Lymphocyte subpopulations in man: ox erythrocytes as indicators in the EA- and EAC-rosette tests: serological and technical aspects. Serological properties of ox erythrocytes (ORBC) make it possible to select cells which exhibit weak agglutinability despite strong antibody sensitization. This property and the non-binding of unsensitized ORBC to lymphocyte surface membranes make these cells excellently suited as indicators in techniques for the identification of erythrocyte-antibody (EA) and erythrocyte-antibody-complement (EAC) rosette-forming lymphocytes (RFC). This report describes the relevant serology for the selection of appropriate cells and antisera. Further, some of the technical aspects of these tests are discussed. A simple method for the sensitization of ORBC with complement is described. The basis for this method is the naturally occurring complement-binding anti-ORBC antibodies of the IgM class in human sera. After zymosan treatment the sera are deficient in the fifth component of complement and hence non-haemolytic, which make these sufficient as sensitizing agents in the preparation of EAC indicator cells. The relations of EA- anc EAC-RFC to be established T and B lymphocyte subpopulations are revealed by the enrichment and depletion of lymphocytes rosetting with 2-aminoethylisothiouronium bromide (AET)-treated sheep erythrocytes (SRBC).


The epidemiology of primary osteoarthrosis of the knee in Greenland. 295 Greenlanders, 5% of the population of Greenland, in the age group 40 years or more, were investigated regarding primary oesteoarthrosis of the knee. The pathological changes were categorized as mid, intermediate, or severe. 86 (29%) of the subjects were found to have osteoarthrosis and the mild form accounted for 72% of these, while only one individual was found to have severe osteoarthrosis. Significantly more individuals from the West coast of Greenland (a mixed Eskimo-European population) as compared with individuals from the East coast (genuine Eskimos) were found to have osteoarthrosis of the knee (38% and 18%, respectively). An investigation of the sex distribution revealed more osteoarthrosis among West coast women than among East coast women (p is less than 0.05), whereas no such differences were found among the men. It was speculated that the difference between the prevalence rates of osteoarthrosis of the knee in the two population groups might reflect differences in occupation and possibly also a genetic predisposition.


Penicillamine-induced polymyositis-dermatomyositis. Two patients with classical rheumatoid arthritis developed myopathy during treatment with penicillamine. In both patients, electromyography and muscle biopsies were indicative of polymyositis. In one patient, muscle enzymes were not examined at the appropriate time; in the other patient muscle enzymes were raised. This latter patient also had a rash and, in the dermal epidermal junction of pathological skin, granular deposits of immunoglobulin and complement were found. The myopathy subsided in both patients after withdrawal of penicillamine.


Posterior atlanto-axial subluxation in rheumatoid arthritis. A case of posterior atlanto-axial subluxation is presented, together with a survey of previously reported cases. The patient's history suggested affection of the vertebral artery, and involvement of the medulla, but there were no physical signs of such. The patient was treated with posterior atlanto-axial fixation with good results.


Neutrophil chemotaxis and serum chemotactic activity in systemic lupus erythematosus. Neutrophil chemotaxis, random motility, serum chemotactic activity derived from complement activation by classical or alternative pathways, and the presence of serum inhibitors of chemotaxis were all studied in 24 patients affected by Systemic Lupus Erythematosus (SLE) and in an equal number of healthy control subjects. Statistical comparison between patients and controls indicated lower chemotactic activity in patient's serum when activated by the classical pathway, and the presence in some SLE patients of a heat-labile inhibitor of the chemoattractants. Low "classical pathway" chemotactic indexes were correlated with low C4 values, active nephritis and recurrent infections. The presence of heat-labile inhibitor was correlated with low values of C3. Our data suggest that defective neutrophil chemotaxis could be one of the mechanisms contributing to the high incidence of infections suffered by SLE patients. The importance of conducting separate studies on cell movement and on generation of serum chemotactic activities by classical and alternative pathways in SLE patients is discussed.


Copper in ankylosing spondylitis and rheumatoid arthritis. To study the role of copper in inflammatory rheumatic diseases, serum copper, serum ceruloplasmin concentration, erythrocyte sedimentation rate, and radio-copper studies were performed in 11 male patients with ankylosing spondylitis, in 12 female patients with rheumatoid arthritis and in 7 normal male subjects. The occurrence of elevated serum copper and serum ceruloplasmin levels can be confirmed in our study for patients with ankylosing spondylitis and rheumatoid arthritis when compared with normal controls. A significant correlation was found for these parameters and the inflammatory activity, characterized by the erythrocyte sedimentation rate. If groups with similar inflammatory activity are compared, higher ceruloplasmin concentrations are found in ankylosing spondylitis than in rheumatoid arthritis, the plasma incorporation of radiocopper also being higher in ankylosing spondylitis patients. Therefore, and because of comparable total serum copper concentrations, the non-ceruloplasmin bound copper level is found to be significantly higher in rheumatoid arthritis patients than in the group of ankylosing spondylitis patients. The significant correlation between erythrocyte sedimentation rate and the cumulative 120-hour urine excretion of radiocopper is in good agreement with the chemical finding of an elevated urinary copper excretion found by others, supporting the concept that the elevation of serum and urine copper levels in inflammatory rheumatoid diseases can be considered as an acute phase response.


Reversible renal side effects of intra-articular osmic acid injection. In 101 patients treated for knee joint hydrops with intra-articular osmic acid injection, an increased incidence of proteinuria and microscopic haematuria was noted on the first day after injection. This increase subsided rapidly and had disappeared 3 days after the injection. Three patients showed transient glycosuria. No signs of permanent renal damage appeared in any patient.


Absence of increased frequency of degenerative joint changes after osmic acid injections. Fifty-two adults and 31 children, who were treated with osmic acid for one knee joint, were observed for 8-18 years. No other local treatment of the knee joints was given. In adults no difference was seen in clinical or radiological findings between joints treated and not treated with osmic acid. The age of the patient had a marked influence on the development of degenerative joint disease. In children, radiological deterioration of the knee joints was marked in joints affected by radiological changes even before treatment. It is concluded that though osmic acid causes superficial damage to the cartilage, it has no significant clinical relevance. Osmic acid can still be recommended as a simple remedy in the treatment of knee joint synovitis, in both adults and children.


Fibrodysplasia ossificans progressiva. Biochemical changes in blood serum, urine, skin, bone, and ectopic ossification. Increased urinary output of total hydroxyproline, hydroxylysine and uronic acid was found in two patients suffering from fibrodysplasia ossificans progressiva. Before treatment of one of the patients, the high molecular weight peptide fraction deriving from newly synthesised collagen was particularly increased. Treatment with disodium etidronate (diphosphonate) reduced the values. The urinary values of sodium, potassium and calcium were also depressed during treatment, and, in both patients, serum phosphate was high, while serum calcium was normal. The hydroxyproline and hydroxylysine contents in skin and bone of FOP patients did not differ from controls, while ectopic ossifications showed a considerable increase in hydroxylysine in relation to normal bone.


C-reactive protein and delayed hypersensitivity in juvenile rheumatoid arthritis. In patients with juvenile rheumatoid arthritis (JRA), the delayed hypersensitivity found when skin-testing with a panel of memory antigens appeared to be reduced. Since C-reactive protein (CRP) has recently been shown to inhibit various parameters of cellular immunity in vitro, we tested the concentration of CRP in serum from 44 patients with JRA who had previously been tested for delayed hypersensitivity. The mean concentration of CRP in the patients was 32.2mg/l, while in age-and sex-matched controls it was less than 5 mg/l. By scatter diagrams and statistical analysis no association was found between the concentration of CRP and various expressions of delayed hypersensitivity in vivo.


Quantitative 99mTc pertechnetate scanning of the sacro-iliac joints. A follow-up study of patients with suspected sacro-iliitis. Quantitative 99mTc pertechnetate sacro-iliac scanning (QTPS) was performed in 30 patients suspected of having sacro-iliac arthritis (SI). Abnormal scanning results but lack of definite radiographic changes were noted in all of them. Twenty-four of these patients were followed-up for an average of 3.4 years; roentgenological abnormalities were found in 23 patients, or 95%, namely definite SI in 13, slight abnormalities in 1 previously normal patient, inactive changes in 3, suspected SI was unchanged in the radiographs in 5 and regression of previously observed grad-I changes was found in 1. In only 1 patient was the radiological picture unchanged normal. No definite roentgenological SI developed in any of the 12 controls (patients with normal (QTPS) we followed in the same way. A close correlation was noted between the QTPS and the patients' complaints of low back pain/stiffness and the clinical findings, including the presence of HLA-B27. The present study confirms that, despite the absence of radiographic changes, QTPS allows identification of a group of clinical and laboratory features which together are sufficiently characteristic of SI to establish that diagnosis. QTPS also enables us to discover clinically silent SI.


The need for early rehabilitation among Finnish municipal employees. The aims of the project were to assess the quantity and quality of subjective need for rehabilitation among the employees of the City of Helsinki, and to make, through team evaluation, recommendations concerning rehabilitation measures that would improve individual situations. On the basis of questionnaire responses it was assessed that about 15% of the hourly-paid and 8% of the monthly-paid employees (10% of all the employees) need immediate medical, vocational or social measures. On the basis of the team evaluation, it was assessed that rehabilitation measures would be needed by 11-12% of the employees. The problems and methods of the study are discussed.


The average myoelectrical activity of skeletal muscles in healthy and paretic individuals in elementary movements of the limbs. The method for evaluation of polyelectromyographic records is described. The method makes it possible to ascertain a deviation degree of myoelectric activity in sick persons with damaged central motoneuron and possibly their return to normal. A set of simple movements was polyelectromyographically examined in 30 healthy persons. These records were transformed into curves of mean value and the standard deviation was enumerated. These patterns were then compared with the pathologic records. The EMG potentials were recorded in the agonist and antagonist of the right and left upper or lower extremity in the motionless state (factor B by Tardieu), simple movement, simple movement against resistance and nociceptive irritation (Babinski phenomenon). The method can be put to good use in the evaluation of therapeutic methods, especially the therapeutic exercise in rehabilitation.


