[Postoperative changes of blood gases after uncomplicated abdominal surgery in geriatric patients (author's transl)]. In 34 elderly male and female patients undergoing upper abdominal surgery under general anaesthesia we investigated duration and degree of postoperative hypoxaemia. In this study only patients with no signs and symptoms of pulmonary or cardiac diseases, verified by normal lung function--vital capacity and FEV1, X-ray and electrocardiographic findings were considered. Postoperative development was free of complications and temperature rises in all cases. The investigations showed occurrence of arterial hypoxaemia during the postoperative period with values near the lower limit where the organism must fall back on cardio-circulatory reserve mechanisms in order to avoid general hypoxydosis. Regarding the restricted pulmonary and cardiac capacity for adaptation and compensation in geriatric patients, we recommend to prolong the practice of O2-application for two or three hours over a period of 24 to 48 hours, especially in patients with postoperative complications such as prolonged gastric atony, temperature, haemorrhage or cardiac and coronary insufficiency. This prolonged application of oxygen by mask or nasal tube should go parallel to other physiotherapeutic measures.


[Changes in pulmonary blood flow during surgery in the lateral position; a computer-scanning study (author's transl)]. The changes in blood flow in the pulmonary circulation arising from the lateral position during surgery were tested by means of 99mTc microspheres and a scanning camera computer system in 30 patients who had urological operations. Blood flow in the undermost lung increased by an average of 17% of the total pulmonary blood flow (SD = 8.0) in a group of 18 persons whose average age was 39.9 years. This redistribution occurred immediately after the patient was placed on his side and was more marked in younger persons than it was in older ones. Accompanying changes in O2 pressure showed no quantitative correlation with the changes in perfusion. The lateral position also affected ventilation by reducing ventilation of the undermost lung. This ventilatory disturbance which was demonstrable in more than 50% of the cases persisted for a short time after the operation whereas the pulmonary circulation returned to normal immediately after the patient resumed a normal position.


[Physical fundamentals of pressure measurement (author's transl)]. The important role of pressure-measurement for many diagnostic, surgical, critical care and biomedical research problems should not be underestimated. For high accurancy the good knowledge of the underlying physical and mathematical principles seems to be necessary. On the other hand many users need some quick and easy methods for units of pressure measurements testing and calibration of their pressure-measurements system. In this survey a small introduction to the units is followed by basic considerations about fluid-mechanics. Fourier-analysis and theory of transmission. (The influence of terms like "natural frequency", "damping" and "phase lag" are shown). After the description of the commonly used pressure-transducers some hints are given to check the systems even in small laboratories.


[Caval catheterization via the internal jugular vein (author's transl)]. Catheterization of the superior vena cava via the internal jugular vein with the indirect technique is practically always successful. The occurence of a pneumothorax is extremely rare. The special advantages of the indirect technique are: small puncture trauma, quick placement of the catheter in the superior vena cava and non-occurrence of false position. Heart irritations or even heart perforations are avoided because of standard catheter length respectively graduated catheters.


[Epidemiological and socio-medical problems assoicated with respiratory disorders in Switzerland (author's transl)]. Disorders of the respiratory tract account for about 13 percent of overall mortality in Switzerland, for about 50 percent of all hospital admissions and for about 7 percent of the nursing days. Cases of obstructive respiratory disease, pneumonia and carcinoma of the lung predominate. Morbidity regarding newly discovered cases of tuberculos is still 0.5 percent and 40 percent of the population are still positive reactors. BCG vaccination of newborns and of all tuberculin-negative schoolchildren is the approved prophylactic procedure. Periodic mass radiography of adults on a voluntary basis, aimed at the early diagnosis of pulmonary disorders, shows an incidence of 0.4/1 000 and of 0.3/1 000 for new cases of tuberculosis and lung cancer respectively. Cases of chronic obstructive respiratory disease who require hospitalization for above-average length and are frequently on sick leave present special sociomedical problems.


[Pharmacokinetics of rifampicin in gastrectomized persons (author's transl)]. A laboratory method was developed whereby the presence of Rifampicin in the blood is determined microbiologically by means of a diffusion test. The organism used was Sarcina lutea. The tests established that the Rifampicin levels in the blood of pylorogastrectomized persons were significantly higher then they were in a normal control group. The daily changes in the Rifampicin levels were simulated and checked by analogue computer. The findings indicated that the increased absorption in gastrectomized persons cannot be due to accelerated passage and that it is presumably attributable to chemical and physical factors. The results are analysed statistically and summarized in graphs.


[Aetiology and treatment of spontaneous pneumothorax (author's transl)]. During the past 24 years 571 cases of spontaneous pneumothorax were observed in 408 persons. The aetiology of spontaneous pneumothorax is reviewed. Diagnostic thoracoscopy followed by suction drainage is recommended. Bilateral tension pneumothorax and recurrent pneumothorax were treated by surgery. The preferential method was local or partial parietal pleurectomy. In some cases the pneumothorax was sealed by a dura graft. There was no substantial functional impairment and no post-thoracotomy death. The average lenght of treatment was 20 days.


Effects of alcohol on kindled seizure thresholds in rats. Seizures were kindled in the amygdala and ventral hippocampus of rats until a stage 5 (clonic convulsion) was elicited. Stage 5 thresholds were than determined. Animals were then injected with either saline, or a 600 mg/kg, or 1600 mg/kg dose of 25% ethanol. The effect of each of these injections on seizure thresholds was assessed. The 1600 mg/kg dose caused a significant elevation in both AD and motor seizure thresholds, relative to the 600 mg/kg dose and saline, which did not differ. The elevation of seizure thresholds was significantly greater for animals with seizures kindled in the ventral hippocampus.


Parameters of the dorsal bundle extinction effect: previous extinction experience. Lesion to the dorsal noradrenergic bundle using the selective neurotoxin 6-hydroxydopamine which depleted telencephalic noradrenaline to less than 5% of control values was found to cause prolonged responding in extinction of a continuously reinforced (CRF) operant lever pressing response (a further replication of the dorsal bundle extinction effect). The parameters involved in causing this effect). The parameters involved in causing this effect were investigated, particularly the role of previous extinction experience. Although resistance to extinction was seen the first time animals were placed in extinction, it disappeared when they were retrained on CRF and extinguished a second time. Experience of extinction as part of the acquisition process, brought about by training on a successive visual discrimination, also prevented the development of over-responding in subsequent extinction. These results are discussed in the context of related demonstrations of the absence of the dorsal bundle extinction effect after partially reinforced acquistion training.


Stress-produced analgesia and morphine-produced analgesia: lack of cross-tolerance. Animals exposed to cold-water swims, rotation, inescapable shocks, abrupt food deprivation and other stressors display temporary analgesia. Since repeated exposures result in adaptation of this analgesia in much the same way that repeated administration of opiates results in tolerance, the possibility of cross-tolerance between cold-water stress-induced and morphine-induced analgesia was investigated. Flinch-jump thresholds were determined in ten experimental groups of six rats each. Three groups showed dose-dependent analgesia following single injections of morphine at 5, 10 and 15 mg/kg, respectively. A fourth group, subjected to a single cold-water swim at 2 degrees C for 3.5 min, displayed analgesia comparable to that produced by 10 mg/kg of morphine. Groups subjected either to 14 daily cold-water swims or to 14 daily morphine injections at 10 mg/kg showed normal thresholds on the 14th day indicating that adaptation and tolerance had developed, respectively. The cross-over groups were exposed to either 13 days of could-water swims followed by morphine or the reverse arrangement. Both groups showed profound analgesia instead of cross-tolerance, suggesting that a non-opiate neural mechanism may mediate stress-induced analgesia.


Dose-dependent reductions by naloxone of analgesia induced by cold-water stress. Animals exposed to cold-water swims, rotation, or inexcapable shocks, display analgesia comparable to that of 10 mg/kg of morphine. The present study investigated whether a narcotic antagonist would eliminate analgesia induced by cold-water swims. In one group of 12 rats, naloxone at 0, 1, 5, 10 and 20 mg/kg was administered at weekly intervals immediately preceding forced cold-water swims (2 degrees C for 3.5 min) and alterations in flinch-jump thresholds were determined 30 min thereafter. In a second group of six rats, the effects of the same dose range of naloxone were determined upon normal flinch-jump thresholds. Naloxone dose-dependently attenuated the cold-water swim-induced analgesia up to a maximal reduction of 50% at 20 mg/kg. In contrast, all doses of naloxone had no effects upon normal flinch-jump thresholds. Since low doses of naloxone completely abolish morphine-induced analgesia, the present data suggest that the analgesia induced by stress is not identical to that of opiates.


Differential effects of ketamine on schedule-controlled responding and motility. Male Sprague-Dawley reats were trained to bar press for food reinforcement on an FI-300 sec schedule. Ketamine (7.5 mg/kg, IP) significantly increased response rates of both drug-naive and drug-experienced rats for the first 10 min after injection. With a 15.0 mg/kg dose of ketamine, response rates decreased significantly during the first 10 min after injection, irrespective of prior drug experience, but increased significantly above control thereafter in drug-experienced animals. Both doses of ketamine enhanced spontaneous locomotor activity significantly, irrespective of prior drug experience. Differences in the time course and dose dependency of these effects suggest that ketamine stimulates schedule-controlled responding and spontaneous locomotor activity via different neuropharmacologic mechanisms.


Effects of atropine on conditioned taste aversion. Atropine sulfate, which has a deleterious effect on various learning tasks, was found to have a similar effect on the acquisition of conditioned taste aversion. Thus, intraperitoneal injection of atropine sulfate shortly before tasting was found to interfere with conditioning of the aversion, but injection of atropine after tasting did not. The interference effect was also obtained with intraventricular administration of atropine sulfate, but not with intraperitoneal injection of the peripherally-acting atropine methylnitrate. These results show that central rather than peripheral mechanisms are involved in this effect, and suggest that conditioned taste aversion, like other kinds of learning, involves cholinergic mediation.


