Improved method of evaluating the cervico-thoracic junction in lateral tomography and air myelography. The author describes a method whereby the entire cervico-thoracic junction can be evaluated with one set of tomograms using a water-equivalent bolus. This technique has proved to be useful in lateral tomography of the spine and air myelography. Advantages include decreased procedure time and less radiation exposure to the patient.


Sialography made easier.

Sialography made easier. The author describes a new method of cannulating stenotic salivary ducts. Due to its speed, simplicity, availability of materials, and rapid mastery by radiological technicians, it is recommended for routine use in sialography.


Patient immobilization with a low-temperature splint/brace material. The authors describe a low-temperature plastic which is useful for the construction of immobilizing devices where beam orientation is critical.


Report from the International Commission on Radiation Units and Measurements. A summary of the activities of the International Commission on Radiation Units and Measurements since 1973 is presented.


The nonspecificity of some radiological signs in excretory urography. Two radiological signs have recently been offered as being specific for an infected and obstructed urinary tract and renal infarction, respectively. The authors suggest that these signs suggest certain possibilities but do not indicate a specific diagnosis.


Evaluation of regional myocardial function in ischemic heart disease by echocardiography. Echocardiography can display motion abnormalities of acutely or chronically ischemic myocardium. In experimental studies, this permits the evaluation of the effect on regional dyskinesis of potentially therapeutic interventions. In clinical studies, the demonstration of segmental dyskinesis has been primarily useful for diagnostic purposes. As more experience is gained with the newer two-dimensional cross-sectional ultrasound techniques, it appears likely that these will afford a major advance in the diagnosis of ischemic heart disease by permitting the routine noninvasive demonstration of segmental ventricular dyskinesis and assessment of regional myocardial function.


Photolysis in 131I, 35S or 14C labeled HgLSCN powders. In 1938, S.V. Raghava Rao reported that a crystal of HgXSCN (X=halogen) has photropic properties and in 1955, the author reported the mechanism of the phototropy is identical with that of HgI2.2HgS. However, a behavior of S, I and C atoms in the crystals irradiated by sunlight was not known. Purpose of this paper is to clarify the behavior of these atoms by using radioactive tracer technique. The results obtained show that when electrons belonging to S2- or I- ions absorb photons and are excited to upper state, these electrons leave behind neutral S or I atoms, which diffuse thermally toward the crystal surface and escape into atmosphere. 14C atoms do not escape. S atoms are more sensitive to light than I or C atoms.


[Studies on halogen quenching through the Stern-Volmer plot (author's transl)]. The quenching effect for halogenated benzenes, methanes and ethanes have been investigated. The halogen quenching was accurately measured using the internal conversion electrons emitted from 113Sn-113mIn. From the quenching constants determined by the Stern-Volmer plots with respect to various halogen quenchers, the following results have been obtained. (1) The quenching constants increase with the number of halogen substituents, so as linearly in halogenated benzenes and exponentially in halogenated methanes and ehtanes. Even the isomers of halogenides have different quenching constants. (2) There is a linearity between logarithm of the quenching constant and a polarographic half-wave reduction potential. (3) Electron excitation provides larger quenching constants than UV excitation for halogenated methames. Based on these results, the mechanism of halogen quenching have been discussed in connection with the exciplex formation.


Interaction of ethanol with amylobarbitone, phenobarbitone and methaqualone. The presence and mechanism of synergism of action between ethanol and amylobarbitone, phenobarbitone or methaqualone was determined by application of simple pharmacokinetic models to log dose-response curves and plasma concentration-time curves for the hypnotics alone or when ethanol was given concurrently. For all three hypnotics, ethanol was found to increase the duration of hypnosis, but the mechanism of action was different for each. A sub-hypnotic dose of ethanol increased the volume of distribution of amylobarbitone and the consequent reduction in fractional elimination prolonged the half-life of the hypnotic. The distribution and elimination of methaqualone were not affected by ethanol, but there was a sensitisation of the target organ, shown by a reduced minimum effective dose. The minimum effective dose of phenobarbitone was also reduced by ethanol, but in addition, the rate of elimination of phenobarbitone was increased after the period of hypnosis.


Selective blockade of dopamine-induced vasodilation by ergonovine maleate in the vasculatures of dogs and rabbits. In urethane anesthetized rabbits, ergonovine maleate significantly attenuated dopamine-induced systemic hypotension. Initial pressor responses to dopamine were significantly prolonged and potentiated by ergonovine. Mesenteric vasodilation elicited by dopamine in dogs was competitively inhibited by ergonovine at doses of 0.09 and 0.18 mg/kg, i.a. Failure of ergonovine to inhibit vasodilatory responses to acetylcholine or isoproterenol suggested selective blockade. These results confirm existing evidence that ergonovine selectively antagonizes peripheral dopaminergic receptors subserving vasodilation.


The stability and reliability of radioimmunoassays for clonazepam, diphenylhydantoin and phenobarbital in blood, serum or plasma. The stability of Clonazepam, Diphenylhydantoin and Phenobarbital has been established in plasma and whole blood samples under a variety of storage conditions. Radioimmunoassay techniques for each of these anticonvulsants is not effected by the presence of the other anticonvulsants. Abnormal states such as icterus, hemolysis and lipemia were studied for their effects on the radioimmunoassay of these anticonvulsants. All the anticonvulsants can be stored at 37 degrees C with appropriate preservation for at least one week.


Effects of imipramine, nitrite, and dimethylnitrosamine on reproduction in mice. Administration of the tricyclic dibenzazepine drug imipramine, a tertiary amine, in the food (100 mg/kg) or sodium nitrite (1 g/liter) or dimethylnitrosamine (0.1 ppm) in the drinking water of Swiss CD-1 mice before and during pregnancy, resulted in increased perinatal death of the offspring compared to controls. Administration of imipramine and nitrite together had no effect on perinatal survival, but instead resulted in infertility or delayed impregnation in some females. A biological synergism or in vivo chemical interaction of the two chemicals is suggested.


Binding to radioactivity from [14C] paraquat to rat lung protein, in vitro. In Vitro incubation of rat lung slices with [14C] parquat produces binding of radioactivity to acid precipitable protein. The binding is concentration and time dependent. More in vitro binding occurs to lung protein than liver, heart, kidney, or spleen.


Carbon tetrachloride activation, lipid peroxidation and liver necrosis in different strains of mice. Males from three different strains of mice (GXF; CF1, and Swiss) were compared in their liver response to CCl4 effects. They were capable to intensively activate CCl4 to .CCl3. No CCl4 induced lipid peroxidation was detected in the liver microsomes from any of them. All the strains remakably responded to the CCl4 induced liver damage. Results further strengthen our previous hypothesis that covalent binding of CCl4 reactive metabolites to cellular constituents is more important in relation to liver cell injury than early changes in lipid peroxidation.


In vitro and in vivo effects of promethazine (Phenergan) on drug metabolism. Prolongation effects of promethazine on the pentobarbital sleeping time are not due to interactions of this drug with cytochrome P-450 or cytochrome c reductase or inhibition of drug metabolism because pentobarbital plasma levels in promethazine treated animals before awakening are not different than in controls. Results suggest additive effects of both drugs on the central nervous system. Those interactions do however play a role during in vitro studies.


Is GABA involved in analgesia?

Is GABA involved in analgesia? The effect of morphine and naloxone on gamma-aminobutyric acid (GABA) concentration in discrete areas of the rat brain has been studied. Neither morphine nor naloxone had a significant effect on regional steady-state concentrations of GABA. The results have been discussed with respect to the role of GABA in pain and analgesia.


Zinc-induced protection against cadmium alteration of drug action. Pretreatment of male rats with cadmium acetate potentiates the duration of hexobarbital hypnosis and inhibits the rate of hepatic microsomal drug metabolism. Pretreatment of rats with zinc acetate protects against these alterations in drug action elicited by cadmium.


beta-Cyclodextrin as an aid to peritoneal dialysis. Renal toxicity of beta-cyclodextrin in the rat. A peritoneal dialysate containing beta-cyclodextrin has been shown to accelerate the removal of intravenously administered phenobarbital in rats. It was found that high concentrations of beta-cyclodextrin were toxic to the animals in the single exchange technique employed. The renal toxicity was estimated by measuring blood urea nitrogen values in the rats following oral and intraperitoneal administration of the cyclic amylose.


Biopterin content of human neuroblastoma cells in culture. The biopterin (Crithidia activity) content of several cell lines of human neuroblastoma was quantified. Adrenergic cell lines contained markedly higher levels than those found in cholinergic neuroblastoma cells, fibroblast-like cells and glioblastoma cells in culture.


[Xenogenic transplantation of aortic segments. Korrelated serological and histological investigations of the rejection mechanism]. With CDF inbred strain rats and randomly bred guinea pigs one syngenic control group and two xenogenic experimental groups were examined. The two xenogenic groups had different transplantation sites of aortic segments, the first of which was orthotoply retroperitoneal, the second heterotoply subcutanous. The following results were obtained: 1. A xenogenic vessel graft induces a massive production of antibodies after the fifth day, reaching a maximum on the 42nd day, and slowly and continuously decreasing thereafter. The tissue of the graft becomes acellular within 12 to 24h p.op. After 5 to 6 days an infiltrate appears, firstly dominated by granulocyts and monocyts and later by lymphocyts and plasmacells. Following the continuous destruction of the elastic fibres aneurysms grow. 2. The two xenogenic groups show that these two transplantation sites have no significance for the humoral response. 3. Both the progress of the antibodytiters (strong increase after the fifth day) after transplantation of aortic segments and the acute and chronical histologic changes suggest an immunological mechanism of hyperacute rejection.


Automatic column chromatographic analysis of saccharides and uronic acids. Using n-proponal/water as the eluting solvent, a flow rate of 50 ml/h and a 90 degrees C column temperature, the separation of a complex mixture of 11 monosaccharides could be much improved over the procedure described by v. Wilm and Sordé using isopropanol/water, 70--100 ml/h flow rate and temperatures of 83--90 degrees C. With a small total error of 3%, the saccharide analysis lies in the region of reproducibility that has also been reached in amino acid analysis. The limit of detection for saccharides lies at 1 x 10(-9) mole/ml.