Application of electromyography in ergonomics: new vistas. The application of electromyography in analysis of muscle strain in working situations is far from straight-forward. Muscle force, for instance, is not directly accessible using electromyography. New insight in electrophysiological phenomena of human muscle provides however a firm basis for analysis of localized muscle fatigue at work. Such applications entail information at the muscle fiber membrane level.


A control study of muscle force recovery in hemiparetic patients during treatment with functional electrical stimulation. A group of forty-nine hemiparetic patients with limited emotional, communication and sensibility involvement and with recent lesion of cerebrovascular aetiology was randomly divided into two groups of twenty-four and twenty-five subjects. Both groups received traditional physiotherapy treatment for one hour/day, one group received twenty min/day of peroneal nerve stimulation. The maximum voluntary dorsal flexion moments of the ankle joint of the affected and non affected extremities were measured with an isometric brace twice a week for one month and for both groups. The recovery of moment in the stimulated group turned out to be about three times greater than in the control group and considerably less dependent upon age, time from lesion, initial value, side of lesion. Three patients using a peroneal brace at home as an assisting device were again evaluated two months later and a further improvement was observed. This work gives statistical support to previous observations based on very few cases and provides a statistically reliable answer concerning the entity of FES induced recovery of muscle force in hemiparetic subjects.


Feasibility and effect of physical training with maximum intensity in men after acute myocardial infarction. The purpose of the present investigation was to study the feasibility and effect of physical training with maximum intensity in a group of symptomfree male postinfarction patients (n = 15). The patients started training one month after discharge after acute myocardial infarction (AMI). The training was carried out as interval training 2 X 60 min a week during 12 months. During each session there were 5-6 intervals of 6 min's duration, during which the patients exercised with maximum intensity. The results were compared to those of an untrained control group. The groups were randomly selected. Compared to the first exercise test in the third week after AMI the final work capacity of the trained patients was increased by 101%--to 1570 kpm/min (257 W), and that of the control patients by 25%--to 1042 kpm/min. (170 W). (P less than 0.01). The corresponding estimated maximal oxygen consumption was 32 and 48 ml/kg . min. respectively. The study demonstrates that training with maximum intensity is feasible in these patients and that the work capacity, which was obtained, was 30-40% higher than usually found after training of postinfarction patients, when submaximal training intensity has been employed.


Assistive communication systems for the anarthric and severe dysarthric patient: a rationale for their use and criteria for their selection. A rationale for the use of nonvocal communication systems by anarthric and severe dysarthric patients is presented. Criteria for selecting nonvocal systems are discussed in relationship to: type of motor dysfunction, intellectual and cognitive capabilities, language abilities, emotional-motivational status and system variables.


Exposure to xylene and ethylbenzene. I. Uptake, distribution and elimination in man. Industrial xylene is a mixture of xylene and ethylbenzene. Twelve male subjects were exposed to industrial xylene in inspired air, six subjects in series I to 870 mg/m3 at rest (30 min) and light exercise on a bicycle ergometer (90 min) and six subjects in series II to 435 mg/m3 at rest (30 min) and during exercise of increasing work loads (90 min). The measurements of xylene uptake were performed continuously with the Douglas bag technique. In both series, about 60% of the amount of xylene supplied to the lungs was taken up. In both series, the concentration in alveolar air was relatively low throughout the entire exposure. The relative concentration in alveolar air displayed a linear correlation to the percentage uptake in the lungs. The ratio between the concentration in arterial blood (mg/kg) and alveolar air (mg/l) amounted to 30--40 at the different work loads. The total amount of xylene expired after the exposure was estimated from the alveolar concentration and alveolar ventilation. In series I, with a total uptake of 1.4 g, the subjects expired about 70 mg, i.e., about 5%. The corresponding value in series II was 40 mg of a total uptake of 1.0 g, i.e., about 4%.


Exposure to xylene and ethylbenzene. III. Effects on central nervous functions. The effect of exposure to the solvent xylene on performance of tests of numerical ability, reaction time (simple and choice), short-term memory, and critical flicker fusion was studied in two separate laboratory series. In the first series fifteen healthy male subjects were studied individually on three separate occasions with exposure to 435 and 1,300 mg/m3 xylene in inspired air and under control conditions. In a second series eight of the subjects were exposed to 1,300 mg/m3 xylene in inspired air. This exposure period began with 30 min of work on a bicycle ergometer (100 W) and continued during the behavioral tests. The procedure was the same under control conditions. Each exposure period lasted 70 min. At certain times during exposure, samples of the subjects alveolar air were collected. Exposure to xylene did not cause any noticeable change in performance during the first laboratory series, when the subjects' total uptake of xylene was estimated to be on an average 180 and 540 mg, respectively. In the second series the physical work induced an increase in the total uptake up to an average of 1,200 mg. In this series clear evidence of performance decrement was observed in three of the performance tests.


Polycyclic aromatic hydrocarbons in the work atmosphere. I. Determination in an aluminum reduction plant. The content of polycyclic aromatic hydrocarbons (PAH) in a Søderberg prebaked aluminum reduction plant and an anode plant was studied. Both stationary and personal sampling were used, and the samples were analyzed by glass capillary gas chromatography. In many samples more than 30 PAH and heterocyclic compounds were identified. Comparison of the results from the different plants revealed that the atmospheric PAH content was significantly higher in the Søderberg plant than in the others. However, the relative distribution of PAH components (PAH profile) was relatively constant in the prebaked and the anode baking plant, and different in the Søderberg plant. As a consequence of the variation in the pollution level among the different job categories, personal sampling showed a broader range of PAH concentrations than the stationary method.


Polycyclic aromatic hydrocarbons in the work atmosphere. II. Determination in a coke plant. The content of polycyclic aromatic hydrocarbons (PAH) in the work atmosphere of a coke plant was investigated on two occasions. Stationary, mobile, and personal sampling were used, and the samples were analyzed by glass capillary gas chromatography. Up to 39 PAH and heterocyclic compounds were indentified in the samples. By personal sampling, the occupational exposure to PAH was determined to vary between 5 and 1,000 mg/m3. A study of the occurrence of PAH on particulate matter revealed that 98% of the PAH was respirable. No significant variation in the relative distribution of the PAH components (PAH profile) was observed during the two sampling periods. The PAH profile for the coke plant was similar to that of a Søderberg aluminum plant, but different from that of a Søderberg paste plant.


[Starch peritonitis].

[Starch peritonitis]. Starch peritonitis is a rare postoperative complication of which 3 cases are here reported. The pathogenesis, diagnostic procedures, symptoms, treatment and prevention of starch granulomatous peritonitis are discussed.


[Blood cholinesterase and hepatic function: a comparison with BSP and galactose elimination as well as serum albumin concentration]. Although quantitative tests of some hepatic functions have been well established, the determination of serum cholinesterase activity continues to be commonly used in their stead. A critical comparison of the serum cholinesterase activity with these quantitative tests, however, is still lacking. Serum cholinesterase activity was therefore simultaneously compared with galactose elimination capacity (GEC), initial BSP-disappearance rate (BSP-ki), and serum albumin levels in 19 healthy control subjects and 46 patients with various chronic liver diseases. Serum cholinesterase activity was less discriminating between controls and patients than BSP-ki. It appears poorly suited, therefore, as a screening test for mild liver disease. Rank correlations between serum cholinesterase activity and GEC, BSP-ki, and serum albumin were statistically higher significant (r = 0.65, r = 0.74, and r = 0.80 respectively). On a statistical basis, serum cholinesterase activity may, therefore, be regarded as an index of the functional reserve of the liver. Evaluation of individual cases, however, revealed some clinically relevant discrepancies. It is concluded, therefore, that for accurate follow-up studies measurements of serum cholinesterase activity may be insufficient substitutes for the quantitative tests.


[Surgical therapy of axial hiatal hernias and reflux disease. 1. Results of an inquiry among Swiss surgeons in 1977]. Of the 153 heads of surgical departments in Switzerland, 152 joined in an inquiry into diagnostic procedures, surgical indications, and types of procedure in the treatment of axial hiatal hernia and reflux disease. Fundoplication is by far the most frequent procedure. Of the modifications performed in complicated reflux disease, 34% are controversial. Surgery for hiatal hernia and reflux disease is performed 3 times less frequently in the German part of Switzerland than in the other parts. German-speaking surgeons ascribe to themselves a greater willingness to perform preoperative diagnostic procedures--endoscopy, radiological and non-radiological tests of esophageal function--than the surgeons of the other parts of Switzerland. However, the German-speaking surgeons are more reluctant than the other surgeons to perform surgery in patients with esophagitis. The German-speaking surgeons are even more reluctant to perform surgery on the basis of subjective symptoms. Axial hiatal hernia is considered a relative indication for surgery by half of Swiss surgeons. Only a few surgeons consider this condition an absolute indication for surgery.


[Stercoraceous perforations of the colon. 2 unusual presentations]. Two cases of stercoraceous perforation of the colon are described in a psychiatric patient and a hemodialysis patient. The unusual symptomatology was acute respiratory failure with hypovolemic shock in one case and acute rectal bleeding in the other. The etiology, clinical manifestations, and treatment are discussed.


[Clinical evaluation of ciclobendazole (C-C 2481) in the treatment of colonic helminth diseases]. A total of 105 patients with mild helminthiases have been treated with ciclobendazole, a benzimidazole derivative related to mebendazole. The treatment lasted 3 days. A group of 74 patients received 200 mg/day ciclobendazole while another 31 patients were given double this dose. The excretion rates achieved were very high at 84.2 and 83.3% respectively in trichuriasis and 93.3 and 100% respectively in ascariasis. In a relatively small number of cases of ankylostomiasis, the values were, however, considerable lower (38.5 and 20.0% respectively). Since ciclobendazole is well tolerated, there is a need for studies with higher dosages and possibly also long-term studies.


