[Replantations: indications and operative technique (author's transl)]. Replantation is indicated without exception in amputations of the thumb, in children, and upon loss of several fingers. Other factors include the type of injury, the interval between injury and vascular anastomoses, the condition and preoperative treatment of the amputated part as well as age, occupation, and general condition of the patient. The operative technique is described with the sequence of repair of the anatomical structures: bone, flexor tendons, arteries, extensor tendons, veines, nerves, and skin; possible complications are mentioned.


[An attempt to predict the noise-induced PTS. Beginning a long-time study (author's transl)]. After the exposure to a sinus-tone of 250 cps the audiogram shows two dips: the first in the low-frequency-range, the second at about 5 kcps. In noise-resistant men (having normal hearing in spite of having worked in noise for many years) the TTS in the high-frequency-range is significantly smaller than in the average of the population. Therefore this depression is to be used for a tentative prognosis of PTS. The test is done with frequency-constant Békésy-audiometry before and after the exposure to a sinus-tone of 250 cps (120 dB HL) for 10 min. Attention is payed to TTS2 as well as to the alteration of the altitude of the spikes and also to the reconstitution of both of them. A decision on the usefullness of this test for the prognosis could be expected in about two or three years.


[The threshold of 1.5 khz as a graduator for the noise induced hearing defect (author's transl)]. Austria's new legislation on the protection of employees and workers provides that the determination and assessment of noise-induced hearing defects caused at the working places may now also be carried out by physicians who are not otologists. Since language-audiometric data are not available to such physicians, the assessments are based only on sound-audiometric hearing results. Therefore, it is understandable that such physicians would like to be able to draw conclusions as to the extent of the noise-induced hearing defect from the sound-audiogram alone. The difficulties encountered in the attempt to determine language-hearing on the basis of sound-hearing are well-known. Among all defects the noise-induced hearing defect is still best suited for such attempts because of its stereo-typical curve in the sound-audiogram. 500 cases with a pure noise-induced hearing defect are subjected to a multiple regression analysis. The result of the investigation confirms the practical observations made. The sound-audiometric hearing loss at 1.5 kHz is closely related to the discrimination capacity for our language and thus gives some indication as to the degree of the noise-induced hearing defect.


[The medicolegal judgement of noise induced hearing loss combined with other kinds of hearing impairement (author's transl)]. In cases of noise induced hearing loss, the medico-legal judgement of causality is often complicated by the coincidence of endogenous hearing impairements, which conceal the audiolical characteristics and the degree of NIHL. The recognition of an occupational disease however is possible only when there is a dominant probability; the possibility of NIHL alone in sight of the labour conditions is not sufficient for this recognition. In such cases, the medical expert therefore, besides of an extensive audiological analysis, must have sufficient information on noise immission, on the course of hearing impairement in regard to working time, and on other diseases and accidents which possibly can influence hearing function.


[Advantages of cryosurgical treatment of malignant skin transformations in the region of the nose and auricle (author's transl)]. Since the beginning of 1974 70 basal cell carcinomas of the face were treated by cryosurgery at the ENT clinic in Göttingen. The cryosurgical removal of basalomas on a cartilagenous base (nose, auricle) avoids hospitalization of the patient and relieves the surgeon of a time-consuming plastic operation. Scar formation after cryonecrosis is, in general, excellent and cosmetically unobtrusive. All patients must undergo strict follow-up examinations since for the surgeon there is no histologic safeguarding by an "excision into healthy tissue".


[Fibrin and fibrinogen degradation products in head- and neck-tumors (author's transl)]. Fibrinogen degradation products (FDP) in sera of patients with malignant tumors in the head-and neck-region are determined with Staphylococcal-Clumping-Test (Behring-Werke, Marburg/Lahn). Concentration of FDP in sera of tumor patients are compared to sera of normal patients. 40 cases out of 70 with malignant tumors showed higher concentration of FDP. The results are discussed.


[Contribution to chronical osteomyelitis of the frontal bone (author's transl)]. Osteomyelitis of the frontal bone occurs in an acute and in chronical form. Aetiology and pathogenesis of the chronical form will be described. It is said, that by usage of antibiotics the typical findings and courses have been changed. According to three own cases osteomyelitis appeared in a haematogene metastatic form after a maxillary sinusitis in different intervals. The outcomes are described and compared with literature. The cause is considered being an unsufficient antibiotical treatment of maxillary sinusitis.