Bimodal distributions of highest ethanol acceptance concentrations in two strains of rats. Two groups of non-deprived male Wistar rats and one group of male Sprague-Dawley rats were offered a choice of water and daily-increasing concentrations of ethanol. Each group's distribution of highest ethanol acceptance concentrations approximated a bimodal distribution with respect to concentration. Further, rats in each group which drank ethanol at high concentrations maintained relatively constant intakes of pure ethanol. These results are discussed in terms of taste and olfaction, central nervous system sensitivity and emotionality.


Effects of cimetidine on stress ulcer and gastric acid secretion in the rat. Cimetidine at 25, 50, and 100 mg/kg significantly inhibited gastric acid secretion in rats with chronic gastric cannulas. Rats receiving either 50 or 100 mg/kg of cimetidine secreted significantly less gastric acid 3 hr after injection. Cimetidine failed to reduce the number or size of gastric lesions in rats exposed to the activity-stress procedure, but cimetidine at 100 mg/kg significantly reduced the number and size of gastric lesions in rats subjected to a supine restraint procedure.


Differential effects of convulsants on visually evoked responses in the albino rat. Visually evoked responses (VERs) were recorded from primary visual cortex in unanesthetized albino rats during pharmacological modulation by one of the following convulsant agents: Physostigmine, picrotoxin, strychnine and Metrazol. The data were analyzed in terms of effects on VER components. The rat VER consists of six distinct waves constituted by three positive peaks (P1--P3) and three negative peaks (N1--N3). Results indicate a differential convulsant action on VER components. The administration of picrotoxin, resulted in a suppression of the peak amplitude of P1--N1 and delayed peak latencies of all components. Strychnine reliably shortened P1, N1 and P2 peak latencies, significantly increased N3 peak latency and only suppressed P3--N3 amplitude. Physostigmine essentially suppressed all component amplitudes but only increased peak latencies for P2 and P3 components. Metrazol, in general, was found to be relatively ineffective in the alteration of any VER component in a systematic manner. The data are discussed in terms of differential modes of convulsant action on the visual system. The results are likewise discussed with respect to their implications for convulsant modulation of photically evoked after-discharges.


levo-Alpha-acetylmethadol and metabolites: some effects on schedule-controlled behavior in the rat. The behavioral effects of acute IP administration of 1-alpha-acetylmethadol, its metabolites, 1-alpha-noracetylmethadol and 1-alpha-dinoracetylmethadol, and morphine were studied in the rat using behavior controlled by a fixed-interval schedule of food reinforcement. Administraiton of all compounds produced a dose-related decrease in response rate. The metabolites were approximately three to four times the potency of the parent compound which was approximately five times the potency of morphine. Data obtained from cumulative response records suggested that the onset of effects for the metabolites was more rapid than for the parent compound.


Schedule induction and sweetness as factors in ethanol consumption and preference by rats. The separate and joint effects of spaced feeding of small portions of the daily food ration (schedule induction) and sweetening of one or the other fluid by 0.2% sodium saccharin on the consumption and selection of water and a 5% ethanol solution were examined in three groups of four male, hooded rats. Fluids were available simultaneously throughout 50-min sessions during which 50 Noyes 45-mg pellets were available either altogether at the beginning of each session or singly at 60-sec intervals. Water was available in home cages. Each group experienced a different sequence of procedures that provided alternation and replication of critical conditions. Sweetening increased consumption of the sweetened fluid and suppressed consumption of the unsweetened fluid. Spaced feeding raised consumption of the preferred fluid. Exceptionally high levels of consumption were recorded when one or the other fluid was sweetened and food presentation was intermittent.


Lead-produced changes in the relative rate of open field activity of laboratory rats. Four groups of rats, continuously exposed to one of two lead acetate solutions, ad lib water or a limited amount of water, were tested for three daily 5 min periods on the open field. The effects of treatment on activity, relative to animals drinking ad lib water, depended upon the concentration of the lead acetate solution. Animals exposed to a 10(-4) M lead acetate solution showed increased overall activity while animals exposed to a 10(-2) M lead acetate solution showed changes in the relative rate of activity. Activity was not affected by limiting the amount of water consumed. These findings illustrate the importance of recording activity in a manner which allows assessment of changes in activity as well as absolute level.


Angiotensin-induced drinking: sexual differences. The dipsogenic effect of Angiotensin-II (A-II) in relation to sexual variables was studied. It was found that Angiotensin-II administered SC constitutes a stimulus which induces more drinking in females than in males. Moreover, the adult females show maximum sensitivity to A-II during proestrus. The males and females castrated at birth, and females androgenized at birth, drink similar volumes of water after A-II SC injection. The pattern of stimulated intake is different in the two sexes, and appears to depend upon the development of the rats.


Cocaine-induced conditioned taste aversions in rats. In two separate studies cocaine hydrochloride at doses between 10--36 mg/kg was found to induce a dose-related conditioned taste aversion (C.T.A.) to saccharin, and to be an effective conditioning agent even when injections of the drug were delayed 90 min after saccharin intake. These data contrast with conditioning agent when unjectuons of the drug were delayed 90 min after saccharin intake. These data contrast with an earlier report [3] which suggested that cocaine was totally devoid of aversive properties. However, they do indicate that cocaine is only a weak aversion-inducing agent. In contrast to other drugs, the doses of cocaine which are required to induce a C.T.A. are very large relative to those commonly employed in behavioural studies. The weak potency of cocaine in inducing C.T.A. may be related to the drug's marked potency in the self-administration paradigm. Some possible determinants of cocaine's weak effects are discussed.


Tetrahydrocannabinol and acetylcholinesterase. Recent evidence suggests that the psychoactive effect of delta-9-tetrahydrocannabinol (delta9-THC), the major psychoactive constituent of marihuana, may be mediated through an alteration of cholinergic neurotransmission. One possible mechanism by which delta9-THC could have its effect is by affecting acetylcholinesterase (AChE) and there is evidence that has suggested that this may be an important mechanism. The results reported in the present study have shown that there is no physiologically important interaction between AChE and delta9-THC or its metabolites that could explain its psychoactive effects or the profound clinical depression observed when human marihuana users are administered the cholinesterase inhibitor physostigmine.


Blockade of both pilocarpine and amphetamine-induced head-shaking with dopamine receptor antagonists. The range of central dopaminergic mechanisms involved in both d-amphetamine- and pilocarpine-induced head-shaking was studied in 7--9 days old rats by means of two DA antagonists: pimozide and spiroperidol. Both blocking agents exert their effects on H--S following dose-response curves which are similar, whatever the drug used to evoke head-shaking. A complete blocking effect on H--S is reached with pimozide at a dose of 2 mg kg-1; with spiroperidol at 0.1 mg kg-1 (for pilocarpine-induced H--S) and at 0.2 mg kg-1 (for H--S evoked by d-amphetamine). These results, together with those previously reported, suggest that dopaminergic and cholinergic facilitatory influences on H--S seem to be organized in series.


Anti-endotoxin actions of methylprednisolone in the isolated perfused cat liver. The efficacy of the synthetic glucocorticoid, methylprednisolone, was examined in vitro using an isolated cat liver perfused with a blood-free medium. Addition of endotoxin (75 microgram/g tissue) to the perfusate did not change perfusion pressure or total oxygen consumption. However, cellular integrity was severely compromised as reflected by increases in perfusate lactate dehydrogenase and cathepsin D activities, increases in tissue lysosomal fragility, and enlargement and vacuolization of lysosomes. Addition of methylprednisolone (1 x 10(-3) M) to the perfusion medium prevented the endotoxin-induced changes in hepatocyte integrity. It is suggested that a major action of endotoxin in the liver is to increase lysosomal fragility, and the protective action of methylprednisolone appears to be related to its lysosomal stabilizing action. The potent anti-endotoxin action of glucocorticoids in vivo may be due in part to the stabilization of lysosomal membranes in tissues such as the liver.


Benzo(a)pyrene metabolism and plasma elimination rates of phenacetin, acetanilide and theophylline in man. The plasma elimination rates of phenacetin, acetanilide and theophylline have been determined in 32 healthy subjects in an effort to find drugs resembling in their metabolism the carcinogen benzo(a)pyrene. The plasma half-lives and metabolic clearance rates of the three drugs were correlated with the inducibilities of aryl hydrocarbon hydroxylase (AHH) in mitogen-stimulated lymphocytes and the plasma half-lives and metabolic clearance rates of antipyrine determined in previous studies. Statistically significant correlations were found between the half-lives and metabolic clearance rates of phenacetin, acetanilide and theophylline and the AHH ratios except for the metabolic clearance rates of phenacetin which did not correlate. The correlations of the three drugs with the half-lives and metabolic clearance rates of antipyrine were equally good. Of all the drugs tested thus far for similarity in metabolism to benzo(a)pyrene, antipyrine showed the best association followed closely by theophylline.


Effects of chronic methadone treatment on maternal body weight and food and water consumption in rats. Body weight gain and food and water consumption of female rats receiving daily methadone injections (5 mg/kg) intraperitoneally prior to mating and during gestation and lactation were studied. In contrast to saline-injected mothers, methadone-treated females had lower body weights throughout pregnancy, but gained weight during lactation; by postnatal day 21, both groups were of comparable body weight. No significant differences in food consumption throughout gestation or lactation were recorded. Total water consumption of methadone-treated rats was higher during the first 2 weeks of gestation and lactation, and lower during the 3rd week of lactation when compared to controls. These results demonstrate that methadone-treated rats have lower body weights throughout gestation and lactation, and that these weight deficits are not caused by insufficient food and water consumption.


Cardiac rehabilitation. An overview.

Cardiac rehabilitation. An overview. The paper is intended to acquaint physical therapists with the theory and practice of cardiac rehabilitation, which is often prescribed for patients who have coronary heart disease, and the therapists' responsibilities in this effort. The related exercise physiology literature is reviewed, and physiological, psychological, physical, and prognostic advantages of cardiac rehabilitation are described. Cardiac rehabilitation is presented in three phases: acute care, outpatient, and further conditioning programs. The protocols for exercise testing and programs of progressive activity are discussed, with emphasis upon the role of physical therapists. Data collected at Tufts New England Medical Center demonstrating the measurable effects of cardiovascular training for patients with coronary heart disease ar presented.