The effect of haemorrhage and bone fracture on bone marrow circulation. Blood flow was measured in the bone marrow and trabecular bone of the dog using 133Xe and hydrogen clearance technique. Estimated from hydrogen wash-out curves, flow in the marrow of the femoral diaphysis was 0.207 ml.min(-1).g(-1), in the marrow of the humerus 0.123ml.min(-1).g(-1) and in the trabecular bone of femoral metaphysis 0.173ml.min(-1).g(-1). Haemorrhagic hypotension and fracture reduced the medullary flow. After haemorrhage an exponential relationship was found between blood pressure and effective bone marrow and muscle blood flow. The correlation between systemic arterial and intramedullary pressures was found to be exponential and between intramedullary pressure and flow linear.


[Investigations on the performance of calcium selective disc-electrodes with electrically charged and neutral ligands in anaerobic serum measurements (author's transl)]. Anaerobically prepared serum samples from healthy subjects were simultaneously analysed for Ca++ in a flow-through-system of three ion selective disc-electrodes (electrochemical multimeasurementsystem). Two of the sensors contained electrically charged ligands, the third contained a neutral carrier. With neutral carriers an improvement of performance was noted in that there was a large increase in selectivity toward H+- and NH+4-ions and a distinct enhancement of reproducibility.


[The influence of capillary permeability on the extravascular protein quantities as measured in situ (author's transl)]. The extravascular protein contents in the perivascular connective tissue of a rat's mesenterial plate was measured ultramicrospectrophotometrically in situ and in vivo after changing the hydrostatic and colloidosmotic pressures of the blood. We analized the perivascular area of the different microcirculatory vessels, arterioles, capillaries and venules. The perivascular protein contents, which corresponds besides arterioles to 40% and besides venules to 59% in comparison to the intravascular blood plasma, decreased in a comparison group under the osmotic influence of the perfusion liquid on the mesenterial plate. An injection of an isotonic saline solution is followed only by small fluctuations of the perivascular protein contents during one hour. After blood loss a transitional increase of extravascular protein at the perivenular area was observed indicating the mobilisation of protein depots. Around arterioles the extravascular protein contents did not change significantly. An intravenous injection of albumin solution was followed by a short-termed increase of tissue protein around the arterioles. Around the venules after 50 minutes the extravascular protein contents increased significantly. Within one hour after the changes of the permeability conditions the maximal induceable protein movements in the perivascular space were calculated as +/- 1.35 g% plasma protein concentration corresponding to a maximun protein exchange of +/- 3.1 mg ml(-1) tissue.


Irradiation therapy with 131I-6beta-iodocholesterol of metapyralone induced adrenal hyperplasia in rats. Marked weight reduction of rat adrenals was observed after 131I-6beta-Iodocholesterol administration whether or not the animals were treated with metapyralone. Damage or even histologic changes of the adrenals have not been found. Though the radiation dose is high with the applied dose of 131-i-6-beta-Iodocholesterol and might limit or even prevent its application in the treatment of human adrenal disease, the influence of endogenous irradiation on rat adrenals is obvious and justifies further investigations.


[Investigations in the streaming blood of the alert animal and man. III. Postprandial and therapeutically induced changes of electrolyte concentration and hematocrit in man during hemodialysis (author's transl)]. Arterial haematocrit and blood electrolyte concentrations are measured continuously by conductometry in three hemodialysis patients. Haematocrit elevation during meals, particularly when rich in carbohydrates, indicate fluid losses into the gut. Simultaneous biphasic responses in electrolyte concentration indicate osmotic and diffusional shifts of water and electrolytes. Similarly, blood volume and electrolyte concentration changes can be followed during and after intravenous infusion of colloid and crystalloid solutions. The quantitative aspects of such measurements are discussed.


Transplantation of the small intestine. An experimental study in young minipigs. An experimental study on small intestinal transplantation on 82 young minipigs is reported. The selected experimental model allows for early recognition of complications in the graft. A monitoring system, based on multiple sequential mucosal suction biopsies is presented, Transplanted segments up to 120 cm were rejected in similar way as are other organs. There was no evidence of a graft versus host reaction.


[Mechanical aspects of bone stability by an in vivo testing method (author's transl)]. This is a report of a new method for in vivo determination of the Young modulus of human os radii. The failure of the apparatus is +/- 1.86 per cent. The accuracy of the measuring procedure on healthy subjects bases on a variation coefficient of nearly 10 per cent. 124 forearms of healthy persons had been studied in relation to age, sex and to the right and the left os radii. There was a statistically significant higher elastic property of the bones of adolescent versus elder men (over 60 years), but no significant differences between male and female. Right and left os radii had nearly the same amounts for the Young modulus.


Haemodialysis in rats.

Haemodialysis in rats. A plate dialyser requiring an extracorporeal blood volume of 1.5 ml was developed to dialyse conscious rats. In experiments in vitro and in vivo its function was tested. The in vitro clearances of urea, creatinine and potassium were 126+/-9 ml/min/m2, 70.5+/-9 ml/min/m2, and 132.5+/-13 ml/min/m2, respectively. The method appears to be suitable for pharmacological and toxicological studies.


Pulmonary gas exchange in candidates for surgical treatment of ischaemic heart disease. The spirometry and pulmonary gas exchange in 38 patients with ischaemic heart disease (IHD), selected for direct revascularization of the myocardium (or combined with left ventricular aneurysmectomy), were examined on the basis of clinical investigation and coronary arteriography. Elevated left ventricular end-diastolic pressure was found in 40% at rest and in more than 50% of patients during exercise. Vital capacity was entirely within the normal limits. A relation was found between the period of time since the first acute myocardial infarction. In 20% of the patients the forced expiratory volume was below the predicted normal, but the decrease was not significant. A mild arterial hypoxaemia was found in 64% of patients at rest and in 70% during exercise; 79% showed an elevated alveolar arterial oxygen gradient. The abnormalities did not depend on the degree of coronary artery and left ventricular involvement nor on the haemodynamic parameters. However, a certain relation to history of cigarette smoking, which appears to affect pulmonary gas exchange more than IHD, was observed. The degree of respiratory disturbance does not in any way influence the proposed surgical treatment.


Emphysema with minor airway obstruction and abnormal tests of small airway disease. In 9 patients complaining primarily of exertional dyspnea, the diagnosis of early emphysema was made on the basis of a decrease of the elastic recoil of the lung and of the single breath diffusing capacity, in the presence of only minor airway obstruction as estimated from the routine pulmonary function tests. Closing volume, the alveolar plateau, dynamic compliance and maximal flow at 50% of the vital capacity were markedly abnormal; the maximal flow-static recoil pressure relationships suggest, however, that none of the patients suffered from small airway disease. We conclude that one should systematically consider early emphysema in the differential diagnosis of small airway disease.


The mechanism of rapid shallow breathing due to histamine and phenyldiguanide in cats and rabbits. In anaesthetized cats and rabbits we analyzed the rapid shallow breathing following exposure to histamine aerosol (mainly an irritant receptor stimulant) and i.v. injection of phenyldiguanide (mainly a J receptor stimulant). Both drugs caused a marked leftward displacement of the tidal volume (VT) vs inspiratory time (TI) relationship (Hering-Breuer threshold curve) without a corresponding increase in inspiratory flow rate so that inspiration was cut off at a lower VT and TI. The leftward displacement of the VT vs TI relationship occurred with a great shortening of the duration of inspiration during occluded breaths (T0I) accompanied by a shortening of the expiratory phase (T0E). These parameters monitored the central respiratory rhythm in absence of the phasic lung volume related vagal loop. It is suggested that the increased central respiratory frequency was due to the augmented firing of fibers from stimulated irritant and J receptors. Stimulation of these endings also caused the TE vs TI relationship to become steeper in cats and to be displaced downwards in rabbits.


Models of the pressure-volume relationship of the human lung. The static pressure-volume (PV) curve from TLC to RV of 11 human subjects was fitted by a hyperbolic-sigmoid model: P = k1/(VM--V)+k2/(Vm--V)+k3, where VM and Vm are the upper and lower asymptotes respectively, and k1, k2, k3 are shape constants. Least-squares nonlinear regression was used to evaluate the constants for the individual and mean data. Average SD of residuals was 0.57 cm H2O and average reduction of residual variance was 99.93%. In spite of substantial differences between PV curves, the latter can be modelled accurately. For the mean PV curve, values for VM, Vm and k1, k2, k3 were 110% VC, -4.34% VC, 260 cm H2O/% VC, 50.5 cm H2O/% VC and 3.13 cm H2O respectively. Unlike previously proposed models, the above includes data below FRC. It describes the truly linear portion of the PV curve at and above FRC. The lower inflection point is accomodated at different lung volumes. When used in a compartmental analysis of a homogeneous lung exposed to a constant pleural pressure gradient, it predicts sequential emptying of dependent and nondependent lung regions consistent with that observed experimentally.


Air flow in snake ventilation.

Air flow in snake ventilation. Ventilation in resting, unrestrained Boa constrictor, Python regius and Thanmophis s. sirtalis was monitored using various combinations of a closed Kopfkappe (head chamber), intratracheal pressure catheters, strain gauges around the trunk, and a flow meter connected to one of the nostrils. Records of intratracheal pressure with and without closing the Kopfkappe show that the latter device induces artifacts in the normal ventilatory pattern. Flow meter readings from quiescent snakes indicate that ventilation is biphasic (outflow-inflow-pause) rather than triphasic (outflow-inflow-outflow-pause), while simultaneous pressure and strain gauge records are variably tri- or quadriphasic.


Computed tomography of the thorax.

Computed tomography of the thorax. Computed tomography of the chest is found to be a useful method in selected cases. Lipomas of the chest and mediastinum can be specifically diagnosed. Extent of malignant pulmonary processes can be assessed for resectability, since it can detect mediastinal nodes not properly seen in conventional chest tomography. Computed tomography of the chest is indicated in these two diagnostic problems.


