Childhood Hodgkin's disease in Uganda: a ten year experience. Between 1967 and 1977, 48 patients with Hodgkin's disease under 16-years-old were treated with MOPP chemotherapy alone at the Uganda Cancer Institute because radiotherapy facilities are not available. Thirty-eight percent had early stage disease (stages I-IIIA). Prolonged first remissions were achieved in 74% of 42 complete responders. Of 11 patients who relapsed, 5 had prolonged second remissions induced by MOPP. Three patients were lost to follow-up and 15 of the remaining 45 died: 12 of these from progressive Hodgkin's disease, 2 from unrelated causes and 1 from Burkitt's lymphoma after 4 months remission from Hodgkin's disease. Acturial survival for all patients is 67% (75% for stages I-IIIA and 60% for stages IIIB-IV). Treatment complications included Herpes zoster and gynaecomastia. The latter is probably related to gonadal dysfunction. All stages of childhood Hodgkin's disease can be successfully managed with MOPP chemotherapy alone.


The determination of the free magnesium level in the human red blood cell by 31P NMR. The phosphorus NMR spectra of intracellular ATP in glycolyzing human red blood cells maintained at 37 degrees C in an atmosphere containing 5% CO2 have been obtained and quantitated under completely aerobic and anaerobic conditions. A comparison of the separation between the alphaP and betaP resonances and the alpha-beta and beta-gamma 31P spin-spin coupling constants of intracellular ATP with appropriate controls directly reveals that 84 +/- 4% and 78 +/- 4% of the total ATP are complexed to Mg2+ in the aerobic and anaerobic states of the cell, respectively. This determination does not differentiate between molecules free in solution and those bound to hemoglobin due to rapid exchange on the NMR time scale of free and complexed ATP. From these data and the prior knowledge of the interactions of various phosphorylated metabolites with hemoglobin and Mg2+, the intracellular concentration of free Mg2+ is determined to be 0.25 +/- 0.07 mM in the aerobic and 0.67 +/- 0.15 mM in the anaerobic state in a sample of normal red blood cells. Knowledge of free Mg2+ permitted a calculation of the distribution of ATP, ADP, glycerate-2,3-P2, and hemoglobin among their free and complexed forms. The results indicate that approximately 40% of the glycerate-2,3-P2 and ATP are complexed to hemoglobin even in aerobic cells and approximately 90% and approximately 60%, respectively, in completely anaerobic cells. The level of free ATP decreases 3-fold anaerobically whereas the MgATP changes very little. The intracellular level of MgADP increases about 2-fold upon deoxygenation. Since the Mg2+ in the red cell is largely complexed, the 3-fold increase in free Mg2+ under fully anaerobic conditions would significantly affect the rates of enzymatic reactions.


Is protein turnover thermodynamically controlled? A parametric correlation (p less than 0.01) has been found between the in vitro thermal stability and in vivo turnover rates of nine intracellular proteins. These results are discussed in terms of a "thermodynamic" model for turnover control, in which the rate of intracellular protein degradation is controlled by intramolecular conformation equilibria. A peculiar exception is provided by glyceraldehyde-3-phosphate dehydrogenase which is stable in vivo, but not in vitro.


Blood-collecting methodology does not affect the maturational pattern of serum hormone concentrations (testosterone, LH, FSH and prolactin) in the male rat. Serum hormone levels of blood collected within 1 min by cardiac puncture following ether anesthesia were compared to those of blood collected by decapitation in male rats 30, 60, and 90 days of age. Neither testosterone (T) nor LH was affected by the method of blood collection. Serum FSH was significantly elevated in blood collected by cardiac puncture, and 30-day old rats were the most sensitive to this effect. Serum prolactin (Prl) was significantly elevated in all age groups when blood was collected by cardiac puncture. Both blood-collecting methods demonstrated that, in the 3 ages tested, serum T increased with age, LH and FSH decreased with age, and Prl did not change with age, indicating that blood collection by cardiac puncture is as valid a method as is decapitation for assessing serum hormone levels during maturation.


Interactions of catecholaminergic receptor blockers with lethal doses of amphetamine or substituted amphetamines in mice. Lethality to both isolated and aggregated mice was determined for graded i.p. doses of d-amphetamine, dl-4-methoxyamphetamine (PMA), dl-2,5-dimethoxyamphetamine (DMA), dl-2,5-dimethoxy-4-bromoamphetamine (DOB), dl-2,5-dimethoxy-4-methylamphetamine (DOM) and d1-3,4-methylenedioxyamphetamine (MDA). Haloperidol (2.0 mg/kg), propranolol (10 mg/kg) and phenoxybenzamine (30 mg/kg) were tested for ability to antagonize the lethal effects of amphetamine and its derivatives. Considerable protection against amphetamine lethality was produced by haloperidol in both isolated and aggregated mice and by phenoxybenzamine in isolated mice, but propranolol was ineffective. An equivalent degree of protection was not achieved by use of any of the three agents before PMA, DMA or DOB. Protection against DOM was achieved only with phenoxybenzamine and only for isolated mice. Extensive protection against MDA was supplied by both phenoxybenzamine and propranolol for either condition of housing. Despite close structural relationships between the toxicants, the antidotal effectiveness of the receptor-blocking agents seemed quite limited and specific, and did not support any generalizations.


Sustained ventricular tachycardia: evidence for protected localized reentry. The components of the reentrant circuit were evaluated in 26 patients in whom sustained ventricular tachycardia could be reproducibly initiated or terminated, or both. Observations suggesting that the proximal His-Purkinje system was not a requisite component included (1) lack of requirement for retrograde His-Purkinje delay or bundle branck reentry, or both, for initiation of the tachycardia: (2) anterograde depolarization of the His bundle during ventricular tachycardial without alteration of the QRS configuration or cycle length; and (3) the presence of random retrograde His potentials during the tachycardia. Evidence that the reentrant circuit was localized to a small area of the ventricles included (1) the ability to capture large segments of the ventricles transiently or continuously with occurrence of intermittent or continuous supraventricular capture either spontaneously or with atrial pacing without effect on the tachycardia. These findings suggest that the reentrant circuit must be small, electrocardiographically silent and relatively protected.


The role of arteriography in abdominal aortic aneurysm. The results of arteriography in the management of 100 consecutive patients with abdominal aortic aneurysms are presented. Arteriographic information had substantial influence upon management decisions and performance of surgery in 75 per cent of cases. We found the preoperative knowledge of the precise vascular pathology or anatomic variants not only permitted a more rational recommendation for or against surgery but aided in the selection of the most suitable surgical procedure.


Histamine-, norepinephrine-, and dopamine-sensitive central adenylate cyclases: effects of chlorpromazine derivatives and butaclamol. A series of recently available derivatives (quaternary and hydroxylated) of chlorpromazine (CPZ) and butaclamol were evaluated with respect to antagonism of norepinephrine- (NE) (rat cerebral cortex), dopamine- (DA) (rat striatum) and histamine- (H) sensitive (rabbit cerebral cortex) adenylate cyclases. With incubated tissue slices (rat and rabbit cortices) CPZ-CH3, 7-OH-CPZ-CH3, beta-OH-CPZ and butaclamol displayed a capacity to inhibit either NE- or H- induced accumulation of adenosine cyclic 3',5'-monophosphate (cAMP). With the broken cellular enzyme responsive to DA, rather potent inhibition of enzyme activity (IC50 less than 24 micron) occurred with butaclamol, beta-OH-CPZ, 7,8,beta-triOH-CPZ, 7,8-dioxo-beta-OH-CPZ and 3,7,8-triOH-CPZ. It is concluded that the metabolites of CPZ contribute to the central therapeutic and/or side effects of the parent compound.


[The prevention of late psychological sequelae following therapeutic termination of pregnancy. The role of the doctor during consultations (author's transl)]. Legal termination of pregnancy only rarely has psychological sequelae, which furthermore are usually moderate and transitory. They are usually found in women who have been pressed to have a termination by third parties, in those women who are ambivalent as far as the termination is concerned, in those who submit to the operation because of a medical indication and in those women where there is a brittle psychological state before pregnancy. The author makes certain suggestions which should help to prevent psychological troubles developing in a certain number of cases.


[Transsphenoidal surgery in hypersecreting pituitary tumors: endocrine follow-up (author's transl)]. Among 18 patients suffering prolactin adenoma and 16 acromegalic patients, plasma levels of PRL and HGH respectively returned to normal vlues (PRL = 9 +/- 2 ng/ml HGH = 4.2 +/- 0.8 ng/ml) immediately after selective removal of the pituitary adenoma by transsphenoïdal route. In all cases tumoral symptoms were reduced. Menses were recovered 36 +/- 5 days after surgery in all patients with prolactin adenoma. Pregnancy succeeded in nine of these women. Per-operative studies of HGH and PRL plasma variations proved to be of good prognostic value. The evaluation of the pituitary functions was performed before and after surgery. In no case pituitary deficiency occured after treatment. Furthermore the regulation of somatotropic and prolactin functions have been documented by the use of different provocative tests before and after treatment. They allow discussion of the pathogenecity of these hypersecreting tumors.


[Frequency of vulvovaginitis in girls with intestinal enterobiasis]. The study included 415 female patients with the diagnosis of enterobiasis seen at the Hospital del Niño, DIF. Vulvovaginitis was found in 78 cases (18%), with definite predominance in the school-age group. The clinical manifestations in order of frequency were: perianal and vulvar pruritus, abdominal pain, leukorrhea and vulvar edema. Graham's perianal and perineal smear method was performed with 100% positiveness in personal and 85% in perineal smears. The treatment should be directed to improve the family sanitary habites and the prescription of the choice drug to the patient and to his family. The following drugs are quite as effective: piperazine citrate, pyrvinium pamoate, pyrantel pamoate and mebendazole. The physician should use the drug that better fits the patients convenience, keeping in mind the easy determination of the dose and the cost in order to offer the patient and his family the best choice.


[Aortopulmonary window vs. persistency of the arterial duct]. On review of the cases of congenital cardiopathies at Hospital General de México, S.S.A., only one case of aortopulmonary fenestration was found and another case of persistence of the arterial duct that was confused with the first diagnosis. Both cases are reported. The world literature on the differential diagnosis of these two and of other malformations with similar clinical manifestations was reviewed. The physical examination of the precordial area and auscultation of murmurs are specially stressed as factors leading to a clinical suspicion of the aortopulmonary septal defect. Comments are made on the clinical hemodynamic course of these two entitites where electrocardiographic and radiological data are similar in both. Thorough hemodynamic studies, catheterization and selective angiography, supply anatomic and pathophysiological data to aid in the correct diagnosis.


