Are current rates of Cesarean justified? Cesarean section is associated with increased maternal and fetal risks. It should not be done except for direct and positive indications. Current emphasis on early conduction anesthesia, the use of the fetal monitor in low-risk patients, section approach to breech delivery, and overemphasis on tests and roentgenograms contribute to excessive cesarean sections. Aggressive obstetrics is also expensive and compares unfavorably with a more conservative approach.


Pattern of combined collapse of right upper and right middle lobes. Three cases of combined collapse of the right upper and middle lobes are presented. The appearance is the mirror image of collapse of the left upper lobe. The radiographic appearance is described, and possible causes and mechanisms of collapse are discussed.


Tuberculous otitis media with complications. Tuberculous otitis media, although uncommon today, is still a differential diagnosis of suppurative otitis media. Our patient's otitis progressed from a draining ear with hearing loss to include facial nerve paralysis and meningitis. Several surgical procedures including radical mastoidectomy were insufficient to halt progression of the disease. After culture of acid-fast bacilli from the aural drainage and the cerebrospinal fluid, antituberculous chemotherapy was started and the patient responded well to treatment.


Multiple intrahepatic and extrahepatic biliary cysts. In most cases of congenital cyst of the extrahepatic biliary system, a single choledochal cyst is described. We have reported a patient with multiple intrahepatic and extrahepatic biliary cysts. Intraoperative cholangiograms demonstrated free reflux among the multiple choledochal cysts, with reflux into the intrahepatic biliary ductal system. After a side-to-side choledochocystoduodenostomy, the patient recovered and has remained asymptomatic for over a year.


Management of chlorpropamide-induced hypoglycemia with diazoxide. Diazoxide, as demonstrated by the case we present, may be of substantial value in abolishing hypoglycemia and in preventing its recurrence. The mainstay of treatment for the patient with chlorpropamide toxicity is the constant close monitoring of clinical and laboratory parameters and the correction of hypoglycemia by administration of exogenous glucose when necessary. However, the need for exogenous glucose is reduced with the concomitant use of diazoxide. We therefore suggest that diazoxide should be considered as a part of the routine treatment of sulfonylurea-induced hypoglycemia.


Recurrent hemolytic anemia secondary to acessory spleens. A patient with recurrent hereditary spherocytosis due to a hypertrophied accessory spleen is presented. In patients in whom splenectomy is performed for hematologic disease, accessory spleens must be sought and removed. Recurrence of the inital disease should prompt a search for accessory spleens.


Calcific constrictive pericarditis in Degos' disease. A 31-year-old woman presented with symptoms and signs of constrictive pericarditis. She had a history of Degos' disease, a rare disorder characterized by skin and bowel lesions thought to be secondary to vasculitis. A chest roentgenogram showed extensive calcification of the pericardium. Although pleural and pericardial involvement has been reported in this disease, constrictive pericarditis is most unusual, and radiographically demonstrable calcification of the pericardium has not been reported previously.


Disc excision and spine fusion in the management of lumbar disc disease. A minimum ten-year followup. Seventy-nine percent of 312 patients who underwent lumbar disc surgery were evaluated at least 10 years postoperatively (mean equal to 13.7 years). Residual back and nerve root symptoms and functional impairment were equally as common among the 143 patients who underwent fusion as they were among the 64 patients who did not. Thirty percent of the patients whose spines were fused and 37.7% of those patients whose spines were not fused were considered long-term failures because of persistent symptoms or the need for reoperation. Thirty-seven percent of the fusion patients had persistent graft donor site symptoms. Examined patients showed a high percentage of residual neurologic defects. An unexplained positive Trendelenburg sign was present in 14.8% of the fusion patients and in 18.2% of the patients whose spines were not fused. Although retrospective studies often have problems of accuracy, this analysis confirms other observations that midline spinal fusion offers few benefits in the management of lumbar disc disease.


Microscopic lysis of lumbar adhesive arachnoiditis. The results of a long-term study of 28 patients operated on for adhesive lumbar arachnoiditis are presented. The technique involved was microscopic lysis of adhesions. The first case of surgery was performed in 1966 and the last, in 1970, with followup through 1976. Numerous observations are made regarding the clinical picture and the appearance of arachnoiditis at the time of surgery. Some conclusions are drawn regarding the causes of this condition with some emphasis on the role of Pantopaque, multiple surgeries, and other trauma. The conclusion is that surgical attack on arachnoiditis is a straightforward surgical exercise that, when carried out with appropriate caution, produces no further neurologic deficits and some short-term improvement. However, the authors feel that this procedure should not be performed at the present time because there does not appear to be a method for preventing the reaccumulation of the scar tissue and subsequent recurrence of the symptoms.


Spinal arachnoiditis. The postoperative variety in particular. The diagnostic and therapeutic courses of 68 patients with the discharge diagnosis of spinal arachnoiditis were reviewed. The combination of oil myelography and spinal surgery was the probable cause of arachnoiditis in almost all cases. The clinical presentation featured leg pain (90%), low-back pain (80%), and sphincter disturbance (25%). Motor, sensory, and reflex changes were present in two thirds of the cases, with a majority having defects attributable to bilateral or multiple root level involvement. Specific analysis of previous operative procedures cerebrospinal fluid (CSF) studies, and myelographic patterns did not disclose any consistent correlation with the clinical presentation. Results are interpreted in light of prior clinical and experimental studies on the reaction of the meninges to trauma and myelography.


Lumbar adhesive arachnoiditis. Etiologic and pathologic aspects. The etiologic factors and pathologic findings in 38 patients with lumbar arachnoiditis are presented. Lumbar spine surgery and the injection of contrast materials prior to the diagnosis of this condition are considered the most important factors in its genesis. In this series, there was microscopic evidence of arachnoiditis ossificans in 3 patients and arachnoiditis calcificans in 1 patient.


Cauda equina arachnoiditis. A correlative clinical and roentgenologic study. A series of 93 consecutive patients whose myelograms were reported as showing arachnoiditis were studied, and correlations between the radiographic appearance and the clinical and surgical findings were tabulated. All but 1 patient had had either lumbar disc surgery and/or Pantopaque myelography. The study led to a classification of such roentgenogram changes which revealed that the majority of patients studied did not have the usual adhesive arachnoiditis, but the picture they projected was more commonly due to spinal stenosis, extraarachnoid dye injection, extradural scar, etc. Only 1 patient of the 93 presented the classic severely disabling paraparesis, intractable pain, and loss of bowel and bladder functions commonly ascribed to adhesive arachnoiditis. The presence of such myelographic changes need not deter necessary surgery for coexisting disc pathology, nerve root entrapment, or spinal stenosis. In only a small percentage of these patients could the symptoms be attributed to the arachnoiditis changes seen in the myelogram.


Failed lumbar disc surgery requiring second operation. A long-term follow-up study. Forty-five patients who had lumbar disc surgery 10 or more years previously, and had required a second operative procedure, have been evaluated. Failures occurred up to 16 years after the first operation, and were most commonly due to pseudoarthrosis in the patients who underwent spinal fusion initially, and to recurrent disc lesions at the same level as previous surgery in the patients who did not have fusion. The clinical and functional results in the second group of patients who required a second procedure were comparable to those of patients who required only a single procedure. In contrast, patients who had undergone spinal fusion who required a second procedure had significantly worse clinical and functional results, both in comparison to the patients who did not undergo fusion as well as to patients who had had fusion as a single procedure. The only predictable, demonstrable source of failure was acquired spondylolysis. Frequently, repair of pseudoarthrosis did not lead to symptomatic relief. These data suggest that spinal fusion, when it fails, has a significantly worse prognosis than simple disc excision in the management of lumbar disc disease.


Arachnoiditis ossificans. Report of a case. Arachnoiditis ossificans is uncommon and has been reported to occur in areas surrounding the brain stem, the spinal cord, and the cauda equina. Predisposing etiologic factors include vascular anomalies, spinal anesthetics, and meningitis. This report adds a case of arachnoiditis ossificans about the cauda equina occurring after septic complications following laminectomy. Surgical excision of the ossific tissue resulted in clinical improvement.


Chronic spinal arachnoiditis. A postoperative syndrome that may signal its onset. Chronic lumbar radiculopathy following spinal surgery is reported, in which 7 of 25 patients reviewed developed a postoperative syndrome immediately after their original surgery. Later, sometimes years later, all 7 patients developed severe chronic spinal arachnoiditis. This syndrome was characterized by transient violent spasms in the legs, muscle cramps, increased radicular pain, and often fever and chills. The recognition of this syndrome and a proposed method of treatment is discussed.


Modified neurosyphilis in the Cape Peninsula. A prospective study of 148 cases of neurosyphillis revealed that 85 patients exhibited a modified 'forme fruste' of the disease. A high proportion of these patients had evidence of activity in the cerebrospinal fluid, while 6 patients have developed features which are diagnostic of neurosyphills. During the study a significant number of active seronegative cases were diagnosed and 11 patients have deteriorated on treatment.


Myeloid leukaemoid reactions in South African Blacks. Myeloid leukaemoid reactions were observed in 18 Black adults and 20 Black children at Baragwanath Hospital, Johannesburg, during a 10-month period. This represented an incidence of 1,3/1 000 adult medical admissions and 3,7/1 000 paediatric medical admissions. During the same period the incidence of myeloid leukaemoid reactions in White children in Johannesburg and in Black and White children in Buffalo, NY, was less than 1/1 000 admissions. The reactions were associated with bacterial infections, neoplasms, hepatorenal failure, acute metabolic disorders and non-malignant blood dyscrasias. The mortality in adults was 55,6% and in children 35%. Sixty-five per cent of all deaths occurred within 24--48 hours of admission. Residual morbidity in survivors was common. The pattern of acute leukaemia in the same hospital population is predominantly myelocytic in both adults and children.


The surgical management of chalasia of the oesophagus. The Hill operation was used to correct chalasia of the oesophagus in 4 children under 1 year of age. Results in all 4 were good, 2 having been followed up for 2 years after surgery and the other 2 for 9 and 12 months respectively. There was no mortality or morbidity associated with surgery or endoscopy and biopsy. Oesophagitis is an important criterior for deciding which patient should be treated surgically in the under-1-year age group. Clinical assessment, radiological evaluation and finally endoscopy and biopsy are important in establishing the presence of persistent oesophagitis. Because of the difficulty of performing manometry in these patients, it has only been performed in those under 4 weeks of age.


