The relationship between apparent depth and disparity in rivalrous-texture stereograms. A series of experiments is reported on rivalrous-texture stereograms composed of narrowband-filtered random noise. Experiment 1 found that the apparent deth-disparity function for such stereograms was different from that observed with similar but nonrivalrous stimuli. In particular, rivalrous divergent disparities produced the same depth as rivalrous zero disparity and this latter disparity itself produced a significant degree of protruding (i.e. 'convergent') depth in a certain type of rivalrous-texture stereogram. Free inspection was permitted and disparities were in the range 16 min convergent to 16 min divergent. Experiment 2 found no convincing evidence for reliable qualitative depth discriminations from tachistoscopic presentations of rivalrous-texture stereograms, using a forced-choice task requiring a discrimination between 16 min convergent and 16 min divergent conditions. This task was solved easily for equivalent nonrivalrous stimuli. Experiment 3 measured a hitherto unreported binocular depth effect, termed 'paradepth', which is produced by presenting a target in one field only. This effect appears to be a genuine biocular depth effect and not just the result of an ordinary monocular masking depth cue. The size of the depth effect was found to be a function of the width of the target. The overall conclusion derived from the series of experiments is that rivalrous-texture stereograms are complex stimuli capable of yielding curious and unexpected depth effects which are not readily explained in detail within any existing theoretical framework.


Moirés maintained internally by binocular vision. Moiré patterns in depth are reported when spatially periodic stimuli are viewed stereoscopically. Near-vertical square-wave gratings with horizontal disparity effected by orientation difference produce a 'venetian blind' effect. A single grating is observed divided into horizontal layers, the number of layers being a direct function of orientation difference. Lines within each layer are slanted with respect to the frontoparallel plane, becoming more so with increasing orientation difference. Subjects with stereo deficits report a decreased effect. Quantitative reports implicate stereoscopic mechanisms responsible for this unique, internal preservation of moiré patterns.


Two dimensionality of the correspondence process in apparent motion. A fundamental process underlying motion perception is the matching of corresponding elements in different views. In this correspondence process spatial separation between elements plays a major role. The relevant separation is shown by the current study to be the two-dimensional, uninterpreted distance, a finding that has an implication to the level at which the correspondence process is carried out. The current findings are compared with earlier results concerning 'optimality' of apparent motion to conclude that optimality cannot serve as a measure for the correspondence strength.


Two categorical stages of object recognition. Visual object recognition was investigated in a group of eighty-one patients with right- or left-hemisphere lesions. Two tasks were used, one maximizing perceptual categorization by physical identity, the other maximizing semantic categorization by functional identity. The right-hemisphere group showed impairment on the perceptual categorization task and the left-hemisphere group were impaired on the semantic categorization task. The findings are discussed in terms of categorical stages of object recognition. A tentative model of their cerebral organization is suggested.


An additional dimension to grating perception. Visual acuity (A) for a two-dimensional multiplicative sinusoidal contrast grid (sinusoidal chessboard) was measured as a function of spatial frequency (omega) of modulation in one of the dimensions. The reduction in acuity as frequency was increased was well described by the equation: A = -2pikomega + c, where k and c are constants. At suprathreshold contrasts, the frequency of modulation appeared to be doubled relative to the underlying modulation frequency. This doubling is not related to the frequency of the harmonic components of the chessboard, but suggests the existence of a perceptual mechanism sensitive to areas of sinusoidal modulation which are seen at twice the frequency of the variation in contrast.


Orientation detectors in the human visual system and figural aftereffects. Figural aftereffects were measured by using square patches of high-contrast grating on a dark background as inspection and test figures. The orientation of the outer square border and the enclosed grating were varied independently in order to evaluate their relative influence on the strength of the induced change of overall apparent size of the test figure. The largest effect is obtained when inspection and test figures are identical in the orientation of both outer border and enclosed grating. The strength of the aftereffect is reduced as a difference in orientation is introduced between inspection and test figure for either the outer contour or the contained grating, although the former is a more potent factor than the latter.


Organochlorine residues and reproduction in the little brown bat, Laurel, Maryland--June 1976. Twelve of 43 pregnant little brown bats (Myotis lucifugus) collected at Montpelier Barn, Laurel, Maryland, gave birth to dead young. Eleven of these 12 dead neonates were abnormally small. Most of the stillbirths were attributable to unknown reproductive difficulties associated with first pregnancies, but four may have been due to high concentrations of polychlorinated biphenyls (PCB) in the newborn. Residues of the PCB, DDE, and oxychlordane crossed the placenta at similar rates.


Pesticide residue levels in soils and crops, 1971--National Soils Monitoring Program (III). Data from the 1971 National Soils Monitoring Program are summarized. Composite samples of soil and mature crops were scheduled for collection from 1,533 4-hectare sites in 37 states. Analyses were performed on 1,486 soil samples for organochlorines, organophosphates, PCBs, and elemental arsenic; samples were analyzed for atrazine only when pesticide application data indicated current-year use. Organochlorine pesticides were detected in 45 percent of the soil samples in the following order of frequency: dieldrin, sigmaDDT, aldrin, chlordane, and heptachlor epoxide. Most pesticide levels ranged from 0.01 to 0.25 ppm. Crop samples were collected from 729 sites, and all were analyzed for organochlorines. Crop samples were analyzed for organophosphates and atrazine only when pesticide application data indicated current-year use. Organochlorines were detected in 42 percent of the crop samples analyzed, organophosphates in 13 percent, and atrazine in 1 percent.


Pesticide application and cropping data from 37 states, 1971--National Soils Monitoring Program. This report summarizes pesticide application and cropping data collected in 1971 from 1,473 agricultural sampling sites in 37 states as part of the National Soils Monitoring Program. Pesticide application data are summarized by all sites, state, and crop. Tables generally give the number of reporting sites, the number of times a compound was applied, the percent occurrence, and the arithmetic mean total application rate. Pesticides applied most frequently to sampling sites were atrazine, 2,4-D, captan, and malathion. Pesticides were most frequently applied to field corn and cotton, least frequently to alfalfa/bur clover and mixed hay.


Organochlorines, cholinesterase inhibitors, and aromatic amines in Dutch water samples, September 1969--December 1975. The Dutch aquatic environment was monitored from September 1969 to December 1975 for organochlorine pesticides and their metabolites, cholinesterase inhibitors, and aromatic amines. The 1,492 samples analyzed included surface water, rainwater, groundwater, and drinking water. The highest concentrations of hexachlorobenzene (HCB) and alpha- and beta-benzene hexachloride (BHC) were found in the Rhine River and its tributaries. Concentrations of the compounds in the Dutch part of the Rhine River decreased downstream. Other organochlorine pesticides and their metabolites, heptachlor, heptachlor epoxide, aldrin, dieldrin, endrin alpha- and beta-endosulfan, and sigmaDDT were detected occasionally, but only in low concentrations. Cholinesterase inhibitors and aromatic amines were always  present in the Rhine River and its tributaries.


Organochlorine pesticide levels in Ottawa drinking water, 1976. Duplicate samples of Ottawa drinking water were collected once a month during 1976 and analyzed for organochlorine pesticides. The samples were analyzed by gas chromatography--mass spectrometry, and pesticides were identified by comparing their retention times, coupled with selected ion monitoring, with those of known standards. The pesticides detected and their mean concentrations in parts per trillion were aldrin (0.9), heptachlor epoxide (3), heptachlor (0.6), alpha-BHC (6), gamma-BHC (3), endrin (4), dieldrin (1), o,p'-TDE (1), o.p'-DDT (3), and o,p'-DDE (0.2).


Pesticide residues in estuarine mollusks, 1977 versus 1972--National Pesticide Monitoring Program. Bivalve mollusks were monitored for residues of 20 organochlorine and organophosphate pesticides and polychlorinated biphenyls in spring 1977 in 87 of the 181 estuaries routinely monitored on a monthly basis during 1965--72. DDT, the only pesticide detected in 1977, occurred at low levels in one estuary each on the Atlantic and Pacific coasts.


[Femoral neck fracture treated by head arthroplasty: factors of life prognosis. 477 cases (author's transl)]. 477 cases of femoral head arthroplasty for fresh femoral neck fractures were reviewed to study the various factors modifying life prognosis during the first six months (age, associated disorders, type of prothesis, postoperative complications). Certain of these factors were found to affect prognosis unfavorably: bad general health, alcoholism, psychiatric or neoplasic disease, diabetes, and also, to a less degree, senility, neurologic and sensorial disturbances, cardiac deficiency. A rate table makes it possible to make a prognosis on the basis of these different factors.


[Study of caryotype in pre-leukaemic states (author's transl)]. Twenty-four patients, in a condition considered to be pre-leukaemic underwent study of marrow caryotype. Nine of them (37.5%) had an abnormal caryotype. The prevalence of abnormalities varied according to the type of pre-leukaemic state: 17% in acquired idiopathic sideroblastic anaemia, 33% in refractory anaemias with excessive myeloblasts, 100% in 3 cases of simple refractory anaemia. The abnormalities were non-systematised. However, in one case there was an abnormality already described in the literature and considered to be specific: deletion of the long branch of chromosome 5. In refractory anaemias with excess myeloblasts transformation to acute leukaemia appeared to be more frequent in patients with an abnormality (4/5) than in patients with a normal caryotype (0/10).


[Acquired deficit in factor X associated with amyloidosis. One case (author's transl)]. A 75-year-old woman developed a haemorrhagic syndrome due to an acquired deficit in factor X whic resulted in death from gastrointestinal bleeding. This deficit was associated with primary amyloidosis. The relationship between the two conditions, the particular features of the haemostatic picutre and the ineffectiveness of replacement therapy are discussed.


[A second "reserve" epicardial catheter in unipolar electrosystolic stimulation via the epigastrium (author's transl)]. At the time of implantation of a unipolar epicardial pacemaker via an epigastric approach, it is suggested that two wires inserted into two different areas should be used. This method is useful in the treatment of wire fractures, exteriorisation of the box, increases in threshold and infections following numerous box changes which the young individual may need.


Over-all accuracy of 99mTc-pertechnetate brain scanning for brain tumours--study of 471 patients. A 3-year follow-up and re-evaluation of all scans on all patients referred for brain scanning in Iceland during 1 year was performed in order to assess the diagnostic reliability of radioisotope scanning for brain tumours. The study included 471 patients. Of these 25 had primary brain tumours and 7 brain metastases. Scans were positive and correctly interpreted in 68% of the patients with primary brain tumours and in 3 of the 7 patients with metastases. The over-all accuracy of brain scanning for brain tumours defined as the total number of correct positive scans and correct negative scans versus total number of scans examined was 96%, this figure being mainly influenced by the high number of true negative scans.


