective mother is responsible for, as by other factors of her social environment, by the partners attitude towards mother and child, by the efforts in respect of a conscious planning of the human reproduction. Small birth orders, favourable conditions regarding family and social environment, but nevertheless conscious family planning are in high correlation with a positive attitude of the young mother towards the newborn child.


[Retinal detachment caused by boxing].

[Retinal detachment caused by boxing]. Five cases (six eyes) of retinal detachment due to fisticuffs are recorded; at least four eyes went blind. Similar observations have been reported by other authors. In boxing, traumatic lesions of the head are inevitable since punches upon the head are crucial in this sport. Because of the risk of severe injuries including blindness and even death, at least brutal boxing must be rejected.


[Length of hospital stay and immobilization of patients with retinal detachment]. Referring to the modern operation techniques (buckling procedures) a reduction of bed rest for patients with retinal detachment is recommended.


[Refractive changes following episcleral implants and cerclage]. Following the operation about 75% of the treated eyes developed myopisation between 0,5 and 4,0 dptrs. During the first postoperative year this myopia initially decreased but beyond the sixth month after surgery no further changes could be observed.


[The usefulness of echography in retinal surgery (author's transl)]. Upon utilization of echography one certainly will not be able to detect retinal defects; however, other parameters of retinal detachment which by means of solely optical examination techniques may remain undiagnosed can be evaluated successfully. This concerns not only the diagnosis of retinal detachment alone but also the measurement of the height of the detachment including its possible variations, the accuracy of this method being up to 0.1 mm. This will also apply to the distinction of serous, haemorrhagic and solid detachment of the choroid, the amount of liquefaction of a subchorioidal haemorrhage as well as the assessment of the relationships between vitreous membranes and retinal detachment: this applies especially to cases with hazy media and decreased visibility of the fundus. Accordingly clinical echography may be successfully applied, prior to retinal surgery, during the operation and during the postoperative follow-up.


[Occurrence of congenital ocular toxoplasmosis in siblings]. The author points out in connection with the description of two families in which evidently several children suffered damage through toxoplasmosis with which the mother had been infected a long time ago (pseudocoloboma of the macula, changes of the macula similar to juvenile degreneration, abortion and malformations such as anophthalmia, rhinoschisis, cheiloschisis, gnathoschisis and palatoschisis), that low titer levels in the Sabin-Feldmann test and in the complement fixation test are by no means totally insignificant for subsequent pregnancies, as is commonly assumed. In any case, women who have already given birth to children with congenital toxoplasmosis should be subjected to toxoplasmosis treatment, as far as possible, before any new pregnancy.


[Discrete inflammatory manifestations of the posterior eye segment (author's transl)]. White eyes with cellular infiltration of the vitreous body are common with inflammations of the posterior eye segment. In mild course of the disease the local signs in the regions of inflammation are discrete; under these circumstances recurrences and remissions of the inflammation may be difficult to be differentiated. Several types of such an inflammation are described.


[Disturbing physiologic diplopia (author's transl)]. Spontaneously observed physiologic diplopia seems to be a pathologic condition caused by a disturbance of high cerebral functions, especially of attention. In a personally observed case an organic psychosyndrome was present. The aetiology and an effective therapy are still unknown. Further studies of similar cases may promote explanation.


[Comparative refractioning in juvenile strabismus patients. Experience with the Auto-Refractor 6600 (author's transl)]. 122 strabismus patients have been refracted in order to compare the cycloplegic effect of Cyclopentolat-HCl (Zyklolat) and atropin. In young patients the cycloplegic effect of Zyklolat is not as sufficient as that of atropin is. Moreover the positions of cylindrical axes show differences up to 30 degrees under Zyklolat in comparison with atropin. On the other hand we give a report of our experience using the Auto-Refractor 6600, the before-mentioned measurings were performed with. -- The important field of the Auto-Refractor is the routine refractioning of co-operative patients. Using it on young children which are unco-operative the Auto-Refractor is not as sufficient as we hoped it to be.


[An unusual case of Marcus Gunn phenomenon]. The author gives a short review on the course of the disease and the typical symptoms of regular Marcus Gunn phenomenon i.e. the retraction of an usually ptotic lid when the patient opens his mouth or moves his jaw to the healthy side of his face. He then reports on a boy now aged 3 and a half that had suffered from Marcus Gunn phenomenon since his birth, although the disease almost disappeared in the first years of his life. Only a short time before the parents noticed again the phenomenon, occurring now in a modified version; the retraction of the lid appears mainly then when the child pulls himself up from a lying position or raises the arm of this side where the ptosis is located.


[Blindness following orbital haemorrhage after head injuries (author's transl)]. The sever orbital haemorrhage (Cords) can follow a contusion of the orbit. Only an immediate orbital decompression by Killian's incision provides permanent loss of vision. Report of seventeen own cases.


[The significance of vitrectomy after perforating injuries]. This paper presents three cases that show the importance of vitrectomy after perforating injuries of the eye. Whenever a trauma produces a mixing of vitreous and lens material in the anterior chamber, vitrectomy is the method of choice. Chronic posttraumatic uveitis can be prevented through this procedure. The three young patients, who were operated with the Vitrektor, reached a 6/6 vision with contact lenses after 1 1/2, 2 and 3 years respectively of observation. No consent can be given to the opinion recently expressed that the removal of infected vitreous after a cataract extraction nearly by an irrigation of the anterior chamber is considered to be a vitrectomy performed for decades. Priority for vitrectomy should be given to Kasner.


[Evaluation of the degree of disability for the privately insured patient (author's transl)]. There are marked differences between the public health system and the private insurance system. This paper shows how to evaluate the degree of permanent disability according to "The General Rules for Private Insurances (AUVB 1965)". At the beginning the evaluation of the degree of permanent disability after the visus naturalis or the visus corrected and at unilateral and bilateral aphakia will be discussed. The paper gives detailed information on the degree of disability for: one injured eye, one injured eye with preexisting ocular lesion, bilateral injury, one injured eye with preexisting lesion of the other eye, one injured eye with preexisting ocular lesions of both eyes, bilateral injury with preexisting lesions of both eyes. For bilateral lesions, the degree of disability is calculated as a function of the reduction in activity by the AUVB 1965; this is given in one table. The rules applying to Austria are compared to those valid in the Federal Republic of Germany (AUB). It is very important to understand these methods of calculation, if one wants to secure an objective ophthalmological evaluation of the degree of disability for the privately insured patient.