A generalized epileptiform convulsion after intra-amniotic prostaglandin with intravenous oxytocin infusion: a case report. A patient who had a generalized epileptiform convulsion after intra-amniotic prostaglandin F2 alpha administration with intravenous oxytocin infusion is described. The convulsion was possibly due to either or both of these drugs. The aetiological associations are reviewed. Intra-amniotic prostaglandins and intravenous oxytocin are frequently used to induce mid-trimester abortions, and the case described serves as a reminder of some of the dangers associated with this procedure.


Incontinentia pigmenti in a Black baby: a case report. This is a case report of a Black baby girl who presented at the age of 7 days with incontinentia pigmenti. While the classic 3 phases of inflammation, hyperkeratosis, and irregular pigmentation are the rule, this patient demonstrates an accepted variation, presenting with irregular pigmentation without having gone through the other phases. Ninety-five per cent of the described cases have been in females. A negative family history, as in this case, is not unusual.


Fanconi's anaemia, with special reference to erythrokinetic features. Serial haematological investigations were carried out in 5 patients with Fanconi's anaemia over periods of 6 months--11 years. All the patients were pancytopenic with a depression of the granulocytic and megakaryocytic elements of the bone marrow throughout the greater part of their illnesses. Erythropoietic acitvity was variable. The initial bone marrow examination revealed depressed erythroid function in 3 patients. The erythroid hypoplasia persisted in 2 of them, while in the third, erythroid activity increased with time, possibly as the result of therapy with oxymetholone. Erythroid hyperplasia was present in the remaining 2 patients, both at presentation and throughout the course of the illness. This could not be attributed to treatment in either patient. Six erythrokinetic studies were carried out in the 5 patients at variable intervals after the diagnosis had been made. In 2 studies erythroid activity was unequivocally depressed, while in a further 3 a significant, though probably suboptimal, erythroid marrow response was present. In the final study erythropoiesis was increased but was markedly ineffective in terms of the delivery of viable red cells into the circulation. In vivo counting suggested that some degree of ineffective erythropoiesis was also present in the other patients and studies with 51Cr indicated a shortened red cell survival in all subjects studied. In 2 of them significant splenic sequestration was present. Leukaemic transformation occurred in 2 patients. In 1 of them its development was heralded by the appearance of micromegakaryocytes in the bone marrow.


[Evaluation of the lecithin/sphingomyelin ratio and the foam test as tests of fetal lung maturity]. The lecithin/sphingomyelin (L/S) ratio and the foam test to determine fetal lung maturity in order to prevent hyaline membrane disease (HMD) were used in 800 patients at Tygerberg Hospital. The incidence of HMD in all neonates diminished from 3.25% in 1971, when the lung maturity test was not done, to 2.12% in 1975, the 4th year that such determinations were done. In the same period the incidence of respiratory distress syndrome (RDS) increased from 3.68% to 4.31%. Only 1% of fetuses in whom lung maturity was determined during the period 1972--1975 developed HMD. This reduced incidence of HMD is considered to be the result of prenatal determination of fetal lung maturity. No correlation was found between fetal lung maturity and length of gestation or physical condition of the neonate. The foam test results were compared with the L/S ratio, and a false positive figure of 8.3% and a false negative figure of 27.1% were found. It is recommended that the foam test be used for screening and the L/S determination be done only if the foam test is negative in high-risk patients.


Experience with amniocentesis at the Johannesburg Amniocentesis Clinic in 1976. One hundred and seventy-six amniocenteses were performed in the Johannesburg Amniocentesis Clinic in 1976. These were for genetic studies, assessment of fetal lung maturity and assessment of the severity of rhesus disease. The indications for amniocentesis and the results are discussed. The overall complication rate was low. This was due to certain precautions and approaches taken, which are detailed.


Goodpasture's syndrome: case report of a survivor. A patient with Goodpasture's syndrome who presented with severe pulmonary haemorrhage and minimal renal involvement is described. The diagnosis was substantiated by immunofluorescence studies on a renal biopsy specimen and by the detection of circulating antiglomerular basement membrane antibody. The patient was treated with corticosteroids and cyclophosphamide. He remains in good health 20 months after diagnosis, although there is a persisting abnormality in single-breath gas transfer for carbon monoxide. Recovery from Goodpasture's syndrome is reviewed in the light of recent advances.


Availability of retired persons for work: findings from the retirement history study. The increase in the proportion of retirees in the population has given rise to concern that the financial burden on workers could become onerous. Consequently, considerable interest has developed in encouraging workers to delay retirement until age 65 and beyond. The effectiveness of programs to accomplish this objective would be enahnced by knowledge of the reasons for early retirement and the characteristics of those who have retired. On the basis of three waves of longitudinal data from the Retirement History Study, an availability measure has been constructed to provide estimates of how many recent retirees would be likely, given the opportunity, to return to work. Incorporating information on perceived income adequacy and work attitudes, the measure is applied in this article to men and women aged 62 to 67 in 1973 who had retired since 1969. An initial screening to determine those with work limitations removed half the retirees from consideration, and the measure indicates that relatively few of those remaining would have been readily available to return to work.


Impact of recession on Swiss pension program. Legislation drafted in Switzerland in 1975--77 aims at countering the effects of inflation and recession by bringing increased revenues into the system, reducing expenditures, devising a mechanism to adjust pensions automatically, and improving income maintenance for the unemployed. The proposed legislation to place the social security system on a sound financial basis now needs voter approval in a referendum. Swiss voters meanwhile rejected (in mid-1977) a government-proposed value-added tax designed to finance increasing government contributions during 1978-82. Still to be resolved, therefore, is the problem of how the government will finance higher contributions and still achieve its staged goal of a balanced budget.


Prepubertal infections with Neisseria gonorrhoeae: clinical and epidemiologic significance. The family constellations and epidemiologic circumstances of three prepubertal girls with vulvovaginitis due to Neisseria gonorrhoeae are reported. In each instance, an infected asymptomatic man, himself a contact to a woman with pelvic inflammatory disease, could be implicated as the potential source of infection. In one instance, asymptomatic infection in a child was uncovered through epidemiologic investigation. Prepubertal gonococcal vaginitis is important not only as a potential indicator of child abuse, but also as a possible link to important transmitters of gonococcal infection. The need for meticulous epidemiologic investigation of these cases is stressed.


Carcinoma of the fallopian tube.

Carcinoma of the fallopian tube. Carcinoma of the fallopian tube is the least frequent tumor of the female genital tract. It may occur at any age but is more common in the sixth decade. The tumor involves both tubes in 26 per cent of cases. The spread is by direct extension to peritoneum. The symptoms include metrorrhagia, leukorrhea, abdominal pain, singly or in combination. The diagnosis is difficult but could be made more frequently if the causes of abnormal bleeding were thoroughly investigated by means of cytology and endometrial curettage. Treatment is by resection of the tumor, total hysterectomy, and bilateral salpingo-oophorectomy followed by chemotherapy. The 5-year survival rate is 38 per cent.


Warfarin induced necrosis of the skin.

Warfarin induced necrosis of the skin. Necrosis of the skin is a rare complication of oral anticoagulation therapy by coumarin congeners. Three males receiving prophylactic warfarin anticoagulation therapy following cardiac valve replacement and one female similarly receiving anticoagulation drugs because of bilateral deep thrombophlebitis associated with carcinoma of the pancreas had typical skin necrosis develop. The lesions passed rapidly through stages beginning with pain, edema, erythema and petechiae. Ecchymoses followed in the localized area with a large bullae containing deep red fluid. Biopsy of the skin revealed involvement of the dermovascular loops with localized necrosis from extensive occlusion of dermal capillaries and venulae by fibrin thrombi. There was red cell extravasation, but inflammatory changes were inconstant. In the patients, in our study, the involvement ranged from small localized lesions of the trunk to extreme extensive skin involvement of both legs with full thickness necrosis in areas. This condition is not dose related nor the result of simple hypoprothrombinemia. It appears to be a conditioned and localized toxicity, although hypersensitivity has not been excluded. Once the diagnosis is made, orally administered anticoagulant drugs must be stopped immediately, and heparinization may be beneficial in confining the process.


Gastrocolic fistula in Crohn's disease.

Gastrocolic fistula in Crohn's disease. The surgeon managing a patient with Crohn's disease should be aware of the possibility of a gastrocolic fistula being present. Readily available roentgenographic contrast studies, coupled with endoscopy, will undoubtedly provide all the necessary information with which to undertake a safe one stage en bloc resection of the diseased segments.


Limitations of portable roentgenography of the chest in patients with acute respiratory failure. The ability of the portable roentgenography of the chest to define the amount of physiologic shunting and the severity of noncardiogenic pulmonary edema was evaluated in 37 observations of 11 patients. Ten of the 11 patients had acute respiratory failure. The roentgenologic assessment of the amount of pulmonary edema and the severity of left ventricular failure was compared with the physiologic shunt fraction, tracer measured lung water and the pulmonary arterial wedge pressure. The roentgenologic scores for edema did not predict the shunt fraction or tracer measured lung water. The roentgenologic score for congestive heart failure correlated with the wedge pressure but not well enough to be clinically useful. Five per cent of the roentgenograms were false-positive and 11 per cent were false-negative. Roentgenologic findings lagged behind physiologic derangements. Thus, the roentgenogram could predict the shunt value of the preceding day. Results indicate that it is hazardous to accept a portable roentgenographic diagnosis of congestive heart failure as a cause of pulmonary edema.


Hemodynamic monitoring during complete vascular exclusion for extensive hepatectomy. Hemodynamic monitoring during normothermic vascular exclusion of the liver, with or without clamping of the upper part of the abdominal aorta appears mandatory, based upon an experience with ten patients. Nine patients underwent extensive liver resection for major tumors unsuitable for conventional surgical procedures. No operative accidents were observed. Permanent monitoring during the procedure included pulmonary artery pressures, radial artery pressures, heart rate and cardiac output, measured by the thermodilution method. Hemodynamic changes after short isolated venous or aortic and combined clampings were also studied. With this procedure, the most critical period occurred immediately after the release of the clamps, with a major rise in the pulmonary artery pressures, which led to hemodynamic pulmonary edema level. The acute modifications of circulating blood volume actually carried a high risk of vascular overloading, and the most reliable method to avoid this was the permanent control of the pulmonary artery pressures. Blood volume replacement was, at its best, adjusted with the use of such a parameter, especially when hemorrhage was important. Combined aortic clamping reduced blood losses and minimized pooling in the splanchnic area and the lower extremities.


