[Dorsal occipito-cerivale spondylodesis with plate fixation of the wire to the occiput (author's transl)]. In occipito-cervical spondylodesis, performed because of instability in this area, there is quite a high incidence of pseudarthrosis. We tried to achieve a biomechanically stable spondylodesis by anchoring the temporary stabilizing wire-loop with a small osteosynthesis plate in the occiput and with a cortical screw in the spinous processus. Our two cases operated by this method showed a favorable result with good reduction. The bone graft consolidated without complications, the wire-loop did not break. This method seems to be less complicated that the fixation with a special plate according to Cabot and Mordent.


Avulsion of the less trochanter.

Avulsion of the less trochanter. After a period with prodromal pain a 13 year old, slightly adiposogenital-looking boy suffered from an avulsion of the lesser trochanter after a minior trauma. He was successfully treated with operative reduction and fixation. The aetiology of the lesion is discussed. On the basis of this case and others reported in the literature, the lesion may be due to separation in an epiphysis already suffering from a disorder.


[X-ray dose reduction in examination of infant's hip with image-intensifier-fluoroscopy-system (author's transl)]. An image intensifier--70mm camera--fluoroscopy system combined with a conventional X-ray tube is used for routine examination of the infant's hip. The high quality of 85% of these 70mm exposures makes immediate diagnostic interpretation possible. An even higher percentage can be achieved by most exact positioning of the patients. Apart from the radiation protection of the gonades, the X-ray skin dose of the primary beam is reduced by 90-95% compared with full size radiography using film screen combinations. This exposure technique can certainly be used not only for the examination of the infant's hip.


[An analysis of the anatomical changes of the RA forefoot and the biomechanical consequences after the resection of the metatarsal heads (authors transl)]. Deformities of the forefoot depend on various mechanical factors as well as on the anatomical structure of the foot and the sufficiency of its individual static-dynamics elements. RA affects primarily the small joints and at the some time accelerates the deformative process of the forefoot. Reviewing literature and using his own observations as a basis the author discusses various causes of deformities and conducts an analysis of the biomechanical consequences after the resection of the metatarsal heads.


[Results of corrective surgery in juvenile cyphosis (scheuermann's disease) using Harrington's compressive rods (author's transl)]. The authors present the results of 20 corrective procedures for juvenile cyphosis using Harrington compressive rods and Hibbs spondylodesis. 16 procedures date back more than one year (average 3 years, 4 months). 10 cases of pure dorsal cyphosis. The pre-operative Cobb-angles for cyphosis averaged 52 degrees, postoperatively an average of 24 degrees was measured. This reflects a 57 p.c. average immediate correction (41 p.c. for pure dorsal cyphosis, 71 p.c. for dorso-lumbar cyphosis) following surgery nearly all cases showed a significant loss of correction (average 43 p.c., dorsal 37 p.c., dorso-lumbar 49 p.c.). Three main reasons for this loss of correction are discussed and documented in detail. 1. Mal-centered and too short a length of spondylodesis; 2. insufficient corrective growth of wedge shaped vertebral bodies post surgery and 3. frequent lumbar decompensation into total round back deformity of the pure thoracic spondylodesis. The following changes in procedure to solve the problem of loss of correction are proposed. 1. Combined posterior and anterior fusions and 2. upper lumbar dorsal fusion together with extended thoracic spondylodesis. The changing indication is discussed. The main but not fatal complication was postoperative wound infection (15 p.c.).


[Mechanical tests with polymethylmethacrylate in fresh specimens and specimens obtained from loosened prosthesis (author's transl)]. Mechanical testing of specimen from fresh acrylic cement and from lossened prostheses between one and two years after implantation shows difference in compressive strength. Air bubbles, blood particles, and folds distinctly influence mechanical properties. Therefore, care should be taken to avoid these enclosures during implantation. But it is not the aging of the acrylic cement which presents the main problem in endoprosthetic fixation, but the cement-bone interface. Clinical experience and this mechanical study show that fracture of the acrylic cement is not due to primary fatigue of the material, but occurs secondarily after loosening of the bonding between bone and cement.


[Biomechanical efficiency and biocompatibility of lubricating sprays PTFE or graphite (author's transl)]. The screws and plates used in operative treatment of fractures cause moments of friction between the bone screw head and the bone plate hole during the tightening of the screws. This results in hidden damage to the grinding metal surfaces, with the danger of erosion corrosion and in a reduction in the  screw force. By covering the screw heads with the lubricating sprays PTFE or graphite friction was significantly reduced, the screw force increased by 40% and extensive damage to the surfaces avoided. Lubricating sprays or their extracts, in fetal calf serum or in dimethylsulfoxide, were added to fibroblast cultures. Toxicity was manifest as changes in the synthesis of DNA, as measured by autoradiography. Sprays or spray extracts in fetal calf serum did not inhibit cell proliferation. In vivo experiments in rats reflected the in vitro results, there being no evidence that toxic substances were released from the sprays by physiological solvents: There was a lack of histopathological changes in the inner organs and a local encapsulation of implants which was essentially like that in a teflon control group.


[Differentialdiagnostic problems in fibrosarcoma of the foot (author's transl)]. 3 cases of fibrosarcoma of the foot are presented. Despite a history of pain up to several years the first radiological examination did not reveal any signs of a malignant tumor. X-rays taken 1/2 to one year later showed a localized osteolytic process. Then the diagnosis was established by biopsy. Consecutive x-rays and timing for a biopsy are discussed.


[A new drill guide for plastic repair of the anterior cruciate ligament by a free ligamenteous graft (author's transl)]. A report of the most widely used grafts for the replacement of the anterior cruciate ligament shows the difficulties of plastic repair. The author recommends the patella ligament used by Brückner but, because of the relative shortness of this ligament, not as a distally based ligamenteous graft but as a free one. The exact topography of the anterior cruciate ligament is given. A new drill guide for repair of this ligament is described and the technique of implantation by making use of that drill guide is explained.


[Osteomyelitis. First experiences with P.M.M.A. chains and balls (author's transl)]. A new therapeutic principle in the treatment of osteomyelitis is introduced-as an alternative to "Suction Drainage"-, i.e. "Gentamycine P.M.M.A. chains". After exact surgical debridement a local therapy with high concentrations of antibiotic is possible. Results of the performed operations on 51 patients are encouraging after 14 months. Long term results are as yet not known.


[Early treatment of intraoperative infections based on bacteriological testing (author's transl)]. Validity and efficiency of an antibiotic prophylaxis after extensive orthopedic and traumatological procedures are not universally accepted. Often the systematic antibiotic prophylaxis is withhold because of considerable disadvantages. A new method is reported, which enables a bactericidal antibiotic therapy based on bacteriological testing of swabs taken during and after surgery. Thus the administration of antibiotics is possible long before the clinical manifestation of an infection. Immediate therapy diminishes the danger of complications from infections. With this method microbial contamination was found and treated in 53 (17.44%) of 305 operations. Of these, only 0.66% resulted in deep infections and 3.6% delayed healings without further complications.


[Fracture and pseudarthrosis of a synostosis between os lunatum and os triquetrum and its treatment (author's transl)]. The unusual case of fracture and pseudarthrosis of a synostosis between os lunatum and os triquetrum is described. Aetiological factors, clinical symptoms and operative treatment are explained and legal aspects concerning insurance-problems are discussed.


Educational frame of reference: an additional model for rehabilitation medicine. Since much of medical rehabilitation is actually training which is focused on helping the patient and/or his/her family become active in the patient's daily care, the addition of the educational frame of reference can make rehabilitation professionals more effective. A recommended model for patient-family education has these components: (1) Identification of patient-family understanding necessary for dealing with his/her problems or potential problems; (2) assessment of current patient-family knowledge, attitudes, and life style; (3) setting of educational goals based on individual patient and family needs; (4) planning an appropriate method of achievement of those goals; (5) implementing the plan; and (6) evaluating according to goals.


Knee lock device for knee ankle orthoses for spinal cord injured patients: an evaluation. The effect of a specially designed knee lock in a knee ankle orthosis was studied in 2 able-bodied volunteers and in 2 patients with spinal cord lesions. This lock allows the knee to bend during the swing phase but locks the knee securely during the stance phase. The device is intended to improve gait pattern and reduce oxygen consumption more than a standard knee lock which keeps the knee straight throughout the entire gait cycle. Energy savings with the knee locking mechanism were significant only at ambulation rates at or above 73 meters/min, a speed which could only be attained by able-bodied subjects. To achieve such high rates of ambulation a patient's hip flexors must be strong; yet a knee ankle orthosis is required only when the patient's knee extensors are weak. In patients with spinal cord injuries, this pattern of muscle strength is rarely encountered. The innervation of hip flexors or knee extensors overlaps, so voluntary control of these muscles will either be present or absent for both muscle groups. Therefore, most spinal cord injured persons who need a knee orthosis would not greatly benefit from this locking mechanism. There may be other conditions in which this device will prove valuable.


Plasma renin and serum dopamine-beta-hydroxylase during orthostatic hypotension in quadriplegic man. To determine whether orthostatic hypotension in patients with cervical spinal cord lesions is the result of impaired sympathetic nerve response and/or impaired renin release, serum dopamine-beta-hydroxylase (DbetaH) activity and plasma renin activity (PRA) were examined during passive tilting in 6 quadriplegic patients and in 6 able-bodied control subjects. Serum DbetaH was measured by an isotopic enzymatic method and PRA by radioimmunoassay. Following head-up tilting, quadriplegic subjects demonstrated a prompt, significant decrease in mean arterial pressure (MAP) and increase in heart rate (HR). DbetaH and PRA both increased significantly 15 minutes after tilt. In normal subjects, although HR increased, MAP was unchanged; DbetaH and PRA did not increase significantly during head-up tilt. The finding of increased DbetaH during tilt hypotension in quadriplegic patients provides evidence that reflex sympathetic nerve stimulation persists despite cervical cord transection. Increased PRA may be attributed to decreased renal perfusion pressure and increased sympathetic stimulation during tilt hypotension. These data suggest that orthostatic hypotension in quadriplegia patients cannot be attributed solely to failure of the sympathetic nervous system or the renin-angiotensin system to respond to the stimulus of orthostasis.