[Treatment of Bell's palsy in pediatrics]. A series of 22 consecutive cases of idiopathic Bell's palsy are presented, 9 patients obtained return to the normal facial function without treatment and 2 more have had an importnat degree of recovery and it is expected they return to the normal facial function. Two cases did not show any recovery as they were cases with a chronic evolution and facial nerve degeneration. They did not receive any treatment. Facial nerve decompression was indicated in 8 cases; one hundred percent normal function was the result in 6 patients and a good result was obtained in the remaining 2 and complete recovery was expected shortly after.


[Osgood-Schlatter's disease].

[Osgood-Schlatter's disease]. Two patients with Osgood-Schlatter's disease studied at the Unidad de Pediatría Hospital General de México are reported. Both with the same ago, sex and clinical symptoms. No surgery was performed. Several considerations are made on etiology, clinical, radiologic and histopathological aspects. Treatment is discussed and a complete review of medical literature is made.


[Cancer (present status)].

[Cancer (present status)]. The basic biological aspects in relation to cancer are reviewed and how this concepts has influenced the rational treatment of this disease. The best results achieved in the treatment of cancer are obtained because of the use of a more radical treatment. And for the patients with not very advanced stages, the results have been improved with the prophylactic treatment on those areas where the tumor usually gives metastases. However, an early diagnosis and the proper treatment are the best way to obtain relieve in this group of patients.


[Progressive fibrodysplasia assificans]. A five years old patient with myositis ossificans progressiva is presented. This very rare disease is inherited as an autosomal dominant and it is characterized by an abnormality of the connective tissue, specifically, aponeurosis, fascias, tendons and ligaments; the muscle are secondarly affected.


[Main surgical entities in the newborn infant and general principles of management]. The present article describes the most important surgical pathology of the infant, who sometimes requires immediate management. The authors mention the essential points for diagnosis and treatment. The main purpose of this article is to emphasize the importance this knowledge has for the pediatrician and general practitioner, who have the first contact with these patients, and in whose hands rests an opportune diagnosis and surgical management.


[Hyperthrophic congenital pyloric stenosis]. An analysis is made of 18 cases with congenital pyloric stenosis, attended at the Hospital General de México S.S.A. The discussion is focused toward: age, sex, clinical, laboratory data and radiological features. Literature to this respect is reviewed finding historical data, surgical techniques employed and etiological hypothesis. We conclude, that every physician who attends children must keep in mind that infants under four months of age, with a history of vomiting immediately after feeding, without biliar contents, progressive in frequency and intensity, accompanied by pyloric stenosis must be suspected. The clinical examination must be directed to finding peristalic waves and pyloric tumor. Pyloromyotomy is the treatment in all cases. The prognosis should be favorable if the diagnosis and correction are properly and promptly made.


[Program of integral general medicine].

[Program of integral general medicine]. This paper intends to present to all the medical profession, but more specifically to the Medican and Latin American medical workers and authorities, the main purposes that arm and give structure to a new concept of teaching and learning medicine called, "Integral General Medicine" (also known as "Plan A-36"). This plan in basically conceived for México and most of Latin American countries, but may be applied to any other. The main idea is to keep the students in close contact with the community in order to achieve the best of their knowledge, both theoretically and practically, since the very early stages of their entrance to the medical school. The whole scholarship curriculum is described with reference to every one of the four academic years that accomplish the program.


[Community in medical education programs of integral general medicine]. This paper includes the chief considerations about the community work in the Integral General Medicine Program Called Plan A36. General considerations are made abour the four years of trainign program in which the medical student in exposed to be in close contac with the most common medical and health problems in his country, and during this period of time, he becomes capable to develop all the techniques to act as a primary contac physicain.


[Control of the healthy child as part of the community medicine]. The authors recommend the need to control the healthy child who periodically attends the pediatrician's or the general practitioner's office, stressing the importance to practice medicine at a primary level without waiting to produce a diagnosis when the disease has reached a dangerous point or else, when unwanted sequels have been established.


[Epidemiological survey of vaccination]. This paper presents the results obtained in an epidemiological survey conducted at Unidad de Pediatría del Hospital General de México, S.S.A., in 1,009 patients, randomly selected. The routine immunization schedule, followed in Mexico during the last few years was investigated. The results are presented for every one of the vaccines, according with the age periods. Considering the group as a whole, the results are significantly low, as far as the recommended standards pretend. It is concluded that it is necessary to strengthen the vaccination program in this country, in order to avoid the possibilities of new breaks of epidemics related with this marked lack of immunization in the community.


[The most important abdominal surgical emergencies in the newborn]. The neonatal period should be considered, in itself, as one of high risk, due to its natural anatomical and physiological lability. It is in this age, when characteristic pathological processes do occur, mainly digestive abnormalities, neonatal nectrotizing enterocolitis, Hirschsprung's disease and others. The authors report a four years statistical analysis in the Pediatric Surgery Service of the General Hospital "La Raza" Medical Center. There were 126 patients operated in the neonatal period. The treatment given in each case and the results obtained were compared with reports from the international literature.


[Intestinal pneumatosis in pediatrics. Report of 72 cases]. We analyzed 72 cases of pneumatosis intestinalis at the Hospital Infantil de México during a 32 years period. We found the higehst incidence in children under 6 months of age. In the new-born period, the entity is associated with necrotizing entrocolitis and in the older children group, this alteration is associated with gastroenteritis. The diagnosis was made by radiology in 93% of the cases and in 7%, it was made at the surgical event. We propose 3 mechanisms in the pathophysiology of the entity having all of them disruption of the integrity of the intestinal mucosa and higher pressure of the intraluminal gas. The mortality rate was high because we included cases from the initiation of the hospital's activities (1943). The conclusion is: 1) The prognosis is based on an early diagnosis. 2) It is imperative to take proper care of the complication. 3) It is also very important to give a rest for variable period of time to the injured intestine with parenteral feeding and eventually, elemental feeding.


[Tracheotomy].

[Tracheotomy]. This work deals with a review of the main aspects involved in the practice of tracheostomy which could be considered an easy procedure; however, the fact is that errors are continuously observed when it is indicated or performed; likewise, many mistakes are made during the care of the patient with a tracheostomy. If all this aspects are of importance in the adult, this importance increases in the child because of the great anatomical and physiological differences which always should be kept in mind in order to avoid complications of the procedure.


[The placenta from the pediatric point of view]. The integrity of the placenta is subject to numerous pathological processes that may make it less efficient, affecting the growth and development of the fetus. Some of these processes have been pointed out to illustrate the fact that perinatal evaluation is incomplete when placental examination is absent. The understanding of many perinatal events will be facilitated when this organ has been more routinely examined and the findings correlated with materno-fetal history and infant development.


[A peculiar syndrome of congenital abnormalities]. Two cases of mental retardation distichia, blepharophimosis, blepharoptosis, synophrys, prominent and long phyllum, auricular defects, palmar simial crease, clinodactyly and lymphedema, in a child and his mother, is represented, suggesting a specific syndrome due to a genetic defect inherited in an autosomal dominant fashion. Two other cases with blepharophimosis, blepharoptosis, prominent and long phyllum and mental retardation are commented, suggesting a different expression of the same genetic defect.


[Juvenile rheumatoid arthritis and scleromalacia perforans]. A 13 year-old-boy with poliarticular seronegative juvenile rheumatoid arthritis (JRA) and bilateral scleromalacia perforans is described. Ocular lesions were thought to be seconadry to vasculitis. Improvement was obtained with systemic and local corticosteroid therapy, and with subconjunctival auto-graft of fascia lata. This is the first report in the literature about scleromalacia perforans in JRA.


[Transumbilical aortography in the newborn infant with abdominal tumor]. The use of the umbilical vessels to perform angiographic studies in the neonatal period, has been previously mentioned. In this paper, we present our experience in the use of this route to carry out aortography in the study of abdominal tumors. This method was performed in the last 2 years in 7 patients, ages 1 to 10 days. The procedure is easy and of low cost and practically without complications if properly applied. We have now another method to evaluate abdominal masses in the newborn.


[Acute respiratory insufficiency in polyneuritis]. Lethality in polineuritis is directly related to severe respiratory distress. The latter dropped from 40 to 0% in severe types at Hospital de Pediatría del Centro Médico Nacional with the procedures of assistance to the positive pressure ventilation and tracheostomy. The application of pressure is offered to be given at the end of expiration to correct hypoxemia from short circuit due to decrease in V/Q relation PEEP in, Retrospective study of 13 cases.


[ Growth hormone in patients with diabetes mellitus of the juvenile type]. Blood glucose and growth hormone were measured in eight juvenile onset diabetic patients and in controls. Blood samples were obtained every 90--120 minutes for two consecutive days; in one of them, the patients received intermediate insulin, and in the other, they were also injected with additional doses of regular insulin, in order to improve their diabetic control. Normal subjects were studied in the same manner during 24 hs. without insulin. Diabetic patients showed significantly higher blood glucose and growth hormone levels when both insulins were used and only significantly higher blood glucose when they received intermediate insulin alone, than control subjects. They also showed significantly higher growth hormone and lower blood glucose levels on the day of intermediate insulin plus regular insulin than on the day of intermediate insulin. In two prebubertal controls, we observed growth hormone spurt only during sleep, while four adolescent controls showed it both while awake and asleep, as it was in all the diabetic patients we studied, including two prepubertal diabetics, one was 10 years old, and the other 13 9/12, with Turner's syndrom untreated with sexual hormones. We discuss our findings comparing with present day knowledge on this field.


[Thrombocytosis in juvenile rheumatoid arthritis]. To find out the possible relationship between thrombocytosis and JRA, 2 to 11 platelet counts (every 1 to 6 months) were  performed in each of 26 patients with active JRA, and were compared with figures for hemoglobin, WBC, sedimentation rate and articular index. Thrombocytosis was found in 88% of the cases. There was positive correlation, with statistical significance, among thrombocytosis, anemia, and sedimentation rate. Significant relationship was also found among thrombocytosis, the presence of articular inflammation and leukocytosis. There was no parallelism between platelets types of the disease. We conclude that in active JRA, thrombocytosis is a frequent finding in relation with anemia and the inflammatory activity of the disease.


[Congenital pulmonary cysts].