[Malignant melanoma of the choroid in melanosis bulbi (author's transl)]. Report of a case with melanosis bulbi observed in a relatively young patient of 33 years, in which a malignant melanoma of the choroid developed. As reported in earlier examinations the incidence of malignant melanoma in cases of melanosis bulbi is much higher than in normal eyes. The authors recommend strongly routine biomicroscopic examinations in cases of melanosis bulbi every 1--2 years to recognize the development of a melanoma in an early stage.


[Diagnostics of intraocular tumors with the radiophosphorus test (author's transl)]. The author reports about the radio-phosphorus-test as an additional method in diagnostics of intraocular tumors in 62 examinations. The conformity between 49 histologically examined cases and the positive test-results amounted to 90%.


[Epibulbar tumours (author's transl)].

[Epibulbar tumours (author's transl)]. After a classification in benign and malignant tumours and in pigmented and non-pigmented growth, attention is drawn to the fact that most of the tumours lie in the palpebral fissure and are benign. Leukoplakia is a clinical description but not a diagnosis. Both the benign and the malignant growths can be called Leukoplakia. The intra-epithelial epithelioma is often incorrectly diagnosed as Bowen's disease. This disease of the skin and the intraepithelial epithelioma of the limbus are histologically quite different, and therefore the term Bowen's disease is incorrect. Not all the various tumours occur with the same incidence, e. g. the squamous cell carcinoma occurs more often in some countries than in others. The malignant melanomas of the conjunctiva are not so malignant as in the caruncle or cornea. In the conjunctiva secundary melanomas can occur after penetration of an intraocular melanoma through the sclera; similary metastases can occur in the form of epibulbar tumours. In all cases the epibulbar tumour should be excised very carefully and a histological examination is necessary for the diagnosis.


[Electronmicroscopic studies of the trabecular meshwork in corticosteroid glaucoma]. The tissue specimen of a 41-year-old patient with cortisonglaucoma, obtained by trabeculectomy, was examined by electronmicroscope. There are massive depositions of band-like and linear arranged structures in the cribriform area and adjacent lamellae of the trabeculum corneosclerale. The pathways for aqueous humor of this region are almost completely obstructed by this material. That is the reason for an increased outflow resistance. The cells of this area show signs of degeneration and are reduced in their numbers. -- The cortisonglaucoma differs from all the other forms of glaucoma especially from glaucoma simplex by these characteristic deposits.


[Trabeculetomy-iridencleisis with marginal cyclodialysis in the treatment of selected cases of childhood- and juvenile glaucoma]. This surgery method is thought for cases, where previous operations have not been successful or for such, in which severe scaring tissue reactions must be expected. The diaphanoscopy of the anterior chamber angle is considered helpfull for the choice of the surgery way. Between 1975 and february 1978 trabeculectomy combined with radical lobelike iridencleisis and marginal cyclodialyse was performed in 4 cases and the i.o. pressure could be normalised. Complications did not occure.


[Clinical experience in glaucoma surgery utilizing silicon catheters (author's transl)]. In 7 probands exhibiting haemorrhagic glaucoma a combined thermosclerostomy with insertion of a silicons tubing (with or without basal iridectomy) has been performed. The catheter had an inner diameter of 0,5 mm, measuring about 5 mm in length and projecting about 1,5 mm into the anterior chamber. The tubing has been anchored proximally with two nylon sutures (10--0) to the corneal wound edge going through full thickness cornea; the distal end has been anchored with two more nylon sutures to underlying sclera. Tenon's capsules and conjunctiva were closed separately. In all cases the tubing has been well tolerated and did not exhibit any sign of displacement, the intracameral opening remained patent. During an observation period of 3--16 months with or without additional antiglaucomatous medication an intraocular pressure between 14--22 mm Hg could be achieved; all patients remained asymptomatic.


[Fluorescein angiographic studies of the effect of Harms' and Dannheim's trabeculotomia ab externo]. The mechanism of the outflow of the aqueous humor was investigated on 9 eyes with open angle glaucoma operated by traveculotomia ab externo. The anterior chamber was filled with 0,2% Fluorescein-Ringer-solution, before and after the operation. Comparing the fluorescein angiographic pictures it can be concluded that the effect of the operation it caused by an improvement of the outflow of the aequous humor through the system of Schlemm's canal as well as through the formation of a fistula.


[Massage of the bulb and intraocular pressure after goniotrepanation (author's transl)]. Intraocular pressure should be controlled via applanation tonometry, beginning with the fourth day after goniotrepanation, for a period of about three weeks, for early detection of postoperative pressure increases which can occur occasionally, so that they may be treated by digital massage of the bulb. This can be effective even in later post-operative pressure increases and support the effect of additional pressure-lowering treatment.


[Experience in therapy and prophylaxis of epidemic keratoconjunctivitis (author's transl)]. 101 patients with epidemic keratoconjunctivitis were treated with different eye drops: cortisone, antibiotics and P.V.P.-Iodine. The treatment of 19 patients with P.V.P.-Iodine showed that inflammatory symptoms disappeared rapidly; corneal complications however such as superficial keratitis could not be prevented. After the outbreak of epidemic keratoconjunctivitis, severe hygienic measures had been taken at the eye-clinic. On account of the hygienic prophylactic measures further infections could be prevented at the clinic almost completely.


[Ultrastructural changes in keratoconus]. In case of keratoconus the epithelial cells are also participating in the pathological processes. Their activity of producing basal membrane is increased. In the stroma four cell types are found; two of them are normal elements. The origin of the two pathological forms is unknown. They may represent as well vagrant cells. Or they originate perhaps from the endothelial cells, being more or less modified. The original endothelial cells are mostly destroyed. In all sorts of the corneal cells one sees abundantly enlarged mitochondria.