Myoelectric control sites in the high-level quadriplegic patient. The purpose of this investigation was to determine optimal myoelectric control sites in the C4 level quadriplegic patient. The criteria used for selecting sites as usable by the patient for myoelectric control were as follows: (1) The remaining repertoire of movement could be performed by the subject without producing interfering myoelectric activity at the control site. (2) Adequate myoelectric output could be produced from the underlying musculature. (3) Electrical silence at rest could be demonstrated at the site. Eight muscle groups of the head, neck and scapula were studied on six high-level quadriplegic patients using surface electromyography. The subjects were asked to perform 12 tasks, including active movements of the head and neck, swallowing and speaking. Following this, the subjects performed a series of maximal and submaximal voluntary contractions. Using the above criteria, sites feasible for functional myoelectric control were found over portions of the frontalis, upper and middle trapezius, and temporalis muscles. Other sites found acceptable for subjects individually were located over areas of the platysma, lower trapezius, and masseter muscles. Thus, myoelectric control sites for the operation of externally powered devices are present in the high-level quadriplegic patient. Sites have been demonstrated from which the user is able to generate adequate myoelectric output for the operation of such devices, but do not limit the remaining movements of the individual.


"Hand gym" for patients with arthritic hand disabilities: preliminary report. To improve function and to delay the tendency toward deformities of the rheumatoid arthritic hand, a new device was evaluated which enables patients to perform range of motion and isometric exercises in their home. Eighteen patients (35 hands) exercised daily for four months. Strength and range of motion showed statistically significant gains. Grip strength increased in 28 hands, volar pinch in 22 hands, lateral pinch in 21 hands. Of 140 PIP joints, 77% increased in range, indicating loosening of intrinsic muscles. Improvement in hand function was reported by most of the patients.


Handicapped driver controls operability: a device for clinical evaluation of patients. A simple device is described for measuring the force input capability of severely handicapped drivers to assist in prescribing motor vehicle adaptive controls to permit these patients to drive. The device uses off-the-shelf components and can easily be constructed in any small shop. Both steering wheel and hand control force inputs with either hand can be assessed. A recommended protocol, interpretation of findings and some clinical data collected at the Texas Institute for Rehabilitation and Research and Houston VA Hospital are also presented and discussed.


Stroke rehabilitation: a family-team education program. A stroke causes considerable anxiety and practical difficulties to the family of the patient. Additional confusion results because the difference between the acute care and the prolonged rehabilitation is poorly understood. For these reasons, a family-team conference was established at the Massachusetts Rehabilitation Hospital. Its purpose was to relieve anxiety and explain the scientific and professional aspects of the team approach to rehabilitation. The family-team program consisted of role descriptions presented by the representatives from the various disciplines involved in the rehabilitation process and a discussion of individual family-patient problems. Results of a three-year study were used to evaluate the sucess of the conference. Records of family attendance were compared with the number of persons contacted. Questionnaires completed by family members at the conference showed that the anxiety level of individual families had decreased. A better understanding of the team approach was indicated in more than 75% of those participating. More than 70% of the families felt more comfortable in visits to their relatives and in approaching team members with future questions. The family-team program is a practical instrument for expanding stroke rehabilitation and for including the needs and participation of the family.


Bell palsy: muscle reeducation by electromyograph feedback. The present case study investigated the efficacy of feedback in restoring muscle control to facial muscles which had been affected by Bell palsy. The subject, a woman, was provided an analog tone as feedback for modifying the muscle activity on the paralyzed (right) side of her face to match that of her nonaffected (left) side. The results showed a statistically significant shift in muscle activity in masseter, zygomaticus, and orbicularis oculi muscles. Post-treatment levels closely approximated the nonaffected side, and resulted in more normal facial characteristics with respect to jaw position and symmetry of smiling. Bidirectional control of the zygomaticus was also demonstrated.


Sinography in management of decubitus ulcers. Draining sinuses are considered a major complication of decubitus ulcers in spinal cord injury patients. Of 144 such patients with decubitus ulcers admitted in 1975 and 1976, 15 had draining sinuses. Twenty-one sinograms were obtained in the process of their evaluation prior to treatment. In 6 patients, sinography resulted in unexpected findings such as excessive depth of the sinus tract, abscess formation, undermining of previous graft, and extension into neighboring joints, affecting both the management of the decubitus ulcers and the surgical approach. It is concluded that sinography should become an integral part of management of decubitus ulcers with draining sinuses.


Tracheo-esophageal anastomosis in treatment of chronic aspiration pneumonitis. A patient underwent tracheo-esophageal anastomosis following repeated episodes of aspiration pneumonia after the resection of a meningioma at foramen magnum. The surgery eliminated the intractable problem with aspiration. This procedure is reversible, and restoration of the laryngeal function can be accomplished when the patient has recovered neurologically. If adequate neurologic recovery does not occur, the anastomosis can be left intact indefinitely.


Venous access using the bovine carotid heterograft: techniques, results, and complications in 75 patients. Between January 1974 and March 1977, arm bovine carotid heterograft arteriovenous fistulas were constructed in 75 patients. Twenty-six fistulas were established between the distal radial artery and an antecubital vein, and 49 fistulas used the brachial artery and the axillary vein. Thirty-eight heterografts have functioned without complication over a maximun interval of 29 months, including 15 of 26 radiobasilic fistulas and 23 of 49 brachioaxillary fistulas. Of the 37 heterograft failures, 28 were caused by thrombosis, six by infection, two by false aneurysm formation, and one by distal arm ischemia. Early postoperative thrombosis was associated with a higher subsequent failure rate after thrombectomy than was late thrombosis and it often required insertion of a new heterograft. Infected heterografts must be ligated and eventually replaced with another fistula at a distant site to avoid the potentially lethal complications of systemic sepsis and local hemorrhage.


Complex cerebral revascularization.

Complex cerebral revascularization. Although carotid endarterectomy is the usual technique for treating symptoms related to extracranial arterial occlusive disease, cerebrovascular and upper extremity symptoms caused by lesions of the innominate, common carotid, or subclavian orifices necessitate more complex revascularization techniques. We have treated five patients, three females and two males, with symptoms of cerebrovascular and/or upper extremity ischemia by highly individualized, complex, revascularization techniques. The procedures were amalgamations of carotid-subclavian bypass, carotid-subclavian bypass with carotid bifurcation endarterectomy, subclavian-subclavian bypass, axillo-axillary bypass, and carotid-axillary bypass. The conditions of all patients were greatly improved and four of the five patients became asymptomatic. These procedures seem to be highly effective in relieving symptoms and they minimize the risks of cerebral and upper extremity revascularization.


Postsplenectomy thrombocytosis: its association with mesenteric, portal, and/or renal vein thrombosis in patients with myeloproliferative disorders. During the past two years, postoperative thromboses of parts or all of the splanchnic venous circulation have developed in four of 30 patients with myeloproliferative disorders who have undergone splenectomy at our institution. The patients' courses were marked by platelet abnormalities, both quantitative and qualitative. In an attempt to avoid this complication, aspirin and low-dose heparin sodium have been administered and there has been no evidence of thrombosis in the four patients so managed.


Rupture of the spleen in infectious mononucleosis: a critical review. Spontaneous rupture of the spleen in infectious mononucleosis is a well-known clinical phenomenon. However, when strict criteria concerning the presence or absence of trauma and the diagnosis of infectious mononucleosis are applied to the 107 cases in the world literature, only 18 true spontaneous ruptures are found. In these, the survival rate was 100%. In addition to pain referral to the left shoulder (Kehr's sign), right shoulder and scapular pain from diaphragmatic irritation, caused by free intraperitoneal blood, can be a valuable sign in determining splenic rupture. Because the spleen remains susceptible to rupture even after recovery based on all clinical, hematologic, and serological criteria, it is recommended that full normal activities not be resumed for two to three months by the nonathlete and for six months by the athlete.


Missile tract infections after transcolonic gunshot wounds. Severe invasive infections around missiles or missile tracts may occur after transcolonic gunshot wounds. Observations in seven patients disclosed that infections of bone, soft tissue, retroperitoneum, and vascular structures resulted from the contamination of these tissues by missiles that had passed through the lumen of the colon. The infections were frequently obscure and difficult to diagnose unless the missile was considered to be a potential source of contamination. Two of seven patients died as a direct result of infection. Aggressive debridement of missile tracts, removal of accessible missiles, and adjunctive antibiotic therapy were useful.


Operative cholangiography and overlooked stones. In a series of 100 consecutive common bile duct explorations in which stones were present and operative cholangiography performed, 22 patients were found to have residual stones. The operative cholangiograms showed the missed stones in three fourths of the patients, even though many of the cholangiograms were of poor quality. It is concluded that operative cholangiography is an excellent technique that will demonstrate most common bile duct stones. Closer cooperation with the radiologist and more emphasis on technique should lead to consistently satisfactory films and more appropriate interpretation, thus resulting in fewer overlooked biliary calculi.


Antecolic or retrocolic anastomoses in Billroth II gastrojejunostomy? A retrospective study of major postoperative morbidity in two groups (50 patients each) that underwent Billroth II gastrectomy for duodenal ulcer disease showed no difference according to the type of anastomosis used (antecolic vs retrocolic). Prevention was not related to the type of anastomosis used, the main means of prevention being the use of meticulous care during the gastrojejunostomy.


Right-sided diaphragmatic injury: rarity or overlooked diagnosis? Although more than 90% of diaphragmatic injuries are said to occur on the left side, we have recently managed six patients with right-sided diaphragmatic injuries. In four instances, the diaphragmatic injury was not discovered until laparotomy was undertaken for concomitant visceral injury. All patients who underwent operations had fractures and abdominal visceral injuries as well. This experience, plus the difficulty of establishing a diagnosis of injury to the right hemidiaphragm preoperatively, makes us suspect that the true incidence of right-sided diaphragmatic tears is higher than usually stated. A high diaphragmatic shadow, elevation of the inferior liver edge, and acute changes at the right lung base are among the roentgenographic findings associated with diaphragmatic tears.


