The diagnosis of diabetes: how to determine which patients to treat. The diagnosis of diabetes depends on identifying a compatible clinical picture with confirmation by demonstrable abnormalities in blood glucose levels. In florid diabetes, classical symptoms of diabetes and high glucose in blood and urine make the diagnosis easy. For asymptomatic diabetes; if confirmed fasting blood glucose measures over 125 mg per 100 ml, the diagnosis is accepted. When the fasting blood glucose measures under 125 mg per 100 ml, I recommend an oral glucose tolerance test and apply suitable criteria for interpretation. The United States Public Health Service criteria represent a reasonable, moderate approach when one modifies the interpretation by cognizance of environmental factors in the patient and by identifying interfering influences as drugs, physical inactivity, fever or starvation. Indeed, one should postpone a glucose tolerance test until these interfering factors abate. Management of the patient with an abnormal glucose tolerance test includes sharing the prognostic dilemma with the patient regarding the likelihood of deterioration in glucose tolerance to florid diabetes. In this situation the term, abnormal glucose tolerance test, is preferred over chemical diabetes. The physician and the patient must develop some degree of comfort with a clinical state that often remains nebulous. Though the writings of authorities occasionally sound dogmatic, rigid, and conflicting, they reflect a viewpoint which opines that no clear answers are available; that the clinician and his patient must accept this posture; and that together they must develop the best therapeutic program for the individual in question.


Pathophysiology of diabetes mellitus.

Pathophysiology of diabetes mellitus. Techniques have been developed for examining the binding of insulin to its target cells and for evaluating the in vivo action of insulin, rekindling interest in the possible role of insulin resistance in adult-onset diabetes. A host of new data have accumulated regarding the contribution of glucagon to the syndrome.


Diabetes and the family.

Diabetes and the family. The reaction of the family to the presence of chronic illness depends on the composition of the family, the presence of significant others, the cultural background, the education of family members, the stage of family development, and finally the health-belief model adopted by the family.


[Results of the therapy of the carcinoma of the breast by partial mastectomy evaluation after over 15 years (author's transl)]. Between 1950 and 1960, 118 partial mastectomies in the treatment of early breast cancer have been carried out in four different techniques with block dissection and radiotherapy. The 5-10-15 year survivals were compared to a similar selection of 217 patients with radical operations. No significant differences could be found between the 5 and 10 years survival rates, but the number of patients living longer than 15 years is much higher following radical operation chiefly in the cases with stage II. It is probably caused by the double frequency of local recidives following partial mastectomy, and after their treatment no patients survived to the 15th year. Partial mastectomy is no routine procedure. It is carried out when the patient refuses radical operation. The partial mastectomy should be the subject of a controlled clinical study.


[Changes of serum-zinc in breast cancer (author's transl)]. Serum-zinc-levels were evaluated in patients with breast cancer in relation to the various stages. Patients with metastatic breast cancer had significantly depressed zinc-levels, wereas patients with disease apparently localized to the breast and draining lymphnodes had nearly normal serumzinc levels. It appears that the determination of serumzinc in breast cancer patients may be of value in discriminating between localized and metastatic disease.


[Emergency colon diagnosis by water-soluble contrast enemas (author's transl)]. When surgery of the colon must be carried out for special indications and emergencies, it is not possible to make diagnosis with Ba SO4 contrast mediums. In these cases, reasonable success can be expected with substitution of three-iodized water-soluble contrast enemas. Through perforations and discharge from the colon they are absorbed into the free peritoneal cavity and enable diagnoses which are nearly comparable in quality to those done with Ba SO4 contrast mediums. In double contrast radiography according to the Malmö technique recognition of surface detail can be considered sufficient. Advantages and disadvantages as well as indications are listed in table form. Examples are documented to complete the chapter on results.


[Aortic aneurysm and horseshoe kidney--case report and collective review (author's transl)]. Based on the own experience and on an intesive study of the literature with a total of 52 patients with an aortic aneurysm and a horseshoe kidney the problems of operative treatment are discussed. The conclusion is made, that the treatment of this rare combination has its special difficulties in nearly 2/3 of all cases, but the same results as conventional surgery of aortic aneurysms, when the renal artery abnormalities are respected and treated with adequate vascular surgical skill.


[Reconstruction of the pharynx and cervical esophagus by deltopectoral flap (author's transl)]. The reconstruction of the pharynx can be done in one or two operations. The deltopectoral flap has proved successful in both cases, as well with the forming of the new pharynx as with the covering of the big throat defect. The methods of operating with own modification, the results in seven cases, and the advantages of the deltopectoral flap are described.


[On the surgery of esophago- tracheal fistulae (author's transl)]. Esophago-tracheal fistulae develop to an increasing extent due to the long-term intubation in intensive-care patients. Their treatment is usually problematic, since the general condition of the patient, weakened by his basic disease, very often does not permit any major intervention; in addition, the topographical location of the fistula makes the access to it even more difficult. In one patient two attempts failed to close the fistula from an extended tracheostomy. The narrow access passage between the anaesthetic tube and the tracheal wall did not permit an exact suture; the heavy formation of scars in the fistular environment did not permit either a preparation in layers or the shift of mucosal flaps for coverage. However, a fistula was successfully closed from a collar mediastinotomy. With normal tracheal width, unrestricted esophagus function was restored without damage to the recurrent laryngeal nerve. The advantages of this surgical method are discussed in greater detail.


[Objective diagnosis of the auriculo-temporal syndrome (author's transl)]. After 263 operations on the parotid fourteen developed the auriculo-temporal syndrome. It occurs more often after extensive procedures with dissection of the facial nerve than after simple extracapsular shelling out. A method of establishing the diagnosis of the syndrome objectively by measuring the electrical resistance is described. The aetiology ist attributed to parasympathetic nerve fibres regenerating in the wrong direction after surgery.


[Investigation of inflammatory paranasal sinus diseases with scintigraphy (author's transl)]. In the course of inflammatory diseases affecting the paranasal sinuses, a number of complications may occur. One of those is the involvement of neighbouring skeletal portions. By this study evidence is given, that there is a high rate of inflammation, spreading to adjoining bone areas. This applis also to early stages and first manifestations. Especially in cases of surgery, complete recovery is rare. The pattern of chronic recurrent osteomyelitis may develop.


[Experimental results and use of the manosonic aerosoliser (U.D.V.) for the treatment of middle-ear and affections (author's transl)]. The Manosonic Aerosoliser (UDV in German) is an Ultrasonic generator delivering a dense aerosol in a closed inhalating circuit in combination with temporary overpressures and sonic vibrations. In order to evaluate the efficiency of this new mode of areosoltherapy the Authors devised a glass model: a small vessel representing a sinus was connected to the aerosol stream by a little tube, a small ball being applicated by its own weight on the aperture to simulate the pathological obstructions (dyspermeabilities). The aerosol was made from a solution of Lithium Choloride and the amount introduced estimated by atomic absorbiton spectrometry. An increase of about 15 fold was found between ordinary and vibrated(sonic) aerosols and 35 fold more between vibrated and U.D.V. A short summary of clinical results is given as a confirmation of the expected efficacity of the U.D.V. treatment.


[Papilloma of the larynx. Immunology (author's transl)]. Electron-microscopic and immunohistological studies show the cross-reactivity of an antigen in verruca plana, condyloma acuminatum and laryngeal papilloma. If this antigen is identical with papova virus or a tumor-performed antigen, cannot be distinguished definately. The fact that sera of patients bearing condylomata acuminata show strong antigen-antibody-reaction with tissue-sections of laryngeal papilloma by means of immunofluorescence microscopy, is discussed in a probably therapeutical point of view.


[Nasal fluid immunoglobulin level in acute sinusitis (author's transl)]. Nasal fluid immunoglobulin concentration in acute sinusitis nasal fluid IgG, IgA and albumin content were estimated in longitudinal profile in acute and chronic sinusitis patients. Transsudation of these proteins becomes stimulated by acute mucosal inflammation. IgA values correlate with clinical findings. The UgA-concentration in chronic and acute sinusitis is very different.


[Diagnosis and therapy of the so-called malignant external otitis (author's transl)]. The malignant external otitis is characterized by the following symptoms: Severe neuralgic pain in the deep ear region is found in the elderly diabe-the cases with a facial palsy due to the infection of the outer ear. In more than 50 percent of the cases with a facial palsy due to the infection the further course was letal (Chandler 1968). A new surgical treatment of the malignant external otitis (Naumann 1977) is presented: After the adequate excision of all infected tissue and cartilage a perforated polyethylen-tube is placed into the infected area along the base of the skull. The combined therapy of a parenteral and local administration of antibiotics helps to improve the bad prognosis of the malignant external otitis.


[Changes caused by earmoulds in shape of the formation of the external auditory meatus (author's transl)]. The lateral part of the external auditory meatus is widened by hearing aids. This was found when comparing angles, diameters and volumes of the  external auditory meatus in two groups of children. One group of 56 children had bilateral hearing aids, the other group of 48 children of the same age had healthy normal ears and did not use hearing aids. The widening process is increased with the length of time that a hearing aid is used.


[Directional hearing and understanding of speech in noise uith "normal hearing" people (author's transl)]. Directional hearing and the ability to understand speech against a noisy background depend among other factors on the binaural signal processing mechanisms in human hearing. In present the practical audiometry can not prove completely the operation of binaural signal processing. This fact will be shown here with three patients who complain of bad understanding speech, but in audiometric tests seem to hear normally. In free field tests of directional hearing and understanding speech against a noisy background they differ clearly from a reference group of normal hearing people.


[Measurements of hearing sensations in ultrasound range by electrical response audiometry (ERA) (author's transl)]. Hearing sensations induced by ultrasound in the frequency range 20-80 kcps are determinable with the Electrical Response Audiometry (ERA). The latency periods of the evoked potentials occured is amounted between 100 and 300 msec. It isn't founded a difference between ultrasound-induced potentials and the potentials evoked by usual tonal stimulies.