[Fractures of the orbital floor (author's transl)]. Within 5 years (1973--1977) 171 facial fractures were treated surgically at the University ENT-Clinic Marburg. 115 cases (67,3%) showed a fracture of the orbital floor, either an isolated fracture of the orbital floor (24 cases) or combined with fractures of the orbital rim in combination with midfacial lesions of the central type (42 cases) or of the lateral type (49 cases). After analysing the mechanism of those fractures the main symptoms and the most important diagnostic investigations (x-ray tomograms, synoptometric investigations, forced-duction-test) are shown. By two examples the results of the prae- and postoperative synoptometric investigations are explained. Those investigations enable a more exact diagnosis in all types of orbital fractures and demonstrate exactly the postoperative functional results.


[The tricho-rhino-phalangeal syndrome (author's transl)]. In a family 4 cases of the tricho-rhino-phalangeal sydrome are observed. The sparse hair and early baldness, the pearshaped nose, and the peripheral dysostosis are typical in the appearance of these patients. Congenital heart leasions and kidney disease, as in one of out patients, might be associated with the tricho-rhino-phalangeal syndrome.


Intestinal absorption of fluoride preparations. Gastric intestinal absorption of five different preparations of sodium fluoride was measured by means of ten hour urinary excretion. Best absorption was by nonenteric coated sodium fluoride. All three enteric coated preparations showed poorer absorption, with marked individual variations. Florical, the currently available preparation, showed better absorption than any enteric coated tablets and only slightly less than sodium fluoride alone. For active cochlear otospongiosis two capsules three times a day should be prescribed.


Bilateral acinous cell tumors of the parotid gland. Acinous cell tumors are uncommon neoplasms which arise either from the secretory cells of the salivary gland acini or from pluripotential duct cells and occur almost exclusively in the parotid gland. Nine previous instances of the bilateral occurrence of this tumor in the parotid gland have been reported. We present a tenth case and illustrate several aspects of the clinical behavior of this unique tumor. The histological pattern of this type of tumor was considered universally to be benign until 1953 when attention was called to a malignant variant. It is difficult to find reference to a benign form after that time. It is, in fact, impossible to forecast the clinical behavior of an individual specimen based upon its histopathology. In order to recognize this unpredictability, the World Health Organization Classification of Epithelial Tumors of Salivary Gland Origin proposed a category, "Acinic Cell Tumors," separate from clearly benign or malignant neoplasms. Later, attention was called to the grammatical designation, "acinous cell tumor." Because acinous cell tumors are uncommon, numerically significant series are gathered from several institutions or over several decades during which treatment methods vary widely. This makes it difficult to accept the validity of conclusions based upon the reported data. There is, however, a clearly documented tendency of the tumor to recur after long symptomless intervals so that extended follow-up is necessary before "cure" is established. Treatment of acinous cell tumors is surgical. The value of radiation therapy in the management of recurrent tumors is not firmly established.


Posterior tracheal laceration: A rare complication of tracheostomy. Tracheostomy is an operation with a long history and many potential complications. Two case reports of acute posterior tracheal wall laceration, a rare complication, are presented. Althoug previously described as being secondary to inadvertent knife contact with the posterior tracheal wall, both of these cases are thought to be due to insertion of the tube with excessive force against tissue made friable by previous radiation. The diagnosis should be suspected if poor ventilation follows insertion of an endotracheal or tracheal tube. The offending tube should be removed and an oral endotracheal tube inserted. After treatment of any accompanying pneumothorax, the site should be evaluated under direct vision as the endotracheal tube is withdrawn proximal to the tracheotomy. If a tear is found, esophagoscopy is performed to insure the integrity of the esophagus. Repair of the tracheal wall is done with a single layer closure through the tracheotomy alternating suturing with ventilation. A generous tracheotomy, soft tubes and care in insertion of tubes into the trachea are suggested preventive measures.


Laryngotracheal separation.