Mammography in the detection, diagnosis and management of carcinoma of the breast. Mammography is a major advance and essential in the earlier detection, diagnosis and management of carcinoma of the breast and should be more widely applied. Although mammography is at least as important as palpation and the only means of detecting nonpalpable lesions, both examinations are most effective as complementary procedures. A breast operation for suspected carcinoma should never be done without preoperative mammography. Mammographic needle localization and biopsy roentgenography are extremely useful, if not essential, in the surgical management of nonpalpable lesions.


Phenol sympathectomy for vascular occlusive disease. Surgical lumbar sympathectomy is often performed as a last resort in treating peripheral vascular occlusive disease. However, the variable success rate and the morbidity of this procedure prompted us to examine phenol sympathectomy and to elucidate the factors which can be used to predict success with the procedure. During the past three years, 127 phenol sympathectomies have been performed for peripheral vascular disease using a standard technique. The technique has proved simple and harmless. The results of a prospective study of 52 patients indicate that it is possible to predict the chance of success after this procedure by using a combination of clinical criteria and systolic pressure measurements at the ankle. A good response is anticipated in patients with rest pain or night pain if the systolic pressure at the ankle is greater than 35 millimeters of mercury. Patients with gangrene of the digits responded if the pressure at the ankle was greater than 60 millimeters of mercury.


The effect of fluid infusions upon serum protein concentrations during hemorrhagic shock. Of 24 dogs subjected to hemorrhagic shock, 12 resuscitated with intravenous infusions containing 2.5 per cent human serum albumin maintained significantly higher, p less than 0.05, serum albumin levels than did 12 others treated with Ringer's lactate solution, with or without 50 per cent dog plasma. These differences persisted for as long as six weeks after hemorrhage. Dogs resuscitated with Ringer's lactate solution and 50 per cent dog plasma had significantly higher serum globulin levels than did the dogs receiving 2.5 per cent albumin containing infusion during the first three days after hemorrhage. The simultaneous addition of 5 per cent glucose, potassium chloride and hydrocortisone sodium succinate to the infusion of dogs receiving 2.5 per cent albumin in Ringer's lactate solution did not provide significant alterations in the serum concentration of protein and protein fractions when compared with those of dogs receiving only 2.5 per cent albumin in Ringer's lactate solution. These findings corroborate the suggestion of a capillary leak of serum albumin into the interstitial space during hemorrhagic shock that persists for at least one week after hemorrhage. The administration of albumin containing solutions during the initial stages of hemorrhagic shock counteracts this albumin loss.


Cutaneous blood flow and its relation to healing of below knee amputation. Twenty-six patients undergoing below the knee amputation for ischemic disease of the lower part of the leg had skin blood flow determinations made at the level of the amputation. Flow was measured using the 133Xe clearance technique preoperatively as well as at four and eight weeks after amputation. Amputation was performed using the standard long posterior flap technique, and patients were treated with either an immediate postoperative prosthetic fit or a controlled environment treatment system. Healing occurred primarily in 19 patients; a local below the knee revision was required in two and an above the knee revision in one patient. Flow was lower than in the nondiseased control group in almost all instances preoperatively, but no definite level below which healing would not occur was identified. Postoperatively, skin flow increased in all instances and had reached levels equal to that for the normal control group by eight weeks or sooner. This suggests that, in many instances of nonhealing, local below the knee revisions may be successful without requiring the higher above the knee procedure. No significant differences were noted between patients with diabetes and those without diabetes or either method of postoperative treatment in terms of healing or cutaneous flow.


Alterations in intestinal structure, fat absorption and body weight after intestinal bypass for morbid obesity. Eleven patients underwent jejunoileal bypass for morbid obesity. Serial intestinal biopsies were obtained prior to, and at timed intervals following, operation in both fasted and fat-fed states. Villus height increased asymptotically, reaching a plateau one year after operation, with an increase of 80 per cent in mean villus length. The postbypass body weight reached a plateau at 63.9 per cent of initial body weight and correlated linearly with villus height following an asymptotic curvilinear course. The time required to attain 90 per cent of total body weight loss was 15.9 months. A study of intestinal fat absorption at both the light microscopic and ultrastructural levels showed that the enlarged villi are lined along the entire villus by functionally mature epithelium capable of transporting lipid. Villus hypertrophy is an important mechanism in the plateauing of weight loss after jejunoileal bypass for morbid obesity.


Function of the parathyroid glands after total thyroidectomy. Parathyroid function, defined as the ability to maintain normocalcemia without substitution, was evaluated in 36 patients following total thyroidectomy for carcinoma. In 16 patients, all visualized parathyroid tissue was sliced and autotransplanted into muscle pockets; one year after the operation, 11 patients had substitution for lack of parathyroid function. In 20 patients, the parathyroid glands were preserved in situ with intact vascular supply; one year postoperatively, three patients had evidence of persistent hypoparathyroidism. The difference in the parathyroid insufficiency rate is significant, p less than 0.005. We conclude that parathyroid autotransplantation has been a failure io preserve the parathyroids in situ whenever this is feasible, autotransplantation being reserved for parathyroids unfortunately removed or devascularized.


The significance of asymptomatic unilateral carotid bruits in preoperative patients. The significance of asymptomatic carotid bruits was evaluated in patients undergoing major vascular operative procedures. A retrospective analysis of 588 patients was performed. Ninety-two patients (15%) had unilateral carotid bruits detected on admission examination. None had had cerebrovascular symptoms. Four postoperative strokes occurred in the total group of 588 patients. All occurred in patients without bruits. There were no permanent or transient postoperative neurological deficits in the group of patients with asymptomatic unilateral carotid bruits. We can find no data to support the necessity for preoperative carotid arteriography and endarterectomy in the patient with an asymptomatic carotid bruit prior to undergoing a major operative procedure.


The results of surgery in amebic liver abscess: experiences in eighty-three patients. Experiences with surgery in 83 patients with amebic liver abscess are presented. The patients' ages ranged from 8 months to 72 years; 85% were men. Symptoms had been present for an average of 4.6 weeks. In 36 (43%) the abscess already was ruptured at the time of admission to the hospital and in an additional eight it ruptured later. Rupture occurred more commonly upward through the diaphragm than downward, and into a serous cavity in 36 patients. Because of the poor general condition and associated illnesses of the patients, surgical procedures were limited to the minimum. Indications for operation were rupture or impending rupture of the abscess, failure of response to medical therapy, and inadequacy of aspiration of left lobe abscess. An additional 27 patients underwent operation because of diagnostic problems or symptoms of an acute abdomen. Two thirds of the patients had one or more complication. The overall mortality rate was 34%. Factors adversely affecting mortality rate were lack of preoperative drug therapy, rupture into a serous cavity, and presence of an associated amebic perforation of the colon.


Screening for colorectal carcinoma in a rural area. A screening project for cancer of the large bowel has been performed in a rural area. After an intensive educational program and with the help of many volunteers, 3,956 people participated in a stool guaiac determination. Five patients had a carcinoma, and five more had adenomas of the large bowel. We conclude that screening for cancer of the large bowel can be performed effectively in a rural area and that the results are gratifying.


Contributions of bile and pancreatic juice to cell proliferation in ileal mucosa. To determine the relative contributions of bile and pancreatic juice to adaptive intestinal hyperplasia, cell proliferation in rat ileal mucosa was studied after supplying bile alone or the combined pancreaticobiliary effluent direct to mid-small bowel. Bile was routed through the choledochus cannulated above the pancreas. Pancreaticobiliary secretions were diverted through a transposed duodenal segment containing the papilla. Diversion of bile into the mid-bowel with and without pancreatic juice caused similar increases in ileal ribonucleic acid (RNA) (16% to 50%) and deoxyribonucleic acid (DNA) (22% to 41%) contents at both 48 hours and 1 week after operation. Specific activity of DNA after injection of tritiated thymidine was greatest after diversion of the combined effluent. After 1 month nucleic acid contents in the upper ileum after pancreaticobiliary diversion were 37% to 59% higher than after transection or biliary diversion (P less than 0.005). Likewise, after biliary diversion villous height and crypt depth were increased only at 1 week, but after diversion of both secretions increases were found at 1 week and 1 month. High luminal concentrations of bile cause transient cell proliferation in ileal mucosa, but the additional presence of pancreatic juice prolongs this adaptive response.


Reconstruction of an iliac vein: a case report and discussion. A case report of a girl with anomalous venous drainage of a lower extremity who had a successful venous transplant is presented, along with a review of some factors thought to be important in venous grafting. In our patient there are several factors that may have contributed to long-term patency. As demonstrated by venogram, there was no alternative or competing pathway for blood to drain from the leg. This would imply a high venous pressure driving blood through the graft. Autogenous vein was used. Local heparin may have been a contributing factor as well. Although growth of anastomosed arteries has been demonstrated, this is the first time growth of a venous transplant has been demonstrated in a human. This growth was in length as well as in diameter. We believe this experience lends encouragement to the use of venous transplant surgery, which may become more common.


Effects of cholesterol gallstone induction on gallbladder function and bile salt pool size in the prairie dog model. The prairie dog gallstone model was used to test the following hypotheses: (1) gallbladder stasis occurs in association with gallstone formation, and (2) bile salt pool size decreases as gallstones develop. Bile salt pool sizes and the extent of equilibration of hepatic and gallbladder bile salt over the course of gallstone development were measured. No evidence for bile salt pool reduction was found, but there was significant evidence of progressively inefficient equilibration of hepatic and gallbladder bile salt very early during gallstone formation. These changes, suggestive of gallbladder stasis and observed only in the presence of cholesterol crystals in bile, persisted as cholesterol stones developed and antedated any reduction in bile salt pool size.


A ruptured abdominal aortic aneurysm presenting as inferior vena caval obstruction. The case report of a patient presenting with inferior vena caval obstruction secondary to ruptured abdominal aortic aneurysm is presented. The cause of the obstruction was not diagnosed prior to laparotomy. Management included replacement of the aneurysm, plication of the thrombosed inferior vena cava, and evacuation of the hematoma. So far as the authors are aware, this is the first case of this type to be reported and one which adds another possible diagnostic consideration in managing inferior vena caval obstruction.


