Symptom passing in a transvestite father and three sons. Three sons of a transvestite father engaged in cross-dressing beginning in early adolescence. The literature suggests that observation may play a role in determining the specificity of the symptoms of conflicted sexual identity. These cases of transvestism in offspring are unusual in that the father played an important role in symptom choice and modeling. It is hoped that in future studies of transvestism in the father will be examined in a more intensive way as a figure with whom an active identification process may evolve.


Creativity and self-actualization in the aging personality. Twenty-five residents (sixty-nine to ninety-three years old) of two Israeli homes for the elderly were investigated in order to see if there was a correlation between the creative attitude (self-actualizing personality) and the way of coping with the process of aging and attitude toward death. The results showed that the more creative-actualizing a personality, the better the coping with aging phenomena and the less denial of death.


Depression in children on a general pediatric service. Masked depression in the hospitalized child is precipitated by maternal separation and anxiety aggravated by environmental, somatic, and existing personality factors. Age, stage of ego development, and comprehension are important influences. Psychiatrically oriented as well as somatically indicated therapy is essential for a favorable outcome. Parents require supportive consideration also.


A psychotherapeutic approach to severely depressed patients. Even severely depressed patients respond to psychotherapy. A knowledge of the psychodynamic patterns of the life of depressed patients is required for effective therapy. The psychodynamics and main psychotherapeutic procedures for the treatment of two common types of severe depression are described.


Psychotherapy in combination with antidepressant drugs in severely depressed out-patients--20-year evaluation. Eight hundred fifty-one severely depressed patients were treated on an out-patient basis over a twenty-year period with psychotherapy in combination with antidepressant drug therapy. The selection of patients and treatment technique is described. Eighty-three percent of the patients had excellent or good results within a period of three weeks. These results are compared with those obtained with electroshock treatment or psychotherapy alone.


The epidemiology of major affective disorders. This article examined the methodological difficulties encountered in the epidemiological studies of affective disorders, the incidence and prevalence of these conditions, and the sociodemographic risk factors. The course of treated and untreated affective disorders is reviewed in terms of implications for treatment modalities and their evaluation, as well as factors suspected to be causally related to affective disorders (concomitants, predisposing and precipitating).


Bipolar affective disorder--techniques and results of treatment. Differences between bipolar and unipolar patients and the natural history of bipolar illness are discussed. Reviewing recent studies, the paper then outlines the treatment of mania, the treatment of depression, and the prophylactic treatment of bipolar illness.


The treatment of depressed geriatric patients. Biological changes more frequently associated with late onset depressions, such as cerebral arteriosclerosis, increased urinary MHPG concentrations, decreased gonadal functions, and increased MAO activity were reviewed and the therapeutic implications of these biological changes considered. The rationale for the use of Hydergine, amitriptyline, Gerovitol H3, fluoxymesterone, doxepin, and trazodone in geropsychiatric patients was discussed.


Assessing the timeliness of ambulatory medical care. The extent to which individuals receive necessary and timely care (timeliness) is one dimension of the process of care that has received little attention. Timeliness can be viewed as the interaction between patient care-seeking behavior and system accessibility,both of which are expected to influence the effectiveness of medical care. This study examines the provider's assessment of the timeliness of care received in the department of medicine of a prepaid program. Provider judgments are found to be significantly related to the provider's perception of problem severity and to the patient's prognosis. Anaylsis of patient-reported problem status one week later are also found to be related to the timeliness of care. Implications of timeliness assessments for monitoring and improving access and care-seeking behavior are discussed.


Manganese pollution in the city environment and its relationship to traffic density. As lead is phased out of gasoline, other additives with anti-knock properties, particularly organic manganese compounds, are being substituted. Unavoidably, such compounds go through the combustion process, are eliminated in exhaust gases, and become part of the city environment. To obtain some indication of the extent of this new pollution street soils from various locations in a heavily trafficked city (Newark, NJ) were analyzed for manganese and lead by atomic absorption. Highly signigicant inverse relationships were found between the concentrations of both contaminants and distances from major traffic arteries. Strong circumstantial evidence is thus provided that: 1) manganese pollution is occurring, along with lead, in the city environment; 2) this new pollution is related to traffic density; and 3) the most likely sources are automobile exhausts. This suspicion is further strengthened by the significant correlations observed between manganese and lead contents in children's blood, suggesting a common source for both. Substantiation of the safety of this practice of adding manganese to gasoline is needed.


Follow-up study of patients treated by X-ray epilation for tinea capitis: psychiatric and psychometric evaluation. To investigate the late effects of radiation to the head upon subclinical mental disorders, a psychiatric and psychometric evaluation was performed on 177 cases treated 10-29 years earlier for ringworm of the scalp by X-ray therapy (N :109) or, by chemotherapy (N :68). Analyses which controlled for educational level and family psychiatric disorders showed that, among whites, the irradiated group manifested more psychiatric symptoms and more deviant MMPI (Minnesota Multiphasic Personality Inventory) scores. They were also judged more maladjusted from their MMPI profiles, and more frequently had a history of treated psychiatric disorders; however, the psychiatrist's overall rating of current psychiatric status showed only a borderline differnece between the two groups. There were no significant differences between irradiated and chemotherapy treated blacks.


Ambulance utilization by patients with acute myocardial infarction. Fifty-five per cent (73/133) of myocardial infarction (MI) patients on Cape Cod during a three-month period reached the hospital by ambulance. the 45 per cent (60/133) not using ambulances were compared to users to identify a subpopulation to which public health programs might be directed to increase appropriate use of cardiac ambulances. Univariate analyses showed a distnce of more than ten miles from the hospital, and a prior history of MI distinguished ambulance users from non-users. Demographic/economic status, delay in seeking care, presenting symptoms, Killip class, and in-hospital mortality rates were not signigicantly different. Step-wise discriminant analysis identified four predictive variables in rank order: distance from the hospital, past history of MI, symptoms of fainting, and negative history for hypertension which correctly classified 72 per cent of our population with respect to ambulance utilization.


Evaluation of the effectiveness of a high school course in cardiovascular nutrition. High school biology students participated in a cardiovascular nutrition education program. The program was evaluated for its effect on the student's knowledge, attitudes, reported eating behavior, and serum lipid levels by matching individual's pre-and post-program results. There was a significant improvement in cardiovascular nutrition knowledge and attitudes toward a low cholesterol pattern of eating. There was also a signigicant improvement in reported eating patterns. However, the rise in serum cholesterol levels one year later did not differ from the rise in serum cholesterol levels in a control school. Improvement in attitudes and reported eating behavior was significantly greater for students whose initial cholesterol level was in the upper quartile of U.S. 16-year olds.


Consumer-based boards of health centers: structural problems in achieving effective control. The fact that consumers have problems in utilizing their formal power as board members is usually attributed to individual deficiencies or cultural differences. The position argued here is that such views need to be questioned and amended. Thus, the ties between a health center and the larger health care system, the relations of consumers to their community environments, and the internal organization of health centers are examined as structural factors which limit the effectiveness of consumer board members. Despite the magnitude and durability of such factors, suggestions are made for increasing the effectiveness of consumer-based boards.


Environmental quality as an issue in the legislative history of the National Health Planning and Resources Development Act of 1974 (PL93-641). It is the purpose of this brief communication to examine the history of the most recently enacted health planning legislation (PL 93-641) to assess how environmental health issues were addressed and resolved during the legislative process.


The animal bite epidemic in Baltimore, Maryland: review and update. In 1972 in Baltimore, a peak of 7,436 reported animal bites (8/1,000 population) was reached. The bite rate for the most susceptible age group (5-14) was 19 per 1,000 population. By 1976, only 5,092 bites were reported, 5.8 per 1,000 total population, and 12.3 per 1,000 population 5-14 years of age. The decline in the number and rates of animal bites is believed due in large measure to the actions taken by the Bureau of Animal Control: education and publicity, increased fees and penalties, and enforcement of the new laws and regulations.


Squamous cells in the human thyroid gland. Squamous epithelium in the thyroid, which may be basaloid, epidermoid, or truly squamous, may be derived from several sources. In the normal thyroid, usually rests of one type or another are responsible for these cell nests. Thus, thymic or ultimobranchial remanants may be found in the lateral lobes of normal thyroid glands. Maldevelopment or excessive descent of thyro-glossal duct remnants may be responsible for squamous epithelial cysts noted in the central portions of the thymus, especially in the isthmus. In diseased thyroids, the most likely derivation of squamous or epidermoid epithelium is through metaplasia of follicular epithelial cells. Thus, in adenomatous goiter and various types of thyroiditis as well as follicular derived neoplasms, such a derivation is most likely. In tumors containing malignant squamous epithelium (adenoacanthoma, adenosquamous carcinoma, or pure squamous carcinoma) there is a range of such lesions, and since many of them appear to be derived from follicular epithelium, it is most likely that squamous metaplasia which has undergone malignant transformation has occurred in these neoplasms.


Polypoid carcinoma of the esophagus. A unifying term for "carcinosarcoma" and "pseudosarcoma". Polypoid carcinomas with spindle-cell sarcomatous features have been designated either as carcinosarcoma or pseudosarcoma. The distinction between these two tumors has depended on the presence of "intermingling" of the carcinomatous and sarcomatous components in so-called carcinosarcoma. But unlike the carcinosarcoma, the sarcomatous component in pseudosarcoma has been considered benign. A polypoid tumor of the esophagus in a 57-year-old male was predominantly composed of spindle cell, sarcomatous cells. The presence of adjacent intraepithelial epidermoid carcinoma with transitional and ultrastructural features confirmed the epithelial origin of this tumor. Because of the absence of "intermingling," the primary tumor was considered to be a pseudosarcoma. However, our postmortem examination showed metastases composed of both carcinomatous and sarcomatous features. A review of the literature on carcinosarcomas and pseudosarcomas shows that only one case of pseudosarcoma reported by Hughes and Cruickshank showed a similar situation and indicates that the sarcomatous component in pseudosarcomas has the same metastatic potentiality as has been reported in carcinosarcomas. We conclude from these studies a basic similarity of the carcinosarcoma and pseudosarcoma. The term polypoid carcinoma is proposed for both these lesions.