[Indication and treatment of frontobasal rhinoliquorrhoea from the ent-surgical and neurosurgical point of view (author's transl)]. This paper deals with some special questions based on joint neuro-rhinosurgical diagnostic and treatment of frontobasal injuries with rhinoliquorrhoea. The indications of the rhinosurgical transfronto-orbital approach with debridement of paranasal sinuses in the same stage are defined. Detailed technical instructions are given for treatment of "midline fractures". The transfrontal intradural approach of the neurosurgeon should be prefered: 1. If there is rhinoliquorrhoea combined with an extensive fracture of anterior skull base. 2. In cases of frontobasal liquor fistual--no matter of localisation and extension--with increasing spaceoccupation should the intracranial decompression be combined with duraplasty. Cerebral lesions with no progressive intracranial pressure should be treated first of all conservatively. The operative treatment of paranasal sinuses is not necessary in every case after transfrontal intradural surgery. X-ray controls have shown the spontaneous healing.


[Computed tomography of cranio-facial injuries (author's transl)]. For the detection of the finest changes in bone structure--like arrosions, porotic alterations, small fracture and fissure lines--computed tomography (CT) is yet surpassed by X-ray tomography: The current resolving power of CT is smaller, our Delta Scanner's layer thickness of 13mm is too large. Nevertheless, the advantages of CT in fronto-basal injuries augment essentially the diagnostic possibilities: with few layers and without great problems in setting projections, most of the possible injuries may be easily surveyed. The traumatized patient ist only minimally discomforted by the whole-body scanner. The lens dose is far less than the values of X-ray tomography reaches. Dislocated fracture fragments, brain traumatisation with and without hemorrhage, defects of the cribriform plate with concimitant brain prolaps, trauma of intraorbital structures, injuries to the nasal cavity and paranasal injuries may easily be detected. These findings influence importantly the surgical intervention and enable one to set up a planning of time and intercollegiate treatment. The postoperative care ist improved and inflammatory complications may be pointed out. In diagnosis of frontobasal injuries we therefore recommand: 1. X-ray survey and eventually X-ray radiograms of the nasal cavity and paranasal sinuses. 2. Computed-tomography (CT). 3. For fine detailed study of bone structures like fissures and smalles fractures X-ray tomography will still remain indispensable.


[The acoustic trauma in animal experiment: I. Morphological reaction in the guinea pig cochlea after traumatisation by shots (a scanning microscopical study) (author's transl)]. Guinea pigs were exposed to shots of a pistol under standardized experimental conditions. The organs of Corti were examined by SEM after surviving times of 5 min, 1, 5 and 10 days. In correlation to the acoustic trauma we found mainly three different ways of morphological reaction of sensory cells. After 1--3 shots alterations and even losts of stereocilia were observed mainly in the 2nd (and 1st) coil from base. Only the rows III and II of outer hair cells (OHC) were concerned while changes in inner hair cells (IHC) were not observed. 5--10 shots regularly caused more severe alterations in the 1st, 2nd (and 3rd) coils of the organ of Corti. The three rows of outer hair cells degenerated within 2--5 days, while inner hair cells did not show any changes of the surface when the pillar cells remained intact. (20) 40 or even 100 shots most often caused a complete damage of all sensory--and supporting cells. The cell detritus was abolished within 5 days. At this time the damaged organ of Corti was replaced by a flat epithelium on the intact basilar membrane.


[Continuous stapedius reflex registration in low and high intensive levels (author's transl)]. To study the whole dynamic range of the stapedius reflex the intensity of the soundstimulus with fixed frequency is continuously changed from 70 to 115 dB. Thus we get results concerning the real reflex eleciting intensity level. the gradient caused by continuous intensity change and a possible limit of contraction. To investigate time resolution phenomenons the stimulating signal is pulsated in a second trial. We used this method of stapedius reflex registration with 48 normal ears and a group of patients with sensorineural hearing loss. The results and the diagnostic possibilities of this method are discussed.


[Experimentally produced cholesteatoma (author's transl)]. Application of various mildly irritant substances to the posterosuperior and anteroinferior aspects of the external auditory canal of the rabbit, with intact ear drum and middle ear, produced cholesteatomas in the skin of the auditory canal, and the tympanic membrane particularly in the pars flaccida. At the anteroinferior insertion of the tympanic membrane, however, cholesteatoma growth could not be induced in these animal experiments. In severe diffuse otitis externa, secondary to the operative closure of the external auditory canal, cholesteatomas also preferably develop in the pars flaccida, the relatively thick, loose intermediate layer of connective tissue allows a rapid expansion of epithelial ridges thus favouring the formation of cholesteatoma in this region.


[New methods in the objective audiometry for the proof of simulation and for the determination of the differential thresholds for frequency and intensity (author's transl)]. The "late acoustically evoked potentials" (50 to 300 msec) can be recorded in different stages of vigilance and awareness; therefore their significance as a correlate of conscious central perception is doubtful. The "very late DC-potentials" (300 msec and more) reflect conscious central perception because of their cognitively determinated features and can be used for the proof of simulation. Their application in ERA comprises the determination of the hearing threshold, the "objective speech audiometry" and the determination of the differential thresholds. The "objective frequency decrement test" gives additional informations about the degree and the specifity of a hearing loss. The objective proof of the differential threshold for intensity demonstrates the insufficient significance of the SISI test.


[Impedance measurements and otosclerosis (author's transl)]. Impedance measurements (model Madsen ZO 72) were performed on 158 patients with otosclerosis and compared with the operative findings. It was found that otosclerosis shows in 95% of the cases a symmetrical tympanogram, type A. Its amplitude does not differ from the standard values: that means that otosclerosis does not correlate with a flattened amplitude of the tympanogram. In addition there is no correlation between the intraoperative finding and the ampitude. The stapedius reflex could not be elicitated by acoustic stimuli.


[Hearing loss due to mumps (author's transl)]. Several years post epidemic parotitis 765 children were examined to check possible hearing impairment. High peak was the year 1970 with predominant cases of parotitis with meningo-encephalitis in November/December. Boys (70.98%) were preferable attacked by the disease (age 5--7 years). Audiometric investigations were carried out in 359 cases (epidemic 1970) and 101 children (during 1975-1977), who had continuous control of hearing ability during hospital stay. 23 (4.9%) of the children showed impaired hearing (full deafness or high-tone hearing loss). No definite correlation to severity of parotitis, signs of meningo-encephalitis, location of infected glandula or length of sickness could be detected.


[Origin of malignant tumors of the upper respiratory and digestive tracts and the ear (from a clinicians-point of view). 2. Pathogenesis of metastases (author's transl)]. Growth and development of metastases depends on 1. Tumor cells themselves, 2. Manipulations on the primary tumor, 3. Lymphatic vessels in the surrounding area of the primary tumor, 4. Blood composition. 5. Extent of tissue resistence through which tumor cells pass. 6. Certain circulatory conditions of the blood. Tumor cells are distinguished from normal cells often by reduced (Verbrauchskoagulopathie, tendency to bleed). An increase in bloodclotting supports the development of haematogenic metastases and the tumor growth. Malignant tumors of the kidney and the intestines may develop micrometastases of the lungs which, for years, as dormant cells, remain undiscovered. Then after 12--14 years metastases (further satelites) are seen e.g. in the ENT-field. In the spreading of tumor cells the flow parameters of lymph and blood play a very important role.


[Pituitary hormone secretion induced by optokinetic stimulation (author's transl)]. A slight optokinetic stimulation induces a significant increase of serum levels of antidiuretic hormone 1,1 +/- 0.8 pg/ml (mean +/- SD) to 3,3 +/- 1,9 pg/ml (mean +/- SD). Serum levels of gGH and cortisol remain unchanged, whereas serum prolactin levels decrease slightly. The ADH secretion seems to be the most sensitive hormonal parameter of the stimulation of the vestibular nuclei induced either by the optokinetic stimulation or by the Coriolis effect.


Tragal perichondrium and cartilage in reconstructive ear surgery. Two hundred and fifty-five ear operations using tragal perichondrium and cartilage for reconstruction are presented. Of these, 108 were myringoplasties, 137 were tympanoplasties with ossicular reconstruction performed by nine different methods, and 10 were tympanoplasties with reconstruction of posterior canal wall defects left by radical mastoid surgery. The method presented in this study of using the tragal perichondrial graft is well suited for myringoplasty and can be used where the drum remnant is very small or the anulus is missing. The natural angle of the tragal perichondrium can take the place of the missing anulus anteriorly, inferiorly or posteriorly. Myringoplasty graft survival at one year follow-up was 92%, and 76% had hearing within 10 db of bone conduction. In tympanoplasty, the tragal perichondrium was used en bloc with its cartilage for reconstruction of the ossicular chain where suited. The malleus was used to reconstruct the ossicular chain in different variations. Other methods used are fully described. At one year follow-up the rate of grafting success for tympanoplasties was 91%, and 78% had hearing within 10 db of bone conduction. A method for reconstruction of the posterior canal wall and tympanoplasty after radical mastoidectomy is presented. It uses tragal cartilage and perichondrium en bloc. At one year follow-up, eight of ten cases operated on by this method had an intact drum and posterior canal wall, one had an intact drum but the posterior canal collapsed into the mastoid, and one had an intact canal wall but the eardrum re-perforated. Nine had postoperative hearing within 10 db of bone conduction. A randomly selected group of 100 tympanoplasties was examined for postoperative gain in hearing according to the speech reception threshold, a more practical criterion of surgical success than 10 db air-bone gap. Although the total number showing improvement was similar to the number gaining hearing within 10 db of pure tone bone conduction (76% vs. 78%), when changes of 5 db were discounted, only 56% were improved (and 33% had a significant gain in hearing).


Meibomian gland adenocarcinoma of the eyelid with neck metastasis. Meibomian sebaceous gland adenocarcinoma of the eyelid is a rare lethal neoplasm. It accounts for less than 1% of all eyelid tumors. There are approximately 200 cases described in the literature. The incidence of regional metastases is 17-28%. Once metastases are present, only half of the patients survive five years. Presented are two cases with neck node metastases. In one of the patients the primary lesion was initially treated with radiation therapy with an unsuccessful result. Subsequently full thickness, wide excision of the lower lid was required to control the primary. Eyelid oculoplastic reconstruction was performed using a masolabial rotation skin flap lined with nasal septal composite graft (cartilage and mucosa). Orbital exenteration was necessary to control the primary tumor in the other patients. The regional metastases in both patients were treated with parotidectomy with preservation of the facial nerve, radical neck dissection and postoperative radiation therapy. One of the patients with poorly differentiated adenocarcinoma died due to brain metastasis. I feel that combined treatment of radical surgery to the primary site, parotidectomy, radical neck dissection and planned postoperative radiation therapy may improve the five-year survival of patients with regional node metastases.