Stretch reflex of the biceps and brachioradialis muscles in patients with upper motor neuron syndrome. The position of elbow flexion commonly observed in patients with upper motor neuron lesions is attributed by many clinicians to hyperactive stretch reflexes. The purpose of this study was to examine the passive stretch reflexes of the biceps and brachioradialis muscles in order to assess their possible relative contributions to the flexion posture. Twenty-one patients with upper motor neuron lesions were tested, using an automated system to produce controlled passive movement strech reflexes. Ratios derived from the electromyographic activity elicited during passive movement were used for quantitative comparisons. The stretch reflex response of the brachioradialis muscle was larger and earlier than the biceps response. A surprising finding was reciprocal activity in these two synergists following phasic stretch.


Sensory dysfunction in children who toe walk. In order to formulate a hypothesis regarding the etiology of toe walking, the sensory processing abilities of 17 mentally retarded children who toe walk were examined. A galvanic skin response was used to compare reactions of the mentally retarded children and a group of normal children to a variety of sensory stimuli. Galvanic skin response testing did not reveal significant differences between the two groups in processing sensory input. Scores of the mentally retarded children from a postrotary nystagmus test were compared to values for normal children of the same age, and the results indicated that vestibular dysfunction was present in all of the subjects. We hypothesize that children may toe walk to increase somatosensory input to the lateral vestibular nucleus (Deiter's) and the  lateral vestibulospinal tract to facilitate support tone in the lower extremities during walking.


Chest physical therapy procedures in open heart surgery. Chest physical therapy is now widely used after open heart surgery to prevent secondary pathology in the lungs and to improve the phhysical condition of the patient. A brief overview of cardiac surgery is presented. Factors occurring before, during, and after surgery that contribute to postoperative respiratory insufficiency are outlined, and a comprehensive three-phase treatment program is described. Also, treatment guidelines, precautions, and contraindications are discussed.


Prevention of electrical shock hazards in physical therapy. Basic electrical safety information for the physical therapist is presented, and the most hazardous areas in a physical therapy clinic are identified. Physical therapy modalities are no safer than the power receptacle (wall outlet) into which they are plugged. High frequency physical therapy equipment should never be operated without a three-prong polarized plug and a matching polarized wall receptacle. Three-to-two prong adapters must never be used. Hydrotherapy is an especially dangerous area and should be equipped with ground fault detector receptacles with ground fault interrupters that cut the current when the electrical ground is lost. Ultrasound leakage current measurements on many older ultrasound units may now exceed today's acceptable standards. An external isolation transformer may be required to modify older ultrasonic units before they meet present standards. Physical therapists must never assume that rountine electrical safety inspections are being conducted by hospital maintenance personnel. The physical therapist is responsible for ensuring that all hazardous areas are rountinely checked for electrical safety.


[Blood flow in the venous system].

[Blood flow in the venous system]. Return circulation is studied by describing observed flow solutions: --The direction of the flow is orthograde from the periphery to the right heart, but there ar some inversions. --This permanent flow allows numerous transitory interruptions. --This is a modulated flow, becoming oscillatory in the central veins, and therefore "non-stationary". --Its condition is not exactly laminar. Finally, the venous circulation could be called a "slow-speed system".


[Thermal test of reactive hyperemia: a propos of an objective study of pyridinol carbamate]. The thermal test of reactive hyperhemia (TTHR) gives a global and reliable appreciation of the cutaneous microcirculation, the importance of which is well known. In this study, sixty-one subjects were treated for from one month to one year with pyridinol-carbamate. The TTHR was modified in seventy-nine per cent of the cases, showing a considerable and lasting improvement. The clinical symptoms followed a comparable evolution.


[Cardiac causes of acute ischemia of lower limbs]. Acute ischemias of the legs of cardiac origin are almost always due to leg embolus caused by fragmentation of an endoauricular or left venticular thrombosis. The two main causes are easily recognized: mitral narrowing and ventricular aneurysm are seldom accompanied by seeding, because a prophylactic treatment with anti-vitamin K is started as soon as the diagnosis is made. Use of prosthetic valves, despite constant improvement in their manufacture and systematic administration of anticoagulant drugs, are always complicated by embolisms (4 to 7% of cases at present). On the other hand, two causes of leg embolisms should be carefully sought since they give rise to revealing seedings. Non-obstructive cardiomyopathy gives a picture of primitive cardiac insufficiency developing progressively. Paroxysmal supraventricular rhythm disorders may be completely overlooked, and only an electrocardiogram continued during 24 hours allows their detection. Embolisms which do not involve the legs, are secondary. Seeding of a chalky fragment from a stenotic aortic valve is very rare. On the other hand, embolisms of anauricular fragment of myxoma and especially membranous embolisms during infectious endocarditis, are not so rare.


[Vascular emergencies in acute disease of the leg]. The author essentially studies the urgent surgical nature of embolism and thrombosis. As far as embolism is concerned, he insists on the importance of arteriography. When done during surgery, it makes it possible to determine the existence of unrecognized embolic clots, which would prevent a good distal reflux from being noted. As for thrombosis, the arterial system (common, superficial and deep) is considered as a whole. This system can be made visible only through arteriography, but it must also be explored by techniques which disclose the hemodynamic conditions of the distal sector.


[Considerations on the role of the so-called non-invasive investigations: Doppler effect, rheography and labeled fibrinogen testi in acute arterial and venous leg]. The author outlines the first results obtained with Doppler investigation in arterial and venous emergencies. He analyzed thereafter the Kakkar test, through which he can detect acute venous more easily than with Doppler. He insists on the difficulty of detecting through either one of these methods, some cases of thrombosis located in the abdominal veins.


[Acute ischemic ulcer].

[Acute ischemic ulcer]. Acute ischemic ulcers are real superficial skin infarcts due to capillary thrombosis. The remainder of the limb has a satisfactory blood supply and healing may be obtained, whatever the eetent of the ulcers, by methods aimed at correcting the general disorders in question and by local treatments in preparation for skin grafts. The prognosis of these ulcers is not as bad as that of chronic arteritis ulcers, which are caused by an important hypovascularization of the limb.


[Irreversible acute muscular ischemia].

[Irreversible acute muscular ischemia]. Between ischemias healing without sequelae and those requiring amputation, a place whould be reserved for the irreversible muscular ischemias of leg muscles, where the limb can still be preserved by excision of more or less large segments of muscles. These muscular necroses are mainly observed in the ischemias seen during the late stages, but sometimes also at an early stage following massive obstruction of poorly supplied or distal arteries. Treatment of these arterial obstructions with irreversible muscle ischemias is more complex than that of cases seen at an early stage and follows precise rules. It includes in particular muscular excisions most often in the anterior and external parts of the leg, which cause moderate functional sequelae. These excisions limit the risk of the septic or biological complications of revascularization in ischemias seen at a late stage.


[Restless legs syndrome].

[Restless legs syndrome]. The restless legs syndrome is restlessness of the extremities, particularly the legs. It occurs mainly during the hours before going to sleep or during the sleep and it frequently causes a refractory insomnia. The patients feel a typical, almost indefinable, particuliar crawling sensation reminiscent of the movement of worms. The intensity of this feeling may vary from time to time. From literature and our experience we concluded that this syndrome is not a disease of itself but an early symptom of an intoxication or auto-intoxication process.


[My experience with iodine].

[My experience with iodine]. Sclerosing therapy requires a perfect knowledge of the advantages and disadvantages of the various sclerosing substances, the best, for many people, being the one with which they have the most experience. The author, however, prefers to use an iodo-iodized solution because of its efficiency. It is painless when injected only within the lumen of the vein. Weak dilutions can be prepared with saline solutions, from 0.05 to 4 per cent, and can be used for large vessels as well as for varicosities. It is reliable and acts gradually without painful inflammation of the vein when the dose is correct. It has few disadvantages : over 25 years of use, no immediate shock was observed and secondary-type intolerance was rare and benign. The was one single counter-indication, namely hyperthyroidism.


[Acute primary lymphedema?].

[Acute primary lymphedema?]. The author studied the acute outset of edema in 6 out of 327 cases of chronic lymphedema and insists on the diagnostic relevance of such manifestations in cases of acute swelling of the legs.


[Contribution of cryotherapy to phlebology]. Taking into account the results obtained by cryotherapy in proctology, the author has tried to apply this method in conjunction with microsclerosis in the treatment of telangiectasia. The results seem very encouraging on the whole, and could be considered an interesting contribution to the treatment of this obstinate and unattractive condition.


[Aetoxisclerol: lst impressions].

[Aetoxisclerol: lst impressions]. Polydocanol is a sclerosing product recently introduced in France. It is less efficient in treating large or medium-sized varicose veins than iodine or trombovar. Because it is pleasant to use, it is mostly advised in the treatment of varicosities and telangiectasias. Like the other sclerosing products that have been used to date, polydocanol can induce allergic reactions in some individuals.


[Sclerotherapy of saphenous varicose veins: some technical points]. This article concerns sclerotherapy techniques. It deals with varicosity of the large or samll saphenous veins and their treatment using sclerosing injections in cases where, for various reasons, the decision not to undertake surgery is made. The following points are successively considered: --management of the treatment: from top to bottom, that is, from the proximal to the distal segment of the varicose vein; --the dose of the sclerosing drug utilized and the relation between the amount and the concentration of the injected doses; --the position of the patient and various movements aimed at injecting the solution in a patient when he is lying down, even if the needle is introduced when he is standing up; --the spasm-inducing capacity of certain sclerosing drugs and the possible utilization of provoked veinoconstriction during treatment for better contact between sclerosing drugs and endothelium; --finally, retention with straps: they are put in place immediately after treatment, maintained from 8 to 15 days without interruption, have little or no elasticity and are non-detachable.