Iodine deficiency produces hypercalcemia and hypercalcitonemia in rats. To determine the effect of thyroid-stimulating hormone (TSH) on secretion of calcitonin by the thyroid, 50 male Sprague-Dawley rats were randomly separated into seven groups. The groups received different diets, medications, or operations [propylthiouracil (PTU), iodine-deficient diet, (LID), acute or chronic thyroxine treatment, sham operation (SO), hemithyroidectomy (Htx), and total thyroidectomy (Ttx)]. two weeks to six months later, serum TSH concentrations were increased in the Htx, Ttx, and LID groups when compared with SO animals. Serum calcitonin concentrations were increased in the LID- and PTU-treated groups and were decreased in animals that chronically received thyroxine. Serum calcium concentrations were increased in the LID animals, decreased in the Ttx animals, and were similar in the other groups. These findings suggest that TSH stimulates both follicular and parafollicular cells in the rat thyroid and that iodine deficiency causes hypercalcemia and hypercalcitonemia.


Comparison of cardiorespiratory effects of crystalline hemoglobin, whole blood, albumin, and Ringer's lactate in the resuscitation of hemorrhagic shock in dogs. We studied the time course and interactions of hemodynamic, oxygen transport, colloid osmotic pressure (COP), and blood volume responses to 500 ml of crystalline hemoglobin (Hgb), 500 ml of whole blood (WB), 1,000 ml of Ringer's lactate (RL), and 500 ml of plasma protein fraction (PPF) given in random order to 12 mongrel dogs subjected to hemorrhagic shock by the standard Wiggers' technique. In general, hemodynamic and oxygen transport responses were greater and more prolonged after the colloids than after RL. These responses were related to concomitant improvement in blood volume and COP. Of the colloids, Hgb appeared to produce somewhat greater hemodynamic and oxygen transport changes. This was particularly evidenced by comparison of these responses when each fluid was the first agent used after the hemorrhage. By virtue of its capacity to increase COP and plasma volume and to carry oxygen, Hgb improved both the gross circulation and the tissue perfusion, as indicated by cardiovascular hemodynamics and bulk oxygen transport variables.


Reoperative parathyroid surgery for persistent hyperparathyroidism. In a 2-year period 30 patients with persistent hyperparathyroidism following 59 prior unsuccessful procedures underwent reoperation. Preoperative arteriography was useful in planning the surgical approach in 56%, and retrospectively was correct in 63%. Selective venous catheterization gave localizing information in 83%, correctly predicting site or side in 60% of the total. Computerized axial tomography was helpful in identifying mediastinal glands before operation. Reoperation was successful in rendering the patient hypocalcemic or normocalcemic in 83%. Of the 11 patients (37%) who were rendered profoundly hypocalcemic, two were subsequently weaned from vitamin D and calcium support; seven have received either fresh or cryopreserved parathyroid autografts. Persistent hyperparathyroidism is a difficult surgical problem which we believe warrants aggressive localization attempts prior to operation. Autotransplantation with cryopreserved parathyroid tissue may be of value in the long-term management of the high incidence of postoperative hypocalcemia in this patient group.


Randomized trial of adjuvant therapy for "high risk" primary malignant melanoma. Retrospective pathological classification of 213 patients with malignant melanoma identified a group at high risk of recurrence (25% developed recurrence in 12 months, 50% by 5 years) after resection for apparent cure. Using these criteria, 70 patients were identified after resection of all apparent disease as being at high risk for recurrent melanoma. They were randomly assigned to one of the three adjuvant treatment arms: chemotherapy with dimethyl triazeno imidazole carboxamide (DTIC), immunotherapy with bacillus Calmette-Guerin (BCG), or combined chemoimmunotherapy. Six of 20 patients receiving DTIC developed recurrence (30%) and four died (20%). Five of 28 patients receiving BCG developed recurrence (18%) and two died (7.5%). There have been no recurrences or deaths in 22 patients receiving combined chemoimmunotherapy. In the prevention of early recurrence, the combined therapy arm was significantly superior to both the immunotherapy arm (p less than 0.05) and the chemotherapy arm (p less than 0.01). In terms of survival, combined therapy also was superior to chemotherapy alone (p less than 0.05).


Effects of intra-arterial infusion of prostaglandin E1 on gastric secretion and blood flow. The effect of intra-arterial infusion of Prostaglandin E1 (PGE1) on gastrict total and mucosal blood flow and acid secretion was studied in an exteriorized, chambered preparation of canine fundic stomach. Total gastric blood flow was measured simultaneously by venous outflow and by gamma-labeled microspheres. Mucosal blood flow also was measured by microspheres. Intra-arterial infusion of PGE1 at 1.0 microgram/min completely inhibited histamine-stimulated acid secretion. This inhibition was accompanied by a significant increase in both total (p less than 0.01) and mucosal blood flow (p less than 0.01). The  ratio of mucosal to total blood flow remained unchanged during histamine stimulation (78 +/- 4%) and PGE1 inhibition (79 +/- 4%). The results suggest that inhibition of acid secretion can occur in the face of increased blood flow. This observation is contrary to the generally accepted concept that inhibition of acid secretion always is associated with a decrease is mucosal blood flow.


Influence of vagus on mechanisms for stimulation and inhibition of gastrin release. In studies in dogs the gastrin response to food, to bombesin (1 micrgoram/kg-hr), and to somatostatin (2.5 and 5.0 microgram/kh-hr) plus food before and after truncal vagotomy was determined. Vagotomy caused an increase in basal levels of gastrin and in the release of gastrin after bombesin and food. Vagotomy augmented somatostatin suppression of food-stimulated gastrin release in a dose-dependent manner. We suggest that vagotomy causes a loss of both stimulatory and inhibitory vagal effects on gastrin release. Loss of vagal inhibition results in increased gastrin release to bombesin and food. Loss of vagal stimulation results in intensification of somatostatin-induced inhibition of postprandial gastrin release.


Congenital central nervous system malformations and vinyl chloride monomer exposure: a community study. Incidence rates for central nervous system (CNS) malformations in infants born to residents of Kanawha County, West Virginia, 1970-1974, were significantly higher than comparable United States rates during those years. Since Kanawha County contains a polyvinyl chloride (PVC) polymerization plant, a case-control study was conducted on the possible relationship between the occurrence of CNS defects and parental occupational or residential exposure to vinyl chloride monomer emissions from this plant. No relationship with parental occupation was found. While a tendency was noted for residences of case families to be located in an area northeast of the plant, this observation did not entirely correlate with existing data on local patterns of wind direction and air pollution.


Teratogenicity of adriamycin and daunomycin in the rat and rabbit. The antitumor drugs adriamycin and daunomycin were evaluated for effects on embryonal and fetal development in the rat and rabbit. Doses of adriamycin ranging from 1-2 mg/kg/day or daunomycin ranging from 1-4 mg/kg/day were administered ip to pregnant rats on days 6-15, 6-9, 9-12 or 12-15 of gestation. Both drugs were teratogenic in the rat, particularly when administered on days 6-15 or 6-9 of gestation. Relatively few anomalies resulted from treatment on days 9-12 or 12-15. On a mg/kg basis, adriamycin was the more potent teratogen, producing major anomalies at doses as low as 1.25 mg/kg. Similar anomalies, but at a lower incidence, were produced by daunomycin at dose levels of 4 mg/kg. Characteristic malformations included esophageal and intestinal atresia, tracheo-esophgeal fistula, hypoplasia of the urinary bladder and various cardiovascular anomalies. Neither drug was teratogenic when given iv to rabbits at doses up to and including 0.6 mg/kg/day on days 6-18 of gestation, but a high incidence of abortion occurred in rabbits treated with adriamycin.


Cranio-dirachischisis totalis in cephalothoracopagus twins. A set of conjoined 13-day-old male hamster twins is described. The twins were joined at the head and thorax. The brain was exencephalic and the neural plate was completely open throughout its length. The notochord was duplicated throughout its entire length. Partial twinning of the neural plate as indicated by histologic reconstruction is suggested with fusion or non-separation of the neural plates in the medial alar wing area. There was complete separation of the neural plates together with duplication of the lower extremities and tails in the caudal region of this specimen.


Effect of inorganic lead on the mouse blastocyst in vitro. In vitro culture of mouse blastocysts over the implantation period was used (1) to find out whether embryos recovered from uteri of mice given an injection of lead, which has been shown in a previous study to inhibit implantation in vivo, were capable of attachment and outgrowth when transferred to a lead free culture medium; (2) to study the effect of different amounts of inorganic lead in the culture medium on blastocyst viability and ability to attach and grow out. The levels of lead used in the medium were comparable to those found in uterine tissue of animals given an implantation inhibiting dose of lead. It was found that the preimplantation blastocyst was unaffected by the administration of lead to the mother as regards the ability to attach and grow out. It was also shown that normal blastocysts were adversely affected by the presence of lead in the culture medium. Addition of increasing amounts of inorganic lead (5, 10 and 20 mumol/l) caused a corresponding decrease in the ability of the blastocysts to attach and grow out, the highest concentration also causing abnormal appearance of the embryos within 48 hours of culture.


Teratogenicity of ethylenethiourea and thyroid function in the rat. Ethylenethiourea (ETU) was given by gavage at a dose of 40 mg/kg/day from Days 7 through 15 of gestation to hypothyroid and euthyroid rats, and to rats given exogenous thyroxine, to determine whether ETU teratogenicity occurs through alteration of maternal thyroid function. At sacrifice on Day 20 of gestation 84-100% of the fetuses in all groups given ETU were malformed regardless of the thyroid status of the dams. Ten percent of the fetuses of dams thyroparathyroidectomized at 75 days of age that were not given ETU were malformed; no malformations were noted among the fetuses of the other groups not given ETU. Hence, ETU was found to induce teratogenicity in rats but not through alteration of maternal thyroid status. In addition, it was determined that ETU lowered serum thyroxine concentration, that hypothyroidism itself increased the background level of malformations in the rat, and that hypothyroidism qualitatively and quantitatively increased the incidence of specific malformations after ETU administration.