Injury to the portal vein: a hazard during common bile duct exploration. Portal vein injury is an unusual but dramatic complication of biliary surgery. Unlike major arterial injury, this complication may, in carefully selected cases, be managed successfully without primary repair.


Hyperparathyroidism due to primary cystic parathyroid hyperplasia. Cysts of the parathyroid glands are uncommon, and functioning parathyroid cysts that cause primary hyperparathyroidism are rare. A 63-year-old man had primary hyperparathyroidism because of cystic hyperplasia of all four parathyroid glands. He also had squamous cell carcinoma of the soft palate, chronic renal failure, hypertension, type-4 renal tubular acidosis, a hyperplastic thyroid adenoma, and hyporeninemic hypoaldosteronism. To our knowledge, this is the first patient to be described with hyperparathyroidism due to multiple parathyroid cysts. The finding of cystic involvement of all four glands supports the theory that at least some parathyroid cysts are either a result of a common embryologic defect or of retention of parathyoid secretions rather than of cystic infarction of parathyroid adenomas.


Hemolytic-uremic syndrome confused with acute appendicitis. Hemolytic-uremic syndrome (HUS) may have signs that are clinically indistinguishable from acute surgical diseases of the abdomen. A 2-year-old girl had HUS and physical findings leading to appendectomy. Various pediatric surgical and medical conditions are mimicked by HUS. Attention to specific diagnostic clues (anemia, evidence of hemolysis, thrombocytopenia, azotemia) may lead to the correct diagnosis of HUS and avoidance of an unnecessary operation.


Internal hernia with gastric outlet obstruction. A patient with an unusual type of internal hernia was treated successfully. To our knowledge, this is the first reported case of a hernia emanating through the gastrohepatic ligament that resulted in gastric outlet obstruction. It is even more remarkable because, although the small bowel was the herniated viscus, the symptoms were due to obstruction of the stomach rather than obstruction of the small bowel.


An arteriosclerotic aneurysm of the hand. A 56-year-old hypertensive man had bilateral arteriosclerotic aneurysms of the hand, the aneurysm on the right having recently enlarged. Since angiography showed the radial artery of the right arm to be the only blood supply to the hand, resection of the aneurysm and primary anastomosis of the radial artery were performed. The etiology of hand aneurysms and evaluation of arterial blood supply are key factors in therapeutic decisions, since arteriosclerotic aneurysms may lack sufficient collateral blood supply to allow ligation of the artery.


Localized tamponade of the right atrium and right ventricle: induction of intracardiac right-to-left shunting after the use of a Gott shunt. After repair of a traumatic tear of the descending aorta, using a Gott shunt between the left ventricle and the distal descending aorta, a patient was readmitted with profound postural cyanosis and dyspnea. Catheterization showed right-to-left shunting at the atrial level caused by extrinsic deformation of the right atrium and right ventricle. Sternotomy showed selective pericardial tamponade on the right side of the heart caused by a localized collection of organizing thrombus and old blood. The previously unsuspected large patent foramen ovale was closed. This complication represents a form of iatrogenic cyanosis tardice and is thought to be attributable to the method of shunting used during the first operation. Moreover, this complication should be easily preventable if the pooled blood and clot in the most dependent portion of the pericardial cavity is adequately evacuated.


[Energy and crude protein requirements of young fattening geese. 2. Inluence of varying energy and crude protein contents of feed on carcass quality]. In 5 trials using a total of 5,7000 geese (Deutsche Legegans maleXWhite Italian Goose female) of which 482 were slaughtered and subsequently dressed, the influence of varying net energy and crude protein levels in the ration on fattening and carcass performance were studied. Increased crude protein contents were found to improve the meat yield. High-energy feeding likewise caused gains to go up, the extra gain almost exclusively consisting in adipose tissue (particularly skin, and intestinal and abdominal fat). In addition, high energy intakes induced earlier juvenile moulting, this effect making the 56-day old carcasses rather bristly. Therefore, it seems more convenient to fatten geese on low-energy rations (500 energetic feed equivalents/poultry [EFp] per kg) up to the age of 63 days because the meat yield (especially of breast meat) is likely to improve considerably when slaughter takes place at a later date. Goose fattening rations should stick to the following parameters (per kg): 500--550 EFp, 160--180 g crude protein, 8 g lysine, 6.5 g thio-amino acids.


[Conception of female rats and litter mortality due to Mn-deficiency]. Sexually mature, female rats were fed an Mn-deficient (1.0 ppm) diet on saccharose/casein basis and studied for their reproductive behaviour. Cycle disorders as sometimes described of females depleted over a longer period, were not observed in any case. Although the experimental animals showed a normal estrus, only 50% of the rats conceived. The rats that had become pregnant produced litters of 2 to 11 animals born alive. However, their mortality was 80%. They died either immediately after birth or during the first days post partum.


[Nickel--an essential trace element. 3. Effect of nickel deficiency on reproductive performance in female animals]. A total of 26 Ni-deficient (less than 100 ppm Ni in the ration) breeding goats and their 30 kids and 24 corresponding control goats with 37 kids were used to investigate, over 6 experimental years, the influence of Ni-deficiency on the reproductive performance until weaning. Following the same arrangement, 7 and 6 mini sows, respectively, and their piglets (71 and 67) were studied. The following statistically secured results were obtained. Ni-deficiency resulted in reduced pregnancy rates (after one insemination) in animals that had revealed clear estrus symptoms. This caused delayed pregnancies and birth of offspring. The conception and abortion rates, the number of offspring and the sex ratio were not influenced significantly by Ni-deficiency. Intra-uterine Ni-deficiency reduced the birth weights and caused lower weight gains during the suckling period. Its influence proved stronger in the kids as compared to the mini piglets. Ni-deficiency caused the mortality of the offspring during the suckling period to increase significantly. The losses in the Ni-deficient kids and mini piglets were by 41 and 51%, respectively, higher than in the corresponding control animals.


[Effect of endogenous factors on ash, calcium, magnesium, potassium, sodium, phosphorus, zink, iron, copper and manganese concentration in the pig bristle. 6. Effect of gender on mineral composition of pig bristle]. Sex-specific hormones were found to influence the bristle's mineral content. The bristles of female (N=151) and male (N=152), 42-day old piglets did not differ in the proportion of the elements under study (P greater than 0.05). The bristles of 36 female and 36 male castrated fattening pigs in the 40-110 kg weight range did not reveal significant differences either (P greater than 0.05). The bristles of sows and boars showed differences in the contents of ash, Mg, K, Na, P, Zn and Mn (P greater than 0.05) as well as in the contents of Fe (P greater than 0.01) and Cu (P greater than 0.05). The difference for the Ca-content could not be statistically secured (P greater than 0.05). The content of the bristle or hair of sexually mature animals in certain elements is influenced by sex hormones and should be regarded as a secondary sexual characteristic.


[Effect of graduated protein supply (0-50%) on hematologic values as well as protein and urea concentrations in the plasma of rats]. The influence of graduated protein supply (0-50% casein) on hematological values was studied in growing rats and compared with other criteria of the supply status. The following results were obtained: Weight development was found to reflect to 30%, the plasma protein content to 40% the level of protein supply. The highest protein levels revealed a trend towards lower values. At a dietary protein content of 15 to 20%, the urea concentrations of plasma went through a minimum. Both with better and with poorer protein supply they proved higher thus suggesting an increasingly energetic conversion of the feed protein. The hematological values hemoglobin, hematocrit and erythrocyt number responded uniformaly to the level of protein supply. This is also attributable to the close statsitical relationship between these three magnitudes. Whilst at the end of the experiment the erythrocyt number with protein-free diet proved lowest, the smallest values for hemoglobin and hematocrit were observed with 5% protein. From 10% on the differences were not so marked. Especially high values were measured, however, for all criteria at 40 and 50%, partly at 25% protein. As the calculation of the mean cell volume (MCV) revealed, insufficient protein supply is likely to affect rather the erythrocyt ripening than iron conversion. In agreement with this idea, the mean corpuscular hemoglobin concentration (MCHC) was not found to be influenced by protein supply.


Replication of an enteric bovine coronavirus in intestinal organ cultures. A coronavirus isolated in tracheal organ cultures from the faeces of a calf with diarrhoaea readily multiplied on passage in intestinal organ cultures. Evidence for multiplication was obtained by the production of viral haemagglutinin in organ culture fluids and the presence of immunofluorescence and viral particles in the columnar epithelial cells of the villi. Thus virus multiplication was studied in vitro in the cell type in which it multiplies naturally.


In vitro studies on Borna virus. I. The use of cell cultures for the demonstration, titration and production of Borna virus. Borna virus produces non-lytic infections in a wide spectrum of primary cell cultures and cell lines. The sensitivity and virus yields vary with the different cell systems. Accurate virus titrations can be performed in the RK 13 cell line by counting immunoflourescent microfoci between the 5th and 10th day after infection. Since the virus is not released from the cells and does not spread via the culture medium, the use of a semisolid overlay in unnecessary in virus titrations. The cell line most productive for Borna virus is the CV 1 line. The conditions for optimum virus production include a prolonged cultivation period of at least two weeks with regular changes of medium, and an incubation temperature of 35 degrees C. Harvest of the virus requires thorough disruption of the infected cells, preferably by ultrasonication, since Borna virus seems to be closely associated with cellular structures.


[Cerebrospinal fluid proteinogram of healthy preterm newborn infants]. The total protein concentration and the protein profile were studied in 40 healthy premature newborn infants at the second day of life. The results were compared to those obtained for 40 full-term healthy newborn infants. Results pertinent to this last group were reported previously. Results here reported confirm that there is a higher total protein concentration in the cerebrospinal fluid of the premature newborn infant. Statistical analysis shows that the difference is significant (t : 2.16). The mean protein profile shows a protein fractions distribution proper to the "mixed profile type". The absence of tau-fraction was the most commonly finding observed in this way. Data were compared to those reported in the literature, and they were also considered proper to immaturity conditions of blood brain barrier.