[Water and potassium metabolism in functional disturbances of the thyroid gland (author's transl)]. Total body water, extracellular water (bromide space), plasma volume and total body potassium were evaluated in hypothyroid (n = 24) and hyperthyroid (n = 18) patients and in controls (n = 10). Whereas the relative extracellular water was the same in all groups investigated, the relative intracellular water was found to be reduced in hyperthyroidism and increased in hypothyroidism (p less than 0.05). As to plasma volume there were no significant differences. A negative correlation between total body potassium and functional disturbance of the thyroid (T4) is thought to be attributable to an alteration of the lean body mass.


The effect of haematoporphyrin derivative on the uptake of 67Ga, 59Fe and 65Zn in tumours. The effect of prior administration of haematoporphyrin derivative on the uptake in tumours of 67Ga, 59Fe and 65Zn has been studied in tumour-bearing rats and mice. An approximately two-fold increase in the uptake of 67Ga was observed in the August 15 rat tumour when the nuclide was administered 17 to 24 hr after haematoporphyrin. No increase in the uptake of 67Ga occurred in three mouse tumours. Haematoporphyrin administration did not affect the uptake of 65Zn and 59Fe in any of the tumour systems. It is concluded that the presence of haematoporphyrin does not markedly increase the ability of tumours to accummulate metallic radionuclides.


[Comparative studies of commercially available T4-RIA-kits (author's transl)]. The investigation of 4 commercially available T4-RIA-Kits with 350 patient sera have shown that: The separation of hypo-, eu- and hyperthyroid values is easier with kit a) and d) than with b) and c), though all kits give acceptable values under routine conditions. For the determination of the "normal range" not less than 100 patient sera are necessary. The time needed for 100 determinations is 2 to 3 hr. A general recommendation for one of the tested T4-RIA-Kits cannot be made since the choice depends also on local circumstances.


[Comparative studies of commercially available T4-RIA-Kits (author's transl)]. The investigation of the tested commercially available T4-RIA-Kits have shown that: The separation of hypo-, eu- and hyperthyroid values is better with kits a) and f) than with b),c),d) and e), though all kits give acceptable values under routine operating conditions, kit b) takes less time and work than the other tested kits, depending on the kit used, the time needed for 100 determinations varies between 1,5 and 4 hr. A general recommendation for one of the tested T4-RIA-Kits cannot be made since the choice of a kit depends not only on the criteria discussed but also on local circumstances.


[Quality control of some commercially available 123I/125I/131I/-orthoiodhippurates by means of high pressure liquid chromatography (author's transl)]. Some of the 123I/125I/131I/-orthoiodohippurates available on the market were examined regarding their radiochemical purity. Because of its high sensibility, the reversed phase high pressure liquid chromatography was chosen as analytical method. The unnecessary radiation exposure of the thyroid, ovaries, testes and red bone marrow caused by the free iodide present as radiochemical impurity was estimated. The results showed that all examined orthoiodohippurates meet the minimum requirements of radiochemical purity established in the European Pharmacopoeia.


Investigation of the effect of chlorophenothane and certain chemically related compounds on the cerebral gamma-aminobutyric acid contents in rats. The effect of chlorophenothane (pp'--DDT) and five structurally related compounds op-DDD (op'-DDD, pp'-DDD, DTE, DCMP and DCP see text) on the cerebral hemisphere gamma-aminobutyric acid (GABA), the main inhibitory transmitter in brain contents and possible correlation with central activities was demonstrated in rats. The tested compounds were given in oral doses of 600 mg/kg in peanut oil. Cerebral GABA content was determined 1, 3 and 6 hrs after the ingestion of pp'-DDT and 3 hrs after each of the other drugs. The mean GABA content in each group of rats was compared with control groups, either without any treatment, or receiving the equivalent volume of peanut oil. pp'-DDT produced a significant reduction in brain GABA contents 3 and 6 hrs after its administration. This was accompanied by excitability, tremor and clonic convulsions. Of the congenors, only DTE exerted a similar effect. The present results point to the possibility of partial involvement of GABA in the tremor and convulsions induced by pp'-DDT. They also indicate the importance of the CCl2 grouping in the molecule for the induction of central effects of pp'-DDT.


Enzymatic changes in peripheral blood leukocytes in rats in subacute benzene vapours poisoning. II. The activity of neutrophils enzymes. The activity of some enzymes of neutrophils in peripheral blood of rats in subacute benzene vapour poisoning (an exposure to the concentration of benzene vapour of 27.000 mg/m3, 6 hr daily for 10 consecutive days) was determined cytochemically. Increase in the activity of alkaline phosphatase and decrease in that of acid hydrolases: acid phosphatase, beta-glucuronidase and beta-glucosaminidase were found. The results obtained indicate destructive action of benzene on lysosomes of peripheral blood neutrophils.


Preliminary screening of anticholinergic effect of some new derivatives of glycolic and aminoacetic acids. The anticholinergic effect of some new alkylaminoalkyl esters of benzilic, cyclohexyl, 1-hydroxycyclohexyl, piperidino-and morpholino acetic acids (Table 1) was evaluated. Only benzilic acid esters were active and the 2-N-piperidinoaminoethyl benzilate hydrochloride (ANC-30) has the highest pA2 value.


Brain dopamine and seizure susceptibility in mice. In electroshock test apomorphine appeared without effect, D, L-amphetamine and L-DOPA (in a high dose) elevated the convulsive threshold, while amantadine decreased it. Among investigated dopamine (DA) receptor blockers spiperone, pimozide and fluphenazine lowered the threshold, haloperidol being without effect. The convulsive threshold elevated by L-DOPA was not affected by neuroleptics and phentolamine but on the other hand DA receptor blockers and phentolamine anatagonized the effect of D, L-amphetamine. The effect of amantadine was not influenced by neuroleptics. In pentylenetetrazol (PTZ) test only amantadine and L-DOPA (in high doses) affected the threshold, increasing seizure susceptibility; the above effect was not abolished by pimozide. Our results seem to indicate that the activity of brain DA system seems not to be involved directly in the susceptibility to electrogenic or PTZ-induced seizures in mice.


Preliminary screening of anticholinergic effect of new 1,3-dioxolane and 1,3,-dioxane derivatives. Some of the 28 investigated new derivatives show distinct anticholinergic activity. The greatest activity, that of 2-cyclohexyl-2-phenyl-5-piperidinodioxane-1,3 was greater than of the atropine sulfate.


Alcohol-related problems in adolescents and women. In the roles of student and homemaker, youthful and female problem drinkers can easily hide alcoholism. Compared with adult male alcoholics, their intake of alcohol is less but they are more likely to use other drugs concomitantly. An understanding of their unique characteristics will help the physician recognize patients in these groups with alcohol-related problems.


Psychiatric problems of alcoholics.

Psychiatric problems of alcoholics. In this overview of the psychiatric disorders and problems associated with alcoholism and alcohol abuse, true psychiatric illness which may account for excessive alcohol use is differentiated from the psychiatric sequelae of chronic alcoholism. This distinction is emphasized because of its important practical implications for treatment.


The effect of drugs interfering with biogenic amines metabolism on gastric secretion and reserpine-ulcers development in rats. The effect of drugs interfering with endogenous catecholamines metabolism on gastric secretion and gastric ulcers development 4 hr following reserpine administration was investigated in rats with chronic gastric fistulas. Drugs inhibiting catecholamine synthesis: alpha-methyl-p-tyrosine (alpha-MT) and sodium diethyldithiocarbamate (DDC) decreased substantially the reserpine-induced gastric acid and pepsin secretion, but only alpha-MT diminished the development of gastric ulcers. Pretreatment with nialamide (NLD) elicited in reserpinized rats a marked inhibition both of gastric secretion and of gastric ulcers development. Dopamine (DA), noradrenaline (NA) and adrenaline (A) decreased the secretion of hydrochloric acid but did not change the intensity of gastric ulcers caused by reserpine. Desipramine strongly inhibited reserpine-induced gastric acid secretion. Reserpine depleted DA, NA and 5-HT stores in the brain and decreased DA and 5-HT levels in the wall of the stomach in which the NA levels were increased. The changes in biogenic amines content induced by drugs in reserpinized rats did not correlate with their influence on gastric secretion and on the development of mucosal ulcers. The inhibitory effect of all of the drugs examined on gastric acid and pepsin secretion in reserpinized rats was accompanied by the inhibition of gastric ulcers formation following NLD and alpha-MT administration only, indicating that ulcer generation following reserpine depends more on changes in mucosal barrier resistance than on gastric acid secretion.


The effect of a new antidepressant drug, C-45, and imipramine on some hemodynamic parameters in the dog. C-45, given to dogs in doses corresponding to 1/30 and 1/10 of LD50 iv, slowed down the cardiac rhythm and depressed systolic, diastolic, and end-diastolic pressures in the left ventricle. A dose of 1/30 of LD50 slightly increased, and a dose of 1/10 of LD50 depressed the indices of contractility of the cardiac muscle. Imipramine produced similar effect but accelerated the cardiac rhythm, and when used in a dose of 1/10 of LD50, it impaired atrioventricular and intraventricular conduction.


Chemical constituents of Ficus bengalensis (part II). Three ketones: 20-tetratriacontene-2-one (1), 6-heptatriacontene-10-one (7), pentatriacontan-5-one (13), and two other compounds, beta-sitosterol-alpha-D-glucose and meso-inositol have been isolated from the stem bark of Ficus bengalensis and their tentative structures are given.


Cancerostatica. I. synthesis of some pyrazolo[1,5-a]pyrimidine and pyrazolo [3,4-b] pyridine derivatives. In basic medium 2-phenyl-and 2-(pyridyl-4')-derivatives of 3-dimethylaminoacrlein yields with 5-aminopyrazol-3-one the corresponding pyrazolo [1,5-a] pyrimidines. However, in acid medium, 2-phenyl-3-dimethylaminoacrolein cyclised to derivatives of pyrazolo[3,4-b] pyridine. A reaction mechanism is proposed. Some of these compounds showed significant cytostatic activity against transplanted Ehrlich asc. carcinoma and Nemeth-Kellner lymphoma.