Familial combined cellular and humoral immune defect with multisystem granulomata. A brother and sister presented with recurrent respiratory infections. Investigations showed combined cellular and humoral immune defects and non-caseating granulomata in lungs, liver, lymph nodes, and skin. Despite antimycobacterial chemotherapy and corticosteroids in the brother and the additional treatment of human immunoglobulin injections in the sister both patients deteriorated with pulmonary and hepatic involvement.


Unexpected longevity in patients with severe kyphoscoliosis. The threat of premature death in the fourth or fifth decades of life from cardiorespiratory failure in kyphoscoliosis is well known. Ten patients with severe kyphoscoliosis (curves greater than 100 degrees), who had survived into their seventh decade free of cardiorespiratory failure, were encountered over a four-year period. Pulmonary function studies on five patients showed impaired chest bellows function. Four patients died of acute respiratory failure at ages 65, 73, 79, and 85. These patients illustrate that severe deformity is not incompatible with a long and active life.


A late complication of a diagnostic mediastinoscopy. A 69-year-old man with a moderately well differentiated squamous-cell carcinoma of the lung, underwent a mediastinoscopy. All histological examinations of the mediastinal nodes were negative. The patient was treated with a curative left pneumonectomy. Three months after this negative mediastinoscopy the patient developed a metastasis in the mediastinoscopy scar. A report of this case and a review of the literature are presented.


Neurofibroma of the trachea: a case report. A tracheal tumour was discovered by radiology in a 36-year-old man with haemoptysis, bronchitis, and dyspnoea. The tumour was situated 5 cm below the vocal cords. A frozen section of a bronchoscopic biopsy specimen confirmed it to be a neurofibroma. Resection was performed endoscopically.


Acute pleurisy in sarcoidosis.

Acute pleurisy in sarcoidosis. A 47-year-old white man with sarcoidosis presented with a six-week history of acute painful pleurisy. On auscultation a loud pleural rub was heard at the left base together with bilateral basal crepitations. The chest radiograph showed hilar enlargement as well as diffuse lung shadowing. A lung biopsy showed the presence of numerous epithelioid and giant-cell granulomata, particularly subpleurally. A patchy interstitial pneumonia was also present. He was given a six-month course of prednisolone, and lung function returned to normal.


Polyvinyl chloride pneumoconiosis.

Polyvinyl chloride pneumoconiosis. A 53-year-old man, who had been exposed for 23 years to polyvinyl chloride (PVC) in the bagging area of a vinyl chloride polymerisation plant, presented with a diffuse micronodular infiltrate on his chest radiograph. Light microscopy of lung obtained by drill biopsy showed a diffuse infiltration with histiocytes and multinucleated giant cells, with some collagen formation. Ultrastructural studies showed foreign particles in the macrophages, which were identical with PVC powder viewed under the electron microscope. Incubation of PVC powder with human lung macrophages in vitro showed that the macrophages englufed the powder to give a similar ultrastructural appearance.


Malignant mesothelioma of the pleura in Barrow-in-Furness. Ffty cases of malignant pleural mesothelioma (47 men and 3 women) have been diagnosed during the period 1966-76 in Barrow-in-Furness, all of them histologically proved and accepted by the Pneumoconiosis Panel. At the time of writing only three survive. There was a history of industrial exposure to asbestos in all 47 men, who had worked in various trades in the shipyard, as had one of the women. One of the women was married to a shipyard plumber, who may have brought home asbestos dust on his clothes. Only one patient, a housewife, aged 28 at diagnosis, had no known asbestos contact. The asbestos content of the lungs has been measured in the last 20 cases, in 18 of whom it was found to be substantially greater than the accepted levels for the general population. In a small number studied by electron microscopy, the predominant fibre was crocidolite. A positive histological diagnosis was achieved in 39 subjects during life in the expectation of securing industrial compensation, but, in spite of this, less than half of the dependants are currently receiving payments. Metastases, though never clinically apparent, were frequent at necropsy.


Evagination of smooth muscle cells in the hypoxic pulmonary trunk. Six female Wistar albino rats were exposed to the hypoxia of a simulated altitude of 5500 m, three for a period of one week and three for a month. They developed ultrastructural changes in the pulmonary trunk consisting of evaginations of muscle cells of its media through gaps in the internal elastic lamina to press into the underlying endothelial cells. Such evaginations were usually devoid of myofilaments and organelles. Some appeared so electron-lucent as to be unrecognisable as muscle apart from the unequivocal connection with the parent smooth muscle cells. Elsewhere we have demonstrated that muscular evaginations in normal pulmonary blood vessels are an artefact brought about by collapse of lung tissue and that they can be avoided by distending the lung. Hence in the present investigation, in which the pulmonary trunk was fixed in distension, the evaginations are interpreted as indicating contraction of the muscle cells able to overcome the distending force. We interpret them as evidence of constriction of muscle cells in the media of the pulmonary trunk in response to hypoxia.


Ventilatory effects of aerosol gentamicin. Bronchial provocation tests with gentamicin solution, 40 mg/ml, and with the drug vehicle solution alone were carried out in 29 subjects aged 19 to 66 years. There were 18 subjects with bronchial asthma, four with chronic bronchitis, four with primary carcinoma of the lung, and three with no chest disease. Two millilitres of each of the two test solutions was given to each subject, in duplicate, via a nebuliser driven by a Bird Mark 8 respirator. Ventilatory function (FEV1 and VC) was measured before and after each inhalation, and changes were expressed as percentage variations from baseline. Seven subjects, all from the asthmatic group, developed at least one immediate FEV1 fall of 20% or more. The reactions ranged up to 71% and occurred to both test solutions. There was a trend towards greater reactions to the vehicle. In two subjects pretreatment with salbutamol and sodium cromoglycate did not modify these reactions. In three of the seven, inhalation of 2 ml normal saline produced FEV1 falls of 25% to 30%, but these falls were not as great as each subject's reactions to the test solutions. Skin prick tests using the gentamicin solution were negative in all subjects. These results show that substantial obstructive reactions may occur in some asthmatic subjects after inhalation of gentamicin. The reactions appear to be non-immunological in nature and may be due to an irritant effect of the drug vehicle.


Airflow in unilateral vocal cord paralysis before and after Teflon injection. The effect of unilateral vocal cord paralysis and intracordal Teflon injection on maximum expiratory and inspiratory flows was studied in 15 consecutive patients. Ten patients had a ratio of forced expiratory flow to forced inspiratory flow at 50% vital capacity (Ve50/Vi50) more than one. Of the remaining five, four had low Ve50 consistent with underlying bronchial disease. Repeat studies were obtained in 10 patients two or more weeks after Teflon injection into a vocal cord for voice therapy. Maximum expiratory flow rates did not change (means 6.64 +/- 0.881/sec before and 6.47 +/- 1.101/s after injection). Inspiratory flow at 50% vital capacity improved in all six patients with a forced expiratory volume in one second (FEV1) greater than 75% of the forced vital capacity (FVC). In patients with an FEV1 less than 75% FVC, no consistent changes could be seen. We conclude that a high Ve50/Vi50 suggestive of variable extrathoracic airways obstruction is a frequent finding in the presence of unilateral vocal cord paralysis. Teflon injection does not cause a significant reduction in forced expiratory flows and improves inspiratory flows in subjects without evidence of underlying bronchial disease.


Management of pulmonary artery sling (anomalous left pulmonary artery arising from right pulmonary artery): a conservative approach. An anomalous left pulmonary artery arising from a right pulmonary artery and passing between the trachea and oesophagus was seen in seven patients over a period of 20 years. All of them had main airway obstruction. Surgical division and re-anastomosis of the anomalous artery in front of the trachea produced an unsatisfactory result in the first two patients. The only surgical procedure undertaken in the subsequent five patients was division of a ligamentum arteriosum; this formed part of a compressing ring in one patient. Three patients, one of whom had associated tracheobronchial stenosis, became completely asymptomatic. Two others, both with tracheobronchial stenosis, still have symptoms; the older has shown considerable improvement, while the younger is only 7 months old. It is suggested that a more conservative approach to the management of this anomaly is justified. In patients with associated tracheobronchial stenosis, symptoms are most probably the result of that anomaly. Surgical division of the anomalous artery is unlikely to be beneficial, and death from postoperative complications frequently occurs. Surgical division of the anomalous artery in patients with extrinsic tracheal compression should be considered only if life is threatened, as spontaneous improvement can be anticipated. Recent advances in respiratory care should assist in the conservative management of distressed infants.


Ductus arteriosus sling: report of a newly recognised anomaly and its surgical correction. Surgical exploration of a 7-week-old infant with a diagnosis of 'pulmonary artery sling' (left pulmonary artery arising from the right) revealed the true nature of the abnormality to be persistence of the ductus arteriosus which connected the right pulmonary artery to the aortic isthmus. This malformation has not been described previously. It has the same symptomatology as 'pulmonary artery sling' and it may be treated by surgical ligation and division. We suggest the term 'ductus arteriosus sling' to describe this rare congenital anomaly.


Chronic cor pulmonale in pulmonary sarcoidosis. Right-heart overload happens relatively rarely in sarcoidosis, even with fibroemphysematous changes. Of 21 cases that we studied, six (28%) had clinical and/or electrocardiographic features of cor pulmonale. The cause of cor pulmonale often evoked is an invasion of the walls of pulmonary vessels by sarcoid granulomas or their compression by the fibrotic process. Pathological studies in one patient showed compression of large pulmonary arteries associated with specific sarcoid lesions in small small and medium-sized arteries.


Interpretation of lung function tests in the sickle-cell haemoglobinopathies. Prediction equations have been evolved for the assessment of vital capacity, total lung capacity, and the single breath carbon monoxide transfer factor in haemoglobin SS and haemoglobin SC disease. These relationships take account of the growth disorder and anaemia in the sickle-cell states. The results suggest that, in the clinically stable state, any effects of alveolar capillary sickling and haemoconcentration and any altered reactivity of haemoglobins S and C with the test gas are of no significance for clinical respiratory physiology. Sex differences in lung function appear independent of haemoglobin type.


Cyclophosphamide pneumonitis.

Cyclophosphamide pneumonitis. Cyclophosphamide can rarely cause interstitial pneumonitis and fibrosis. Although it has been reported previously in patients being treated for lymphoma, it occurred in this case in a man under treatment for glomerulonephritis. The temporal sequence of the respiratory insufficiency and the histopathology, when compared to the previous examples in the literature, suggest that cyclophosphamide was aetiologically responsible for the lung disease. There may be an interval of one or more months after discontinuation of cyclophosphamide therapy before clinical or radiological improvement occurs.