Visceral Kaposi's sarcoma presenting as colitis. An unusual example of Kaposi's sarcoma is reported in which the patient presented with a history of intractable diarrhea of 18 months duration. The roentgenographic and endoscopic findings were those of a segmental colitis. The diagnosis was established following the appearance of skin lesions and after a subtotal colectomy was performed. Kaposi's sarcoma was present in both the skin and colon.


Chondroma within the flexor hallucis longus tendon sheath. A case report and literature review. Chondromas in tendon sheaths are a rare entity proviously reported in the flexor sheaths on the hand and possibly the foot. This is the first reported case of condroma of the flexor hallucis longus tendon sheath at the ankle region. A literature review with regard to pathogenesis, classification, and recurrence has been presented.


[The role of ventilatory disturbances in the late postoperative hypoxaemia after upper abdominal surgery. A contribution to the risk of upper abdominal surgery in patients with respiratory damage (author's transl)]. The purpose of our investigations was to evaluate the influence of disturbed inspiratory gas distribution on postoperative hypoxemia in patients with abnormal lung function undergoing upper abdominal surgery. The lung function analyzer Hewlett-Packard 47402 A was used (Volume-time and flow-volume curves of forced expiration, single and multiple breath nitrogen washout tests with indices of ventilatory gas distribution). It was demonstrated that postoperative hypoxaemia in the undamaged lung is almost exclusively the result of augmented true right to left shunt. In patients with abnormal lung function the cause of postoperative hypoxaemia is, for the most part, an increase of disturbances of ventilatory gas distribution. These changes in the postoperative period can be explained by a reduction of FRC, that follows from changing of position (sitting-lying) and from pain. In patients with borderline lung function this reduction of FRC postoperatively may limit surgical treatment. The management of pain is of great importance in these patients. Continuous epidural anaesthesia certainly produces the best results in this respect.


Ketamine-diazepam anaesthesia for abdominal surgery. A review of 1000 cases with continuous "Micro-Mini" drip administration technique. During a twenty-one month period, over 1000 patients who underwent various types of intra-abdominal operations were anaesthetized with a combination of diazepam and ketamine using a continuous "Micro-Mini" drip administration technique. The results obtained from 1000 cases were eminently satisfactory. This paper also reviews all the previous literature on ketamine anaesthesia related to abdominal surgery. All the undesirable adverse side effects associated with ketamine anaesthesia in adult patients have been almost completely eliminated using this technique. Overall, the excellent results clearly indicate that ketamine has a definite place in anaesthesia for intra-abdominal operations.


[The use of dopamin in shock and heart failure (author's transl)]. The action of dopamine was evaluated in 18 patients with cardiogenic shock after myocardial infarction, in 14 patients with heart failure and in 18 patients with low-output syndrome after cardiac surgery. In the patients with shock, dopamine increased significantly systolic arterial blood pressure, myocardial contractility, diuresis and sodium excretion. In patients with heart failure a great increase in diuresis and sodium excretion with decrease of CVP was observed. In patients after cardiac surgery dopamine produced a significant increase of arterial blood pressure and diuresis with decrease of CVP. The clinical application of dopamine and the advantages of the use of dopamine combined with other catecholamines were discussed.


[Tracheal wall/load during prolonged intubation. Experimental investigations on a model trachea (author's transl)]. Prolonged endotracheal intubation may be complicated by tracheal wall lesions caused by the blocking cuff of the tube. This happens when the tracheal wall load exceeds the capillary perfusion pressure. It is therefore important to control this load. As direct measurement presents difficult methodological problems, there have been many attempts to approximate the pressure load using different formulae. In a model trachea we showed the significance of the tracheal wall pressure as approximated by an indirect measurement principle. Our investigations demonstrate that the examined indirect method provides a sufficient approximation of the tracheal wall load only if it is used with the new low pressure high volume cuffs. It fails if it is used with the customary high pressure low volume balloons.


[Water diuresis during methohexitone anaesthesia. Studies in chronically instrumented dogs (author's transl)]. Seven chronically prepared dogs (electromagnetic flow transducers around the pulmonary and left renal artery, left atrial catheter) maintained on a controlled sodium and water intake were studied. About 20 h after the last intake of food and water, the effects of i.v. methohexitone (initial dose: 6.10 +/- 0.84 mg/kg bw; sustaining infusion: 0.34 +/- 0.10 mg/min.kg bw) on renal excretion of sodium, potassium, urea and water as well as on several haemodynamic values were investigated over a period of 60 min (MP) after a control period (CP) of 60 min in the unanaesthetized state. In 18 of 19 experiments water diuresis (U/Posm less than 1) was observed between 20 and 40 min after starting the administration of methohexitone. Urine volume increased from 44 +/- 21 microliter/min.kg bw (CP) to 104 +/- 62 microliter/min.kg bw (MP).I.v. administration of arginine-vasopressin (ADH) completely abolished water diuresis. During MP, there was a decrease in cardiac output (-11%), stroke volume (-36%) and left atrial pressure (-27%), heart rate increased (+ 43%). Mean arterial blood pressure and renal blood flow did not change. It is assumed-as plasma osmolality did not change-that the central release of antidiuretic hormone is suppressed by methohexitone.


[Technique for removal of anaesthetic vapours from the operation theater. CO2-concentrations in the Jackson Rees system using a removal unit (author's transl)]. The Jackson Rees system was used for short operations in 50 infants combined with or without a system for removal of excess anaesthetic vapours developed by the authors. The CO2-concentration in the system was measured directly before the upper airway of the patients. No statistically significance difference between the CO2-concentration with or without the use of the removal system. A variable power of suction up to 61/min is thought to be sufficient and harmless.


The endocrine control of embryonic lung maturation in the chicken. I. Morphological and biochemical differentiation of lungs after "in ovo" decapitation. The effects of "in ovo" hypophysectomy on lung maturation of the chick embryo were investigated. Both biochemical and morphological aspects of differentiation were markedly delayed in experimental embryos: the phospholipid content of lungs was lower than in controls at all stages, whereas the water content remained very high. The type II pneumocytes, which normally appear within the epithelium on day 16 of incubation, started to differentiate only between days 18 and 20 of incubation in the decapitated embryos. The differentiation of type I pneumocytes leading to the formation of air capillaries was also slowed down: they did not appear until the end of incubation in decapitated embryos, whereas they normally start to appear on day 19. The presence of an intact hypophysis is thus essential for normal lung maturation in the chicken.


Electron-microscopic studies on the development and aging of the oviduct epithelium of mice. The fine structure of the oviduct epithelium of the newborn to the old mouse was studied with an electron microscope. Just after birth, epithelial cells lining  the ampulla of the mouse oviduct are simple columnar in shape and of one type in fine structure. They contain numerous free ribosomes, an extremely poor rough endoplasmic reticulum, and a small Golgi complex. In the 3-day-old mouse, the epithelial cells are differentiated neither into ciliated nor secretory cells, and are characterized by the appearance of many autolysosomes and a solitary cilium. The ciliary cells differentiates 5 days after birth. Ciliogenesis is frequently observed at 5-10 days. The important role of the fibrous granules for ciliogenesis and that of the Golgi apparatus for membranogenesis of the cilia are described and discussed. The secretory cell having mucous secretory materials is differentiated at 23 days. In the epithelial cell lining the ampulla of the aged (22 to 24-month-old) mouse oviduct, large autolysosomes and vacuoles 2-6 micrometer in diameter occur in the ciliated cell, though cilia and other cell organelles are well preserved. In the old mouse the secretory granules almost disappear and the rough endoplasmic reticulum is strikingly dilated in the secretory cell. No features showing the transformation between the secretory cell and the ciliary one are seen in the mouse oviduct.


Biokinetical analysis of the movements of the pelvic limb of the horse and the role of the muscles in the walk and the trot. The movements of the right hind limb of horses with normal locomotion were studied using cinephotography and electromyography. A model of the cycle of a stride in the walk and the trot was constructed and the kinetic parameters of the segments of the limb were calculated. A good correlation was obtained between the kinetics and the periods of the cycle of a stride during which individual muscles display activity. The results of this study demonstrate that: at placing and lifting, i.e., when a change occurs in the direction of the movement of the limb; b) At the walk, the greatest forces operant at the centres of gravity of the limb segments in the direction of the progression are present in the beginning and the end of the support phase. The first top in the acceleration curve is produced by activity in the retractors of the limb (hamstrings, gluteus medius muscles). At the end of the support phase, when activity in the retractors of the limb no longer exists, the dynamic effect of the moment of the weight about the point of support of the stabilized inclined limb, as well as the elastic resilience of the muscular tissue are responsible for the push-off. At the trot, the greatest forces in the direction of progression are exerted in the middle of the support phase and are largely due to muscular action; c) In the second part of the support phase in the walk, the stifle flexes and the hock extends, which results in stretching the tendinous peroneus tertius and subsequently in flexion of the hock as soon as the hoof starts rolling over; d) The gastrocnemius and cranial tibial muscles in the reciprocal tendinous apparatus centre the line of action of the resultant load on the tibia during the locomotion and reduce the strain due to bending; e) At the end of the support phase, the action of the rectus femoris muscle is replaced by that of the vastus lateralis, which prevents hooking of the patella on the medial ridge of the femoral trochlea by rotating it laterally around a longitudinal axis.