[Prognostic-evolutive evaluation of patients in coma based on ocular reflexes]. The ocular reflexes (ciliospinal, photomotor, oculocephalic, vestibulo-ocular, corneal) were studied in 84 comatose patients. The scope of the investigation was the assessment of each reflex in terms of its resistance according to the degree of depth of the coma. From the statistical viewpoint it was possible to emphasize the photomotor, corneal and vestibulo-ocular as the most resistant ones. The periodic evaluation in short time intervals of these five reflexes, observing their extinction or their re-appearance, permits a better prognostic assessment in a longitudinal viewpoint of the comatose patient.


Electromyographic diagnosis of the carpal tunnel syndrome. Sensory conduction velocities of the median nerve were studied from digit to palm and from palm to wrist in normal subjects and in patients with the carpal tunnel syndrome. Definite slowing was noted in the palm to wrist segment, even in the early carpal tunnel syndrome. It was noted that 37% of normal women over 40 years of age had electrophysiological evidence of the carpal tunnel syndrome.


[Primary amebic meningoencephalomyelitis. Report of a case]. A case of primary amebic meningoencephalomyelitis due to Naegleria sp observed in a 14 years old boy is reported. Symptoms due to myelitis at the dorsal level assumed ascending character during the first days of disease. Manifestations due to encephalic involvemente were discrete. Cerebrospinal fluid changes were marked by pleocytosis, and the eosinophil cells participation in the cytomorphological profile was persitently high. Amphotericin-B was used intravenously (25 mgm/day) until 1,500 mgm of total dosis. Remission of encephalitis manifestations was prompt, as well as of meningeal signs. Cerebrospinal fluid changes disappeared progressively. Sensitive-motor changes due to spinal cord involvement persisted as permanent sequelae. Naegleria sp., was isolated from the cerebrospinal fluid in the acute stage of the disease, as well as, from the water of a lagoon where the patient used to swim.


[Neurocutaneous melanosis. Report of a case]. The clinical, laboratorial and radiological features of a 3-month-old child with neurocutaneous melanosis are described. The patient was born with multiple disseminated benign cutaneous nevi, proven by skin-biopsy, and presented with drug-resistant seizures and psycho-motor retardation. Serial cerebrospinal fluid studies showed high protein and low glucose levels, with pleocytosis and malignant cells in the fluid. Pneumoencephalogram showed mild non-obstructive hydrocephalus. Immunological studies showed normal immunological activity at three months of age and very poor activity at one year. The patient died at 16 months of age, after the sudden onset of intracranial hypertension and meningeal signs. Immunotherapy and chemotherapy were suggested but not accepted by the family. Some comments are made based on this and other 43 cases described in the literature; the value of laboratory studies in detecting malignant transformaiton in the meninges in patients with benign skin nevi is stressed.


[Giant aneurysm of the middle cerebral artery. Report of a case]. A case of giant aneurysm of the middle artery with the size of 12,0 x 8,0 x 6,0 cm is reported. Some aspects of the treatment of such aneurysm are considered. As far as we know this is the largest intracranial aneurysm ever recorded.


Infratentorial neurilemmoma of the trigeminal nerve in a child. Report of a case. A case of trigeminal nerve infratentorial neurilemmoma in a 11-year-old girl is reported. The author remarks on this tumor's low incidence in this age group. A correlative analysis between the clinical and radiological findings in this case and those reported on the literature is made.


[Parasagittal meningioma simulating an extracerebral mass. Report of a case]. The case of a fronto-parietal parasagital "in plaque" meningioma which growed mainly in the subdural space is reported. The atipical angiographic picture of a subdural hematoma is described with comments on the mechanisms that occasioned this radiological appearance. The rarity of this finding and the need of angiographycal study of both internal and external carotid systems by the intracranial meningiomas are emphasized.


Dermatoleukodystrophy with neuroaxonal spheroids. A Japanese brother and sister, the progeny of healthy parents, were born with thickened, wrinkled skin and died between the age of 2 and 3 years with a progressive cerebral disease characterized by generalized mental and motor impairment. Postmortem neuropathological studies disclosed a remarkable leukodystrophy in which multiple axonal spheroids were the outstanding feature. Ultrastructurally, the spheroids contained granules resembling ceroid-lipofuscin bodies. Similar granules were found in degenerating oligodendrocytes and in Schwann cells. The skin showed hypercellular and sclerotic features, suggestive of a genodermatosis. This combined neurologic and dermatologic syndrome, which, to our knowledge, has not hitherto been recognized, may well result from a genetically determined metabolic disorder, the nature of which still remains undisclosed.


Normal pressure hydrocephalus. Recognition and relationship to neurological abnormalities in Cockayne's syndrome. Normal pressure hydrocephalus (NPH) in adults is a well-known cause of dementia. We describe NPH in children having the recessively inherited Cockayne's syndrome (CS). Cockayne's syndrome is characterized by cachectic dwarfism, neurological dysfunction, and cutaneous sunlight sensitivity. We noted that the NPH-associated triad of dementia, gait disturbance, and incontinence developed in CS patients. Computerized tomography of the brain in our four CS patients showed hydrocephalic enlargement of the brain ventricles greatest in the older patients. There was no evidence of cortical atrophy except in the one patient who had CS with xeroderma pigmentosum. Lumbar puncture and radionuclide cisternography in the two patients tested showed normal CSF pressure, with complete blockade to flow of radionuclide above the tentorium cerebelli, ventricular reflux, and delayed absorption. Studies of NPH in CS may elucidate the pathophysiology of NPH and methods to alter its sequelae.


Human botulism studied with single-fiber electromyography. In two cases of mild human botulism, conventional electromyography (EMG) was normal. In one case, the investigation with reptitive nerve stimulation showed slightly abnormal results, but in the other case the findings were within normal limits. Single-fiber EMG showed abnormal neuromuscular function and at later investigations as well, when the patient no longer showed any muscular fatigability. The jitter was frequency dependent and decreased with higher innervation frequency. The single-fiber EMG findings normalized after three months. The results are in agreement with the known disturbance of acetylcholine release.


Normal and abnormal patterns of cerebrovascular reserve tested by 133 Xe inhalation. Cerebrovascular functional reserve was tested by noninvasive measurement of regional cerebral blood flow (nrCBF) at rest in quiet darkness and when repeated during standard multiple psychophysiologic activation. The test was applied to normal volunteers and patients with different neurologic disorders. The test included counting, conversation, music, and observing movements, while rCBF was measured over both cerebral hemispheres, brain stem, and cerebellum. In normal persons at rest, mean gray matter flow (Fg) values were the same for each hemisphere. Highest Fg values were observed in brain stem and both frontal regions. During activation in normal persons, there was a significant increase in Fg values over both hemispheres and in brain stem. During activation, three types of abnormal rCBF responses were seen: Demented patients showed no change, patients with vascular occlusion showed little or no increase over the ischemic hemisphere, and some patients with epilepsy showed excessive increases.


Electrophysiological study of hemiplegia. Motor nerve conduction velocity, brachial plexus latency, and electromyography. Motor nerve conduction velocities of the ulnar and common peroneal but not the median nerves were substantially reduced in the affected limbs in a series of hemiplegic patients. Slowing of conduction velocity of the common peroneal nerve was related to the reduction of skin temperature in the hemiplegic limbs. Brachial plexus latencies to biceps and deltoid muscles were longer in the affected than in the unaffected sides in five of 12 hemiplegic patients. Electromyograms (EMGs) of limb muscles showed absence of spontaneous activity in 83% of patients. Spontaneous EMG activities in 12 of the 13 patients were related to an associated subclinical neuropathy or plexopathy in the involved limbs. Entrapment andtraction causing subclinical or clinical neuropathy or radiculopathy may be present in some hemiplegic patients.


Visuospatial judgment. A clinical test.

Visuospatial judgment. A clinical test. We constructed and developed a brief test assessing capacity for discriminating the direction of lines. Application of the test to patients with unilateral brain disease disclosed a remarkably high frequency of defective performance in those with right hemisphere lesions. The performance of patients with left hemisphere lesions was comparable to that of control patients. Brevity and ease of administration make the test convenient for clinical use.


The natural history of acute confusional migraine. Children with migraine, or, less commonly, with no previous history of migraine, may have agitated confusion lasting from several minutes to hours. There is a tendency for the confusional attacks to recur, but they are eventually replaced by typical migraine. The natural history of this syndrome with 1 1/2 to 5 years' follow-up in five children is reported. The mechanism is believed to be cerebral ischemia of one or both hemispheres.


Bilateral congenital subdural cysts associated with porencephaly and CSF-subdural fistula. A report of two cases. Tow infants had bilateral congenital subdural cysts associated with encephaloclastic porencephaly and a CSF-subdural fistula. The cysts occupied 80% to 90% of the crainal cavity. There was severe atrophy and malformation of the underlying brain, suggesting that its development had been disturbed at an early stage of gestation. The clinical and radiologic findings were indistinguishable from those of hydranencephaly.


The thymus in infants with perinatal telencephalic leukoencephalopathy. Selected organ weights and body measurements of intants with perinatal telencephalic leukoencephalopathy (PTL) were compared to those of infants without cerebral white matter abnormalities. Although infants with PTL tended to have lower values of all weights andmeasurements, only thymus and spleen weights were significantly lower in infants with PTL. Infants with PTL were much more likely than infants without PTL to have thymic atrophy histologically. These findings are compatible with hypotheses that PTL and its correlates-thymus atrophy and reduced organ weights-are manifestations of undernutrition, viral infection, and/or exposure to endotoxin.


Sydenham's chorea and seizures. Clinical and electroencephalographic studies. The hospital records of 28 children (mean age, 9.4 years) with typical Sydenham's chorea were reviewed. Nineteen of 28 patients had antistreptolysin O titers of greater than or equal to 200 Todd units. Other causes of chorea were excluded by appropriate laboratory and clinical follow-up studies. At the onset of the movement disorder, 17 of 28 patients had abnormal EEGs consisting of irregular posterior slowing in 15, sharp epileptic spikes in 5, and high-voltage sharp waves in 2. Two patients with spikes predominantly in the temporal lobe regions developed complex partial seizures. On follow-up evaluation, the EEGs returned to normal within one to four weeks. Seizures did not recur after therapy with anticonvulsants. Seizures have been reported only rarely in association with Sydenham's chorea. Our observation suggests that seizures may occur during chorea but may often be masked by frequent choreic movements and thus not recognized. The EEG changes and seizures were transient in our patients studied so far.