Laryngotracheal separation. The popularity of the motorcycle, specifically trail bike riding, in the past several years has produced an increasing incidence of severe "clothesline" injuries to the larynx and trachea. Even at moderately high speed the impact of a horizontal cable with the neck of the rider causes a sudden hyperextension of the neck, and an avulsion of the larynx from the trachea, separating at the relatively rigid fibrous connective tissue between the cricoid cartilage and the first tracheal ring. Interruption of the strap muscles, the recurrent laryngeal nerves, laceration of the esophagus, and compression fracture of the cervical vertebral bodies can occur. The unseated rider requires immediate assistance, airway obstruction being his greatest problem. In the early minutes after the accident he must be transported to an emergency facility where tracheostomy and resuscitation can be provided. Mediastinal infection, tracheoesophageal fistula, subglottic stenosis, and intermittent depression many follow the initial repair. Rehabilitative measures include permanent tracheostomy, the use of neuromuscular pedicle graft, hyoid bone graft, intracordal injection of teflon paste, and carbon dioxide laser excision of webs and cicatricial tissue.


Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): Report of a case with respiratory tract involvement. The term "sinus histiocytosis with massive lymphadenopathy," introduced in 1969 by Rosai and Dorfman, refers to a newly recognized disease entity characterized by painless cervical lymphadenopathy, fever, leukocytosis, increased erythrocyte sedimentation rate, and hypergammaglobulinemia. The typical course is one of insidious onset, protracted duration of the active disease state, and eventual spontaneous remission, occasionally with subsequent recurrences. Lymph nodes other than those in the cervical area may be involved, and extranodal involvement can occur (such as in the orbit, skin, or respiratory tract). Clinically, this entity may closely simulate malignant lymphoma or nonneoplastic conditions with lymphadenopathy. We present a case in which this disease process extensively involved the respiratory tract and produced obstructive symptoms. The otorhinolaryngologist should be aware of this disease entity and should include it in the differential diagnosis for patients with cervical lymph node enlargement or bronchial obstruction.


Adenylate energy charge, energy status, and phosphorylation state of stria vascularis under metabolic stress. The purpose of the reported experiments was to measure the strial concentrations of adenosine triphosphate (ATP), adenosine diphosphate (ADP), and adenosine monophosphate (AMP) in order to arrive at estimates of three commonly used adenylate ratios. Under normal conditions, the concentrations of ATP, ADP, and AMP were found to be 11.4, 3.7, and 0.6 mmoles/kg dry weight, respectively. Of the three substances, AMP is the most sensitive indicator of metabolic stress, since its concentration doubles within 6 sec. of ischemia and reaches a peak level of about 1500% of the control following 65 sec. of ischemia. Under normal conditions, the "adenylate energy charge," the "energy status," and the "phosphorylation state" amount to 0.84, 3.0, and 1.52 gram wet weight/mumole, respectively. In ischemia of 10 min. duration, the adenylate energy charge decreases 3 fold, the energy status 7 fold and the phosphorylation state 14 fold. The size of the adenylate pool shows a slight increase in the earliest stage of ischemia, but declines progressively thereafter. The apparent equilibrium constant of strial adenylate kinase was found to be 0.48. The advantages and limitations of the different adenylate ratios, as indicators of metabolic health and as regulatory parameters, are discussed.


Failures after irradiation in early vocal cord cancer. Radiation therapy for early laryngeal cancer offers an excellent probability of cure as well as preservation of vocal function. Reported failure rates range from 9 to 21% in patients with T1 lesions, and from 28 to 44% in those with T2 lesions, the majority of whom are subsequently salvaged by surgery. Results obtained at the Radiotherapy Center of the University of Wisconsin Hospitals in 44 patients during the period from 1960 to 1972 yielded failure rates of 21% in patients with T1 tumors and 38% in patients with T2 tumors at 5 years. Five of the eight recurrences were salvaged with surgery yielding an overall tumor control rate of 93%. The larynx was preserved in 82% of the cases. Determinate 5-year survival was 91% in T1 cases and 86% in T2 cases. Failure rates at 3 years were 18% for T1 tumors and 30% for T2 lesions. These results are in conflict with those reported by Brandenburg and Rutter as being 46% and 60% respectively. Ultimate success in the treatment of laryngeal cancer rests in the full cooperation between surgeons and radiotherapists.