On the development of the cerebellum of the trout, Salmo gairdneri. I. Patterns of cell migration. Patterns of cell migration in the cerebellum of Salmo gairneri RICHARDSON, 1836 were studied in fish ranging in length from 4.5 to 230 mm. Sagittal and transverse series were stained with haematoxylin-eosin or according to Nissl or Golgi. The cerebellum of the trout comprises three main parts, i.e. the massive corpus cerebelli, the folded valvula cerebelli and the transversely oriented lobus vestibulolateralis. The early cerebellar anlage is a simple plate, which is delimited from the tectum mesencephali by the fissura rhombo-mesencephalica. The histogenesis may be divided into three phases. During the first phase the matrix layer produces the mantle layer. During the second phase the three typical cerebellar layers are formed. The third phase is characterized by growth. As regards the first phase, the mantle layer develops throughout almost the entire extent of the cerebellar anlage. Only in a narrow paramedian strip (matrix zone M) this layer does fail to appear. In regions where the mantle layer is formed, the matrix no longer occupies the whole width of the wall and is termed the ventricular matrix. The largest part of the ventricular matrix is gradually exhausted. However, in some places this matrix persists as a layer of proliferating cells. This holds for the matrices of the caudal border of the cerebellum; matrix zone L, surrounding the lateral recesses of the fourth ventricle, and matrix zone P, connecting the matrix zones L. The mantle layer produced in the first phase of histogensis mainly develops into the ganglionic layer. The second phase of histogenesis is characterized by the formation of a secondary matrix. Newly produced cells of the matrix zones M, L and P migrate away from their sites of origin towards the regions where a mantle layer prevsiously has been formed. The majority of these cells develops into granule cells. Migration of the cells produced in the first phase of histogenesis occurs in the radial direction. Because of the curvature of the cerebellum this direction changes with respect to the main longitudinal axis of the brain from region to region. The migration paths of granule cells show variable directions, namely (a) tangential followed by radial, for granule cells in the corpus cerebelli and in the medial parts of the valvula cerebelli and the lobus vestibulolaterialis, (b) tangential, for granule cells in the lateral parts of the valvula and (c) radial, for granule cells in the lateral parts of the lobus vestibulolateralis. The analysis of these migration patterns elucidates both the histogenesis and the morphogenesis of the cerebellum of the trout.


On the development of the cerebellum of the trout, Salmo gairdneri. II. Early development. The early histogenesis of the cerebellum of Salmo gairdneri RICHARDSON, 1836 has been studied in fish ranging in length from about 5 to 14 mm, both with light microscopical and electron microscopical techniques. Structurally, the matrix cells correspond to those of other vertebrates. Mitoses occur predominantly at the ventricular surface, but peripheral mitoses are found as well, particularly in the period of highest mitotic activity. Mantle cell somata can be distinguished from the elongated matrix cells on the basis of their rounded shape. The neurogenetic and gliogenetic periods overlap considerably. Presumably the first mantle cells are all neuroblasts: as soon as the mantle layer starts to form, axonal profiles are found. In a slightly later stage glial differentiation is manifest in the radial processes contacting the meningeal surface. In young stages a distinction between neuroblasts and glioblasts can only be made on the basis of the structure of their processes. Processes of glioblasts can be distinguished from axons and dendrites by their paucity of microtubules. Dendrites, appearing in late-embryonic stages, contain the same organelles as axons, but in larger amounts. The first differentiation of mantle cell somata is an increase of rough endoplasmic reticulum, and that to a lesser degree in glioblasts than in neuroblasts. Neuronal nuclei are rounded and more electronlucent than those of mantle cells. Apart from zonulae adhaerentes between the internal processes of matrix cells, puncta adhaerentia occur frequently in the cerebellar anlage. However, they rarely occur on young neuron;. The possible significance of these junctions is discussed. The present study indicates that growth cones and filopodia are characteristic of most and probably of all types of cells in the early developing cerebellum. Growth cones contain much vesicular and tubular endoplasmic reticulum and in filopodia a fine filamentous network is present. In the somata of mantle cells growth areas were found, i.e. areas under the cell membrane with a similar content as growth cones. It is suggested that these areas anticipate the outgrowth of a new process.


Scanning electron microscopic studies of ileal epithelial cells in suckling rats. The ileal epithelial cells containing the tubulo-vacuolar systems and supranuclear vacuoles in suckling rats were investigated with scanning electron microscopy, using specimens treated with osmium-thiocarbohydrazide-osmium staining methods, and critical point drying and cracking. The cracked surface of the apical cytoplasm is seen as irregular and small hollows and pores of the anastomosing and branching tubulo-vacuolar system. The cracked surface of the supranuclear vacuoles shows the ellipsoidal structures. Numerous pores of various size and irregular shape are present on the apical inner surface of the supranuclear vacuole. These pores are clearly the openings from the tubulo-vacuolar system to the supranuclear vacuole. Some small pores are visible on the inner lateral surface of the supranuclear vacuole, especially near the nucleus. They are probably the pathways of the absorbed materials from the supranuclear vacuole into the lateral cytoplasm. Usually, the inclusions of the supranuclear vacuole reveal the globes or coarse and sponge-like networks.


Quail Rathke's pouch differentiation an electron microscopic study. Adenohypophyseal region of quail embryo has been examined by electron microscopy from stage 12 to stage 21 of Zacchei (1961). The Seessel's pouch develops prior to the early stages of adenohypophysis formation, then regresses while Rathke's pouch proliferates and differentiates. From Rathke's pouch formation by stage 12 (48 h of incubation) until appearance of the first secretory granules by stage 21 (6 days of incubation), there are no major ultrastructural modifications in adenohypophyseal cells. Mitochondria, Golgi vesicles, polysomic ribosomes, pinocytotic vesicles, and mitotic figures become more numerous while nucleocytoplasmic ratio and the number of ribosomes and lipid droplets decreases. The major change is the appearance of secretory granules by day 6 of incubation. This phenomenon occurs at the same time as in chick embryo, despite an incubation period shorter for quail than for chick. Mitotic figures are mainly distributed near the pouch lumen, while secretory granules are first located in the peripheral cells of the cephalic part of pars distalis primordium. The hypothetical role of mesenchyme and vascularization is discussed.


On the development of the cerebellum of the trout, Salmo gairdneri. IV. Development of the pattern of connectivity. Synaptogenesis has been studied in the corpus cerebelli of the trout Salmo gairdneri, Richardson, 1836. The first synapses are observed in hatchlings and occur between parallel fibres and the shafts of Purkinje dendrites. Subsequently the axosomatic synapses of Purkinje axon collaterals on the neurons of the ganglionic layer appear, and finally the synapses made by climbing fibres and mossy fibres, and by stellate cell axons develop. Young synapses in the cerebellum of the trout resemble the mature structures so closely that the criteria for the identification of the latter can also be applied to the former. The number of parallel fibre synapses and of Purkinje axon collateral synapses increases considerably during development. Eurydendroid cells, the axons of which leave the cerebellum, receive an abundance of Purkinje axon collaterals on their somata and main dendritic trunks. Mossy fibre synapses are numerous in the granular layer. Climbing fibre contacts and synapses of stellate cell axons, both with Purkinje cells, are found occasionally. The following pattern of connectivity is proposed. The main input-output system is formed by the mossy fibres, the granule cells, the Purkinje cells and the eurydendroid cells. Additional pathways are formed by (1) the mossy fibres, granule cells and eurydendroid cells, and (2) the climbing fibres, Purkinje cells and eurydendroid cells. The afferent-efferent systems, mentioned above, are influenced by a number of internuncial elements: (1) The Golgi cells receive their input from the parallel fibres and contact with their axon collaterals the dendrites of granule cells. (2) Axon collaterals of Purkinje cells are in synaptic relation with Golgi cells. (3) Axon collaterals of Purkinje cells impinge upon the somata and main dendrites of other Purkinje cells. (4) Stellate cells, which derive their input from the parallel fibres, synapse with dendrites and somata of Purkinje cells. The possible functional roles of all of these neuronal elements are discussed.


On the development of the cerebellum of the trout, Salmo gairdneri. V. Neuroglial cells and their development. The neuroglia of the cerebellum of Salmo gairdneri Richardson, 1836, has been studied in mature and developing specimens with light and electron microscopy. The light microscopic observations were largely carried out on Golgi material. The cerebellum of the trout contains all of the neurologlial cell types described for the mammalian cerebellum, viz. ependymal cells, Golgi epithelial cells, velate protoplasmic astrocytes, smooth protoplasmic astrocytes and oligodendrocytes. In addition two types of glial elements, which combine characteristics of ependymal cells and of velate astrocytes, are found. These elements are designated as ependymoid astrocytes and astrocytoid ependymal cells. Smooth astrocytes and oligodendrocytes were observed only in later stages of development and possibly arise from the secondary matrix. The other glial cell types, as well as transitional forms between these types, are present in rather early stages, and show a similar ultrastructure. It is plausible that all these types develop from the glioblasts produced by the ventricular matrix layer. Many glial cells are radially oriented and keep in contact with the meningeal surface throughout development. The lattice formed by matrix cells in the earliest stages, and by glial cells and the axons of granule cells later on, plays a role in directing the migration of cells. Other functions of the glia, such as dividing the cerebellar cortex in synaptic compartments, are suggested. It may be concluded that the high degree of differentiation of the teleostean cerebellum is also reflected by the morphology of the neuroglia.


[Scanning electron microscopic study of the changes of the luminal surface of rat thyroid epithelial cells following exposure to cold for 6 to 48 hours (author's transl)]. Scanning electron microscopic observations of thyroid follicle cells of rats exposed to 4 degrees C for 6 to 48 hours were found to show an increased number of apical microvilli in comparison to those of controls kept at 22 degrees C. These ultrastructural differences--which were statistically significant 48 hours after start of the experiments--are related to stimulation of thyroid gland activity by exposure to cold.


The development of alkaline phosphatase activity in limb buds of mouse embryos in vitro and its relation to chondrogenesis. The development of alkaline phosphatase (aPh) activity and chondrogenesis were studied in the limb buds of mouse embryos (day 11 p.c.) that had been grown in an organ culture. During a 12-day culture period an increase in aPh activity to more than 40 mU/limb bud was measured from day 2 in vitro onward. Depending on the time of application, aPh formation can be inhibited by certain substances. Cytosine-arabinoside inhibits aPh activity when the substance is added on day 2, 3, or 4. Chondrogenesis, on the other hand, is affected on days 1, 2, and 3 and to a lesser degree on day 4. Actinomycin D interferes with aPh activity after its addition on day 1, 2, 3, or 4. Chondrogenesis is only inhibited when the drug is applied on the 1st, 2nd, or to a lesser degree on the 3rd day. Cycloheximide inhibits aPh formation on all days of treatment, but to a lesser degree on days 5 and 6; chondrogenesis is most influenced on days 2, 3, and 4. On day 6 of the culture period, aPh activity can be demonstrated histochemically only in the region of humerus and proximal parts of radius and ulna. Alterations in the distal cartilage skeleton, therefore, do not influence the activity data. A prerequisite for an increase in aPh activity is cartilage growth in the proximal part of the limb buds and subsequent induction of a perichondral cell population to proliferation and differentiation.