[Clinical aspects, diagnosis and therapy of tropical pulmonary eosinophilia]. In Switzerland, tropical pulmonary eosinophilia occurs in subjects who have stayed in endemic areas of lymphatic filariasis (mainly India and South East Asia) and in adopted children from these countries. Clinically, the disease manifests itself as asthmatic bronchitis or pneumonia. Blood eosinophilia is regularly present and chest X-ray shows various types of infiltrate. Tropical pulmonary eosinophilia is distinguished from Loeffler's syndrome by (a) the severe and protracted course, (b) measurable antibodies against filarial antigens, and (c) the therapeutic response to diethylcarbamazine. The pathogenesis of both syndromes may be explicable by the fact that soluble parasitic allergens bind to cellules of the respiratory tract and induce hypersensitivity reactions under the influence of reagins. Both syndromes must be differentiated from parasitoses of the lung tissue, from side effects of drugs, and from allergic, non-parasitic bronchial asthma. The clinical aspects of both syndromes are illustrated by three cases.


[Treatment of iatrogenic transvenous foreign body embolism]. Embolization of central venous devices, such as infusion catheters, ventriculo-atrial drains for hydrocephalus or intracardial pacemaker leads, may cause fatal secondary complications. Removal of the embolized foreign bodies is therefore mandatory in the majority of cases. 26 in a series of 27 patients underwent removal procedures which have been successful in 24. The specific approach is described in the different subgroups of embolized foreign bodies. Removal has been achieved transvenously through the internal jugular vein in most instances of embolization of infusion or pressure catheters, using forceps or ureteric stone catheters. Thoracotomy was necessary in 8 patients, twice with with cardio-pulmonary bypass. There were no complications due to interventions for catheter extraction. This experience justifies an active approach to treatment once the diagnosis is established.


[Risk of disease in 10,500 travelers to tropical countries and 1,300 tourists to North America]. A survey on rate of illness among 10 500 tourists returning from the tropics and a control group of 1300 from the United States and Canada was performed by a questionnaire completed during the flight back to Switzerland. Only 25% from southern destinations, but 53% from North America, were never incapacitated during their travels. The vast majority of the illnesses were of no consequence, as was reflected by a low rate for bed confinement of 4% and 1% respectively. The most frequent symptoms in the tropics were diarrhea in 34% (mostly of short duration and mild degree), constipation in 14%, upper respiratory illness in 12% and insomnia in 11%. There were significant differences according to sex, age and tropical experience. The influence on pre-existing diseases was assessed. 7% of the tourists returning from the tropics were sick in the course of the year following the journey.


[Autoimmune hemolytic anemia induced by mefenamic acid]. A case of autoimmunohemolytic anemia following mefenamic acid therapy is described. A free anti-erythrocytic antibody of the IgG class was found in the serum of the patient. The same antibody was also found in the eluate of the patient's red cells. No blood group specificity could be demonstrated. Direct participation of the drug in the antibody red cell reaction could be ruled out by "facilitation" and "inhibition" tests.


[The exhaled hydrogen test: its value in the quantitative diagnosis of carbohydrate malabsorption]. A study has been conducted to determine the accuracy of breath-H2 measurements for quantitating the malabsorption of small amounts of carbohydrate. H2 pulmonary excretion was measured after an overnight fast at 30-min intervals for 4 h in 7 healthy subjects after ingestion of 4 doses of lactulose (2.5,5,10 and 50 g). In 3 subjects the test was repeated without lactulose. The volume of H2 excreted was directly proportional to the amount of ingested lactulose: mean cumulative H2 excretion over a 2-h period after 5, 10 and 50 g was 2.9, 6.6 and 37.6 ml H2 respectively; H2 response after the 2.5-g dose was not perceptible. Individual H2 excretion before lactulose ingestion was highly variable: 0.096 +/- 0.075 mlH2 (mean +/- 1 SD); the individual base line rate over a fasting period showed marked fluctuations. It is concluded that the inter- and intraindividual variations of H2 excretion limit the accuracy of the H2 breath test for quantitating malabsorption of small amounts of carbohydrate.


[Disseminated intravascular coagulation with microangiopathic hemolytic anemia and bone necrosis associated with a prostatic microcarcinoma]. Presentation of a case of disseminated intravascular coagulation with micro-angiopathic hemolytic anemia, associated with a micro-carcinoma of the prostate. In the absence of other etiology it is postulated that the carcinoma was responsible for the hematological disturbance in spite of its small size andlack of either metastases or mucin secretion. The unusual discovery in this disease of bony necroses of the vertebrae, which are attributed to ischemia following micro-thromboses, is also discussed.


[Pathological and embryological studies on abortion cases related to the Seveso accident]. After the explosion accident on July 10, 1976 in Seveso (Italy), material from 30 interrupted pregnancies and from 4 spontaneous abortions was investigated by embryological and histomorphological studies. No indications of mutagenic, teratogenic or fetotoxic effects of TCDD could be found. The cases of spontaneous abortion, albeit more suspect for dioxin damage, showed different morphological alterations obviously due to a variety of causative factors independent of TCDD. On the other hand it is not possible to exclude entirely an embryotoxic effect of TCDD because in the majority of cases the fetal tissues were incomplete.


[The oto-vertebral syndrome].

[The oto-vertebral syndrome]. The oto-vertebral syndrome is a rare combination of malformations of the ears, spinal anomalies, and congenital heart disease. The syndrome appears to be caused by early embryonic exogenous damage during the 6th or 7th week of embryonic development. The case is reported of a 28-year-old man with bilateral aplasia of the external ear, bilateral aplasia of the ear canal, hypoplasia of the mandibula, severe thoracic scoliosis, and ventricular septal defect with pulmonary hypertension. He was admitted with dyspnea on exertion, syncope, and severe cyanosis. Cardiac catheterization revealed severe pulmonary hypertension with moderate right-to-left and slightly left-to-right shunt (Eisenmenger syndrome). Right and left ventricular function, as evaluated by angiocardiography, was slightly reduced. Because of the severe hemodynamic alterations, symptomatic therapy with digitalis, repeated venesection, and anticoagulation was initiated.


[Legionnaire's disease in Switzerland].

[Legionnaire's disease in Switzerland]. The sera from 2453 patients suffering from pneumonia were investigated for antibodies against the agent causing "Legionnaires' disease". A complement-fixing antigen developed in this institute was used for the screening of these sera, and the positive results were confirmed with the IF-test developed by CDC Atlanta. Antibodies were found in 23 Swiss patients. The clinical details from one of these patients are presented.


[Lesions of the kidney and the efferent urinary tract due to cantharidine]. 5 cases of cantharidin intoxication are reported. 4 patients had used cantharidin as an aphrodisiac and one to induce abortion. All presented with urinary tract symptoms. Four patients had gross hematuria. In one case non-oliguric renal failure occurred, with increase of plasma creatinine to 5.6 mg/100 ml. renal biopsy was performed in 2 cases. On light and electron microscopy glomerula showed only minimal changes such as podocyte swelling. The tubuli were markedly altered, with luminal enlargement, intraluminal cell debris, flattening and shrinking of the epithelial cells and distortion of brush borders. Whereas all 5 patients recovered completely, some deaths due to cantharidin poisoning have been reported in the literature. Since cantharidin is markedly toxic, its use in humans should be strongly discouraged.


Prognostic and therapeutic considerations in ischemic heart disease. Coronary arteriography and coronary artery bypass surgery have provided a tremendous stimulus to learn more about the natural history of ischemic heart disease. It has become apparent that the most important approach to understanding prognosis involves placing patients into subsets. Clinical presentation is an entry into subsets but is an inadequate way to assess the problem. Anatomical information in the form of coronary arteriographic abnormalities and left ventricular functional abnormalities are powerful prognostic determinants. It remains important to consider matters such as increased blood pressure, cardiomegaly, and perhaps other factors such as cigarette smoking as additive to any anatomical information which can be obtained for any given subset. Premature ventricular contractions, particularly of the complicated type, may be a very powerful and important additive prognostic consideration in all patients with ischemic heart disease but especially those prone to sudden cardiac death. Coronary bypass, surgery now widely practiced in Western Europe and the United States, is an established, integral part of therapy for certain subsets of patients. It clearly cannot resolve the total issue of therapy and must be utilized selectively and critically along with other intensive medical measures to hope to control risk factors and progression of the coronary arteriosclerotic process.


Dental lead levels in Bombay inhabitants. Lead content in teeth of Bombay inhabitants has been measured. The lead concentration in teeth ranged from 4.27--82.5 microgram/g of whole tooth with a geometrical mean concentration of 15.5 microgram/g of tooth. There is no significant difference between the lead content in the teeth of males and females. The mean lead value is compared with those from other countries.


Cadmium toxicity studies under long term-low level exposure (LLE) conditions. I. Metabolic patterns in rats exposed to present environmental dietary levels of Cd for two years. A long term-low level exposure (LLE) experiment was conducted on rats to determine the metabolic patterns for realistic environmental dietary levels of cadmium. Male rats fed with 61 ppb of cadmium ad libitum, 50 labelled with 109 Cd radiotracer as cadmium chloride via drinking mineral water and 11 unlabelled via food for 2 years. The diet was characterized in its metal content by neutron activation analysis to obtain the total dietary intake of different elements. The kidney was found to be the tissue with the major concentration of cadmium which accumulated continuously during the experiment. The variation of the accumulation pattern of Cd concentration in the liver and intestine indicated an itiial rapid increase of Cd during the first 100 days. After this period an apparent equilibrium was attained in both these tissues until the end of the study. The intracellular distribution of cadmium in kidneys, liver, intestine and pancreas were similar, the cytosol fractions containing about 80% of the cellular cadmium. Dialysis experiments indicated that significant amounts of cadmium were able to be associated with cellular organelles, the mitochondria representing the most important organelle capable of binding cadmium. The cytoplasmatic Cd-profiles obtained at various stages of the experiment showed that the metal was only bound to a low-molecular-weight component, cadmium-binding protein (CdBP), which represents the specific cellular-binding component for cadmium under the long term-low level exposure (LLE) conditions. No significant variations in the concentrations of the elements in different organs were observed in animals supplemented with 109Cd untreated controls.