Evoked electromyographic test applied for recurrent laryngeal nerve paralysis. This study was performed to apply the evoked electromyographic (EMG) test to the larynx and to find out whether or not this test is useful for diagnosis of patients with recurrent laryngeal nerve paralysis. As a result, it was considered that the present test was useful for the following: 1. Diagnosis of the site of lesion: The decision is easily made whether the recurrent laryngeal nerve is damaged alone or together with the superior laryngeal nerve, and on the site of damages along the recurrent laryngeal nerve in some cases. 2. Determination of prognosis: The cases showing no evoked wave may not recover completely. For the cases showing an evoked wave, information on prognosis can be obtained from the degree of changes in latency and evoked wave form. 3. Indication of the state of nerve regeneration: The evoked EMG test is able to reveal the state of reinnervation of the paralyzed laryngeal nerve as well as and even earlier than the ordinary EMG test.


Plant antitumor agents. XVI. 6alpha-Senecioyloxy-chaparrinone, a new antileukemic quassinoid from Simaba multiflora. Fractionation of Simaba multiflora A. Juss. guided by bioassay has resulted in the isolation of a new antileukemic quassinoid 6alpha-senecioyloxychaparrinone (2) and the previously reported quassinoid chaparrinone (3). The structure of the former has been established by spectral and chemical methods. Compound 2 has high anti-neoplastic activity against several mouse leukemia systems (P-388, L-1210 and in solid-tumor B-16 melanoma). This demonstrates for the first time that the presence of a C-15 ester function is not required for antineoplastic activity in the quassinoids.


Potential anticancer agents IX. Isolation of a new simaroubolide, 6alpha-tigloyloxychaparrinone, from Ailanthus integrifolia ssp. calycina (Simaroubaceae). Chaparrinone (1) and 6alpha-tigloyoxychaparrinone (2) were shown to be responsible for the antitumor and cytotoxic activities of the root bark of Ailanthus integrifolia ssp. calycina. The structure of the latter compound was established by analysis of spectral data. Compound 2 exhibited a more pronounced biological activity than chaparrinone (1) and demonstrates, for the first time, anticancer activity of a simaroubolide ester substituted at only the 6-position.


[Biological diagnosis of leishmaniasis (author's transl)]. Serochematological, immunological and direct parasitological methods used in the diagnosis of man, dog and wild host reservoirs of Leishmaniasis are described. From their own investigations of more than 5.000 cases, the authors compare the respective technical advantages and the specific indications of each method.


[The dermal and naso-pharyngo-oral leishmaniasis (author's transl)]. The naso-pharyngo-oral leishmaniasis is not limited to South America. Cases have been reported in Africa showing that its prevalence in this area has been underrated. Its diagnosis is easy and early treatment will prevent facial lesions.


[Patho-physiology of anemia in kala-azar (author's transl)]. In kala-azar, anemia is caused by an hemolysis induced by an activation of the complement by antigen-antibodies complexes in which the antigen is wether the parasite itself or a messenger from it.


[Cutaneous leishmaniasis in Saudi-Arabia (author's transl)]. Fifteen cases of dermal leishmaniasis have been observed in the personnel of a french company operating in a deserted area of north Saudi-Arabia. All patients were stationed there for more than six months and had good accomodation. The host reservoir of virus of this small epidemy is not dog but must be looked for in wild rodents, the multiplication of which seems related to the growing dispersed dumping of town refuse on wide suburban areas.


[Cutaneous leishmaniasis in Algeria (author's transl)]. Report of 27 cases and comments on their epidemiological, clinical, immunological features and on the question of their treatment and prophylaxis.


[Visceral leishmaniasis in Algeria (author's transl)]. A clinical description of visceral leishmaniasis often observed in algerian children; the biological data and the question of diagnosis are studied and the author's experience of treatment and prophylaxis is given.


[Sudanese kala-azar in West Africa (author's transl)]. Report of a case of visceral and cutaneous leishmaniasis in an european boy living in Upper-Volta and whose brother had a merely cutaneous form of the disease. Comments on the role of personnal susceptibility, environment and arthropod vectors. In each given area would it exist a special type of leishmania related to the local vectors and which would give various clinical forms according to a second degree ecological system associating man and parasite.