[Utilization of the vitreophage in cataract surgery. Juvenile and traumatic cataract, postcataract membranes]. 15 cases of congenital and juvenile cataract have been operated on utilizing the vitreophage of Klöti. In 3 instances posttraumatic cataracts have been removed, in two cases a cataracta complicata, in 9 cases after-cataractous membranes. Serious complications have not been encountered in any of our cases. One patients with congenital cataract and two probands with cataracta complicata developed postoperatively considerable flare in the anterior chamber and vitreous body, possibly the result of a phacolytic reaction. Excision of thick, inelastic after cataractous membranes proved to be difficult at times. The advantage of lensectomy lies in the possiblity of removal at the same sitting of opaque vitreous structures which had become visible during surgery.


[Diabetic retinopathy: 10 years after light-coagulation (author's transl)]. A retrospective study of 19 patients, who suffered from diabetic retinopathy, were submitted to a xenon-light-coagulation 10 years ago and have been regularly checked, shows better results in the treated eyes than in the untreated fellow-eyes in regard to visual acuity and background morphology. In cases of poorly controlled metabolism, heavy smoking and simultaneous suffering from hypertension and nephropathy the prognosis of the treated eyes is unfavourably affected.


[Fundus changes due to arteriosclerosis and chronic-arterial hypertension (author's transl)]. The authors report on difficulties in ophthalmoscopac differential diagnosis of fundus changes due to arteriosclerosis and hypertension. An attempt is made to present a classification of hypertensive alterations which -- in close association with the scheme published by Keith, Wagner and Neubauer -- uses the same descriptive terms but restricts itself to distinguish between changes of the vascular system on the one hand and changes of the parenchym as a consequence of the vascular changes on the other hand.


[Remarkable cases of temporal arteritis]. Blood-circulatory disorders and their end results at the fundus of the eye must always draw our attention to a possible Arteriitis temporalis Horton, even if there are no general symptoms, when the clinical picture disguises the vascular disease, or even when an important symptom of the disease, such as the accelerated basal sedimentation rate, is missing.


[Electroophthalmologic studies of papillitis, vascular papilledema and obstructed papilla]. The photopic electroretinogram (ERG) and the brightness visually evoked cortical potentials (HEPs) were recorded from patients with oedema of the optic disc caused by papillitis (7 patients), by vascular disease (10 patients) and by intracranial hypertension. For the ERG a Henkes-electrode in reference to an earlobe electrode was used. The H-EPs were recorded bipolar in the midline 5% to 25% and unipolar 15% in reference to an earlobe electrode (inion to nasion = 100%). For evaluation the amplitudes and the peaktimes of the a- and b-wave of the ERG were measured. In the H-EPs the amplitudes and the peaktimes of a negatives peak at approximately 70 ms (NGZ) and a positive peak at approximately 120 ms (PGZ) were obtained from the bipolar recording and a positive peak at approximately 100 ms (PGZ) and a negative peak at approximately 140 ms (NGZ) obtained from the unipolar recording were measured. The photopic ERGs of the affected eye showed normal values, however the H-EPs were distinctly pahtological. With the exception of the negative peaktime (NGZ) of the bipolar leads of the intracranial hypertensive papiloedema, all peaktimes were lengthened and amplitudes decreased. These findings were especially evident in the bipolar tracings of papillitis and unipolar tracings of intracranial hypertension.


[Differential diagnosis of amblyopia and retrobulbar neuritis with electroophthalmologic methods]. The electroretinogram (ERG), the brightness visual evoked cortical potential (H-EP) and the pattern reversal visual evoked cortical potential (M-EP) were recorded from 7 patients with amblyopia and 5 patients with neuritis retrobulbaris. The ERGs and the H-EPs of the amblyopic eyes were normal whereas the amplitude of the M-EP was significant diminished. The parameters of the ERG recorded from the patients with neuritis retrobulbaris showed normal values, however the H-EPs were significantly decreased and the peaktimes were delayed. Also a decrease in the amplitudes of the M-EPs was noticed. This method is a usefull clinical contribution in the differential diagnosis between amblyopia and neuritis retrobulbaris.


[Electroophthalmologic and fluorescein angiographic studies in a case of exudative retinal detachment with spontaneous healing]. Electroophthalmological and fluorescein angiographic studies were performed on a 13 year old girl with exsudative detachment of the retina during a hypertensive crisis. The ERG showed a significant reduction during the course of the detachment. After healing the ERG values had improved as compared to those values recorded during the acute illness, but never reached normal levels. The lesions of the retina and the pigment epithelium caused by the detachment were responsible for pathological EOG. The fluorescein angiography showed circumscript and conglomerate lesions in the pigment epithelium.


[The morphology of the iris (author's transl)]. Scanning electron microscopy provides new information about the ultrastructure of the iris. The anterior surface of the iris, oriented towards the anterior chamber, is covered with a single layer of mesenchymal cells. Openings between the dendrite-like branching extensions of these cells form communicating channels between anterior chamber and stroma. The collagen fibres of the iris stroma are organized as rather tightly packed two-dimensional networks. The meshes of these networks form channels, oriented in an anterior-posterior direction, reaching the vessels of the iris. These vessels are wrapped by a tightly packed fibrous coating, consisting of collagen fibres which embrace the vessels in a helical fashion. It is assumed that the transiridial convection current acts as part of a temperature regulating mechanism.


[The effects of the xenon arc lamp upon the iris of the pigmented rabbit eye (author's transl)]. The ultrastructural alterations of 10 pigmented rabbit irides 15 minutes to 257 days after irradiation with a xenon arc lamp were analysed. Pulse duration was varied while irradiation power was kept constant at 3.24 W. 0.32 J (= 100 ms pulse duration) were delivered to the left eye and 3.2 J (= 1 second pulse duration) to the right side. The area of damage event was considerably smaller at the lower energy level. However depth of the crater was the same at both higher and lower levels. Cells and organelles disintegrate forming lamellar structures and coarse granules. The shape of the pigment granules remains intact. Collagen fibres disintegrate into subunits loosing their periodicity. Mesenchymal cells cover the area of damage few days after irradiation at the low energy level. A thin scar remains at the impact site. High energy irradiation shifts the equilibrium towards degenerative phenomena. Secondary degenerative processes are powerful enough to induce a total decay of the iris substance. The reactivity of the iris irradiated by a xenon arc lamp thus depends from either irradiation duration, power level or from both (energy).