EEG-responses caused by environmental noise during sleep their relationships to exogenic and endogenic influences. At a certain level of intensity acoustical stimuli occurring during the night lead to sleep disorders. Whereas presumed after-effects (decrease of performance, functional and organic diseases) can as yet not be related to noise, it is evident that the primary effects which can be recorded immediately after stimulus onset are caused by noise. Because of the small number of experimental trials carried out in different investigations, the results of each single paper can only be tentative. Therefore--concerning awakening reactions and less than a change of at least one sleep stage--the data from publications of comparable method and evaluation have been summarised. With these data all calculations have been repeated. The results and influence of several exogenic and endogenic factos are demonstrated. Becuase of the different methods used only 10 out of 60 publications have been used. In spite of this restriction of data, at least as far as trends are concerned, they appear to be consistent; numerical results should at this stage only be regarded as tentative.


Behavioral competition: a mechanism for schedule interactions. Rats pressing a lever for food reinforcement showed large positive-contrast effects when provided with the opportunity for a competing wheel-running response. Positive and negative behavioral contrast may reflect reallocation of competing interim and terminal responses between schedule components following changes in the reinforcement conditions in one component.


Emotions are expressed more intensely on the left side of the face. Pictures of human faces posing six distinct emotions (plus a neutral expression) and their mirror reversals were split down the midlines, and left-side and right-side composites were constructed. Subjects judged left-side composites as expressing emotions more intensely than right-side composites. The finding indicates hemispheric asymmetry in the control over emotional expression in the face.


Prenatal exposure to prednisone in humans and animals retards intrauterine growth. Prednisone treatment for infertility and subsequent pregnancy maintenance in humans resulted in a significant decrease in the birth weight of full-term infants and a marked increase in the percentage of newborn infants weighing 2500 grams or less, that is, "light for dates" in comparison to control offspring. A parallel experiment with mice indicated that the reduction of birth weight was caused by exposure to corticosteroids rather than to maternal disease or malfunction.


Hepatic fibrosis in schistosomiasis: egg granulomas secrete fibroblast stimulating factor in vitro. Cytosol extracts and culture supernatants of isolated egg granulomas obtained from livers of mice with Schistosoma mansoni infection stimulated fibroblasts to incorporate tritiated thymidine and to proliferate in vitro. This finding suggests that hepatic granulomas may play a role in regulating hepatic fibrosis in Schistosoma mansoni infections.


Changing postdoctoral career patterns for biomedical scientists. Between 1973 and 1977 the total number of Ph.D.'s holding postdoctoral appointments in the biomedical sciences increased at a rate of more than 550 individuals (12.5 percent) per year. During this same period the total number of doctorates awarded each year in these disciplines showed very little change. The postdoctoral growth can be attributed to substantial increases in both the numbers of recent graduates taking postdoctorals and the length of stay on these appointments. The lack of alternative employment opportunities has contributed heavily to the postdoctoral buildup. Continued growth is likely to have important consequences for biomedical research and research training.


Atmospheric reactions of polycyclic aromatic hydrocarbons: facile formation of mutagenic nitro derivatives. Directly active mutagens are formed on exposure of the promutagen benzo[a]pyrene to gaseous pollutants in smog. In simulated atmospheres containing 1 part per million nitrogen dioxide and traces of nitric acid, directly mutagenic nitro derivatives are readily formed from both benzo[a]pyrene and perylene, a non-mutagen in the Ames reversion assay. Possible formation of direct mutagens by such reactions on sample collection filters, in exhaust effluents, and in the atmosphere should be recognized.


Chimpanzee problem-solving: a test for comprehension. An adult chimpanzee was shown videotaped scenes of a human actor struggling with one of eight problems and was then shown two photographs, one of which depicted an action or an object (or both) that could constitute a solution to the problem. On seven of the eight problems, the animal consistently chose the correct photograph. This test problem-solving comprehension permits the animal's knowledge about problem-solving--its ability to infer the nature of problems and to recognize potential solutions to them--to be examined.


Taste responses in sheep medulla: changes during development. Response characteristics of taste neurons in the sheep solitary tract and nuclei alter during development. Solitary tract cells in younger fetuses respond to stimulation of the tongue with fewer salts and acids than do cells in older fetuses, lambs, and adults. Further, responses to specific salts and acids develop in a particular sequence, not randomly. These changes may relate to maturation of taste receptor sites.


Aphagia and adipsia after preferential destruction of nerve cell bodies in hypothalamus. Microinjections of the excitatory neurotoxin kainic acid into the lateral hypothalamus of rats produced a period aphagia and adipsia. Kainate-treated rats displayed transient motor effects during the first hours after the injection but did not show the persisting sensory-motor and arousal disturbances typically observed in animals with electrolytic lesions in this part of the hypothalamus. Histological examination revealed a significant reduction in the number of nerve cell bodies in the lateral hypothalamus. Silver-stained material indicated no evidence of damage to fiber systems passing through the affected region. Assays of dopamine in hypothalamus, striatum, and telencephalon did not indicate significant differences between experimental and control animals. These results are in agreement with recent reports of the anatomical and biochemical effects of intracerebral kainic acid injections and suggest that the observed effect on feeding behavior is related to the destruction of neurons in the lateral hypothalamus.


Origin of the retina from both sides of the embryonic brain: a contribution to the problem of crossing at the optic chiasma. Cells originating from one of the first two blastomeres of the frog embryo were labeled either by injecting them with horseradish peroxidase or by changing the ploidy of one blastomere. Both methods show the labeled cells confined to the same side of the brain as the labeled blastomere except for cells that have moved from the opposite side into the ventral diencephalon and ventral part of the retina. Reciprocal movement of cells from each side of the prospective forebrain into the prospective retina on the opposite side starts before the neural tube closes and results in the formation of an incipient optic chiasma which may provide the pathway for optic axons to grow from the retina to the opposite side of the brain.


Echo detection and target-ranging neurons in the auditory system of the bat Eptesicus fuscus. Some of the neurons in the nucleus intercollicularis and auditory cortex of the echolocating bat Eptesicus fuscus respond selectively to sonar echoes occurring with specific echo delays or pulse-echo intervals. They do not respond for a wide range of other types of sounds or for sonar echoes at longer or shorter pulse-echo intervals; they may, therefore, be specialized for detection and ranging of sonar targets.


Alterations of hemostasis associated with malignancy: etiology, pathophysiology, diagnosis and management. As outlined in this paper, the patient with disseminated malignancy suffers many alterations of hemostasis; in addition, hemorrhage or less commonly thrombosis is the final clinical event in many of these patients. Patients with malignancy present a major clinical challenge in this day of new oncological awareness and more aggressive care. Thus, it is important to realize that these alterations of hemostasis do exist and they must be approached in a logical manner with respect to diagnosis as well as efficacious therapy. By far the most common alteration of hemostasis in malignancy is that of hemorrhage associated with thrombocytopenia either drug-induced or from bone marrow invasion. However, hemorrhage due to disseminated intravascular coagulation is also quite common. In addition, many antineoplastic drugs, as well as radiotherapy, may lead to hemorrhage in these patients. Thrombosis, which is also commonly seen in the patient with malignancy, is usually a manifestation of disseminated intravascular coagulation manifest as an intravascular thrombotic rather than an intravascular proteolytic event. When suspecting this, confirmatory laboratory evidence must be sought and the patient treated apropriately. When approaching the patient with malignancy and either hemorrhage or thrombosis, all of the potential defects in hemostasis must be taken into account, defined from the laboratory standpoint, and treated in as precise a manner as possible.


Two linear rules relate the latencies of visual responses to their critical durations. The latency of a neural response sets a limit on its critical duration since stimulation delivered after a response has already occurred can no longer affect that response. However, this tautologic upper limit does not uniquely define the critical duration. Intracellular recordings from the lateral eye of Limulus yield two linear rules which empirically relate the critical duration of a neural response to its latency: When response magnitude (peak amplitude, spike frequency) is used to construct the temporal summation function, the critical duration is equal to the latency minus a constant. When response latency is used instead, the critical duration of the response latency is equal to the latency divided by a constant.


Changing response measures alters temporal summation in the receptor and spike potentials of the Limulus lateral eye. Temporal summation and reciprocity were studied in the retinula and eccentric cells of the excised Limulus lateral eye as a function of variation in response measure: Using the latency instead of the peak of the receptor potential as a response measure produced considerably shorter critical durations. Using the area under the receptor potential as a response measure produced no critical duration up to a stimulus duration of 640 msec; instead, supersummation occurred at long durations. Similar effects were observed in the optic nerve spikes, where the response measures were first spike latency and maximum spike number sampled in time windows that ranged from 40 to 640 msec. The critical durations clearly depended on the response measure used and, when a 640-msec window was used, no critical duration occurred; supersummation again occurred. Increasing the sampling period within which maximum spike number was measured increased the critical duration and changed the formal properties from those characteristic of the receptor potential's peak to those characteristic of the receptor potential's area. The implications of the more central portions of the nervous system using different summation times for different perceptual tasks are discussed; it is suggested that the choice of response measures is crucial in studies of temporal summation.


Audio-ocular response characteristics.

Audio-ocular response characteristics. The characteristics of eye movements elicited by auditory stimuli, the audio-ocular response (AOR), differ from those made in response to visual stimuli. Their latencies are longer, their accuracies slightly worse, and their velocities slower. In addition, AOR latencies decreased with increasing stimulus eccentricity; this is opposite to the latency variation of visually evoked saccades.


A critical examination of the use of signal detection theory in evaluating a putative analgesic--transcutaneous electrical nerve stimulation. Experiments using normal human subjects were performed to determine the effect of a putative analgesic, transcutaneous electrical nerve stimulation (TENS), on the perception of noxious thermal stimuli and also to examine critically the general applicability of signal detection theory (SDT) to the evaluation of analgesic agents. In order to provide a control for factors related to suggestion, subjects were assigned to groups in which real or sham TENS was administered. It was shown that previously suggested criteria for demonstrating actual analgesia using SDT should be reevaluated. First, discriminability changed in one of the sham groups, suggesting that discriminability can be affected by changes in mental state which may occur during the evaluation of an analgesic. Secondly, criteria changed without accompanying changes in discriminability; this was interpreted as reflecting actual analgesia, rather than only changes in response bias, produced by TENS.