Pneumatic otoscopy and impedance studies in middle ear diagnosis. The direct inspection of the tympanic membrane and its movement with Siegle pneumatic otoscopy through the binocular microscope and the electroacoustic measurements of impedance at the tympanic membrane give valuable information in the diagnosis of tympanic membrane and middle ear disorders. Problems such as otosclerosis and tympanosclerosis with ossicular chain fixation, ossicular discontinuities, ossicular chain prosthesis defects and perilymph fistulas, and the problems of middle ear fluid can be identified and differentiated. Frequently a precise diagnosis can be determined prior to surgical exploration. The use of these instruments enables the otologist to anticipate surgical findings and plan a specific procedure, thereby avoiding operative surprises. The routine use of the pneumatic otoscope and an electroacoustic impedance bridge is recommended in every case of suspected tympanic membrane or middle ear disorder, particularly where an operation is being considered. The combined information obtained through use of the two diagnostic techniques is almost always greater than that obtained by either instrument alone. Pressure recordings were made in a series of examinations with the pneumatic otoscope using the ear microscope. These pressures, both positive and negative, are acceptable and well within the range utilized by clinical electroacoustic impedance bridges. Contraindications to the use of pneumatic otoscopy and the electroacoustic impedance bridge are discussed.


The osteotomy in rhinoplasty.

The osteotomy in rhinoplasty. The purpose is to assist the surgeon in the selection of modifications for nasal osteotomies. Details of the technique include: 1. Incision for osteotomy made perpendicular to the pyriform rim and modified incisions, intraoral or through the Weir incision. 2. Rasping of the lateral nasal vault prior to any osteotomies. 3. Removal of a modified beveled wedge of bone prior to the medial osteotomy, unroofing the bony dorsum to a higher level. 4. The medial osteotomy done prior to either the lateral or the intermediate osteotomy. The intermediate osteotomy is performed prior to the lateral. 5. "Complete" and "fading" medial osteotomies are utilized as indicated. 6. The lateral osteotomy may be relatively straight and low depending then on a transverse fracture or may be high and curved meeting the fading medial osteotomy. 7. A sub-periosteal tunnel with the osteotome guard external to the bone is preferred to a submucosal tunnel.


Round window ultrasonic irradiation for Meniere's disease with ENG monitoring. Utrasonic irradiation of the labyrinth via the round window is effective in controlling otological vertigo. This method of surgical management for incapacitating vertigo is presented with demonstrative intraoperative electronystagmograms and irradiated cat neuro-epithelium. Such data suggest that more intense irradiation doses than previously reported should be applied to effectively destroy the diseased labyrinthine end organs. Precise end points of destructive irradiation are defined by characteristic intraoperative electronystagmograms. The authors suggest this is an ideal procedure when the situation of an unaffected cochlea, coexisting with a diseased labyrinth, requires a minimally invasive, destructive procedure which preserves hearing while eradicating vertigo.


Laryngotracheoplasty for acquired subglottic stenosis in infants and children: experience with six cases. Six children aged 6-50 months with acquired subglottic stenosis persisting after medical and endoscopic treatment underwent 7 open resections of the stenotic tissue followed by internal stenting. Five were successfully decannulated after an average treatment time of 6.8 months; the sixth died after accidental extubation. All 5 have satisfactory vocal and respiratory function 11 to 36 months postoperatively (6-18 months postextubation). Transcartilaginous open resection of subglottic stenosis is a feasible treatment option which can be used, even in the infant, when expectant observation is not advisable.


Management of tinnitus aurium with lidocaine and carbamazepine. At present there are two methods of management of tinnitus: one old, by masking with a noise generator, and one new, by biofeedback. Neither of these methods is convenient and neither gets at the heart of the problem. A third method, using intravenous lidocaine as a test and oral carbamazepine therapy, was developed in the Pain Clinic of the Auckland General Hospital in New Zealand. This paper will report our brief experience with these drugs in the management of tinnitus and other similar disorders. Twenty-seven patients with intractable tinnitus had a significant reduction from a test dose of intravenous lidocaine and were treated with oral carbamazepine. Of this group 1 patient (4%) had complete relief, 21 patients (78%) had partial relief, and 5 patients (18%) had no relief. Complications were few and not serious, and either disappeared spontaneously or when the carbamazepine was stopped. One patient with palatal myoclonus, refractory to all other forms of treatment, had complete relief on a small dose of carbamazepine. It may be that palatal myoclonus, hemifacial spasm, and other such clonic convulsive disorders will be amenable to the same treatment.


Computerized tomography or paranasal sinus neoplasms. Computerized tomography represents a new and valuable diagnostic tool to the otolaryngologist and head and neck surgeon in several ever-increasing aspects of his clinical practice. This report presents CT scans utilizing the E.M.I 5005 body scanner on patients with neoplasms of the paranasal sinuses presenting to the Head and Neck Service of The University of Texas System Center M. D. Anderson Hospital and Tumor Institute. Only patients undergoing surgical resection of such lesions are included so that actual operative and surgical pathological findings can be used for critical comparison of diagnostic information derived from polytomography and computerized tomography. Seven illustrative cases are presented. In general, computerized tomography has been found to be equal to polytomography in assessing bone destruction or involvement by tumor, and superior to polytomography in determining accurately the soft tissue extent of disease. CT scanning, however, has been found to have limitations in the delineation of soft tissue disease in areas of high contrast in tissue density, and in the evaluation of possible intracranial tumor extension in isodense, avascular lesions.


Ménière's disease in children.

Ménière's disease in children. Approximately 3% of all patients with Meniere's disease are in the pediatric age group. These children require extensive evaluation. A history of physical or acoustic trauma should be sought and an allergic work-up should be obtained. A search for metabolic disturbances and identification of inflammatory disorders is also necessary. If a treatable etiology is identified, specific therapy should be directed toward its control. If, after careful evaluation, the etiology remains obscure, non-specific therapy should be instituted in an effort to alleviate the symptomatology of Meniere's disease. Surgical decompression of the endolymphatic sac and drainage into the mastoid cavity results in relieving the symptoms, particularly vertigo, and appears to be efficacious in patients who have failed diligent attempts at medical therapy.


Horizontal glottectomy.

Horizontal glottectomy. Horizontal glottectomy is a procedure which allows removal of the whole glottis, together with its cartilaginous framework. It is performed by means of two horizontal incisions, the lower through the cricothyroid membrane, and the upper one across the wings of the thyroid. The gap is then closed by approximating the cricoid to the thyroid remnants (cricothyropexy). The indications for horizontal glottectomy are: 1) "double" cancers (i.e. two independent tumors, one on each vocal cord). 2) Hyperkeratosis of the glottis associated with carcinoma in situ. 3) Verrucous cancers of the glottis. 4) Cancers of one vocal cord invading the opposite one via the anterior commissure. In a period of 4 years, 16 patients have been operated on with good early results.


[Functional disorders of the gastrointestinal tract (author's transl)]. Functional disroders are the most important cause for complaints in the gastrointestinal tract. Dysfunction may concern one or more physiologic properties like tonus, motility, secretion, sometimes also resorption and digestion, or their interaction. Functional disorders of the esophagus (esophagospasm and achalasia) become manifest as dysphagia. Halitosis, bad taste, burning tongue, and flatulent abdomen are frequent symptoms of functional disorders of the gastrointestinal tract. Irritable bowel syndrome is probably the functional disorder most freqently found in the gastrointestinal tract. Characteristic symptoms are pain in the lower and upper middle abdominal region, obstipation and/or diarrhea, flatulent abdomen, mucous discharge with the stools and urgent defecation with cramps relieved after discharge. Prognosis quoad vitam is good, the course, however, is subject to many changes. Therapie is symptomatic. Diagnostic and psychotherapeutic measures are intended to help remove carcinophobia and to overcome conflicts and fears.


[Gastric xanthelasma (author's transl)]. A report is given about 42 cases with xanthelasma of the gastric mucosa diagnosed with 5 1/2 years. The condition was found (considering the total number of gastroscopies) in men 1.38 times as often as in women; the average age of all patients at the time of diagnosis was 62.5 years. Xanthelasma lesions are yellow or yellowish-white spots in the mucosa, consisting of foam-cells microscopically. The cytoplasma stains pale pink in a HE preparation; there is almost no staining with PAS, and sudan black staining is definitely positive in most cases. PAS and sudan black staining do allow differentiation of signet ring carcinoma cells. Gastric xanthelasma occurs quite often concurrently with chronic gastritis. It is due to local, not to general disturbances of lipid metabolism. Lipids probably are formed within the mucosa cells or may--in cases of intestinal metaplasia--originate from the gastric contents. Gastric xanthelasma does not constitute a nosologic entity, it is merely a consequence of other diseases of the gastric mucosa.


[Infarction of the small intestine in secondary amyloidosis with nephrosis (author's transl)]. A case report is given of a 65 year old patient suffering from chronic tuberculosis of the lungs, nephrosis and secondary amyloidosis, who had infarction of a jejunal segment. Narrowing of the small arteries in the jejunal submucosa and in the adjacent mesenterial structures was demonstrated post mortem and was thought to be the cause of the lethal event along with hypovolemia due to nephrosis.


[Crohn's disease--Indication for surgery (author's transl)]. 60 to 90% of patients with Crohn's disease have to undergo surgery due to complications; one half of these patients do suffer a relapse. Comments are given as to the rate of recurrence and the factors which may influence it (age, localisation and duration of the disease, timing and technique to surgery). The absolute and relative indications for surgery as well as preoperative preparation are discussed in detail. Optimal therapy of Crohn's disease is only possible in close cooperation between gastroenterologist and surgeon.