Alcohol intoxication and the alcohol withdrawal syndrome. Although acute alcohol intoxication can cause death, hepatic metabolism of ethanol is usually rapid, and in most cases general supportive care of the intoxicated patient is all that is required. Abrupt cessation of prolonged excessive alcohol intake gives rise to the alcohol withdrawal syndrome. The fundamentals of treatment are careful assessment of the patient and judicious use of a benzodiazepine.


Synthesis of some 2,3-disubstituted quinazolones as possible anticonvulsants. By the condensation of 2-phenyl-3-acylchloride quinazolin (3H)-4-one with N-phenyl- and N-methyl piperazines or piperidine, 15 new 2-phenyl-3-piperidino/substituted piperazino acyl-quinazolin (3H)-4-ones 1--3 have been prepared. All the compounds barring one exhibited at the 100 mg/kg dose level significant activity against pentylenetetrazol induced seizures but these compounds did not afford any protection against electroshock induced seizures.


Rehabilitation for alcoholics.

Rehabilitation for alcoholics. Chemotherapy, psychotherapy, behavior modification, and participation in Alcoholics Anonymous have been used successfully to treat the alcoholic patient, but all have limitations and some have potential dangers. All require long-term follow-up and family participation.


The effect of agents stimulating dopaminergic system on incorporation of exogenous adenine into striate body slices of the rat. We tested the effect of various concentrations (10(-6)--10(-4) M) of dopamine (DA), apomorphine (APM), amantadine (AMD), dimethylaminoadamantane (DMAD) and haloperidol (HP) on in vitro incorporation of 14C/U/adenine to slices of the rat striate body. Two mechanisms participated in this incorporation: one of them (uptake I) of Km = 1.92 micron, the second (uptake II) of Km 434 micron, APM inhibited both uptake I and II, while AMD and DMAD only the uptake I. HP at concentration inhibiting the dopaminergic receptors did not affect the inhibition by APM, AMD or DMAD of incorporation of exogenous adenine to striatal slices. Incorporation of exogenous adenine was not related to stimulation by specific (DA) or unspecific (APM, AMD, DMAD) stimulants of dopaminergic receptors in the rat striate body. The inhibition of the uptake produced by APM, AMD and DMAD may be related to the mechanism of action of these compounds.


Studies on the quantitative structure-activity relationships in pyrazine carbothioamide derivatives. Quantitative relationships were studied between tuberculostatic potency in vitro and structure parameters of pyrazine carbothioamides. The activity of the compounds was found to be dependent on the parameters related both to the size of the substituent and electronic properties of the molecule. An equation was obtained, statistically significant on the 99% level, which described about 71% of variance of activity data for the compounds under study as a function of molar refractivity of the substituent and the wave length at which absorption maximum occured.


Studies on quantitative relationships between the structure and in vitro tuberculostatic potency of 2-cyanomethylbenzimidazole derivatives. Quantitative relationships were studied between in vitro tuberculostatic potency and physico chemical parameters relating to the structure of 2-cyanomethylbenzimidazoles. The activity of the compounds was found to be mathematically described as a square function of molar refractivity of the substituent or the RM values and a linear function of the wavelength at the absorption maximum or the connectivity index for the aromatic ring in the substituent. The equation was obtained, statistically significant on the 99% level and describing of about 83% of variance in activity data, which may be of value for the design of new active derivatives.


The choice of medium suitable for the reaction of thiol groups with halogen derivatives in the synthesis of some purine and pyrimidine compounds. I. Synthesis of azathioprine. Investigations were carried out using 6-mercaptopurine and 1-methyl-4-nitro-5-chloroimidazole as model compounds. The reaction kinetics were investigated by the UV spectroscopy at various time intervals. The investigations resulted in elaboration of an efficient synthesis of azathioprine which can be applied on an industrial scale in a yield of 80%.


Cancerostatica. II. Synthesis and preliminary cytostatic screening of some alpha-carboline derivatives. 6-Phenyl-and (6-pyridyl-3')-2-chloro-3-aminopyridines were transformed by treatment with HNO3 into the corresponding pyrido [4,5-b] triazoles [7,8]. In PPA medium at 180 degrees, triazoles 7 and 8 decompose to 2-substituted alpha-carbolines 9,10 and anilino-3-hydroxypyridines 11, 12. Some of these compounds showed significant cytostatic activity against transplanted Ehrlich ascites carcinoma and Nemeth-Kellner lymphoma.


Pregnancy in adolescents: helping the patient and her family. Dealing with the complex problem of pregnancy in adolescence may involve working with many people. If the physician approaches the patient with an attitude of acceptance and understanding, the adolescent girl may be helped to make realistic decisions concerning her pregnancy and to adjust in a healthy manner. If she does not receive such assistance, pregnancy may be a misunderstood event that leads to further negative psychologic sequelae.


Asymptomatic hematuria and proteinuria in children: differentiating the causes. In dealing with asymptomatic hematuria or proteinuria in the pediatric population, the physician should begin with an organized, logical sequence of diagnostic steps, including careful review of the history, physical findings, and laboratory data. If serious glomerular disease is suspected (eg, presentation atypical of acute poststreptococcal glomerulonephritis, nephrotic syndrome beyond the usual age for idiopathic nephrotic syndrome of childhood, renal insufficiency, severe hypertension), biopsy is probably inevitable, and early referral to a nephrologist is urged.


Medical consequences of alcohol abuse.

Medical consequences of alcohol abuse. It is important for the primary care physician to be aware of the early physical effects of alcohol abuse on various body systems so that the alcoholic can be recognized and treated at the earliest possible time. There are many conditions which should alert the examiner to possible alcoholism.


The pharmacology of alcohol.

The pharmacology of alcohol. The metabolic breakdown of ingested alcohol is specific for each person. Blood alcohol concentration after a given dose of alcohol depends on many factors, including the degree of tolerance developed by daily drinking. Metabolic alterations in the CNS, liver, gastrointestinal tract, endocrine system, and skin produced by acute and chronic alcohol consumption can result in a variety of disorders.


Coagulation factors in opposed and unopposed oestrogen treatment at the climacteric. Laboratory tests of blood coagulation and platelet activity were undertaken in fifty-two climacteric patients who received cyclical oestrogen regimens for six consecutive months, following which they were given cyclical sequential oestrogen/progestogen regimens for periods ranging from fifteen months to twenty-seven months. The cyclical sequential regimen employed was determined by the dosage of oestrogen prescribed during the initial six-month period: norethisterone (2.5 mg or 5.0 mg) on days sixteen to twenty-one of cyclical treatment with oestrone piperazine sulphate or conjugated equine oestrogens, and DL-norgestrel (0.5 mg daily) from day twelve to day twenty-one of cyclical oestradiol valerate treatment. The results suggest that the addition of a progestogen to the cyclical oestrogen treatment does not modify blood coagulation factors or platelet aggregation.


Effects of progestogens on serum lipids in the post-menopause. Measurement of serum cholesterol, triglycerides, and phospholipids was undertaken in patients with a natural menopause or following oöphorectomy who received cyclical oestrogen regimens for six consecutive months. The regimen employed was either a 'high' or 'low' dose of equine conjugated oestrogens, piperazine oestrone sulphate or oestradiol valerate. After six months a change was made to cyclical sequential oestrogen/progestogen regimens for varying periods. Patients with a natural menopause given either 'high' or 'low' dose regimens showed no significant changes in serum cholesterol, triglyceride or phospholipid levels compared to baseline values. However, the serum cholesterol levels of the oöphorectomized subjects were significantly elevated in comparison with the perimenopausal group. The addition of progestogen to the oestrogen did not cause any significant alterations.


The effect of oestradiol valerate and cyclic oestradiol valerate/DL-norgestrel on calcium metabolism. Fasting plasma and urinary calcium and urinary hydroxyproline are known to rise at the menopause, reflecting increased bone resorption. Oestradiol valerate and cyclic oestradiol valerate/DL-norgestrel are shown to reduce this evidence of increased bone loss. It is concluded that these preparations will be effective in preventing post-menopausal loss of bone.


The effect of ovarian sex steroids on bone mineral status in the oöphorectomized rat and in the human. The effect of oöphorectomy and hormone replacement therapy after oöphorectomy on bone mineral in the femur and vertebra of the rat has been studied. Oöphorectomy resulted in osteoporosis of the femur but not of the seventh caudal vertebra. The administration of a progestogen (ethynodiol diacetate 9 microgram/day) apparently prevented loss of bone mineral content of the femur. This was due to increased periosteal bone formation and widening of the femur. An oestrogen (mestranol 0.9 microgram/day) had no significant effect on the femoral osteoporosis but increased bone mineral content of the vertebra. Combined therapy with oestrogen and progestogen had no effect on any parameter of bone mineral content. The preliminary human study indicated that a progestogen may also be as effective as an oestrogen in prevention of post-menopausal bone loss. There was no evidence of reduction of bone resorption (as indicated by urinary hydroxyproline output) by the progestogen and therefore it is postulated that a progestogen might retard bone loss in the post-menopausal era by stimulating bone formation.


The modifying effect of progestogen on the response of the post-menopausal endometrium to exogenous oestrogens. Cyclical regimes of unopposed oestrogens are associated with the development of both cystic glandular and atypical hyperplasia, and the incidence of hyperplasia is related to the dose of oestrogen prescribed. Atypical hyperplasia develops later than, and perhaps from, cystic glandular hyperplasia. With sequential oestrogen/progestogen therapy the incidence of this condition was greatly reduced, and therefore, progestogens appear to protect against the development of this condition. In all cases but one, sequential regimes also reversed both spontaneously-arising and oestrogen-induced hyperplasia to a normal endometrium. Cyclical high-dose unopposed oestrogen therapy may not be capable of reversing spontaneously-arising hyperplasia, and this condition may progress to endometrial adenocarcinoma. Spontaneously-arising hyperplasia can be present before therapy commences, but may be unsuspected, as it can occur in the absence of abnormal vaginal bleeding. Therefore, cyclical oestrogen therapy should not be prescribed unless pre-treatment curettage has been performed and spontaneously-arising hyperplasia has been excluded; and unless subsequent monitoring of the endometrial response is being performed by serial biopsy.


Clinical considerations in the management of the menopause: the endometrium. Exogenous oestrogens prescribed for the relief of menopausal symptoms are being given in pharmacological doses and the term 'hormone replacement therapy' is inappropriate. The frequent development of endometrial hyperplasia during unopposed cyclical oestrogen therapy is therefore to be expected, but no single pattern of vaginal bleeding accurately reflected the histology of the endometrium. As such doses of oestrogens are required for effective relief of symptoms, progestogens must be given to protect against endometrial hyperstimulation. Patient acceptability of sequential oestrogen/progestogen therapy is high (90%) and with such therapy breakthrough bleeding may subsequently be shown to be a reliable indicator of underlying endometrial pathology.