Studies on retinal blood flow. II. Diabetic retinopathy. Diabetic patients grouped according to the evolutive stages of their retinal involvement were examined by a direct method for estimation of segmental retinal blood flow by slit-lamp fluorophotometry. Initial stages of retinal involvement in diabetes, in which the only alteration is a breakdown of the blood-retinal barrier, show values of segmental blood flow that are within normal limits. Patients with a minimal background retinopathy show a slight increase in retinal blood flow, whereas an highly significant increase of segmental blood flow is observed in the more advanced stages of background retinopathy with maculopathy. In general, a good correlation is apparent between the progressions of diabetic background retinopathy and increase in retinal blood flow. On the other hand, patients with proliferative retinopathy show lower values of retinal blood flow, which are attributable to a marked decrease in arterial diameter.


Vitreous fluorophotometry in juvenile-onset diabetes mellitus. Vitreous fluorophotometry was carried out in 99 juvenile-onset, insulin-dependent diabetics and 31 control subjects. The mean vitreous fluorescein concentration one hour after intravenous administration of fluorescein, 7 mg/kg, was 5.4 +/- 0.3 ng/ml (mean +/- SEM) for controls and 9.5 +/- 0.4 ng/ml for diabetics (P less than .005). Diabetic patients with or without background retinopathy, when randomly matched for age or duration of their disease, had similar vitreous fluorophotometry measurements. The break-down of the blood-retinal barrier to fluorescein appears to be the earliest detectable ocular abnormality of diabetes.


Leber's congenital amaurosis. A retrospective study of 33 cases and a histopathological study of one case. This report is a retrospective study of 33 patients seen over a 16-year period in whom a diagnosis of Leber's congenital amaurosis was made. The findings of an autosomal recessive heredity in 33%, connatal blindness (visual acuity less than 20/200) in 95%m nystagmus in 75%, and a markedly abnormal electroretinogram in 100% is in agreement with the findings of previously published large series. The difficulty in making the correct diagnosis initially was related to the wide variety of fundus findings and a high association (30%) of central nervous system disease. In the differential diagnosis of connatal blindness, only Leber's congenital amaurosis exhibits an absent or markedly diminished response on electroretinogram. The histopathologic findings in a 6-month-old infant with this disorder are compared with those of previously published reports.


Retinitis pigmentosa. Genetic percentages. A total of 173 patients, from 124 families, with retinitis pigmentosa were evaluated for the presence of various forms of genetic transmission. Of the 124 pedigrees, it was evident that some form of genetic transmission had occurred in 59 (48%). In 65 families (52%), the proband was the only known affected family member (isolated case). In those families with know genetic transmission, 17% (10 patients) were X-linked recessive, 39% (23 patients) were either probable or certain autosomal dominant, 41% (24 patients) were certain or probable autosomal recessive, and 3% (2 patients) were of a genetic type that could not be determined with certainty. These findings are, to my knowledge, the first published series from the United States to indicate that the X-linked recessive form of retinitis pigmentosa is a more prevalent genetic trait than has been emphasized previously.


Ocular hypotony following retinal vein occlusion. In a study of 130 cases of unilateral retinal vein occlusion uncomplicated by rubeosis, we found that more than 80% of the patients had a lower intraocular pressure (IOP) in the eye with the occlusion than in the fellow normal eye. The reduction of IOP was greater with central than with branch vein occlusion, greater with hemorrhagic than with venous stasis retinopathy, and greater in patients who had high pressures in their fellow eyes. The pressure reductions persisted during follow-up periods of up to two years. How retinal vein occlusion lowers IOP is obscure and may involve more than one mechanism. Outflow facility was increased (compared to the fellow eye) in hemorrhagic retinopathy and in branch vein occlusion, both of which are association with retinal ischemia, but not in venous stasis retinopathy. Calculated rates of aqueous formation were low in central vein occlusion but not in branch vein occlusion.


Whiplash maculopathy.

Whiplash maculopathy. Maculopathy in three patients, caused by whiphash injury demonstrated three features that are characteristic of this subtle disturbance of the macula: a history of flexion-extension, head and neck trauma; a history of immediate mild reduction of central visual acuity in one or both eyes; and grayish swelling of the foveal zone accompanied by a small (50 to 100-mu) pit or depression in the fovea. In patients with this disturbance, the retinal opacification and the visual disturbance are transient, but the tiny depression in the retina with its whitish border is permanent.


The visually evoked response. Binocular facilitation and failure when binocular vision is disturbed. The visually evoked response (VER) caused by the horizontal sinusoidal movement of a display consisting of a checkerboard with 15-minute checks of relatively low contrast oscillating at 6.3 Hz is itself sinusoidal with a frequency of 12.6 Hz. When viewed binocularly, the VER is 25% to 30% greater in amplitude than the sum of the amplitudes for monocular viewing. This binocular faciltation may be a VER correlate of normal binocular single vision. It is lost in small-angle esotropes and in normals whose binocular function is disturbed by a vertical prism placed over one eye. Characteristic curves relating VER amplitude and phase angle to frequency to oscillation of the checker-board display suggest that two "systems" carry information to the visual cortex: a long and a short latency system. In amblyopia, the long latency system may be selectively impaired.


Retinal pigment epithelial window defect. The clinical and histopathologic features of a solitary retinal pigment epithelial window defect are presented. Fluorescein angiography disclosed an area with early choroidal fluorescence but no late staining. Histopathologic studies showed an intact but attenuated retinal pigment epithelium with partial to complete loss of melanin granules, partial atrophy of the photoreceptor cells, and sclerosis of the choriocapillaris.


Epibulbar mucogenic subconjunctival cysts. Two patients had freely movable epibulbar subconjunctival cysts that occurred in the absence of trauma, inflammation, and infection. Histopathologic examination of these cysts revealed them to be linked  by nonkeratinizing epithelial cells and goblet cells. The cysts had little or no stroma and contained PAS-positive mucoid material. Electron microscopy of adjacent conjunctiva indicated that the epithelial cells were actively producing mucous granules and did not form many hemidesmosomes. The mechanical displacement of epithelial cells, as well as their mucous-producing ability, probably contribute to cyst formation. The relative lack of hemidesmosomes may explain why these cysts are freely movable.


Alteration of the blood-retinal barrier in experimental diabetes mellitus. Vitreous fluorophotometry was used to evaluate the integrity of the blood-retinal barrier to fluorescein in hooded rats. Streptozotocin-induced diabetes mellitus caused a breakdown of this barrier within ten days. Normalization of blood glucose levels with insulin significantly reduced (P less than .005) the increased permeability. This functional microangiopathy might prove to be the earliest detectable change in the retinal circulation in experimental diabetes.


Intraocular penetration of topical clindamycin in rabbits. Clindamycin is a recently developed, semisynthetic antibiotic whose spectrum of activity suggests a potential for the treatment of common ocular infections. The upake by various ocular tissues and serum in albino rabbits after topical administration of 0.2% clindamycin hydrochloride was studied. Therapeutic levels were achieved in the cornea, aqueous humor, and iris-ciliary body and persisted for two hours. Peak concentration occurred in the cornea within 15 minutes and in the aqueous humor and the iris-ciliary body at 30 minutes. Freezing of the tissue reduced active clindamycin levels in the cornea by a factor of 2 to 2 1/2 of those determined by fresh tissue analysis but had no apparent effect on aqueous humor and iris-ciliary body. There were, however, no detectable levels in the serum or vitreous humor.


Soluble gentamicin ophthalmic inserts as a drug delivery system. A comparison was made of soluble 14C-gentamicin ophthalmic inserts with drop, ointment, and the subconjunctival routes of administration. The insert is a solid, solubilizable collagen polymer containing 14C-gentamicin. We compared the levels of 14C-gentamicin in the rabbit tear film and in multiple corneal and scleral biopsies to determine which route of administration gave the best results. The wafer route of administration gave the highest tear film and tissue concentration of drug. The tear film concentration by subconjunctival injection was surprisingly low. Soluble collagen inserts offer a new method of delivering high doses of gentamicin in infected corneal tissue in a convenient and atraumatic fashion.


Classification of human cataracts.

Classification of human cataracts. A stereoscopic system of lens photography was developed and was applied in the classification of different forms of cataract. Lenses, after surgical extraction, can be classified by a technician, independent of ophthalmological collaboration. This system meets the needs of the laboratory scientist and has been adopted by the Cooperative Cataract Research Group.


Studies on retinal blood flow. I. Estimation of human retinal blood flow by slit-lamp fluorophotometry. This article describes a new direct method for estimation of human retinal blood flow by slit-lamp fluorophotometry. The apparatus consists fundamentally of a modified slit lamp with an eye piece containing two fiberoptic probes connected to a double photometric detection system. Both optic fibers are focused on a retinal arterial segment, and the passage of a fluorescein bolus is automatically registered, giving, after correction, the mean transit time. Fluorescein angiography allows the determination of the volume of the arterial segment under study. Values for superior temporal retinal blood flow in healthy individuals show a mean value of 4.2 +/- 0.5 microliter/min. Studies in anemic patients show an increase of approximately 52% in the retinal blood flow. The potential causes of error associated with this technique, apart from the slight increase in intraocular pressure induced by the contact lens used, do not appear to be significant.


Corneal wick electrode for recording bright flash electroretinograms and early receptor potentials. We developed a corneal wick electrode that is free of photovoltaic artifact when used with a bright flash strobe and is convenient for routine clinical application. The corneal wick electrode is employed for bright flash electroretinogram (ERG) recordings and for research measurements of the early receptor potential. The wick electrode gives accurate, stable, reproducible recordings with an amplitude comparable to that obtained with standard contact lens electrodes.


Response to topical epinephrine in chronic open-angle glaucoma. The epinephrine pressure reduction was determined in 32 patients with elevated intraocular pressure (IOP) and 18 patients with untreated chronic open-angle glaucoma. The prevalence of responders was 53% of those patients with elevated IOP and 56% in those patients with open-angle glaucoma. This lack of difference between the two groups is suggestive of the need for caution before applying epinephrine in clinical practice as a predictive factor of future field loss.