Tuberculous pericarditis in Birmingham.

Tuberculous pericarditis in Birmingham. Forty-one patients with acute tuberculous pericarditis were studied retrospectively. Anti-tuberculosis chemotherapy alone was effective in thirty. Five patients died, two from unrelated causes, two due to delayed diagnosis, and one after pericardiectomy. Constrictive pericarditis developed in seven patients, six of whom had successful pericardiectomy. Corticosteroids could not be shown to have reduced the risk of developing constriction. When constriction occurred it did so within the first six months of illness in all cases in contrast to a separate series of 15 patients who presented with constrictive pericarditis. These had had no previous history of tuberculosis, and in 10 cases where pericardiectomy was done, no histological evidence of tuberculosis was found. They were European with an average age of 49 years whereas in the group with acute tuberculous pericarditis 33 were Asian and the average age was 36 years.


Depression of central respiratory drive by nitrazepam. In a group of patients with chronic bronchitis, repeated night sedation with 10 mg nitrazepam produced a fall in central respiratory drive and a steady rise in arterial carbon dioxide tension. The changes produced over a five-day period were not clinically important, except in two patients who were already hypercapnic before receiving nitrazepam. The use of this drug in patients with carbon dioxide retention should be avoided.


[Effects of Mycoplasma synoviae infection on the state of health, reactions to vaccination and results of fattening in broiler chickens (author's transl)]. Four cases in which contact infection was experimentally induced in broilers by Mycoplasma synoviae (M.s.) are reported. The chickens were inoculated against Newcastle disease (NCD) and infectious bronchitis (IB) in accordance with the Netherlands vaccination programme. Fattening was continued for six weeks. The rate of horizontal transmission of M. synoviae infection varied with the severity of the virus infection (i.e. vaccination). There was a close correlation between this finding and the adverse effects of M. synoviae infection on the severity of the reactions to vaccination, the final weight, the table quality and feed conversion. Moreover, there was evidence to suggest that M. synoviae accelerates the appearance of dyschondroplasia in broilers.


The effect of diet on the establishment and growth of Ostertagia ostertagi in calves. Three groups of four calves were raised parasite-free. Each group received a different diet. At the moment of infection one group was fed with milk equivalent artificially dried grass, and concentrates, the second with water, grass pellets (16 mm), and concentrates, while the third was fed with water, artificially dried grass, and concentrates. Each animal was infected at an age of 8 weeks with 10,000 larvae of Ostertagia ostertagi and necropsied 28 days later, No significant differences between the groups were observed with regard to the number of worms post-mortem, length of worms, number of eggs per female, or gain of weight of the calves.


Lysozyme and its presence in bovine milk and serum. The literature on the presence of lysozyme in various biological fluids in physiological and pathological conditions is reviewed. Preliminary results of lysozyme estimations in bovine milk show that lysozyme levels are definitely higher in colostrum and mastitis milk than in normal milk. The biological role of the enzyme in the milk still has to be defined. On the other hand, lysozyme may interfere with microbiological screening techniques for penicillin in cow's milk; the lytic effect of purified human lysozyme on B. stearothermophilus var. calidolactis was demonstrated microscopically.


A genetic study of Behçet disease in Israel. The frequency of HLA-B5 in 24 Israeli Behçet disease (BD) patients from various subpopulations was significantly greater than in 615 control individuals (P less than 0.003). The relative risk for a B5 carrier to develop BD was calculated to be 5.0. Six patients were offspring of consanguineous marriages, which is not unexpected in the populations studied. Five of the patients had only one HLA-B antigen, which in four cases was B5. Two of the latter were B5 homozygotes, indicating a possible greater susceptibility. This study confirms the reported association between BD and HLA-B5 in a populationnot previously investigated. Furthermore, these data support the suggestion that B5 is associated with BD in populations deriving from the Mediterranean Basin, the Middle East and Far East.


Scanning electron microscopy of the channel catfish olfactory lamellae. The olfactory lamellae of the channel catfish (Ictalurus punctatus) are composed of sensory and indifferent (non-sensory) epithelia organized into two distinct regions on both surfaces of each lamella. The smaller sensory region located adjacent to the midline raphe has fewer cilia per unit surface area than the indifferent epithelium and contains the olfactory neurons whose ciliated dendritic terminals occur at the epithelial surface. The indifferent epithelium, comprising the greater surface area of the olfactory lamella, is covered with a dense mat of non-sensory cilia. Fractured carbon dioxide critical point dried lamellar tissue revealed the underlying cellular structure. The lamellae are composed of two layers of epithelium enclosing a thin stromal layer. Olfactory receptors were observed in the fractured tissue only within the sensory epithelium.


Kupffer's vesicle in Fundulus heteroclitus: a scanning and transmission electron microscope study. Kupffer's vesicle, a transitory organ peculiar to teleost embryos, was investigated in embryos of Fundulus heteroclitus by scanning electron microscopy. The roof of the vesicle is constructed to rather large columnar cells which are in continuity wiht hypoblast cells. Each of the roof cells is adorned with a single long cilium which emerges from a depression in the center of the surface and extends into the cavity of the vesicle. Studies with a transmission electron microscope confirm and extent these observations. The surface of the roof of the vesicle variously exhibits the presence of droplets and viscous and/or filamentous material. The exposed surface, however, sometimes appears clean and somtimes appears to have undergon partial destruction. The periblast floor of the vesicle is characterized by the presence of numerous folds and/or microvillus projections into the cavity of the vesicle. A filamentous precipitate is sometimes present. These observations are discussed in terms of the possible functional significance of this unique evanescent organ of the teleost embryo.


Septate junctions in insects: comparison between intercellular and intramembranous structures. Septate junctions have been studied in the hind-gut of Periplaneta americana, Incisitermes schwartzi and Thermobia domestica. The topographical disposition of intercellular septa revealed by lanthanum impregnation corresponds well with that of particle rows seen in freeze fracture preparations. However, there is no precise correspondence between the undulations of septa and the disposition of particles within a single row. The spacing of particles is variable and generally less than that of the undulation periodicity of septa. On the other hand, the disposition of septa, and of the rows of particles that correspond to them, appears to be variable: sometimes rectilinear and in close parallel, these may curve or form series of 'finger-print' loops. Moreover, the septa are evidently not deployed as continuous ribbons around the cell since intrruptions are freuqently observed. In addition to their mechanical role in intercellular cohesion, septate junctions apparently ensure a more or less complete closure of the intercellular space (i.e. provide a permeability barrier) and thus play a role comparable with that of tight junctions in epithelia of vertebrates.


Septate junctions between digestive vacuoles in human malacoplakia. Typical septate junctions between digestive vacuoles in phagocytic cells of human malacoplakia are described in this paper. Evidence for a honeycomb pattern of hexagonal subunits is presented for their cleft material. Junctions were not observed between other organelles or in cells other than phagocytes. It is assumed that the septate junctions described here may reflect a pathological change in the organization of the membrane components of digestive organelles.


Fine structure of muscle insertions on the larval shell and operculum of the nudibranch Phestilla sibogae (Mollusca: Gastropoda) before and during metamorphosis. In Phestilla, the attachment of the larval body to shell and operculum occurs at muscle insertion sites. Attachment zones are specialized areas of squamous epithelium wherein the cells contain structures considered to be cytoplasmic anchors. The anchors are intracellular organelles consisting of apical and basal hemidesmosomal plaques connected by bundles of tonofilaments which traverse the cells. Muscle-to-epithelium and epithelium-to-shell adhesion is probably due to an extracellular cement. At metamorphosis, both shell and operculum are lost. Electron microscopic investigation of shell and opercular attachment sites during metamorphosis has demonstrated that apical hemidesmosomes lose their integrity and tonofilament bundles pull away from the apical plasmalemma of the epithelial cells as the cells lose contact with the shell or operculum.


Ultrastructure of a cephalic sensory organ in larvae of the gastropod Phestilla sibogae (Aeolidacea, Nudibrachia). The cephalic sensory organ is a superficial sensory receptor located between the velar lobes at the level of the shell aperture. Three cell types make up this sensory area: (1) six flask-shaped cells bearing numerous cilia: (2) adjacent supporting or accessory cells which have numerous, often branched, microvilli; and (3) vacuolated cells which occupy the center of the area. The flask-shaped cells appear to be the sensory units. These cells have a deep invaginated lumen, with ciliar arising from the cell surface in the lumen oriented either toward the base of the lumen or toward the epidermal surface these cilia, some of which extend slightly above the body surface, are presumed to be non-motile, as they lack (dynein?) arms on the axonemal A tubules and lack striated rootlets. The six flask cells are in intimate contact with the underlying cerebral ganglia and axons from each cell pass into ganglionic tissue. The supporting cells may be sensory, but no direct connection with the nervous system was seen. The function of the central vacuolated cells is not known. This cephalic organ may be a derivative of the original apical tuft of the trochophore stage.


Flight muscle differentiation in nymphs of a dragonfly Anax imperator. Flight muscle fibers of Anax imperator nymphs, in different developmental stages are analyzed for several morphological features, such as the arragnement and numerical ratio of actin and myosin filaments, the pattern of the T system and sarcoplasmic reticulum, the number of microtubules and the fractional volume of mitochondria in each fiber. The T system is initially represented by longitudinal grooves on the cell surface, joined with vesicles of the sarcoplasmic reticulum; this pattern rapidly changes and the grooves start to break up into longitudinal segments. The thin to thick filament ratio is at first quite high (about 4-4.5:1) but rapidly falls to the final (3:1) when the myofibrils are well developed at the fiber periphery. Statistical analyses show that the measured values are significantly different in the various stages of development, also indicating a progressive reduction of the ratio variability. The reduction of thin to thick filament ratio and the variance decrease fit quite well with the hypothesis that the synthesis of actin and myosin depends on independently regulated messenger RNA molecules.