The pressure reversal of a variety of anesthetic agents in mice. The aim of this work was to study in mammals the ability of high pressures to reverse the anesthesia produced by a wide range of general anesthetics. Dose-response curves were obtained using mice at pressures ranging from 1 to 125 atm for five agents, namely alpha-chloralose, ethylcarbamate, phenobarbital and, for comparison, nitrogen and argon. The increase of ED50 was found to be a linear function of pressure in each case, but the proportionate increases in ED50 with pressure were greater for the three non-inhalation agents than for the two gases. Thus, the ratio of ED50 at 100 atm to that at 1 atm was 1.74 for alpha-chloralose, 1.68 for ethylcarbamate, and 1.54 for phenobarbital. On the other hand, the corresponding ratios for argon and nitrogen were only 1.36 and 1.34. The potencies of three short-acting agents (trichloroethanol, ketamine, and alphadione) were shown to increase with decreasing pressure, although ED50 values could not be obtained. It is concluded that pressure reverses the actions of a wide variety of anesthetics in mice. The results of this study are not inconsistent with either the fluidized lipid membrane or the critical volume hypotheses of anesthetic action.


Hypotensive anesthesia for total hip arthroplasty: a study of blood loss and organ function (brain, heart, liver, and kidney). The authors attempted to determine whether hypotensive anesthesia or the method of inducing hypotension has any effect on postoperative brain, liver, or kidney function and myocardial status following total hip arthroplasty. Thirty patients were anesthestized with halothane-nitrous oxide for total hip arthroplasty and randomly assigned to one of three groups. In two groups mean arterial blood pressure was decreased to 50 torr by high inspired concentrations of halothane (n = 90) or sodium nitroprusside (n = 12). In the third group (n = 9) mean blood pressure was maintained within 20% of control. Intraoperative blood losses decreased from 1,183 +/- 172 ml in the normotensive group to 406 +/- 102 ml and 326 +/- 41 ml in the halothane and nitroprusside hypotensive groups, respectively. Neither method of inducing hypotension nor hypertensive technique affected the results of postoperative tests of cerebral, hepatic, or renal function and myocardial status. These tests were performed before anesthesia and operation and at intervals in the postoperative course. In this small group of patients, deliberate hypotension for total hip arthroplasty added no morbidity and significantly shortened operating time, decreased blood loss, and decreased the number of blood transfusions needed.


The natural course of arteriosclerosis in animals and man. A thorough search for the natural history of arteriosclerosis involving the cerebrum, aorta, and peripheral vessels has been made. The disease's rate of progress has been studied anatomically, clinically, radiologically, and plethysmographically. We conclude that arteriosclerosis is usually associated with other diseases such as diabetes, high blood cholesterol, and hypertension. Heart disease in particular is often the cause of the patient's death, rather than the peripheral arteriosclerotic disease itself. The usually slow development and course of arteriosclerosis indicate that its treatment is largely a medical problem. It seems important to control the various risk factors and to utilize surgical therapy to attack specific lesions which threaten the tissues. A thorough cardiovascular profile of the patient should be compiled and should include a glucose tolerance test and lipoprotein phenotyping.


Hemodynamic changes induced by prolonged NaCl and DOCA administration in spontaneously hypertensive rats. The results of this study demonstrate that the spontaneously hypertensive rat is sensitive to salt excess. The hypertensinogenic effect of salt was mediated through elevation of peripheral vascular resistance. The addition of DOCA aggravated the hypertension, mainly be elevating the cardiac output without appreciably decreasing peripheral vascular resistance. SHR'S EXPOSED TO 1% NaCl consumed more fluids and excreted more sodium and urine than control rats. Those exposed to 1% NaCl and DOCA had higher fluid consumptions and excreted more sodium than the other two groups. These effects of sodium in a neurogenic strain of hypertensive rats suggest a possible interplay between the neurogenic and salt-dependent components in the development and maintenance of hypertension. They also suggest that SHRs, like other hypertensive rat models, are salt sensitive.


Arterial flow in the lower leg correlated with plasma levels of two formulations of papaverine hydrochloride. In patients with severe peripheral vascular disease (mean arterial flow of 40 ml/min), a suspension of papaverine in a soft gelatin capsule produced plasma levels almost three times higher than those following treatment with a sustained-release tablet formulation. The higher plasma levels resulted in significantly greater vasodilation with increased distal arterial flow. The onset of peak pulsatile flow with the soft gelatin form came sooner than with the sustained-release form. However the durations of vasodilation were similar with both papaverine preparations. The vasodilatory activity of papaverine appeared to be greater in the sympathectomized leg. The soft gelatin formulation of papter reconstruction of a large artery, and may be effective in sustaining a longer vasodilatory effect in patients with small vessel disease, when surgical procedures may not be applicable.


Relative significance of plasma renin activity and concentration in physiologic and pathophysiologic conditions. Plasma renin activity (PRA) and concentration, measured after acid treatment of the plasma (PRC3.3), were determined on the same plasma samples in different conditions. Log PRA and log PRC3.3 were significantly (P less than 0.001) and similarly related to sodium intake, age, and plasma aldosterone concentration in normal subjects. The correlation coefficient between log PRA and log PRC3.3 was 0.49 in 80 sodium-replete and sodium-deplete normal subjects, and it was 0.84 in 84 hypertensive patients untreated or under treatment with thiazides. On the contrary, during beta adrenergic blockade, PRA decreased significantly (P less than 0.001) by 62% while the changes in PRC3.3 were not significant. At maximal exercise, PRA increased significantly by 168% while the PRC3.3 increase of 24% was not significant. In hypertensive patients with unilateral renal artery stenosis the ipsilateral renal vein/artery ratio was higher for PRA (2.46) than for PRC3.3 (1.56), whereas both ratios on the controlateral side were similar and close to one (1.14 and 1.06). The conditions in which PRA and PRC3.3 determinations are concordant or discordant are discussed.


Arteriovenous fistula and forward hypertension in the portal circulation. The notorious predilection for rupture of splenic artery aneurysms in women of childbearing age is once more stressed by this case report. Although such ruptures usually result in a catastrophic interabdominal bleeding, in rare instances they lead to the formation of an arteriovenous fistula and consequent portal hypertension. Arterialization of the portal vein results in a progressive development of intrinsic hepatic morphologic changes and hepatoportal sclerosis, which further elevate the pressure in the portal system. This combination of pathophysiologic hemodynamic features closely resembles the original concept of Banti. He postulated that portal hypertension began with pathologic changes within the spleen which were associated with an increased blood flow through this organ. This led to increased flow and pressure in the portal venous system and ultimately cumulated in cirrhosis of the liver. This concept of the pathophysiology of portal hypertension has been universally abandoned, but it could serve as a model of the sequelae of an arteriovenous communication within the portal system.


Hemodynamic effects of isometric exercise in normotensive and hypertensive subjects. Isometric exercise increases arterial pressure and heart rate in normotensive individuals and also in patients with labile and fixed essential hypertension. The hypertensinogenic effect of isometric exercise is mediated through an increase in cardiac output because the peripheral vascular resistance is usually not affected. The cardioaccelerating effects of isometric exercise are mediated through an initial vagal withdrawal and a later stimulation of the sympathetic system. However hypertensive patients with defective sympathetic adjustments are not immune to the hypertensinogenic and cardioaccelerating effects of isometric exercise. Since isometric exercises are performed several times during daily activities, they may result in dangerous elevations in arterial pressure in patients with already increased arterial pressure, and this may eventually lead to cerebrovascular accidents and/or cardiac decompensation. It is therefore recommended that patients with elevated arterial pressure, or persons prone to hypertension, should refrain from such activities.


Arterial compliance in permanent essential hypertension: preliminary report. Systemic arterial compliance was measured in 22 patients with permanent essential hypertension and compared with 11 sex- and age-matched normal normal subjects. Determinations were made from analysis of the monoexponential blood pressure-time curve during diastole, according to a simple visco-elastic model. Arterial compliance was significantly decreased (P less than 0.001) in hypertensives. In the overall population, arterial compliance was negatively correlated to age (P less than 0.005) and blood pressure (P less than 0.001), suggesting that the changes in compliance could be attributable to the level of blood pressure per se and/or to the rigidity of the arterial wall. Administration of vasoactive substances (angiotensin and sodium nitroprusside) enabled a strong negative relationship (P less than 0.01) between arterial compliance and diastolic blood pressure to be demonstrated in each individual. The slope of the curve was not dependent on age and represented the ability to decrease compliance per unit rise in pressure. The slope was steeper in hypertensives, suggesting a change reactivity of the arterial wall in these patients.


Pulmonary veno-occlusive disease: a case report. A case of pulmonary veno-occlusive disease in a 17-year-old Indian man appears to be the first case reported from Asia. Primary pulmonary hypertension was diagnosed on the basis of clinical and catheter data. The patient died shortly after catheterization. Histology reveald pulmonary veno-occlusive disease as a cause of pulmonary hypertension.


Severe cyanosis due to atrial septal defect and an anomalous inferior vena caval valve. Uncomplicated atrial septal defect is often associated with mild arterial desaturation. A case is reported with severe cyanosis and life-threatening hypoxemia due to an atrial septal defect. Cardiac catheterization revealed normal right heart pressures and an atrial septal defect with shunting of inferior vena caval blood into the left atrium. At surgery an anomalous inferior vena caval valve was found directing inferior vena caval blood into the left atrium. The embryologic basis for this association is discussed. The delayed onset of severe cyanosis may have been contributed to by the thoracic scoliosis.