[The effects of a gigant-pulse-laser upon the iris of the pigmented rabbit eye (author's transl)]. The eyes of 10 pigmented rabbits were irradiated by a Q-switched Nd:YAG laser. The pulse energy delivered to the right eye was 187 mJ while the left eye was irradiated with 58 mJ. The pulse duration in both cases was 25 ns. The destructive effects were analysed for two different positions of the focus. In the upper half of the eye the focus was positioned at the anterior iris surface. In the lower half it was adjusted near the pigment epithelium. The eyes were analysed by electron microscopy at intervals of 15 minutes to 128 days after irradiation. The immediate effects were found to depend from the position of the focus but less from pulse energy. At later phases, tissue reaction depends from pulse energy. -- Scarification, at the lower energy level, is almost complete after 32 days. At the higher energy level, degenerative processi are setting in; 3 days after irradiation a progressing iris atrophy is observed which has not yet faded at the 128th day.


[The EMI-scanner CT 5005 for exploring all organs the eye and the orbit (author's transl)]. The EMI-scanner CT 5005 is well suited for exploring all the organs of the body, from top to toe. Its advantages, particularly in ophtalmology, are discussed: quality of imaging not only brain and other soft organs, but bones as well; precise analysis of the base of skull with the matrix 320X320; possibility of primary coronal section. The machine has proven very successful in the study of the orbits, their content and surroundings.


[Computerized tomography of the orbita (author's transl)]. Computerized tomography of the orbita is today the most accurate method to determine the causes of exophthalmus. It can detect and localise precisely congenital, inflammatory and neoplastic disease of the orbita and its surroundings. Specific diagnosis is not always possible; it may be attained, if complementary neuroradiological methods are applied. Higher spatial resolution will probably allow to apply computerized tomography also to other, more discrete orbital diseases.


[Combined use of computerized tomography and echography in ophthalmology (author's transl)]. Computerized tomography does not give as fine an information as echography in the presence of intraocular changes, such as retinal detachments, organized vitreous hemorrhages or the differentiation of a choroidal prominence. Complementary computerized tomography, however, can be helpful in the presence of unclear echographic results in opaque media. Furthermore, an analysis of the value of computerized tomography and echography for the evaluation of orbital lesions is presented based mainly on the results of the preoperative tissue diagnosis in 31 histological proven lesions. The results show that a complementary CT-scan is not necessary in orbital lesions of the anterior third when a clear echographic tissue diagnosis exists. In lesions of the middle third of the orbit, echography and CT complement each other. For lesions situated within the orbital apex or for those which are in connection with adjacent structures, such as the intracranial space or the periorbital region, computerized tomography is superior and of a greater help than standardized A-scan echography aided by contact B-scan.


[Computerized tomography -- results in affections of the chiasm and visual pathway (author's transl)]. 272 cases with visual field defects were examined by CT and analysed. 78 patients showed a chiasmatic lesion, 45 patients a lesion of the optic tract or the lateral geniculate body and 136 patients a lesion of the optic radiation or the occipital cortex. 96% of the CT pictures were topographically corresponding to the known optic field defect. In more then 75% of the operated patients the nature of the CT lesion was confirmed. 10 cases were negative in CT and 3 false positive. Because of the high rate of exact topographic diagnosis CT should be the initial investigation in visual field defects. But the nature of a lesion has to be diagnosed with caution, taking into account the entire clinical picture.


[Axial computerised tomography - answered and unanswered questions on the ophthalmologist (author's transl)]. The results of 67 examinations with computerized axial tomography are presented with reference to the indications. 15 examinations were performed in exophthalmos, 11 in unknown visual field defects, 9 in optic atrophy of unknown origin, 8 each in optic neuritis, papilledema and unclear visual disturbance. 8 furthur examinations were performed in different cases. The axial computerized tomography proved to be an efficient complementary examination technique if it is limited to well defined indications. The best results are obtained examining exophthalmos and visual field defects.


[Computertomography for diagnosis of optic nerve and chiasmal gliomas (author's transl)]. Discussion of the clinical symptomatology of optic nerve and chiasmal gliomas based on personal observations. Evaluation of plain X-ray diagnostic procedures, A-scan ultrasonography and especially computertomography for diagnosis of optic nerve and chiasmal gliomas. Discussion of modern attitude in treatment of these tumors: surgical, irradiation therapy.


[The computerized tomography in findings posttraumatic hematoma (author's transl)]. The authors report two cases of posttraumatic hematoma in the orbit. The first patient presents an unilateral amaurosis through indirect trauma of the optic nerve. The computerized tomography reveals a hematoma of the optic nerve sheath, confirmed by surgery. The second patient presents a posttraumatic limitation of the ocular motility and the computerized tomography reveals a hematoma of two extraocular muscles.


[Computed tomography findings in bilateral blindness (author's transl)]. The use of computed tomography (CT) simplifies neuroradiological investigations. A CT helped to confirm the diagnosis of an occipital vascular leasion in two cases of bilateral blindness.


[The search for the right place and for optimal fixation of an intraocular lens (author's transl)]. Whereas by far not all properties of the crystalline lens can be realized with an artifical intraocular lens, maximal stability of such a device is its most important feature. The latter can be achieved by the adherence of the lens to the capsular membrane, left behind after extra-capsular cataract extraction. In this way the suspension system of the crystalline is used for the fixation of the intra-ocular lens. The stability of the contents of the eye viz. of the vitreous, of the aqueous humour, and of the iris diaphragm, is maintained to a high degree. Stability of the iris diaphragma is achieved when irido-capsulo-lenticular adhesions are allowed to develop, but the iris diaphragm can also be stabilized by support from the optical part of a modified capsular lens in the posterior chamber.