Effect of pulmonary function of split-course radiation therapy for carcinoma of the lung. A group of patients treated with radiation therapy for bronchogenic carcinoma were evaluated with serial pulmonary function testing. The patients were treated with a split-course technique with 60-Cobalt. A total of 30 patients with unresectable carcinoma have been studied. Measurements of vital capacity (V.C.) and forced expiratory volume at one second (F.E.V.1) were made prior to therapy; at the beginning and end of the split; upon completion of therapy; and thereafter at 1, 2, and 6 months post therapy. The percentage changes in V.C. and F.E.V.1 from pretreatment values are plotted against time. A trend to improve throughout the treatment course is suggested by these results. Twelve patients have been studied at six-month follow-up: eight of the patients showed less than a 10% reduction from pretreatment V.C. and F.E.V.1 and had no respiratory impairment; of the other four patients, three had evidence of progression of disease in the thorax.


Renal blood flow changes following mannitol infusion. The effect of mannitol infusion on the renal physiology, was evaluated in experimental animals and in man. In animals plasma flow and glomerular filtration rate were determined by the PAH extraction and by the innulin clearance technique. In patients renal blood flow measurements were carried out using the Xenon133 washout technique. Baseline studies were obtained and repeated following the intravenous infusion of 20% mannitol. A significant increase in total renal blood flow could be demonstrated in experimental animals, but only a minimal increase of total flow was demonstrated in man following the infusion of mannitol. This observation suggests that the diuretic effect of mannitol is very likely due to the osmotic effect in the tubule causing increased interstitial renal pressure rather than by an increase of actual renal blood flow. This observation is supported by the clinical experience that mannitol remains a powerful diuretic in even hypotensive patients with low renal blood flow.


Pneumothorax in sarcoidosis.

Pneumothorax in sarcoidosis. We have observed four patients with sarcoidosis who developed pneumothorax. In one of the patients who had a thoracotomy, non-caseating granulomata were seen to be extensively involving the pleura. The patient had five episodes of spontaneous pneumothorax involving both lungs before and after surgery. Such episodes were not observed following insititution of corticosteroid therapy. Whether pneumothorax and sarcoidosis are two independent processes occurring in the same individual or whether the pneumothorax is causally related to the sarcoidosis has not been determined. The fact that the sarcoidosis is usually very extensive before pneumothroax develops would suggest the latter. Rupture of emphysematous blebs or necrosis of subpleural sarcoid tubercles have been proposed as the mechanisms of pneumothorax in sarcoidosis.


[Plummer-Vinson syndrome].

[Plummer-Vinson syndrome]. The Plummer-Vinson syndrome is very uncommon in Latin America. Four cases showing the clinical-radiological and hematological features of this syndrome are described. Three cases were treated with esophageal dilatation and Ferro therapy. The radiological evaluation may show deformities in the faringo-esophageal lumen other than the esophageal webs, such as hypertrophy of the cricopharingeal sphincter and of the retrocricoid venous plexus as well as the demonstration of esophageal webs in the patients without symptoms or signs of the Plummer Vinson Syndrome.


Unusual complications of renal cyst puncture. The authors present a case of subcapsular hematoma with compromise of renal function and a case of arteriovenous communication as two infrequent complications of renal cyst puncture.


Non-invasive estimation of male bladder retention. Using opaque solution of varying amounts instilled in bladders already having indwelling catheters, radiographs were made by a standard technique. From a number of those showing the most common bladder contour (globoid, without distortion) an average was obtained and tracings of actual size made to form templates. This seems to compare favorably to other methods in accuracy and is quite superior in speed of estimating residuals after voiding, without invasion.


The circumaortic left renal vein report of two cases diagnosed by renal venography. The venographic appearance of the left circumaortic renal vein is described. This developmental abnormality is more common than may be evident from the radiological literature and awareness of its existance is important in the interpretation of the inferior vena cavogram and also for proper placement of the sampling catheter in renal vein renin collections.


[Combined use of iodine 123 and technetium 99m pertechnetate in a recurring struma ovarii]. A case of ovaric strauma diagnosed with combine use of I123 and tecnesium 99m pertecnetate is presented. We believe that I123 is more useful than I131 for the detection of ectopic thyroid tissue.


[Comparison between computer tomography and ultrasound in abdominal and renal growing and displacing processes (author's transl)]. The advantages and limitations of both methods are analyzed and compared. The comparison is effected on the basis of the present standard of equipment. The results obtained with both methods are demonstrated by means of the example of frequent epigastric diseases. Despite the still limited number of patients examined simultaneously both by ultrasound and computer tomography, it seems that the sensitivity of both methods in case of growing and displacing processes in the epigastric or renal regions, does not differ greatly. A comparison of the specificity of both methods will be effected only after a large number of patients has been examined by both methods at the same time.


[Extension of thoracal diagnostics through computer tomography (author's transl)]. The utilization of transverse layers in computer tomography opens up a new level of examination for localization of pathologic processes in the thorax and their spread. The good resolution of roentgen absorption differences in the soft parts enables the use of computer tomography in the diagnosis of pericardial effusions and for further differentiation of known mediastinal growing and displacing processes. This method is also suitable for the identification of aneurysms, since it is not invasive and places hardly any strain on the patient. Finally, computer tomography can also be used for radiotherapy and operation planning, as well as in target biopsy on account of the true-to-scale and reproducible image of the body cross-sections.


[Endobrachyesophagus (Barrett's syndrome)--a not sufficiently familiar disease pattern (author's transl)]. The clinical picture of endobrachyesophagus (Barrett's Syndrome) which is little known among radiologists, is described, taking the authors' own observations into account. As soon as the complications leading to clinically manifest complaints occur, consisting of high or centrally positioned peptic stenosis and/or ulceration, diagnosis can be established by means of the usually characteristic findings when a barium sulfate contrast medium is made to pass through the esophagus. Endoscopic-bioptic exploration of the esophagus is mandatory to verify the diagnosis, and, in particular, to exclude any malignant process, the more so since malignant degeneration of cylindrical cell metaplasia, on which endobrachesophagus is based, must be reckoned with in up to 10% of the cases.


[Recurrency in primary duodenal carcinoma (author's transl)]. 18 months after the operation (duodenectomy and partial pancreatectomy) a tumor recurrency is observed in a 64 years old patient with primary adenocarcinoma of the duodenum. The roentgen diagnostic shows a partial destruction of the upper jejunal loops combined with a free passage.


[About the angiographic diagnosis of intestinal carcinoids (author's transl)]. Using two angiographically well documented cases the angiomorphological features of intestinal carcinoid tumors are described. One case is a carcinoid of the terminal ileum with hepatic metastases, the other case a cecal carcinoid without distant metastases. The primary tumor of the second case is strikingly hypervascular--most primary carcinoid tumors heretofore described in literature were hypovascular. In both cases is the mesentery afflicted in the typical manner indicating spread to local lymph nodes. By reviewing the literature the pathophysiologic mechanisms causing the anatomic changes are explained.


[Cholangiography and diuretics (author's transl)]. Contrast media intended for use in cholangiography are partly eliminated heterotropically via the kidneys. This can create difficulties in properly evaluating a cholangiogram. To overcome this problem, other protections are used, especially tomography (2, 3, 4, 5). This paper discusses of a third possibility, namely, whether the contrast medium in the renal calyces can be diluted by means of a diuretic, and so eliminated as a disturbing factor. The condition for this is, however, that excretion of the contrast medium via the bile ducts is not influenced in any way. This problem is investigated both experimentally and by means of a clinical study.


[Mammographic mass examinations for breast cancer among rural population selected via physical examination and epidemiologic questionnaire (author's transl)]. The authors report on their four years' experience in oncologic mass examinations focused on the age group above 30. After 43980 serial examinations, they performed mammography in 3082 women with mammary cancer risk. 156 operations were performed, and 33 histologically established cases of mammary carcinoma were recorded, with 21 early-stage cases. Of 21 occult tumors, 18 did not manifest any metastases. Thanks to the epidemiologic questionnaire, 10 mammary cancer patients were registered. The score of confirmed findings exceeded quantitatively, and, especially, qualitatively, the mammary carcinoma morbidity of the region. The results prove the feasibility of the combined method. The major part of the population did not appear for mass examination. The advanced stage of the 55 cases of breast cancer belonging to this group, as well as that of the 10 cases of which became manifest during the examination interval, would indicate that much is to be said for a more effective health promotion campaign among the population.


[Synoviorthesis of the knee using osmic acid: apropos of 61 injections]. The authors report their experience of 61 injections of osmic acid into the knee during the course of rheumatoid polyarthritis. The results stated to be very good and good, are classified by the disappearance of pain, swelling and stiffness, or a improvement in any one of these criteria. As observed in 67% of cases at the third month the result following changed with time. While these favourable results persisted into the fifth month, there was a remarkable maintenance of them to the 30th month in those patients who it was able to follow so long. The most distinct and lasting results were seen in those joints which showed the least radiological change. Tolerance of the injection of osmic acid was satisfactory apart from several painful reactions which improved in the 24 hours following injection. Two cases of thrombo-phlebitis were seen and one case of rupture of the synovium. If the results obtained with osmic acid appear less impressive than those obtained with isotopes, the simplicity of the method attracts attention as it needs no complicated equipment and is applicable to young invalids.


[Anatomopathological introduction to the study of chondrocalcinosis]. Although the macroscopic aspects of chondrocalcinosis easily permit diagnosis, the morphological analysis of the basic lesion--the crystalline microgeode--raises the problem of the relationship between chondrocalcinosis and the chondrocyte lodge and arthrotic lesions. According to studies with the optical and electron microscope, the crystalline precipitate of calcium pyrophosphate in the basic cartilaginous substance always appears distinct from the chondrocytes, but in its vicinity the chondrocytes are often altered by degenerative lesions. There appears to be no relationship between arthrosis and chondrocalcinosis of frequency alone is considered.


[Study of 108 cases of cervico-brachial neuralgia: the concepts of idiopathic cervico-brachial neuralgia and cervico-arthrotic cervico-brachial neuralgia]. On the basis of a series of 108 cases of cervicobrachial neuralgia a study was made of the clinical characteristics, circumstances of appearance, associated neurological signs, sequelae, relapses, and aetiologies of these observations. This series permits consideration of the aetiopathogenesis of cervicobrachial neuralgias of rheumatic origin from a new angle. The disco-osteophytic nodule does not appear to play the role classically attributed to it. Three forms are distinguished: idiopathic cervicobrachial neuralgia of transient occurrence with a cyclic duration and little tendency to recurrence and not related to concomitant arthrotic lesions; long-term cervicobrachial neuralgia lasting more than 20 weeks and always requiring a search for narrow canal and root anomaly -sometimes the form of onset of cervicarthrotic myelopathies; cervico brachialgia caused by cervicarthrosis seen after the age of 60 and consisting of projected pain rather than true cervicobrachial neuralgia, often recurrent.