Endometrial factors under treatment with oestrogen and oestrogen/progestogen combinations. In a continuing prospective study, uterine curettage was undertaken on sixty-four patients attending a Menopause Clinic prior to consideration of gonadal hormone therapy. Two of these patients (3.1%) were found to have endometrial hyperplasia, and subsequently they were not given gonadal hormone therapy. Sixty-two patients with normal endometrium at pre-treatment curettage received cyclical oestrogen regimens or sequential oestrogen/progestogen treatments. Four (30.8%) of the thirteen patients in receipt of cyclical 'high-dose' oestrogens developed cystic glandular hyperplasia, whereas none of the patients taking either cyclical 'low-dose' oestrogens (thirty patients) or cyclical-sequential oestrogen/progestogen regimens (nineteen patients) developed endometrial hyperplasia. Among the patients with a normal endometrium, both before and during cyclical gonadal hormone therapy, regular withdrawal bleeding was experienced by thirty-two patients (51.6%). Breakthrough bleeding occurred in nine (14.5%), while twenty-one patients (33.9%) had no vaginal bleeding. Of the four patients with normal endometrium at pre-treatment curettage who subsequently developed endometrial hyperplasia during cyclical 'high-dose' oestrogen therapy, regular withdrawal bleeding was experienced by two patients, and in one of these breakthrough bleeding also occurred. Furthermore, in the four patients who developed endometrial hyperplasia, this condition occurred within six months in two patients and within 9 and 10 months respectively in the remaining two. In the nineteen patients receiving cyclical sequential oestrogen/progestogen regimens, all had regular withdrawal bleeding, while one patient had breakthrough bleeding during sequential therapy. It is concluded that in those climacteric patients who present with severe menopausal symptoms which necessitate the administration of high-dose oestrogen regimes it is necessary either to undertake both pretreatment uterine curettage or to add a progestogen to the oestrogen in a sequential regimen.


Effect of progesterone on the sebaceous glands. The effect of progesterone on the rate of sebum secretion was examined in intact and gonadectomized male and female rats. In intact adult male rats, progesterone administered for 3 weeks decreased sebum secretion, whereas in intact adult female rats, progesterone slightly increased sebum production. In castrated adults progesterone increased sebum secretion in both sexes, a greater response occurring after castration at 21 days of age than after castration at 10 weeks. Thus, the response to progesterone in the adult rat differs in intact males and females and is affected by changes in the endocrine environment induced by gonadectomy, especially near the time of puberty.


Logistics of study on hormone therapy in the climacteric. The practical implications of conducting a prospective study into the effects of hormone replacement therapy (HRT) in peri- and post-menopausal women are discussed. The minimum number of woman-years of observation required to yield data of statistical significance is around 50,000, which would involve the participation of 1000 general practitioners.


Future research--potentially rewarding areas for investigation. Further research is still needed for many aspects of hormone replacement therapy in post-menopausal women. The type of regimen to be used, and in it the type of oestrogen, the type of progestogen, the route of administration, and the dose all require further evaluation. Careful investigation will then be needed to determine the effect of the chosen regimen on the presenting symptoms, and also long-term effect on coagulation factors, carbohydrate and lipid metabolism, osteoporosis and endometrial carcinoma. At present there are no definite criteria as to which patients should be chosen for therapy or the duration for which treatment should be given.


Positive myocardial scintigraphy at the bedside--evaluation using a portable gamma camera. A study was undertaken to evaluate the role of positive infarct scintigraphy in the diagnosis of acute myocardial infarction (AMI), using Technetium99m stannous pyrophosphate (Tc-PYP) and a portable gamma camera. Sixty-one patients admitted to the Coronary Care Unit (CCU) with a presumptive diagnosis of AMI or ischaemic cardiac pain were studied. Positive scans were present in 24/25 (96%) patients with AMI and new Q waves, and in 10/12 (83%) patients with AMI and no Q waves. Nine of eleven (82%) patients with chest pain and no infarction had negative scans. Of thirteen patients with unstable angina, ten (77%) had positive scans. A further eight patients undergoing coronary artery bypass surgery for angina pectoris were studied pre- and postoperatively. Two patients had strongly positive postoperative scans. The Tc-PYP scan is valuable in the detection of peri-operative infarction following coronary artery surgery, and in patients with unstable angina the technique may detect small amounts of myocardial necrosis undetectable by more conventional means. When the diagnosis of infarction is obvious from the ECG, enzymes, or a combination of the two, the Tc-PYP scan provides no extra information helpful in patient management.


Bacteraemia after manipulation of the urinary tract. The importance of pre-existing urinary tract disease and compromised host defences. The factors related to the occurrence of bacteraemia following urinary tract manipulation were studied in a large community hospital. During a 3-year period, forty-six of 326 episodes of hospital-acquired bacteraemia were associated with urinary tract manipulation. All thirty of forty-six cases felt to be definitely related to urinary tract manipulation (other obvious sources of bacteraemia being absent) had pre-existing urinary tract disease, especially of an obstructive type; only one in this group died from sepsis. The remaining sixteen patients had other possible sources of bacteraemia besides urinary tract manipulation and had disorders associated with defects in host defences; twelve (75%) in this group died from overwhelming sepsis. Thus, if bacteraemia occurs in a patient having had urinary tract manipulation but without any underlying urinary tract abnormality or impairment in host defences, its source should be searched for in other areas of the body.


Immunoblastic lymphadenopathy--report of a case. A case of immunoblastic lymphadenopathy has been presented which had the characteristic clinical and histological features. The patient did not respond to chemotherapy and succumbed to the disease. Instead of the usual polyclonal gammopathy associated with this condition, he showed a fall in IgM levels, IgG and IgA being within normal limits. The significance of the latter finding is not known.


Familial Hodgkin's disease.

Familial Hodgkin's disease. A family with Hodgkin's disease is described. Each affected member of the family had mediastinal involvement and in each case the histology was that of nodular sclerosing Hodgkin's disease. The significance of these findings with reference to the aetiology of the disease is discussed.


Tuberculous abscess of the brain.

Tuberculous abscess of the brain. A bacteriologically confirmed case of tuberculous abscess of the brain is reported. Tuberculous brain abscess unlike tuberculoma does not exhibit the typical granulomatous changes and the diagnosis is confirmed by demonstration of tubercle bacilli either by staining or culture. An antituberculous regime should be started immediately the diagnosis has been established.


Bilateral neuralgic amyotrophy complicating Weil's disease. The case of a patient with leptospirosis (treated with trimethoprim) with late neurological complications manifesting as a bilateral plexus syndrome is described. The probable reasons for the continued weakness, in this patient, of the muscles supplied by the anterior interosseus nerve, despite improvement in the proximal muscles, are briefly discussed.


A case of Mollaret's meningitis associated with a lymphoma. A patient with recurrent benign meningitis (Mollaret's meningitis) responding to treatment with colchicine by a reduction in frequency of attacks who has subsequently developed a non-Hodgkin's lymphoma is described.


The Budd-Chiari syndrome in pregnancy.

The Budd-Chiari syndrome in pregnancy. A case of Budd-Chiari syndrome in a young woman, which started probably in the last trimester of pregnancy, is described. The diagnosis was made clinically and was confirmed by inferior venacavography and on exploratory laparotomy. The possible connection of the syndrome with the pregnancy is discussed.


Axial volvulus of Meckel's diverticulum. Two cases of axial volvulus of a Meckel's diverticulum associated with a diverticular band are described. In both cases, the pre-operative diagnosis was of acute appendicitis. The importance of further exploration if the appendix is insufficiently inflamed to acount for the symptoms and signs is emphasized.


Induction of spermatogenesis in hypogonadotrophic hypogonadism. A young male who presented with isolated bihormonal gonadotrophin deficiency is described, Basal levels of LH and FSH were low and there was no response to clomiphene citrate or LHRH. The remaining anterior pituitary function was intact. The administration of a combination of human menopausal gonadotrophin and human chorionic gonadotrophin caused testicular maturation with spermatogenesis and full androgenization. The patient was able to father a child.


Barium granuloma of the transverse colon. A case of barium sulphate granuloma of the transverse colon following gunshot wounds to the abdomen has been described. Scanning electron microscopy with electron probe microanalysis was used to confirm the presence of barium sulphate and the absence of lead or other elements related to the gunshot wounds.


'On-the-spot' blood glucose requirement at a peripheral diabetic clinic. In 100 consecutive diabetics attending a peripheral clinic subsequent blood glucose analyses indicated the need for some change in treatment in 24 patients. As it can be difficult to predict which patients should have their blood glucose levels checked provision of some form of comprehensive and reliable 'on-the-spot' analysis is essential for the best management of diabetics attending such clinics.


Chronic inflammatory bowel disease in Asian immigrants. Chronic inflammatory bowel disease occurs sporadically among the immigrant Asian population in Britain, but information about the incidence and clinical features is lacking. We therefore report our experience of 13 patients seen in a gastrointestinal unit in Birmingham over the past 12 years.


[Supraclavicular and subaxillar plexusanaesthesias in 821 patients. Efficiency, side-effects and complications under the aspect of the educational--engagement on a medical school (author's transl)]. Local anaesthesia of the plexus brachialis has been performed in 821 patients within a period of two years (544 times in supraclavicular and 277 times in subaxillar technique). Effectiveness and side-effects have been evaluated on the base of objective parameters, of the findings of the anaesthetist and of the judgement of the patient. Results have been compared between individual differently experienced anaesthetist. Results demonstrate a good resp. sufficient anaesthetic effectiveness in both kinds of regional anaesthetic method, depending to some extent on the individual experience. Nevertheless complications in form of pneumothorax and lesion of the nerve happen independently of the grade of the experience of the anaesthetist. To avoid the danger of pneumothorax, the subaxillar type of plexus-brachialis-anaesthesia performed as centrally as possible, is preferred to the supraclavicular type. This technique can be recommended widely.


[Continuous brachial plexus block (author's transl)]. A technique for continuous block of the brachial plexus is described using an indwelling teflon cannula positioned according to the anatomical dictates of the supraclavicular and interscalene spaces. The anatomy is presented as key to consistent results. Advantages of a continuous block are an extension of normal block duration, block placement independent of operating times and a possible application to intensive care patients.