[Results of lens implants in Dr. Binkhorst's patients (author's transl)]. Postoperative results of lens implants after extracapsular cataract extraction in 99 of Dr. Binkhorst's patients in the year 1976/77. Evaluation of functional and morphological results. The visibility of the fundus is seriously compromised in comparison to intracapsular extracted aphakes without implant. Preoperative calculation of the lens to be implanted will reduce post-operative ammetropy to a minimum.


[The implantation of intraocular lenses (author's transl)]. To become an implant surgeon means that one is ready to accept some opposition from part of the profession as well as to known all the shortcomings of conventional cataract extraction. A good knowledge of the history of implantation is necessary to avoid past errors in the shape, manufacture sterilization and in the locus of insertion of the intra-ocular lens. At the start few indications will be retained mainly unilateral cataracts traumatic or not, the aim being restoration of a full binocular vision. The interest of the test of Pulfrich is stressed for the follow up of cataract. A large number of contra-indications will be respected mainly corneal dystrophics or degeneration, uveitis, myopia, detachment and diabetes. The would-be implant surgeon has to train in modern extracapsular cataract extraction, learn the refinements of implantation technique with a full and constant respect of the corneal endothelium. He also should be able to cope with eventual complications and to suture the implant to the iris. He has at first to limit his choice to a small number of implant models which have proved safe: the iris clip and iridocapsular models of C. D. Binkhorst and the slotted-medallion of J. G. F. Worst. Experience will allow in time widening of indications and new improvements of technique.


[A review of 400 intraocular lens implants (author's transl)]. 400 intraocular lenses (iris-clip and iridocapsular pseudophakoi of the Binkhorst type) were implanted at the Lucerne Eye Hospital between 1973 and 1978. The present review emphasizes the paramount position of the ophthalmosurgeon among the complicating factors. The 2-loop metallic iridocapsular lenses were abandonned; secured iris-clip lenses are now after intra- and extra-capsular lens extraction. Aspiration of lens masses or needling of a secundary cataract were necessary in 27% of extracapsular lens extraction. Precipitates on the psuedophakoi were absent after intrakapsular lens extraction, indicating the uveitis being of phacogenic, not pseudophacogenic origin.


[Intraocular lenses - aphorisms of an operating practitioner (author's transl)]. The implantation of an intraocular lens is an almost ideal solution to manage monocular cataracts. We recommend this operation if medically indicated; it is technically more difficult, needs microsurgical skill and general anesthesia and therefore should be limited to a reduced number of highly qualified operation-teams. Uncontrolled enlargement of indications will result in higher complication-rates. As we do not yet know on complications due to alteration of foreign intraocular material after many years, we rather prefer to operate double-sided cataracts in the conventional way, specially in younger patients. Regarding to the global problems of curable (operable) blindness, we think that young eye-surgeons should be trained for conventional cataract operations without using microscope.


[Special indications for lens implantation (author's transl)]. After hesitation in the indication for the implantation of irisclip-lenses, experience shows that indications which have not yet been planned must be seriously considered: for instance cataract in patients with retinitis pigmentosa. The already highly restricted visual field is not additionally reduced by the wearing of the strong convex glasses. Furthermore the author reports about refinements of the implantation technique.


[Special indications, contraindications, particular methods of treatment in correction with intraocular lenses (author's transl)]. For the past 5 3/4 years intraocular lens implantion belongs to the routine operations performed in the Lucerne Eye Clinic. Whereas unilateral cataracts are the main and frequent indication for intraocular lens implants, there are certain cases of uni- and bilateral cataracts also, where the implantation of intraocular lens, due to its advantages, is specially indicated. Such cases are presented briefly in this paper. Good results are achieved through strictly observing the methods of treatment before and after the implantation of the lens.


[Treatment of retinoblastoma (author's transl)]. Retinoblastoma remains a rare disease, but still one which has an uncertain life and functional prognosis. The diagnosis is often made late because the principal signs such as leukokoria and strabismus are unrecognized, thus a conservative treatment is not possible. However, treated at an early stage, a child suffering from retinoblastoma has every chance of a complete cure and even normal vision may be preserved. Irradiation therapy plays an essential role, using localized radiation by radioactive applicators or by external betatron electron-beams. Based on 52 cases, the methods of treatment and the results obtained at the Ophthalmology Department of Lausanne are reported, including one case of spontaneous cure of a bilateral retinoblastoma.


[The treatment of melanoma of the choroid using localized radiation of cobalt 60 applicators (author's transl)]. Sixty one cases of melanoma of the choroid have been treated conservatively in our Department over the last 9 years, using Cobalt 60 applicators. Analysis of these cases has shown that the tumours most susceptible to, and which react favourably to this treatment, are those of less than 11 mm diameter which are not in contact either with the macula or the optic nerve.


[The echography of ocular tumours and their microscopic architecture (author's transl)]. The echography of ocular tumours (7 malignant melanomas and 2 metastatic tumours) is presented in correlation with their microscopic architecture. A metastatic tumour presenting echographic characteristics typical of malignant melanoma was considered as such at the ultrasound test. All 7 malignant tumours were diagnosed through the ultrasound test, but it was impossible to foretell a predominant type of cell.


[Radiotherapy of intraocular tumours (author's transl)]. Ocular radiotherapy has considerably improved during the last 60 years. It allows very often, not only to save an eye, but also to maintain a useful function. But it is only one single element, although important, in our fight against intraocular tumors.


[Radiotherapy of intraocular tumours, particularly of melanoma of the choroid (author's transl)]. From 1964 to 1976 a number of 131 patients, suffering from melanoma of the choroid have been treated with 106Ru/106Rh beta-ray applicators. In 81 cases (61.8%) this treatment has been successful. 26 eyes (19.9%) had to be enucleated in spite of the irradiation. 24 patients (18.3%) died, 13 of them of metastases. Only in 46 patients, out of 81, we have reached total destruction of the tumor with flat chorioatrophic scar. In 27 cases visual acuity of 1.5 to 0.5 could be preserved. Radiogenic late complications in the capillary system with disturbances of the retinal blood circulation were the cause of visual deterioration. The 107 surviving patients were controlled during a period of 6.5 years in the average. Survival rate 91.2% after 5 and 84% after 10 years. Another group of 214 patients with melanoma of the choroid, who had been treated from 1955 to 1970 by enucleation reached a survival rate of 72% after 5 years. Treatment with 106Rh beta-irradiation therefore leads to no increased danger of metastases. The following indications for this treatment are suggested: 1. Prominence of the tumor not exceeding 5 mm, largest diameter at its base not more than 15 mm. 2. Distance of the dorsal edge of the tumor at least 1-2 optic disc diameters from the nerve head. 3. Peripheral delimitation against the ciliary body. 4. No tumor growth outside the eye.