[Clinic and therapy of anal fissure (author's transl)]. A distinction has to be made between primary and secondary anal fissure. If a secondary fissure is present, the underlying disease has to be treated in the first place. Surgery is the therapy of choice of chronic primary fissure; digital dilatation and sphincterotomy are used in most of these cases. Both methods were applied in a controlled, randomized study; results indicate that subcutaneous lateral sphincterotomy is to be preferred, since rates of postoperative incontinenece and of relapses are lower.


[Lymphoplasmocytoid immunocytoma of the rectum (author's transl)]. A case report is given of a patient with a lymphatic tumor of the rectum, which was diagnosed by rectoscopy and which was classified histologically as a lymphoplasmocytoid immunocytoma according to the new Kiel nomenclature of Non-Hodgkin-lymphomas. Clinical symptomatology does not differ from symptoms of other tumors of the colon; endoscopy, cytology and histology are important for diagnosis, since the therapy of choice may be radiotherapy or cytostatic therapy depending upon stage and extent of the tumor.


[Perforation of a gall stone causing incomplete duodenal stenosis (author's transl)]. A case report is given of a 78 year old woman, who showed clinical symptoms of incomplete duodenal stenosis after perforation of a gall stone into the duodenum. The diagnosis was established by X-ray examination and endoscopy. The biliary stone measuring approx. 3 cm in diameter was stuck in the pyloric channel and was removed surgically. Incidence, sex and age distribution and complications of cholelithiasis are shortly discussed.


[Importance of mould allergens in chronic recurrent gastrointestinal diseases (author's transl)]. This report deals with allergological, diagnostic and therapeutic methods in gastrointestinal allergic diseases with special consideration of mould allergens. Possibilities of using these methods in Crohn's disease and in ulcerative colitis are being discussed.


[Energy expenditure on basic work-posts in metallurgy]. The paper presents results of measurements of the whole energetic cost on the work-posts recognized by the management as basic. Altogether 121 determinations of energetic cost were performed on 18 different work-posts in two basic divisions of the steelworks. The results revealed that despite a considerable technical progress there is a significant number of work-posts, on which energetic cost exceeds 2600 kcal/8 hr. On these work-posts apart from the great energetic load, other loads, connected with material work environment on character of work, occur. This means that additional factors frequently increase their harmful effects on organism. The magnitude of energetic expenditure on a given work-post establishes the hierarchy of modernizational requirements for the plant's technical services.


[Retention of radioactive aerosols (products of radon-222 decay) by various types of anti-dust masks]. The paper presents results of measurements of the efficiency of retention of radon decay products, occurring as radioactive aerosols, by anti-dust masks. The efficiency of three types of masks: PM-1, PM-3, PP-2 "Delta" was studied under various conditions of equilibrium between radon and products of its decay in the air. It was concluded that the efficiency of retention of radon decay products, occurring as radioactive aerosols, by the mentioned types of masks, comes to 75--87%. Anti-dust PM-1 (F-14 filter) and PM-3 (F-13 filter) masks are recommended as most efficient.


[Accidental contamination with cesium-137]. The paper describes an accidental 137Cs internal and external contamination of a woman 28 years old by handling of two unsealed 137Cs sources of 2.5 Ci total activity. The only abnormality found by laboratory tests was leukopenia. The chromosomes of blood lymphocytes were also investigated. 137Cs content in urine between the 8th and 40th day after accident ranged from 34, 53 to 12.01 nCi/day. The mean feces: urine ratio was 0.25 +/- 0.06. The increase of 137Cs excretion in urine, after administration of diurectic "Lasix" and potassium was not observed. Mean biological half-life calculated from regression curve was 64 days. Body content found by whole body counting, performed on the 8th and 15th day after accident, was 6.5 muCi and 5.1 muCi respectively. The initial 137Cs body burden of 6.9 muCi was calculated for the value 5.1 muCi. The corresponding total radiation dose was 0.26 rads and quarterly dose was 0.16 rads.


[Activity of acid phosphatase in saliva of industrial workers exposed to fluorine compounds]. Assuming that fluorine is a strong inhibitor of phosphatases, the activity of acid phosphatase in the saliva of 42 phosphorus fertilizers plant workers was studied. The workers were chronically exposed to fluorine compounds. Saliva had been collected for studies before the workers entered the productive plant and after the 1st and 2nd working hour. Enzyme activity was determined by Bessey and Lowry's method and was related to both the volume of the saliva and total protein level. The studies revealed a significant decrease in the activity of acid phosphatase after the 1st and 2nd working hour in those working in the division with a higher exposure to fluorine compounds. The results of these studies were confirmed by in vitro studies carried out additionally. Taking into account biological activity of acid phosphatase it seems that the observed phenomenon of inhibiting enzymatic activity may be connected with the frequency of parodontopathy in the studied group of workers. The results of these studies may be used for working out a biological test of workers' exposure.


[Examination of the respiratory tract in workers occupationally exposed to beryllium]. Owing to the fact that in our home literature there are no data concerning evaluation of respiratory tract status in persons occupationally exposed to beryllium, a population of one plant, exposed to beryllium in concentrations less than the MAC was subject to x-ray of chest, extended functional tests of lungs and examinations of blood gases. In the group under study, one found in 13% deviation in lungs' x-ray with limited intraparenchymatous changes, and in 46% a decrease in lungs' ventilating reservers of a small degree. Association of radiological changes with imperfection of lungs' ventilating reserve of restrictive type was found in one man who was removed from the work in exposure to beryllium, as a person with an increased risk of falling ill.


[Health conditions of a group of factory arc welders]. 73 welders were examined, who weld in an assembly room of a machine factory, mainly by an electric arc. In anamneses 60% of persons under examination notified of coughing, expectorating, dyspnoea during work, and frequent acute rhinitis. Clinical symptoms of respiratory tract disease, resulting from welding, were found in 10% of welders. Simple bronchitis, resistant bronchitis with pulmonary emphysema, pleural adhesions were diagnosed. In one case fibronodular tuberculosis was found (1%). In 8% of workers, aged 40--50, a dynamic arterial hypertension and radiological symptoms of aortosclerosis were found. 5% welders had granulocytopenia. Disturbances of the examined systems occurred in factory welders with duration of employment above 10 years.


[Activity of lysosomal acid phosphatase in leukocytes of rats chronically intoxicated with benzene vapors]. In rats chronically exposed to benzene vapours of 1200 mg/m3 concentration, 6 hr daily, 6 days a week, during 12 weeks, acid phosphatase activity (AcP) was evaluated in neutrophils and lymphocytes of peripheral blood. One found an increase in AcP activity in neutrophils, correlating with duration of exposure, lymphocytopenia, correlating with duration of exposure, and increase in AcP--positive lymphocytes percentage, mainly with cytoplasmic and lysosomocytoplasmic localization of enzyme. Besides distant effects of chronic benzene intoxication were evaluated, 5 months after the exposure had been intermitted. Normal AcP activity in neutrophils, lymphocytopenia, and increase in AcP--positive lymphocytes percentage were found with cytoplasmic and lysosomo-cytoplasmic localization of enzyme. The authors suggest a possibility of using the changes observed in lymphocytes, on a subcellular level, to evaluate distant effects of occupational exposure to benzene.


[Thymol test, concentration of total protein and bilirubin and activity of various serum enzymes in a population exposed to diphenylformamide]. 445 workers occupationally exposed to subtoxic diphenylformamide concentration were examined. No significant differences were found in results of thymol test, concentration of total protein, bilirubin, and activity of basic phosphatase in blood serum, compared with the control group. A higher activity of asparagine--and--alanine aminotransferas and gamma--glutamylotranspeptidase was found; it was, however, statistically insignificant.


[Nervous system diseases in workers of a large metallurgical plant. II. Impact of occupational factors]. Correlation between some factors connected with work performance in a big metallurgical plant, employing approximately 16000 persons, and the occurrence of nervous system diseases was analysed. It was found that among the most frequent diseases of nervous system cured in neurological dispensary of a big metallurgical plant are: ischias, epilepsy, syndrome of subjective ailments following a past cranio-cerebral trauma and vasomotor headaches. The studies performed did not reveal any clear correlation between the character and arduousness of work and the type of nervous system diseases occurring most frequently in a big industrial (metallurgical) plant. The prevalence of ischias is not significantly dependent on occupational factors. The possibility of continuation of work or necessity to stop working in result of a nervous system disease depend on the type of the disease.


Nocturnal diuresis in panhypopituitarism. Although impaired water diuresis in adrenocortical insufficiency is well-known, little attention has been paid to the diuretic pattern at night. In two cases of panhypopituitarism, the nocturnal diuretic pattern was found to be quite different from that in the morning, and marked diuresis did occur after water loading at night, without any significant change of serum cortisol which remained at a low level throughout the day. At the antidiuretic stage in the morning, urine osmolality continued to rise gradually, in spite of the water loading, to the level of 666 mOsm/liter. At the water restriction test, the urine was concentrated only to the same level of 600-700mOsm/liter. At the ascending stage of urine osmolality, exogenously injected pitressin showed little antidiuretic effect, although the kidney was able concentrate urine to the higher level later. In the morning, 3 liters of 5% glucose infusion failed to produce a marked diuresis in spite of extreme plasma dilution and expansion. Furosemide immediately induced diuresis even in the morning and the kidney recovered its ability to respond to pitressin. Glucocorticoid also improved the diuretic pattern in the morning, but a latent period of about 2 hr was always observed before the appearance of the effect. What happened during this latent period was unclear, but it was interesting to note that a mechanism similar to that which induces diuretic response seemed to occur without glucocorticoid at night.