[Congenital pulmonary cysts]. The clinical and surgical experience on congenital pulmonary cysts at the Hospital Infantil of México was reviewed. No preponderance in sex or family inheritance was found. The clinical diagnosis was made in over one half of the patients and was confirmed in the 18 patients who were operated. Treatment should be surgical with resection of the affected pulmonary lobe. In some cases it was possible to excise only the pumonary cyst, without total removal of the lobe. Mortality resulted in three of the surgical patients. The most frequent pulmonary cysts in this series were the bronchogenic and patients with parasitic cysts, lobe emphysema and pulmonary sequestrum were excluded.


[Seasonal variations in ascorbic acid concentration in children from Mexico City]. With the purpose of finding out whether the concentration of ascorbic acid in the serum in children suffered significant variations through the different months of the year, 301 blood samples were studied; 108 were studied in the month of January; 92 in the month of May and 101 in September. No statistically important difference was found after comparing the averages corresponding to the 3 samples studied. However, the analysis of the concentration of ascorbic acid in terms of the ages of the patients showed an unquestionable seasonal variation in the sera corresponding to children under 3 years of age. This same age group showed the most significantly low averages through the different stages of the calendar year.


[Familial Pierre Robin's anomaly].

[Familial Pierre Robin's anomaly]. The present paper describes a family with daughter and son affected with clinical characteristics of Pierre Robin's anomaly. The pedigree suggests an autosomal recessive inheritance pattern. The authors mention that in order to have more genetic evidence on this trait, an extensive study of families, with at least one proband should be made for a correct genetic analysis.


[Basic diet in medicosurgical problems]. This review describes the chemical composition of the elemental diet and the metabolic findings which support its management in medical and surgical entities. The efficacy of the elemental diet has been reported in a variety of gastrointestinal problems and diseases characterized by an increase of the rate of body catabolism. The procedure used in the administration of this type of diet and the potential risk of complications in children are mentioned.


[Etiological factors in children with reading disorders]. Twenty-three children with reading retardation were studied from the etiological point of view, finding that 14 cases were associated with a low I. Q.; 5 with integrative defect of the C N S; 3 with sensorial defects; one with emotional conflicts and one with language duality. Reading retardation; dyslexia; intellectual retardation; integrative defects of the CNS; sensorial defects; emotional conflicts; language duality.


[Infections in children with cancer].

[Infections in children with cancer]. In 38 patients with acute lymphocytic leukemia and Hodgkin's disease 60 episodes of infection were registered showing the unquestionable increased susceptibility to infections in these cases. In 90% of the patients the infectious focus was localized and the pulmonary showed to be the most frequent. The etiology of the infection was established in 53% of the episodes and the bacterial, both gram-positive as gram-negative, showed the greatest frequency. In the second place came viral infections (measles and chicken-pox). Finally, two pathogenic agents, unusual in children without cancer were seen: Candida albicans and Pneumocystis carinii. Treatment was given according to the etiological agent. When it was not determined, methycillin-gentamicin was given and if the problem was pulmonary and response was not obtained within 4 to 6 days, trimetoprim-sulfametoxazole was chosen. Five children died as direct consequence of infection (13% of the patients), 2 of them (5%) without tumoral activity at that moment.


[Infant mortality in cuba; analysis of a program for its reduction (1970-1976)]. Analysis is made of the results of the reduction program of infantile mortality which began in 1970. Said reduction dropped from 38.7 in 1970 to 22.8 per thousand live births in 1976, for a diminution of 41.5%. The early neonatal decreased from 18.2 to 12.3 per thousand live births for a drop of 32.7%. The late noenatal decreased from 5.3 to 2.30/100 live births with 57.2% reduction and the postneonatal dropped from 15.2 to 8.2 per thousand live births for a diminution of 46.5%. Infantile mortality is reported for the different departments and the order in which the main causes of death are grouped is stressed as follows; 1st, perinatal affections (B43-B44); 2nd, congenital anomalies (B42); 3rd, influenza and pneumonia (B31-B32); 4th, enteritis and other acute diarrheal diseases (B4) AND 5th, sepsis (A21). The average number of puericulture office visits per infant under 1 year of age increased from 2.7 to 6.7. Institutional births increased from 93.3 to 97.8%. The steps taken to achieve these results are described.


[Normal pressure hydrocephalus. Part 2. The evaluation of severity of cerebral dysfunction by measurement of "barrier ratio" and regional cerebral blood flow (author's transl)]. In the previous study, quantitative analysis of RI ventriculography was reported in fifty-three cases with chronic communicating hydrocephalus. In this study, according to the same criteria as that of previous report, fifty-three cases were divided into two groups, namely NPH group (twenty-seven cases) and control group, which were considered as mere chronic communicating hydrocephalus without and NPH chalacteristics. (twenty-six cases). Results of "barrier ratio (B.R.)" measurement and regional cerebral blood flow study in these cases are as follows: 1) "Barrier ratio" using of 99mTcO4-: Concerning about B.R. of 99mTcO4- there was no significant difference between NPH and control group. However it tends to be that shunt surgery is not so effective in NPH cases in which B.R. shows abnormally low value. 2) rCBF by 133Xe clearance method: Regional cerebral blood flow was diffusely decreased in NPH patients, especially in its frontal area, suggesting the frontal area would be more severely damaged in NPH cases. These findings leads us to the conclusion that whether the shunt surgery might be effective or not depends on severity of cerebral dysfunction and the cerebral dysfunction is clearly evaluated by RI technique mentioned above.


[Convexity cavernous hemangioma, its angiographic and CT findings. Report of a case (author's transl)]. A case of cavernous hemangioma which developed in the parietal convexity is reported. Angiography reveals that the mass is located extra-axially in the parietal convexity and the middle meningeal artery feeds the tumor. The feature of tumor stain is pooling or laking of contrast medium which is partially visualized even 10 minutes after injection of contrast medium. CT findings are almost identical to those of meningioma.


[Cerebral hemodynamics in the vegetative state patients--relationship between patterns of dysautoregulation and prognosis (author's transl)]. The pathophysiological analysis of cerebral hemodynamic mechanisms and its metabolism in the vegetative patients was not enough until now. It was reported in this paper that the correlation between cerebral hemodynamics, metabolism and neurological function was analysed in 14 patients with vegetative state caused by cerebrovascular disorders. The materials consist of 14 vegetative patients due to 7 hypertensive intracerebral hemorrhage, 6 subarachnoid hemorrhage and one cerebral infarction. In all of them, the cerebral hemodynamics such as cerebral blood flow (CBF), CO2 reactivity and autoregulation, and cerebral metabolism were measured sequencially by 133Xe clearance methods. In the majority of cases, both values of mean hemispheric CBF and cerebral oxygen consumption (CMRO2) were markedly decreased with severe impairments of autoregulation and CO2 reactivity on the bilateral hemispheres but much more significatly on the affected hemispheres. Futhermore, from view points of the pressureflow relationship in the CBF studies, the patterns of dysautoregulation could be classified into 2 types as follows; Type 1 is the complete loss type, which has no plateau formation in all ranging of systemic arterial blood pressure (SABP). Type 2 is the incomplete loss type with 2 subdivisions, in which the abnormal narrowing plateaus are recognized in relatively higher or lower range of SABP (called as the upper or the lower type of incomplete loss type respectively). And then, the phenomen, which we gave a term as "shift-off phenomenon", was recognized in 8 cases that the proper values of resting SABP was seated outside the plateau level of the auto-regulatory capacity. The correlation between CBF dynamics and the grade of vegetative state was analysed. In 2 cases with slight communications (vegetative grade1), mean hemispheric CBF value was 32.5 (ml/100 g/min.) and CMRO2 was 2.01 (ml/100 g/min.) with the normal or the upper type in incomplete loss of dysautoregulation. In 3 cases of vegetative grade 2, who could slightly response to vocal order, mean CBF and CMRO2 showed 27.0 +/- 2.0 and 1.7 +/- 0.08 respectively. In these cases, dysautoregulations with the upper type incomplete loss were recognized. In 3 cases of vegetative grade 3, who had only spontaneous movement of body and slight emotional expression but no response to vocal order, mean CBF was in 22.4 +/- 1.9 and CMRO2 in 1.28 +/- 0.21. The patterns of dysautoregulation showed the lower type of incomplete loss. We had experienced the shift-off phenomenon in all of 5 cases with the upper type of incomplete loss and in 3 of 7 cases with the lower type of incomplete loss dysautoregulation. As conclusion, in cases of vegetative grade 2 or 3 whose patterns of dysautoregulation are the upper or lower type of incomplete loss with the shift-off pnenomenon, it would be a useful therapeutic method to get away from vegetative state that SABP could be corrected and controlled within the proper plateau level of autoregulation by the suitable administration of some vasoactive agents.


[Oculomotor palsy caused by aneurysms at the internal carotid-posterior communicating artery junction and its prognosis following intracranial surgery (author's transl)]. Sixty-three cases of an aneurysm at the internal carotid-posterior communicating artery junction with aneurysm-induced unilateral eye-lid ptosis, a symptom of the third nerve palsy, were described. 1) The incidence of this palsy in 189 cases of the aneurysm was thirty-three percent. 2) The palsy before the aneurysm rupture was recognized in three cases (5 percent). The onset of this palsy following an aneurysm rupture was most frequent in the first day and in almost half of the patients within two days, but in four cases the palsy appeared three or four weeks after the aneurysm rupture. 3) The size and direction of the growth of the aneurysms in carotid angiograms were compared between palsy and non-palsy groups and there were no significant differences between them. 4) Thirty-one patients who had had a palsy before direct aneurysm surgery were followed one to ten years post-operatively. In twenty-three (74 percent), the unilateral eye-lid ptosis was recovered by the follow-up. In eleven of the twelve cases operated within two weeks after the onset, the palsy was recovered. On the other hand, in seven of eight not-recovered cases there was a delay of more than two weeks before operation.


[Sturge-Weber syndrome associated with atlanto-occipital assimilation: a report of a case (author's transl)]. A unique association of Sturge-Weber syndrome and atlanto-occipital assimilation is presented. A 18-year-old male was admitted in emergency because of the sudden severe headache and vomiting. He had vascular nevus in the right half of the face at birth and several episodes of generalized convulsive seizures. On admission craniogram demonstrated calcification in the right occipital area. Neurological examination revealed tenderness in the nuchal region, moderate limitation of cervical mobility in a antero-posterior direction, Bruns-Cushing type nystagmus, bilaterally diminished gag reflex, and positive Romberg's test. Spinal tap showed crystal clear CSF with normal pressure. EEG showed paroxysmal slowing focus in the right parieto-occipital area. Polytomography of the craniovertebral junction demonstrated the unilateral atlanto-occipital assimilation on the left associated with the aplasia of the right posterior arch. Myelography was negative. A right carotid angiography disclosed the dilatation of the basal vein of Rosenthal and abnormal venous vasculature. CT-scan demonstrated the calcified region of the right occipital area more distinctly than the plain roentogenogram, but the enhancement study of the leptomeningeal angioma of the Sturge-Weber syndrome was negative. Never been found this rare association in a review of the literature, the authors discussed the clinical and radiological findings of both diseases.