High resolution scanning electron microscopy of frog sartorius muscle. A field emission-type scanning electron microscope (SEM) was used to study the three-dimensional ultrastructure of frog sartorius muscles. Various preparative procedures were tested to seeks better specimen preparation for high resolution SEM observation. Procedures should be chosen depending on the information desired. The cell surface and intracellular organization of muscle fibers were best visualized when the tissues were fixed with tannic acid-OsO4 and torn after critical point drying. The basal lamina appeared as a continuous felt-like layer, onto which fine filamentous materials adhered. The true outer surface of the sarcolemma was not seen, whereas the true inner surface was occasionally exposed and exhibited numerous caveolae, membraneous fragments and fine filaments attached to its surface. In freeze-fractured and dried tissues, the cleaved sarcolemma showed numerous apertures of caveolae and T-system tubules. Inside the cell, the myofibrils showed a typical branding pattern of the sarcomere. Thick myofilaments were regularly beaded except for the pseudo-H-zone. Around the myofibrils the sarcoplasmic reticulum and T-system were also clearly observed. The results are discussed with special reference to the usefulness and limitation of the high resolution SEM in studying the ultrastructure of cells and tissues.


A single spiral artefact in arthropod cuticle. Spirals are often seen in sections transverse to the axes of bumped structures in arthropod cuticle. (Sections through arthropod cornea or exocones yield excellent examples.) As arthropod cuticle has a helicoidal architecture (Bouligand, 1965), it might be expected that the spirals are a simple consequence of that structure. According to a symmetry argument, the spirals thus predicted must be double spirals. In contrast, the observed spirals are usually single. We propose that the single spirals result from an interaction between the microtome knife and the cuticle architecture. The direction of knife travel defines an orientation within the cuticle, subverting the symmetry arguments that require double spirals. Bouligand (1972) presented a model for the interaction of the knife with the cuticle. However, we offer arguments and observations show that Bouligand's model is incorrect. We argue from detailed observations of the single spiral that it is indeed a knifing artifact and that its explanation probably lies within a certain class of models. Two related models based on relative movements of cuticle components are examined via computer techniques.


Ultrastructure of the anterior sense organs of adult Gastromermis Boophthorae (Nematoda: Mermithidae). The amphids of adult Gastromermis boophthorae exhibit an organization unlike any previously reported. Each amphid consists of a distal cuticular channel which opens to the exterior, and a proximal amphidial gland. The cuticular channel is double and 15-18 cilia are held in a tight bundle by the inner channel. The amphidial gland contains an extensive reticulum, and the nerve axons which give rise to the amphidial cilia are arranged around the outside of the gland; anteriorly these axons are characteristically flattened. A granular secretion is produced by the amphidial gland and passes via the reticulum to the double cuticular channel, thus bathing the ciliary bundle. The ultrastructure of the amphids is discussed in relation to functional considerations.


Comparison of the ultrastructure of stimulated and unstimulated mechanoreceptors in the taste hairs of the blowfly Phaenicia serricata. The structure of mechanoreceptors at the base of labellar taste hairs of the blowfly Phaenicia serricata were examined in stimulated and unstimulated conditions (i.e. with the hair bent or unbent). Physiological recordings from the mechano-receptor showed that the receptors responded when the hair is bent dorsally or ventrally and when the hair is bent at extreme angles. These conditions are the same as those placed on hairs in the anatomical studies. Bending the hair toward the ventral labellar surface caused the hair base to compress and indent the tubular body and its surrounding membrane and sheath at the distal end of the mechanoreceptor dendrite. In compressed tubular bodies, microtubules oriented longitudinally were bent and separated a greater distance from each other. Separation as much as 70 nm was observed in compressed tubular bodies as compared with a maximum of 26 nm between micro-tubules in tubular bodies of unbent hairs. The dense amorphous material between microtubules of compressed tubular bodies formed prominent bridges 18 nm thick connecting the microtubules at intervals of 48-74 nm. Thin 10 nm filaments were also evident in the spaces between microtubules. When the hair was bent toward the proximal end of the proboscis, the tip of the tubular body was bent about 15 degrees. The tubular body appears to function as a firm but resilient structure over which the dendritic membrane can be stretched during mechanostimulation. Comparison of morphology of bent and unbent hairs suggests a means by which mechanical force from the movement of the hair is transferred to the receptors by structures in the hair socket region. No differences were found in ciliary structures of stimulated and unstimulated receptors.


A morphological study on gills of the brown shrimp, Penaeus aztecus. The gills of Penaeus aztecus were examined by light and electron microscopy. They are dendrobranchiate, consisting of a central axis with biserially arranged branches that subdivide into bifurcating filaments. A septum divides the lumina of these structures into afferent and efferent channels. Hemolymph from the sternal sinus flows through the afferent channels into the filaments where it is directed into the efferent channels and finally to the pericardial cavity. In addition to these channels, numerous blood vessels permeate the gill. The cuticle covering the gill overlies a thin epithelium which is separated from hemolymph by a basal lamina. The epithelium, which is active in cuticle secretion, has a series of pillar processes that form subcuticular lacunae. The apical membranes of epithelial cells become folded in shrimp exposed to hypo- and hyperosmotic salinities. Granular cells that contain elaborate Golgi apparati and several types of granules are present throughout the gill. Nephrocytes resembling glomerular podocytes line the efferent channels. A large nerve traverses the septum in the axis.


Epithelial dysplasia in cancerous and noncancerous esophagi. Subserial examinations of the noncancerous esophagus from 86 autopsy materials (male 47, female 39) in Kagoshima Prefecture revealed epithelial dysplasia in 54 instances (63%); 32 males (68%) and 22 females (57%). Higher grades of dysplasia were shown in 17 males (36%) and 3 females (8%). Histologically a formation of the rete ridge-like elongation of basal epithelium was characteristically conspicuous in these materials. Tabacco and alcohol intakes were regarded as promoting factors of dysplasia. Distribution and severity of dysplasia around carcinoma were histologically examined on semiserial blocks in 100 surgical materials under the consideration of preoperative treatment. A coexistence of carcinoma with extensive dysplasia was found in 24 instances and that with multifocal dysplasia in 46. Multicentric in situ carcinoma was found in 19 patients. These in situ carcinomas were frequently surrounded by severe dysplasia and occasionally showed gradual transition to the latter. The lesion of invasive carcinoma sometimes did not show sharp demarcation from the surrounding mucosa, especially in cases of well differentiated squamous cell carcinoma. The results indicate that dysplasia plays a significant role on carcinogenesis of the esophagus as a precursor lesion.


Introduction of a method of valvuloplastic esophagogastrotomy in proximal gastrectomy. A technique of valvuloplastic esophagogastrostomy is proximal gastrectomy to control postoperative reflux esophagitis is reported. After proximal resection of the stomach, the medial stump is closed in two layers. The mucosal layers of the lateral stump are sewn but leaving the seromuscular layers open. The esophagus is anastomosed to the mucosal stoma at the middle of the gastric stump. The distal esophagus is wrapped by the lateral stump like Nissen's fundoplication to create the artificial fundus. Intragastric esophageal wall facing the fundus acts as a long one-way flap valve to prevent reflux. Ten dogs were prepared with this method and were compared with end-to-end and end-to-side anastomosis prepared in five dogs each. Cinefluoroscopy and esophageal pH demonstrated various degress of reflux in all the dogs with end-to-end and end-to-side anastomosis, and mild reflux in one out of the ten dogs with valvular anastomosis. A sharp rise in pH at the anastomotic site was consistent in the remaining nine valvuloplastic dogs. High pressure zone, 9.9 mmHg on an average at the site of anastomosis was present in valvuloplastic dogs, while the pressure was 0 mmHg in end-to-end and 5.2 mmHg in end-to-side anastomosis dogs. Clinical application of this procedure in ten patients obtained satisfactory results. The technique offers a reliable method of valvuloplastic anastomosis in esophagogastrostomy.


Whole body bone scintigram and stage classification of the patients with adenocarcinoma of lung. One hundred and six patients having adenocarcinoma of the lung were studied by whole body bone scanning with 99mTc-phosphates in connection with their clinical stages. Abnormal accumulation was found in 64 patients (60%). There were 64 patients who received surgical treatment. Among these 64 patients, 38 underwent bone scanning within 3 months after the establishment of their clinical stages. Twenty-two of them were classified as Stage I clinically. Pathological stage classification after the surgery revealed these 22 to be classified into 3 groups; 6 for Pathological Stage I, 4 for Pathological Stage II and 12 for Pathological Stage III. None of these 6 in Stage I showed abnormal accumulations. However, 1 of 4 in Stage II and 6 of 12 in Stage III were found to have abnormal accumulations. Therefore, if bone scintigrams had been taken into consideration for clinical stage classification, 7 patients would have never been placed into Clinical Stage I and could be expected more precise treatment. The authors recommend application of the results of whole body bone scanning to stage classification of adenocarcinoma of the lung. Needle biopsy is also recommended to confirm the metastasis at the site of radioisotope accumulation in the rib.


Cytological diagnosis of cancer of the colon and rectum. Results of cytological examination in 120 cases of colon and rectum cancer during the 11-year period ending in 1968 prior to the practical use of fibercolonscope were first studied. At that time, quite favorable results were obtained in cancer of the lower colon and the rectum, but the results were not so satisfactory in cancer of the right side of the colon. After 1969 when the fibercolonscope was introduced into the clinical practice, the range of cytological diagnosis under direct vision was at once expanded to the entire colon. Consequently, diagnosis by the cytological method in 140 cases of cancer of the colon and rectum experienced in 6-year period between 1969 and 1974 revealed favorable results. The results of the cytological diagnosis in cancer of the right sied of the colon, previously not always favorable, improved markedly after the introduction of the cytological method under direct vision through fibercolonscope. When early cancer of the colon and rectum is defined as in early gastric cancer, 40 lesions in 36 patients were detected during the past 19 years. The rate of positive result in cases of early cancer obtained by various diagnostic methods was 83% by the cytological method, 78% by biopsy and 91% by polypectomy. In cases in which both biopsy and cytological method were used, one or both frequently gave positive results. These results would indicate the possibility of correct diagnosis in many cases through the combined use of the cytological method and biopsy, without polypectomy.