Timolol. A new drug for management of chronic simple glaucoma. Timolol maleate, a potent beta-adrenergic antagonist, reduces intraocular pressure in rabbits. With topical application in one eye, a significant reduction in pressure is seen in the contralateral, untreated eye also. When used in conjunction with timolol, other adrenergic amines, such as norepinephrine and epinephrine, produce an additional hypotensive response. On the other hand, pretreatment with timolol does inhibit the ocular hypotensive response to topically applied albuterol. No further reduction in pressure is seen after application of this beta-adrenergic agonist to eyes pretreated with timolol. In a double-blind study with patients who had previously been receiving various medications for control of elevated intraocular pressures, timolol was as effective as pilocarpine in reducing intraocular tension. Many common complaints associated with pilocarpine therapy, including miosis, ocular irritation, and blurred vision, were not encountered with timolol therapy.


Intraocular pressure response to topical epinephrine and HLA-B12. Twenty high responders to topical corticosteroids (intraocular pressure greater than 31 mm Hg after six weeks of topical 0.1% dexamethasone, four times daily) and 20 low responders (IOP less than 20 mm Hg) of similar age, sex, race, initial IOP, and facility of outflow were selected. After 24 hours of treatment (two doses) of topical 1% epinephrine hydrochloride, the high corticosteroid responders showed a mean (+/-SD) corrected decrease in IOP of 3.6 +/- 2.0 mm Hg as opposed to 1.8 +/- 2.1 mm Hg in the low corticosteroid responders. Within both corticosteroid groups, individuals with the antigen HLA-B12 showed significantly greater decreases in IOP. This suggested that the presence of HLA-B12 was not only associated with increased responses to corticosteroids but also to epinephrine.


Pars plana approach for pupillary membranes. Pars plana surgery was performed, using a vitreous infusion suction cutter, for the treatment of after-cataracts, traumatic pupillary membranes, inflammatory pupillary membranes, and varoius pupillary membranes combined with other posterior segment problems. Surgical complications were minimal. A permanent pupillary opening was achieved in all but one case. Visual success was dependent on the underlying disease. One should not operate during active phases of uveitis.


Endothelial damage with phacoemulsification and intraocular lens implantation. Specular microscopy was used to study the corneal endothelium in a series of patients undergoing phacoemulsification with and without intraocular lens implantation by one experienced surgeon. Cell loss after phacoemulsification alone  was variable, but the mean was 18%, with a median of 11%. The patients undergoing phacoemulsification plus lens implantation showed a mean cell loss of 26%, with a median of 17%. This is considerably lower than has been reported with standard intracapsular extraction plus lens implantation. The decreased endothelial damage is attributed to the technique of inserting the lens through a small incision and maintaining an air bubble between the lens and the cornea throughout lens insertion and wound closure.


Atypical pterygium. A clinical feature of Terrien's marginal degeneration. Three case reports illustrate a manifestation of Terrien's marginal corneal degeneration, the pseudopterygium. When present, the pseudopterygium has a characteristic appearance, which is of diagnostic value. This condition occurs at positions other than the 3- and 9-o'clock positions, and it grows onto the cornea at an oblique axis and has a rather broad, flat, leading edge. The pseudopterygium may appear extremely early in the disease when the marginal furrow may still be a subtle finding.


Epicanthus and epiblepharon.

Epicanthus and epiblepharon. There are four recognized types of epicanthus: epicanthus supraciliaris, epicanthus palpebralis, epicanthus tarsalis, and epicanthus inversus. Epiblepharon is a congenital anomaly that may appear in upper or lower eyelids. In the lower lids it tends to regress spontaneously and must be differentiated from congenital entropion, because treatment of the two conditions is not the same. Epiblepharon is considered herein with epicanthus because of similarity in treatment, especially in the case of epicanthus tarsalis. Epiblepharon of the upper eyelids may be considered to be essentially an exaggeration of epicanthus tarsalis. Epicanthus tarsalis and epiblepharon of the upper eyelids are treated by making a new fold in the upper lid and performing a V-Y plasty at the inner canthus. Epiblepharon of the lower lid is similarly treated if it does not spontaneously regress.


Adult cystinosis. A case report.

Adult cystinosis. A case report. A 41-year-old man, referred because of the suspicion of retinal detachment, was found to have retinoschisis, moderately severe renal disease, and adult cystinosis with crystals in the cornea and conjunctiva. Conjunctival crystals were demonstrated by light and electron microscopy, and chemical analysis confirmed the presence of excessive amounts of cystine. Studies of renal tissue showed changes that were interpreted as being due to hypertensive vascular disease. Light and electron microscopic examination of kidney tissue showed no cystine crystals, and chemical analysis indicated only trace amounts of cystine.


Cryosurgical iridocyclectomy.

Cryosurgical iridocyclectomy. A new surgical technique, cryosurgical iridocyclectomy, was used in the excision of an iris melanoma encroaching on the ciliary body. Iris-tumor-anterior ciliary body segment was removed en bloc. The elucidate the mechanical basis for the success of the procedure, similar operations were performed on three enucleated eyes. It was confirmed that traction on the iris by a cryoprobe resulted in forward movement of the ciliary body without iridodialysis. The iceball that formed prevented iridodialysis at its usual plane of cleavage. Cryosurgical iridocyclectomy is recommended for excision of small discrete iris tumors that encroach on the anterior ciliary body.


Histochemistry of human extraocular muscle. A reliable method for evaluating biopsy specimens of human extraocular muscles is presented to better understand the pathological responses of these highly organized striated muscles. Three muscle fiber types and their distribution are described with morphological and histochemical measurements used commonly for limb muscle. The granular and fine fibers have single end plates and may be comparable to limb-twitch fibers (type 2 and type 1 fibers). The coarse fibers have multiple end plates and may correspond to multiple end plated tonic fibers found in avian and amphibian limb muscles. The fibers of extraocular muscles are arranged in three concentric zones. Because of the zonal arrangement, a complete cross section should be evaluated in diseases of the ocular muscles to estimate any changes in fiber type distribution.


Calibration error in dark adaptometer.

Calibration error in dark adaptometer. We noted that the adjustable fixation device present on some models of the Goldmann-Weekers dark adaptometer has a calibration error that results in a consistent and predictable overestimation of retinal eccentricity. The error occurs because the eye being tested is not in the geometric center of the projection sphere. The true retinal locus may be computed by trigonometric analysis. A conversion table is available for reference.


Curved ruler for measurement along the surface of the globe. A curved ruler for measurement along the surface of the globe has been designed to measure the arc instead of the cord measurement. The ruler is especially helpful when one is doing large recessions and posterior fixation of the recti muscles (Faden operation).


Clinical evaluation of the 6600 Autorefractor. The 6600 Autorefractor was evaluated on 200 patients undergoing refraction. The automatic refractor showed a high degree of accuracy in determining the needed refractive correction, but the errors are sufficient that the automatic refractor alone without subjective refinement cannot be substituted for conventional complete refracting methods with subjective refinement. However, for aphakic patients and for patients with clear media and cylindric corrections over 0.50 diopters, the automatic refractor can be used as a substitute for retinoscopy in determining the starting point for a subjective refraction.


Is the Autorefractor reading closest to manifest refraction? A comparison of the patient's previous spectacles and the 6600 Autorefractor reading. In a study of 56 patients, the old glasses of a previously refracted individual were as close to the final subjective refraction as the reading obtained with a 6600 Autorefractor. Therefore, the previous spectacle correction might logically be used for the starting point of a subjective refraction, with retinoscopy or automatic refractor results being used for this purpose in patients whose previous spectacle refraction is unknown or in the first refraction of an aphakic patients.


A simplified test of epinephrine responsiveness. Forty-three ocular hypertensive and 33 ocular normotensive subjects received two doses of topical 1% epinephrine hydrochloride in one eye. The epinephrine was administered twice, ie, at time "zero" (8 AM) and 12 hours later (at 8 PM). The mean intraocular pressure responses at four hours and at 24 hours (12 hours after the last dose of epinephrine) were significantly correlated, r = 0.59 (P less than .001). This suggested that the simpler four-hour test was an equally accurate measure of the ocular responsiveness to topical epinephrine.


Acoustic reflex and loudness discomfort in acute facial paralysis. An extensive research protocol was used to evaluate the conditions of 48 consecutive patients with acute facial paralysis. The results indicated that after nerve excitability testing, the acoustic reflex was the most efficient indicator of impending nerve degeneration and predictor of recovery. The presence of increased sensitivity to intense acoustic stimuli (loudness discomfort level) indicated poor prognosis. The data demonstrate that dysacusis (hyperacusis) is not related to stapedial muscle paralysis and also question the validity of "topographic diagnosis" in determination of the site of the lesion in facial paralysis.


Carotid artery rupture. Management and prevention of delayed neurologic sequelae with low-dose heparin. Carotid artery ligation, whether elective or an emergency, is an operation that most head and neck surgeons do with some trepidation because of the possible neurologic consequences. Of 440 major head and neck operations for cancer in which the carotid artery was exposed, 20 (4.5%) patients suffered a carotid rupture or had the vessel ligated just prior to rupture. We describe the typical patient and his management. Of these 20 patients, five died as a direct result of rupture or ligation, ten survived rupture and/or ligation with neurologic sequelae, and five survived rupture and/or ligation without neurologica sequelae. Of the ten patients with neurologic problems, four had immediate strokes, and six had delayed strokes, ie, these occurred greater than eight hours after ligation. Seven patients who required carotid artery ligation, separate from the previously mentioned group, received 5,000 units of heparin sodium subcutaneously every 12 hours in a prospective study. Of these seven patients, one died immediately postoperatively, and six survived without any neurologic sequelae. We discuss the cause of delayed neurologic problems and the rationale for the use of low-dose heparin.


Experimental tracheal reconstruction with external ear canal autografts. Experimental tracheal reconstruction was performed on four beagle dogs with the use of external ear canal autografts. Moderate success was achieved. There were no complications and no loss of a physiologic airway.