[A case of visceral leishmaniasis with a difficult parasitological diagnosis and unexpected complications (author's transl)]. Report of a typical syndrome of which the leishmanial origin has been difficult to prove. The decrease of cellular immunity may be responsible for the pulmonary tuberculosis and Hbs hepatitis which occured after the successful treatment of the leishmaniasis with Glucantime and Lomidine.


Zygosporogenesis in Blakeslea tirspora (Mucorales). Zygospore development in Blakeslea trispora was studied using light microscopy, scanning electron microscopy, transmission electron microscopy and freeze fracturing technique. The results are compared with those obtained for Phycomyces blakesleanus and Choanephora circinans.


Lymecycline or doxycycline for treatment of urinary-tract infections: a comparison of attained urine concentrations. The urine and serum concentrations of lymecycline and doxycycline were investigated in a cross-over study in ten volunteers. Both drugs were found in therapeutic serum levels but lymecycline had a mean urine concentration of 240 microgram per ml compared to 60 microgram per ml of doxycycline. The results are discussed with regard to treatment of some urinary-tract infections.


Measurements of membrane potentials using the dye safranine. A metachromatic shift in the spectrum of the cationic dye safranine occurs upon induction of electrical potentials across the mitochondrial membrane by adding respiratory substrate, ATP or a cation conductor valinomycin (when a potassium gradient exists across the membrane) to a mitochondrial suspension. The extent of spectral change correlates linearily to the membrane potential. During the spectral change safranine is taken up by the mitochondria and most of the dye can be recovered in the pellet after centrifugation. By measuring the spectral changes a fairly good estimate of membrane potentials in mitochondria and bacteria is obtained. This method is compared to other optical methods of studying membrane potentials and is possible applications in different systems in the future is discussed.


New plasmid-mediated phosphorylation of gentamicin C in Staphylococcus aureus. A clinical isolate of Staphylococcus aureus resistant to gentamicin, kanamycin and 3',4'-dideoxykanamycin B contained two enzymes capable of inactivating gentamicin, i.e., an aminoglycoside 2''-phosphotransferase and aminoglycoside acetyltransferase.


The professional attitudes of Nigerian first year medical students. In a study of the development of professional attitudes in medical students, a modified version of the Medical Attitudes Inventory (Harris, 1974) was administered to 141 male and female first year medical students in Lagos, Nigeria. The results show that the students have well-defined attitudes on certain issues and are divided on others. The findings are discussed in terms of their implications for medical education, attitude research and durability of students' attitudes in and beyond medical school. The influence of contemporary social factors on student professional attitudes is also considered. The instrument has sufficient psychometric attributes to warrant further use.


Teaching sociology to medical students.

Teaching sociology to medical students. A recent change in many medical curricula has been the introduction of courses in the behavioural sciences. These courses, while introduced with the intention of emphasizing interpersonal and behavioural skills, have not been shown to lead to any of the changes towards which they are directed. Rather, there is evidence that students find these courses 'waffly' and boring. If the sociology component of these courses is to lead to change, then there is the need for a continuing process of evaluation and modification. In this paper we report upon one medical sociology course, its evaluation, subsequent modification and re-evaluation. Our evidence would suggest that sociology courses can lead to changed attitudes and values, but that such changes are contingent upon the overt application of relevant sociological concepts to the health care field.


The teaching of child health in a medical college in central India. Aware of the importance of a knowledge of children and skill in their care, the World Health Organization and the Government of India have been working together to improve the training and education of the medical in that subject. To that end the Organization has supported the work of a committee of medical educators, which has studied the teaching of child health and has published an experimental curriculum suitable for use in medical colleges in India ('Ad hoc' Committee on Education and Training in Paediatrics; WHO, 1970, 1971, 1974, 1975). This article tells of the experience with that curriculum in one medical college in Central India since 1974. It is first necessary to indicate the position of medical education in the country.


Illustrated multiple choice examinations. Interpretation of visual data is an essential component of clinical competence. Illustrated multiple choice items have been used to measure interpretation, but the effects of introducing visual material into multiple choice items has not been critically assessed. A series of problem-sequenced multiple choice items containing, in the stem, a description of visual data such as a radiologist's report, was selected and matched with identical items where the description was replaced by reproductions of the original data. These two series of items were arranged into two parallel examinations which were taken by groups of final year medical students. From a comparison of the performance of the students in these two examinations it is concluded that substitution of actual visual data for the written description increases the difficulty of items, but is without consistent effect on discrimination. The illustrated format was commended by students for its clinical relevance but certain problems with the reproduction of radiographs and the selection of data have been revealed.