[Experience with sclerosis of the perforating veins]. The problem of sclerosis of the perforating veins, a subject of heated debate, seems now unanimously accepted. Indeed, their suppression is considered as important as sclerosis of the arches in preventing early and complete relapses. Their investigation can be clinical (examination of staged tourniquet), phlebographic or instrumental (thermography or Doppler). Their treatment can be either surgical (excellent in long reflux, perforating veins that are large in size and few in number) or medical (sclerotherapy). The latter present many variations with either direct injections in the perforating veins, telesclerosis above or below the perforating veins, telesclerosis on open veins after thrombectomy or extirpation with a Bassi hook. But whatever the technique used we cannot neglect the suppresion of short reflux which is a condition of the quality and duration of the results obtained.


[Technic of sclerosing: faithfulness to principles: some variations in the management]. Sclerosis of the stem of the vessel is the essential goal of the sclerosing method. To achieve it, the sclerosing fluid should be in contact with all the endovenous surface. Sclerosis due to the extension of a provoked veinitis does not last very long. Contact with the sclerosing fluid is obtained: 1) Through a single injection in the stem, the motion of the fluid being directed with the impulsions created by the raising or lowering of the limb, depending on the site of the injection. 2) Fragmentation of the total dose in several injections over the total length of the stem of the vessel.


[Current data on salicylates].

[Current data on salicylates]. The best-known among the sclerosing products, sodium salicylate, should still be the most commonly used. It gives a large and reliable sclerosis with a flexible posology and a large margin of safety. The injection cramp may be relieved by adding to the concentrated product 60% of an equal amount of 2% Xylocaine. Practically speaking, the weakness of the sclerosing capacity necessitates, for large arches, the use of more powerful drugs. Salicylate, however, can completely sclerose 2 internal saphenous veins out of 10, and 3 external saphenous veins out of 10. After reduction of the long reflux, salicylate seems today to be the best product to use in all varicose vein cases.


Early skeletal release in the infant with craniofacial dysostosis: the role of the sphenozygomatic suture. We describe our experience with early skeletal release in 10 infants with craniofacial dysostosis. The cranial base is the key to the deformity, and we extend the release toward it as well as resecting strips from the calvarium. Three procedures are described. The early results are encouraging.


The tailor-tack mastopexy.

The tailor-tack mastopexy. A simple method of dermal mastopexy is described which eliminates the need for patterns or complex preoperative measurements. The breast is shaped with the patient in the semi-sitting position after she is under anesthesia (local or general). The surgeon then has the chance to view the finished product before the cutting surgery beings. This method helps to eliminate errors in the nipple-areolar placement, and will be particularly helpful to the surgeon whose experience in mastopexy is limited.


Radical operation to stop axillary odor and hyperhidrosis. We have developed a subcutaneous tissue shaver for the radical treatment of hircismus and hyperhidrosis. With this shaver the sweat glands can be removed from the undersurface of the axillary skin through a small incision. We report 3,000 cases of hircismus and hyperhidrosis treated by our method. The postoperative scar has been minimal, healing has been quick, and good results were achieved by this method.


Surgical depilation for treatment of pseudofolliculitis or local hirsutism of the face. By cutting away their roots, unwanted terminal hairs can be removed when they are in their active phase (anagen) by a method called surgical (subcutaneous) depilation. There can be recurrences when hirsutism is being treated in females, because of vellus hairs which have their roots in the dermis. The residual vellus hairs can be eradicated by electrical depilation, however. Recurrences in males (pseudofolliculitis) are usually due to terminal hairs in a resting place (telogen); these "club hairs" can also be removed by electrical depilation.


Pyoderma gangrenosum: recognition and management. Pyoderma gangrenosum, a progressive necrotizing and ulcerative disease of the skin, presents serious problems in diagnosis and management to physicians not familar with the entity. The clinical basis of the diagnosis is outlined, and the possible etiological mechanisms are reviewed. Treatment is primarily nonsurgical, relying on oral administration of corticosteroids and conservative local care of the ulcers.


A new method of documenting hand cases.

A new method of documenting hand cases. A photocopier can be used as a helpful adjunct in the precise documentation of the condition of the hand. It is cheap and easy to use, and it provides a permanent and accurate record.


Cartilage regeneration from perichondrium. Experimental studies and clinical applications. Animal experiments with flaps and free grafts of perichondrium have produced new cartilage. The presence of blood seems to promote the formation of new cartilage in such instances. These perichondrial grafts have been used to produce better contours of the auricular cartilage in congenital deformities, and to reconstruct missing parts of the human ear. They are also being used clinically in joint surgery in cases of traumatic arthrosis and rheumatic arthritis to obtain painless motion.


Treatment of uncontrolled drooling by bilateral excision of submaxillary glands and parotid duct ligations. Fourteen patients with uncontrolled drooling were treated with bilateral excision of the submaxillary glands and either transfer or ligation of the parotid ducts. In this small series, all had good results but the duct ligation group was slightly better.


Early non-surgical closure of postoperative palatal fistulae. Ten of 11 patients who developed oronasal fistulae subsequent to palatoplasty and/or pharyngeal flap operation obtained complete physiological closure of the fistula by using a vinyl palatal appliance for a two to three month period. All these fistulae were diagnosed within 10 days to two weeks after the surgery, and the appliance therapy was started immediately. We believe this treatment to be an effective, uncomplicated method for non-surgical closure of recent postoperative oronasal fistulae.


Use of a T-tube in management of a pharyngeal fistula after laryngectomy. Pharyngocutaneous fistula is a frequent complication after total laryngectomy, and may cause the patient to remain hospitalized for long periods of time while efforts are made to close the defect. We describe a case in which a gallbladder T-tube was used to hasten closure of a recalcitrant fistula, and we have since used this often as an adjunct to the customary methods of management of this complication.


Pacinian neuroma, an unusual cause of finger pain. Two cases of painful lesions of the fingers are presented. Both proved to be Pacinian neuromata, and they are the sixth and seventh such cases reported in the literature. This lesion is rare, but it should be considered in the differential diagnosis of painful lesions of the hand.


A safe anesthetic for rabbits, using methoxyflurane. Methoxyflurane was given by inhalation as the sole anesthetic agent to 42 New Zealand white rabbits, with no mortality. The depth of respiration as well as the changes in the color of the ears were monitored constantly. A technique for administering methoxyflurane without intubation is described.


Correction of a long face. Case report.

Correction of a long face. Case report. We describe a case in which maxillary alveolar hyperplasia (the long face syndrome) was corrected by excising a 12 mm band of bone through the maxilla, "down-fracturing" it, and telescoping it up into a new position.


[Training in mutual communication of married couples addicted to alcohol (author's transl)]. The article reports on the planning and realization of a two-weeks' therapeutic recreation programme involving addicts and their partners. Twelve couples participated, of whom 10 men and 4 women were addicts (alcohol and drugs) who had just completed a successful four-months' withdrawal treatment course on an inpatient basis. The aim was to change partnership interaction patterns via systematic training of communication rules according to a sort of "model" design. Tape playback and group feedback techniques were used. The result of this communication training was greater mutual frankness of the partners. The positive results of this type of married-couple therapy encouraged the authors to institutionalize concomitant communication therapy in collaboration with the couples themselves during inpatient withdrawal treatment.


[Rehabilitation training with chronic mental patients (author's transl)]. In a half-way house a behaviorally oriented rehabilitation training with chronic schicophrenics, hospitalized more than 12 years averagely, was conducted and evaluated. With interviews it was systematically investigated with what kind of difficult situations a patient is confronted at discharge and which behavioral competencies are therefore especially needed. Behavior therapy with the main components of instruction, behavior rehearsal and social reinforcement changed the behavior of the patients significantly. A general plan for diagnosis and training of competencies is developed that can be applied to structure the training of the staff in educational-therapeutic behavior as well as the training of the patients themselves.


[Theory and practice of finding a therapeutic vacancy for addicts--demonstrated in the case of a female patient habituated to heroin (author's transl)]. This article tries to describe the problems, difficulties and setbacks experienced by patients, doctors, psychologists or social workers when looking for a public health insurance body competent to bear the cost, as well as for a vacancy in a suitable hospital or institution where appropriate therapy can be effected. The case history of a female heroin addict was chosen as a model example to show that the simultaneous activities by a variety of offices or bodies is rarely crowned with succes. The author surveys several other cases where similar protacted mechanisms of decision to be arrive at by bodies who might be requested to bear the cost interfered with the therapy in patients addicted to alcohol and/or drugs. A suggestion is presented aiming at arriving at a decision in minimum time and according to a compact pattern.


The advent of guilt feelings as a common depressive symptom: a historical comparison on two continents. Historical shifts in the symptomatology of mental disease are surprisingly overlooked but common phenomena that should cast considerable light on the relation between social and intrapsychic processes. The enormous increase in chronicity and mortality in mental hospitals during the second half of the 19th century, and the shift from the shell-shock of the first World War to the battle fatigue of the second are examples which have been well documented but not well explained. The advent of guilt feelings in depression or melancholia is a lesser known instance but one with perhaps greater theoretical significance. Melancholia has been known almost throughout recorded history, but until the 16th century the number of recorded cases exhibiting exaggerated guilt feelings and self-accusations was very small, and the old physicians did not include them in their descriptions of the condition. In Asia and in Africa, moreover, it is claimed that these symptoms are rare even today, except among the Westernized. If we fully understood the other features of the disease or if the symptoms had no relevance to course and treatment, these facts might be treated simply as curiosities; but neither is the case. Depression is still not adequately understood, and some theories on it derive largely from the exaggerated guilt feelings and the psychic structure which is supposed to produce the latter. Hence it could be instructive to examine under what conditions these symptoms first became common in different societies.