Pediatric tracheotomy. A five-year comparison study. A five-year retrospective study (1972-1976) of pediatric tracheotomies that were performed on patients (age limit, 14 years) was undertaken with the following objectives in mind. We chose to compare the indications, complications, and both the short- and long-term follow-up results of patients who were arbitrarily classified into two groups. Group 1 consisted of those patients who weighed more than 2,500 g at the time of tracheotomy, and group 2 were those who weighed less than 2,500 g. A total of 61 patients were included in our study. Forty-eight patients (57 tracheotomies) were placed into group 1, and 13 patients (15 tracheotomies) were in group 2. The results of our study demonstrate that there is a higher morbidity, complication rate, and death rate in the patients in group 2.


Auditory function in sickle cell anemia. Auditory function was assessed in nine black subjects with sickle cell anemia and compared with a control population. No differences were found for measures of hearing acuity and undistorted speech discrimination. However, some suggestion of reduced neural function was observed in terms of acoustic reflex measures and time-compressed speech discrimination. One subject with sickle cell anemia displayed a distinctive auditory profile that we treat separately.


Experimental grafting of the auditory nerve. The auditory nerve of five cats was sectioned unilaterally. Its proximal stump was immediately sutured to the proximal stump of the simultaneously severed facial nerve to study afferent sensory nerve regeneration. After time intervals of nine to 18 months, the nerve anastomosis was tested by electrical stimulation of the anastomosis and by recording evoked cortical responses at the auditory cortex. Electrophysiologic evidence of both fiber regeneration within the sectioned auditory nerve and of the reestablishment of a functional synapse at the cochlear nucleus was obtained. Further support of the concept of a possible auditory nerve grafting was added by the histologic examination of the nerve anastomosis and of the cochlear nuclei, which showed signs of the outspreading of axons from the facial nerve through the auditory nerve and through the barrier of the brain stem into the areas of the cochlear nuclei.


Complications of combined therapy in head and neck carcinomas. The combined modalities of surgery and radiation therapy in the treatment of head and neck cancer have vasity improved survival rates of larger neoplasms with heretofore poor prognoses, when treated with either modality alone. One of the unfortunate problems with combined therapy is the increase in postoperative complications. During the past four years, in the Department of Otorhinolaryngology, University of California, Davis we have used both preoperative and postoperative radiotherapy in a random fashion in the combined approach to head and neck cancer in 45 patients. We have also operated on 37 patients whose conditions failed to respond to radiation. The complication rate of these three groups is compared. Each group was examined for possible contributing factors to these complications, such as age, hemoglobin levels, serum protein levels, albumin-globulin ratios, and preoperative weight loss. Our results show that surgery for radiation failures is met with a disastrously high complication rate, 45% of them of the major category. Postoperative radiotherapy results in a much lower complication rate than when radiation is used preoperatively and is our treatment of choice.


Lactate dehydrogenase as a measure of inflammation in experimental otitis media. A reliable animal model for acute otitis media due to Streptococcus pneumoniae was used to study the accumulation of lactate dehydrogenase (LDH) in middle ear effusion during acute pneumococcal otitis media and after penicillin treatment. The findings indicate that LDH levels rise in the middle ear effusion during the early phase of acute infection and decrease as the infection resolves over time. Penicillin treatment affects the natural course of infection by resolving most visible signs of inflammation and by sterilizing the middle ear. However, once middle ear infection was established, penicillin treatment did not reduce the elevated levels of effusion LDH, suggesting that inflammation persists after sterilization of infected middle ears.


Squamous cell carcinoma of the skin metastatic to parotid nodes. Preauricular masses may represent metastases to parotid nodes from carcinoma of the skin of the face, scalp, and neck. At the University of Florida from January 1966 to March 1977, a total of 20 patients were treated whose first evidence of metastasis was a preauricular mass ranging in size from 1 to 6 cm. All had been treated from two weeks to five years previously for at least one ipsilateral squamous cell carcinoma of the face or scalp. In no patient has a mucosal primary site of the head and neck subsequently developed. Treatment consisted of surgery or irradiation of both. The results suggest that superficial parotidectomy is usually inadequate for complete removal of these nodes, since the nodes lie lateral to the posterior facial vein and not the facial nerve. Surgery followed by irradiation appears to result in better survival than either modality alone.


Lentigo maligna and lentigo maligna melanoma. Recognition and treatment. Lentigo maligna is the preinvasive stage of lentigo maligna melanom, which is a specific type of cutaneous malignant melanom found almost exclusively in the head and neck area. The distinguishing features and the biological behavior of this disease are discussed. Emphasis is placed on early diagnosis by clinical differentiation from other pigmented lesions and by biopsy specimen. Treatment by adequate surgical removal with appropriate reconstruction is discussed and illustrated with case reports.


Painful ophthalmoplegia. The Tolusa-Hunt syndrome. A 36-year-old man had the Tolusa-Hunt syndrome, an unusual cause of painful ophthalmoplegia with a neurologic deficit that may not be distinguishable from the many other disease processes that involve the orbital apex. Diagnosis was made by excluding the other causes, and there was a prompt response to high-dose steroid therapy, which prevents or minimizes any permanent neurologic deficit. Because of this and the fact that the otolaryngologist is often involved in the diagnosis and treatment of the many causes of painful ophthalmoplegia, it is important to be aware of this syndrome.


Temporary loss of hearing after a glycerin test. The glycerin test has been proposed as an adjunct in the diagnosis of Meniere's disease. Complications of the test are rare and usually minor. We describe a case in which a 20- to 40-dB hearing loss developed in the uninvolved ear of a patient during a standard glycerin test. He made a complete recovery within three days after the test. We discuss the possible mechanisms of the loss.


Radical neck dissection after prosthetic repair of carotid artery. A carcinoma of the pyriform fossa developed ten years after a Teflon patch graft angioplasty of the common and internal carotid vessels. The graft was embedded in fibrous tissue and covered by pseudoadventitia, which could be dissected free without difficulty. If radiation therapy is used, it should be administered postoperatively. The Teflon graft can be protected from possible salivary fistulae by a dermal graft that is covered by a levator scapulae muscle flap, which is sutured to the prevertebral fascia to separate the carotid vessels from the pharynx, but it is not recommended that the tumor resection be staged to achieve this carotid protection.


Antibodies to Akabane virus in Australia. Neutralising antibody to Akabane virus was shown to develop in cattle in northern Australia throughout the year and also on the east coast of New South Wales in the summer during 1975/1976. Other species found to have antibody to Akabane virus were buffaloes, horses, camels and sheep, but no antibody was found in domestic chickens, ducks, wallabies or man. The biting midge Culicoides brevitarsis has been detected in all the major areas where antibody was demonstrated in this study.


The duration of latent infection and functional immunity in droughtmaster and hereford cattle following natural infection with Babesia argentina and Babesia bigemina. Tne Droughtmaster and 9 Hereford cattle were born in an enzootic babesiasis area and became naturally infected with Babesia argentina and B.bigemina during a 3 year period. They were then kept free of cattle ticks (Boophilus microplus) for the remainder of the experiment. Annually for the next 3 years their individual infection status with Babesia was determined by sub-inoculation of blood into splenectomised calves. At the end of this period the functional immunity of all cattle was challenged by blood inoculation of heterologous strains of B. argentina and B. bigemina. Infection with B. argentina persisted in all Herefords for 2 years and in 7 for 3 years after they had been freed of B. microplus. The number of Droughtmasters with detectable B. argentina infection progressively declined, and at the end of 3 years only 2 of 10 were still infected. No Herefords were shown to be infected with B. bigemina following 1 year's freedom from B. microplus but latent B. bigemina infection of at least 2 year's duration was demonstrated in one of the Droughtmasters. A marked degree of resistance was apparent in all cattle when they were challenged with an heterologous strain of B. argentina. There were no differences between the response to challenge of the Herefords and Droughtmasters nor between the reactions of cattle which had apparently naturally sterilised B. argentina infection and those which were still infected. The heterologous strain of B. bigemina produced parasitaemia in the majority of animals but only minimal fever and anaemia resulted with no significant differences between the breeds.


The anthelmintic efficacy of non-benzimidazole anthelmintics against benzimidazole resistant strains of Haemonchus contortus and Trichostrongylus colubriformis in sheep. The anthelmintic efficacy of 6 non-benzimidazole compounds and thiabendazole against standardised, benzimidazole resistant strains of H. contortus and T. colubriformis in sheep was determined using a controlled test. All compounds were administered intraruminally at their recommended therapeutic dose rates and 4 of the compounds were also assessed at half their recommended therapeutic dose rates. Levimisole at a dose of 6.4 mg/kg body weight, morantel at 4.4 mg/kg and 8.8 mg/kg, naphthalophos at 6.25 mg/kg and 12.5 mg/kg, rafoxanide at 7.5 mg/kg and phenothiazine at 530 mg/kg were 98% or more effective in removing adult infections of benzimidazole resistant H. contortus. Rafoxanide at 3.75 mg/kg, phenothiazine at 265 mg/kg and carbon tetrachloride at 0.05ml/kg were less effective, removing 80%, 73% and 72% respectively of the benzimidazole resistant H. contortus worm burdens. Against the benzimidazole resistant T. colubriformis levamisole at 6.4 mg/kg, and morantel at 4.4 mg/kg and 8.8 mg/kg removed 99%, 68% and 86% respectively of the adult infections. All other anthelmintics had little or no efficacy at the dose rates tested. Thiabendazole at 44 mg/kg had no significant effect against these strains of H. contortus and T. colubriformis. Several non-benzimidazole anthelmintics have shown high efficacy in this experiment and should be suitable for treating infections with benzimidazole resistant H. contortus. Of the anthelmintics tested, only levamisole and morantel show high efficacy against benzimidazole resistant T. colubriformis.


Evaluation of a pregnant mares' serum and human chorionic gonadotrophin mixture for alleviating summer infertility in sows. A controlled on-farm trial was conducted to evaluate the effectiveness of a commercial gonadotrophin hormone mixture at overcoming a seasonal decrease in fertility in pigs in a sub-tropical environment (summer infertility). The average weaning to oestrus interval of the untreated sows was more than double that of the treated sows and this difference was highly significant. However, fewer of the treated sows farrowed and they produced smaller litters. The improvement in fertility in the treated group achieved by reducing the weaning to oestrus interval was more than cancelled out by an overall reduction in the number of weaners produced.