[Articular chondrocalcinosis after 80 years of age]. In 108 women over 80 (mean age 88,4 years, extremes 80 and 99 years) hospitalized in a geriatric service for various reasons, radiograms were made of both knees in the frontal aspect on standard film to detect calcinosis of the meniscus and chondrocalcinosis of the joint. In 25 women (23.1%) the radiographs revealed calcinosis of the meniscus with or without chondrocalcinosis. In these 25 cases a lateral X-ray was also made of the two knees, frontal X-rays were made of the pelvis, thumbs and shoulders. In 22 cases (88%) these revealed calcification of the fibrocartilages or articular cartilages in joints other than the knee. Seven of the 25 women had at least one attack of articular inflammation (especially of the knee) resembling a pseudo-gout crisis. The frequency of chronic arthropathies resembling arthroses was high in the 25 patients with chondrocalcinosis: 8 (32%) had an internal or external femoro-tibial arthrosis, as against 11 of the 83 patients (13%) of the same age without chondrocalcinosis, a significant difference. Eleven of the 25 women had signs of femororotular arthrosis on the lateral X-rays of the knees, 5 had coxarthrosis (with in 3 cases a radiological image of fibrocartilaginous or coxofemoral cartilaginous calcification). One women had chronic radiocarpal arthropathy evocative or chondrocalcinosis. Ten had a scaphotrapezoidal arthrosis, 5 arthrosis of the shoulder, 3 with radiological aspect of glenohumeral chondrocalcinosis.


[Dorsal medullary compression in vertebral hyperostosis]. The authors present two observations of dorsal medullary compression by intraspinal benign osseous proliferations developing in subjects who present with anterior vertebral hyperostosis. In the second observation operative intervention confirmed the site and nature of the lesion. The authors have researched the same radiological findings in other cases of vertebral hyperostosis. They describe the lesions which are of considerable practical importance as they are able to injure the spinal cord and the nerve roots, resulting in a hyperostotic dorsal myelopathy. All unexplained paraplegias should be investigated for such lesions by meticulous tomographic studies.


[Reflex algodystrophy of the lower limbs during pregnancy]. Four cases of neurotrophic rheumatism during the course of pregnancy are reported. Observations in 9 cases from the literature allowed the isolation of the principal features of this sort of algodystrophy. It occurs in the last trimester of pregnancy, attacking usually and almost exclusively the lower limbs, especially the left hip. There is rapid resolution after delivery, occasionally preceded by a rebound in the post-partum period. Responsability of pregnancy as the cause of the neurotrophic rheumatism is not in much doubt. It apparently arises from a shift of mechanical factors linked with the uterine enlargement which without doubt causes pressure of the pelvic sympathetics.


[Pyrithioxine a new basic treatment of rheumatoid polyarthritis: initial study of 72 cases with a 6-month follow-up]. Pyrithioxine has certain chemical resemblances to penicillamine and is used as original treatment in a series of 72 cases of rheumatoid arthritis over a period of six months in a dose of 600 mgs daily. Results were favourable in 63% of cases with important lowering of the articular index, return to normal of the sedimentation rate and less frequently a reversal of the Waaler-Rose reaction. Secondary complications were essentially muco-cutaneous, sometimes gastric and necessitated stopping treatment in 15% of cases. No other serious side effect has been observed. When compared with penicillamine pyrithioxine would appear less efficacious but better tolerated. The usefulness of this new medicament in the treatment of rheumatoid arthritis needs to be further explored.


Platelet production in hypoxic and RBC-transfused mice. Platelet production rates were studied in hypoxic, red blood cell (RBC) transfused, and normal mice. In addition, platelet depletion was induced in some of the mice by injection of rabbit anti-mouse platelet serum (RAMPS) to stimulate platelet production. Hypoxia alone caused an increase in haematocrit and platelet count at 1-3 d, followed by a decrease in platelet counts to below normal values at 6-7 d. On the otherhand, RBC transfusion caused increase haematocrit and decreased platelet count of mice at 1-4 d, with a return of platelet counts to normal by 5-6 d. Normal mice and mice transfused with RBC responded to platelet depletion with rebound-thrombocytosis with maximum platelet production 3-5 d later and elevated platelet counts on days 5-6. However, platelet production in platelet-depleted mice exposed to hypoxia was less marked, and platelet counts did not reach normal levels. The data are consistent with the hypothesis that hypoxia causes thrombocytopenia by stem cell competition between erythroid and megakaryocytic cell lines and/or inhibition of thrombopoietin production.


Effect of phenytoin on DNA synthesis by human bone marrow. Diphenylhydantoin (phenytoin) when incubated with human marrow interfered with the synthesis of deoxyribosenucleic acid (DNA) by those cells. This interference was dose related but was present at all concentrations, 25 microgram/ml to 100 microgram/ml. Cells unable to complete DNA synthesis would die in the marrow, lead to ineffective haemopoiesis and an increased folate requirement.


Serum ferritin in megaloblastic anaemia. Serum ferritin concentrations have been estimated in 30 patients with untreated megaloblastic anaemia, 27 with Addisonian pernicious anaemia. A significant difference was found between the mean serum ferritin level of the 27 pernicious anaemia patients (330 microgram/1) and of 22 normal control subjects (164 microgram/1) (P less than 0.05 greater than 0.02). There was an inverse correlation between serum ferritin and Hb concentration in men with pernicious anaemia but not in women. Serum ferritin levels were lower in 10 of 13 patients studied after 24 h of vitamin B12 therapy and in all 13 studied at 48 h after therapy. The fall continued during the haematological response to therapy. It seems likely that serum ferritin reflects reticuloendothelial iron and the high levels in untreated megaloblastic anaemia are due to the shift in iron from Hb to reticuloendothelial stores. The wide variation in serum ferritin at any given Hb level presumably reflects variation in iron stores of the individual patient.


Activation of complement by stroma from normal and paroxysmal nocturnal haemoglobinuria red cells. Stroma from normal, AET-treated and PNH red cells and their KC1-extracts (partially purified on Sephadex G-200) are able to trigger the activation of the alternative complement pathway. This fact has been demonstrated by: 1 - the lysis of PNH cells incubated in serum treated with stroma from normal or PHN-RBC or with their extracts; the addition of Mg2+ or Ca2+ or of their chelators (EDTA, EGTA) to the extract-treated serum enhances or abolishes the lysis 2 - the reduction of complement acitvity in fresh serum incubated for 60' with PNH-extract 3 - the appearance of C3 breakdown products in serum incubated with PNH-extract, demonstrated by crossed immunoelectrophoresis. In contrast, the same stroma (or extract) inhibits the sucrose lysis test, in which the lysis takes place through the classical complement pathway. No differences on the complement activation were observed between PNH and normal RBC stroma and between their chromatographic extracts. These findings may suggest the possible role of diurnal variation of Mg2+ and Ca2+ concentration in precipitating haemolytic attacks and the possibility that small amount of circulating red cell stroma might maintain the haemolysis on PNH RBC.


Prognostic value of in vitro bone marrow culture in refractory anaemia with excess of myeloblasts. Bone marrow from 17 patients with refractory anaemia with excess of myeloblasts (RAEM) was cultured in methylcellulose semi-solid medium. Compared with normal bone marrow, 3 patterns of growth occurred corresponding with different clinical stages of the condition. Patients whose bone marrow grew normal colonies and those who produced a predominance of microclusters had the longest life expectance, while those who produced a predominance of macroclusters had the shortest life expectancy with a high rate of acute leukaemic transformation. Colony culture appears to be a useful prognostic tool in the condition.


A description of an intensive treatment project for the rehabilitation of severely brain-injured soldiers. Thirteen severely brain-injured veterans are currently participating in an intensive rehabilitation project. This is a one-year vocational rehabilitation project conducted 30 hours weekly in a therapeutic workshop environment, in which all aspects of the patient's rehabilitation needs are dealt with. The three major goals of this project are: (a) Changing and modifying the behavior of the individual through the use of psychotherapy, cognitive training, training in the use of prosthetic devices and vocational training; (b) creating a supportive environment within the project in which staff and patients live together for a few hours daily and where patients are treated in groups; (c) generalizing the therapeutic effects to the community at large. This includes work with the social environment of the patient: family, friends, employer and rehabilitation workers of the Ministry of Defense. Preliminary results indicate that considerable therapeutic gains could be achieved while the patient is in a sheltered therapeutic milieu. However, there is less success in generalizing these effects to the behavior of the patient outside the sheltered environment.


Brain lesion diagnosis by recording cochlear and brainstem responses to sound stimuli. A technique has been developed for the recording of the cochlear action potential (electrocochleography) and the brainstem evoked responses to click stimuli by means of earlobe and scalp electrodes with an average response computer. This technique has already proved its usefulness in diagnosis of hearing loss. Since the brainstem responses are generated in the successive brainstem auditory nuclei and since the auditory nuclei and pathways constitute a relatively large volume of brainstem tissue, there is reason to believe that this same technique can also contribute to the diagnosis of brain stem lesions and their localization. When these recordings were made in patients with clinical signs of brain stem involvement, one (or more) of the usual response waves was smaller in amplitude, prolonged in latency, or completely absent. Recording of the cochlear and brainstem evoked potentials thus seems to be a new, simple and rapid tool for the diagnosis of brainstem lesions.


Recovery of communicative functions after prolonged traumatic coma. Fifteen patients with prolonged coma after craniocerebral injury were observed for a year or more, and their communicative functions were evaluated. Nine of them showed a considerable degree of recovery, while 6 remained in a vegative state. Of the 9 with recovery, 6 showed complete recovery of semantic functions, while 3 remained with aphasic deficits. Eight out of these 9 remained dysarthric. Communicative recovery began as late as 5.7 months after injury, and it roughly paralleled recovery in locomotion and A.D.L. Restlessness and sweating were favorable prognostic factors. Excessive salivation, snout reflex, corneomandibular reflex, retractory nystagmus and stereotypic movements were unfavorable. The 8 patients who remained dysarthric showed marked diminution of their expiratory and inspiratory reserves, and of their forced vital capacity.