Influence of elevated plasma free fatty acids on the glucagon response to hypoglycemia in normal and in pregnant women. We investigated the influence of an insulin-induced hypoglycemia on plasma glucagon in nonpregnant healthy young women and in women during the last month of gestation. Both groups were tested either in the basal state or during a period where free fatty acid plasma levels were increased by infusion of a lipid emulsion supplemented with heparin. Regular insulin was injected intravenously at the dose of 0.1 U/kg body wt in controls and 0.3 U/kg in pregnant women in order to obtain a similar lowering of blood glucose in all groups. In controls, the increase in plasma glucagon was maximum 30 and 45 min after insulin injection and averaged 130 pg/ml; the infusion of triglycerides and heparin which raised plasma FFA to about 1300 muEq/liter decreased basal plasma glucagon levels and reduced, by about 70%, the glucagon response to hypoglycemia. During the last month of pregnancy, the glucagon response to insulin-induced hypoglycemia was reduced by 60% (mean maximal increase 52 pg/ml); furthermore, raising plasma FFA to about 1500 muEq/liter completely abolished the glucagon rise induced by the insulin hypoglycemia. These results support the view that the glucagon release from A-cells can be modulated by the level of circulating plasma FFA.


Mechanism and significance of carbohydrate intolerance in chronic alcoholism. Intravenous glucose tolerance tests were carried out in 61 chronic alcoholic patients, divided into two groups, and in a third group consisting of healthy, nonalcoholic volunteers. Members of one experimental group were drinking alcohol throughout the study. The patients of the other experimental group received no alcohol and were in withdrawal from alcohol. The glucose tolerance tests were carried out on each patient on admission to the hospital and 1 wk later. During the test, blood was drawn at 10 min intervals for glucose, immunoreactive insulin, and glucagon determinations. The results indicated that there was transient carbohydrate intolerance in the great majority of both patient groups, and it became evident that the carbohydrate intolerance was the result of continuous alcohol consumption and was not part of the withdrawal syndrome. Significant decrease in insulin secretion was found in the early part of the glucose tolerance tests in the majority of the patients in both alcohol and withdrawal groups. Based on results of this study and evidence from the literature, it is suggested that chronic alcoholism is dabetogenic in susceptible individuals and that the transient carbohydrate intolerance found in our study represents and early step in the development of adult-onset diabetes eventually developing in a significant number of chronic alcoholics.


Postheparin plasma lipase activities in obesity: failure to increase with adipose organ enlargement. Published studies have shown that overproduction of very low density lipoproteins is a major factor leading to hypertiglyceridemia in obesity. Few systematic studies of triglyceride removal or postheparin lipoprotein lipase activity (LPLA) in obesity have appeared. We have examined heparin-released lipoprotein triglyceride hydrolase activities in 12 lean and 12 obese age- and sex-matched volunteers after overnight fasting. Heparin doses were calculated to compensate for the disproportionality between body mass and plasma volume in obesity. Triglyceride hydrolase activities of hepatic (HTGLA) and extrahepatic (LPLA) origin were distinguished by in vitro inhibition of LPLA with protamine sulfate. Incremental heparin doses were given to each subject to determine lipase activities under conditions of maximal release and to define sensitivity to heparin-facilitated lipase release. Maximal postheparin LPLA and HTGLA (u/ml plasma or u/total plasma vol) were similar in lean and obese individuals despite a nearly three-fold increase in calculated adipose tissue mass in the obese. Since adipose tissue LPLA has been reported to increase in proportion to adipocyte size, the lack of difference in maximal postheparin LPLA was expected. There was an inverse correlation between plasma triglyceride concentration and LPLA/kg adipose tissue. These empirical observations may reflect relatively decreased heparin-releaseable (functional) LPLA in relation to adipose organ mass in obese subjects. The mechanism of this relationship has not been established.


Effect of somatostatin and a glucagon-specific analog on glucose homeostasis during arginine infusion. The glucose response to arginine infusion in normal rats was studied during insulin and glucagon deficiency (somatostatin infusion, 1 mg/kg/hr) or selective glucagon deficiency ([D-Cys14]-somatostain infusion, 1 mg/kg/hr). In control studies, plasma glucose levels rose 14 mg/dl in response to arginine and returned to basal levels at the termination of the infusion. Insulin levels increased 136 +/- 12 muU/ml and glucagon increased 76 +/- 12 pg/ml during the infusion. Infusion of somatostatin resulted in supression of both arginine-induced insulin and arginine-induced glucagon release, and marked hyperglycemia ensued. The administration of [D-Cys14]-somatostatin during arginine infusion produced no associated hyperglycemia. It resulted in suppression of glucagon secretion and a modest rise in insulin release. These results demonstrate that the hyperglycemic effects of somatostatin in arginine-treated animals do not arise in animals treated with glucagon-specific somatostatin analogs.


Hexokinase isozymes of normal human subcutaneous adipose tissue. The isozymes of hexokinase in surgical specimens of human subcutaneous adipose tissue were separated by elution from DEAE-cellulose with linear KCl gradients at ph 7.4. Two peaks of activity were found: Peak 1 eluted at 0.05M KCl, and Peak 2 at 0.19M KCl. Michaelis constants (Km) for glucose were: Peak 1, 6.5 x 10-5M; Peak 2, 1.5 x 10-4M. Peak 2 was more susceptible than Peak 1 to inactivation by trypsin, 0.1 mg/ml, and was protected by 0.1M glucose. Both peaks were protected from heat inactivation (45 degrees) by 0.1M glucose. Peak 2 comprised 66 +/- 5 percent of the total hexokinase activity. No activity with the characteristics of hexokinase III was detected in human fat. In all these characteristics, the isozymes of human adipose tissue closely resemble hexokinases I and II from rats.


Immune reconstitution in the immunodeficient chicken by transfer of embryonic lymphoid cells. Embryonic chickens were rendered immunodeficient by in ovo injection of homologous IgM on the 10th embryonic day. The immunodeficient embryos were intravenously given lymphoid cells taken from normal embryonic bursa, spleen or thymus on the 15th embryonic day. Gain of splenic or bursal weight, natural antibodies to sheep red blood cells (SRBC), frequencies of rosette forming cells (RFC) binding to SRBC or dinitrophenyl-SRBC (DNP-SRBC) and of immunoglobulin bearing cells (IBC) in the bursa and the spleen were investigated to assess the effect of transferred cells during the embryonic stage. Transferred bursal and splenic cells showed an ability to restore the frequency of RFC or IBC in the recipients. However, reversion from the immunodeficient state was not observed in the thymic cell transfer. These findings suggested that the cells derived from embryonic bursa and spleen contained stem cells which developed into RFC and also into precursors of IBC.


In vitro destruction of urinary calculi by laser-induced stress waves. A new, nonsurgical technique is proposed for the destruction of urinary calculi. This technique exploits recent advances in laser-fusion research in the generation of shock waves from high-intensity pulsed lasers and the principles evolved from extensive military research on fragmentation resulting from the interactions of shock waves on solids. In the in vitro experiments reported here, stress waves were generated by irradiating a thin film confined between glass and metal substrates with a high-intensity pulsed laser. It was shown that a nominal 2-J, Q-switched Ruby or Nd-glass laser is easily capable of producing stress waves of up to 10-kbar peak pressure and that the rise time of the stress pulse is on the order of the laser pulse duration. Urinary calculi (kidney or bladder stones) of different sizes, shapes, colors, hardnesses, and composition were fragmented by laser-induced shock waves into sizes quite capable of being passed spontaneously. Critical laser parameters have been determined, and the associated threshold pressure for the destruction of the hardest types of urinary stones has been measured. The possible application of this technique to in situ destruction of urinary calculi is described.


A new bedside emergency resuscitation cart. Existing bedside emergency resuscitation carts all have certain shortcomings, which interfere with the rapid, efficient care of the hospitalized patient in a catastrophic episode. A systems study was made of the performance criteria of such a cart under conditions which require its use. The primary result of the study was a new design for a bedside emergency resuscitation cart and a suggested list of emergency medications and equipment, every item of which is visible and available without opening drawers to search for it. It is suggested that such a cart, fully equipped, be kept on every nursing station and in every special care department of a hospital.


A noncontacting electromagnetic device for the determination of in vivo properties of bone. A noncontacting, electromagnetic device to monitor stress waves in bone has been developed. Since bone exhibits piezoelectric-like behavior, a propagating stress wave in bone generates both electric and magnetic fields. The present device detects the magnetic field and thus provides a measure of the stress-wave amplitude in the bone. Excised dry and wet human femora, as well as a model system consisting of a bar of strongly piezoelectric ceramic, were examined using the device. Magnetic signals associated with elastic waves were also recorded in the long bones of human volunteers. Since the observed signals are not perturbed by the mechanical quality of the soft tissue over the bone, the device may be used to quantitatively assess the mechanical properties of bone in vivo.


Reliability of Doppler and impedance techniques for the diagnosis of thrombophlebitis. The accuracy of Doppler ultrasound and impedance diagnostic techniques for identifying deep venous thrombosis was determined by comparison with patient venograms. Those patients suspected of having deep venous thrombosis were tested by ultrasound, impedance, and venography, with venography the standard for establishing the accuracy of the noninvasive methods. The deep inspiration, the Valsalva and abdominal pressure maneuvers, and the pneumatic cuff technique were employed with the impedance tests. The incidence of false negative and false positive results were determined for each noninvasive method separately and for both methods used concurrently. When both methods were considered, the number of false positives was high; however, all cases with major thrombosis were detected in the group of patients examined. A positive result with ultrasound or impedance tests should be considered an indication to perform venography, or if venography is contraindicated, to perform other noninvasive tests.


Electrodynamometric evaluation of nasal escape in speech disorders. A new method of detecting the degree of nasal air emission in patients with speech disorders during "continuous" speech. The method employs the use of an electronic sensor placed in front of the nasal opening, which then picks up nasal escape and transfer it to an electrical signal that is recorded on an LED digital readout. The degree of nasal air emission, as portrayed on the LED, is then charted, permitting differentiation of the various speech disorders. This newly described method of nasal speech evaluation is of the utmost importance in the rehabilitation of patients with speech disorders and has proven to be quick and reliable in clinical use. It is also useful in patient selection for the various reconstructive operative procedures used to correct speech abnormalities. The clinical device is helpful to the speech therapist in detecting nasal speech abnormalities and evaluating the clinical progress of a given patient during speech therapy.