Directional hearing under progressive impoverishment of binaural cues. Auditory stimuli--bursts of broadband, 4.0-kHz high-pass and 1.0-kHz low-pass noise--generated by loudspeakers arrayed in the horizontal plane were picked up by miniature microphones placed in the external ear canals and recorded on tape. When these recorded sounds were presented through headphones, listeners were able to identify the various loudspeakers that originally generated the sounds about as accurately as they could when the sounds were presented free-field. When the recorded sounds were processed so that either one or more of the interaural difference cues were removed directly or their removal was approximated, performance proficiency depended upon the frequency composition of the stimulus. It appeared that accuracy in identifying the loudspeaker that originally generated the broadband and 1.0-kHz low-pass noises could be maintained by the presence of interaural temporal differences. Accuracy on the task for the 4.0-kHz high-pass noise depended in large part on the presence of interaural intensity differences. No one performed proficiently when only interaural spectral differences were available.


Temporal summation in the receptor potential of the Limulus lateral eye: comparison between retinula and eccentric cells. Temporal summation and reciprocity (Bloch's law) were studied in the receptor potential recorded from the retinula and eccentric cells of the excised Limulus lateral eye. Taking the peak of the receptor potential as the response measure yielded critical durations that ranged between 65 and 170 msec, depending on the cell type and the criterion level of response. At high but not at low response levels, the critical duration is significantly longer in eccentric cells than in retinula cells. Deviations from Bloch's law were found; these deviations were largest at intermediate response levels.


[Demonstration of group adherence in keratin products of the epidermis (hair, nails) using magnesium chloride]. The authors describe their own method of proving group properties from hair and nails by means of mixed aglutination using magnesium chloride. This method--as far as is known from literature --does not seem to have been used yet.


[Analysis of the causes of fatal burns]. In 500 casualties who died from thermal injuries comprising 314 men and 186 women, all above 15 years of age, the causes of the injuries were analyzed. In 266 the injuries were contracted at home, 140 were industrial injuries and 94 other injuries (transport, criminal, agriculture). The authors discuss the causes of injuries and their frequency. Finally they draw attention to the adverse development of non-occupational injuries in the home.


[Cardiomyopathy as a cause of sudden and unexpected death]. Sudden and unexpected death was described in a 30-year-old and a 19-year-old women and a 14-year-old boy. The cause of the death was hypertrophic obstructive cardiomyopathy.


Mothers are still mortal.

Mothers are still mortal. The origin, background, and mechanism of operation of the Maternal Mortality Study Committee in Wisconsin is outlined. Its value as a teaching vehicle is emphasized. Trends in maternal mortality in Wisconsin and the continued decline are presented, with 45 per 100,000 live births in 1953 to 9.2 per 100,000 live births in 1975. An appeal for standardization of terms and definitions and a continuation of these studies in each state is made. Study committees in many states are inactive. It is suggested that chairmen of maternal mortality committees in many states are inactive. It is suggested that chairmen of maternal mortality committees and representatives meet in geographic areas comparable to Districts of The American College of Obstetricians and Gynecologists to compare trends and statistics. Hemorrhage, once considered the important cause, has decreased from 56.4% of maternal loss to a low of 12.1% in 1975. Presently, a category listed as "other causes"--that is, other than hemorrhage, sepsis, and toxemia--account for approximately 60% of deaths. This group includes anesthesia, emboli and coincidental disease involving kidneys, heart, malignancy, and diabetes. An appeal is made to continue these studies.


Assessing psychologic symptoms in adolescents. Assessing the meaning of psychologic symptoms in adolescents can be a difficult task. Pediatricians, internists, and family practitioners are often the first professionals consulted by families worried that their teen-agers may be in psychologic distress. The practitioner is faced with the difficult decision of meeting the adolescent's need himself or referring the patient to an adolescent psychiatrist for further evaluation and possible treatment. In making this decision the practitioner must carry out a complex assessment task which requires the simultaneous evaluation of multiple clinical variables. This paper presents a conceptual scheme for evaluating the psychologic status of an adolescent patient.


Carcinoid tumor in retinitis pigmentosa. A carcinoid tumor was discovered by chance in a 25-year-old woman with the dominant type of retinitis pigmentosa. Although a coincidental association cannot be ruled out, there is at least a possibility that the two diseases have a common embryologic origin.


Emergency operations for Crohn's disease. Seventeen patients with Crohn's disease requiring emergency operative procedures disclosed important factors leading to successful outcome. In seven of the ten patients not known to have Crohn's disease, the history strongly suggested this diagnosis. Two patients died; three others had major complications, including two anastomotic leaks and two postoperative intraperitoneal abscesses. Wide drainage of abscesses, preservation of intestinal absorptive surface, avoidance of anastomoses in the presence of acute infection, and vigorous supportive nutrition are important features of the management of patients requiring emergency operation for complications of regional enteritis.


Serum parathormone in the identification and surgical management of hyperparathyroidism. A prospective series of 200 patients with persistent hypercalcemia had an abbreviated diagnostic work-up consisting of parathormone radioimmunoassay, chest roentgenogram, intravenous pyelography, and serum protein electrophoresis. All patients with hypercalcemia and hyperparathormonism had neck exploration if roentgenograms failed to reveal evidence of ectopic hyperparathyroidism. Serum iPTH proved to be at least 96% accurate in predicting parathyroid disease while at the same time resulting in considerable diagnostic economy. An elevated iPTH was particularly helpful in distinguishing between hypercalcemia due to destruction of bone by malignancy and primary hyperparathyroidism with a coexisting malignancy. Further, measurement of parathormone was useful in evaluation of postoperative hypercalcemia.


Improved treatment via home monitoring refractory vertigo. The ubiquity of dizziness in clinical practice and the complexity of diagnosis and treatment has necessitated the development of a home monitoring procedure which assists the patient in collecting information concerning the course of his condition and his condition and his response to therapy. A case report of a patient with refractory, long-term, posttraumatic vertigo is presented to demonstrate the feasibility and utility of this procedure. It was found that (1) the patient was able to monitor his progress continuously for 118 days; (2) the information generated appeared to be valid; and (3) this information was integrally associated with a functional improvement in the patient's condition.


Angioid streaks in pituitary tumor.

Angioid streaks in pituitary tumor. The diagnosis of angioid streaks on fundus examination allows the examiner to focus on a limited number of commonly associated conditions, such as pseudoxanthoma elasticum, Paget's disease, and sickle cell disease. There have been sporadic reports of pituitary tumors associated with angioid streaks. This is the first case report of pituitary tumor associated with angioid streaks. This is the first case report of pituitary tumor associated with angioid streaks documented by fluorescein angiography, EMI scan, and histopathologic diagnosis of the tumor, and also in which pseudoxanthoma elasticum was ruled out, both clinically and by a negative skin biopsy.


"Cholera solution" in short bowel syndrome. An oral glucose and electrolyte solution (glucose 120 mmole/liter, Na 100 mEq/liter K 10 mEq/liter, Cl 70 mEq/liter, HCO3 40mEq/liter) was used successfully in a patient with the short bowel syndrome. We believe this solution reversed fluid and electrolyte losses and was responsible for her clinical improvement.


Malignant melanoma metastatic to the gastrointestinal tract from an occult primary tumor. We have described two cases of malignant melanoma of the small bowel which metastasized from occult primaries. Malignant melanoma in the bowel is more common than one might think, being third only to adenocarcinoma of the kidneys and squamous cell carcinoma of the cervix. It appears at this time that palliative resection, along with chemotherapy and immunotherapy, is the procedure of choice in patients with this condition.


Circulating anticoagulant associated with chronic active hepatitis. Chronic active hepatitis is frequently associated with a variety of serologic abnormalities. A patient with chronic active hepatitis and a circulating anticoagulant to factors XI and XII is described. Circulating anticoagulants should be suspected in patients with chronic active hepatitis and a prolonged partial thromboplastin time. This risk of liver biopsy in these patients is unknown, but this possible hazard should be considered in all patients with chronic active hepatitis.


Gram-negative endocarditis caused by Campylobacter fetus. Campylobacter fetus is a rare cause of endocarditis that is difficult to diagnose because of the fastidiousness of the organism. The source of infection is unknown and it may involve a normal or previously damaged aortic valve. The onset is insidious, and if there is a prior history of recent onset of fever, thrombophlebitis, and diarrhea, infection caused by this organism should be considered. Echocardiography may be useful. The organism is sensitive to a variety of antibiotics, including the combination of penicillin and streptomycin. The prognosis and survival are good.


Diphtheria and tetanus antitoxin levels in Thai children. Determination of diphtheria and tetanus antitoxin levels by an indirect haemagglutination method were conducted in 101 nonimmunized schoolchildren, 155 pediatric patients and 102 blood donors. Diphtheria and tetanus antitoxin levels were found mostly adequate among immunized children. Diphtheria antitoxin levels were found adequate in 68.3% of the non-immunized schoolchildren. Tetanus antitoxin levels were found inadequate for protection in the non-immunized children and adults. Immunization of children and adults with diphtheria and tetanus toxoid are highly recommended.


Dengue with haemorrhage and shock in Jakarta, Indonesia. Pediatric patients with fever and haemorrhage were studied in Jakarta, Indonesia between May 1973 and January 1974. Eighty-one of 104 demonstrated unequivocable evidence of dengue with clinical findings similar to those reported associated with dengue haemorrhagic fever in Thailand. The majority of patients had extremely high antibody titers against dengue measured by both hemagglutination-inhibition and by plaque reduction neutralization tests and all four types of dengue virus were isolated. Eight of the patients died.


A new concentration of human intestinal capillariasis on western Luzon. A new concentration of 32 cases of human intestinal capillariasis is described. This subepidemic occurred 120 Km from the nearest previously reported cases and the disease is locally acquired. All but one patient ate raw food and all ingested the small freshwater fish Ambassis commersoni (bagsang). Although good results were obtained with a modified treatment schedule using thiabendazole, mebendazole proved to be easier to administer, was more rapid in action, and no side effects were experienced. The proposed pathological life cycle is reviewed. The need for more awareness of this potentially widespread disease amongst the professional community is discussed.