Radiographic features of pleural effusions in pulmonary embolism. A prospective analysis of 155 patients with pulmonary embolism was undertaken to describe the radiographic characteristics of associated pleural effusions and related abnormalities. Approximately one half of these patients had pleural effusions. Patients with other potential causes of effusion, such as heart failure, pneumonia, or cancer, were eliminated from further analysis. In the remaining 62 patients, radiographic evidence of pulmonary infarction accompanied pleural effusions in one half of the cases. One third of patients with parenchymal consolidation had no evidence of effusion. Atelectasis and other nonspecific radiographic abnormalities occurred in less than one fifth of the cases. Typically, pleural effusions were small and unilateral, appeared soon after symptoms of thromboembolism began, and tended to reach their maximal size very early in the course of the disorder. Pulmonary infarction was associated with larger effusions that cleared more slowly and were more often bloody in appearance on thoracentesis. Chest pain occurred in all but one patient and was a valuable diagnostic clue. Pain and pleural effusions were always ipsilateral and almost always unilateral, but neither correlated well with the presence or time course of infarction. Effusions that were delayed in onset or that enlarged late in the course were associated with recurrent pulmonary embolism or superinfection. These radiographic features may be helpful in the diagnosis and management of pulmonary embolism.


Health effects of ozone exposure in asthmatics. To investigate whether ambient air quality standards for ozone adequately protect high-risk populations, we assessed pulmonary and biochemical responses of 22 asthmatic volunteers to 2-hour controlled exposures to ozone at concentrations approximating 0.2 ppm, with secondary stresses of heat and intermittent exercise. All subjects had physician-diagnosed asthma; clinically, they covered a range from minimal wheezing to persistent marked abnormality in forced expiratory performance. Control experiments included repeated sham exposures (to purified air with no ozone added) as well as brief exposures to the odor of ozone followed by purified air. No meaningful changes in forced expiratory measures, lung volumes, or single-breath N2 indices were found after ozone exposure relative to control. Symptoms, scored semiquantitatively, increased slightly but not significantly with exposure to ozone. Small but significant (P is less than 0.05) group mean blood biochemical changes occurred with exposure to ozone; these included increased glucose-6-phosphate dehydrogenase and lactate dehydrogenase activities, increased erythrocyte fragility, and decreased concentration of reduced glutathione. Hemoglobin concentration and acetylcholinesterase activity decreased with ozone and decreased to a lesser extent in control studies. Concentrations of ozone readily attainable in smog episodes thus appear to be capable of affecting blood biochemistry in at least some asthmatic persons, in the absence of obvious adverse pulmonary responses. Whether the biochemical effects represent harm to health or a normal response to stress remains to be determined.


Isoflow-volume curves in the diagnosis of upper airway obstruction. We evaluated the ability of air and helium-O2 maximal expiratory flow-volume curves to distinguish upper airway obstruction from the diffuse, peripheral airway obstruction of chronic obstructive pulmonary disease. The increase in expiratory flows at peak, 75, 50, and 25 per cent of the vital capacity during helium-O2 breathing compared to air breathing was determined in 5 normal subjects and 3 patients with chronic obstructive pulmonary disease while breathing through fixed resistances, and in 6 patients with documented tracheal obstruction. In the normal subjects, the helium response at all 4 points remained normal and was unchanged from baseline until the simulated obstruction was severe (6-mm orifice), at which point all ofthe helium responses increased by 50 per cent. The patients with chronic obstructive pulmonary disease maintained their low baseline helium responses until the obstruction was severe (6-mm orifice), when only the expiratory flows at peak, 75, and 50 per cent of the vital capacity increased by at least 50 per cent. Five of the 6 patients with upper airway obstruction had helium responses very similar to those of the normal subjects with similar degrees of simulated obstruction, but the one patient with concomitant airway obstruction extending well below the carina had very small helium responses at each point. We conclude that upper airway obstruction can usually be identified by high helium responses and that upper airway obstruction, if severe, can be identified even in the presence of more peripheral airway obstruction by a normal helium response at high lung volumes.


Methoxamine-induced increase in afterload. Effect on left ventricular performance in chronic obstructive pulmonary disease. With a radionuclide technique, left ventricular ejection fraction and stroke volume index were measured in the basal state and after the stress of a methoxamine-induced increase in afterload in 10 men with severe chronic obstructive pulmonary disease. The resting mean left ventricular ejection fraction was normal in all 10 patients. After an acute increase in resistance to left ventricular ejection with methoxamine, the left ventricular ejection fraction and the stroke volume index did not decrease significantly, even in the presence of cor pulmonale in 5 patients. Mean pulmonary capillary wedge pressure was normal before, and did not change significantly after, methoxamine infusion. The data suggest that latent left ventricular dysfunction is not present in this group of patients with severe chronic obstructive pulmonary disease.


An analysis of cross reactions among mycobacteria by in vivo and in vitro assays of cellular hypersensitivity. Homologous and heterologous skin test reactions in sensitized guinea pigs to antigens from 11 species of mycobacteria were fitted by a linear model that permitted the ranking of each species on the basis of cross reactivity. When the same species were ranked on the basis of in vitro transformation of sensitive lymphocytes in response to homologous and heterologous antigen preparations, a different ranking order was observed. Reasons for the lack of strict correlation between skin tests and in vitro lymphocyte transformations are discussed.


Comparative study of histamine and exercise challenges in asthmatic children. Fifty asthmatic children were tested with both a standardized treadmill exercise and a histamine inhalation on 2 separate days. Ninety per cent had a positive response to histamine, whereas 74 per cent had demonstrable exercise-induced bronchoconstriction. There was a close relationship between responsiveness to histamine and exercise, because all patients who responded to histamine had exercise-induced bronchoconstriction. Eight children (16 per cent) responded to histamine only. Although prechallenge pulmonary function has an effect on the incidence of exercise-induced bronchoconstriction, it does not appear to influence the responsiveness to histamine. Therefore, when provocation testing is being done for the purpose of diagnosing asthma, histamine is preferable to exercise.


Studies in sarcoidosis: intradermal Mycoplasma test. Mycoplasma strain 215-M, closely related to Mycoplasma orale type 1, was grown in human macrophage monolayers in vitro. Sonicated homogenates of macrophages diluted in saline solution were used for intradermal skin tests in 19 patients with sarcoidosis and in 25 patients with a variety of other diseases. Positive skin-test reactions to this newly developed Mycoplasma test material were observed significantly more often in the patients with sarcoidosis than in the other patients.


[Intrauterine growth retardation: biochemical changes in human central nervous system (author's transl)]. The development of the central nervous system has been verified using biochemical techniques in two premature infants with intrauterine growth retardation. In both cases a retard of brain growth and maturity was detected. In the case less affected alterations consisted in a decrease in size of forebrain and cerebellum and a diminution of the DNA in cerebrum. In the other case sizes of cerebrum, cerebellum and brain stem were markedly reduced. The values of DNA and RNA were also lower than in controls being cerebellum and brain stem the more altered regions. The lipid composition of cerebrum, cerebellum and brain stem is also reported for both cases.


[Toward a renewed definition of health (author's transl)]. With several arguments and testimonies is founded the need for a renewed definition of health. It is offered to the discusion the following project; Health could be conceived as the model of a capacity of vital normatization which allows the person to enjoy his paycophysic harmony in dynamic equilibrium with his natural and social circumstances. The author thinks that at preent time, and humanistic definition like this, could not be easily understood and applied because of power structures and materialistic forces which act on the man of today. Notwithstanding this objetion, moral exigences and a personal feeling of sympathy toward the health matters, push the author to offer this project to the discusion.


[Urinary tract abnormalities with anorrectal malformations (author's transl)]. Thirty five patients with anorrectal malformations are reviewed. These are divided in high and low anomalies according to some simple clinical data, better than the drawing of reference lines to determinate the height of puborrectalis muscle. Malformations were associated in 13 cases with urinary tract estructural anomalies and in four cases with isolated vesico-ureteral reflux. Diagnosis of urinary tract infection was made in 14 patients, 12 of them with recto-urinary fistula. A point is made about the complete and early exploration of all these patients to prevent irreparable renal damage that could be developed.


[Plasmatic levels of gastrin in children under seven years (author's transl)]. Gastrinemia was determined in 100 healthy children whose ages ranged from three months to seven years, who were separated in three groups: from three months to two years, from two to four years, determining the gastrin by radioinmunoassay twice in each case. As no significant difference was found among the three groups, total results were grouped together to confect a graph ranging from the 5th to the 95th percentile. Average percentage of gastrinemia was determined at 76.81 pcg./ml. (50 percentile), with extreme values between 48.31 pcg./ml. (5th percentile) and 105.31 pcg./ml. (95th percentile).


[The direct isotopic cystography in the study of the vesico-ureteral reflux (author's transl)]. A technique of direct isotopic cystography is presented. It uses 99mTc-DTPA and scintillation camera connected to a computer. The study included a group of children affected of vesico-ureteral reflux; the results are discussed and compared to those of the classical radiological method of voiding cystography. Both techniques seem to complete each other. The radiological method allows a high quality in the definition of the morphological disturbances which causes the reflux. The radioisotope method has a lower radiotoxicity--about 100 times less than voiding cystograph--and high diagnostic sensitivity. The direct isotopic cystography has, in this sense, a broad interest in the periodic control of the vesico-ureteral refluxes treated with conservative procedures.


[Experience and application of diagnostic pneumoperitoneum in the anomalies in the umbilical region (author's transl)]. By means of 30 pneumoperitoneograms performed "postmortem" and five performed for diagnosis, the exploratory technique, radiologic anatomy of umbilical region, and the usefulness of the process in the diagnosis in children are discussed. Pneumoperitoneum may be indicated in diagnosis of bleeding Meckel's diverticulum, in exclusion or confirmation of remnants of the omphalomesenteric duct in cronically moist lesions of the umbilicus resistent to symptomatic treatment, in cases of non-communicating urachal cysts which can not be diagnosed by cystogram, and in the differential diagnosis of abdominal tumors related to the umbilical region.


[Digestive atresia and associated malformations (author's transl)]. The authors report a study on the associated malformations found among 143 cases of digestive atresia at various levels. They are classified as single, multiple, single with trisomy and multiple with trisomy. Malformations are analysed in quality and quantity depending on the organ affected and the digestive level bearing the atresia.