Psychodynamics, homosexuality, and the question of pathology. A persistent polarity has existed among theories concerning the origins and the nature of preferred homosexuality. One major group of theories, including most psychoanalytic approaches, stresses early developmental contributions and tends to view homosexuality as psychopathological--a deviation from healthy and fully mature living. The other major group of theories assumes homosexuality not to be psychopathological and views homosexuality as either a spontaneous expression of a natural, polymorphous sexuality, or as one possible outcome, among many equally healthy and rewarding outcomes, of social conditioning. Common to both groups of theories is the shared assumption that psychodynamic contributions and etiology imply pathology--a psychodynamic dimension is either accepted and pathology is assumed, or pathology is denied and any possible psychodynamic contribution is debunked. The notion that psychodynamic causes and contributions imply pathology is, as I will show, a historical artifiact deriving from Freud's original libidinal fixation theory of neurosis. Such an assumption is not only no longer necessary, but also is inconsistent with a more contemporary psychondynamic understanding of human experience and several important psychoanalytic principles. I will explore the manner in which this assumption has been responsible for polarization and miscommunication among various contributions in psychoanalytic, sociological and political literature on the nature of homosexuality--including the presumption of pathology that is built into the very language and choice of metaphors employed in psychoanalytic discussions of homosexuality. I will also suggest an alternative conceptual approach.


The manipulative patient: an interactional approach. The words manipulative or manipulation are used in the contemporary psychiatric literature to describe certain persons and their habitual modes of behavior. The terms represent an attempt to describe some essential quality of the patient's style of relating to others. In the following discussion, we will attempt to shift this perspective to a more interpersonal one, seeing the attribution of this label as part of a sequence of communication, mutual perception, and struggle between caretaker and patient. The accusation that a patient is manipulative signals the disruption of the helping process.


Alcoholism and systems theory: building a better mousetrap. A considerable body of research evidence has accumulated in the alcoholism field with respect to when persons who overly rely on alcohol modify their behavior and seek alternate ways of dealing with life. It is the purpose of this paper to identify a number of these factors and relate them to a theoretical perspective that, while not new, is of relatively recent vintage for alcoholism specialists. That perspective is General Behavior Systems Theory (GBST), and it will be contended that its basic postulates comprise a framework that is especially congruent with the findings related to when alcohol-dependent persons change. As such, it provides a set of ideas which offer more fruitful guidelines for assessment and intervention than those resulting from exclusive reliance on other extant models (see Siegler et al., 1968; Miller and Barlow, 1973), in particular, the traditional and predominant illness conception.


Thoughts on computerized psychotherapy.

Thoughts on computerized psychotherapy. This essay looks at the eventuality of computerized psychotherapy and attempts a philosophical analysis of the value, limitations, and efficacy of such hypothetical computerized psychotherapy devices (CPDs). The essential thesis is that while computers may be 'intellectually' capable of performing certain skills that have up until now been associated wholly with the human mind, still other, affective responses, such as empathy, sympathy and compathy, are not within the CPD's ken. Thus, in cases where such affective potential is believed to be a therapeutic necessity, the possibility of the CPD as an effective therapeutic agent may be undesirable.


Anorexia nervosa: reflections on theory and practice. Psychodynamic theory provides a critical element in the conceptual framework necessary for a therapist's understanding of the abnormal behavior exhibited by patients with anorexia nervosa. A model of the syndrome is presented here which the author has found useful in the ongoing treatment of patients. The paper has arisen out of a desire to clarify thinking and practice in the course of treating patients manifesting the classic syndrome identified in those whose symptoms are not secondary to physical disease or psychosis.


A study of former mental patients who returned to visit the ward on which they were hospitalized. We have observed that former psychiatric inpatients often return to visit the ward after they have been discharged. Nothing has been written about this phenomenon, but it seemed to us that since not all discharged patients return to visit, a difference must exist between those who do visit and those who do not. The following report presents the results of our investigation into the distinguishing characteristics of the visiting ex-patients. Reider (1953) and Safirstein (1967, 1970) have described the phenomenon of institutional transference, which deals with patients' attachment to the institution rather than to an individual therapist. However, our data show that the phenomenon of former patients visiting goes beyond that, in some instances reflecting meaningful relationships with staff members and other patients, but in other instances indicating continuing treatment needs of various kinds.


The interactional process in preadolescent friendships. The study of friendship in children has long been a neglected area of human development. As Hartup (1975) pointed out, there is a paucity of data both with respect to the nature of the interactional process between friends and the language children use in conceptualizing friendship. The purpose of the present investigation was to examine the interactional process in preadolescent friendships within the framework of Harry Stack Sullivan's social development theory.


Defense mechanisms and coping behavior in terminal illness. An overview. Psychosomatic medicine is increasingly concerned with illness behavior, a concept which includes defense mechanisms and coping styles. An attempt was made to compare defensive processes and social adaptation in a group of 31 patients suffering from a probable terminal illness of iatrogenic origin. The surprising degree of conformity between the defense profiles towards the illness and those towards general life stress was found. Reaction-formation and stoicism were the defense mechanisms most often associated with successful defense. Interdependence of several ego measures such as defense against general life stress, defense against illness and social adaptation could be shown in various evaluations. Surprisingly, however, aggravators of illness turned out to be psychologically more stable than minimizers, a result which is in contrast to behavior in nonterminal illness. Theoretical implications of the results are discussed.


Testing cooperation in parents with children destined for home dialysis. Ten married couples with children in the dialysis department of the University's Children Hospital of Heidelberg are examined by means of different tests (Joint Rorschach, Simfam, Giessen Test, Bales scale, Expert rating) and compared with a group of ten psychologically 'extraordinary' as well as ten psychologically 'ordinary' couples. The problem was to find out whether the emotional family atmosphere is stable enough to provide the child with home dialysis or whether the parents need psychotherapeutic preparation.


Pathological primary identifications and their effects on the psychosomatic economy of the individual. The paper deals with the problem of the unstable psychosomatic economy and the patient's consequent susceptibility to psychosomatic disturbances. This goes back to a primary psychobiological defect in the sphere of his earliest identifications, which comes to the surface in emotional crisis situations. The term "Psychosomatic Phenomenon' is used to describe this basic disturbance in the patient's relationships, which can be observed in his interactions with the psychotherapist or interviewer, where it takes the form of a noticeable lack of fantasy, poor relationships and a reduced capacity for psychic experience and elaboration. The author's object-psychological approach has grown out of years of experience in the analytical treatment of hospitalized psychosomatic patients. A 'toxic environment' can be seen to have been a disturbing influence on the early development of the infant. A child whose mother herself knows no autonomy cannot develop its own fantasies through autoerotic activity and thus cannot build up a libidinal object in its inner world. The result is that such an individual is incapable of meeting the inevitable somatic disorganizations with differentiated reorganization processes and so has no defense against physical illness.


Sending the patient home.

Sending the patient home. Some patients become grossly disorganized during a hospital stay for medical illness. In the midst of a confusing medical picture, the unpredictable behavior of such patients causes great consternation among the medical or surgical staff. Families also become particularly anxious; their concern about the medical problem shifts to concern about the altered mental state. Physicians and family members frequently agree that such patients should continue their hospital stay past the point where medical attention per se is needed in order to regain control over the disturbed mental functioning. This paper presents an alternative therapeutic approach, suggesting that sending the patient home to a more familiar environment may result in improved psychological functioning. A model for viewing the interaction between 'constancies' in the brain/mind environment (particulary the hospital milieu) is presented. This model takes into account the facts of the internal regulatory mechanisms of the brain, the facts of illness and lack of the more familiar orienting cues in the environment.


Discussion groups for medical patients. A vehicle for improved coping. Describing 14 professionally run discussion groups for multiple sclerosis patients, this paper delineates appropriate functions and goals of the medical discussion group. Such groups address coping activities related to affiliation with a social reference group, information seeking and, in a more limited way, consolidation of intrapsychic resources. The discussion describes the dynamic issues which arise in the groups and explores ways in which group dynamics interact with the medical format.


Event-related slow brain potentials, cognitive processes, and alexithymia. A psychophysiological approach to alexithymia involves the search for reliable neural correlates of cognitive and symbolic processes rendering meaningful indicators that can be entered as elements into the diagnostic process, framed within a theory, and tested against the clinical experience. Relevant work on event-related slow brain potentials is reviewed, and some recent data bearing on a psychophysiological differentiation between psychosomatic and psychoneurotic patients are presented and discussed within the framework of a modified concept of activation. In outlining certain research strategies and goals it is contended that they may provide an experimental data base complementing and expanding psychodynamically derived formulations.


Self-control, biofeedback, and change in 'psychosomatic' approach. The new psychosomatic treatment modalities of biofeedback and relaxation techniques have in common an emphasis on self-control or self-regulation. The surging popularity of the self-control techniques at present may reflect a change in the self-image of medicine, which emphasizes its role as a collaborator of the patient in his self-control of disease processes. The modern concept of psychosomatic medicine emphasizes a systems or field approach to evaluation and treatment rather than 'psychogenic' causes of physical illness. The self-control treatment modalities form an important part of the armamentaria of a modern 'psychosomaticist'. We present preliminary data suggesting that 'potentiation' of biofeedback treatment may be useful. In borderline hypertensives, using pharmacologic means to reduce blood pressure during a biofeedback session may help subjects identify and re-create the 'low blood pressure states' without further aid of drugs. Hypertensives seeking biofeedback treatment are extremely internal in locus of control and tend to generalize their self-control to other areas of life to foster health and to prevent illness.


The significance of certain dreams reported by psychosomatic patients. Several types of dreams reported by psychosomatic patients with alexithymic characteristics are presented. Two special features of the dreams are noted: (1) the dreams contain events which are very traumatic and (2) the protagonists of the dreams failed to fully perceive their own feelings. It is postulated that the failure of the protagonists to fully perceive their own feelings played an important role in fostering the development of the traumatic events. Feelings such as anxiety and sadness are key signals which incite the ego of the dreamer to set protective operations into motion. The diminution of awareness of these feelings may, therefore, delay the implementation of protective operations to a point which allows the traumatic events to progress dangerously far. It is interesting to note that the few psychosomatic patients without alexithymic characteristics who were included in my series reported a type of dream which was identical to one of the types of dreams reported by patients with alexithymic characteristics. This concurrence suggests the possibility that the dreams form a link between the psychologies of these two sub-groups of psychosomatic patients.