Sewage stabilization pond: The effects on Schistosoma Mansoni transmission. The "facultative" sewage-stabilization pond was investigated with respect to transmission of S. mansoni. The results of field and laboratory experiments suggest that the ecologic factors i.e., physical and chemical play important roles in a combined interplay affecting the hatchability of S. mansoni eggs, infectivity of miracidia of S. mansioni and the potential existence of the planorbid snails host, B. glabrata. The results seem to indicate the successful reduction of S. mansoni transmission in the pond itself. If the pond is designed properly in terms of depth, detention time, etc., it will serve as an efficient barrier for transmission of S. mansoni. It is expected that the same would be true for other human schistosomes.


Prevalence of Giardia lamblia in children attending an out-patient department of Siriraj Hospital. Giardia lamblia has been considered a facultative pathogenic organism. The prevalence of this organism was found in 18.58% and 18.18% of children with and without associated symptoms. The prevalence is higher than those previous studies from Southeast Asia. Most children are commonly infected after 1 year of age. Giardiasis should be suspected in any child with unexplained chronic diarrhoea, abdominal pain and failure to gain weight. The diagnosis is important because the disease is curable after appropriate treatment.


Clinical observations on glucocorticoids in cobra envenomation. A clinical trial of corticosteroid treatment in five cases of cobra, Naja naja, bite with systemic poisoning is reported. The results reveal that corticosteroid had no demonstrable beneficial effect in the neurotoxic poisoning of the cobra. Specific antivenom is the most important therapeutic agent for systemic poisoning. The combination of antivenom and corticosteroid had no effect on the development of local necrosis.


Single-day treatment of trichomonas vaginitis with low dose of ornidazole. A total of 107 cases of trichomonas vaginitis were treated with different regimens of ornidazole. The overall success rate of the treatment assessed by wet smear and clinical signs after three days in 68 cases was 98.5%. The side effects were mild and of short duration. These were noted in 14.7% of the assessable cases. No significant differences were seen in the success rate between the three drug regimens and the preliminary conclusions of the trial are that ornidazole is safe and effective in the treatment of trichomonas vaginitis in Korean women with an oral dose of 1.0 gm, 1.0 gm plus 0.5 gm intravaginally or 2.0 gm given in a single day.


Current status of schistosomiasis japonica in Sorsogon Province, Republic of the Philippines. A resurvey of Irosin and the eight municipalities surrounding it for schistosomiasis japonica using COPT and FECT was done in order to determine the status of the disease thirty years after it was first reported in the town of Irosin in 1947. In Irosin, the results by FECT showed that there was a decrease in prevalence from 5.7% to 2.8%, however, if by COPT, then there was an increase from 5.7% to 12.2%. There is a definite trend of the disease to spread from Irosin into the surrounding municipalities. Whereas in 1951, only Irosin and Juban have been established as endemic foci for schistosomiasis, the result of previous surveys by the schisto-unit at Irosin and the present study seem to indicate that the disease has spread into seven additional towns surrounding Irosin. In like manner, the snail intermediate host, Oncomelania quadrasi has a tendency to spread to outlying areas outside of Irosin and Juban.


Interactions between larvae of Aedes aegypti and Aedes albopictus in mixed experimental populations. The interaction between larvae of Ae. aegypti and Ae. albopictus in mixed experimental populations under adequate and inadequate food supply were studied in the laboratory. The results revealed that Ae. aegypti had the beneficial effects on the development and survival of Ae. albopictus when food was adequate but adverse effects on Ae. albopictus is exterminated when Ae. aegypti is present. Urbanization and ecology of mosquitoes could be factors in the decreasing number of Ae. albopictus population in urbanized areas. Further experiments are necessary to study the interaction of mosquitoes under various conditions.


VIPomas and the watery diarrhoea syndrome. Vaso-active intestinal polypeptide (VIP) is a recently discovered polypeptide widely distributed throughout the gastro-intestinal tract and nervous system. Elevated plasma VIP levels are found in gut and neural endocrine tumours producing the watery diarrhoea syndrome. Fifty per cent of these tumours are intrinsically malignant and the mortality rate may be as high as 30% even from the bening growths owing to the serious metabolic sequelae of the syndrome. The plasma VIP level is not elevated in any other non-tumourous diarrhoeal condition. The biological action of VIP closely resembles the clinical features of the Verner-Morrison syndrome and experimental evidence strongly suggests that VIP is the causal agent. The measurement of plasma VIP is of exceptional diagnostic value, since detection of elevated levels enables early removal of the tumour and may be life-saving.


Treatment of chronic destructive pneumonia with cephalosporins, penicillin and metronidazole. Three hundred and ten patients with chronic destructive pneumonia (CDP), a necrotizing pneumonia probably caused by aerobic and anaerobic bacterial synergism, were treated with cephalosporins (80 of these with cephalosporins, penicillin and metronidazole). The reasons for selecting these drugs to treat CDP are given and evidence is presented which suggests that the combination of cephalosporins, penicillin and metronidazole is more effective therapy for CDP than cephalosporins alone. This finding supports the thesis that anaerobes are implicated in the aetiology of CDP.


[The role of medical services in combating disasters]. Natural and man-made disasters are an ever present threat, particularly in densely populated cities. Doctors, and other people who provide medical care, plead for comprehensive action plans to ensure survival in cases of disaster. Diaster medicine represents a new, multidisciplinary and comprehensive approach. To combat disasters, however, requires knowledge of, and participation by, many disciplines within and outside the field of medicine. Guidelines, to initiate a comprehensive and coordinated anti-disaster programme, are presented. The purpose is to ensure that all resources are used with maximum effect and that all stumbling blocks to efficiency are removed.


BCG vaccination of the newborn.

BCG vaccination of the newborn. Newborn infants given one of three BCG vaccines at birth reacted to Heaf tuberculin testing 6-12 weeks later with a visible and palpable ring of nodules. This correlated with the Heaf grade I reaction previously describes with BCG vaccination. Review of hospital and clinic records, although regrettably incomplete, revealed no case of tuberculous meningitis or miliary tuberculosis in a vaccinated child in our area since the campaign for vaccination of newborn babies began. Tuberculosis in vaccinated babies should be carefully investigated to determine age at vaccination, type of vaccine, degree of exposure to infection and socio-economic factors which may be important in producing this "vaccine failure". Vaccination will give 60-80% protection to the newborn for about 5 years.


Smoking habits of blacks in industry.

Smoking habits of blacks in industry. A number of Black workers from a factory near Johannesburg were questioned about their smoking habits. Compared with an earlier study, a significantly greater number of younger workers now smoke-and mainly cigarettes. The roles played by the strong tobacco lobby and that of the Department of Health are considered.


Embryonal rhabdomyosarcoma. A case report. A patient with embryonal rhabdomyosarcoma, who presented with septic criminal abortion, is discussed. The fact that the correct diagnosis was obscured by the unusual sequence of events is commented upon, and the need for critical evaluation of apparently clear-cut cases is demonstrated.


Water-soluble vitamins in severe liver disease. Biochemical deficiency of thiamine, vitamin B6, ascorbic acid or nicotinic acid occurred in 71% and 88% of patients with fulminant hepatic failure (FHF) and decompensated chronic liver disease (DCLD) respectively. Transient high plasma vitamin B6 concentrations in FHF were followed by low levels later in the illness. Although patients with DCLD of alcoholic aetiology tended to have lower circulating levels of vitamins than those with non-alcoholic DCLD, the prevalence of abnormally low concentrations did not differ. Decreased dietary nutrient intake and alcohol appeared to be less important determinants of biochemical vitamin deficiency than the presence of liver disease per se. Finally, urinary excretion of these vitamins or their major metabolites in patients with severe liver disease correlated poorly with circulating levels of vitamins.


The influence of paraquat on the in vitro oxygen consumption of rabbit lung. The effects of paraquat on the aerobic metabolism of rabbit lung slices were investigated. The oxygen consumption of lung slices was examined at different oxygen tensions and in the presence or absence of glucose as substrate in a Krebs-Ringer phosphate medium. In an air phase, the oxygen consumption of control lung tissue with glucose in the medium was practically the same as the oxygen consumption without glucose over a 3-hour period. In a 100% oxygen phase, glucose induced a marked increase in oxygen uptake, which persisted for about 2 hours. Thereafter, a decrease occurred in oxygen consumption which was notably faster than that of lung tissue without added glucose. With 10 mM glucose in the medium, paraquat (10(-5)M and 10(-3)M) immediately stimulated the oxygen consumption of lung slices. Although the initial increase in aerobic metabolism seemed to be glucose-dependent, the secondary inhibitory effect of paraquat appeared to be of the same magnitude in the presence or absence of glucose. Both the initial stimulation as well as the secondary inhibition were much more pronounced in a 100% oxygen atmosphere than in an air phase. These results indicate that the rabbit lung is sensitive to paraquat toxicity in vitro, and confirm that oxygen and paraquat supplement each other's toxicity in the lung.


Gastric perforation in the newborn.

Gastric perforation in the newborn. Three newborn infants who developed gastric perforation are reported. One infant survived and 2 died. The aetiology of neonatal gastric rupture is discussed, as well as some diagnostic features. The importance of early diagnosis and prompt surgical intervention is stressed.


A child with the nephrotic syndrome associated with endemic syphilis. A 21-month old infant with endemic syphilis who presented with nephrotic syndrome is described. Clinically, the features correlated well with those of renal disease associated with secondary syphilis. The onset of renal disease in association with syphilis after early infancy may be a valuable aid in drawing attention to the possibility of endemic syphilis. Morphologically the features were those of an immune complex-mediated glomerulonephritis. We regard the presence of a large number of immature-looking glomeruli as a retrogressive phenomenon.


Complement consumption and progression to post-streptococcal nephrotic syndrome. A report of two cases. The immunopathogenesis of the nephrotic syndrome which occurs in about 0,3% of Black children with post-streptococcal glomerulonephritis has not been clearly defined. Findings in 2 out of 582 Black children with post-streptococcal glomerulonephritis who developed nephrotic syndrome suggest that minimal activation in the blood of complement components, particularly C3, early in the nephritic process may determine progression to nephrosis. Differences reported by other workers between normocomplementaemic and hypocomplementaemic patients with post-streptococcal glomerulonephritis support this interpretation.