The effect of oral chenodeoxycholic acid on cholesterol solubility in hepatic bile. By oral administration of chenodeoxycholic acid (CDCA) varying in dose for 7 consecutive days to patients who underwent cholecystectomy with biliary drainage for cholesterol gallstone, the biliary cholesterol dissolubility was studied in pursuit of the optimum dose in CDCA therapy for cholesterol gallstone. The rate of dissolution of biliary cholesterol by CDCA administration was highest in cases of 250 mg/day in dose, followed by those of 750 mg/day. When the dose was observed from per kg of body weight, the dissolubility of cholesterol was highest in the case of 6.3 mg/kg, followed by one of 12 mg/kg. Thus, it is presumed that in CDCA therapy for cholesterol gallstone a dose of 250 mg/day is too small and 750 mg/day too large in amount from the viewpoint of its effectiveness. The optimum dose probably lies between 5 mg/kg and 12 mg/kg. A transient elevation in levels of SGOT and SGPT was observed only in one case treated with 750 mg/kg.


[A review of 25 years' clinical application of fast electrons in radiation therapy (author's transl)]. The first betatron developed for current use of fast electrons in radiation therapy (15 MeV, Siemens) has been installed at the Dermatologische Klinik der Universität Göttingen in 1952 (Bode, Markus). The first human carcinoma treated with fast electrons was irradiated using the first 6-MeV-betatron (Dr. Gund, Siemens) at the 2nd institute of physics of the Göttingen university (Bode, Kopfermann, Paul, 1949). Characteristics of the electron radiation utilized for treatment and its particular advantages in dermatological radation therapy are reported. Two clinical examples, one of them the first human carcinoma irradiated with fast electrons, are described, and the frequency distribution of the indications for electron therapy at the dermatological clinics of the university is tabulated for a total of 3419 cases treated between 1949 and 1972 (Bode et al.).


The neutron therapy facility (DT, 14 MeV) at the radiotherapy department of the university hospital Hamburg-Eppendorf. The neutron therapy facility at the Radiotherapy Department of the University Hospital Hamburg-Eppendorf is described. This unit has been developed for clinical purposes according to the initiative and conception of the radiotherapist by AEG/Fed. Rep. of Germany and RDI/USA since 1969. The installation was completed at the beginning of 1974. Special treatment head and bed systems allow isocentric treatment and arc or multiple port therapy. For routine work operation conditions of 8 to 12 mA total beam current and 500 kV accelerating voltage are used. The neutron output at 12 mA is about 3.5 x 10(12) n/s giving a phantom dose rate of more than 20 rad/min for a field size of 17.8 x 17.8 cm2 at 80 cm source-skin distance. Technical installations for improvement of dose rate and half-life of the target are planned. Results of physical measurements about neutron energy distributions, contributions from neutrons and gamma-rays to the total absorbed dose, build-up effect, axial and lateral dose distributions as well as isodose profiles for different field sizes in a homogeneous phantom are presented. Bewteen February 1976 and November 1977 up to 180 patients have been treated.


[Radiotherapy of blastomatous hemangiomas - under special consideration of 44 eyelid hemangiomas (author's transl)]. The propriety of blastomatous hemangiomas to show spontaneous regression is underlined. Under certain indications, above all in case of eyelid hemangiomas, a radiotherapy is indicated. The moment of manifestation lies within the first three months of life, and the female sex is affected two times more frequently. The head represents the predilection spot within the distribution scheme of hemangiomas. 44 patients with eyelid hemangiomas who had been treated between 1968 and 1972 by the described irradiation method had check-up appointments five years later. The therapeutical results were evaluated according to certain criteria. 95,5% of the blastomatous hemangiomas showed a very good or satisfactory regression. Only 4,5% did not present any satisfactory success. In an advanced age of the patients, the hemangiomas do not always respond favourably to radiotherapy. In case of a strictly executed indication and a faultless irradiation technique, irradiation damages can be avoided. Our results show that, with regard to the spontaneous regression of blastomatous hemangiomas, total doses of 1000 to 1500 rd are sufficient. Finally the authors cite the standpoints of radiotherapy concerning the treatment of blastomatous hemangiomas and give recommendations for dosage principles.


[Therapy of carcinoma of the gingiva: results of radiotherapy and combined therapy in 88 patients in the years 1950 to 1976 (author's transl)]. The results of radiotherapy alone or in combination with surgery in the treatment of 58 patients with primary cancer of the gingiva and 30 patients with primary cancer of the buccal mucosa and secondary manifestation on the gingiva are represented. More than 60% of the patients after combined treatment survive symptomless for more than five years. The results of ratiotherapy are inferior to the results of the combined treatment also in early lesions. Analysis of the own experience and data from published series show that in most cases of gingiva cancer the combined treatment should be preferred.


Five-year survival of patients with larynx carcinoma treated with irradiation. 182 cases of laryngeal carcinoma treated with irradiation alone or combined surgery and radiotherapy are presented. The five-year survival of the whole series was 56%. 109 (60%) of the cases had a glottic, and 73 (40%) a supraglottic tumour. Of the patients with glottic tumour 58% and of those with supraglottic tumour 53% survived five years. There was no significant difference between cases treated with conventional X-rays and cobalt therapy except in T1 cases which were treated with radiotherapy alone: of the 21 cases treated with X-rays eleven (52%), and of 29 treated with cobalt 24 (83%) survived five years.


[Advantages and disadvantages of a 5.7 MeV linear accelerator compared to a 60Co-unit (author's transl)]. A comparison between a 60Co therapy unit and a 5.7 MeV linac shows the following advantages of the accelerator: 1. More favourable depth dose distribution with an improvement of the field homogeneity in the midplane for mantle techniques by a factor of 3 without the use of compensating filters. 2. Change of the maximum from 4 to 12 mm depth and thereby better skin sparing and greater dose tolerance of the skin and subcutaneous tissue. 3. Up to 10 times less penumbra. 4. Increased and stable dose rate of approximately 250 rd/min. At the moment the main disadvantages are the 20 to 30% higher purchase and running costs, and furthermore a downtime of at least 1 week per year for servicing and repair.


[Sonographic representation of fibroses (a contribution to the problem of tissue differentiation) (author's transl)]. Twelve patients with radiogenic fibroses were submitted to a sonographic examination by means of a grey-scale compound-scanner. As these skin fibroses are well suited for inspection and palpation, they are qualified to serve as a model with regard to the problem of sonographic tissue differentiation. Fibroses of medium and high degree are determined by characteristic properties in the B picture, whereas fibroses of low degree cannot be recorded by this technique.


[Short-term incubation in vitro with precursors of nucleic acids on human primary tumors and metastases of carcinoma of the breast (author's transl)]. A technique of short-term tests in vitro by means of the incubation of tumor cell suspensions is utilized as a radioactive-biochemical method for pretherapeutic determination of the resistance in human cancers of the breast. Cell suspensions from primary tumors and metastases reveal individually different responses to cytostatics in vitro. It is possible, therewith, to differentiate two tumor collectives related to in vivo resistant or in vivo sensitive tumors. The responses of the primary lesion and the axillary lymphatic metastasis of the same carcinoma may in single cases also differ in vitro, according to clinical experience with the therapy of breast cancer. A distinct relation can be shown between the histological type of a carcinoma and its in vitro capacity of resistance.


Real time ultrasound tomography of the adult brain. Initial clinical results are reported from a new real time, 2-dimensional ultrasound scanner modified for adult cephalic applications. An optimized transducer design and the use of the dynamically focused phased array imaging system have resulted in ultrasound tomograms of the brain which are significant improvements over previous attempts. Horizontal and coronal images of the ventricles, the corpus callosum and other midline structures are routinely displayed in a 45 degrees sector format. In addition, pulsating cerebral arteries are displayed in real time. Quantitative information can be obtained concerning cerebral vascular patency by using the selectable M-mode feature of this system. The results indicate that real time ultrasound tomography has potential for clinical application.


Prolonged contraction of isolated human and canine cerebral arteries induced by uridine 5'-triphosphate. Uridine 5'-triphosphate (UTP) induced long-lasting contractions of isolated human brain arteries; contractions without decrement were observed for periods of up to 20-24 hours at which time the tissues were relaxed in a dose-dependent manner by theophylline. In some vessels, rhythmic oscillations accompanied the prolonged elevation in tension. In canine middle cerebral arteries, UTP produced dose related contractions within the dose range of 1.7 X 10(-6) to 1.7 X 10(-4) M; these responses were unaffected by methysergide 2.8 X 10(-7) M, phenoxybenzamine 2.9 X 10(-5) M or indomethacin 9.8 X 10(-6) M, suggesting that the UTP mechanism of action is probably independent of tryptaminergic or alpha adrenergic receptor activation, or of prostaglandin biosynthesis. The ability of UTP to produce prolonged contraction of cerebral vessels, thus, provides an in vitro preparation in which it is possible to study some of the basic mechanisms that are associated with cerebral vasospasm.


Serum lipids, platelets, and fibrinolytic activity in cerebrovascular disease. Fifty patients with occlusive cerebrovascular disease (ischemic thrombotic cerebrovascular disease--ITCBVC) were studied for clinical features, angiographic findings, serum lipids, platelet functions and fibrinolytic activity. Angiograms were abnormal in 24 of 36 cases. Two-thirds of these had an abnormality of the internal carotid artery in the neck; one-third had occlusion of the middle and/or anterior cerebral arteries. A statistically significant rise of serum triglycerides, pre-beta lipoproteins, platelet adhesiveness and aggregation, and a decrease in fibrinolytic activity were noticed in these patients as compared to age and sex matched controls. The correlation coefficient did not show any intercorrelation between the platelet adhesiveness and raised lipid fractions. These factors could be responsible for the atheroma resulting in large vessel occlusion.


Cerebral protection with barbiturates: relation to anesthetic effect. The effect of racemic mephobarbital and its optical isomers on survival time of mice exposed to 5% O2 was studied. There was an increase in survival time from 4.2 minutes to 12.6 minutes for 100 mg/kg of the anesthetically active (-) isomer and the racemic form, but no increase for 100 mg/kg of the inactive (+) isomer. Since it has been shown that there is no difference in brain concentrations between the isomers, we conclude that the barbiturate protective effect is bound to the anesthetic effect. All mice convulsed, and since the non-anesthetized animals convulsed earlier and stronger than the anesthetized, it was possible that barbiturate protection was accounted for by its anticonvulsant effects. Diazepam 7.5 mg/kg, while reducing convulsions to the same degree as barbiturates without producing anesthesia, only increased survival time to 6.2 minutes. Thus, the barbiturate protective effect is distinct from the anticonvulsant effect. It seems to be bound to a stereospecific receptor for both protection and anesthesia.