The myofascial pain dysfunction: dental symptoms and psychological and muscular function. An overview. A preliminary study by team approach. Patients with myofascial pain dysfunction (MPD) are traditionally seen by dentists. No organic lesions are found, and there is accumulating evidence that psychological factors influence both the onset and the development of the disorder, thus calling for a multiprofessional investigation approach. This report presents a preliminary study by a team consisting of a psychiatrist, a dentist and a physiotherapist. 25 patients with MPD diagnosis were examined. Almost all of the patients had tense muscles in neck and back, indicating that muscular tension is not a local phenomenon in the masticatory muscles. It was possible to distinguish two main categories of MPD patients, the 'typical MPD patients' and the 'multiproblem patients'. Problems that need further investigation are pointed out.


Induced abortion and psychotherapy.

Induced abortion and psychotherapy. The modern women's emancipation movement, concerned with the right of women for self-determination in the question of abortion, embraces the assumption, borne out by most recent epidemiological studies, that abortion does not produce psychological damage in most women. However, an induced abortion is a stressing experience and may for some few susceptible women, even be a traumatic one. The psychotherapist who is overly influenced by statistics and the socio-political climate and/or his own insufficiently resolved inner conflicts, may unconsciously ignore or minimize the importance of an abortion experience for a specific patient in his care. As the case illustrations show, the focusing and through elaboration of this experience may determine the final successful outcome of treatment, especially in brief psychotherapies.


Correlation of fluoroscopically detected coronary artery calcification with exercise stress testing in asymptomatic men. Cardiac fluoroscopy followed by a submaximal exercise electrocardiogram was used to evaluate 129 healthy men (average age 49 p 6) for assessment of possible latent ischemic heart disease in an asymptomatic population. Of 108 subjects who completed the exercise protocol, 37 (34%) had at least one fluoroscopically detected calcified coronary artery. Of the 16 subjects with a positive exercise stress test, 13 (81%) had calcification of at least one coronary artery, Thirteen of 37 (35%) with calcification had a positive exercise test. Those with calcification of at least one coronary artery had a ninefold increased risk of a positive exercise stress test (p less than 0.0001). The location of a calcific deposit conferred greater risk of exercise-induced ischemic changes than did multivessel involvement. Forty-seven per cent of men with calcification in the left anterior descending coronary artery had an abnormal exercise electrocardiogram vs. 33% and 16% of persons with left circumflex and right coronary artery calcifications, respectively.


Giant air cells of the petrous apex: tomographic features. Sixteen hundred consecutive tomographic examinations of the temporal bones were reviewed and 15 patients with petrous apical air cells larger than 1.5 cm diameter were encountered. Familiarity with the normal tracts of pneumatization, and precise localization of atypical air cells by tomography are helpful in differentiating deformity of the internal auditory canals due to asymmetric pneumatization from the change caused by acoustic neurilemmomas. Characteristic radiographic and CT features differentiate petrous apical air cells from other destructive lesions in the region.


Ventilation patterns mimicking COPD in patients with diaphragmatic pacing for Ondine's curse. Ventilation was studied with 133Xe in 18 patients with central hypoventilation (Ondine's Curse) in whom diaphragmatic pacers were implanted. Three distinct patterns emerged: Type I, improvement in ventilation on the paced side (11 of 18 patients); Type II, improvement on both the paced and unpaced side (4 of 18); and Type III, no improvement (3 of 18). With the pacer off, many of these patients have patterns that mimic chronic obstructive pulmonary disease and that revert to normal with pacing. This retention, clearly reversible, cannot reflect permanent airways or airspace disease.


Gallium-67 uptake in silent myocardial infarction: a case report. Scintigrams obtained 24 and 48 hours after the injection of 67Ga in a patient undergoing evaluation for fever of unknown origin revealed positive myocardial uptake. The subsequent clinical course, electrocardiograms, radionuclear studies, and postmortem examination confirmed a silent myocardial infarction in the region of 67Ga localization. No other clinical reports were found of an acute myocardial infarction diagnosed by scintigraphy with 67Ga.


The diagnosis of pneumothorax by ventilation-perfusion imaging. Two patients with pneumothorax had ventilation-perfusion studies to rule out the possibility of pulmonary embolism; the presence of air in the pleural space was not known to the authors when the study was analyzed. A typical ventilatory pattern characterized by small volume difference at total lung capacity followed by disproportionately greater decrease of the volume of the affected lung at tidal breathing was observed. In one case, the routine chest radiograph failed to demonstrate air in the pleural space. A similar volume difference between the two lungs was noted on the perfusion images.


Renovascular hypertension in children and adolescents. Renovascular disease often leads to hypertension in children. The most frequent cause is fibromuscular dysplasia of focal type affecting main and peripheral arteries. Diastolic readings in excess of 110 mm Hg with normal serum creatinine and urinalysis are suggestive of renovascular disease. Excretory urography was positive in 65% of patients with unilateral disease. Radionuclide scans complement a positive excretory urogram but may be positive when the urogram is negative. Plasma renin activity was raised in the majority of patients; if the patient does not have peripheral branch stenosis, the renal vein renin ratio will lateralize in unilateral renal disease. The overall results of surgery are encouraging: 86% of surgical procedures alleviated hypertension in unilateral disease.


The sphenoidal sinuses: radiographic patterns of normal development and abnormal findings in infants and children. Developmental patterns of sphenoidal sinuses were determined from lateral radiographs of 1702 patients from newborn to 15 years of age. Pneumatization of the conchal sinuses was seen as early as 6 months of age; 90% showed sphenoidal sinus pneumatization by 4 years of age; 100% by 10 years of age. Extension of pneumatization into the basisphenoid may be evident after 4 years of age, and 95% showed basisphenoidal pneumatization after age 12. An apparent lack of pneumatization of the sphenoidal sinuses in patients over 10 should stimulate investigation for sphenoidal sinus disease. Although isolated sphenoidal sinus abnormalities were rare, sphenoidal sinus involvement was common (67--75%).


Measurements on hand radiographs from 32 cri-du-chat probands. Various measurements were performed on the hand radiographs of 32 Danish cri-du-chat probands. Mean pattern profiles were made for males, females, children, and adults. Metacarpal index and relative slenderness for metacarpals and proximal phalanges were calculated. The hands were smaller than in normal persons of the same sex and age. In most of the probands, the 3rd, 4th, and 5th metacarpals were disproportionately short, and the 2nd, 3rd, 4th, and 5th proximal phalanges were disproportionately long. Only 1 case had a positive metacarpal sign.


The echographic characteristics of fatty tissues and tumors. Fatty tissues and tumors have been described as characteristically cyst-like on ultrasound examination, with relatively few internal echoes. The authors offer several examples of lipomatous masses and tissues which are markedly echogenic. In vitro studies suggest that this is an inherent property of body fat and is not due to coexistent fibrous tissue or tumor vascularity. The echogenicity of fat has important implications for diagnostic ultrasound: (a) the presence of fat in tissues and masses may be demonstrated by ultrasound, and (b) because the high-level internal echoes blend with the echo pattern of bowel gas and retroperitoneal fat, lipomatous abdominal masses may easily be overlooked.


Lipomatous tumors of the kidney and adrenal: apparent echographic specificity. Several fatty tumors of the kidney and adrenal gland were evaluated by gray scale ultrasound. An extremely dense echogenic pattern was common to all lesions. There were three solitary angiomyolipomata (renal hamartoma), a presumed diffuse hamartomatous involvement of the kidney in a patient with tuberous sclerosis, and one myelolipoma of the adrenal gland. This marked echogenicity is thought to be a feature of fatty tumors and enables relatively specific preoperative diagnosis of these lesions, all of which are benign. With regard to renal angiomyolipoma, this assessment may allow conservative treatment and preservation of functioning renal tissue.


Gray-scale echography of the pancreas. Re-evaluation of normal size. One hundred ultrasonograms of patients without pancreatic disease were reviewed. The head, neck, and body of the pancreas were measured in the longitudinal and transverse/oblique planes. The mean thickness of the pancreatic head was 2.01 +/- 0.39 cm (standard deviation) in the longitudinal plane and 2.08 +/- 0.40 cm in the transverse/oblique plane. The same respective measurements were 1.18 +/- 0.36 cm and 1.16 +/- 0.29 cm for the body and 1.00 +/- 0.30 cm and 0.95 +/- 0.26 cm for the neck. The anatomy and consistency of the normal and diseased pancreas are discussed.


Use of ultrasonography in planning intracavitary radiotherapy of endometrial carcinoma. A diagnostic ultrasound examination is a simple and reliable method of obtaining anatomical information for intracavitary irradiation of endometrial carcinoma of the uterus. Scanning before treatment to determine uterine size and shape assists in choosing the most appropriate applicator. Scanning after insertion of an afterloading applicator facilitates calculation of radiation doses at critical points within and on the surface of the uterus. Poor applicator position can also be detected. Diagnostic ultrasound examinations should be adopted as a routine procedure in establishing intracavitary irradiation programs for adenocarcinoma of the uterine fundus.


Expectation of aplastic anemia following radiotherapy for malignancy. In Japan after 1969, 11 cases of aplastic anemia following radiotherapy for malignant disease were detected. The population at risk in irradiated patients was estimated at 674, 664 man-years. The expected cases of aplastic anemia in this population were calculated as 10.1. There is no statistically significant difference between the expected and the observed values.


Application of radiographic magnification technique with an ultra-high-speed rare-earth screen/film system to oral cholecystography. 2X magnification employing a 200-mu focal spot and an Alpha 8-XM screen/film system was applied to oral cholecystography and the results compared with those for the conventional contact technique with the Par-RP system. The basic imaging properties of the system, as well as phantom studies, indicated that the image quality obtained with magnification is comparable to or better than that for the conventional technique. In clinical studies on the detection of gallstones, the conventional technique revealed 5 true-positive and 17 true-negative cases and 1 false-positive and 2 false-negative cases, while the magnification technique provided 7 true-positive and 18 true-negative cases but no false cases. With the magnification technique the skin dose was reduced to approximately half that for the conventional contact technique.