[Complications of the irradiation therapy with beta applicators in malign melanomas (author's transl)]. Depending on prominence and localization of malign melanomas of the choroid, there are - besides enucleation - other clinical treatments possible. Irradiation therapy with beta applicators (106Ru/106Rh) gives also radiogenous complications. But contrarily to a treatment with cobalt-60 applicators, these complications are less important.


[Problems of surgical therapy after irradiation for tumors of the eyelids (author's transl)]. We discuss 10 consecutive cases which have had surgery after irradiation for tumors of the eyelids. Reasons for surgical treatment after irradiation: 1. Relaps within the irradiated area. Conditions of tissue prohibit additional irradiation. 2. No effect of irradiation. 3. Relaps in deeper layers or further growth, not noticed during irradiation. Additional irradiation ruinous for the eye. - Surgical problems after irradiation: 1. Inadequacy of usual techniques. 2. More extensive surgery then primary excision of tumor.


[Results of the 90Sr- and 90Y-radiation after surgical removal of 123 pterygia (author's transl)]. Out of 107 patients 123 pterygia were surgically removed: 24 pterygia of the progressive Type I, 49 of the semi progressive Type II and 50 of the regressive Type III. After surgical removal of the pterygia Type I and Type II followed a treatment with strontium 90 beta radiation with 2700 rep: 900 rep at the 2nd, 8th and 15th day after surgery. The recurrence rate was high in Type I (62%) and Type II (16%), but lower than it is reported in these groups operated without following radiation. More often pterygia of Type I and II are seen in people of the highlands.


[Biochemical research in depression (author's transl)]. The biochemical research of depression did not gain in before the exploration of the nodes of effect of the antidepressants. For the present the point of research was the search for disturbances in metabolism of the biogenic amines in brain. The noradrenalin and serotonin-hypothesis was propounded postulating a disturbance in noradrenalin, or serotonin regulation, respectively at the receptor in depression. Until now experimental results did not support this hypothesis, just as the investigations of electrolytic changes in depression did not lead to homogeneous results. On the contrary the neuroendocrinological research showed important results; In endogenous depressive patients an increased cortisol-secretion was ascertained, and in about 65% of the patients a missing or strongly reduced cortisol-suppression after injection of dexamethason was noted, moreover, the growth-hormone-secretion after insulin-hypoglycemia is reduced in a part of depressive women in the menopause. Finally the thyrotropin-secretion stopped in 20--40% of the endogenous depressive patients after injection of thyrotropin-releasing hormone.


An isolator for avian disease research.

An isolator for avian disease research. An isolator is described, fabricated in glass-reinforced plastic, suitable for housing 25-30 chicks to 6 weeks of age, or for fewer older birds, for use in experiments involving infectious agents.


Infiltrating pituitary neoplasms in the rat. 11 cases of spontaneous pituitary neoplasms in rats, which showed infiltration into brain tissue, are reported. This represents an incidence of about 0.42%.


The ferret, Mustela putorius furo, as a new species in toxicology. Comprehensive studies on the haematology, urine chemistry, serum chemistry and gross pathology have been carried out and reported. Seasonal weight changes were confirmed and were initiated, together with sexual activity, when ferrets were brought in to a constant temperature (18-19 degrees C) and 14-hour daylight cycle during the winter months. Levels of haemoglobin, erythrocytes and haematocrit were higher than in most common laboratory species. Similarly, serum electrolytes and glucose levels were higher than in Wistar rats or beagle dogs. Ovaries, uteri and testes displayed a seasonal maturation and atrophy. All other parameters were similar to common laboratory species.


Financial control of laboratory animal facilities: partial cost recovery in an academic institution. The objective of cost management in the animal house is to make efficient use of resources and to regulate the activity of the user. Regular charging of users keeps them aware of their responsibility both ethically and financially. Forward budgetary control is encouraged and regulation of the work load achieved through planned requirements helps to reduce animal wastage.


Vaginal opening in the Mongolian gerbil, Meriones unguiculatus: normal data and the influence of social factors. Mean age at vaginal opening was 41 days, range 33-53 days. Bodyweight at weaning and age at vaginal opening were negatively correlated, but there was no relationship between bodyweight and age at vaginal opening. The presence of a male before vaginal opening did not accelerate either the time of its occurrence or first conception. The vaginas of females caged singly from weaning opened earlier than in those kept in groups of 2 or 3.


Transfer isolator to protect personnel from exposure to peracetic acid. A transfer isolator is described which confines peracetic acid fumes used in the gnotobiotic operation of isolators. The use of this isolator protects both personnel and animals from contact  with peracetic acid, provides additional isolator space and reduces wear on the gloves and sleeves of the main isolator.


Mating post partum, concurrent lactation and reproduction in the laboratory rat. 32 of 35 sexually mature CFHB rats paired with proven males and thereafter allowed to mate post partum and nurse young concurrent with pregnancy, produced a total of 227 litters. The proportion of females producing litters decreased both with increasing age and parity, and with the number of young nursed. Litter size declined both as age and parity increased, and when gestation was extremely prolonged. The incidence and extent of delayed implantation (gestations greater than 25 days) were affected by the number of young nursed but not by increasing age and parity. There was no evidence for the existence of implantation periods coinciding with multiples of oestrous cycles.