Arterial hypertension in immediate postoperative period after valve replacement. Paroxysmal hypertension occurred during the first 8 hours after cardiac valve replacement in 15 of 186 consecutive patients. The clinical characteristics of this hypertension were similar to those of hypertension after myocardial revascularization, except that this complication occurred much less frequently after valve replacement (8.1%) than after myocardial revascularisation (33%) (P less than 0.001). Hypertension resulting from hypoxia, hypercapnia, shivering, or arousal from anaesthesia was excluded from consideration. The rise in systemic arterial pressure (average 34/35 mmHg +/- 4.9/4.3 SE) was usually associated with a reduction in central venous pressure (12/15 patients) and a mild increase (2 to 4 cm saline) in left atrial pressure. The incidence of hypertension was not related to the valve replaced (aortic or mitral), type of lesion (stenosis or regurgitation), preoperative level of blood pressure, or use of hypothermia during operation. However, none of the 18 patients who had double valve replacement showed significant rise in blood pressure after operation. It is suggested that these hypertensive episodes may be related to pressor reflexes from the heart and/or great vessels.


Non-invasive observations on initial low frequency vibrations of the first heart sound--correlation with the 'presystolic' murmur in mitral stenosis. The initial low frequency component of the first heart sound, 'M', has been studied in normal subjects, and in patients with vario-s prosthetic mitral valves and with mitral stenosis, using simultaneous low frequency phonocardiography, echocardiography, and apex cardiography. The techniques showed 'M' to have a constant morphology in preisovolumic systole. In mitral stenosis, 'M' and the preisovolumic 'presystolic' murmur appear to be the same phonocardiographic phenomenon. While 'M' was present in sinus rhythm, augmentation of this normal vibration occurred particularly during the short cycles of atrial fibrillation. Leaflet coaption and movement of the ventricular wall as detected echocardiographically do not appear to play a role in its pathogenesis but the sound could emanate from the ventricular wall as it tautens and decreases its compliance at the onset of systole.


Myocardial infarction among men below age 40. Studies were made in Göteborg over a period of 6 years of all cases of acute myocardial infarction diagnosed among men below the age of 40. Thirty-six cases were registered and 8 of these died outside hospital. Three patients died early during the hospital stay. The remaining 25 patients were compared with a random sample from the general population in Göteborg with respect to conventional risk factors. Smoking, and high plasma cholesterol values were dominating findings among the patients, whereas there was no significant differences in blood pressure levels. Coronary angiography was performed in 18 patients of whom 2 showed normal coronary arteries and left ventricular angiograms. These 2 patients were the only ones free from risk factors. Of the remaining 16 patients, 10 had only one vessel affected.


Long-term oral antiarrhythmic therapy with mexiletine. Forty-eight patients with ischaemic heart disease received oral mexiletine for the control or prevention of ventricular arrhythmias. The most frequently used doses were 200, 250, and 300 mg 8-hourly. The treatment period varied from 2 days to more than 1 year (median 3 months). No ventricular arrhythmias were detected in more than one-half of the patients. Severe side effects occurred in 15 (31%) of the 48 patients. Major ventricular arrhythmias were observed in 14 (29%) of the 48 patients at a time when the majority had plasma concentrations within the therapeutic range. The value of mexiletine in the management of patients at risk of sudden death is likely to be limited.


Heart type creatine kinase isoenzyme (CK MB) in acute cerebral disorders. Heart type creatine kinase isoenzyme (CK MB) was detected in the serum in 23 out of 53 patients (43%) with acute cerebrovascular, traumatic, or infectious brain damage. Electrocardiogram disclosed abnormalities suggestive of acute myocardial injury in 15 of these 23 patients. Eleven of them also showed increased LD1 activity. Subendocardial haemorrhage was detected in 3 out of 8 necropsied patients with serum CK MB activity. Among those 30 patients in whom no CK MB activity was found electrocardiographic abnormalities suggestive of acute myocardial injury were observed in 2 and increased LD1 was seen in 4 cases. The mortality was higher if either CK MB isoenzyme or electrocardiographic abnormalities suggestive of acute myocardial injury were present, compared with the patients lacking these signs (P less than 0.01). Present findings suggest that acute brain damage may secondarily  cause myocardial damage more often than has been believed before. Results also indicate that a combination of acute brain damage and acute myocardial injury often indicated a poor prognosis.


Re-entry via Mahaim fibres as a possible basis for tachycardia. Paroxysmal tachycardia with widened QRS complexes was recorded in a 21-year-old man. In sinus rhythm there was no evidence of pre-excitation. His bundle studies revealed an abnormally short HV interval of 30 ms. Premature atrial stimuli produced an increased PR interval. At short coupling intervals the His bundle activity became incorporated within the QRS complex. Concurrently, a left bundle-branch block pattern appeared identical to that seen during tachycardia. Closely coupled ventricular extrastimuli initiated a tachycardia identical to the initial episode. A re-entry mechanism via anterograde Mahaim fibres and retrograde His bundle -AV node pathway is postulated.


Non-invasive diagnosis of pseudoaneurysm of left ventricle. A patient free of symptoms, with a pseudoaneurysm of the left ventricle after inferoposterolateral myocardial infarction, is reported. The diagnosis was established by nuclear cardiography and echocardiography of the left ventricle.


Aortic valve replacement during acute rheumatic fever. Emergency aortic valve replacement was performed during an attack of acute rheumatic fever in a 12-year-old black boy. He had an uneventful recovery and has remained asymptomatic 27 months after operation. In the light of this experience and that of others, one might conclude that the decision to operate on these patients should be based on the severity of the haemodynamic derangement rather than on the state of activity in the rheumatic process.


A morphometric study of regional variation in lung structure in infants with pulmonary hypertension and congenital cardiac defect. A justification of lung biopsy. The structure of the pulmonary circulation throughout the lung has been analysed by morphometric techniques in 4 infants dying with ventricular septal defect and pulmonary hypertension. Failure of the intra-acinar pulmonary circulation to develop normally is shown by a reduction in arterial size and number, and an increase in muscularity is judged by the degree of medial hypertrophy and by extension of muscle further along the arterial pathway than is normal. For these features, one section of lung tissue, 1 cm square, proved to be representative of the entire pulmonary vascular bed, and also gave satisfactory assessment of lung growth and development. Lung biopsy can help in the clinical management of children with congenital cardiac defects and pulmonary hypertension if, in selecting tissue at biopsy, allowance is made for any regional differences in pulmonary blood flow.


Improvement in exercise haemodynamics by isosorbide dinitrate in patients with severe congestive cardiac failure secondary to ischaemic heart disease. Seven patients with severe chronic congestive cardiac failure secondary to ischaemic heart disease performed submaximal supine exercise before and after 5 mg sublingual isosorbide dinitrate at the time of cardiac catheterisation. Exercise before isosorbide dinitrate produced a poor response in left ventricular performance. After isosorbide dinitrate this response was significantly improved. Compared with the control exercise period, cardiac index increased from mean 2.6 to 3.1 1/min per m2 (P less than 0.0025), stroke volume index from mean 22 to 27 ml/m2 (P less than 0.0025), and left ventricular stroke work index from mean 21 to 30 g m/m2 (P less than 0.01). Mean left ventricular filling pressure fell from 37 to 26 mmHg (P less than 0.01). Although isosorbide dinitrate reduced left ventricular filling pressure at rest from mean 26 to 17 mmHg (P less than 0.005), there was no significant change in mean cardiac index or stroke volume index, while left ventricular stroke work index decreased from mean 29 to 22 g m/m2 (P less than 0.05). Isosorbide dinitrate effectively reduces left ventricular filling pressure in the resting patient with congestive cardiac failure but produces a more comprehensive improvement in left ventricular performance during exercise.


Effects of selective and non-selective beta-adrenergic blockade on coronary dynamics in man assessed by rapid atrial pacing. The effects on coronary dynamics of propranolol and atenolol were studied in 12 patients undergoing cardiac catheterisation for suspected coronary artery disease. Myocardial blood flow was measured using the coronary sinus continuous thermodilution technique. Data were obtained immediately after drug administration and during rapid atrial pacing. The immediate effects were similar for both drugs. A significant reduction in heart rate was accompanied by a small reduction in myocardial oxygen consumption. Changes in coronary sinus flow induced by rapid pacing were closely related to changes in tension-time index. This relation was not modified by propranolol or atenolol. Neither propranolol nor atenolol therefore has significant coronary vasoconstrictor properties. Cardioselectivity appears to be unimportant with respect to beta-adrenergic blockade and the coronary circulation.


Value of pacing in cardiac failure associated with chronic atrioventricular block. The effect of permanent pacing on chronic complete atrioventricular block complicated by cardiac failure was studied in 6 patients by measurement of indirect left atrial pressure 15 minutes after institution of pacing and again 3 to 12 months later. In addition, 21 patients with complete heart block and clinical plus radiological evidence of cardiac failure at the time of pacing 3 to 6 years earlier were also reviewed. Only 1 of 6 patients studied haemodynamically improved and 1 died in cardiac failure. Of 21 patients assessed clinically, 10 had improved and 8 had died after a mean follow-up of 53 months. In the absence of syncope, pacing was of little symptomatic benefit but still may be justified to prolong survival. Both studies indicated a particularly poor prognosis for patients known to have coronary artery disease. No reliable means were found of determining the prognosis in the individual patient with cardiac failure before pacing.


Clinical value of delayed thallium-201 myocardial imaging in suspected acute myocardial infarction. Fifty patients with acute chest pain had thallium-201 myocardial imaging performed three to six days after emergency admission to hospital. The image was abnormal in 20 out of 22 patients with acute transmural myocardial infarcts but in only 1 of 5 with acute subendocardial infarcts. Indistinguishable scan abnormalities caused by old infarcts were seen in 7 patients, and caused by myocardial ischaemia in 1 patient. A single thallium-201 myocardial scan some days after the onset of symptoms appears to be of little value in the clinical assessment of patients with suspected acute myocardial infarction.