Brain evoked potential use in a physical medicine and rehabilitation setting. The objective of this effort was to explore the use of evoked potential (EP) procedure on a head injury unit in a Department of Physical Medicine and Rehabilitation. The method employed both auditory and visual stimulation presented bilaterally to various patients. Recordings of the brain's responses to such stimulation were obtained. Results permitted evaluation of brain stem, subcortical and cortical functioning, ipsilaterally, contralaterally, and bilaterally. EP data provided useful information for patient assessment and rehabilitation planning for head injured patients--particularly for those who were unable to cooperate in their own examination.


Very prolonged unresponsive state following brain injury. A study was made of patients suffering from a prolonged unconscious state following brain injury from road accidents, cardiac arrest, falls and post-operative unconsciousness after cardiac surgery. Seventeen patients (Group A) were admitted to Harzfeld Hospital several months after the injury in a state of continued unresponsiveness; 6 others (Group B) were admitted because of rehabilitation potential despite unconsciousness, or because of behaviour difficulties in their rehabilitation. The duration of unresponsiveness ranged from 3 months to 4 years. Observation and follow-up showed late neurologic recovery after 1 year or more in 6 subjects as shown by ability to swallow, improved posture of the head or trunk, limb movement and increased awareness. Five of the Group B subjects were discharged, 4 in a markedly improved state. Eleven of 17 unresponsive subjects of Group A died, and 6 remain alive in hospital, 2 significantly improved. The duration of hospital care was 12.8 months in Harzfeld Hospital, and a total of 21.9 months from the time of injury. Those who still survive in hospital have now a mean stay of 50 months. Complications, and implications for treatment are described and the attitude thought appropriate to the management of these long-term patients in the face of their families is discussed in the light of our experience over 6 years.


Eye movements in brain damaged patients. Saccades, smooth movements and vergence were recorded in 28 patients with brain lesions using an infrared scleral reflexion technique. Large impairment in eye movement responses under visual feedback were recorded from the majority of the patients. The implication of these deficiencies on the vocational rehabilitation of the patients is discussed.


Cranio-cerebral injured patients: A psychiatric clinical description. It seems possible to outline a relatively constant progression of psychiatric symptoms in the brain injured patient. Preliminary observations indicate that two sub-groups merit more extensive investigation: The group with frontal pathology, in which a more extensive trial of amphetamine seems justified, and the other group, with tubular vision, in which more thorough premorbid and postmorbid psycho-dynamic evolution would be of great value.


Long-term exposure to jet fuel. II. A cross-sectional epidemiologic investigation on occupationally exposed industrial workers with special reference to the nervous system. Thirty jet fuel exposed workers selected according to exposure criteria and thirty nonexposed controls from a jet motor factory were examined, with special reference to the nervous system, by occupational hygiene physicians, psychiatrists, psychologists, and neurophysiologists. The controls and the exposed subjects were matched with respect to age, employment duration, and education. Among the exposed subjects the mean exposure duration was 17 years, and 300 mg/m3 was calculated as a rough time-weighted average exposure level. The investigation revealed significant differences between the exposed and nonexposed groups for (a) incidence and prevalence of psychiatric symptoms, (b) psychological tests with the load on attention and sensorimotor speed and (c) electroencephalograms. When the control group was selected, it was ensured that the two groups were essentially equivalent except for exposure to jet fuel. It is concluded, therefore, that the differences found between the groups are probably related to exposure to jet fuel.


Mining, lung cancer and smoking.

Mining, lung cancer and smoking. Several studies have shown an increased lung cancer mortality among Swedish metal and iron ore miners, as probably caused by exposure to radon and its daughters. An earlier study of zinc-lead miners has been updated. The results show a 16-fold increase in lung cancer mortality. Surprisingly, nonsmokers were more apt to develop lung cancer than smokers, but the induction-latency time was about nine years shorter on the average for the smokers. An explanation for these findings might be that smoking increases the thickness of the mucus layer and therefore protects the bronchial epithelium from alpha radiation, but it also promotes the development of cancer once induced by the radiation.


Exposure-response relationship between styrene exposure and central nervous functions. For the study of the relationship between styrene exposure and symptoms and signs of central nervous dysfunctions, 98 male workers occupationally exposed to styrene were given clinical, neurophysiological and psychological examinations; also a symptom survey was made. Urinary mandelic acid concentrations, measured once a week during five consecutive weeks, were used to express the exposure intensity. Different unexposed groups were used for reference. No exposure-response relationship was observed between symptoms of ill health and the urinary mandelic acid concentration, although the exposed group as a whole expressed significantly more symptoms than the reference group. The occurrence of abnormal electroencephalograms was about 10% in the group of workers with mandelic acid concentrations below 700 mg/l, but it was 30% among those whose mandelic acid concentration exceeded 700 mg/l, a level corresponding to the 8-h time-weighted average (TWA) of styrene exposure of about 30 ppm. With regard to psychological functions, the first change in visuomotor accuracy became discernible when the urinary mandelic acid concentration exceeded 800 mg/l. A more pronounced decrement appeared in both visuomotor accuracy and psychomotor performance when the mandelic acid concentration exceeded 1,200 mg/l, which corresponds to an 8-h TWA of styrene exposure of about 55 ppm.


Exposure of rabbits to styrene. Electronystagmographic findings correlated to the styrene level in blood and cerebrospinal fluid. Objective methods for critically evaluating the toxic effect of industrial solvents are highly desirable. As many of these solvents are suspected to cause vertigo, an animal experimental model was set up for studying the effects of solvents on the vestibular systems. The vestibular function was studied by registration of involuntary eye movements--nystagmus--which are elicited via central vestibulo-oculomotor connections. During exposure to styrene a so-called positional nystagmus was demonstrated that indicated vestibular disturbances. Nystagmus is normally elicited by rotatory acceleration. During exposure to styrene the direction of this rotatory nystagmus was reversed. The incidence of the positional nystagmus correlated well with the blood level of the solvent, measured by gas chromatography. Kinetic studies also demonstrated a rapid equilibration between the level of the solvent in arterial blood and cerebrospinal fluid, and therefore suggested that estimation of the arterial level reliably indicates the level in the central nervous system.


Percutaneous absorption of solvent vapors in man. It is known from industrial experience and experimental studies that percutaneous absorption of concentrated liquid solvents may be considerable and even hazardous if large enough areas of skin are exposed for long periods of time. Percutaneous penetration of xylene, styrene, toluene, 1,1,1-trichloroethane and tetrachloroethylene vapors at ambient air concentrations of 600 ppm for 3.5 h was studied in a dynamic exposure chamber with a restricted number of human volunteers. Although the small number of exposed persons precluded conclusive quantitation of absorption and valid intercompound comparisons, aromatic solvents and tetrachloroethylene appear to penetrate skin much more readily than 1,1,1-trichloroethane. Skin penetrating properties of solvents seem, under the circumstances, to be associated primarily with lipid solubility. It was approximated that percutaneous exposure (total body surface) to 600 ppm of xylene vapor for 3.5 h corresponded to an equally long inhalation exposure of less than 10 ppm. Similar percutaneous exposure to 1,1,1,-trichloroethane corresponded to an inhalation exposure of only 0.6 ppm. Disease-affected skin may display altered permeability characteristics, and one volunteer with atopic dermatitis exhibited a more than three times larger absorption of xylene vapor when compared to subjects with normal skin. It may be concluded that in the work environment percutaneous absorption of solvent vapors from the surrounding air through undamaged skin is likely to be insignificant.


[Prevention of myocardial infarct?].

[Prevention of myocardial infarct?]. Myocardial infarction remains one of the leading causes of mortality and morbidity in spite of the medical and surgical therapy currently available. Only the prevention of coronary atherosclerosis seems likely to modify this situation. Epidemiological studies have established hypertension, hypercholesterolemia and cigarette smoking, among others, as risk factors. Based on these findings, it was hypothesized that control of these factors might diminish the risk. This hypothesis has been tested in man repeatedly over the past twenty years. Except as regards cigarette smoking, the results of the studies are ambiguous. Before advising the general public on measures of prevention, more data on the etiology of atherosclerosis are needed.


[Lymphocyte stimulation in various age groups]. The study of lymphocyte functions is of great significance for evaluation of the immune response. One of the most valuable assays being the mitogenic response of lymphocytes to different antigens or mitogens, the question of the extent to which lymphocyte response decreased with advancing age has been studied. Peripheral blood lymphocytes from healthy individuals aged 21 to 97 years were assayed for the blastogenic response to different mitogens. A significant age-dependent reduction of lymphocyte stimulation could be observed with two of the three mitogens tested. Since these mitogens in the concentrations used are mainly T lymphocyte stimulators, it can be concluded that an age-dependent reduction in T lymphocyte functions is present. These findings are not only of diagnostic significance but also have therapeutic implications for all geriatric diseases in which immunity may play a role. Furthermore, the experiments described show that the lymphocyte transformation assay with different mitogens is a simple reproducible assay which has its place in every routine evaluation of the immune response system.


[Smoking, chronic bronchitis, bronchiolar obstruction and bronchial carcinoma]. The case histories of 474 patients with lung cancer were screened. Chronic bronchitis was assumed to precede lung cancer if chronic cough and sputum had been present for more than five years. Daily consumption of cigarettes, cigars (= 5 cigarettes) or pipes (= 1 cigarette) and the number of pack-years were noted. FEV1 in percent of the slowly inspired vital capacity (FEV1 %VC) was regarded as a sensitive index for the degree of bronchial obstruction. Group 1 included 221 lung cancer patients with a clear history of preexisting chronic bronchitis. Group 2 included 175 cases without such history. Heavy smokers and severely obstructed patients were found more often in group 1 than in group 2 (p less than 0.0005). A lack of correlation was evident between smoking habits and FEV1 %VC when group 1 was fused with group 2: r= -0.071, p greater than 0.20. Indeed, light, heavy, and very heavy smokers were evenly distributed in group 1 among severely and slightly obstructed patients. However, in group 2 heavy and very heavy smokers were found more frequently in patients with slight bronchial obstruction than in patients with severe bronchial obstruction (p less than 0.01). It appears that an important subgroup of heavy and very heavy smokers with lung cancer are protected from chronic bronchitis as well as from bronchial obstruction. The reasons for this protection are not clear.