Safety and efficacy of extracorporeal blood oxygenators: a review. A review of the scientific literature relative to safety and efficacy of disposable blood oxygenators, augmented by 20 years of clinical and laboratory experience utilizing heart-lung bypass devices, has produced tables and lists describing clinical problems associated with the use of disposable blood oxygenators, basic requirements for an effective and safe oxygenator, and parameters of oxygenators requiring testing for safety and efficacy. The current status of voluntary guidelines and regulatory standards for oxygenator safety and efficacy is reviewed.


Advances in ventricular synchronous demand cardiac pacemakers. New ventricular synchronous demand (VVT) pacemaker functions have been developed that provide improved performance in electromagnetic interference (EMI) environments and improved sensing of ventricular premature contractions. All previous ventricular synchronous pacemakers had an inherent design conflict between choosing the optimal (relatively long) input refractory interval needed for limiting the maximum pulse delivery rate and choosing the optimal (relatively short) input refractory interval (sensing dead time) following either a sensed or paced cardiac contraction. The necessary compromise resulted in a device that in the presence of EMI, stimulated at a rate (approximately 150 ppm) which was dangerously fast for certain patients, yet was insensitive to early poststimulation (400 to 500 msec) premature ventricular contractions, resulting in a risk of T-wave stimulation. Partly because of these deficiencies, the VVT function has not been widely employed by the medical profession: instead, the ventricular inhibited (VVI) pacemaker has evolved as the treatment of choice for the cardiac patient with intermittent heart block, even though total inhibition by certain EMI radiators is a potentially serious problem. New VVT structures have been developed that allow control separation of the maximum EMI discharge rate and the sensing refractory interval by employing independent input and output refractory intervals. New low-power digital devices provide building blocks applicable to the developed architectures.


Controlled voltages for electroconvulsive therapy. A description is given for the design of an isolated output, servo-controlled voltage, electroconvulsive therapy (ECT) machine for the safe, controlled application of 60-Hz alternating current (ac) signals between 0 and 230 V rms for controlled periods ranging from 0.1 to 2 sec. Added safety is provided by current limiting in the range of 360 to 770 mA rms for patient impedances ranging from 500 to 50 omega. The use of this equipment has permitted a detailed description of the impedances characteristic of unilateral ECT.


Paediatric follow up of pregnancies complicated by subnormal oestriol excretion. Interim report. In 92 pregnant women with low urinary oestriol excretion after 30 weeks' gestation, there was a higher incidence of fetal distress, premature delivery and induced labour, while resuscitation of the infant at birth was required more often than in controls. The birth weights, head circumference, and body lengths of the infants were significantly lower than those of the controls. In the 26 cases where maternal oestriol levels were persistently low, three were associated with placental sulphatase deficiency, and three infants died postnatally. Four infants had evidence of neurological defects on follow up, as did four infants in the control group. The low head circumferences, weight, and length were still present at two years of age. It is concluded that, although low oestriol excretion during pregnancy is associated with increased risk to the fetus, it is not associated per se with permanent neurological damage, provided the infant is born alive, and is congenitally normal. However, many infants remain smaller than average, at least for the first years of life.


Glycosylated haemoglobin levels in patients with diabetes mellitus. Glycosylated haemoglobin A1 levels were measured in 186 patients with diabetes mellitus and 108 non-diabetic controls. Forty-nine diabetics were considered well controlled with at least three blood glucose levels below 10 mmol/L, while 50 diabetic patients were poorly controlled with at least three blood glucose levels above 15 mmol/L. Mean glycosylated haemoglobin A1 levels for the 108 normal controls was 7.45% +/- 0.73%, for the well controlled diabetics, 10.7% +/- 2%, and for poorly controlled diabetics, 15.0% +/- 2.5% of total haemoglobin. In patients with the onset of diabetes after the age of 40 years, there was a significant difference between the haemoglobin A1 levels in those with diabetic retinopathy and those without complications. There was a significant association between haemoglobin A1 levels and the duration of the disease in diabetics controlled with insulin.


Psychiatric consultations in a children's hospital. One hundred and ninety-one consecutive psychiatric referrals from the medical and surgical wards of a children's hospital were studied. The referral rate approximated 2% of admission rate, and patients who were referred stayed in hospital longer than three times the average stay for all inpatients. The hospital's medical units supplied 69% of referrals and the rest came from the surgical units. The male to female ratio of admissions to hospital was 3:2, but that of referrals was 1:1 (a significant difference (P less than 0.02). Main diagnostic categories for patients under one year of age were congenital and metabolic disorders (35%), and psychosocial problems which included maltreatment and children at risk (58%). The records for patients between one and 14 years of age imply that over 50% of them had family social problems or behaviour disorder. Of patients over 14 years of age, 93% had affective disorder.


Choice reaction time in workers using trichloroethylene. Eight-choice reaction time studies were carried out on women using trichloroethylene (TCE) as an industrial solvent, and simultaneous tests were performed on control subjects. The women exposed to TCE showed an increase in choice reaction time compared with the control subjects. This divergent trend was substantial at a factory where TCE levels exceeded the recommended threshold limit value (TLV). The divergence was less pronounced, but still clearly evident at another factory where TLV was not exceeded.


The environmental impact statement: an important addition to the certification of early deaths. An environmental impact statement (EIS) has been made in conjunction with a prospective study of 56 consecutive deaths of persons under 60 years of age in a local population. EIS is the cheapest and the quickest means by which to continually highlight the weaknesses of a national health system.


The comprehensive cancer centre.

The comprehensive cancer centre. Comprehensive cancer centres have arisen around the world, very often on the foundations of radiotherapy departments, as in the case of the Cancer Institute in Melbourne. Such centres offer the complete non-surgical approach to cancer through multidisciplinary interaction with full diagnostic back-up, and are centres of excellence in at least one branch of surgical oncology. They are physically or organizationally autonomous entities. They undertake basic as well as clinical research. They provide training of personnel in cancer diagnosis, treatment and research.


Accuracy in diagnosis of acute pancreatitis. During an eight-year period, 113 cases of acute pancreatitis were studied to determine the accuracy and modes of diagnosis in the first attack. In 65% of cases, a confident diagnosis was made on a combination of the clinical picture and a marked elevation of the serum amylase level. Diagnosis on laparotomy was made in 30% of cases, and autopsy diagnosis in the remaining 5%. Cullen's and Grey Turner's signs, radiology test results, and the presence of hyperglycaemia were of little or no diagnostic value. Recently developed laboratory tests may increase the diagnostic yield in the future. The precise indications for laparotomy diagnosis in the first attack are discussed. Laparotomy for diagnosis did not increase the mortality rate in this series.


Perforation of the interventricular septum complicating myocardial infarction. The presentation and management of 21 patients with postinfarction ventricular septal defect (VSD) in whom surgical treatment was considered or performed since 1970 have been analysed and reviewed. An acute group of 11 patients, each of whom developed cardiogenic shock, 9 of whom came to surgery within one week from the onset of their VSD, had a poor outlook, only 27% becoming long-term survivors. Six patients were classified as subacute because their surgery was precipitated by worsening congestive cardiac failure in all, and by pulmonary oedema at the time of surgery in three patients. Four chronic patients were operated upon electively. The results in the subacute and chronic groups were excellent, and all are long-term survivors. Operative closure of the defect is best achieved by the use of a patch. Infarctectomy and aneurysmectomy are necessary in more than half of the cases. Left ventricular assistance by the intra-aortic balloon counterpulsation catheter has been disappointing and did not contribute to long-term survival. The major factor determining survival is the integrity of the closure, and the function of the remaining viable myocardium. Reoperation for reopening of the defect should always be considered.


Illegal drugs and nutrition in undergraduate students. The nutritional status of 82 marihuana-smoking students from two establishments of tertiary education was studied and compared with 63 controls. There was little difference between these two groups of students. Thirty-four per cent of those taking drugs had a diet which was deficient in one or more nutrients, compared with 30% of the controls. Four of the students who took drugs and three controls had a marginally reduced serum level of vitamin B12, but all were taking oral contraceptive agents. Sixteen marihuana-smokers had either a low folate or low pyridoxal serum level, and another three had reduced serum levels of both vitamins compared with a total of eleven among the controls. Forty-three students (52%) had used, or were using, lysergic acid diethylamide (LSD) in addition to marihuana, and 10 had used mushrooms (Psilocybe cubensis). Thirteen students appeared to be "stoned" at interview.


Cerebral radionuclide scintigraphy in the stroke syndrome. The cerebral scans of 365 patients with the stroke syndrome were reviewed retrospectively over a 30-month period. Positive static studies occurred in 140 patients )38%), of which 73 (52%) had an associated reduction of flow to the affected hemisphere on the dynamic study. Positive dynamic studies alone accurred in 69 patients (19%), increasing the positive yield by 50%. Dynamic studies also differentiate extracranial (carotid) occlusion from intracranial vascular occlusion, and may contribute to prognosis and management. Infarction in the middle cerebral artery territory is five times as common as infarction in any other arterial territory. An unexpected finding was the high incidence (5%) of watershed infarctions. These are more common than posterior cerebral artery strokes (4%), and anterior cerebral artery strokes (1%). When patients with vertebrobasilar and lacunar strokes, and those scanned within one week or after six weeks from the onset of symptoms are excluded, the positive yield was 54% for static studies, and 67% over all.


Incidence of suspected extracranial cerebrovascular disease in a small community. This study reports the investigation and treatment of 31 patients who suffered symptoms suggestive of extracranial cerebrovascular disease and presented to one community practice. It suggests that extracranial cerebrovascular disease may be more prevalent than is generally presumed, and emphasizes the need for better methods of investigation and a more positive approach toward its treatment.


Synergism between tetracycline and amphotericin B in experimental amoebic meningoencephalitis. The efficacy of tetracycline and amphotericin B in the treatment of primary amoebic meningoencephalitis was studied by means of a mouse model. The results showed marked synergism between these two drugs. Mice who recieved 50 microgram amphotericin B daily succumbed to the infection with only 28.6% survival compared to 0% in untreated controls. In contrast, survival percentage was increased to 66.7% and 84.6% in mice receiving the combined dosage schedule of 50 microgram amphotericin B with 2 tetracycline, and 50 microgram amphotericin B with 3 mg tetracycline, respectively. The finding of synergism between tetracycline and amphotericin may provide a better means for the treatment of this disease.