Use of 129caesium, 99Tcm stannous pyrophosphate, and a combination of the two in the assessment of myocardial infarction. Acutely damaged myocardium was shown in 103 patients with suspected acute myocardial infarction using 99Tcm pyp. A significant incidence of false positive and false negative results occurred, 'true' results being defined by standard clinical, electrocardiographic, and enzyme criteria. Localisation of infarction compared reasonably well with standard electrocardiographic criteria but more frequently suggested true posterior involvement. Serial estimates of infarct size may be of value in the recognition of infarct extension during the acute phase. Viable perfused myocardium was shown in 63 patients with a variety of cardiac disorders using 129Cs. The technique gives a reliable indication of anterior infarction but tends to underestimate inferior infarction. There was good correlation with the electrocardiogram with regard to localisation and extent of infarction. Nineteen patients received both isotopes and were included in each of the above groups. The combination permits further assessment of equivocal results Furthermore as 129Cs demonstrates both previous and recent infarction and 99Tcm pyp accumulates only in acutely damaged myocardium it was possible to estimate the extent of previous and recent myocardial damage.


Pronounced dependence of ventricular endocardial QRS potentials on ventricular volume. To evalulate the relation between ventricular endocardial potentials (QRS amplitude) and ventricular dimensions, left and right ventricular endocardial potentials were recorded with hook electrodes in anaesthetised open-chest dogs during transfusion and withdrawal of blood. Left ventricular end-diastolic diameter was measured by ultrasonic crystals, and end-diastolic volume was determined by thermodilution. In each dog, left ventricular endocardial potentials, whether recorded from anterior or posterolateral walls, decreased linearly as left ventricular end-diastolic diameter or volume increased, and vice versa. With an average increase in left ventricular end-diastolic diameter from 40.1 +/- 1.7 to 44.6 +/- 1.8 mm, left ventricular endocardial potentials decreased from 32.8 +/- 2.5 to 23.5 +/- 2.3 mV (P less than 0.001); and for an increase in left ventricular end-diastolic volume from 1.36 "/- 1.25 to 3.43 +/- 0.58 ml/kg left ventricular endocardial potentials decreased from 36.2 +/- 6.6 to 14.9 +/- 4.3 mV (P less than 0.001). Changes in right ventricular endocardial potentials paralleled the changes in left ventricular endocardial potentials. These findings indicate that acute changes in ventricular dimensions influence endocardial potentials considerably, and suggest a potential clinical application for detecting acute changes in ventricular volume.


Assessment of atrioventricular conduction in aortic valve disease. To determine the frequency of atrioventricular conduction disturbances in aortic valve disease, 26 consecutive patients (age 54 +/- 2 years) with symptomatic aortic valve disease were studied by His bundle electrocardiography at the time of cardiac catheterisation and were compared with a group of patients who underwent cardiac catheterisation and were found to have coronary artery or mitral valve disease but no aortic valve disease. Patients with aortic valve disease had significantly longer PR, AH, and HV intervals than cardiac patients not having this abnormality. Patients with aortic stenosis had prolonged HV, 52 +/- 6 vs +/- 42 +/- 2 ms (P = 0.06), whereas patients with chronic aortic regurgitation had prolonged PR, 245 +/- 27 vs 163 +/- 5 ms (P less than 0.001), and prolonged AH, 178 +/- 30 vs 102 +/- ms (P less than 0.001). Patients with combined lesions had significant prolongation of PR, AH, and HV intervals. Three patients with acute aortic regurgitation caused by endocarditis had normal atrioventricular conduction. Though the presence of valvular calcification did not significantly alter the pattern of atrioventricular conduction in these patients, those with calcified aortic valves had longer HV (P less than 0.005) than the control group. In addition, ventricular dysfunction or coronary artery disease did not affect the pattern of atrioventricular conduction in these patients. Thus, atrioventricular conduction disturbances are common in symptomatic aortic valve disease. With aortic stenosis the site of delay occurs more frequently below the His deflection, whereas in aortic regurgitation it is more frequent above the His deflection.


Relation of angina to coronary artery disease in mitral and in aortic valve disease. Of 129 patients with either mitral or aortic valve disease angina was present in 55 (42%). It was more frequent in aortic (60%) than in mitral valve disease (33%). The standard 12-lead electrocardiogram was not helpful in distinguishing underlying occlusive coronary artery disease. Coronary arteriography demonstrated coronary artery disease in 26 patients (20%), only 2 of whom had no angina. The incidence of coronary artery disease was almost identical in both the mitral and aortic groups (22% and 17%, respectively), but the percentage of those with demonstrable coronary artery disease accompanying angina was much higher in the mitral group (67% as against 29%). Angina in mitral valve disorders is thus much more likely to be the result of disease of the coronary arteries. Coronary arteriography is mandatory in all patients in both groups who have angina. Otherwise it seems unnecessary as coronary artery disease was found in only 2 patients who did not have angina.


Characterisation of heart rate response to exercise in the sick sinus syndrome. Patients with sick sinus syndrome have abnormalities of the sinoatrial node. We have measured the heart rate response to exercise in 7 patients with sick sinus syndrome without significant associated heart disease (group A) mean age 53.4 years, and compared this with 7 'normal' patients who were age-matched to within 5 years (group B), and 7 younger, well-trained subjects (group C). All underwent maximal treadmill exercise. Although maximum oxygen consumption (VO2max), 1/min per kg, in group A was not significantly different from group B (23.8 +/- 4.7 vs 19.9 +/- 0.8, mean +/- SE) maximum heart rate, beats/min, in group A was significantly lower than in group B (124 +/- 8.9 vs 163 +/- 3.7, P less than 0.001). At the end of 3 minutes of Bruce Stage I exercise, group A patients had a heart rate less than 130/minute (95% confidence level), whereas group B patients had heart rates greater than 134/minute. VO2 was plotted against heart rate (HR). Patients in group A had a significantly lower slope (deltaHR 5.20 +/- 0.33/delta1 ml VO2/kg per min, P less than 0.001). There was no significant difference in the slopes between groups A and C. On exercise patients with sick sinus syndrome have a normal VO2, but a reduced heart rate response as compared with age-matched normal patients. This abnormal heart rate response to the physiological stimulus of exercise may be of help in the evaluation of patients with sick sinus syndrome who do not have significant underlying heart disease.


Systemic sarcoidosis with refractory ventricular tachycardia and heart failure. A patient who presented with recurrent arrhythmias, including refractory ventricular tachycardia, and heart failure, was later found to have sarcoidosis with pulmonary and lymph node involvement.


Near fatal puerperal thrombosis on Björk-Shiley mitral valve prosthesis. A 22-year-old woman required emergency mitral valve replacement three weeks post partum because of thrombotic obstruction of her prosthetic mitral valve. Low dose subcutaneous heparin was administered from the 17th week of pregnancy. Though there was a successful fetal outcome, heparin did not prevent thrombosis on the prosthesis and its continuation into the puerperium proved nearly fatal.


Rupture of right coronary artery aneurysm into the right atrium. A 63-year-old man presented with acute congestive heart failure and was found to have a continuous murmur. Two years earlier, he had an inferior myocardial infarct, when no murmurs were heard. Angiography showed a right coronary artery aneurysm communicating with the right atrium. The distal vessel was occluded. The aneurysm was resected and the patient remains well. It is proposed that this was a congenital aneurysm which led firstly to the myocardial infarct and finally ruptured into the right atrium.


Effect of propranolol on sympathetic nervous activity in hydrallazine-treated hypertensive patients. 1 The effect of propranolol was examined on a) blood pressure and heart rate responses due to i.v. hydrallazine b) modification of these cardiovascular parameters during cold pressor test c) urinary catecholamine excretion rate. 2 Intravenous hydrallazine reduced significantly mean blood pressure by 15.2 mm Hg and increased heart rate by 24.9 beats/min. Propranolol reduced significantly mean blood pressure by 19.0 mm Hg and heart rate by 14.1 beats/min. Hydrallazine plus propranolol caused a significant reduction of mean blood pressure (by 37.7 mm Hg) but this was not accompanied by a significant fall in heart rate (by 3.3 beats/min). 3 During the control period, cold pressor test increased mean blood pressure by 16.0 mm Hg. Heart rate was increased by 12.5 beats/min in four patients. However, there was a reduction in heart rate (5.5 beats/min) in two other patients. During the propranolol period, cold pressor test-induced increase of mean blood pressure was not reduced but propranolol blocked the increase of heart rate. 4 Urinary catecholamine excretion rate was increased during hydrallazine administration. This excretion was not modified by propranolol.


Comparison of the effects of D-(-)-ephedrine and L-(+)-pseudoephedrine on the cardiovascular and respiratory systems in man. 1 In a preliminary double-blind trial the effects of ephedrine and pseudoephedrine on the blood pressure and heart rate of resting healthy volunteers were compared. Ephedrine 60 or 90 mg were required to raise the diastolic blood pressure above 90 mmHg, whereas 210 or 240 mg pseudoephedrine were required to produce the same effect. 2 In a second double-blind trial, patients with reversible airways obstruction were given 60 mg ephedrine or 210 mg pseudoephedrine and the effects on forced expiratory volume in one second (FEV1) compared. Both isomers produced some bronchodilation, but the effect of pseudoephedrine was less than half that of ephedrine. 3 The reasons for these differences between the isomers are discussed and the efficacy of pseudoephedrine as a nasal decongestant pointed out and explained in relation to its effect on alpha-adrenoceptors in the nasal blood vessels.


Pharmacokinetics of clonidine and its relation to the hypotensive effect in patients. 1 The kinetics of clonidine and its relation to the blood pressure response after single intravenous doses of 75 micrograms--275 micrograms in hypertensive patients were determined. 2 Clonidine disposition could be described by a two compartment open model and pharmacokinetic parameters show a rapid distribution phase of 20--30 min and a mean plasma clearance of 4.6 ml min-1 kg-1 (75--200 microgram). The half-life of the beta-phase was found to be in the range of 7.4--11.4 h. Indications of dose dependent kinetics were obtained. 3 A dose-dependent decrease in blood pressure was obtained. 4 The maximal reduction in MAP (mean arterial blood pressure) was significantly (P less than 0.01) related to plasma concentrations of clonidine. 5 The reduction in MAP was always related to plasma concentrations of clonidine (r = 0.88, P less than 0.01) when pseudoequilibrium of distribution of the drug was achieved.


Clobazam--a new hypnotic?