[Epileptic sleep seizures in childhood (author's transl)]. 64 children with seizures occuring during sleep were studied. No claim is made to definitive clinical results, but the clinical peculiarities of certain epileptic crises that tend to occur more frequently in sleep are presented. In 62.5% of all our cases are being treated as benign epilepsy, with centro-temporal E.E.G. foci and typical characteristics of age, hour of appearance and therapeutic response. In 32.5% are generalized seizures, and these have the widest age range at onset. The fits are at times unrelated to the length of previous sleep and respond less favourably to treatment. In 5% are either unilateral seizures or partial complex one. The incidence of a positive family history is higher than found in other epileptic groups, suggesting that sleep seizures are genetically determined.


[Foreign bodies in lower respiratory tract (author's transl)]. We present a series of 114 cases of children under seven years of age with solid foreign bodies in lower respiratory tract. These cases were analysed under diagnostic and therapeutic aspects. The index of clinical diagnosis is taken into consideration, based on the respiratory symptoms and the aspirative antecedent; the radiologic diagnosis: opacity and indirect signs; endoscopy as diagnostic and therapeutic procedure, and the use of other medical and surgical treatments. From the results obtained we draw the following conclusions: a) Almost all cases of foreign bodies can be diagnosed from a good clinical history, and a radiologic study of the thorax, in inspiration-expiration. b) Endoscopy is the selective diagnostic and therapeutic tool; morbidity and mortality is negligible, and hospitalization period short. Either tracheostomy or bronchotomy are done very rarely. c) The pathologic lesions are dependent upon the shape of the object, its nature, the time it has been in the air tract and the response of the host. d) Foreign bodies appear most frequently in the right principal bronchus.


[Galactosemia and cow's milk intolerance (author's transl)]. The clinical, biochemical and anatomical studies of one case of galactosemia with cow's milk intolerance in a one month old infant are reported. Diagnosis was ascertained measuring the enzyme (Gal-1-P-Uridyl-transferase) deficiency with the methods of Anderson, Kalckar and Isselbacher. Overload and enzymatic studies were also carried out in relatives. The interest of this association of galactosemia with cow's milk intolerance, and its clinical and therapeutic implications are pointed out in the discussion.


[Fasting insulinemie levels and after overload with oral glucose in overweight children (author's transl)]. Fasting insulinemie levels and after overload with oral glucose are studied in a group of 30 overweight children aged between 2--12 years. The results are: An increase in insulin secretion according to the age only in the overload test. The insulin and glucose areas in the overweight child is statistically bigger than in the healthy child. We conclude that hyperinsulinism in obesity, may be related with a insuline-resistance and with some kind of glucose intolerance.


[Allergic granulomatous angitis. A report on 4 cases (author's transl)]. The authors describe four new cases of allergic granulomatous angiitis presenting symptoms of bronchopneumonia with asthma, weight loss, and persistent fever. There was associated eosinophilia in each case, and the outcome was rapidly fatal. Autopsy confirmed the presence of characteristic lesions; necrotizing angitis, vein involvement, and extra-vascular granulomatous infiltration, mainly in the lungs and heart. The characteristic clinical, biological, and histological changes seen in Churg and Strauss's syndrome should enable differentiation from other granulomatous angititis affections, especially PAN. A different diagnostic approach is needed, however, as surgical biopsy of the lungs, and/or needle biopsy of the liver is necessary.


[Cases of acute leukaemia following immunosuppressive therapy for disseminated sclerosis and for Behçet's syndrome (author's transl)]. On the basis of two personal cases of acute leukaemia occurring following immunosuppressive therapy for disseminated sclerosis and for Behçet's syndrome, the literature is reviewed. Thirty three similar detailed cases were collected. They are characterised in general by the prolonged use of immunosuppression. The acute leukaemia affected the granulocyte series in the majority of cases. In 30%; the leukaemia was preceded by a phase of several months of preleukaemic type dysmyelopoiesis. The mechanisms of action explaining this carcinogenic risk in a general way are multiple: the role of marrow aplasia, chromosomal abnormalities, the activation of a leukaemogenic virus, the role of immunodepression and that of repeated antigenic stimulation may all be discussed. The risks associated with such treatment should thus be borne in mind when evaluating its indications.


Route of absorption of drug and ointment after application to the eye. Chloramphenicol, tetracycline hydrochloride, sodium sulfacetamide, and fluorescein sodium prepared in both aqueous solutions and ointments were placed in the conjunctival sac of humans. Each drug soon was tasted in the back of the mouth with no difference being noticed with the use of aqueous solution or ointment. Tetracycline and fluorescein studies showed that systemic absorption were similar regardless of whether solution or ointment were used. Furthermore, it was found that the ointment passed through the lacrimal drainage system and into the nose and throat. The ocular contact time of ointment with the eye is greater than that of water, and ointment is much more slowly absorbed via the lacrimal drainage system. Both the drugs and the ointment base applied topically to the eye travel through the nasolacrimal system as the way of elimination when given in the small volumes that are held by the conjunctival sac.


Intravitreal cephalothin in experimental staphylococcal endophthalmitis. Intravitreal cephalothin was used to treat experimentally induced bacterial endophthalmitis in rabbit eyes. A dose of 2 mg and less was apparently nontoxic to all intraocular structures. Thirty-two hours after injection of a 2 mg dose, the level remaining in the vitreous was above the minimal inhibitory concentration for most susceptible organisms. Treatment of experimentally induced staphylococcal infections of the vitreous was successful with early intravitreal injection. When therapy was delayed, vitreous bands and posterior lens cataracts developed. Eyes of control animals receiving intramuscular and subconjunctival injections of cephalothin all progressed to phthisis bulbi.


Introduction of the ocusert ocular system to an ophthalmic practice. This study, on a sample of 81 patients, was primarily shortterm. The objectives were to determine what type of patient would be successful on the Ocusert; to see if we had similar pressure control with the Ocusert as with drops; and to see if the advantages were obvious to our patients. We found that 56% of our patients could wear the unit successfully (after 3 months of study). The major reasons for discontinuing the Ocusert were discomfort and retention, but age was also a significant factor to success. We found the most critical period of adjustment was the first 2 weeks. It was found that 46% of the group stayed in the smae pressure range, 30% moved to a lower pressure range, and 24% moved to a higher category of intraocular pressure.


The conjunctival flora of nursing home patients and staff. Conjunctival cultures were obtained on 118 patients and 59 staff members of a nursing home. The bacteria found and the sensitivities of the pathologic bacteria are related. Twenty-eight of the 118 patients had enteric organisms in their conjunctival sacs while none of the staff had these organisms.


Acute corneal calcification.

Acute corneal calcification. This case report describes acute unilateral calcium deposition in the central cornea of a uremic patient with corneal exposure. A mechanism of calcium deposition is discussed. It is suggested that a high calcium-phosphorus product, combined with local factors secondary to injury of the exposed corneal epithelial cells, helped to trigger rapid and dense calcification. Details of the removal technique are presented. Constant irrigation of freshly prepared chelating agent combined with vigorous and frequent massage of residual deposits is necessary to completely remove dense concentrations of calcium.


[Technical details concerning vidian neurectomy by intranasal approach]. In the period between May 1975 and 1976, 196 operations were carried out with an approach via the pterygomaxillary fossa, the majority for neurectomy of the vidian nerve in cases of vasomotor rhinitis or ethmoid polyposis. Other cases included neurectomy of the nerve of Bock in cases of obstructive tubaritis. The ease, precision and minimal operative trauma of this approach in comparison with the transmaxillary was the motive which led to an increase in our indications for surgery of the pterygomaxillary fossa. The experience acquired has led to the development of a routine procedure. This routine method is limited in the sense that note must be taken of a surgical field which is too narrow to work blind. It involves three risks: uncontrollable bleeding, functional failure if the nerve is not sectioned and possible ophthalmological complications.


[Objective audiometry by recording of early and middle-latency auditory evoked potentials using an external method]. The bio-electric potentials induced by a stimulus in the cochlea and the various structures of the auditory pathways of the brain stem and the primary auditory cortex may be collected using an external method. The authors frequently emply in clinical practice early components, which correspond to the cochlea response in the cochlear nucleus of the medulla, in the olive of the pons and the posterior quadrigeminal tubercle, and middle latency components, sub-cortico-cortical potentials generated in the thalamus and the primary auditory cortex. Combined use of early and middle latency components makes it possible, without preparation and with simple sedation in the child, to obtain an objective determination of threshold. In oto-neurology, this examination provides appraciable information concerning lesions in the auditory pathways: acoustic neuroma, brain stem tumour, multiple sclerosis, central deafness in patients with cerebral motor insufficiency.


Further observations on posterior ampullary nerve transection for positional vertigo. An evaluation was made on ten patients with benign paroxysmal positional vertigo (BPPV) in whom transection of the posterior ampullary nerve was performed by the middle ear approach under local anesthesia. The undermost ear in the provocative test position was selected for surgery. All ten patients were relieved of positional vertigo by the procedure. Of the five patients who were relieved of BPPV by posterior ampullary nerve transection prior to 1974, the long-term follow-up on four revealed continued relief of vertigo. Five additional patients treated by this surgical procedure since 1975 have also experienced relief from BPPV, but a moderate sensorineural hearing loss occurred in one patient. Two additional patients with BPPV were explored surgically but the singular canal could not be located. Persistence of the vertigo in these two patients strengthens the conclusion that the posterior semicircular canal sense organ is largely responsible for BPPV.


Flexible bronchoscopy in nonvisualized carcinoma of the lung. Of 1,000 consecutive patients undergoing fiberoptic bronchoscopy, 331 eventually were proven to have primary lung cancer. Of the 331 carcinomas, 253 were beyond the visual range of the flexible bronchoscope. However, under fluoroscopic guidance, the diagnosis of carcinoma was established in 194 (76.7%) of these nonvisualized tumors. Cytologic analysis of brush specimens was more often positive for malignancy than specimens obtained by forceps biopsy. An expert cytologist and experienced bronchoscopy team are esential for a high percentage of reliable positive diagnoses in bronchogenic carcinoma.


Sinus histiocytosis with massive lymphadenopathy. Report of its occurrence in two siblings with retropharyngeal involvement in both. Sinus histiocytosis with massive lymphadenopathy (SHML) was found in two siblings, both of whom had retropharyngeal involvement. In one of the children the retropharyngeal swelling appeared to produce obstructive symptoms, requiring excision of the involved lymph nodes. These cases appear to constitute not only the first proven familial occurrence of SHML but also the only reported instances of retropharyngeal involvement. SHML is an uncommon disease of unknown etiology that must be distinguished from other diseases associated with marked lymphadenopathy, particularly as its course is generally benign and not altered by any known form of medical treatment.