[Operative stress during electroacupuncture and enflurane anaesthesia assessed by serum cortisol (author's transl)]. Before, during and after gynaecological operations performed either in electroacupuncture or enflurane anaesthesia plasma-cortisol levels were determined and compared to each other. During stimulation and operation plasma-cortisol increased continuously, indicating elevated sympathetic tone, whereas with enflurane anaesthesia plasma-cortisol levels were markedly lower. Postoperatively after electroacupuncture cortisol levels decreased, and rose again with the onset of pain. After enflurane anaesthesia cortisol levels increased continuously for a period of more than 90 min. Because of the strong correlation between degree of stress and plasma-cortisol level, our results demonstrate surgery under electroacupuncture analgesia to cause a stress greater than that during enflurane anaesthesia. The changes in cortisol levels were observed during stabilized cardiovascular conditions. Conditions varying plasma-cortisol levels too, are discussed.


[The effect of buprenorphin on circulation, respiration and the electroencephalogram (a postoperative study of 12 neurosurgical cases) (author's transl)]. Buprenorphin was given to 12 patients as a postoperative analgesic after neurosurgery, and the effects of the drug on the circulation, respiration and the electroencephalogram were studied. The circulation was not significantly affected, respiration was moderately depressed, the analgesic action was satisfactory. The depression of consciousness was reflected in the electroencephalographic pattern.


[An experimental study of the effect of etomidate on central sympathetic activity, respiration and circulation (author's transl)]. The effect of Etomidate on central sympathetic activity, respiration and circulation were studied in animals at rest and under asphyctic conditions. The doses used were 0.15, 0.3 and 0.6 milligrams/kilogram bodyweight. Injection of the drug into animals at rest caused excitation lasting for about 10 seconds and then lowering of sympathetic activity by about 15-30 per cent. With doses of 0.6 mg the depression lasted for about 15 minutes. Central stimulation by asphyxia often a more pronounced dose-dependent depression of sympathetic activity by about 15-40% of the original level was observed. Activity of the phrenic nerve was affected only with doses of 0.6 mg; the reduction by about 30% lasted for up to 15 min. Injection of 0.6 mg was followed within one minute by a short-lasting fall in blood pressure by about 10%. The heart rate remained unchanged at rest but during asphyctic conditions the heart rate was less slowed down than would normally occur with vagal stimulation. Etomidate apparently also depressed the vagal centres. Similarities and differences in action between Etomidate and propanidid are discussed.


[The effect of etomidate on CSFP (author's transl)]. The effect of etomidate on cerebro-spinal fluid pressure (CSFP) was investigated in 25 patients. Mean arterial blood pressure (MAP), heart rate (BPM) and blood gases were measured additionally. Cerebral perfusion pressure (CPP) was calculated from the difference MAP minus CSFP. Etomidate lowered CSFP (p less than 0,01 paired Student t-test). Ketamine-induced increase of CSFP (p less than 0,01) was normalized by etomidate. Premedication with etomidate delayed ketamine-induced increase of CSFP, which dropped to normal after a second dose of etomidate. The effect in reducing CSFP of etomidate was seen despite elevation of pCO2(p less than 0,01) in all patients breathing spontaneously.


[Controlled hypotension with sodium nitroprusside in neurosurgical patients (author's transl)]. Sodium Nitroprusside (Nipride) was administered by infusion pump intravenously in 27 neurosurgical patients for intraoperative, postoperative and posttraumatic blood pressure lowering. This was accomplished with intension to reduce the risk of hemorrhage during operation on highly vascularized tumors or aneurysms and to combat hypertensive crisis after surgery and brain injury. The effect was documented by direct arterial blood pressure registration and the drug proved to be fast acting, potent and readily reversible. Dosage varied between 1 and 10 microgram/kg/min with systolic pressure decreasing about 6 to 60% of the initial value. There was ill correlation between infusion rate and blood pressure drop which demanded particular caution at the beginning and the end of infusion. A decrease in pulse pressure and a moderate tachycardia were generally observed, however no complications were seen due to a Sodium Nitroprusside administration over less than 12 hours duration in our series.


[Haemodynamic response to sodium nitroprusside in healthy people and in patients with left heart failure (author's transl)]. In 10 healthy persons (group I) and in 10 patients with left heart failure the haemodynamic response to reduction of the arterial blood pressure with sodium nitroprusside (SNP) is studied. The systolic arterial pressure (SAP) is reduced in two stages first to 100 mm Hg and than to 90 mm Hg. The SAP was then allowed to reach 100 mm Hg by reduction of the SNP dose. At this SAP a constant amount of SNP and 500 ml Dextran 60 were infused. In group I the cardiac index (CI) decreases from 3,6 +/- 0,4 1/minXm2 at a SAP of 136 +/- 11 mm Hg to 3,2 +/- 0,2 1/minXm2 (p less than 0,05) at a SAP of 101 +/- 2 mm Hg. At a SAP of 89 +/- 3 mm Hg the CI is 3,0 +/- 0,3 1/minXm2 (p less than 0,05). The right atrial pressure (RAP) and the pulmonary capillary wedge pressure (PCWP) are significantly reduced (p less than 0,01). After infusion of 500 ml Dextran 60 the CI increases to  3,9 +/- 0,3 1/minXm2 (p less than 0,05). In group II at a SAP of 132 +/- 8 mm Hg the CI is 2,7 +/- 0,2 1/minXm2, at a SAP of 99 +/- 3 mm Hg the CI is 3,0 +/- 0,3 1/minxm2 (p less than 0,05) and at a SAP of 91 +/- 2 mm Hg decreases to 2,7 +/- 0,2 1/minXm2. RAP and PCWP are significantly reduced (p less than 0,01). After infusion of 500 ml Dextran 60 the CI increases to 3.3 +/- 0,2 1/minxm2 (p less than 0,05). These results show, that SNP-Infusion in patients with left heart failure can improve cardiac performance. In patients without cardiac disease the CI decreases after SNP-Infusion due to the low preload of the heart. In both groups preload restoration with Dextran 60 can increase the cardiac index.


[The influence of intraoperative autotransfusion (IAT) on plasmaproteins in patients with posttraumatic intraabdominal bleeding or hemorrhage during vascular surgery (author's transl)]. In 29 patients (12 vascular and 17 trauma cases) the effect of intraabdominal bleeding and surgical management under intraoperative autotransfusion on several plasmaproteins was examined. The following parameters were monitored immediately before and after autotransfusion as well as 24, 48, 72 hours and one week later, in the thawed serum: 1. albumen and the carrier proteins prealbumen, transferrin, retinol-binding protein, 2. acute phase reactants: c-reactive protein coeruloplasmin, haptoglobin, 3. fractions of complement:  C1q, C3c, C5  and C 3-activator, 4. serum-cholinesterase. With usual treatment by infusion of electrolyte solutions during operation and the following days, and further applicated blood transfusion, plasma and fresh frozen plasma by clinical needs, while the immediate blood loss during operation was replaced by autotransfusion, there was no change in preoperative dates. Only at the 3rd day the typical picture of catabolic situation of the postoperative period was observed in vascular cases and not at all in trauma cases. Thus the changes were closely related to the preexisting disease or state of shock, without further detoriation by intraoperative autotransfusion. 7 days later a sometimes overshooting normalization of the parameters was observed. Only cholinesterase remained extremely low, especially in vascular cases.


[Erythrocyte concentrates as substitutes of whole blood; changes in transfusion methods in a regional hospital (author's transl)]. In Switzerland the amount of blood donations is determined by the demands for plasma; as a result there is a surplus of erythrocyte concentrates for which more uses should be found. Trials in a regional general hospital proved that these concentrates can be advantageously employed in the field of surgery and anasthesia: due to close cooperation between the clinical department and the blood donor sevice the demand for erythrocyte concentrates rose from 5 per cent to 80 per cent within 5 years.


Nutritional blood flow to the limbs after access procedures. We have measured the blood flow to skin and muscle in normal subjects, asymptomatic dialysis patients, and dialysis patients, and dialysis patients who complained of cold hands (symptomatic patients) in whom a radiocephalic fistula had been constructed. Mean skin blood flow in asymptomatic dialysis patients was identical to that in normal subjects. Skin blood flow in the fistula hand of symptomatic dialysis patients was greatly reduced but it was normal in the contralateral hand. Muscle blood flow at rest was lower in dialysis patients than in normal subjects, but was reduced still further in the fistula hand of symptomatic patients. Muscle hyperaemia in response to exercise was greatly impaired in the fistula hands of all patients, irrespective of symptoms. The haemodynamic consequences of arteriovenous fistulae may be a cause of pain, paraesthesiae, muscle wasting or claudication in dialysis patients.


Haemodialysis-induced leucopenia and activation of complement: effects of different membranes. The effects on neutrophil count and complement activity of five different haemodialysis membranes were studied. There was no correlation between the degree of neutropenia and intensity of complement activation. With cuprophan membrane both occurred simultaneously but to unrelated degrees; polyacronitrile induced mild, not significant neutropenia but marked activation of complement; polycarbonate membranes induced severe neutropenia without detectable complement activation. Where complement activation occurred it was via the alternative pathway. Haemodialysis induced neutropenia may have many causes and complement activation is probably not the major responsible factor.


Aluminium studies in dialysis encephalopathy. The dialysis encephalopathy syndrome has a geographical distribution related to the aluminium content of the dialysis water supply. There is a close relationship between concentrations of water aluminium and serum aluminium, and patients with dialysis encephalopathy have serum aluminium concentrations greater than 400 microgram/litre. High serum aluminium is also associated with osteomalacic bone disease, and worsening anaemia. In dialysis encephalopathy, elevated concentrations of aluminium are found in CSF and in grey matter, and an aluminium burden of 2-8 g is calculated from whole body in vivo analysis. There is sufficient evidence for an aluminium toxicity syndrome to warrant specific removal of aluminium by water purification systems.


Comparison of intermittent with continuous peritoneal dialysis. Our experience with 41 patients on CAPD is presented (127 patient months). Thirty-three patients were previously on intermittent peritoneal dialysis. We used 4 exchanges of 2 L each per 24 hours (8, 6, 6 and 4 hours dwell times). There was a dramatic fall in serum creatinine of 27%, BUN fell 22%, total CO2 rose 15%. Haemoglobin rose 10% and serum albumin fell by 5%. The incidence of peritonitis was one episode per 7.1 patient months. All patients noted an increase in well being. There were almost no dietary restrictions and patients gained real body weight. In most instances, their antihypertensive medication could be discontinued. This technique is superior to all the other forms of peritoneal dialysis.