Clobazam--a new hypnotic? 1 A double-blind randomized trial to compare the relative efficacy of the 1,5-benzodiazepine, clobazam, the 1,4-benzodiazepine nitrazepam, and placebo as hypnotics was carried out. 2 A preference technique was used and the analyses were performed sequentially. 3. The results confirmed that nitrazepam was superior to placebo as a hypnotic but failed to show that clobazam was superior to either placebo or nitrazepam in a ratio of 2:1. Thus, it seems likely that the hypnotic properties of clobazam are minimal. 4 Clobazam is not suitable for use as a hypnotic in hospitalized patients.


Quantitative determination of ergot alkaloids in biological fluids by radioimmunoassay. 1 Cross-reactivity of ergot alkaloids with an antiserum produced against lysergic acid conjugated with human serum, albumin was utilized to develop a radioimmunoassay for ergotamine, dihydroergotamine, dihydroergotoxine, ergometrine and methylergometrine in biological fluids. The antisera showed no cross-reactivity with simpler indole structures. 2 A procedure for extraction and concentration of alkaloids in biological fluids was developed. 3 The assay is sensitive for 1.8 ng/ml ergotamine, 1.5 ng/ml dihydroergotamine, 2.2 ng/ml dihydroergotoxine, 0.7 ng/ml ergotmetrine and 0.5 ng/ml methylergometrine. 4 The assay is sufficiently sensitive to permit the measurement of urine and plasma ergot alkaloid levels and it is suitable for determination in cases where a known ergot alkaloid is used.


The effects of indomethacin on arachidonic acid and prostaglandins e2 and f2alpha levels in human skin 24 h after u.v.B and u.v.C irradiation. 1 Clinically normal human abdominal skin was irradiated with either three times its minimal erythema dose (MED) of ultraviolet B (u.v.B) or six MEDs of ultraviolet C (u.v.C) radiation. In both instances erythema was maximal at 24 h. 2 Exudate was recovered by a suction bulla technique from normal and irradiated skin at 24 h after irradiation. 3 Arachidonic acid, prostaglandins E2 and FSalpha, as measured by GC--MS, were significantly elevated at 24 h. Radioimmunoassay also showed increased PGF2alpha-like concentrations. 4 Oral indomethacin only partially reduced the erythema resulting from both types of radiation but totally suppressed the elevation of PGE 2 and F2alpha concentrations. 5 Topical indomethacin also suppressed u.v.B-induced increases in prostaglandins E2 and F2alpha. Unexpectedly, the vehicle alone produced a similar suppressive effect on prostaglandins although erythema appeared unaltered. 6 Most of the arachidonic acid metabolized by indomethacin-sensitive pathways is not converted to prostaglandins E2 and F2alpha in human skin.


Individual variation in daily dosage requirements for phenytoin sodium in patients with epilepsy. 1 Ninety adult patients receiving phenytoin sodium were studied prospectively in an epileptic centre. Serum concentrations of phenytoin under steady state conditions were measured by gas liquid chromatography. When clinically indicated the daily dosage rate was adjusted by 50 mg steps until a serum concentration of 10--20 mg/l was produced. 2 Concentrations within the above range were obtained in 50 patients; the required dosage rate varied from 200--500 mg/day. Twenty-five clinical, biochemical and haematological attributes were recorded for each patient and tested for correlation with dosage requirement. 3 The dosage requirement correlated most strongly (r = 0.57, P less than 0.001) with body surface area. This relationship (approximately 200 mg/day per m2) accounted however for only one third of the total dosage variance. 4 Amongst 18 patients receiving simultaneous treatment with phenobarbitone, the effective plasma clearance of this drug taken in conjunction with body surface area accounted for a significantly greater proportion of the total dosage variance. Multiple regression analysis failed to reveal other, more widely applicable predictors of individual phenytoin dosage requirements.


Liver size and indices of drug metabolism in epileptics. 1 The relationship between liver size and in vivo (antipyrine kinetics) and in vitro (cytochrome P-450) drug metabolism was investigated in twenty-one epileptics on long-term anticonvulsant therapy and in controls. 2 The epileptics exhibited significant enlargement of the liver and enhancement of drug metabolism compared to the controls. 3 Liver size correlated to antipyrine kinetics only in controls. Concentration of cytochrome P-450 in liver biopsy specimens correlated with liver size neither in controls nor in epileptics. 4 The total hepatic cytochrome P-450, estimated on the basis of liver weight and cytochrome P-450 concentration of biopsy samples, correlated linearly with antipyrine kinetics, except in patients with the most severely disturbed liver architecture. 5 Measurement of liver size is essential when comparing in vivo and in vitro drug metabolism, but the changes in liver histology are also of great importance.


Lactoperoxidase-catalysed iodination of surface proteins on human melanoma cells. The cell-surface proteins of 6 different melanoma cell cultures have been labelled with 125I using lactaperoxidase-catalysed iodination. Fractionation of the proteins was achieved using 5--22.5% polacrylamide-gradient gel electrophoresis in the presence of sodium dodecyl sulphate (SDS) and the proteins were detected by autoradiography. Up to 24 labelled proteins were detected in the individual cell cultures, but the proteins labelled differed considerably in the 6 cultures examined. A possible reason for this, involving variation in the glycosylation of cell-surface glycoproteins is discussed. Cells of the same melanoma line had similar cell-surface proteins at different passage levels, but changes in the labelled proteins occurred when the culture conditions were altered. The cell-surface proteins of high molecular weight were cleaved by trypsin, but most of the low mol.-wt. proteins were resistant to trypsin. The "large external transformation sensitive" (LETS) protein detected as a major protein on fibroblasts in culture was not a dominant protein on the melanoma cells. It was detected on only 4/6 cell cultures. Possible relationships of the cell-surface proteins described in this study to morphology, immunological properties and proteolytic activity of human melanoma cells are discussed.


Effect of an implanted Walker tumour on metabolism of folic acid in the rat. The metabolism of 2-[14C] folic acid has been studied in rats with an implanted Walker 256 tumour and in a closely matched group of controls. In animals with tumours, more of the labelled folic acid is converted to 10-formyltetrahydrofolate and 10-formylfolate than in normal animals. No 5-methyltetrahydrofolate could be detected in tumour tissue, or in the livers of tumour-bearing animals. When a mixture of 2-[14C]- and 3',5',9-[3H]-folic acid is given to tumour-bearing rats a similar pattern of metabolites is found. There is apparenly less scission of the folate molecule in tumour-bearing rats than in normal rats.


Split dose cytotoxic experiments with misonidazole. The toxicity of misonidazole (1-(2-nitroimidazol-1-yl)-3-methoxy-2-propanol) towards mammalian cells in vitro has been determined as a function of O2 tension. Misonidazole under hypoxic conditions (less than 10 Parts/10(6) O2) shows the greatest toxicity. Split-dose experiments indicate that lethal damage can be "repaired" by O2, the magnitude of this repair being time dependent and a function of O2 concentration, with maximum repair in air seen after 2 h at 37 degree C. Unlike radiation damage this repair is not inhibited by modest hyperthermia (41 degrees C) during the split-dose interval. The implication of these results as regards the mechanism of misonidazole toxicity under anaerobic conditions is discussed.


Effect of high-dose melphalan on marrow and intestinal epithelium in mice pretreated with cyclophosphamide. The lethal effect of high-dose melphalan in mice could be offset by pretreatment with cyclophosphamide, cytosine arabinoside or low-dose melphalan. The reason for improved survival is unclear. Althoug animals given high-dose melphalan died with symptoms of gut death, in only one instance, that with low-dose melphalan itself, did pretreatment protect the intestinal epithelium as measured by the microcolony assay. A small enhancement in the recovery of the haemopoietic tissue in pretreated animals was noted, although this on its own is unlikely to explain the phenomenon. Experiments in tumour-bearing mice showed that pretreatment with cyclophosphamide did not reduce the toxicity of melphalan to the Lewis lung carcinoma.


Anti-tumour cytotoxicity of poly(A)-containing messenger RNA isolated from tumour-specific immunogenic RNA. The transfer of tumour-specific cytotoxicity against a murine fibrosar-coma has been demonstrated in vitro using xenogeneic RNA extracted from tumour-cell-immune animals. Poly(A)-tailed messenger RNA from immunogenic RNA was isolated by passage through an oligo(dT)-cellulose column, and evaluated to determine whether the same tumour-specific cytotoxicity could be transferred. Aliquots of normal C3H mouse lymphocytes were treated with poly(A)-containing immune RNA, whole-cell immune RNA lacking poly(A) and total cellular immune RNA. Treated cells were tested in vitro using an adaptation of the Takasugi and Klein microcytotoxicity assay. Percent cytotoxicity was calculted using cells treated with fractions of normal RNA as control. An increase in tumour cytotoxicity was found with poly(A)-containing immune RNA. The optimum dose of poly(A)-tailed immune RNA was estimated as 6.5 microgram of RNA per 4 x 10(6) lymphocytes. Populations of lymphocytes were separated using glass and nylon wool. T- and B-enriched populations were treated with various RNA components. The adherent cell population showed no significant cytotoxicity, whilst treatment of the nonadherent population with poly(A)-tailed immune RNA produced high levels of cytotoxicity.


Ultrastructure, karyology and immunology of a cell line originated from a human transitional-cell carcinoma. A cell line (J82) was derived from a poorly differentiated, invasive, transitional-cell carcinoma, Stage T3. The cells have been propagated in vitro for 5 years and showed 100% aneuploidy and a mixed epithelial-fibroblastic morphology. The majority of cells contained 2Y chromosomes and several distinctive markers. Peripheral-blood lymphocytes from the donor of the J82 cells were tested sequentially for cytotoxicity toward autologous and allogeneic tumour cells. Autologous cytotoxicity was detected against J82 cells in early in vitro passage. Allogeneic lymphocytes from some patients with transitional-cell carcinoma were also cytotoxic to J82 cells in primary culture. However, selective cytotoxicity by lymphoid cells from bladder-carcinoma patients was not detected against J82 cells in long-term tissue culture.


Growth of human tumour cell colonies from biopsies using two soft-agar techniques. Two techniques for growing colonies of human tumour cells in soft agar have been applied to cell suspensions derived from fresh tumour tissue from 48 patients. Colonies were obtained in 31 cases, with plating efficiencies between 0.01 and 15%. In 11 cases the plating efficiencies were 1% or above. There was evidence that some categories of tumour grew more readily than others under these conditions. The potential applications of the methods to clinical and experimental oncology are discussed.