[The re-emergence of human rabies in Switzerland. A case history]. The circumstances, clinical symptoms, and outcome of a case of human rabies are reported. The disease was conveyed by a housecat. Since the report gave no cause for concern, antirabies vaccination was not considered to be necessary. After a delay of 157 days prodromi appeared and the patient was finally hospitalized 3 days later displaying signs of the encephalitic stage. After 2 days, the patient went into the paralytic stage; death occurred 3 days later due to refractory circulatory and respiratory failure. In endemic rabies areas such as Switzerland, human rabies may, as demonstrated by our case report, always sporadically occur. Rabies should be considered in cases of encephalitis or encephalitis-like syndromes.


[Rabies in a veterinarian].

[Rabies in a veterinarian]. A 57-year-old veterinary surgeon developed rabies 174 days after injury during an oral palpation of a rabid cow. He had been vaccinated prophylactically with Duck embryo vaccine several months before exposure but never had his serum antibody level controlled. He died 45 days later. The prodromal and encephalitic stage lasted 5 days each. Intensive supportive medical treatment was given from the beginning of the paralytic stage. The clinical course was complicated by progredient respiratory failure, diabetes insipidus, severe hypotension, and increase of intracranial pressure. The diagnosis of rabies was confirmed by rising antibody titers prior to the patient's death.


[Determination of antibodies against nicotinic acetylcholine receptor: clinico-immunological correlations in 30 patients with myasthenia gravis]. In 30 patients with myasthenia gravis, serum assays were performed for antibodies to human nicotinic acetylcholine receptor. 19 of 20 generalized forms which were symptomatic and 6 of 9 patients in remission at the time of blood sample had detectable amounts of antibodies. The six highest levels were found in benign courses. 2 patients had a five- and twofold drop in antibody level during rapid deterioration. Patients in remission after thymectomy may still have low to moderate levels, while symptomatic patients occasionally have no detectable antibody.


[Effect of tetrabamate, phenobarbital and a small quantity of alcohol on certain perceptive-motor aspects in connection with automobile driving]. Studies have been conducted of the respective effects a dose of 300 mg tetrabamate administered daily for one week, of 45 mg phenobarbital also given daily for one week (tetrabamate contains 15% phenobarbital) and of a small amount of alcohol alone or associated with one or the other of these drugs. Several perceptual-motor components involved in the driving function have been measured by testing signal detection of threshold contrast under mesopic vision following glare and without glare, critical fusion frequency, perceptual-motor reaction pattern for simple reaction time or choice reaction time during which the different signals do not appear with the same probability, and perceptual style by means of the rod-and-frame test.


[The value of submaximal ergometer tests for the determination of physical fitness]. Maximal work endurance of heart and circulation measured by submaximal work load on an ergometer can be estimated with reasonable accuracy by means of the physical working capacity 170 (PWC 170) only in healthy individuals aged 30 years or below. Limitation of exercise by pulmonary factors does not appear to bias the results essentially. In healthy people aged 40 or over, the risk of miscalculating maximal working ability based on PWC 170 increases considerably despite maintenance of high statistical correlation to maximal work load. In patients with coronary heart disease, there is no statistical correlation between PWC 170 and maximal work load; therefore, symptom-limited ergometry is required in these patients. For the assessment of quality in follow-up tests, the watt-pulse at submaximal work load appears to be the most adequate parameter. It is recommended that submaximal tests be also carried out in a rectangular-triangular manner, for the purpose of comparison with symptom-limited tests and for evaluation of changes in the dynamics of pulse and blood pressure regulation.


[Hyperventilation and oxygen supply to the myocardium]. 1. Voluntary hyperventilation during rest and in the recumbent position induces a fall in H+ concentration, PCO2 and PO2 in mixed venous blood and in the blood of the coronary sinus. 2. In 7 of 12 patients the arterio-venous O2 difference increased by more than 10% of the control value (mean increase 21%). At the same time the O2 extraction of the myocard increased (mean increase 17%) in these subjects. Blood pressure and pulse rate varied only slightly in these experiments. 3. Chest pain and angina pectoris due to hyperventilation are the result of impaired myocardial O2 supply, a finding which is valid for subjects with and without coronary heart disease.


[A case of Peutz-Jeghers syndrome combined with bilateral breast cancer, an adenocarcinoma of the cervix and ovarian genital cord neoplasms with annular tubules]. The clinico-pathological findings are presented in a case of Peutz-Jeghers syndrome associated with a bilateral mammary invasive ductal carcinoma, a well-differentiated mucinous adenocarcinoma of the cervix and microscopic, bilateral ovarian sex cord tumors with annular tubules. The sex cord tumor with annular tubules was described in 1970 by SCULLY, who recognized its striking association with the Peutz-Jeghers syndrome. Two cases of adenocarcinoma of the cervix and another case of uterine adenocarcinoma of unspecified localization associated with Peutz-Jeghers syndrome were found in the literature. It is possible that women with Peutz-Jeghers syndrome run an increased risk of developing adenocarcinoma of the uterine cervix.


[Electric stimulation in the treatment of chronic pain]. Electrical stimulation in the treatment of chronic pain, though an old method, has become very attractive again in the last ten years. The use of transcutaneous, percutaneous and implanted stimulating devices is discussed. Although the method is sometimes contested and the mechanism of action not yet clear, it can no longer be ignored. Even if the clinical successes are in the long run only limited, the application of the method must be considered. If only one in three or four patients is still painfree after a few years by the use of an implanted electrical stimulating device, it is a tremendous boon for this particular patient when all other kinds of conservative and surgical treatment have failed.


[The role of prevention of infectious diseases in health maintenance]. The prophylaxis of infectious diseases is one of the triumphs of medical science. In examining the role and the responsibility of the physician in this activity the author emphasizes the importance of fundamental research (in the laboratory and the clinic), the need to employ prophylactic measures which are known to be effective, and, finally, the obligation of individual physicians and organized medicine to assume responsibility for problems which extend beyond their national boundaries. The encouragement of preventive medicine depends, among other factors, upon the development of a strong personal relationship between patient and physician. The current system for the remuneration of physicians hinders this relationship instead of promoting it.


Legionnaires' Disease--the Benidorm episode. The clinical pattern of illness in 2 fatal cases of Legionnaires' Disease is described. Common factors in the 2 patients were residence in a hotel in Benidorm, Spain, a severe and progressive pneumonia unaffected by wide-spectrum antibiotics and failure to incriminate an infecting organism. The similarities with the Philadelphia outbreak, in which a bacillus known as the Legionnaire agent was isolated, led to a retrospective diagnosis in the Benidorm episode. Subsequent serological surveys indicate that Legionnaires' Disease is widespread in nature; it is not a new disease.


Serum protein analysis and bone marrow cytology in patients with an extreme elevation of the erythrocyte sedimentation rate. One hundred patients in whom an Erythrocyte Sedimentation Rate (ESR) in excess of 100 mm. in the first hour was found on 2 consecutive occasions were investigated. Serum protein electrophoresis was performed on 96 of these patients and bone marrow examination on 55 patients. Acute infection was the commonest diagnosis though the majority of patients had 2 or more separate conditions each contributing to the elevation of the ESR. Quantitive serum protein electrophoresis was abnormal in all but one patient and was of limited diagnostic value. A definite band in the globulin region was detected in 11 patients, 7 of whom were found to have myelomatosis. Bone marrow examination was useful only in patients with a discrete band in the globulin fraction or with a specific haematological abnormality. It is suggested, therefore, that bone marrow examination be confined to patients with such abnormalities irrespective of an elevation of their ESR.


Cephalothin induced neutropenia during the treatment of bacterial endocarditis. The occurrence of cephalothin induced neutropenia in 3 patients with infective endocarditis is described. In each patient, withdrawal of cephalothin was followed by rapid haematological recovery. It is apparent that granulocytopenia may frequently occur in patients receiving prolonged, high dose, intravenous cephalothin for the treatment of bacterial endocarditis.


Severe fat embolism: a review of 24 cases. Twenty-four patients suffering from fat embolism syndrome, severe enough to warrant transfer to an artificial ventilation unit, are reviewed. All developed the condition following trauma. Five patients were managed with oxygen therapy and sedation, but the other 19 needed intubation and ventilation to achieve adequate arterial oxygenation. In spite of intensive supportive therapy, 6 patients (who had all required ventilation) died, one due to heparin therapy, the others from progression of the syndrome. A poor prognosis seemed to be associated with young age, a rapidly progressive condition and a continued need for 100 per cent oxygen after institution of artificial ventilation. There seemed to be no relationship between outcome and severity of injury, type of surgical management and time of onset after injury. The clinical features of these patients are discussed with reference to the many unanswered questions that surround this condition.


The therapeutic uses of calcitonin.

The therapeutic uses of calcitonin. Calcitonin is a potent hormonal inhibitor of bone resorption. Its major therapeutic effect is in the treatment of Paget's Disease of bone, in which it has been shown to reduce bone pain, lead to radiological and histological improvement in bone, and to restore abnormal biochemistry towards normal. Some patients are resistant to treatment, and in others resistance may develop during treatment. Although antibodies to pig or to salmon calcitonin develop in almost 50 per cent of treated patients it is only very rarely that resistance may be ascribed to antibodies. There are a number of other clinical states of increased resorption in which the value of calcitonin therapy has yet to be established.


Rifampicin inhibition of protein synthesis in mammalian cells. Rifampicin produces a dose-dependent decrease in protein synthesis in rat thymocytes. At concentrations up to 200 micrograms per milliliter, rifampicin does not alter rat thymic transcription. Rifampicin causes a direct inhibition of protein synthesis in rat thymic and hepatic microsomes, and in cadaveric human hepatic microsomes. Protein synthesis inhibition could explain the toxicity of rifampicin in man.


Potassium activation associated with intraneuronal free calcium. Relations between calcium entry and activation of a calcium-dependent outward current during depolarization were examined under voltage clamp in dorid giant neurons injected with the calcium-sensitive photoprotein aequorin. Activation kinetics and amplitude of the slow calcium-dependent component were both found to be related to the rate and extent of free calcium accumulation and to the electromotive force acting on potassium ions, independent of the calcium activation kinetics. This indicates that the activation of the calcium-dependent outward current is more closely related to the transient intracellular accumulation of free calcium ions than to the movement of calcium through the plasma membrane during depolarization.