Study of spastic dysphonia using videofiberoptic laryngoscopy. Spastic dysphonia is a speech disorder, characterized by a "strangled voice quality," irregularly occuring phonatory arrests, and a jerky pattern of speech. This is often extremely disruptive to the patient's ability to communicate. Two cases are presented in which a new technique, videofiberoptic laryngoscopy, was employed in the study of these patients. The characteristic laryngeal behavior of this disorder is documented and recorded, particularly noting the increase in supraglottic activity and how different vocal maneuvers alter this activity.


Head and neck manifestations of scleroderma. Scleroderma has rarely been discussed in the otolaryngologic literature. A review of the records of 71 scleroderma patients admitted to UCLA Hospital during the past five years indicates that head and neck manifestations are common, occurring in 80% of these patients. The initial symptoms in 30% among them were related to the head and neck. It is the purpose of this paper to familiarize otolaryngologists with scleroderma. Although it has not been emphasized in the past, this is a disease whose early symptoms and findings may require otolaryngologic consultation and whose later course is characterized by head and neck symptoms and findings in the overwhelming majority of patients.


Size of bony labyrinth of human infant and adult compared to that in certain animals. Comparative anatomic studies of the bony labyrinths of humans and those of a full grown pony, zebra, grizzly bear, seal and domestic cow were performed. Fusible metal was injected into the labyrinths and the resultant casts were then measured. The similarities and differences were noted and discussed.


Perilymphatic oxygen tension and vasoactive drugs. The oxygenation of the perilymph in response to the intravenous injection of vasoactive drugs has been measured in 67 cats using the polarographic method. Of all drugs used, only angiotensin induced a significant raise of perilymphatic PO2. Histamine, 50% glycerol and 7% Na2CO2 reduced the perilymphatic PO2. Papaverine, furosemid, pyridylcarbinol, naftidrofuryl and low molecular dextran have no significant effect upon the perilymphatic oxygen tension. Rapid changes of systemic blood pressure were found to correlate with subsequent modifications of the oxygen tension in the perilymphatic space.


Quantitative evaluation of postnatal bone growth in the auditory ossicles of the dog. The postnatal bone growth (appositional and internal) in the auditory ossicles and in the tibia of three mongrel dogs was studied by means of tetracycline and alizarin labeling. The appositional growth is characterized by an increase in the external dimensions of the auditory ossicles within the first month of postnatal life. No trace of bone deposition was found after this period of time. The patterns of internal growth are: 1) the rate of primary osteon formation shows the same value in the incus and malleus; 2) these values are always less than those in the primary osteons of the diaphysis of the tibia of the same dog; 3) the time required for the formation of these osteons in the auditory ossicles, like in the other parts of the skeleton, increases significantly with age.


Hemangioma of the nasal bones: radiographic appearance. Four additional cases of hemangioma involving the nasal bones are presented, bringing the reported cases to 15. The radiographic findings of nasal bone hemangioma are distinctive, permitting easy diagnosis. Hemangioma involving the nasal bones may result in a reticular or "soap bubble" osteoporosis, spiculation, bone thickening, or a channelled appearance of the nasal bone. Treatment is by local excision.


Combined flap-wire reconstruction of the oral cavity. The concept of immediate reconstruction for head and neck defects following tumor resection provides the impetus for the development of new reconstructive techniques. In this article, the authors describe the evolution of local and regional flaps and the more recent use of composite tissues. The application of a combined forehead-deltopectoral flap and Kirschner wire for the reconstruction of a large defect involving the oral cavity, mandible and facial-cervical skin is presented in a case report and evaluated as to its efficacy in the treatment of head and neck cancer.


Surgical treatment of congenital choanal atresia. In a follow-up, 2 to 27 years postoperatively, of 43 patients with unilateral choanal atresia a high frequency of relapses was observed. In 47% of the cases, preoperative symptoms had reappeared, and in 84% scar tissue had reduced the choanal opening to less than half of normal size. In most of the patients a transpalatinal approach was used, either ad modum Ruddy, Wilson or Owens. In order to improve the results, the surgical method and the postoperative treatment were changed in a new series of 15 patients with unilateral atresia. These patients, 6 to 26 years of age, were operated on by a transplantinal approach during two months in the autumn of 1974. After removal of the atresia, the posterior part of the nasal cavity was modeled, with a dental drill, to increasing diameter towards epipharynx. To keep the opening patent a PVC tube was left in the choana for six weeks postoperatively. The results were encouraging. Two and a half years after the operation there were no relapses.


Vocal cord paralysis and thyroid surgery. A technique used to identify the recurrent and superior laryngeal nerves using a flexible fiberoptic bronchoscope is presented. The author has used this technique in 12 cases and found it superior to other techniques that he has tried.


Alcohol and the oculomotor system.

Alcohol and the oculomotor system. The influence of alcohol on the oculomotor system was observed by means of the caloric eye tracking pattern (CETP) test, the visual suppression test on caloric nystagmus, and the positional nystagmus, eye tracking and gaze nystagmus tests. In Group A (nine cases whose CETP before the intake of alcohol was normal), the influence of alcohol consumption appeared regularly and consistently in the following order: abnormality of CEPT greater than or equal to positional alcohol nystagmus greater than or equal to abnormality of the eye tracking pattern greater than or equal to alcohol gaze nystagmus. On the contrary, in Group B (eight cases whose CETP before the consumption of alcohol was already abnormal), with one exception, the regularity noted in Group A was not observed. This phenomenon may be attributable to the presence of latent disorders of the oculomotor system. In both groups, the duration of the caloric nystagmus itself was slightly shortened and its amplitude somewhat suppressed after the consumption of alcohol. The results were confirmed by experiments in which the subjects kept their eyes open in darkness. On the other hand, when the eyes were kept open in light surroundings, the duration and amplitude of the caloric nystagmus were exaggerated in appearance because the mechanism of visual suppression was disturbed by alcohol.


Estimate of vitamin A in the guinea pig cochlea. Microfluorometric estimates of the membranous structures of the freeze-dried guinea pig cochlea have demonstrated that vitamin A is present in these tissues at a concentration of 21.2 microgram/gm (SD +/- 4.77 microgram) which is approximately ten times the vitamin A concentration in most other tissues.


Temporal bone findings in hemifacial microsomia. The temporal bone findings in a case of hemifacial microsomia are described with photographs. The right facial hypoplasia was associated with anophthalmia and microtia on the same side. The right petrous bone was hypoplastic and showed total superior dehiscence of the internal acoustic meatus. Th otic capsule was deformed with an underdeveloped cochlear modiolus grossly deficient in spiral ganglion population. The spiralling cochlear shell showed partial deficiency of the interscalar septum between the middle and apical coils. The cochlear duct was shorter than that on the normal side; the organ of Corti however was normal. The vestibular system did not show any structural abnormality except for the degeneration and reduction of the Scarpa's ganglion cells and nerve fibers. An additional interesting fact was that the facial nerve was totally absent in the temporal bone except for its nervus intermedius component.


Necrotizing sialometaplasia. A self-limited pseudotumoral palatal ulcer. Necrotizing sialometaplasia of the palate, an enigmatic pseudomalignant penetrating ulcer, is a benign lesion which heals spontaneously in three to ten weeks. Relative painlessness contributes to patient delay in seeking medical attention, and suggest that many cases are subclinical. Clinically, the patient age group and morbid gross appearance mimic malignant palatal tumors. Lack of awareness of this entity has led to the misdiagnosis of carcinoma in several previous cases. However, the histopathologic features of sialadenitis, focal lobular necrosis with mucosal ulceration and glandular squamous metaplasia, are distinctly benign. A typical case and literature review are presented.


Cricothyroid muscle in respiration.

Cricothyroid muscle in respiration. Although the phonatory activity of cricothyroid muscle is well-known, its respiratory role often remains unrecognized. Recent data suggest this muscle plays a major role in the overall regulation of breathing by its control of expiratory resistance and flow. Cricothyroid contraction in expiration results in vocal elongation increasing glottic size. Such a mechanical effect reduces airway resistance and shortens expiratory duration. By such a mechanism, the rate of respiration may ultimately be modified using the larynx as the principal effector of this control. In this regard, cricothyroid expiratory activity is a pressure-sensitive evoked response influenced by afferent vagal stimuli. Its activity is triggered by a critical threshold of pressure-increase with respect to time, and its duration is directly dependent on the duration of positive subglottic pressure. The threshold of cricothyroid activation is reduced in hypercapnia and elevated in hypocapnic states.


Dysplastic epithelial changes in nasal polyps. In 33 patients undergoing nasal polypectomy, severely dysplastic or intraepithelial malignancy was observed focally in the surface lining of these polyps. Follow-up on 29 of these patients showed that the changes did not recur or progress to invasive tumor, and that local excision was curative. Investigations as to the possible causation of such changes failed to provide any answers. Other hypotheses in relation to the pathogenesis and significance of these changes are put forward.


Major immunoglobulin ratios in carcinoma of the head and neck. Serum immunoglobulin A (IgA), immunoglobulin G (IgG), and immunoglobulin M (IgM) levels were determined on 245 patients with carcinoma of the head and neck and on 92 controls. Ratios of these levels were calculated for each subject. The patients with cancer demonstrated elevated serum IgA levels (P less than .0001) and elevated IgA/IgM and IgA/IgG ratios (P less than .05). No differences were noted when the IgM/IgG ratios were compared between the cancer and the control groups. These observations are offered as evidence that previously reported elevations of serum IgA levels in patients with carcinoma of the head and neck are not merely an index of nonspecific increased immunoglobulin production in these patients.


Lymphocyte morphology in mucoid middle ear effusions. Cytologically, the mucoid middle ear effusions could be divided into a lymphocyte-monocyte type and a type where the granulocytes predominated. By alpha-naphthyl-acetate esterase (ANAE) staining procedure the T lymphocytes were found to make up the majority of lymphocytes in the first type, often accompanied by large numbers of ANAE-positive macrophages. In the second type the relative and particularly the absolute numbers of T cells were smaller. The T lymphocytes in aural effusions, distributed in agreement with their normal distribution in blood, could be the basis of possible delayed hypersensitivity immune mechanisms in the middle ear, but definite proof, either demonstrating receptor molecules directed to antigens or a specific response by T cells, is still lacking.