Immunoglobulins in blood serum of foetal pigs. A total of 1,147 samples of blood serum, collected from porcine foetuses, were examined for the presence of immunoglobulin. The foetuses, from 182 sows, were sampled at abattoirs in Queensland during 1975. For detection and measurement of immunoglobulins, rabbit anti-pig serum and monospecific anti-pig IgG, anti-pig IgM and anti-pig IgA were employed in immunoelectrophoresis, double diffusion and single radial immuno-diffusion assays. Twenty-four foetuses (from 7 litters) had detectable IgG or IgM. None of the samples were positive for IgA. Two of the serums (from siblings) had high antibody titres to porcine parvovirus but in the remainder of the immunoglobulin-positive serums no antibody activity was detected.


Observations of the first service non-return rates of the hypoglycaemic, concentrate-fed dairy herds. Fourteen dairy herds which had been subjected to the Compton Metabolic Profile test on a total of 29 occasions were selected from the records of the institute for Research on Animal Diseases, United Kingdom, because they had a wide range of mean blood-glucose concentrations. Two herds had to be rejected from the study because of inadequate breeding records, leaving 12 herds (26 profile tests) to be included. The first service non-return rate of each herd was calculated from the breeding records of 10 cows mated closest to the date of each profile test. These rates were positively related to the mean blood-glucose concentrations of the lactating cows (P less than 0.01).


The use of electrocardiography in the diagnosis of poor racing performance in the horse. Electrocardiograms were reocrded from 153 racehorses and 10 Olympic three-day-event horses. The horses were then grouped into those presented for routine examination, those in which there was a complaint of poor performance, those going to the Montreal Olympics, and those with upper respiratory tract abnormalities. When the ECGs of the four groups were compared on the basis of detection of abnormality, it was found that 93.2% of the poor performance group showed abnormalities of various types. The routine examination group showed 21.1% of horses with abnormal ECGs, and over half of these have been followed to the point where it can be said they raced unsuccessfully. In particular, this applied to those horses with T wave abnormalities in 4 or more leads, and to those with intraatrial block. There were significant T wave changes in 50% of the Olympic horses, and 43.7% of horses with laryngeal hemiplegia showed abnormality. While it can be concluded that T wave changes are highly significant findings in an ECG, it is also true that modification of the training programme is a way of helping trainers to get the best out of horses which might otherwise have a serious limitation of their performance potential.


Blood glutathione peroxidase activity in horses in relation to muscular dystrophy and selenium nutrition. The activity of glutathione peroxidase, a selenium containing enzyme, was measured in the blood of horses to determine its usefulness as an indicator of selenium status. In 15 horses the enzyme activity was positively related to the blood selenium concentration (P less than .001, r-0.98) over the range of enzyme activities of 8.2 to 140 units (mumoles NADP-oxidised/min/gHb) and selenium concentrations of 0.24 to 2.74 mumol/l. In a group of 8 horses which 2 foals had died with lesions of muscular dystrophy the enzyme activity increased from a mean of 11.8 units before treatment with selenium to 34.5 units after 2 intravenous injections of sodium selenite given one month apart. Another group of 8 horses grazing paddocks adjacent to this affected group did not receive any selenium treatment and had a mean enzyme activity of 11.9 units. Blood glutathione peroxidase activity was measured in 50 pasture-fed horses and 180 stall-fed horses. The range of activities found (7 to 158 units) indicated that selenium intake in horses varied widely between localities. All pasture-fed horses grazing areas where muscular dystrophy had occurred in foals had low activities (less than 20 units). In stall-fed horses the enzyme activity was influenced by selenium treatment, and horses which had been treated usually had higher activities than horses in the same stable with no history of selenium treatment. It was concluded that blood glutathione peroxidase is a suitable indicator of selenium status in horses.


Bovine enzootic haematuria in Queensland. Bovine enzootic haematuria was diagnosed in Queensland in coastal areas in association with bracken fern (Pteridium esculentum) on 3 properties or with mulga fern or rock fern (Cheilanthes sieberi) on 4 properties, and in inland areas in association with C. sieberi on 3 properties. In the absence of bracken fern, long-term ingestion of C. sieberi is suggested as a cause of bovine enzootic haematuria. Haemangiomas, haemangiosarcomas, transitional cell carcinomas, papillomas, fibromas and an adenoma were detected in the urinary bladders of 19 affected cattle and were accompanied by chronic cystitis.


Angiostrongylus cantonesis infection of the brain of a captive Bennett's wallaby (Macropus rufogriseus). Eleven immature adult Angiostrongylus cantonensis were recovered from beneath the meninges of a captive Bennett's wallaby (Macropus rufogriseus) which died after displaying posterior paresis followed by paralysis and intermittent opisthotonic spasms of increasing frequency for 7 days. Congestion and focal malacia with haemorrhage were seen in the brainstem and cerebellum. Sections of worms with scanty inflammatory response were seen beneath the congested haemorrhagic leptomeninges of cerebrum and in a cerebellar folium. Infection was thought to have originated from feed or water contaminated with larvae released from a molluscan intermediate host.


Sodium chloride poisoning in cattle.

Sodium chloride poisoning in cattle. Consumption of a sodium chloride based supplement followed by food and water restriction in yards for over 30 hours, resulted in nervous disorders in 5 of 60 three-year-old steers within hours of being released into a paddock. Clinical signs were associated with polioencephalomalacia which was confirmed in 2 of 3 affected steers by microscopic examination of brains. Oedema of the corpus striatum, thalamus and midbrain was observed in 2 animals, and vascular necrosis with neutrophil invasion into the vessel walls was seen in the cerebrum of one steer. Consideration of the history, clinical signs and necropsy findings resulted in a diagnosis of indirect salt poisoning. The affected animals had the lower body weights in the group.


Experiments on the detection of roll motion. Four experiments investigated the detection of whole-body roll motion by normal adult males. Experiments 1, 3, and 4 employed an earth-horizontal rotation axis, and Experiment 2 an earth-vertical rotation axis. Comparison of Experiments 1 and 2 showed that the presence of gravireceptor stimuli increased the range of detectable angular accelerations and reduced the time required for detection. In Experiment 3, stimuli were presented from a side-down orientation and this increased detection times when compared to roll from the upright. Experiments 1, 2, and 3 used blindfolded subjects; however, Experiment 4 found no effect on detection times of viewing a head-stabilized visual target. The overall data show detection of angular position and velocity and suggest synergistic action of the semicircular canals and gravireceptors. The influence of somatosensory stimuli is considered. Finally, implications of the findings for flight simulators are discussed.


Circadian rhythm of body temperature during prolonged undersea voyages. Circadian rhythms of oral temperature were assessed in 12 watchkeepers during a prolonged submarine voyage and compared with a "standard" rhythm obtained from nonwatchkeepers ashore. Initially, the parameters of the rhythms were similar to those of the standard; however, among eight ratings working 4-h watches in a rapidly rotating cycle, considerable changes in the rhythms occurred as the voyage progressed, and concurrent alterations in sleep patterning were observed. The most characteristic change in the rhythm was a marked decline in its amplitude. In most subjects, the rhythm also tended to depart from its original circadian pattern; in at least one case, it effectively disintegrated. One subject's rhythm appeared to "free-run" with a period greater than 24 h. A strong circadian rhythm was maintained in only one of these eight subjects. In four officers whose watch times were at fixed hours, adaptation of the rhythm to unusual times of sleep occurred in 2 of 3 cases where the schedule demanded it. The results are discussed in relation to the design of optimal watchkeeping systems for submariners.


Embryonic implantation, dietary intake, and plasma GH concentration in pregnant mice exposed to hypoxia. Inseminated mice were: 1) exposed to 8% O2, 2) pair fed to mice exposed to 8% O2, 3) fasted at 21% O2 or 4) maintained at 21% O2 (control) between Days 1-3 of pregnancy. The frequency of embryonic implantation sites in mice was reduced by greater than 60% in 8% O2 exposed and pair fed animals, and by 100% in fasted mice. During the initial 24 h of exposure to 8% O2, a significant component of the body weight lost by hypoxic mice was associated with the reduction in dietary intake. The contragestational effects of hypoxia and fasting were attributed to the endocrine consequences of inanition induced by hypophagia and adypsia. Plasma samples collected at 6-h intervals revealed a significant reduction in GH concentration in treatment groups compared to the controls.


Laboratory comparison of technique for rewarming hypothermic casualties. The efficacy of inhalation, hot bath, piped suit and spontaneous rewarming have been directly compared under controlled conditions. Hot bath rewarming was significantly more effective at raising deep body temperature than the piped suit technique and both were more effective than the other two methods. The effect of inhalation rewarming was not significantly different  from that of spontaneous rewarming. All techniques gave rise to afterdrops of core temperature of widely varying degrees and durations. It is concluded that inhalation rewarming should not be employed if it entails a delay in transporting a patient to a facility for rapid external rewarming. Piped suit rewarming is a convenient field alternative to the use of a hot bath and a simple apparatus for carrying this out is described. The sluggish response of rectal temperature to cooling and rewarming in this study suggests that it should not be relied upon as the sole indicator of a patient's thermal state during treatment. Auditory canal temperature is a more valid substitute.


Monocular peripheral vision as a factor in flight safety. The performance of static visual identification tasks and simulated operational flying tasks, by nine binocular pilots and nine adapted monocular pilots, was measured in a unique operational visual simulator. It was hypothesized that, with head free to move, and adapted monocular pilot would perform as well as a binocular pilot, while an unadapted monocular (simulated by covering an eye) would perform less well. Other hypotheses were advanced. The static primary central task required sequential identification of dial readings. The dynamic primary central task involved simulated aircraft landing operations. During each set of primary tasks, a set of secondary peripheral visual tasks was performed. Results of the primary tasks and times of execution of the secondary tasks were subjected to analysis of variance. Factors included head position (fixed or free), stimulus location in peripheral field, eye state (seeing eye, blind eye), and type of central task (static, dynamic). All hypotheses were validated.