Haemo- and peritoneal dialysis treatment of patients with diabetic nephropathy--a comparative study. Thirty-two patients with advanced chronic renal insufficiency due to juvenile onset diabetes mellitus were submitted to dialytic treatment, 16 with intermittent haemodialysis and 16 with peritoneal dialysis. Both groups were similar with respect to onset of diabetes, course of renal insufficiency, as well as start and duration of dialysis treatment (382 and 389 patient months respectively). Patients on haemodialysis showed a more rapid progress of retinopathy and neuropathy, whereas the control of hypertension proved to be more difficult with peritoneal dialysis. A reduced peritoneal dialysance of urea, demonstrated in patients with diabetic nephropathy, could be improved by dipyridamole administration, whereas this drug showed no effect on the dialysances of urea and inulin in patients with chronic renal insufficiency of non-diabetic origin. There were no differences between the survival rates of the two groups which were substantially lower than in non-diabetic dialysis patients.


Development of a sorbent peritoneal dialysate regeneration system--a progress report. A sorbent regenerative dialysate system for peritoneal dialysis has been developed (Pericycle). Clinical results and data demonstrate that the sorbent system provides a suitable dialysate. The sorbents effectively remove uraemic metabolites from the dialysate. Calcium and magnesium removed by the cartridge and glucose metabolised by the patient are replaced by the infusion system. The machine pumps regenerated dialysate into and spent dialysate out of the patients. A pressure sensor in the patient line prevents excessive inflow and outflow pressures by stopping the inflow or outflow pump respectively. The Pericycle provides a simple, safe, portable method for conducting peritoneal dialysis in the home or hospital.


Haemofiltration with sorbent regeneration of ultrafiltrate: first clinical experience in end stage renal disease. A sorbent system (Redy D11 cartridge) capable of 'in line' regeneration of ultrafiltrate during haemofiltration (Amicon 0.5 m2) has been developed and applied on 3 X 4 hr/week schedule to 3 patients with end stage renal failure previously treated for up to 6 months with haemodialysis. Total experience, to date, is 8 patient months. Tolerance to fluid removal improved with the new system. Patient well being and rehabilitation has been maintained. The system offers the potential of haemofiltration without sterile replacement fluid or expensive fluid balancing machines.


Comparison of haemodialysis (HD) and post dilution haemofiltration (HF) on an unselected dialysis population. In a comparison of post-dilution haemofiltration (HF) with routine haemodialysis (HD) HF was found to be technically feasible and without difficulty a method of treating end-stage renal failure patients. HF offers the theoretical benefit of a high removal rate of middle molecules at the expense of measured small molecule clearances. The reported improvement in blood pressure and hyperphosphataemia in HF could not be found in our unselected population. The better tolerance to fluid removal during HF may be due to the linear weight loss during treatment but cannot be attributed to constancy in serum osmolality HF (3 X 20-23L ultrafiltrate/week) seems to be an adequate treatment for small patients. In large, heavy patients without significant residual renal function the ultrafiltration volume has to be increased in relation to body weight. HF was found to be superior to HD in patients with fluid removal problems and frequent hypotensive episodes during HD.


Importance of the plasma refilling rate in the genesis of hypovolaemic hypotension during regular dialysis and controlled sequential ultrafiltration-haemodialysis. The effects of ultrafiltration (UF) on plasma volume (PV) have been studied in eight patients using regular dialysis (RD) and controlled sequential ultrafiltration-haemodialysis (CSU) performed with a Rhodial 75 dialysis system. For a given value of UF the reduction of PV is determined by the plasma refilling rate. During CSU ultrafiltration induces a rapid increase in oncotic pressure without decreasing plasma osmolality. The high plasma refilling rate which can reach 1500 ml/hr allows moderate hypovolaemia despite high rates of UF and contributes to the usual good clinical tolerance of CSU. During RD a rapid decrease in plasma osmolality contributes to a water shift from the vascular space towards the interstitial and intracellular spaces and severe hypovolaemia can occur despite moderate ultrafiltration. CSU offers an adequate treatment for sodium overloaded patients with hypervolaemia, but is of no benefit in routine conditions.


Ultrafiltration and high sodium concentration dialysis: pathophysiological correlation. Five stabilised uraemic patients underwent two different procedures using the Gambro Ultradiffuser: ultrafiltration alone for one hour (mean body weight loss 2.97 +/- 0.24 kg) and ultrafiltration with simultaneous dialysis for one hour (mean body weight loss 2.92 +/- 0.22 kg) using a given dialysate sodium concentration which reproduced the changes in osmolality which occur during ultrafiltration alone. This mean sodium concentration was 154.75 +/- 2.02 mEq/L. The results did not show significant differences for the two procedures as regards tolerance to dehydration. These results underline the key role of osmolar stability in making dehydration tolerable.


Partial protection against acute renal failure in rats with reduced renal mass. Glycerol-induced acute renal failure (ARF) was studied in rats with two degrees of reduced renal mass (RRM). RRM animals, when compared with sham-operated animals, showed a partial protection against this model of ARF. This protection depends on a less marked decrease in glomerular filtration rate and renal plasma flow after ARF induction in RRM rats, with an increased filtration fraction. It is suggested that glycerol injection in RRM rats could induce a mainly efferent arteriolar vasoconstriction, in contrast to control rats, whose glomerular arteriolar vasoconstriction is mainly afferent.


Effect of saralasin on plasma renin activity and arginine-vasopressin in hypertensive man. This study was carried out to assess the influence of saralasin (SAR), an angiotensin II-analogue, on peripheral and central angiotensin II-receptors by measurements of plasma renin activity (PRA) and arginine-vasopressin (AVP) release. Before and during i.v. infusion of 10 microgram/kg/min of SAR over a 30 minute period, blood samples were obtained from 15 recumbent hypertensive patients (7 renovascular, 8 essential) to determine hormone activities by radioimmunoassay. In 10 patients with a decrease of blood pressure following SAR, PRA increased significantly whereas AVP levels increased significantly in only 7 of these patients. In the remaining 5 patients without a fall of blood pressure, PRA and AVP remained virtually unchanged. The results indicate that an enhanced AVP release may be due to a hypotensive stimulus induced by SAR in angiotensinogenic hypertension. A direct influence of SAR on central receptors is unlikely under the conditions studied.


Sustained negative feedback between haematocrit and serum erythropoietin concentration in end-stage renal failure. In a longitudinal study the individual values of serum erythropoietin (SEp) in end-stage renal failure were investigated in 15 patients. SEp was determined by use of the foetal mouse liver cell assay on three occasions: (A) 2--6 months before the onset of RDT, (B) on day of first dialysis, and (C) 2--6 months following the onset of RDT. In every patient SEp increased from (A) to (B), and decreased again from (B) to (C). Changes of haematocrit were exactly opposite to changes of SEp. The results demonstrate that even in the terminal stage of chronic renal failure erythropoietin production is stimulated or suppressed in response to variations in the degree of anaemia.


Elevations of gastrointestinal hormones in chronic renal failure. Fasting levels of 5 gut hormones were studied in 30 patients with advanced uraemia (CRF), 40 undergoing regular dialysis (RD) and 555 renal transplant patients (RT). Mean values of gastrin and total glucagon were markedly elevated in CRF and RD patients compared with 20 normal subjects; there were lesser elevations in pancreatic glucagon, insulin and vasoactive intestinal peptide (VIP). Secretin levels were unchanged. In RT patients, fasting levels of VIP and pancreatic glucagon had returned to normal, while levels of gastrin, total glucagon and insulin remained slightly elevated compared with controls. Food stimulated hormone levels were measured in 18 RD patients and compared with 18 controls. After eating, RD patients failed to show the late increase in total glucagon, or the suppression of VIP and secretin seen in normal subjects; the pattern of gastrin and insulin response was similar to controls, but after the initial increase plasma levels in RD patients tended to show a slower decline. Thus involvement of the gastrointestinal tract in uraemia is associated with functional disturbance of the endocrine system of the gut.


Pathogenetic mechanisms in tubular renal disease. Injections of heterologous tubular material into rabbits caused the formation of immune complexes deposited predominantly on the tubular basement membrane. Much fainter deposits were found on the glomerular basement membrane. Immunohistological studies revealed that the antigen involved originated from cells of the proximal tubules. In other animal experiments, purified tubular material was used for immunisation in order to analyse the antigenic structure of renal tubules. These rabbits were found to produce autoantibodies against an antigen present in the tubular as well as the glomerular basement membrane. Morphological studies of the kidneys from the immunised animals revealed alterations in the tubular epithelial cells and interstitial tissue which were characterised microscopically and electron microscopically by swelling and degeneration of the epithelial cells, and cellular infiltrates in the interstitium.


Studies on bicarbonate reabsorption in chronic renal failure. The role of nephron loss, extracellular fluid volume (ECFV) expansion and body potassium stores on bicarbonate reabsorption in chronic renal failure (CRF) was evaluated. In 17 CRF and 3 control subjects, tubular HCO3 reabsorption was studied by HCO3 1M titration technique; ECFV (22Na space at 4th hour) and cell K content (muscle biopsy) were also determined. Nephron loss per se does not cause any change of HCO3 reabsorption rate per unit GFR. With ECFV expansion induced by HCO3 infusion, a Tm HCO3 is rapidly reached only in controls and in CRF patients showing a significant basal ECFV expansion. In these subjects reabsorbed HCO3/Na ratio is constant, suggesting that under these conditions, HCO3 reabsorption depends on the same mechanisms that control Na reabsorption. In cell K depleted CRF patients, HCO3 reabsorption rises more than in controls and no Tm HCO3 is detected, at least within the limits of isotonic ECFV expansion induced by titration; in these subjects HCO3 reabsorption does not appear to be limited by natriuretic factors. In CRF subjects with normal ECFV and cell K, there is a greater HCO3 tolerance to ECFV expansion induced by titration technique than in controls.


Cerebral and hepatic urea synthesis in patients with chronic renal insufficiency. Urea production by the liver and the brain was evaluated in patients with chronic renal insufficiency and in subjects with normal renal function by measuring the arterial-venous differences of urea across the hepatosplanchnic bed and the brain. In five out of seven patients with chronic renal insufficiency no urea release into the hepatic veins was observed, whereas a high urea output by the brain was measured in 6 out of 8 patients. In the control group urea was released only into the hepatic veins. These data demonstrate a defect in hepatic urea synthesis and a switch to cerebral ureagenesis in chronic renal insufficiency.