Mycetomas in goats.

Mycetomas in goats. Naturally occurring mycetomas were found in 3 goats. Two had mycetomas on their hind legs and the third on its left scapula. In 2 goats the causative agents were identified by culture, histopathology and serology as Actinomadura madurae. In the remaining goat diagnosis was based only on histopathology and the causative agent was considered to be A. pelletierii. Despite minor differences between goat and human strains of A. madurae, it would seem that goats could be useful experimental models.


Scalp carriage of Pityrosporum species: the effect of physiological maturity, sex and race. The change in carriage rates of Pilyrosporum sp. over the years before and after puberty were studied in Caucasoid and Negroid children using a semiquantitative cultural technique. Caucasoids yielded yeasts more often than did negroids; older or sexually mature children yielded yeasts more often than did prepubertal children. There appeared to be a decrease in numbers of yeasts isolated a few years after the pubertal peak.


Trichophyton ajelloi isolated from a child. A case of widespread tinea corporis due to Trichophyton ajelloi in a young child is presented. The fungal isolate was unusual in that abundant microconidia were produced together with typical macroconidia. It was pathogenic for the guinea pig.


Preoperative radiotherapy for stage III carcinoma of the breast. We have concluded from these observations in this pilot study that preoperative radiation therapy does not play a particularly helpful role in the management of patients who have the clinical finding of borderline operable carcinoma of the breast and it does not improve the survival rate. Patients within this category of locally advanced disease must be considered to have systemic metastatic disease at the time of diagnosis, as has previously been stressed by many. For this reason, any therapy directed to the regional area for local control must be combined with some form of systemic therapy if there is to be any hope for an increase in survival time.


Colonic protection from dimethylhydrazine by a high fiber diet. Results of this experiment showed that a high fiber bran diet had the ability to lower significantly the incidence of pathologic changes in the colon of mice receiving 1,2-dimethylhydrazine, a drug known for its specificity for causing carcinoma of the colon. This finding adds support to the hypothesis which clains that the addition of bran to the diet has the ability to lower the indicence of carcinoma of the large intestine.


Stored blood platelets and microaggregate formation. The structure and function of platelets in stored blood were tested for 21 days of storage with both light and electron microscopy as well as determination of platelet aggregation response to adenosine diphosphate. Observations were made for a period of 21 days of storage at 4 degrees C. These observations demonstrate the appearance of spontaneous platelet aggregates in stored blood which differ morphologically from aggregates induced by the addition of adenosine diphosphate during the first ten days of storage. The appearance of spontaneous platelet aggregates paralleled a decrease in platelet count and progressive decline in the number of morphologically normal appearing platelets. The platelets that were induced to aggregate with adenosine diphosphate formed more closely packed aggregates that those that formed spontaneously and that the adenosine diphosphate-induced aggregates could still be induced through the tenth day of storage, at which time few morphologically normal platelets could be clearly identified in the plasma. Spontaneous platelet aggregates showed no fibrin in the microaggregates but rather significant numbers of leukocytes contained in the aggregates which degenerated progressively beyond a storage period of five days.


Football, neck muscles and head impact.

Football, neck muscles and head impact. Any blow to the head may be injurious because it is the manner of response to the blow rather than the blow itself that produces the injury potential. Impacts to inanimate objects or to the heads of anesthetized animals produce data that are simplified by the fact that the involved mass is a constant, and the contact time is consistently negligible. On the football field, all the muscles in the body of the player are tensed at the snap of the ball, and the involved mass varies widely during the resulting prolonged contact time. This causes variable accelerations, variable forces and variable velocity changes as well as a varying mass which can only be measured, therefore, according to the impulse momentum theorem, Ft = deltaMV.


Evaluation of carbenicillin and a comparison of clindamycin and gentamicin combined therapy in penetrating abdominal trauma. Results of this study suggest that an antibiotic or antibiotics to be effective in abdominal trauma must cover both aerobic and anaerobic bacteria. A single drug, such as carbenicillin, appears to serve this purpose. If one is allergic to penicillin, then clindamycin along with gentamicin can be used. The routine use of an aminoglycoside in abdominal trauma is unnecessary. Aminoglycoside should be added to carbenicillin therapy only in patients with Klebsiella infections. Furthermore, we also support the recommendation made by others that antimicrobial therapy of abdominal trauma should begin preoperatively.


Chemical burns and skin preparation solutions. Skin preparation burns associated with chemical agents are uncommon. They occur most frequently in those patients placed in the lithotomy position undergoing gynecologic operations, the burn being on the buttocks, and in those undergoing orthopedic operations, the burn being on the extremities and under a tourniquet. Thimerosal has been the most common agent to be implicated. The basic mechanism involves irritation coupled with maceration and pressure--conditions that can cause an acute pressure sore and superficial skin loss. To prevent these burns from occurring, the skin must not be abraded excessively before the final skin preparation solution is applied; the agent should not be allowed to pool and become trapped under the tourniquet or the torso of the patient, and the agent should be allowed to dry before the patient is draped. In our experience, the agent that has been the most effective and the least irritating to the skin during the time it has been used is povidone-iodine.


Colloid osmotic and pulmonary wedge pressures in acute respiratory failure following hemorrhage. Acute respiratory failure evolved in five patients following hypovolemic shock related to trauma or surgical operation, or both. A reduction in colloid osmotic pressure, increases in pulmonary artery wedge pressure and reductions in colloid osmotic pressure-pulmonary artery wedge pressure gradient to levels which are likely to account for pulmonary edema were observed. Accordingly, reduction in the colloid hydrostatic pressure gradient may, in part, explain the development of acute respiratory failure after acute blood loss. In one instance, however, the absence of such reduction in the colloid osmotic pressure-pulmonary artery wedge pressure gradient together with increases in pulmonary vascular resistance showed that colloid osmotic pressure and pulmonary artery wedge pressure are not exclusively operative in the pathogenesis of the clinical syndrome of acute respiratory failure.


Observations on bladder function following radical hysterectomy using carbon dioxide cystometry. It is suggested that carbon dioxide cystometry offers a simple, rapid method for the evaluation of bladder dysfunction in the postoperative period. Certainly, those patients recognized to have abnormal cystometric findings postoperatively are more likely to have voiding difficulties. Variable findings will be noted cystometrically, depending upon the interval between operation and cystometric studies because the pattern does become less pronounced with time.


Glucose kinetics and responsiveness to insulin in the rat injured by burn. The are persistent alterations in glucose metabolism in the rat during the first week after a 20 per cent body surface area burn injury. The basal rate of endogenous glucose production is elevated, and it is not suppressed to a normal degree by an exogenous glucose infusion. The hormonre data suggest that increased glucagon levels are responsible for the elevated rate of gluconeogenesis both before and during an exogenous glucose infusion. Basal glucose uptake was also elevated after injury, and there was a normal increment in the glucose metabolic clearance rate during an exogenous glucose infusion. The increase in the glucose metabolic clearance rate relative to the increase in the insulin concentration was equivalent in the burn and control groups of rats. This indicated a normal responsiveness to insulin after injury. Because there was no impairment in the capacity to take up an exogenous glucose infusion, we would question the insulin resistance rationale for administering insulin to patients rendered hyperglycemic by glucose infusion.


Factors leading to surgical treatment of intussusception. We have reviewed the histories of 36 children treated operatively for 37 intussusceptions on one surgical service at this hospital during a period of ten years. Thirteen children had undergone operative procedures without attempted hydrostatic reduction. The only death that occurred was in a 800 gram premature infant. Pre-existing conditions altering intestinal motility were present in seven children. A definite lead point in the intestinal tract was present in six patients. Although hydrostatic reduction plays a major role in the management of uncomplicated intussusception in the pediatric age group, surgical treatment is sitll a necessary alternative for the management of intussusception.


Parietal cell vagotomy facilitates fundoplication in the treatment of reflux esophagitis. The technique of parietal cell vagotomy is recommended as an adjuvant procedure to be used with fundoplication operations for the treatment of reflux esophagitis. There are three reasons for recommending this procedure: it permits the performance of fundoplication with greater facility and precision; it insures the preservation of the hepatic branches of the vagus nerve, and it reduces acid secretion. These advantages can be achieved without causing the untoward effects of dumping and diarrhea that occur with truncal vagotomy and pyloroplasty.


Evaluation of patients after augmentation mammoplasty. The diagnosis and treatment of disease in the breast after augmentation mammoplasty requires a thorough understanding of the techniques of augmentation. Absolutely no compromise should be made because of the prosthesis. Using a careful history, physical examination, knowledge of techniques of augmentation and currently available diagnostic tools, the breast after augmentation mammoplasy can be safely and accurately treated.


Stab wounds of the skull.

Stab wounds of the skull. Sixteen cases of penetrating stab wounds of the head, where the knife blade has still been in situ on arrival at hospital, are presented. The indications for cerebral angiography, to establish vascular injury, and the spectrum of presentation are discussed. A technique of safe removal is described. There were no fatalities in the cases reviewed.


Traumatic bilateral carotid-cavernous sinus fistulas with progressive unilateral enlargement. The authors present a patient with traumatic bilateral carotid-cavernous sinus fistulas associated with fracture of the sella turcica. Repeat angiography ten days after admission revealed that the left fistula had enlarged and was shunting the entire output of the left carotid artery and a portion of the output of the basilar artery. A muscle embolization procedure was sucessfully performed on the left side but was complicated by hemorrhage from the left cavernous sinus prior to closure. Problems associated with the enlargement of carotid-cavernous fistulas are discussed.


Interhemispheric subdural hematoma.

Interhemispheric subdural hematoma. The clinical presentation and surgical management of an interhemispheric subdural hematoma, a rare entity, is presented and the literature reviewed. Either hemiparesis, worse in the lower than the upper extremity, or lower extremity monoparesis is characteristic of this lesion. Computerized tomography (CT) is the preferred diagnostic procedure. An interhemispheric hematoma, either acute or chronic, is best treated by osteoplastic craniotomy. Specific anatomical considerations, clinical features, and the recommended surgical technique is described.