Obstructive jaundice due to hydatid cyst of the liver. Obstructive jaundice due to a hydatid cyst of the liver occurred in a young Italian woman; the disease was contracted in the patient's home country, before her arrival in Australia.


Intravenous co-trimoxazole therapy in serious infections. The intravenous therapy with co-trimoxazole was used to control serious sepsis in 15 patients in the intensive care unit of a large metropolitan hospital. Co-trimoxazole was found to be a safe, effective, and eminently satisfactory alternative to the present vogue treatments of serious, bacteriologically undiagnosed infections.


Acute pancytopenia due to megaloblastic arrest in association with co-trimoxazole. Three patients who were taking co-trimoxazole developed acute pancytopenia due to megaloblastic arrest, and two of the three died while pancytopenic. One patient had a pre-existing megaloblastic anaemia. In the other two patients, there was no macrocytosis or neutrophil hypersegmentation despite the severe megaloblastosis. Because specific treatment is needed urgently, it is important to distinguish megaloblastic arrest from drug-induced hypoplasia.


Trimethoprim-sulphamethoxazole and thrombocytopenia. Thrombocytopenia is an uncommon but serious side effect of the antimicrobial combination of trimethoprim and sulphamethoxazole. Thirty-one cases in seven years, including two deaths, have been reported to the Australian Adverse Drug Reactions Registry. Females were affected twice as frequently as males. In 70% of the patients platelet counts were 20x10(9)/L or less. Thrombocytopenia which is associated with this agent may occur at any age.


[The attitude of medical students towards informing patients of their condition (author's transl)]. During the winter term 1976/77 and in the summer term 1977 233 medical students of the fourth term were asked about their "attitudes and experiences" as "to which extent the patient wants to be and should be informed about his illness". About half of the investigated students--the number varies with the indicator--displayed attitudes and experiences corresponding to the patients' reality and needs. This was rated as an indicator of patient-centered orientation. The rest displayed patterns of attitudes and presuppositions similar to those we noted in physicians in hospital. The patients' great need of information is usually underrated, the individual aspects are not clearly recognized and there is only a slight inclination to tell the patient the whole truth, especially with regards to the prognosis. Age, sex, experiences in hospitals and professional objective of each of the investigated students do not have a relationship with these orientations. Having given a critical discussion of methods the authors demonstrate the didactic conclusions which the Marburg Institute of Medical Sociology would draw from its investigations.


[Bioavailability of Ce-Ferro forte. Comparative iron load test (author's transl)]. The intraindividual relative bioavailability of three oral iron preparations was investigated in 9 male and 3 female healthy volunteers. After an overnight fast each of the volunteers took 110 mg Fe++ in a weak gelatine capsule soluble within the duodenum (Ce-Ferro forte) or 105 mg and 100 mg Fe++ respectively in commercial preparations. Care was taken that a 3 days interval took place between the investigations. Before taking and 1/2, 1, 2, 4, 6, 8 and 12 hrs. after taking the iron capsule, blood was withdrawn into heparinized test tubes and plasma iron concentrations were determined using an atomic absorption spectrophotometer. After taking Fe++ sulfate in a weak gelatine capsule (A), the mean plasma iron increased significantly higher in comparison to preparation B in the 2nd and in the 4th hour and in comparison to preparation C in the 1st hour. The area under curve of iron increase was 531 +/- 329 (SD) after A, 415 +/- 327 And 414 +/- 390 after B and C respectively without significant changes. From these data was concluded that Fe++ sulfate in a duodenal soluble weak gelatine capsule has a beter bioavailability than the 2 other preparations investigated.


[Endoscopy of duodenal ulcer: diagnosis and control of the disease course (author's transl)]. In 5040 consecutive endoscopies 672 duodenal ulcers were found. The experience with this series shows, that the direct endoscopic examination of the duodenal bulb represents a significant improvement for the diagnosis and control of the clinical course of the duodenal ulcer. Radiologic methods have not absolutely lost their diagnostic importance. However it may be frequently difficult to distinguish an acute from a healed lesion. The duodenoscopy is able to clarify this difficulty which is a reason for preferring the endoscopic examination for the diagnosis of duodenal ulcer.


Thin needle biopsy of solid tumors in children. Thin needle biopsy of a suspected tumor will usually yield material amenable to cytologic examination and sufficient for diagnosis. Sixty children with suspected solid malignant tumors were subjected to this procedure. The masses biopsied were in bone, abdomen, mediastinum, tongue, pharynx, soft tissue, and peripheral lymph nodes. The diagnostic yield was 66% on first biopsy and rose to 93% on repeated biopsies. The diagnostic accuracy was 97% in malignant tumors with histologic confirmation. There were no proved false-negative diagnoses, and two (3%) false-positive (for malignancy) diagnoses. All patients were followed up. There were no complications of note.


Combination chemotherapy with MOPP in children with recurrent brain tumors. Twenty-three children with CNS tumors were treated with combination chemotherapy including nitrogen mustard, vincristine sulfate, procarbazine, and prednisone (MOPP). All but one had progressive or recurrent tumors following surgery and irradiation. In addition, nine of these patients had prior chemotherapy. Seventeen out of 23 patients (73.4%) responded to MOPP chemotherapy including seven patients who had prior chemotherapy with single or multiple agents such as VCR, nitrosoureas, intrathecal methotrexate, and VM-26. Three comatose patients who were being kept on Decadron without benefit recovered from coma. At the time of this report 8 of the 17 responders are surviving without evidence of recurrence 7--30 months from the start of MOPP chemotherapy. In two of these children chemotherapy has been completely stopped.


Ionization collection efficiencies of some ionization chambers in pulsed and continuous radiation beams. The most commonly used method of calibrating high-energy photon or electron beams consists in converting cavity ionization to dose by the application of the appropriate Clambda or CE multipled by the 60Co correction factor. The correct interpretation of calibration data for pulsed photon or electron beams requires a knowledge of the charge collection efficiencies of the ionization chambers used. The results are presented of efficiency measurements for both pulsed and continuous beams made with these chambers: 0.6-cm3 Farmer, 0.5-cm3 Spokas, 3-cm3 Shonka, 1-cm3 PTW, and 1-cm3 Memorial pancake. The dependence of collection efficiency on collection voltage, dose rate, and dose per pulse is demonstrated. These results are shown to agree with Boag's formulas for collection efficiency. Attention is drawn to the fact that several kinds of dosimeters provide only minimal collection voltages for efficient collection of charge at high dose rates, especially in Linac electron beams. It is recommended to check the collection efficiency of chambers which are to be used at high dose rates, and a simple method for this purpose is described.


An automated dosimetry data-acquisition and analysis system at the LAMPF pion therapy facility. An automated data-acquisition and analysis system has been developed for dosimetry measurements on the pion therapy beam at the Clinton P. Anderson Meson Physics Facility Biomedical Channel in Los Alamos using a PDP-11/45 computer and CAMAC interface. Initialization, test, and monitor programs allow the user to set the physical limits of scanner travel, test the data lines, calibrate the analog signals for the scanner position, and monitor the analog versus digital values of the scanner position during operation. Data-acquisition programs scan beams in one, two, and three dimensions. Many options are available to the user in selecting the scan parameters and in changing some of these parameters during scanning. Data-analysis programs provide reproduction of stored data, comparison of linear scans, beam profiles along any line of a planar or volume scan, and isodose distributions from any planar scan or from any planar scan or from any plane of a volume scan. Other programs summarize stored data files and search for specific data according to the user's instruments.


Noise characteristics of a microchannel plate x-ray image intensifier. The noise performance of an experimental microchannel plate x-ray image intensifier has been evaluated. The intensifier, constructed for use with photons of energies between 20 and 150 keV, uses an MCP as the photon-to-electron converter. The influence of noise was determined by analysis of the optical-density fluctuations of a photograph of the viewing screen of the intensifier when the conversion layer was exposed to between 1 and 60 mR. Additionally, the contrast-detail performance of the experimental device was determined. The influence of both stochastic noise, due to quantum mottle and pulse-height variations, and structural noise, due to fluctuations in inherent gain from point to point, have been considered by using a model that adds these components.


Development of Bragg diffraction imaging for medical use. Experience gained in developing a real-time acoustical imaging system using Bragg diffraction is presented. Particular emphasis has been placed on medical applications. We have studied the difficulties in assembling a system capable of producing high-quality images. Engineering data on the optical mounting and on the design of the transducer along with representative images are presented and discussed.


New method for the experimental evaluation of x-ray grids. This work describes a new method for the experimental evaluation of antiscatter x-ray grids in radiography. Five commercial grids are evaluated in terms of two parameters which are determined only by the construction of the grid and the x-ray energy. A comparison of the grid performances was made for the x-ray energies and scatter conditions that usually apply to chest radiography and mammography. The results show that for maximum scatter conditions the grid enhances the subject contrast by factors of approximately 6 and 2 in chest radiography and mammography, respectively, and that the contrast increases as the grid ratio increases. Also, in these examinations, the results show that, with improved grids, it is possible to reduce the patient exposures required for the no-grid case by approximately one-half without loss of the image-information content (signal-to-noise ratio).


An evaluation of the performance characteristics of different types of collimators used with the EMI brain scanner (MKI) and their significance in specific clinical applications. The characteristics of various types of collimators have been studied systematically for the EMI Mark I brain scanner. The degree of collimation ranged from the 13-mm adjacent A and B slices to 3-mm separated slices. Multiple phantom studies (including variable density immiscible liquid interfaces) have been performed to evaluate the effect of collimation on (a) the line-spread function, (b) the change in effective absorption number, and (c) volume averaging. Effects associated with the technique settings involving the kVp, the mA, and the scan time were also investigated. The results of TLD dose measurements as a function of collimation are presented. The significance of collimation in specific clinical studies involving small, fairly well-circumscribed lesions is discussed.


An instrument for aligning patient-positioning lasers. The accurate adjustment of patient-positioning lasers is difficult and tedious. An optical instrument has been developed which enables rapid and extremely accurate adjustment of these. The instrument may be applied to several other tests of the alignment and adjustment of teletherapy and simulator machines.