Chronic non-infective conjunctivitis in rabbits. A high proportion (36%) of rabbits in a long-term experiment developed a severe chronic purulent conjunctivitis. Bacteriological examination failed to reveal an organism common to all cases, and the condition was only partially controlled by a neomycin and hydrocortisone eye ointment. Cutting down the possibility of hay dust entering the rabbits' eyes led to marked improvement: the conjunctivitis was virtually eliminated when hay was given in a specially-designed solid-sided hopper which prevented the release of dust during feeding and which, being detachable, could be refilled away from the rabbit rooms to minimize general atmospheric dust.


Genic heterogeneity and genetic monitoring of mouse outbred stocks. An outbred stock of Swiss:SE mice has been surveyed for genic heterogeneity at 12 loci, encoding biochemical polymorphisms in mice. Using horizontal starch-gel electrophoresis, 6 loci (Es-1, Es-2, Es-3, Es-5, Trf, Dip-1) revealed no genic heterogeneity within the total sample of 289 male mice examined. The other 6 loci (Mpi-1, Mup-1, Hbb, Gpi-1, Pgm-1, Ldr-1) each showed a 2-allelic variation within each of the 3 stock units (pavillions) involved. A pavillion effect on the observed genotype numbers was found for Pgm-1 and Gpi-1 (P less than 0.10). Inadequate genotyping may have occurred at Gpi-1 and Ldr-1, as suggested by a 'week effect' on the observed genotype numbers (P less than 0.05). For studying long-term genetic changes within outbred stocks, a routine monitoring procedure using biochemical polymorphisms is recommended.


Early postnatal physical and behavioural development of degus (Octodon degus). 6 litters of Octodon degus were studied from birth to 10 days of age. Newly-born degus (mean weight 14.6 g) had open eyes, upper and lower pigment, fur, and teeth. Within 3-4 hours of birth they were able to walk supporting their full weight, right themselves rapidly, sit upright on their haunches, or rear upright with support, and vocalize. By the 1st or 2nd day, the young animals displayed functional grooming (face washing, hind-paw scratching, rapid head-shake). Solid food was ingested from day 6, although newborns chewed wood chips and 3-day olds gnawed dried faeces. Young degus were tested daily in an open field apparatus and showed increased activity and exploration, with repeated testing while decreasing distress vocalization after the 4th or 5th day. Degus are proposed for the study of developmental topics since their degree of development at birth allows for immediate testing. The degus studied here seem to be more fully developed at birth than those studied in Britain.


Hepatitis B surface antigen (HBsAg) in leprosy patients of Calcutta: its prevalence and subtypes. Hight incidence of hepatitis B surface antigen (HBsAg) in lepromatous leprosy patients have been reported by many workers. This paper reports on a study undertaken over a period of more than two years to determine the prevalence of HBsAg and its major antigenic subtypes amongst the various clinical types of leprosy and apparently healthy individuals of Calcutta population. The overall incidence of HBsAg in lepromatous leprosy is found to be 3.8% (9 out of 234) in our study. The incidence of HBsAg in tuberculoid leprosy and non leprosy control cases were almost identical, 2.5% (11 out of 431) and 2.7% (14 out of 519) respectively. The incidence of HBsAg in lepromatous leprosy in the present study was apparently higher than tuberculoid or non leprosy cases, although statistically not significant. Hence the association between HBsAg and lepromatous leprosy could not be established in our study. None of the major antigenic subtypes of HBsAg could be related to any particular type of leprosy. The subtypes 'ad', 'ay' and 'ar' were present at varying proportions in all the groups tested. The antigenic subtype 'ay' was found to be prevalent in Calcutta population in higher proportions.


Serum immunoglobulins in leprosy.

Serum immunoglobulins in leprosy. Serum immunoglobulins were quantitated by radial immunodiffusion in 25 cases each of tuberculoid and lepromatous leprosy. Immunoglobulins estimated from 50 normal healthy adults were the control. Serum IgG was markedly raised in both tuberculoid (mean 2420 mg/dl) and lepromatous leprosy (mean 2493 mg/dl) when compared with the controls (mean 1288 mg/dl) and the difference was significant (p less than 0.01). However the difference in serum IgM and IgA levels in cases as compared to controls were not statistically significant. Serum IgM was slightly raised, the mean values obtained being 222 mg/dl in tuberculoid leprosy, 221 mg/dl in lepromatous leprosy and 202 mg/dl in control. Serum IgA was reduced in lepromatous leprosy (mean 129 mg/dl) as compared to the controls (mean 168 mg/dl) and the cases of tuberculoid leprosy (mean 165 mg/dl). The range of values obtained in both groups of patients showed greater scatter than the controls and a few cases of both forms of leprosy showed very low values of both serum IgA and IgM.


A study of serum fibrinolytic activity in leprosy. Fibrinolytic activity was studied in 50 patients of leprosy and 30 healthy individuals who served as control. Fibrinolytic activity was determined by measuring euglobulin lysis. No significant alteration in fibrinolytic activity was observed in patients with non-lepromatous leprosy, the levels being approximately similar to control group. However, fibrinolytic activity was found to be significantly decreased in patients of lepromatous leprosy and lepra reaction group. The observed decrease in fibrinolytic activity can be explained on the basis of presence of tissue destruction and vasculitis seen in leprosy more so in patients with lepromatous leprosy and lepra reaction.


A study of patients with erythema nondosum leprosum syndrome. 25 cases of Erythema Nodosum Leprosum (ENL) Syndrome have been clinically evaluated. Majority patients (84%) were males in the middle age group. Fever (56%), arthralgia (100%) and neuritic pains (100%) were common presenting constitutional symptoms. ENL was not related to DDS therapy or to any precipitating factors. Severity of reaction graded by clinical scoring was well correlated with fibrinolytic activity. Fibrinolytic activity was found decreased in all the cases. The decreases in fibrinolytic activity was more so pronounced in patients having higher clinical scorings.


Reconstructive surgery of claw hand in leprosy. 32 hands in 31 known cases of leprosy were operated using the Paul-Brand technique for the intrinsic minus deformity. 29 hands revealed good results whereas remaining 3 also had definite improvement in their function and cosmesis. Bunnel's opponens plasty was performed in 7 cases to restore back the power of opponens in the thumb. Meticulous pre and postoperative management proved to be very necessary.