Biological activity of endogenous and exogenous calcitonin in patients with osteitis fibrosa and chronic renal failure. Successful treatment of osteitis fibrosa with 1alpha-hydroxycholecalciferol (1alpha-OHD3) in 9 patients with end-stage chronic renal failure was associated with a significant increase in plasma levels of immunoreactive calcitonin (iCT) independently of changes in plasma calcium, and a decrease in levels of parathyroid hormone (iPTH). In 9 further patients whose plasma alkaline phosphatase activity failed to suppress with 1alpha-OHD3, changes in iPTH were associated with proportionate changes in iCT. This suggests that a rise in endogenous calcitonin (CT) secretion contributes to the success of treatment with 1alpha-OHD3. In 13 further patients, injections of salmon CT induced a fall in plasma calcium and phosphate which was proportional to the prevailing level of plasma alkaline phosphatase. These data provide further evidence that bone resorption can be effectively inhibited when CT levels are raised either by exogenous CT or its endogenous stimulation.


Does long term haemofiltration provoke secondary hyperparathyroidism? One thousand nine hundred and forty-nine haemofiltration procedures have been performed since 1976; 4 different types of haemofilters have been tested in gravimetric and volumetric haemofiltration machines. Balance studies revealed a diminished calcium intake of about 1/3 of that found in conventional dialysis. Magnesium balance is negative and leads to decreasing serum Mg values. Inorganic phosphate is removed in similar quantity to dialysis. PTH levels increase during 3--18 months of treatment, whereas 25-OH-D3 levels rapidly fell, gc-globulin- and HCT-levels did not change markedly. g-c globulin could be detected in filtrate samples in remarkable amounts, 25-OH-D3 was found in traces. Radiologically no apparent alteration occurred. We recommend Vitamin D supplementation to compensate for the losses and thereby avoid development of secondary hyperparathyroidism.


Total parathyroidectomy with autograft of parathyroid tissue in treatment of secondary hyperparathyroidism. In 16 patients with severe symptomatic hyperparathyroidism reduction of hyperplastic parathyroid mass was performed by total parathyroidectomy with autotransplantation of parathyroid tissue. In all patients except one serum parathormone (PTH) levels returned to normal and postoperative difficulties in calcium homeostasis were rarely observed. Fifteen patients had normal PTH levels after surgery. Graft function was proven in 10 cases, but in 5 cases graft function could not be definitely established with the methods applied. One graft failure was observed. Total parathyroidectomy with autotransplanation of parathyroid tissue is recommended as the treatment of choice when surgical correction of secondary hyperparathyroidism is necessary.


[Iconographic presentation of venous ulcers of the toes and thighs]. The author has had experience with ulcers of venous origin on the toes, knee and thigh, and demonstrates some of them. They are rare, and as a general rule are the result of a traumatism (shoes or seating). The author attaches little importance to cosmetic treatment and is strongly opposed to foot baths with Permanganate of K, since they require that the edematous leg remain in a vertical position in the warm water. In addition to elastocompression of the leg, well applied and only for walking, he insists on the efficacy of posture treatment reasonably and conscientiously practiced. The absence of posture treatment is, together with hemopathies and calcinosis, the root cause of so-called long-term ulcers.


[Necrotic ulcers after per-operative sclerosing injection]. A crossectomy of the internal saphenous vein was performed without difficulty, followed by a back-flow injection into the crural internal saphenous with a 40% sodium salicylate solution. During the following days, deep scabs appeared on one-third of the thigh, with deterioration of the necrosed internal saphenous. There was a slow and painful cure within 5 months, without a large scar. This method of back-flow injection is rarely performed at present. The product injected can sclerose the collateral veins with skin lesions and cause a phlebitis of the femoral vein through injection of the communicating veins.


[New therapeutic measures for the treatment of ulcers]. In this study we tested the effect of vibrating electromagnetic waves on both arterial and varicose ulcers. The two transmitters we used were the diatrom and the fel, which differ in the energy transmitted and the means of application (direct contact electrode for the fel, distance transmission for the diatrom). Out of 17 cases treated we obtained 15 cures. This proportion of positive results encountered in traumatology and in dermatology for cases where the vascular factor played an important role, makes it possible to consider the application of vibrating electromagnetic waves as a valid therapy for ulcers.


[Intermittent claudications of arterial origin: some epidemiological and physiopathological features]. The authors repeat part of their report to the 79th French Congress of Surgery, presented in September, 1977. They recall that chronic obstructive arteriopathies affect from 1.5% to 4% of the population, and that in half of the cases, the symptoms are those of a simple intermittent claudication. Atheromatosis is the main cause, but to this must be added many other risk factors, smoking and metabolic disorders, especially glucidic and lipidic ones. There is spontaneous worsening in only half the cases. Other vascular and coronary ailments and problems of the cerebral vessels are responsible for most of the deaths of patients affected by arteriopathies of the lower limbs. The precise pain mechanism of the intermittent arterial claudication, its physio-pathological significance, like the mechanisms of vasomotricity and the development of the collateral circulation, are not yet completely clear. A therapeutic attitude can only be taken keeping in mind these developmental and physiopathological data: claudication is a symptom that does not necessarily mean that the limb is threatened.


[The Doppler test: its practical importance in the study of lesions of the supra-aortic trunks]. Ultrasonography by the Doppler effect is of indisputable use in the investigation of lesions of the supra-aortic trunks leading to the brain. It allows a direct study of the extracranial carotidian and vertebral axes, and gives an idea of the intracerebral circulation. It detects the main lesions affecting them, provided that such lesions have hemodynamic repercussions. The Doppler does not replace arteriography, but is a complementary exam making it possible to decide on or to dismiss the need for it. Its harmlessness and simplicity make it a standard exam in cerebral vascular pathology.


[Fibrocystic deterioration of the popliteal artery. Apropos of 1 case]. Set off by a sports movement, a subacute ischemia of the lower limb allowed the delayed discovery of a segmental stenosis of the popliteal artery in a young man. It involved a compression by fibro-cystic deterioration of the wall of the artery. Separation of the cyst from the diseased arterial wall was followed by the restoration of circulation by means of an internal saphenous vein graft.


[Arterial claudication].

[Arterial claudication]. The authors recall that in their report presented to the 79th French Congress of Surgery (September, 1977), they included the results of 26,632 chronic obstructive arteriopathies, 49.8% of them at the intermittent claudication stage. Medical treatment was initially proposed in 27% of cases. The results were followed up in 1,660 patients. At term (8 years and more), there were good results in only one third of the patients, and 28% of the patients had to be operated on. Lumbar sympathectomy was practiced on an isolated basis in 35% of cases. At the cost of a minimal (0.7%) mortality rate, with improvement beyond eight years in 61.5% of patients, and only 19% having to undergo direct revascularization. Direct revascularization was proposed in 38% of cases. At the aorto-iliac stage, thrombo-endarterectomies and single and bi-lateral prothetic bridgings gave very similar results: a mortality rate of 3.4% on the average, with good results beyond eight years in 76.6% of patients. Direct revascularizations are practiced almost as often on the femoro-popliteal level for simple intermittent claudications. Mortality is low (1%), and the long-range results similar (76.4% of good results beyond 8 years), but the installation of a prothesis at the femoro-popliteal stage so often fails that it should not be done if the intermittent claudication is tolerable. Surgery plays a prime role in the treatment of claudications of arterial origin, a role that the success and the continuation of the good results, when applied under the proper conditions, amply justifies.


[Study of arterial diseases of the lower limbs using an exercise test monitored by Doppler effect ultrasonometry]. A study has been carried out using Doppler ultrasonometry on 223 cases, 191 of them suffering from occlusive or stenosing arterial illnesses and 12 with deep massive venous thrombosis, together with 68 control cases. Systolic tensions in the popliteal, dorsalis pedis and posterior tibialis arteries, both at rest and after a conveniently standardized effort, were studied every five minutes over periods of up to thirty minutes. The results are shown grouping these patients according to their clinical features and giving their different responses to the test. Special emphasis is given to cases of badly compensated recent intermittent claudication, diffused atheromatosis, asymtomatic arterial stenosis, thromboangiitis obliterans, Leriche's syndrome and hypertensive ulcers.


[An unusual case of intermittent venous claudications]. The authors report on a case of intermittent venous claudications in a 76-year-old man, who three months previously suffered a sudden acute attack of phlebitis in the right upper limb. The Doppler exam showed post-phlebitic failure of the humeral valve and diminished permeability of the axillobrachial axis of the vein, with sub-clavicular obstruction. The discussion provides an opportunity for reviewing the various anatomo-pathological definitions and explanations of the mechanism of intermittent venous claudications.


[Does intermittent claudication justify surgical intervention]. The authors have re-examined their therapeutic attitude toward the intermittent claudication upon arteriopathy. They feel that it is useful to divide patients having an arteriopathy (Stage II) into two groups: the first having isolated (or dominant) high aorto-iliac lesions and the second with isolated or dominant lesions at the mid-femoral level. In the first group, we remained faithful to reconstructive surgery and our preference goes to thrombo-endarteriectomy with accompanying low lumbar sympathectomy. In femoral lesions, we do not recommend reconstructive surgery of the arteries but rather low lumbar sympathectomy. For the past year, we have undertaken a program of physical re-education and the results seem very encouraging, especially in patients having isolated femoral lesions. It is not impossible that this physical therapy may be used instead of lumbar sympathectomy, to which one can always resort in case of insufficient results.


[A case of an aneurysm of the popliteal vein with repeated pulmonary embolisms]. The authors report on a case of a patient having several unexplained pulmonary embolisms. A phlebologic and phlebographic exam make it possible to diagnose an aneurysmal dilatation of the popliteal vein as the cause of the thrombo-embolic problems. Cure was obtained through the resection of this venous ectasia.


[Non-arterial intermittent claudications]. There can be no doubt as to an arterial cause in the case of pain experienced when walking. However, there are claudications that, at least at the start of their appearance, confuse the diagnosis. They are mainly seen in the fields of neurology and rheumatology, and more seldom in venous or even general pathology. The overall clinical information combined with additional exams, mainly the Doppler-effect ultrasonic exam, can leave no doubt.


[Diagnostic value of percussion of the veins]. Despite the present development of instrument techniques for diagnosis, clinical procedures still remain valid. It is for this reason that, for the past fifteen years, we have continued to use an almost forgotten test: percussion of the veins. Opinions concerning this test and its technical description being contradictory in the literature, we sought to define the exact circumstances under which it should be used, and how to apply it. Our diagnostic results were favorable, the technique simple, and our study was aimed mainly at describing its merits.