Morphological study of the ovaries of leukaemic children. The ovaries of leukaemic children were studied in 31 specimens obtained at autopsy. Twenty-eight ovaries from normal children of the same age who died from misadventure served as control. All ovaries from normal childred showed follicle growth and contained several large antral follicles. Follicle development was inhibited in all ovaries of leukaemic children; 22% showed no follicle growth (quiescent ovaries), and in the ovaries in which there was follicle development, the number and size of antral follicles was significantly smaller than in the control. All children had been treated with cytotoxic drugs, the duration of the treatment being correlated with the stage of ovarian development. The ovaries of children treated for only 1 week were near-normal, while those treated for more than 2 months showed inhibition of follicle growth. It is argued that the disturbance in follicle development is an effect of the cytotoxic drugs, and not an effect of the disease itself.


Mammary-carcinoma cells in mouse liver: infiltration of liver tissue and interaction with Kupffer cells. Interactions between TA3 mammary-carcinoma cells and liver cells were studied with the electron microscope in mouse livers that had been perfused with a defined medium containing the tumour cells. Infiltration of liver tissue by the TA3 cells proceeded in the following steps. First, numerous small protrusions were extended through endothelial cells and into hepatocytes. Next, some cells had larger processes deeply indenting hepatocytes. Finally a few tumour cells became located outside the blood vessels. Two variant cell lines, TA3/Ha and TA3/St, differing in cell coat and surface charge, did not differ in the extent of infiltration. TA3/Ha cells were often encircled by thin processes of liver macrophages (Kupffer cells). Encircled cells were initially intact, but later some of them degenerated. These observations suggest that TA3/Ha cells were phagocytized by the Kupffer cells. Encirclement appeared to be inhibited after only 30 min, when many cells were still partly surrounded. Encirclement of TA3/St was much less frequent. After injection of tumour cells intra-portally in vivo, similar results were obtained, which demonstrated the validity of the perfused liver model. TA3/Ha cells formed much fewer tumour nodules in the liver than TA3/St cells.


Failure to mourn a stillbirth: an overlooked catastrophe. The reasons for the difficulty of mourning a stillbirth and the therapeutic management of this mourning process are outlined. A case is described of failed mourning of a stillbirth which gave rise to a profound disturbance in mothering of a subsequent live baby. A psychotherapeutic technique is discussed which facilitates the failed mourning of a stillbirth.


Emotional experience and the implication grid. The research reported here consisted of a series of experiments aimed at developing a technique which could be used in the study of personal emotional experience. Hinkle's development (1965) of Kelly's construct theory (1955) was chosen as the starting point. Hinkle's original technique was applied using emotional rather than interpersonal constructs. This failed to demonstrate the internal consistency of the implication grid methodology shown in Hinkle's work. Modifications were made to the implication grid so as to simplify the subject's verbal task. Further experimentation demonstrated the validity and reliability of the modified grid. The structural consistency of different areas of individuals' emotional construct systems was investigated, and variations in the level of integration were demonstrated between these different areas.


Deliberate self-poisoning and self-injury in the psychiatric hospital. Acts of self-poisoning and self-injury carried out by in-patients and day patients while in treatment at two psychiatric hospitals were recorded over a one-year period. Comparison with results from a survey based on referrals to a general hospital in the same area demonstrated that the rate at which these events occurred was over 50 times greater for patients in psychiatric care than in the general population. A larger proportion of the psychiatric hospital incidents involved self-injury. Analysis of the records of a consecutive series of all psychiatric hospital patients revealed that at least one-third had a previous history of self-poisoning or self-injury. Of the patients carrying out such acts in one hospital, 77 per cent had a history of this behaviour prior to admission. Clusters of incidents were identified. Possible factors underlying this behaviour in the hospital setting and means of prevention are suggested.


Arousal response predictions derived from ego psychology. The purpose of this study was to examine the prediction from ego psychology that excessive stress leads to either a struggling or distancing response. Male subjects, preselected on the R-S scale, were exposed to an explicit pornographic movie in the presence of a female confederate. Skin conductance levels, self-report data, and a work association test with double entendre words were the dependent measures. The results indicated that subjects struggle rather than distance themselves when confronted with apparently stressful stimuli.


The Middlesex Hospital Questionnaire: a validity study. The MHQ is a brief self-rating inventory purporting to measure aspects of six distinct categories of psychoneurosis and affective status. It has been found to be a reliable instrument and also valid as a profile measure. Two individual scales have also previously been explored in respect of validity. The present report describes a further attempt to examine the validity of individual scales in relation to pertinent single clinical diagnostic entities in a study involving 800 patients. The phobic and obsessional scales are found to be particularly accurate and differentiating in this respect. Patients variously diagnosed as suffering from anxiety states, depressive states and personality disorder tend to score very highly on several scales. The instrument serves overall to distinguish satisfactorily between such populations and others suffering from schizophrenia and anorexia nervosa. It also markedly differentiates them from 'normal' populations.


On the validity of the Middlesex Hospital Questionnaire: a comparison of diagnostic self-ratings in psychiatric out-patients, general practice patients, and 'normals' based on the Hebrew version. The short clinical diagnostic self-rating scale for psycho-neurotic patients (The Middlesex Hospital Questionnaire) was translated into everyday Hebrew and tested on 216 subjects for: (1) concurrent validity with clinical diagnoses; (2) discriminatory validity on a psychoneurotic gradient of psychiatric out-patients, general practice patients, and normal controls; (3) validity of subscales and discrete items using matrices of Spearman rank correlation coefficients; (4) construct validity using Guttman's smallest space analysis based on coefficients of similarity. The Hebrew MHQ was found to retain its validity and to be easily applicable in waiting-room situations. It is a useful method for generating and substantiating hypotheses on psychosomatic and psychosocial interrelationships. The MHQ seems to enable the expression of the 'neurotic load' of a general practice subpopulation as a centile on a scale, thereby corroborating previous epidemiological findings on the high prevalence of neurotic illness in general practice. There is reason to believe that the MHQ is a valid instrument for the analysis of symptom profiles of subjects involved in future drug trials.


Psychoneurotic profiles in the adult population. Self-reported psychoneurotic characteristics and aspects of affective status have been examined within the adult population of a market town and the surrounding rural community using a standardized instrument. Features of anxiety in particular are more common amongst females than males, peaking in the third, fourth (phobic avoidance behaviour being also especially evident at this time) and fifth decades of life. Many of the characteristics are also importantly related to age in both sexes and to social class. Some are widespread within the population and probably reflect more enduring personality traits. Others are less common, more age specific (e.g. early adult life, middle age, the menopause in females; the involutional period in males) and are probably more often construed by the individuals concerned and by others as 'illness'. The similarity of the relevant segment of the present profiles to those previously obtained from a suburban population aged 40-65 years is noteworthy. The most likely interpretation is that the measuring instrument is reliable and that the reporting behaviour of psychoneurotic and effective characteristics and morbidity is identical in both populations.


The use of catheter-tip pressure transducers for the measurement of intrauterine pressure in labour. The disadvantages of the fluid filled polythene catheter used for measuring intrauterine pressure have been overcome by designing a catheter with a pressure transducer at the tip. The information which it gives is accurate and reliable. The optimum method of use has been determined and clinical trials performed. There is no demonstrable morbidity from its use.


Fetal hazards of the intrauterine pressure catheter: five case reports. Five patients with fetal complications associated with the use of an intrauterine pressure catheter in labour are described. In four, a fetal vessel was punctured either by the catheter or its introducing sheath. In the remaining patient, cord compression resulted from entanglement with the catheter. These problems may be minimized by a careful catheter introduction technique.


Perforation of a placental fetal vessel by an intrauterine pressure catheter. Perforation of a fetal vessel on the placental surface by an intrauterine catheter is reported. The immediate recognition of this unusual complication is important. To minimize the risks of perforation, haemorrhage and infection, several precautions should be observed when inserting the catheter.


Simplified management of pregnancy complicated by diabetes. Simple methods for the management of pregnancy complicated by diabetes are described. Emphasis was placed on keeping patients out of hospital, good control of diabetes and vaginal delivery at 38 weeks: using these methods, there were nine perinatal deaths in a consecutive series of 101 pregnancies complicated by diabetes. Four of the perinatal deaths were due to the respiratory distress syndrome. The patients whose diabetes was diagnosed during pregnancy had significantly heavier babies (18 pregnancies, mean birth weight 3337 g) than the established diabetics (83 pregnancies, mean weight 3011 g) despite significantly lower fasting blood glucose levels in the former and similar mean gestational ages at delivery. Mean fasting blood glucose levels for the whole series during the first, second and third trimesters were 9.0, 6.7 and 5.6 mmol/l respectively. The mean duration of antenatal stay in hospital for complications related to diabetes was 29 days. Diabetic retinopathy did not seem to be adversely affected by pregnancy.


Serum free fatty acids, insulin and blood glucose in pregnancy. Blood glucose, serum insulin and free fatty acid levels were determined in 60 pregnant and 44 non-pregnant women. The mean blood glucose level was significatnly lower in pregnant women than in non-pregnant women but there were no significant changes during pregnancy. The mean serum insulin and free fatty acid levels were not significantly different from the levels for the non-pregnant women, there was also no significant change in their mean levels throughout pregnancy.


Hypovolaemia, pre-eclampsia and diuretics. Six patients with severe pre-eclampsia were found to have low central venous pressures. This was considered to be an indication that hypovolaemia was present, depsite concurrent generalized oedema. Treatment with sufficient intravenous saline and albumin, to restore the central venous pressure to normal, resulted in improved renal function and avoidance of permanent renal impairment in all cases. These observations support the view that diuretics should not be administered to patients with pre-eclampsia.


Unconjugated serum oestriol levels in mother and baby with meconium staining of the amniotic fluid. To examine the effect on oestrogen metabolism of the stimulus which causes the passage of meconium, we measured maternal venous and cord artery and vein serum unconjugated oestriol levels in 46 patients with meconium staining of the amniotic fluid and 19 controls. Mean cord vein oestriol levels were significantly lower than in controls in the presence of meconium stained amniotic fluid and no fetal acidosis (cord artery buffer base of 36.2 meq/l or more) (P less than 0.02). The same tendency was seen with acidotic infants (P less than 0.05). There is thus evidence of a change in oestrogen metabolism associated with meconium staining of the amniotic fluid.