Bursting neural networks: a reexamination. Many of the motor neurons in the lobster (Panulirus interruptus) stomatogastric ganglion exhibit plateau potentials; that is, prolonged regenerative depolarizations resulting from active membrane properties, that drive the neurons to fire impulses during bursts. Plateaus are latent in isolated ganglia but are unmasked by central input. These findings emphasize the role of cellular properties as compared to synaptic wiring in the production of cyclic motor patterns by ensembles of neurons.


Norepinephrine in chronic paranoid schizophrenia: above-normal levels in limbic forebrain. In postmortem examination of brains of four patients with chronic paranoid schizophrenia, above-normal norepinephrine levels were measured in the ventral septum, the bed nucleus of the stria terminalis, the nucleus accumbens, and the mammillary bodies. No changes were detected in other limbic forebrain regions, including the hypothalamus and the medial olfactory (preoptic) area. The results point to the possibility of a malfunction of limbic noradrenergic mechanisms in schizophrenia, especially the paranoid variety.


The structure of crystalline tris: a plastic crystal precursor, buffer, and acetylcholine attenuator. The crystal and molecular structure of the widely used buffer tris(hydroxymethyl)aminomethane (tris) has been determined from single-crystal diffractometer data to a standard agreement factor (R value) of 0.026 and bond length standard deviations of 0.002 angstrom. Tris crystallizes in the orthorhombic system, space group Pn21a, with four molecules per unit cell; a = 8.844(1) angstroms, b = 7.794(1) angstroms, and c = 8.795(1) angstroms. The center-to-center distances of tris molecules in the ordered phase range from 0.4 to 1.0 angstrom less than they do in the orientationally disordered (plastic) phase of similar molecules.


Fluorinated molecule as a tracer: difluoroserotonin in human platelets mapped by electron energy-loss spectroscopy. The intracellular distribution of fluorine has been delineated in human platelets incubated with 4,6-difluoroserotonin, utilizing a scanning-transmission electron microscope equipped with an energy-loss spectrometer. Discrete intracellular structures corresponding in location to dense bodies contained high concentrations of fluorine. Electron energy-loss spectroscopy, which apparently can detect less than 10(-20) gram of fluorine in an area of 10 square nonometers, can thus localize fluorinated tracer molecules with biological activity.


Ah locus: genetic differences in susceptibility to cataracts induced by acetaminophen. The Ahb/Ahb homozygous and the Ahb/Ahd heterozygous inbred mouse strains from the (C57BL/6)(DBA/2)F1 X DBA/2 backcross are genetically responsive to 3-methylcholanthrene. They both also develop, within 6 hours after a large intraperitoneal dose of acetaminophen, an irreversible opacity in the anterior portion of the lens. Such cataract formation does not occur in similarly treated nonresponsive inbred strains or nonresponsive Ahd/Ahd individuals from the same backcross. Differences in acetaminophen metabolism and toxicity are associated with the Ah locus in the mouse, and differences in heritability at the Ah locus exist in the human. Our ophthalmologic findings may be important clinically to certain patients receiving either a single large overdose of this drug or high doses over a long period.


Delayed hypersensitivity in man: effects of systemic anticoagulation. Skin test reactivity, lymphocyte transformation, and mononuclear cell tissue factor generation were evaluated both before and during systemic anticoagulation in 24 volunteers. Anticoagulation with warfarin decreased skin test induration and tissue factor generation, but lymphocyte trnasformation remained unchanged. An intact coagulation mechanism, including tissue factor generation, appears to be important for the development of skin test induration in humans.


Saccharin-induced sister chromatid exchanges in Chinese hamster and human cells. Since the induction of sister chromatid exchanges in cultured cells has been shown to be the most sensitive mammalian system to detect the effects of mutagenic carcinogens, Chinese hamster ovary cells and human lymphocytes were exposed to the sodium saccharin found to induce bladder cancer in rats. Both that saccharin and a highly purified extract of it increased the yield of sister chromatid exchanges in both types of cells. The results, which were repeatable and statistically highly significant, indicated that the weak carcinogen, saccharin, is also mutagenic in the sense that it induces cytogenetic changes.


Myoadenylate deaminase deficiency: a new disease of muscle. Five cases of a new disease presented with muscular weakness or cramping after exercise; three of the cases also had an elevated serum creatine phosphokinase. Muscle biopsies were histologically normal but lacked adenylate deaminase by stain and solution assay, while the erythrocyte isozyme was normal. A clinical diagnostic test has been developed, and the human enzyme was separated by acrylamide-gel electrophoresis.


Ellipsosomes: organelles containing a cytochrome-like pigment in the retinal cones of certain fishes. Ellipsosomes are dense spherical bodies containing a very large concentration of a heme pigment spectroscopically resembling pure cytochrome c. They are located at the outer ends of the inner segments of the cones of certain fishes. Although, superficially, they resemble the similarly located oil droplets in the cones of birds and reptiles, their ultrastructure and staining properties resemble those of the neighboring mitochondria. However, like the oil droplets, they may serve as intracellular color filters.


Tumor promoters inhibit morphological differentiation in cultured mouse neuroblastoma cells. When added to mouse neuroblastoma cultures, the potent tumor promoter 12-O-tetradecanoyl-phorbol-13-acetate (TPA) inhibits spontaneous neurite formation as well as that induced in response to serum deprivation, prostaglandin E1, 5-bromo-2'-deoxyuridine, and papaverine. Other tumor-promoting macrocyclic plant diterpenes also inhibit neurite formation, whereas nonpromoting diterpenes do not. Inhibition by TPA was reversible and was unrelated to toxicity.


Cortical neurons sensitive to combinations of information-bearing elements of biosonar signals in the mustache bat. The auditory cortex of the mustache bat, Pteronotus parnellii rubiginosus, is composed of functional divisions which are differently organized to be suited for processing the elements of its biosonar signal according to their biological significance. Unlike the Doppler-shifted-CF (constant frequency) processing area, the area processing the frequency-modulated components does not show clear tonotopic and amplitopic representations, but consists of several clusters of neurons, each of which is sensitive to a particular combination (or combinations) of information-bearing elements of the biosonar signal and echoes. The response properties of neurons in the major clusters indicate that processing of information carried by the frequency-modulated components of echoes is facilitated by the first harmonic of the emitted biosonar signal. The properties of some of these neurons suggest that they are tuned to a target which has a particular cross-sectional area and which is located at a particular distance.


Intracellular translocation of iodine-125-labeled insulin: direct demonstration in isolated hepatocytes. Insulin labeled with iodine-125 binds to receptors on isolated rat hepatocytes. At low temperatures initial binding is restricted to the plasma membrane as detected by direct quantitative autoradiographic analysis with the electron microscope. With increasing time and temperature of incubation there is a systematic and progressive translocation of autoradiographic grains to a highly limited area of the cell periphery representing no more than 15% of the radius of the cell.


Spine stems on tectal interneurons in jewel fish are shortened by social stimulation. Spined pyriform interneurons in community-reared jewel fish have more dendritic branches and spines in the deep tectal layers than those in isolates reared without visual-tactile contact with conspecifics. Furthermore, in the same dendritic loci in which the community-reared fish had more spines, the spine stems were shorter. The findings suggest that social stimulation induces localized formation of spines, which swell with synaptic activation. Shortening of the spine stem through elongated swelling of the spine head is likely to alter synaptic effectiveness through changes in electrotonic conductance.


Regeneration of symmetrical hindlimbs in larval salamanders. The complete circle rule of the polar coordinate model of pattern regulation was tested for regenerating hindlimbs of Ambystoma larvae. The hindlimbs were made symmetrical in the circumference of either the thigh or the shank, and their ability to regenerate from both levels was observed. Thighs composed of two anterior halves failed to regenerate, whereas thighs composed of two posterior halves often regenerated distally complete, correspondingly symmetrical limbs; shanks composed of either two anterior or two posterior halves regenerated distally complete, correspondingly symmetrical limbs. These results are in contrast to what is predicted by the complete circle rule and suggest a modification of this rule.


A neural map of auditory space in the owl. Auditory units that responded to sound only when it originated from a limited area of space were found in the lateral and anterior portions of the midbrain auditory nucleus of the owl (Tyto alba). The areas of space to which these units responded (their receptive fields) were largely independent of the nature and intensity of the sound stimulus. The units were arranged systematically within the midbrain auditory nucleus according to the relative locations of their receptive fields, thus creating a physiological map of auditory space.


Intracellular calcium: its movement during pentylenetetrazole-induced bursting activity. The intracellular calcium concentration in the cytoplasm decreased and the calcium concentration near the cell membrane increased during bursting activity induced by pentylenetetrazole in snail neuron. Incubation in medium containing cobalt chloride or lanthanum chloride did not change this tendency, which suggests that this calcium distribution change is due to the stored calcium in the subcellular structure moving toward the cell membrane.


The development and regulation of new medications. The unmet needs of many patients make the successful search for new and better drugs an urgent goal. Increasing regulatory demands have generated delays in the availability of new drugs and concerns about the long-term profitability of the innovative pharmaceutical industry. A rational and flexible approach to drug regulation could ease some of the most worrisome constraints without jeopardizing the public welfare. Changes in our national drug regulatory policy and in the performance of the Food and Drug Administration will serve our society better than drastic legislative mandates intended either to emasculate the FDA or to grant the agency broad new powers.


The problem of defensive medicine.

The problem of defensive medicine. Defensive medicine--the use of diagnostic and end-treatment measures explicitly for the purposes of averting malpractice suits--is frequently cited as one of the least desirable effects of the current rise in medical litigation. Many physicians and policy-makers claim that defensive medicine is responsible not only for the increasing costs of health care but the exposing of patients to significant risks of harm from unnecessary procedures. Very little solid information is available about defensive medicine. The studies that have been conducted have been fraught with statistical difficulties and are by no means definitive. Even more important than the issue of defensive medicine is the more basic problem of our system of compensation for medical injuries.