Evaluation of mammographic screen-film systems. Four screen-film systems were evaluated for their imaging properties in mammography, Modulation-transfer functions were measured at 40 kVp. Absolute screen-film sensitivities in mR and entrance exposures were measured with tungsten and molybdenum target tubes. Five radiologists viewed radiographs of a phantom containing microgranules of SiC ranging in diameter from 590 to 120 micrometer. The Rarex-B screen--composed of yttrium oxysulfide--performed best, allowing phantom radiographs at 185 mR with image quality sufficient to demonstrate microgranules greater than 330 micrometer in dimension.


Hyperthermia and low dose-rate irradiation. Hyperthermia combined with 60Co gamma irradiation was studied using V79 hamster cells cultured in vitro. Modest hyperthermia (41 degrees C for 6 hrs.) enhanced the cell killing produced by acute exposure to radiation. The same treatment enhanced the effect of low dose-rate irradiation (200 rads/hr.) even more. The sequence in which modest hyperthermia was combined with low dose-rate irradiation was important. Maximal enhancement was observed when hyperthermia was followed by irradiations. The probable explanation is that, by damaging the repair system, prior heat renders the cells unable to repair sublethal damage during subsequent low dose-rate irradiation.


Cytogenetic effects of contrast media and triiodobenzoic acid derivatives in human lymphocytes. Micronuclei counts in blood samples from 9 patients before and after angiocardiography have confirmed previous results suggesting the diatrizoate contrast medium was largely responsible for the observed cytogenetic damage. To discover the agents in the medium causing the cytogenetic damage, we exposed human lymphocyte cultures to diatrizoate and to the monoamino- and diamino-derivatives of triiodobenzoic acid. The results show the amino-derivatives are capable of inhibiting mitosis and inducing micronuclei and chromosome aberrations at lower concentrations than diatrizoate.


Dietary enhancement of intestinal radioresistance during fractionated irradiation. Rats fed laboratory chow or elemental diet 3 were given fractions of 240 rads of 60Co gamma-radiation abdominally (1200 rads/week) until all animals had died. Changes in appetite, body weight, and mortality were monitored as a function of the cumulative dose received. More radiation was needed in the diet-fed group to achieve both 0 and 100% mortality, a difference of 37% at the mean lethal dose level. Both groups developed similar progressive anorexia but the diet-fed animals lost weight more slowly. Data indicate that basic intestinal radio-resistance is enhanced by feeding the elemental diet.


Preoperative diagnosis of potentially precancerous breast lesions by computed tomography breast scanner: preliminary study. Eighteen cases of severe atypical epithelial hyperplasia of the breast were detected preoperatively by computed tomography breast scanner (CT/M) with contrast enhancement. The CT number before enhancement ranged from -17 to +31 and increased to 26 to 42 after enhancement (5.2-8.4% increase in attentuation). These data suggest that CT/M can differentiate these potentially precancerous lesions from benign fibrocystic disease.


Clinical use of transcatheter electrocoagulation. Transcatheter electrocoagulation is an effective method of experimental vessel occlusion even in the presence of thrombocytopenia and heparinization. This technique was used to occlude 13 arteries in 3 patients. In vitro testing suggests that intra-arterial bipolar platinum electrodes may achieve the therapeutic objectives more rapidly and with less risk, but more investigative work is required.


Contrast agents lower ventricular fibrillation threshold. Ventricular fibrillation thresholds were measured in anesthetized, closed-chest dogs during the injection of Renografin 76 or Conray 400 into the left coronary artery. Both agents significantly lowered fibrillation threshold--Renografin to 58 +/- 7%; Conray to 20 +/- 5% of control, respectively. The experimental method estimates fibrillatory potential of contrast media more precisely than previous methods. The initial results parallel relative toxicities observed in clinical usage.


Imaging of canine tumors with 11C-methylputrescine. The polyamines--putrescine, spermidine and spermine--are present in elevated concentrations in rapidly growing cell lines and in several neoplasms. Five dogs with benign or malignant tumors and one normal dog were imaged with a rectilinear scanner following I.V. administration of 2--8 mCi 11C-methylputrescine. High concentrations of 11C-methylputrescine were found in the liver, and in the kidneys and urine in the dogs with good renal function. Concentrations were higher in tumors than in skeletal muscle, blood or lung. The tumor/blood ratio varied from 2--21; tumors were demonstrated by imaging in four dogs in which the ratio exceeded 4.0. 11C-methylputrescine is a possible tumor imaging agent.


Multiple adjuvant therapy on a murine fibrosarcoma: actinomycin-D, X-irradiation and local tumor hyperthermia. The tumoricidal activities of single dose x-irradiation (RAD) and concomitant Actinomycin D (AMD) with or without local tumor hyperthermia (LTH) on an in vivo Methylcholanthreme-induced fibrosarcoma (Meth-A) are described. The addition of LTH enhanced the actions of AMD, RAD and AMD + RAD; the trimodality treatment was most effective. Based on delay of tumor growth, the radiation dose reduction factors for AMD + RAD + LTH compared to RAD; AMD + RAD + LTH, were approximately 2.8, 2.1, and 1.8, respectively. The shape of the curves suggests a further decrease in the ability of the tumor cell to repair sublethal damage with AMD + RAD + LTH. The clinical relevance is not determined.


137Cs afterloading intrauterine packing for stage I and stage II adenocarcinoma of the endometrium. Eleven patients with Stage I or Stage II adenocarcinoma of the endometrium were treated with 137Cs afterloading intrauterine packing. Treatment results and complications were similar to those obtained with radium afterloading tandems and colpostats (20 patients) and Heyman packing (2 patients). 137Cs is preferable in patients with roomy or irregular intrauterine cavities and also offers reduced radiation exposure to personnel.


The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. A gas-density cleft within a transverse separation of the vertebral body, appearing in extension and disappearing in flexion, was observed in 10 cases of vertebral collapse at the thoraco-lumbar junction. The patients were 55 to 83 years old (mean, 68) and 7 of them were on chronic corticosteroid therapy. Such an intravertebral cleft has not been found by the authors in vertebral collapse of tumoral, inflammatory, or traumatic origin and is thought to represent ischemic vertebral fracture. This sign could be helpful in the differential diagnosis of vertebral collapse in elderly patients.


Medical malpractice insurance. Part II. Some proposed solutions. Organized groups of physicians should be considered potential initiators of any concerted effort to solve the medical malpractice problem. This may occur by a number of means, among them (a) establishment of malpractice review panels, (b) a patient's compensation board, (c) no-fault malpractice insurance, (d) substitution of claims-made insurance policies for the present-occurrence system now in use, and (e) malpractice insurance funds supported by insurance premiums and administered by panels composed in part of insured physicians. Cooperation between the insurance industry and the legal and medical professions might make it unnecessary for external agencies to impose regulations and policies at some future date.


Hand changes in primary biliary cirrhosis. The radiographic findings in the hands of 13 patients with primary biliary cirrhosis are described. Erosive arthritis was present in 12 of the 13 cases. Seven patients hand osteopenia due to hepatic osteodystrophy. Intraosseous lytic defects were present in 3 cases. Chondrocalcinosis, a previously unreported finding, was seen in 2 patients, and one exhibited hypertrophic osteoarthropathy. The significance of these radiographic findings is discussed.


Chemical pneumonitis after the intravenous injection of hydrocarbon. A case reported in which a man intravenously injected himself with a hydrocarbon insecticide. The radiographic findings and clinical course were typical for hydrocarbon pneumonia. Symptoms developed almost immediately and radiographic findings cleared within 72 hours. Because the hydrocarbon was introduced intravenously, the role of aspiration in the development of hydrocarbon pneumonitis is obviated.


Radiographic characteristics of male breast cancer. The authors studied 171 male breast tumors (20 cancers and 151 benign lesions) from 1969 to 1977. A proposed symptomatic triad can lead to an early radiological diagnosis of male breast cancer, even without evidence of advanced disease: small mass, well defined contours, and eccentric location in relation to the nipple.


Thickness of the descending aortic wall: an unreliable angiographic sign for dissecting aneurysms. A large fusiform atherosclerotic aneurysm of the aorta with a long, thick, laminated, calcified thrombus mimicked the angiographic appearance of a dissection of the descending aorta with a 20-mm wide thrombosed false channel. Therefore, an increase in the width of the aortic wall exceeding 10 mm may not be a uniformly reliable sign for dissecting aneurysms of the descending aorta.


Experimental internal iliac artery embolization: evaluation of low viscosity silicone rubber, isobutyl 2-cyanoacrylate, and carbon microspheres. The angiographic, morphologic, and histologic effects of carbon microspheres, isobutyl 2-cyanoacrylate (IBC), and low viscosity silicone rubber (LVSR) were compared. Carbon spheres did not effectively occlude the internal iliac artery, but resulted in small vessel occlusions leading to the most frequent complications. IBC was effective in causing occlusion but resulted in significant inflammatory changes within the thrombus and vessel wall. LVSR gave satisfactory occlusion without inciting vessel wass inflammatory reaction. Two of 4 animals developed a hind extremity paralysis. None of these materials is approved for general intravascular usage.


Transhepatic dilatation of choledochoenterostomy strictures. During the last seven years percutaneous transhepatic biliary drainage (THD) was used in 13 patients to relieve obstructive jaundice caused by postsurgical stricture. Nine patients had internal drainage with dilatation, and external drainage alone was feasible or available in 4 patients. Of these 4, 2 had further reconstructive surgery without lasting results, jaundice was not completely relieved in 1 because of biliary cirrhosis, and 1 died in hepatic coma from sclerosing cholangitis. Eight patients treated with internal drainage and dilatation became asymptomatic with normal serum bilirubin values; the ninth patient, with biliary cirrhosis and portal hypertension, improved only moderately.


Computed tomographic brain scanning in patients with lymphoma. A retrospective study of 118 lymphoma patients revealed the computed tomographic brain scan to be sensitive to involvement of the orbit and the brain parenchyma by lymphoma. Brain parenchymal lymphoma was seen only in diffuse histiocytic lymphoma; dural infiltration was less readily detected. Leptomeningeal lymphoma could not be directly demonstrated by the CT scan, even with the use of intravenous contrast medium. Serial CT scans contributed to patient care by differentiating the sometimes confusing nonlymphomatous brain lesions.