Transfer of digoxin across the placenta and into breast milk. Eleven mothers given digoxin throughout pregnancy because of rheumatic heart disease were studied. Digoxin was identified in the placenta and, for the first time, in milk. Paired cord and maternal blood samples obtained at parturition showed lower digoxin levels in cord blood than in maternal blood. The total tissue-bound digoxin level in the placenta correlated closely with maternal digoxin levels. These findings suggest strongly the presence of a placental barrier for digoxin. Similar digoxin concentrations (0.825 +/- 0.015 nmol/l) were found in milk samples obtained daily between the third and seventh days post partum. The half-life of digoxin in the newborn was 36.2 +/- 5.43 hours (Mean +/- SEM); thus all the digoxin present at birth would be excreted within 10 to 11 days.


The passage of fat emulsion across the human placenta. Six patients near term were given an intravenous infusion of a fat emulsion (Intralipid) a few hours before normal delivery or Caesarean section. Six other non-infused patients were studied as controls. Maternal venous and umbilical venous and arterial blood samples were taken at delivery and analyzed for individual fatty acid concentrations in triglyceride, free fatty acid (FFA) and phospholipid fractions. The emulsion, being rich in oleic and linoleic acids, affected the composition of the maternal triglycerides. The fetal lipids were also altered and the infusions resulted in large positive umbilical venous-arterial (v-a) differences in FFA and triglyceride fatty acid concentrations, but this was not the case for phospholipid concentrations. The fatty acids with the largest v-a differences were those prominent in the emulsion.


Neonatal serum bilirubin levels in spontaneous and induced labour. An investigation was made into the onset and severity of neonatal jaundice in 114 patients following spontaneous labour and labour induced by (a) amniotomy, (b) amniotomy and simultaenous infusion of oxytocin, (c) amniotomy and simultaneous administration of oral prostaglandin E2 (PGE2). No significant difference in serum bilirubin levels in the first five days of life was found in the four groups.


Plasma testosterone in molar pregnancy: Correlation with gestational age, uterine size, theca-lutein cyst and serum HCG. Plasma testosterone and serum HCG were measured by radioimmunoassay in 46 patients with intact molar pregnancy. There was no significant difference in plasma testosterone between patients with theca-lutein cyst and those without the cyst. This suggests that ovarian contribution to the elevated testosterone in molar pregnancy is probably a minor one. No correlation was found between plasma testosterone and uterine size. However, a positive correlation (r=+0.3567, P less than 0.001) was found between plasma testosterone and the HCG and a rising trend in plasma testosterone was observed with increasing gestation. These results suggest that molar trophoblast is probably the major source of elevated testosterone in the maternal circulation.


The effect of sex steroids on the in vitro synthesis of DNA by malignant ovarian tumours. The deoxyribonucleic acid (DNA) synthesis of 12 ovarian tumours was studied by means of short term organ tissue culture, exposure to tritiated thymidine and subsequent autoradiography and visual grain counting. The DNA synthesis in each tumour was studied before and after exposure to 12 separate hormone combinations. It was found that any combination of 17 beta-oestradiol with either of the two progestogens used had greater inhibitory potential than when any of three hormones tested was used alone.


Acute pancreatitis and vitamin K deficiency in pregnancy. Two patients with acute pancreatitis in pregnancy are described. In both, bleeding from vitamin K deficiency occurred after the initial attack of pancreatitis and the bleeding tendency was successfully treated with vitamin K.


Antichlamydial antibody in tears and sera, and serotypes of Chlamydia trachomatis isolated from schoolchildren in Southern Tunisia. A predominance of TRIC serotype A has been isolated from schoolchildren in a population in Southern Tunisia with severe hyperendemic trachoma. The serotyping results correspond precisely with the serological findings in patients' tears and sera. Geometric mean titres of serum or tear antibody in defined populations or areas can thus give a useful indication of the prevalent serotypes. Collection of tear fluids on sponges is a more practical method than collection by filter paper strips and gives higher levels of antibody. The presence of antibody to Chlamydia trachomatis in tears correlates well with the presence of infectious agent in the eye and with the intensity of conjunctival inflammatory disease. The measurement of antichlamydial tear antibody can thus provide a meaningful index of the prevalence and intensity of active trachoma in a population. The role these antibodies may play in resistance to re-infection is not yet clear.


4-hydroxy-3-methoxymandelic acid (HMMA) excretion in retinoblastoma. 4-Hydroxy-3-methoxymandelic acid (HMMA) concentrations in aqueous humour, urine, and serum were simultaneously estimated to determine if these levels were raised in cases of retinoblastoma. The catecholamine content of aqueous humour was significantly higher than that of urine and serum, but as there was no significant difference in the HMMA concentration in retinoblastoma and other non-malignant conditions it seems likely that retinoblastoma is not a catecholamine-secreting tumour.


Ocular saccades in Duane's syndrome.

Ocular saccades in Duane's syndrome. Since Hering's law might be affected when paradoxical innervation exists, 10 patients with Duane's syndrome were studied. Eye movements were measured by binocular recording of electro-oculogram. Our study shows clearly that the sound eye's motility is also affected. When adduction of the affected eye is present, Hering's law holds, whereas when adduction is limited this law cannot be demonstrated.


The relationship between head and eye movement in congenital nystagmus with head shaking: objective recordings of a single case. Head shaking and congenital nystagmus were recorded in a patient presented with visual tasks. When she was at rest the nystagmus took a 6 cycles per second saw-tooth wave-form. When she was attentive the nystagmus beat at a 2 to 2.6 cycles per second with a saddle-shaped deformation which permitted foveation. The head shaking occurred occasionally when the patient was attentive and was phase-locked to the nystagmus with resemblances in wave form and direction. Deceleration of the head shaking to zero velocity and peak displacement (to the left) coincided with the onset of the saddle of the nystagmus and hence assisted foveation; all other parts of the head-shaking cycle were detrimental to vision. It is proposed that the head shaking has a common pathological origin with the nystagmus and that, just as an isolated congenital nystagmus wave form becomes altered with attention to permit periods of foveal fixation, the pattern of combined head and eye nodding in this patient provided similar peroids of fixation.


Neuro-ophthalmological complications of enlargement of the third ventricle. A wide variety of visual sensory and ocular motor problems may occur as a direct result of enlargement of the third ventricle. Four patients are described with optic nerve dysfunction, partial third nerve palsy, proptosis, and Sylvian aqueduct syndrome all resulting from an enlarged third ventricle. The pathogenetic mechanisms are discussed.


Foveo-macular retinitis, solar retinopathy, and trauma. Three patients are described with foveal lesions resembling minute holes following trauma. The similarity of the lesions to foveomacular retinitis and solar retinopathy suggests that all these conditions produce a similar, localised neuroretinal lesion with sparing of the pigment epithelium. Loss of the photoreceptors at the fovea would be expected to produce a lesion resembling a small retinal hole.


Senile macular changes in the black African. One thousand black African and 380 white Caucasian patients over the age of 50 were examined for evidence of age-related macular changes, namely, drusen, pigment epithelial atrophy, and disciform macular degeneration. Drusen and pigment epithelial changes were found to occur twice as commonly in Caucasians as in Africans; there was a much greater difference in the prevalence of disciform macular degeneration between the 2 groups. The cause of the differences remains unexplained.


Senile macular degeneration and geographic atrophy of the retinal pigment epithelium. The case is reported of a man who had oval areas of atrophy of the retinal pigment epithelium in paracentral areas which previously had heavy concentrations of drusen OU. This supports the suggestion by others that atrophy of the RPE in senile macular disease may in some cases occur in the absence of previous serous detachment of the RPE.


The perifoveal vasculature in albinism.

The perifoveal vasculature in albinism. The perifoveal vasculature was studied in a series of patients with oculocutaneous tyrosinase-positive albinism. Fluorescein angiographic studies show a normal distribution of the major retinal blood vessels and in some cases of the capillaries in the macular area of these patients.


An unusual macular lesion simulating a neoplasm. A 55-year-old woman with reticulum cell sarcoma of the stomach presented with a sudden decrease in vision and acute blood loss anaemia with thrombocytopenia. Superficial retinal haemorrhages were present in both eyes. These haemorrhages were absorbed gradually, yet a large macular mass appeared in the right eye which simulated a neoplasm. This mass disappeared over a period of a few weeks leaving minimal changes in the pigment epithelium and remarkably good visual acuity.


Polymorphous presentations in vitelliform macular dystrophy: subretinal neovascularisation and central choroidal atrophy. Two dominantly inherited macular dystrophies demonstrate the difficulty in establishing a diagnosis based on the fundus appearance. In 1 family the propositus presented with unilateral retinal haemorrhage associated with subretinal choroidal neovascularisation which remained unilateral over an 8-year period. In the other family the propositus presented with bilateral central choroidal atrophy. All affected family members had an abnormal electro-oculogram and a normal electroretinogram, suggesting the diagnosis of vitelliform macular dystrophy. Since vitelliform macular dystrophy has a wide range of expressivity, with polymorphous appearances of the fundus, the diagnosis is best made by the presence of a dominant mode of inheritance and an abnormal electro-oculogram.


Orbital blood cyst.

Orbital blood cyst. A blood cyst of the orbit is an unusual cause of proptosis and most likely arises in a pre-existing haemangioma. If the cyst occurs at the apex of the orbit the blood should be aspirated. This is followed by excision of the cyst wall, the dissection being done with the aid of an operating microscope. If there is evidence of intracranial connection of the blood cyst, namely, splayed superior orbital fissure or cerebrospinal fluid leak, then the patient should be treated with an antibiotic to prevent intracranial infection.


Phosphorus-31 chemical-shift tensors in barium diethyl phosphate and urea-phosphoric acid: model compounds for phospholipid head-group studies. The molecular orientations of the 31P chemical-shift tensors in the phosphodiester barium diethyl phosphate (BDEP) and in the nonesterified urea-H3PO4 (UPA) complex were determined from single-crystal studies. Although the tensors possess qualitatively similar orientations, there are differences between the two tensors of the order of 20 degrees. The principal values of the BDEP tensor are within 5% of those found in powder spectra of phospholipids, and, for this and other reasons, which are discussed in detail, we believe BDEP is a good model chemical-shift tensor for lipid phosphate. With the BDEP tensor alone, one can label certain head-group conformations as improbable, and, in conjunction with oriented bilayer spectra, one can determine the conformation of lipid head groups. In addition, we suggest a technique for orienting crystals based on the transformation properties of shift tensors, and we demonstrate this method by applying it to UPA. Finally, our results allow us to assess the effect of shift anisotropy relaxation on 31P liquid spectra at high fields.