[Intermittent claudication. Synthesis and conclusions]. The intermittent claudication is a symptom. By itself, it does not justify surgical treatment. On the other hand, it is advisable when accompanied by a threat of trophic disorders. Direct arterial surgery is often necessary in the case of suprainguinal, aorto-iliac lesion, rarely in the leg. Indeed, under the inguinal area, nature tends to compensate for occlusions of the trunk by the formation of a parallel network. A logical treatment is to contribute to this tendency, by increasing the upward and downward pressure gradient through muscular exercise and lumbar sympathectomy. In practice, the choice between hyperemia surgery and reconstructive surgery rests on functional data, that make it possible to evaluate the potential of the parallel network and of the peripheral vascular bed.


Insulin-like effect of bovine growth hormone in vivo as demonstrated by oxidation of 14C-U-glucose in diabetic rats. The rate of appearance of radioactive carbon dioxide after injection of 14C-U-glucose, 14C-3,4-glucose, 14C-1-pyruvate, 14C-2-pyruvate, and 14C-1-acetate was measured in untreated, insulin-treated, and bovine growth hormone (bGH)-treated rats and compared to the results obtained from normal rats. The CO2 specific activity (SA) curve obtained from normal rats (mean of four experiments) injected with 14C-U-glucose reached a maximum value of 487 in 50 min and fell exponentially to near zero levels by 5 h. In contrast, the curve for untreated diabetic rats reached a peak of 247 in 17 min. In normal rats, 75% of the injected 14C was recovered as CO2 in 5 h compared to recovery of 31% by diabetic rats. Daily administration of 2 U protamine zinc insulin (PZI)/100 g body weight to diabetic rats returned these measurements to normal levels. A single injection of 400 microgram bGH (1.5 USP U/mg) into each diabetic rat 2 h before the start of the experiment yielded an SA curve and a percent recovery value comparable to results found with insulin treatment. The chronology of the insulin-like effect of the bGH was pertinent since other time intervals (including chronic bGH treatment) produced no similarity. Experiments carried out with 14C-3,4-glucose, 14C-1-pyruvate, 14C-2-pyruvate, and 14C-1-acetate suggest that bGH affects the glycolytic pathway at some point between the phosphorylation of glucose and the formation of pyruvate.


Removal of extracellular fluid from muscle: assessment of a method. Controlled compression of mouse biceps brachii muscle caused only partial extrusion of an extracellular protein (125I-albumin) from the muscle. Concentrations of sodium and potassium in the expressed fluid at any stage of compression did not correspond with concentrations expected for extracellular fluid. This procedure, therefore, does not selectively remove extracellular fluid from muscle.


[Philosophy of the treatment of intermittent claudication]. Everything points to the prime importance of good health habits and the prevention of risk factors. Long-term medication has only a limited and still questionable impact. Surgery will never be proposed straight off, but only if the claudication is persistent and troublesome in an active individual. Lumbar sympathectomy always provides a degree of improvement and entails a minimal risk. There is no secondary deterioration. Yet in cases of associated phlebites, it can aggravate trophic skin problems. Reconstructive surgery gives far better immediate results but at the price of increased risk and a secondary deterioration that makes difficult repeat operations necessary. It is thus necessary to be very careful in using surgery to deal with intermittent claudications.


[Indications and technics for sclerosis of varices]. Principles and applications of treatment inducing sclerosis of varicose veins according to the method of Raymond Tournay, based on the hemodynamics of the venous return flow hampered by the pathological condition of reflux into the large varicose veins and its effect. The stemming of this reflux, provided it is really successful, totally relieves the healthy return passages, both superficial and deep, and restores the conditions for normal venous functioning.


[Obstruction of the superior vena cava and right subclavian vein: a propos of 2 unusual cases]. Two uncommon cases of vein obstruction are presented. In the first case a syndrome of superior, caval vein obstruction was caused by idiopathic fibrous mediastinitis involving the vein wall, and creating a tumefaction in the lumen of the vein simulating the existence of a benign tumor (fibroma) of the wall. This tumefaction was removed by endvenectomy, and the venotomy was repaired by a pericardial patch. In the second case the obstruction of the right subclavian vein was caused by a stenosed valve without signs of inflammation nor consecutive thrombosis. Until the present day no other similar case of a stenosed valve in the right subclavian vein has been reported.


["Psychological defense" as a compensation mechanism and its significance in the psychotherapy of schizophrenia]. The concept of pyschological compensation as an essential aspect of the patient's attempts at adaptation is established, without the consideration of which it is impossible to work out a theory of personality-centered therapy. Some characteristics of psychological compensation in schizophrenia are considered on the basis of V. N. Myasishtchev's theory of relations. F. V. Bassin's and Roshnov's concepts of "psychological defense". The great importance of the clinical method used for determining such processes and the risk of errors involved in "understanding psychopathology" and "psychodynamic psychiatry" are underscored.


[Empirical investigations on the position of the therapist in group psychotherapy]. A new sociometric approach has been used to objectify the relative position of the therapeutist in group psychotherapy through the use of such parameters as valency and potency. The method described in this paper may be used for determining the course of therapy and provides information about the proper functioning of the group and the influence of the therapeutist upon the patients participating in psychotherapy. This allows undesirable effects to be corrected.


[Psychological and ethical problems in the rehabilitation of mental disorders]. There is a discrepancy between the somatotherapeutic and rehabilitative state of development of institutionalized psychiatry. In addition to objective factors, causes of this discrepancy may be found in the unsatisfactory education and training of middle-level medical personnel. It is above all the behavior and attitudes to patients that indicate remaining traces of authoritarian and hierarchical structures in psychiatry, there being a major difference in this respect between sociopsychiatrically oriented hospitals and district and specialized hospitals, respectively. In rehabilitation, it is necessary to take as a starting point the patient's personality. It is for this reason that the use of psychotherapeutic principles is an essential prerequisite of the rehabilitation of mental patients. On the subjective side of the therapeutic and rehabilitative process it is necessary for patients to be in a position of being able to develop from a submissive object of medical activity into an actively participating (or emancipated) subject.


[The effectiveness of open and closed groups]. Studies of four closed and four open groups of patients participating in psychotherapy, which were conducted in a psychotherapeutic inpatient department using pre- and post-test diagnoses (the test used being the MMPI, FPI, Q-Sort, and Giessen tests), showed that these were not different as regards the frequency of statistically evident changes recorded upon the completion of psychotherapy. The authors also discuss the advantages and disadvantages of open and closed groups, with particular consideration being given to organizational aspects.


[Activity of the psychologist within the inpatient psychotherapy of behavior disordered children and adolescents]. The author, after discussing the problem of cooperation between the physician and psychologist within the framework of psychotherapeutic activity, deals with the special functions of psychologists. Work done in this respect at the Dresden Medical Academy's department for psychotherapy of malbehaving children and juveniles of normal intelligence is described. Also outlined in this paper are the role played by the psychologist in the use of various methods of therapy and his cooperation in the continuing education and training of nurses, the psychometric control of the course of therapy, and the rehabilitation of children and juveniles.


[Imbecile children visit geriatric patients. A possibility for clinical sociotherapy]. 130 observation minutes of organized visits of imbecile girls in school age to geriatric patients accommodated for a long time (17 chronic schizophreniacs and 8 cerebro-organic patients) were analysed. Singing, ball and party games for children and dancing two by two to recorded music proved as suitable means of communication. This kind of contacts led to a social activation especially by schizophreniacs who had a lack of drive and seemed to be regressive, also caused an increase of drive and self-reliance by formerly timid, reserved girls. The staff was even relieved by the presence of the children, because these activated the geriatric patients. The arrangement can be realized without great effort in big psychiatric hospitals.


[Experiences with psycho-vegetative tests in the study difficulties of student teachers]. A total of 125 student teachers, who at the time when these investigations were conducted were unable to work or study, respectively, were subjected to the ENR test of Brengelmann/Brengelmann and the VELA test of Fahrenberg. Fifty-six student teachers had to take their names off the books. Their failures were closely correlated with introversion,  neuroticism, and vegetative lability. The latter may already be evident from the medical history of the subject and should be sufficient cause for psychological testing in case the student should encounter difficulties in his work. Rigidity is not yet fully developed in the age group to which students normally belong and shows no significant correlation with failure.


[Arteriovenous malformations in the region of the external carotid artery]. This article reports two cases of extracranial angiomatous vascular malformation, with blood being conveyed thereto by the external carotid artery. Visible and palpable clusters of dilated and pulsating vessels in the scalp or jugular region as well as vascular murmur are of major importance for clinical diagnosis. Conditions of flow may be objectified with the use of angiography. Therefore, the radiography of vessels should always be used to reliably determine the absence of combined extra- and intracranial vascular malformations.


[Application of the multiple vocabulary test to determining premorbid intelligence levels]. The authors present three basic approaches to solving the problem of determining the premorbid level of intelligence for diagnostic and prognostic purposes. The indirect way of measuring the premorbid level of intelligence was chosen because of the empirical nature of this approach and the possibility of establishing a firm basis for this. Using a number of samples, it has been possible to show that the multiple vocabulary test satisfies all requirements that must be made of a method of measuring the premorbid level of intelligence. They are above all independence of aging and disease processes as well as a high level of internal validity. Results to date indicate that the multiple vocabulary test is a useful method of rapidly and reliably determining the general level of intelligence. Its special importance lies in the fact that it allows the premorbid level of intelligence to be ascertained, thus contributing to an empirical elucidation of problems associated with decreases in proficiency and general mental deterioration due to organic or psychological factors.


[Application of the multiple vocabulary test to assessing mental disorders]. The multiple vocabulary test has been used to investigate approaches to objectifying general mental deterioration. Compared to methods used to determine the actual level of intelligence, the premorbid levels of intelligence which were determined with the use of the multiple vocabulary test were roughly the same for patients with brain injuries that cannot be detected by means of specialized instruments. In the case of patients where brain injuries were detectable through the use of instruments, the premorbid level of intelligence was significantly higher than the actual intelligence level. Patients with general mental deterioration showed highly significant differences between premorbid and actual levels of intelligence. The results obtained indicate that the multiple vocabulary test is a useful means of diagnosing general mental deterioration due to organic or psychological factors. Also discussed by the authors in their present paper are hitherto unsolved problems that stand in the way of an objective diagnosis of dementia and loss of intelligence.