Effect of dose and dose schedule on the response of intracranial pressure to mannitol. Analysis of monitoring records of 150 patients given over 1000 infusions of 20% mannitol delineared three variables affecting the response of intracranial pressure (ICP) to mannitol: the original ICP; the current dose; and the dose given over the preceding three hours. The level of ICP influenced the response to mannitol as much as the amount of mannitol; giving more mannitol than was required to bring ICP below 25 mm Hg led to the need for larger following doses. One hundred-milliliter-bolus doses were often as effective as larger doses. The results suggest that doses of mannitol given to control increased ICP should be kept as small as possible.


Late thrombosis of middle cerebral artery following clipping and coating of aneurysms. Twenty days after clipping and coating with Aron Alpha (ethylcyanoacrylate) of two adjacent middle cerebral artery aneurysms, the patient developed a complete thrombosis of the parent vessel at the site of the aneurysms. The routine postoperative angiograms on the seventh day after surgery had revealed a patent middle cerebral artery. The possible roles of Aron Alpha and multiple Heifetz clips are discussed.


Arachnoid cyst producing recurrent neurological disturbances. A patient with an arachnoid cyst of the posteriro fossa experienced repeated episodes of transient right upper extremity numbness and weakness. Review of the literature indicates that arachnoid cysts of the posterior fossa and spinal canal as well as extradural spinal cysts may present with symptoms of transient neurological deficit which often suggest the diagnosis of multiple sclerosis.


Transoval trigeminal cisternography.

Transoval trigeminal cisternography. A new water-soluble contrast medium, metrizamide (Amipaque) was used to visualize the subarachnoid space within Meckel's cave. By a needle introduced through the foramen ovale, successful filling of the trigeminal cistern was accomplished in 48(80%) of 60 patients. Transoval trigeminal cisternography offers a possibility to control the position of the tip of the needle in various blocking procedures of the trigeminal ganglion, and may also be used for target localization in stereotactic radiosurgery in the treatment of trigeminal neuralgia.


Acute hypertensive cerebellar hemorrhage with signs of lower brainstem compression. A case of acute hypertensive cerebellar hemorrhage is reported. The patient was comatose on admission and successfully survived following evacuation of the hematoma. Surgically treated similar cases are reviewed in the literature. It is suggested that prompt diagnosis, immediate removal of the hematoma, prevention of rebleeding, and careful management of pre- and intra-operative anoxia may result in better results with this highly lethal condition.


Extra-intracranial anastomosis preliminary to treatment of carotid artery-cavernous sinus fistula. The authors emphasize the value of extra-intracranial anastomosis prior to occlusion of the cervical segment of the main cerebral arteries, and report a case of carotid-cavernous sinus fistula successfully treated by combined extra-intracranial anastomosis and intra-luminal occlusion of the carotid artery with a balloon catheter.


Hypogastric artery aneurysm: a very rare cause of sciatica (and a tricky diagnostic problem!). A 68-year-old hypertensive male suffering from acute sciatica with pronounced motor disturbances and urinary retention, was found to be suffering from aneurysm of the hypogastric artery. Surgical treatment of the aneurysm resulted in an incomplete recovery. The possible relationships of the aneurysm to the symptoms and treatment are discussed.


Leiomyosarcoma metastatic to the brain.

Leiomyosarcoma metastatic to the brain. A rare instance of leiomyosarcoma metastatic to the brain in a 60-year-old male is presented. The primary site was in the gastrointestinal tract. Previously reported cases of similar nature are reviewed.


Neurosurgical management of the elderly patient. The records of 59 patients above the age of 65 operated on for diverse neurosurgical problems between January 1975 and September 1976 were reviewed. It was found that in only about half of the cases was the referral diagnosis correct. Most of the referred patients diagnosed as cerebrovascular accident or senile dementia were found to be suffering from intracranial space-occupying lesions or normal pressure hydrocephalus. Post-operatively there was a significant improvement in 48% of this group of geriatric patients, with no change in 23% and a poor result in 29%. when the data on patients with benign lesions were considered separately, it was found that in this group there was a significant improvement in 60%, with no change in 23% and a poor result in only 17%.


A thrombosed giant aneurysm of the internal carotid artery with brain stem displacement. A giant aneurysm with a maximum diameter of 5.2 cm arising from the right internal carotid artery grew to occupy the interpenduncular cistern and displaced the upper brain stem. Most of the lumen of the aneurysm was occluded by a thrombus and its real dimension in situ was visualized by CT scan. The neck of the aneurysm was successfully clipped but removal of the aneurysm was not feasible. Following surgery, clinical signs and symptoms gradually improved and subsequent decrease in size of the thrombosed aneurysm was documented by serial CT scans.


Congenital saccular aneurysm in a 19-day-old neonate: case report and review of the literature. A 19-day-old neonate presented with a massive intracranial hemorrhage which was found at autopsy to be due to a ruptured intracranial saccular aneurysm. Detailed histologic evaluation revealed that this was a true congenital lesion. A survey of the literature yielded 19 cases of saccular aneurysm in the first year of life. Together with this report, nine cases are now on record, containing sufficient histologic detail to suggest a congenital basis, contrary to the assertion casting doubt on the existence of the entity. Attention is drawn to the practical importance of recognizing this lesion as a rare cause of intracranial hemorrhage in the neonate, since successful surgical intervention has been reported in several cases.


Intrasellar fibromyxochondroma.

Intrasellar fibromyxochondroma. A case is reported in which a fibromyxochondroma grew within the sella turcica, recurred twice and was removed each time.


Vetebral hemangiomas: spinal angiography and preoperative embolization. Seven cases of symptomatic spinal hemangiomas are discussed. Special emphasis is given to a patient in whom pre-operative embolization was necessary. A marked reduction in the blood supply was achieved, with the result that the subsequent laminectomy was carried out without great difficulty.


Enlarging optic chiasmal glioma with stable visual acuity. A 13 1/2-year-old girl with stable, reduced visual acuity, nystagmus and Small, pale optic discs initially noted at age nine months, developed signs and symptoms of increased intracranial pressure. At craniotomy, an intrinsic glioma of the optic chiasm and both optic nerves extended into both frontal lobes, the hypothalamus and the third ventricle.


Computed tomography in the differential diagnosis of low-density intracranial lesions. Computed tomographic (CT) findings of low-density lesions of the brain were compared with the pathologic nature of the lesions. Twenty-one lesions having densities uniformly lower than those of the normal brain, most of which showing no significant early enhancement effect, were selected. Such lesions were either cystic non-neoplastic lesions, cystic tumors, solid tumors or solid but non-neoplastic lesions. Although CT proved to be the single, most sensitive diagnostic method detecting such low-density lesions, it was often difficult or even impossible to differentiate cystic from solid, or neoplastic from non-neoplastic lesions based on the CT features alone.


Binasal hemianopia.

Binasal hemianopia. The visual fields of 100 patients referred for neuro-ophthalmologic examination were reviewed; eight cases had binasal visual field defects. Most clinicians have suspected an intracranial cause for such field defects since the classic report of Cushing and Walker in 1912. However, in this study, the cause for the binasal hemianopia was found to be ischemic optic neuropathy in two patients, and one case each of optic nerve drusen, glaucoma, congenital optic nerve pits, and retinitis pigmentosa sine pigmento. Thus 75% of the cases had an intraocular cause for the binasal hemianopia. Two patients had congenital hydrocephalus, and an intracranial basis was thus noted in 25% of these cases. The neurosurgeon should realize that the patient with binasal field defects is much more likely to have an ocular cause than an intracranial one for his problem.


Local hypothermia in experimental spinal cord trauma. A series of controlled animal experiments comparing the effects of one, four, and 18 hours of local hypothermia at 6 degrees C begun four hours after compression lesions to the thoracic cord in dogs is reported. Four hours of local cooling delivered by a small silastic epidural heat exchanger, without durotomy or tissue perfusion, is shown to give greater functional benefit than cooling for one hour or 18 hours. Experimental design, pathophysiological implications, and clinical relevance are discussed.


Phrenic nerve conduction studies in the evaluation of ventilatory problems in patients with cranio-cervical trauma. Five patients with hypoventilation and paresis of the diaphragm following trauma to the cervical spinal cord, brain stem, or both, were evaluated with phrenic nerve conduction studies while being considered for implantation of a phrenic nerve stimulator. Several distinct patterns of phrenic nerve function were elicited in the various cases, allowing accurate predictions and management decisions to be made. Phrenic nerve conduction studies are felt to be a valuable diagnostic tool in the management of the hypoventilating patient with cranio-cervical trauma. The procedure is safe, rapid, and easily performed at the bedside.


Cerebral pseudoatrophy and computed tomography: two illustrative case reports. The detection of cerebral atrophy in the demented patient is best accomplished by computed tomography (CT). However, CT is a static tool in the evaluation of cerebral disease. Two cases of "pseudoatrophy", one secondary to malnutrition, the other secondary to communicating hydrocephalus, will illustrate the problems in the evaluation of "atrophic" change on the basis of one CT examination alone.


Sudden visual loss secondary to an orbital varix. A 45-year-old man presented with precipitous loss of vision and rapidly changing field defects in one eye. Computerized tomography and B-scan ultrasonography revealed a small orbital mass adjacent to the optic nerve. This was removed via lateral orbitotomy. On pathologic examination it was diagnosed as a small orbital varix. Drs. Frederick C. Blodi and Stephen Trokel comment on the case.


Elimination of aniseikonia in monocular aphakia with a contact lens-spectacle combination. Correction of monocular aphakia with contact lenses generally results in aniseikonia in the range of 7--9%; with correction by intraocular lenses, aniseikonia is approximately 2%. We present a new method of correcting aniseikonia in monocular aphakics using a contact lens-spectacle combination. A formula is derived wherein the contact lens is deliberately overcorrected; this overcorrection is then neutralized by the appropriate spectacle lens, to be worn over the contact lens. Calculated results with this system over a wide range of possible situations consistently results in an aniseikonia of 0.1%.