Human tympanic membrane--malleus attachment. Preliminary study. The relationship between the malleus handle and the tympanic membrane in humans has been studied with primary attention being directed to the fibrous layer of the tympanic membrane and its method of attachment to the malleus. This attachment is most intimate at the level of the umbo and becomes progressively more tenuous as the short process is approached. The long process of the malleus, comprised of a bony core, has a definite sleeve of cartilage surrounding its entire length. This cartilage is surrounded by a perichondrial layer which has previously been termed a periosteum. In the lower third, the fibrous lamina propria appears to split equally and the fibers then blend imperceptively with those of the perichondrial layer surrounding the manubrium. At high levels, the attachment is less intimate, most of the fibers appearing to pass lateral to the malleus handle. The embryologic development of the tympanic membrane-malleus junction has been considered and the anatomical features of this area have been considered in relation to functional requirements.


Reconstruction of the external ear using multiple burow's triangles. Basal cell carcinoma of the auricle presents a challenge in both excision and reconstruction to the clinician. The folloing case report discusses and illustrates the use of controlled excision with assessment of margins and reconstruction using chondrocutaneous advancement flaps and multiple Burow's triangles.


[Endocrine interrelationships of the thymus (author's transl)]. We have studied the interrelation between the thymus and the hypophyso-adrenal and hypophyso-testicular axes in male rats. In the first part of our work, we have essayed the plasma levels of testosterone, LH, corticosterone and ACTH in neonatally thymectomized or thymectomized and hypophysectomized animals. The results obtained allow us to conclude that there is an indirect action (via hypophysis) of the thymus on the testes and a direct action on the adrenals by the intermediary of one active extract. In the second part of our study we measured hormonal activity of the thymus in hypophysectomized or adrenalectomized or orchidectomized rats. The results obtained show that there is no effect of the testes on the thymus secretion; on the other hand the thymus is under the control of hypophysis and adrenals.


Investigation of exposure to nickel and lung cancer mortality: case control study at aircraft engine factory. A case-control mortality study was performed at an aircraft engine factory to assess the possible association between exposure to nickel-containing compounds and death from lung cancer. Forty-two non-salaried male workers who died of lung cancer from 1966 to 1976 were identified from a chronological registry of death certificates that has been maintained by the company's medical department. Each of the decedents was matched with the next two non-salaried decedents in the registry who were of the same sex and comparable age (+/- 10 years), and who died of causes other than cancer. Without knowledge of the workmen's identities or causes of death, one of the authors classified the deceased workmen as exposed or non-exposed to nickel compounds during their employment. The proportion of workmen who died of lung cancer and were exposed to nickel (11/42) was found to be equal to the proportion of workmen who died of non-cancerous causes and were exposed to nickel (22/84). This study indicates that workers in an aircraft engine factory who were chronically exposed to low atmospheric concentrations of presumably weakly carcinogenic nickel compounds did not have any apparent increase in the relative risk of mortality from lung cancer prior to treatment.


Urine nickel concentrations in nickel-exposed workers. Electrothermal atomic absorption spectrometry was employed for analyses of nickel concentrations in urine samples from nickel-exposed workers in 10 occupational groups and from non-exposed workers in two control groups. Mean concentrations of nickel in urine were greatest in workers who were exposed to inhalation of aerosols of soluble nickel salts (e.g., workers in nickel plating operations and in an electrolytic nickel refinery). Less marked increases in urine nickel concentrations were found in groups of metal sprayers, nickel battery workers, bench mechanics and are welders. No significant increases in mean concentrations of nickel were found in urine samples from workers who performed grinding, buffing and polishing of nickel-containing alloys or workers in a coal gasification plant who employed Raney nickel as a hydrogenation catalyst. Measurements of nickel concentrations in urine are more sensitive and practical than measurements of serum nickel concentrations for evaluation of nickel exposures in industrial workers.


[Study of thyroxine synthesis in non-toxic goiters using dispersed thyroid cells (author's transl)]. The ability of thyroid tissue from non-toxic goiter to synthesis thyroid hormones was investigated by measuring 131 I-iodide incorporation in T4 in dispersed thyroid cell system. Dispersed thyroid cells were prepared by trypsinization from 5 pathological and 2 Normal thyroid specimens. The patients with non-toxic goiter were euthyroid or in mild hypothyroidism. The capacity of T4 synthesis was decreased in 4 cases and increased in 1 as compared to that of normal thyroid tissue. In one case, the impairement of T4 synthesis seemed to be related to the presence of thyralbumin as the major thyroid iodoprotein. In the 3 other cases with a decreased T4 synthesis, a good correlation was found between the capacity of T4 synthesis in dispersed thyroid cells and the thyroid activity in vivo (6 hr - 132 I-uptake). The discrepancy between in vivo and in vitro data in the case showing an increased T4 synthesis could be explained by the difference in the iodide supply in vitro (5 X 10(-8) M) and in vivo (urinary iodide : 2 microgram/24 hr). Thyroid cell preparations may serve as an experimental model to confirm or invalidate the hypothesis of a defect of thyroid hormone synthesis in non-toxic goiters.


The seial thrombin time in the diagnosis of consumptive coagulopathy. Acute consumptive coagulopathy may be initiated by diverse events. It is frequently necessary to establish the diagnosis with urgency. Rational therapy can only be approached with knowledge of the relative impact the primary consumption exerts upon hemostasis as well as the effects of secondary fibrinolysis. A constellation of interlocking tests within the capability of the small laboratory is presented. This includes the prothrombin time, the activated partial thromboplastin time, the serial thrombin time, the heat precipitation fibrinogen level, the platelet count, red cell morphology, the levels of fibrin (fibrinogen) degradation products and selected factor assays. This series can be completed within 45 minutes. Interpretation, with particular emphasis upon the stage in the natural history of the process when evaluation is instituted, and underlying diseases which modify typical patterns are discussed. The discriminant function of the serial thrombin time is stressed.


[Interaction of TSH with human plasma membranes from normals and diseased thyroid glands (author's transl)]. Binding of TSH to plasma membranes purified from normal human thyroid gland is specific, saturable and dependent upon temperature, time, pH and salt concentration (standard assay conditions: 27 degrees C, 30 min, pH 7.8, 20 mM Tris). Displacement curve of 125I-TSH by unlabelled TSH shows a curvilinear relationship between B/F and B which can be interpreted by the presence of two sites with apparent binding constants about 5 nM and 500 nM and capacities of about 3 and 30 pmol/mg membrane protein, respectively. Systematic study of binding characteristics of membranes from 6 normal glands, 7 euthyroid multinodular goitres, 14 Graves' goitres and 2 toxic nodules do not show difference in the dissociation constants and capacities of sites between normal and diseased thyroid and between nodular and perinodular tissue in toxic nodules.


Protein binding of drugs.

Protein binding of drugs. Basic considerations involved in the interaction of drugs with proteins are reviewed. The important role of the concentration of unbound drug in determining therapeutic and toxicologic effects is emphasized. Ultra-filtration is suggested to be the method of choice for the determination of concentrations of unbound drug in plasma in clinical practice.


[Interference of T4 in different serum T3 radioimmunologic determination kits]. The cross reactivity of T3 antibodies for T4 was studied with five T3 RIA kits. T4 used was provided from T4 RIA Kits (Abbot Beckman, Corning). The results are shown on the table indicating the concentration of T3 or T4 required to displace 50% of the T3 125 from anti T3. The cross reactivity for T4 of T3 antibodies from Lepetit and Phadebas was the same and was smaller than cross reactivity with the other laboratories. In clinical practice serum T4 levels of hypo and euthyroid subjects are not so high to false T3 determination. In hyperthyroid subjects the diagnosis cannot be influenced by this cross reactivity. However, the study of the kinetic and monodeiodination of T4 into T3 may be wrong when T4/T3 ratio increases.


Standardization of serum protein analyses. A brief historical review is presented of the development of bovine serum albumin as a standard for the determination of serum total protein. Bovine serum albumin is now available as a standard reference material from the National Bureau of Standards. Also reviewed is the present status of the immunoglobulin standards.


[In vitro synthesis of 3,5,3'-triiodothyronine catalyzed by thyroid peroxidase (author's transl)]. 3,5,3'-triiodotyronine formation was studied in vitro after iodination of goiter thyroglobulin catalyzed by purified thyroid peroxidase. A fractionnal number of T3 is always obtained per mole of thyroglobulin in both in vitro and in vivo. This result cannot be explained by a heterogeneity in thyroglobulin iodination or in a partial conversion of T3 to T4. It is suggested that thyroglobulin is heterogenous either in its primary sequence or in its teritiary configuration. Thyroglobulin contains tyrosine residues which are specific for the T3 formation and moreover T3 is not the precursor of T4. The efficiency of T3 formation was studied: the maximal number of T3 molecules is obtained with 30 iodine atoms per mole of thyroglobulin. In addition the results suggest that the tyrosines which are coupled with a high efficiency are iodinated sequentially.


[Fetal and neonatal triiodothyronine (author's transl)]. Thyroid hormones of amniotic fluids give informations about their presence in the fetus. T3 and T4, determined by radioimmunoassay, are found as soon as 12 weeks of gestation. Their amounts are higher at 17 weeks than at 30-40 weeks of gestation. Thyroid tissues of premature and full term neonates were analysed by chromatography after hydrolysis and 127I determined. T3 amount was very low near birth and increased with duration of survival. These results may be related to hormonal serum changes observed in the early neonatal period.


[The low serum triiodothyronine syndrome in nonthyroid diseases. Distribution of plasma TSH concentrations]. T3 serum concentrations (RIA) was low in 25 cases and normal low in 10 among 57 patients with serious systemic illnesses. These 35 patients were in clinical euthyroid state and had a normal T4 serum concentration and F.T.I. T.S.H. serum concentration was normal in 28 cases of 31 low T3 syndrome observed.