Risk factor intervention for health maintenance. Risk factors for disease consist of (i) personal habits, such as cigarette smoking and excessive alcohol consumption, and (ii) bodily characteristics, such as hypertension and high serum cholesterol. Progress in identifying and quantifying risk factors is opening the way to the prevention of disease and maintenance of health. Systematic, controlled trials of intervention against risk factors are beginning to produce evidence on the extent of success in reducing both the factors and the mortality from associated diseases.


Medicine: meritorious or meretricious.

Medicine: meritorious or meretricious. In spite of remarkable advances in medical therapy and in the development of fantastic diagnostic devices, American society appears increasingly disenchanted with the physician. The paradox can be explained by the high cost of medical care, the overselling of medicine's capabilities, the expectation that the physician will be both ultrascientific and as emphathic as yesterday's doctor, and little recognition that the curing of one illness in the elderly exposes this group to other disease. Finally, though the physician is trained to manage illnesses, he is also given the excessively broad task of improving personal and societal practices disadvantageous to health.


Genetics and Medicine: an evolving relationship. The rapid expansion of knowledge in human and medical genetics has revealed at least 6 percent average heterozygosity per structural gene locus, in excess of 2300 Mendelian (single gene) variants and several hundred chromosomal variants in man. This means that with the exception of monozygous twins, no two individuals are alike in their phenotype. Therefore, each person has a relative state of health, and genetic factors contribute significantly to disease. The ubiquity of genetic diversity requires the development of services for genetic screening, diagnosis, and counseling to prevent and treat a major portion of disease in modern society. Specific programs in Quebec and Canada illustrate how individuals and populations can be served by such services. Better education of citizens and health professionals in human genetics is essential for the further improvement of genetics services in society.


Iatrogenic supralevator fistula.

Iatrogenic supralevator fistula. This study scrutinizes supralevator fistula and evaluates a method of successful management. We reviewed 3,190 anorectal operations done between January 1970 and July 1976; 370 of these were for fistula, an incidence of 11.7%. Our data of 350 low or midlevel fistulas and 17 supralevator fistulas (seven deep ischiorectal sinuses and ten high intermuscular abscesses intraluminally drained) are correlated with those from another series. Three extrasphincteric fistulas were studied. The initial origin of these fistulas is cryptoglandular disease with the extrasphincteric supralevator fistula probably resulting from surgery. Surgical technics are described. Improper management of supralevator abscesses can result in an iatrogenically produced extrasphincteric fistula, a difficult and sometimes impossible fistula to cure.


Hypertension after clonidine withdrawal. Rebound hypertension occurred in two patients upon clonidine withdrawal. Treatment of the hypertensive crisis consists of both alpha- and beta-adrenergic receptor blockade, reserpine, or the reintroduction of clonidine. With effective control of pressure during the crisis, long-term antihypertensive therapy must be resumed.


Grey scale ultrasonography: evaluating the jaundiced patient. Over a period of one year, 75 patients with jaundice were evaluated by grey scale ultrasonography. Intravenous cholangiography was attempted in 26 instances (bilirubin value greater than 4.3 mg/100 ml) and was diagnostic in only four. Ultrasound, on the other hand, was diagnostic for surgical jaundice in 62 of the 75 cases (82%). In 52 of the 62 patients a cause for the extrahepatic obstruction was demonstrated: 40 had cholelithiasis and choledocholithiasis, and 12 had tumors (11 pancreatic tumors, one lymphoma). In the remaining ten instances, obstruction was sonographically demonstrated but the cause was not. Of these, four patients were subsequently proven to have distal common duct stones, five had carcinoma of the pancreas and one had cholangiocarcinoma. This evidence indicates that ultrasound should be the noninvasive procedure of choice in the clinical assessment of obstructive jaundice.


Multiple pneumococcal pyarthrosis complicating rheumatoid arthritis. Pneumococcal pyarthrosis was documented in seven and ten joints, respectively, in two patients with rheumatoid arthritis. The recognition of multiple pyarthrosis superimposed upon rheumatoid arthritis can be difficult. The present cases are compared with eight previously reported cases of pneumococcal arthritis in patients with rheumatoid arthritis.


Late benign syphilis of the skin.

Late benign syphilis of the skin. Two cases of late cutaneous syphilis are presented. After treatment for secondary syphilis in 1957 and retreatment for rising VDRL titers ten years later, one patient had developed a nodular syphilid. The other had several gummas. He had two quantitative nonreactive vDRL tests and a negative Treponema pallidum immobilization (TPI) test, but two reactive fluorescent treponemal antibody absorption (FTA-ABS) tests. Syphilis was suspected histologically and was confirmed by the specific serologic testing, the characteristic clinical presentation, and the prompt response to penicillin treatment. The clinical, serologic, histologic, therapeutic, and pathogenetic aspects of late benign syphilis of the skin are discussed.


How to handle the rape victim.

How to handle the rape victim. All physicians should know the basics of care for the alleged rape victim. In a systematized approach, the procedure is presented for treating the patient and for collecting testimonial evidence in the event the assailant is apprehended and the crime becomes a legal case.


Continuous monitoring of skin temperature using a liquid-crystal thermometer during anesthesia. Forehead skin temperature measured by a stip of liquid-crystal material was compared to esophageal, rectal, and axillary temperatures measured by thermistor probes in patients having general anesthesia for coronary artery bypass grafting. Before extracorporeal circulation, forehead skin temperature was lower than axillary, rectal, and esophageal temperatures by approximately 2.2 C (4.0 F). During rapid warming, forehead skin temperature rose concurrently with the other temperatures measured but remained significantly different. The liquid-crystal strip may be useful as a safe, convenient method for routine monitoring of temperature trends during general anesthesia in patients whose exact core temperature need not be continuously monitored. We believe that infants, patients undergoing extracorporeal circulation, major abdominal, vascular, or neurosurgical procedures, or patients with a history of temperature regulatory problem are probably best monitored by a method which more exactly reflects core temperature.


Combination chemotherapy and radiation therapy of undifferentiated small cell bronchogenic carcinoma. We reviewed 76 cases of small cell bronchogenic carcinoma seen at the University of South Florida Medical Center. One third of the 55 patients who have subsequently died did so within one month of diagnosis. Thirty-five patients were treated with cyclophosphamide, adriamycin, vincristine, and radiation therapy including prophylactic cranial irradiation. Of these 35 patients, 40% demonstrated a complete remission for a total objective response rate of 63%. The projected median survival of patients referred for study is 14 months. Improved survival was found in patients less than 60 years of age, with limited disease, who responded to treatment and in whom there were no violations of protocol. Patients treated with combination therapy appear to survive longer than untreated patients and those treated with radiation therapy alone. Toxicity was tolerable and there were no deaths related to treatment. Small cell bronchogenic carcinoma is a rapidly progressive systemic disease responsive to multimodality therapy with long-term survival in some patients.


Subcutaneous mastectomy with delayed subpectoral augmentation. National survival statistics for breast cancer victims are basically the same today as they have been for the last 50 years. Less than 60% survive five years after diagnosis, and they frequently must accept mutilating results of treatment. To improve this bleak picture, our efforts should be directed toward prevention. One aspect of prevention would be to identify the breasts most likely to develop malignancies and remove the breast tissue with planned restoration of contour. Subcutaneous mastectomy and immediate insertion of Silastic gel prostheses has not met with the desired results either medically or esthetically. The complications with this procedure are numerous, and there is an unnatural "cystic" appearance on the chest wall with a thin skin covering through which the prostheses can be palpated. We advocate subcutaneous mastectomy with appropriate fixation of the nipples and areolae on the pectoral muscle and fascia, followed several months later by subpectoral augmentation. This two-staged procedure has proved to be a reliable one with few serious complications. It is hoped it will play a significant role not only in reducing the mortality associated with breast cancer but also in lessening the undesirable psychologic impact of the loss of breasts.


Mesenchymal hamartoma of the liver.

Mesenchymal hamartoma of the liver. A surgically treated case of a mesenchymal hamartoma, a rare, benign liver tumor of infants and occasionally children, is reported. The clinical picture is characterized by marked, usually rapid abdominal enlargement. If untreated, the tumor may compromise other organ systems, resulting in death. The treatment is surgical removal. The tumor is characterized by proliferation of collagenous connective tissue, immature mesenchyme, and multiple cysts or pseudocysts of varying sizes. The origin of the tumor has not yet been definitely determined. Ultrasonography combined with radionuclide scanning was useful in establishing a working, preoperative diagnosis.


Clindamycin and gentamicin in surgical infections. The combination of clindamycin phosphate and gentamicin sulfate in treating 53 patients with a variety of serious infections was studied. Initial cultures of specimens from 31 patients yielded both anaerobic and aerobic pathogens. Eleven cultures showed only anaerobic organisms and 11 showed only aerobes. Of patients treated with clindamycin and gentamicin and surgical intervention, 87.8% had bacteriologic cure. Clinical response was poor in only two cases. Two patients developed rash and one had diarrhea, but no reactions suggestive of pseudomembranous colitis were seen.


Extracardiac rhabdomyoma: a rare entity. Extracardiac rhabdomyomas are rare benign lesions of striated muscle origin. A review of the world literature revealed about 27 acceptable cases of benign, adult-type rhabdomyoma with a distinct male predominance. In most of the reported cases, the tumor was located in the head and neck region, usually submucosal or deeper. The case reported here is unusual because the tumor was subcutaneously located in the neck. The tumor was fairly well circumscribed, multilobulated, and easily shelled out. Light microscopy showed large round to elongated cells with granular, highly eosinophilic cytoplasm, often with peripheral vacuolation. Cross striations were infrequent. The nuclei were often peripheral and had prominent nucleoli. Electron microscopic studies confirmed the tumor's myogenic origin. Myofibrils with Z band material, abundant mitochondria, and glycogen particles were observed.


Tumors of the parapharyngeal space.

Tumors of the parapharyngeal space. A variety of tumors of the parapharyngeal space were operated upon during one training year at the Pack Medical Foundation, New York. These tumors characteristically present as a mass of the upper neck, behind the angle of the mandible and/or as a lateral pharyngeal mass bulging medially. Surgeons who operate in the parapharyngeal space must be thoroughly familiar with the complex anatomy of blood vessels, nerves, and muscles in this area and possess a thorough knowledge of the variety of tumors in this region of the head and neck.