Theoretical considerations of effects of x-ray film-screen characteristics on threshold detectability of small low-contrast objects. An expression is derived for visual contrast of a radiographed small object that takes into account the proportion of scattered radiation as well as the shape of the sensitometric curve of the film-screen combination. Based on this expression for visual contrast applied to two different film-screen systems, predictions are made for threshold perceptability of low-contrast objects radiographed with the two imaging systems in the presence of scattered radiation and at different points on the sensitometric curves.


An instrument with digital readout for indirect determination of kVp. An electronic instrument with digital readout has been designed and constructed for indirect determination of the kVp applied to diagnostic x-ray tubes. The signals from two detectors exposed simultaneously to a differentially filtered x-ray beam are processed by analog computing circuitry to yield an output signal directly proportional to the applied peak kilovoltage. Theory and preliminary results are presented and discussed.


Measurements of the effects of x-ray film--screen characteristics on threshold detectability of small low-contrast objects. Experiments were performed to test threshold detectability of a small nylon bead radiographed with two different image receptors and under different scattering conditions. In another paper, the present authors predicted, on theoretical grounds, the visibility of small low-contrast objects radiographed in the presence of scattered radiation. The experiments discussed in this paper tested these predictions using an observer-testing method resulting in Receiver Operating Characteristic (ROC) curves. In addition to the rigidly controlled experiments from which the ROC curves were obtained, another experiment was performed in which a human phantom was used and the radiographs rated as to the visibility of small artificial lesions. By and large, the experiments confirmed the predictions made from the theoretical analysis, using visual contrast as a measure of detectability.


Energy dependence of correction factors for two models of Keithley diagnostic ion chambers. The energy dependence for each of two models of ionization chambers compatible with the Keithley model 35020 Digital Dosimeter, is determined by measurement of the exposure correction factors determined over the diagnostic x-ray range (0.4--4.9 mm AL HVL) for several for several samples of each model. The results of an analysis of variance performed by model on the correction factors are reported as mean correction factors for the x-ray beams evaluated, with a relative standard error of less than 1% for both cases. Energy-dependence curves for the two chamber models are given, and their use is described.


Measurements and calculations of the influence of thin inhomogeneities on charged particle beams. The predictions of an analytic technique for calculating fluence and dose distributions beneath thin inhomogeneities are presented for a number of structures, including a rectangular cavity or bar, a cylinder, a disk, and an angled or diffuse edge. Experiments with both electrons and protons for several geometries are presented and compared with predictions based on this technique. We offer some clinical guidelines for avoiding large perturbations due to scattering effects.


Towards optimum blurring in spiral tomography. Attempts to increase the degree of blurring of nonfocused layers in tomography are inevitably associated with a worsening in the amount of artefactual detail introduced. A mathematical optimization technique has been employed to indicate how these conflicting characteristics may best be reconciled. The technique uses plausible definitions, based on the transfer function, of the effectiveness and the fidelity of the blurring, and generates a sequence of spread functions in which these two aspects are optimally combined.


Thermometry considerations in localized hyperthermia. The introduction of local hyperthermia as a method of cancer therapy implies the necessity of quantitative measurements of the thermal dose. Our intention is to describe the nature of the problem, both physically and physiologically, with illustrations drawn from thermographic measurements in phantoms and in animals. The characteristics of a thermometry calibration facility are described. Some measurement problems associated with conventional thermometer probes are mentioned and several new thermometers which were developed for use in the electromagnetic fields are reviewed. We present some of the concepts that will guide the development of noninvasive thermometry. Systemic hyperthermia is not considered. We recommend that other reviews specifically directed toward localized hyperthermia be prepared on the methods of heating and on thermal physiological problems.


A technique for calculating the influence of thin inhomogeneities on charged particle beams. A method has been developed for calculating the fluence and dose perturbations which occur in the shadow of inhomogeneous structures exposed to beams of charged particles. It is shown that differences in scattering power in adjacent portions of irradiated material can give rise to fluence perturbations which, in turn, are responsible for dose perturbations. A quantitative analysis of this process is developed which permits calculation of both the perturbed primary fluence and dose distributions. Results of these calculations are given for a square-faced edge discontinuity. The analytic technique, however, can be applied to more complicated interfaces and the general formulae are developed in this paper. They include provisions for the important modifying effects of beam divergence, of overlying or underlying homogeneous material, and of nonuniform beam profiles. In a companion paper, more complex geometries are analyzed and comparisons between calculations and experiments are presented.


Bacterial protoplast fusion: recombination in fused protoplasts of Streptomyces coelicolor. Numerous recombinants arose when protoplasts of S. coelicolor were treated with polyethylene glycol and regenerated on non-selective solid medium. In six-factor crosses, recombination frequencies of more than 10% (up to 17%) were routinely observed. This recombination did not require either of the known sex factors, SCPI and SCP2. The proportion of multiple crossover classes was much higher than amongst recombinants produced by conjugated between mycelia. Analysis of the spatial distribution of crossovers in double and quadruple  crossover recombinants showed only a slight tendency for crossovers to occur closer together than randomly on the complete linkage group. This suggests that genomes brought together by protoplast fusion are complete, or nearly so (in conjugation, in contrast, one genome is represented by a comparatively short fragment). Individual colonies arising from fused protoplasts did not contain different parental genomes without recombinants, but recombinants often occurred without parentals. Several recombinant genotypes often occurred in the same colony, showing a segregation of some, only, of the parental alleles. Complementary genotypes, parental or recombinant, did not occur in the same colony. It is postulated that complete genomes of fused protoplasts usually become fragmented and that crossing-over, often repeated, occurs between the fragments, to generate haploid recombinants. Analysis of fusions between propoplasts of four different genotypes indicated that the average number of protoplasts fusing together was low, but nevertheless appreciable numbers of fusions involved three or four genomes. Crossing-over between them produced recombinants inheriting markers from three or four parents. The generation of nearly random populations of recombinants between two or more parent strains by propoplast fusion under the conditions described appears to have simple applications in industrial and academic strain construction.


Evidence for plasmid like DNA in a filamentous fungus, the ascomycete Podospora anserina. The existence of plasmid like DNA was demonstrated in senescent mycelia of Podospora anserina (strain s) by biophysical and electronmicroscopic methods. According to their contour length of about 1.4 and 2.7 micron respectively the molecular weight for the monomer is in the range of 3.10(6).


Number and molecular weights of the basic proteins of rat liver ribosomes. 1) Efficient separation of the proteins from rat liver ribosomes can by achieved by two-dimensional polyacrylamide gel electrophoresis. Complete separation of all components, however, is not possible with one system only. Comparison of the results obtained with different systems suggests further heterogeneity of S15, L22, L28, L33 and L35 and enables identification of S15a, S15b, L22a, L22b, L28a, L28b, L33, L33a, L35a and L36b. 2) Ribosomal proteins were substituted with iodoacetamide prior to electrophoresis or handled in all steps of the procedure in the presence of reducing agents. These procedures prevent the formation of oxidation products described erroneously as ribosomal proteins S5, S6, L15, L17 and L32 in earlier papers. 3) Estimation of the molecular weights was performed by two-dimensional separation of the small and large subunit proteins using sodium dodecyl sulphate in the second dimension. The positions of the 70 basic proteins in the 2-D patterns were identified. 4) The small and large subunit proteins have molecular weights in the range of 8000 to 35,000 and 11,000 to 55,500 Dalton, respectively. The number average molecular weights for the small and large subunit proteins are 22,500 and 26,500 Dalton, respectively. The sum of the molecular weights is 0.67 x 10(6) Dalton for the proteins of the small subunit and 1.05 x 10(6) Dalton for the proteins of the large subunit.


Analysis of the methylated 'cap' structures of vaccinia mRNA by two-dimensional thin-layer chromatography. Two different twodimensional cellulose thinlayer separations for blocked, methylated mRNA 5'-termini are described. They allow rapid analysis even of complex mixtures of mRNA "cap" structures on the basis of their methyl group content and base composition. These simple procedures are especially useful for the analysis of [3H-methyl]-labeled mRNA in combination with tritium fluorography. A qualitative and quantitative analysis of the methylated "cap" structures of in vitro labeled Vaccinia "core" mRNA is presented. The presence of methylated "cap" structures in Vaccinia RNA increases the in vitro translation efficiency of methylated Vaccinia RNA over Vaccinia RNA transcribed in the absence of a methyl group donor.


The in vitro reassembly of rough endoplasmic reticulum: ribosome binding capacity. Rough endoplasmic reticulum membranes were dissolved in 1% deoxycholate and the deoxycholate was then dialysed out for five days. Well-defined bilayer vesicles were formed only if the dialysis was performed at room temperature for the first six hours. The vesicles were separated into a pelleted fraction (Fraction 1) and a fluffy layer (Fraction II) by centrifugation. As measured by amino acid incorporation ability, Fraction II bound polysomes, while Fraction I did not. When smooth endoplasmic reticulum was assembled, it was found that Fraction II so derived had a polysome binding capacity which was more sensitive to increased KCl concentrations (25 mM - 100 mM KCl) and that it bound significantly more monosomes than the corresponding fraction derived from rough membranes. The SDS-polyacrylamide polypeptide patterns of the various fractions were compared.


Iron hydroxide: model for enzymes that oxidize proteins. The particles of an iron hydroxide sol were found to be a suitable model for protein-oxidizing enzymes such as peroxidase and polyphenol oxidase. In addition to small molecules such as pyrogallol, human serum proteins, albumin and gamma-globulin, are shown to be substrates of the oxidizing model. The activity is markedly increased by the addition of small amounts of copper to the iron in the particles of the sol. The size and molecular weight of the enzyme model, as well as the number of active centers were determined.


Effect of biotin on phosphorylation, acetylation, methylation of rat liver histones. Biotin deficient rat liver histones showed decreased phosphorylation and methylation, and increased acetylation rates as compared to normal rat liver histones: these alterations may be related to the observed lower stability of the interactions between histones and DNA. The modifications of the metabolic process might be the consequence of an alteration of the synthesis of the enzymes involved in histone phosphorylation, acetylation and methylation mechanisms and are presumably related to a biotin effect upon the synthesis of RNA and proteins.