Chest film detection of coronary artery calcification. The value of the CAC triangle. Eighty-six adult patients were studied by PA chest film and fluoroscopy for coronary artery calcification (CAC). A triangular area (CAC triangle) along the left mid-heart border of the PA chest film was used in identifying CAC. Of 57 patients, 24 (42%) with CAC observed fluoroscopically had a strongly suspected or positive CAC triangle. The CAC triangle in the PA chest film has proved useful in identifying coronary artery calcification on the plain film.


Computed tomography of intraorbital optic nerve gliomas in children. Optic nerve gliomas were diagnosed with computed tomography (CT) in 10 children. CT: (A) provides the best radiographic means of demonstrating the orbital portion of the optic nerves; (b) can evaluate the clinically unsuspected optic nerve for bilateral gliomas; (c) demonstrates gross intracranial involvement; and (d) can be used to follow the course of a glioma. Gliomas can present on CT as (a) a uniform thickening of the entire nerve; (b) a solitary fusiform enlargement of the nerve; or (c) an irregular solid thickening along the nerve. The authors routinely use axial CT of optic nerves as the primary diagnostic scan.


Direct sagittal computed tomographic scans of the face and paranasal sinuses. Sagittal CT scans regenerated from the axial scan data have utilized multiple thin overlapping cuts to reduce noise level. Even with this technique, computer rearranged scans provide less than optimal delineation of the intracranial and facial structures. The authors obtained direct sagittal scans of the head using a special accessory table adapted for use in wide aperture whole body scanners. These positional or true sagittal scans have spatial and density resolution nearly equal to that achieved in the standard axial plane. The table configuration is described. Normal sagittal CT anatomy of the face is compared to gross anatomical sections, specimen radiographs, and plain film tomograms.


Comparison of computed tomography, ultrasonography, and gallium-67 scanning in the evaluation of suspected abdominal abscess. A retrospective study was made of 29 consecutive patients who were evaluated for suspected abdominal abscess by at least two of three imaging modalities: gallium-67 scanning, ultrasonography, and computed tomography. No statistically significant difference in accuracy of the findings could be demonstrated. Consideration of the advantages and disadvantages of each imaging modality will often indicate which to use in an individual case. Findings from the three imaging techniques sometimes provided complementary rather than identical information.


Progesterone, 20alpha-dihydroprogesterone and PGF; interrelated hormonal changes during pseudo-pregnancy in the rat. Ovarian and uterine tissue concentrations of progesterone, 20alpha-dihydroprogesterone (20alphaOHP) and prostaglandin F (PGF) were measured during hormonally-induced pseudopregnancy, as were plasma levels of progesterone and 20alphaOHP, in hysterectomised and sham-operated rats. Elevated levels of PGF in uterine and ovarian tissues were coincident with declining concentrations of progesterone and increasing concentrations of 20alphaOHP in the sham-operated rats. Maximum PGF concentrations were apparent in uterine tissue 14 days after hCG injection, coincident with the plasma, ovarian and uterine nadir concentrations of progesterone. A small but statistically significant increase in ovarian PGF was apparent at this time in sham-operated rats. This elevation of ovarian PGF was abolished by hysterectomy.


Effect of meclofenamate on renal vascular resistance in early Goldblatt hypertension in conscious and anesthetized dog. Blood pressure and renal blood flow were monitored in conscious normotensive (N) and 2-kidney Goldblatt hypertensive (H) dogs. Plasma renin activity was signficantly increased 4--8 days after partial renal artery occlusion. At this time intravenous administration of meclofenamate, 5 mg/kg, had no effect on blood pressure in the N or H or on renal vascular resistance in the N or in the H (contralateral kidney). The renal vasoconstrictor response to angiotensin II was increased in duration by meclofenamate in both the N and H. In contrast to the absence of an effect of meclofenamate on renal vascular resistance in the conscious dog, the synthesis inhibitor caused a consistent increase in RVR in the N and H when they were anesthetized in the terminal experiment. These results suggest the lack of an influence of prostaglandins on renal vascular resistance in the unaffected kidney in Goldblatt hypertension.


Effects of intracerebroventricular administration of PGE1, E2 and F2alpha on electrically induced convulsions in mice. Intracerebroventricular administration of prostaglandins E1 or E2 was shown to block, while PGF2alpha increased the incidence of tonic convulsion due to electroshock in mice. The Prostaglandins were administered intracerebroventicularly (i.c.v.) to conscious mice by a modification of Haley and McCormick's method (1) prior to a transcorneal maximal electroshock (MES) or a transcorneal supra-maximal electroshock (SMES). PGE1 and PGE2 i.c.v. blocked the tonic hindlimb extension (THE) and protected the animals from death induced by MES with ED50's for PGE1 and PGE2 for inhibition of the THE of 6.6 (4.3--12.0) microgram/mouse i.c.v. and 13.3 (8.9--22.4) microgram/mouse i.c.v. respectively. When PGE2 was administered intraperitoneally (i.p.) in doses as high as 4.0 mg/kg it did not block the THE. However, the duration of the THE as well as the mortality were reduced by doses of 0.5--4.0 mg/kg PGE2 i.p.. Both PGE1 and PGE2 were shown to cause a dose related significant (p less than .001) decrease in the duration of the THE with SMES in doses of 1--10 microgram/mouse i.c.v. for PGE1 and 2--40 microgram/mouse i.c.v. for PGE2. PGF2alpha, administered i.c.v. prior to a transcorneal electroshock equivalent to a current at the ED1 level, increased the incidence of the THE as well as the mortality in doses of 20--50 microgram/mouse.


Prostaglandin D2, another renal prostaglandin? Prostaglandin (PG) D2 was biosynthesized by rabbit renal papillae incubates in vitro. Quantification of the renal prostaglandins by gas chromatography-mass spectroscopy demonstrated that the concentration of PGD2 generated by renal papillae was 1/6 to 1/10 the amount of PGE2 or about 1microgram/g tissue/30 min. Infusion of the sodium salt of PGD2 into the renal artery of the dog produced a dose related increase in renal blood flow and urine flow, free water clearance, sodium excretion and potassium excretion without changes in systemic hemodynamics. At low doses PGD2 increased renal blood flow to all cortical zones. Higher concentrations of PGD2 produced a shift in the intrarenal distribution of blood flow toward the juxtamedullary nephrons.


The effect of indomethacin on the biosynthesis and metabolism of prostaglandin F2alpha in man. Healthy volunteers received 60 microgram of [8,10,10(-2)H3] PGF2alpha by intravenous infusion both before and during a course of treatment with indomethacin (200 mg/day). Excretion of deuterated 5alpha, 7alpha-dihydroxy-11-ketotetranor-prostane-1, 16-dioic acid in urine was quantified by GC-MS using a reverse stable isotope dilution procedure. Indomethacin was found to have no detectable effect on the metabolism of the labelled PGF2alpha whereas output of the endogenous metabolite was markedly reduced by the effect of the drug on prostaglandin biosynthesis.


[Late results (10 years) after complete arterialization of the cirrhotic liver]. The authors present the results obtained after 10 years in two patients with hepatic cirrhosis in whom arterialization was carried out, of the liver, in association with a portocaval, or as an isolated intervention. These 2 cases represent the longest post-operative follow-ups of a group of 29 patients in whom hepatic arterilization was performed. The authors have used an original procedure of arterialization through the re-permeabilized ombilical vein. In the paper are given indications on the method on the basis of the experience acquired between 1965 and 1976.


[Ulcer on the presternal tube after esophagoplasty of the greater curvature of the stomach]. Two cases are discussed, of ulcerations that have developed on the pre-sternal tube following oesophagoplasty according to the D. Gavriliu procedure. In the first case the ulceration determined stenozing of the pre-sternal tube necessitating a by-pass at the lower end of the tube with iso-peristaltic transverse colon. In the second case an external fistula developed at the level of the ulceration. After excision and restoration of the tube continuity by suture two more ulcerative episodes were noted, that benefited from drug treatment and excision of the ulceration.


[Postoperative acute necrotizing enteritis]. The authors present a case of acute necrotizing enteritis, occuring after anexectomy and drainage that had been performed for ruptured pyosalpinx. There was difficulty in the macroscopic assessement of the lesions, and this made necessary resection of over 2 m of ileon. The diagnosis was established by histologic examination. Operatory recovery was obtained, in contrast with unfavourable results mentioned in the literature.


[Surgical anatomy of the vagus nerve].

[Surgical anatomy of the vagus nerve]. In the paper are reviewed the data from the literature and the personal observations of the authors which indicate that the vagus nerve trunks have a mixed fiber structure, different from that indicated by the classical descriptions of the vagus nerves. A series of details are presented, concerning the radius of distribution of vagal emanations in the sub-diaphragmatic territory. Special stress is laid on the innervation of the surgical aspects are mentioned, and of pathological physiology, with theoretical implications, as well of practical importance for troncular vagotomy.


[Traumatic lesions of the stomach].

[Traumatic lesions of the stomach]. In 53 patients with traumatic lesions of the stomach hospitalized between 1967 and 1975 in the Emergency Hospital of Bucharest a death-rate of 17% was noted, determined by the complexity of visceral associated lesions. The etiology was the following: 34 wounds by knife, 3 due to ricocheted bolt and 16 by abdominal contusions. The authors stress the necessity for careful and accurate exploration of the abdominal cavity during surgery and the posterior aspect of the stomach should be visualized through the bursa omentalis. The technique should be individualized for each particular case.


[Role of the articular immobilization position in prevention of post-traumatic rigidity in humans]. The position in which the articulation is immobilized is in fact the pattern in which capsular fibrosis and of the connective tissue is settled. It will also determine the degree of remanent articular mobility. The author does not recommend immobilization in the so-called "functional" position since this does not prevent the developement of articular rigidity and is even responsible for their developement. In view of maintaining the articular function when the articulation itself is involved or when it is immobilized due to lesions in its vicinity, immobilization should be made in a position allowing for maximal elongation of the connective fibers in the area which depends from the vascular and nervous viewpoint from the traumatic lesion, or that which is involved by surgery, that is in positions which are quite different from those used at present.