Dapsone treatment and deformities. A retrospective study. Gandhi Memorial Leprosy Foundation conducted a study from 1963-72. Records of 2608 patients pertaining to type of leprosy, year of detection and registration, involvement of nerves, treatment, reactions, deformities, were available for a retrospective study. Patients having problems like neuritis and deformities and of the types lepromatous and borderline were the ones who tended to be regular clinic attenders. Lepromatous and Borderline and Polyneuritic types and N3 group were prone to develop deformities. There seemed to be association between reaction and causation of deformities. Because of the neurotoxic effect and ability to concentrate in the affected nerves, dapsone might enhance the risk of deformities. Low deformity rates in N1 and N2 types of nerve involvement reaffirmed the necessity of early diagnosis of leprosy.


Screening for diabetes mellitus in leprosy patients with complicated ulcers. All patients admitted to an ulcer ward in a leprosy hospital over the period of one year were screened for glycosuria. Out of 154 patients screened 4 showed glycosuria. These 4 patients had more severely complicated ulcers evidenced by their longer duration of admission. Early diagnosis and treatment of diabetes in leprosy patients with complicated ulcers is important.


Medical records in leprosy programme.

Medical records in leprosy programme. It is an established fact that Medical Records play a vital role in the care of various diseases but it has a very important and significant role in a disease like leprosy. Its importance should not be underestimated as Leprosy poses many problems which have some unique characteristics and special features. First of all it is to be accepted that our knowledge of Leprosy is still none to no where, in spite of the age old nature of the disease it is imperative to have proper records of the disease which may lead to invaluable results.


Acute fatal DDS poisoning. (Report of 4 cases). Acute dapsone poisoning is rare and such cases are either accidental or suicidal. Though accidental DDS poisoning are reported in children, the same is fairly uncommon in adults. Only 2 such cases are reported in India literature. We here report 4 cases of fatal sucidial DDS poisoning in adults resulting death in 3 cases. The reported acute symptoms include nausea, vomiting, hyperexcitability followed by depression, Carpopedal spasm or convulsions. The most marked signs are dyspnoea and cyanosis. The symptoms are due to methaemoglobinaemia, and or sulphaemoglobinaemia. Normally dapsone induces red cell haemolysis and even with small therapeutic doses of 25-100 mg per day, and in toxic doses reduces the oxygen carrying capacity of blood and damages the red cells making them more vulnerable for haemolysis. The peculiarity of the presentation in this series are manifestation of severe haemorrhagic episode in one case and progressive jaundice in another besides cyanosis. None of the cases had carpopedal spasm or convulsion. Out of four cases three died inspite of intensive care, intravenous vitamin C, exchange transfusion (2 cases) and other supportive measures. Intravenous methylene blue could not be used in these cases due to non-availability.


Erythema multiforme bullosum due to rifampicin. A case of Erythema Multiforme Bullosum in patient of lepromatous leprosy with pulmonary tuberculosis due to Rifampicin is described. It is stressed that ethambutol may act as a trigger factor to the toxic effects of Rifampicin.


Speech perception by profoundly hearing-impaired children. This article reviews the limitations of defining profound hearing impairment solely by reference to pure-tone audiograms. Instead, profoundly hearing-impaired children may be described as those whose ability to distinguish spectral features in speech is extremely poor, and for whom the gross intensity variations in the waveform envelope are the principal acoustic cues. Examples of pattern cues that are available to profoundly hearing-imparied children are presented through an optical analog, and the usefulness of these cues is shown with regard to vowel and consonant identification, word stress-pattern perception, and distinction among sentences that differ in number of syllables, pattern, intensity, or rate. Perception of speech material through vision (lipreading) and also through combined auditory and visual modes are described, with a discussion of articulatory and language factors that influence intelligibility. Instructional strategies are briefly reviewed as they relate to educational improvement of speech-perception abilities of profoundly hearing-impaired children and to the development of special sensory aids.


Speech and language testing with distinct ethnic-racial groups: a survey of procedures for improving validity. Several procedures are being used currently to improve the validity of speech and language evaluation for ethnic or racial groups from lower-income populations. Procedures mentioned in this article include: (1) developing a new test, (2) modifying test items or keyed responses on existing tests, and (3) developing new norms for existing tests. Examples are given for each procedure, and advantages and disadvantages are discussed.


The influence of pauses in the competing signal on synthetic sentence identification scores. Thirty normal-hearing subjects participated in an experiment testing the effects of pauses in the competing discourse on the synthetic sentence identification (SSI) task. When speech noise was added to the continuous discourse used for competition, subjects found it more difficult to identify the key words in the synthetic sentences.


Speech, language and hearing disorders in a adult penal institution. It has been speculated that the prevalence of communicative disorders among prison inmates is considerably higher than that found in the general population, but research regarding inmate speech and hearing disorders is limited. This study investigated the nature and extent of communicative disorders in an inmate population of a medium-security penal institution in southeastern Virginia. The results of the screening indicated a slightly lower prevalence of stuttering, higher prevalences of articulation, voice, and hearing disorders, and more deficient receptive vocabulary skills than found in the general population. Some dialectal variations among black inmates are noted and the possible influence of linguistic-cultural interference on the results is discussed.


A study of some factors affecting generalization of language training. Two related experiments examined generalization across contexts involving different sentence forms when selected grammatical features were trained within a single syntactic context. Results obtained within a single-subject multiple baseline design showed that training the verbal/auxiliary (contracted with pronoun he) was sufficient to induce its generalization across a variety of verbs, object noun phrases, and a different subjective case pronoun, but not across an objective case pronoun. Similar results were obtained for the uncontractible auxiliary in the past tense. Generalization of the uncontractible auxiliary in the present tense was noted across different verbs; so also was the generalization of contractible copula to different adjectives qualifying the subjective case pronouns he and she (but not in qualifying an objective case pronoun it). Finally, generalization of possessive s inflection across male, female, and animal categories was evident. Trained behavior generalized to home situation in one of the experiments. Some unexpected results also suggest that training on certain forms of either verbal auxiliary or copula may be sufficient to generate correct production of both of them.