Designing a comprehensive service for a health care group: a framework for planning. This article describes an exercise which was designed by a multidisciplinary group, including a community physician, health economist, clinician and operational research practitioner, to explore the essential nature of planning services for a particular health care group. The first programme, described in the article, was concerned with psychogeriatric services, including both community and hospital provision, but it is indicated that the exercise can be adapted to all other services, and has already been used to evolve a comprehensive accident and emergency service in a particular health area. Participants came from a wide variety of disciplines, including community medicine, psychiatry, geriatrics, hospital and community nursing and non-medical administration. The tutors to the course were those who had been involved in its planning and they spent the time working with the participants to explore the concepts involved and to produce some practical solutions that could be used in the field.


Assessment of the M.Sc. course in Occupational Medicine at the London School of Hygiene and Tropical Medicine, 1969--74. The M.Sc. course in Occupational Medicine started in September 1969 at the London School of Hygiene and Tropical Medicine. Between 1969--74, ninety-eight doctors attended this 9 month full-time course. Thirty-four were British and sixty-four from overseas. A questionnaire was mailed to all of them. Eighty-four replied, i.e. a response rate of 86%. Thirty-one of the U.K. doctors and fifty-three of the overseas replied. The difference between the UK and overseas doctors working full-time in occupational medicine was very marked before and after the course. 100% of the U.K. doctors and 89% of the overseas thought their objectives of attending the course were fulfilled. 97% of the U.K. doctors said the course covered the problems of their country as compared with 77% of the overseas. 100% of the U.K. doctors found the knowledge gained of practical value to their work. Suggestions were also made on topics taught and on the practical instruction of the course. It appears that the M.Sc. course is successful and that the objectives outlined when starting the M.Sc. were to a great extent fulfilled. The new changes introduced this year 1976 in the organization and the content of the course are also discussed, and their advantages emphasized.


MCQ and higher examinations as exemplified by the primary Fellowship of the Faculty of Anaesthetics, Royal College of Surgeons of England. A major problem of the use of multiple choice examinations is the inherent difficulty of the questions, a fact which cannot be assessed in relation to questions not previously used. Questions which have been used during previous examinations, however, will have an available measure of the difficulty in the form of candidates' previous scores. The performance of candidates in a current examination can be compared with that in a previous examination. On the strength of these differences it is possible to decide whether the candidates in any single examination are better prepared than their predecessors or less well prepared. Pass marks can be appropriately adjusted.


The early detection of childhood deafness. Early commencement of habilitative measures is vital for a deaf child's development. This implies a need for early diagnosis. Some improvement has occurred in recent years, but early diagnosis is still the exception rather than the rule. To determine some of the factors which lead to early diagnosis, a survey of parents of young Australian deaf children was undertaken. This showed that, while the majority of children were suspected to be deaf on the basis of informal observation by parents, relatives or friends, the most consistent early diagnosis came as a result of follow up of infants at risk. Certain factors acted to delay diagnosis. Dissuasion and inappropriate advice from doctors significantly delayed diagnosis in 25% of all cases. Further, over half the hearing-impaired children who were tested in screening programmes were not detected, and the false sense of security given the parents in these cases resulted in long delays before suspicion of deafness (based on informal observation) developed. If early diagnosis of deafness is to become the rule, a purposeful attempt to use risk criteria, coupled with improved screening programmes, will be the most promising avenues to follow. Improved education of the community at large may also assist, but this is a much longer-term aim.


Thyroid autoantibodies in an Australian community. Little data are available concerning the prevalence of thyroid autoantibodies in the Australian community. The present study, performed in a non-iodine deficient area, reveals a high prevalence of microsomal and thyroglobulin autoantibodies in healthy females. The proportion of females with one or either antibody is almost three times greater than that observed for males, but, in both sexes, the prevalence does increase with age.


Acupuncture anaesthesia for squint surgery. An account of an operation for squint using acupuncture analgesia is given. This is the first ophthalmic operation carried out in Australia using this form of analgesia; and is probably the first surgical operation of any type carried out in Australia using acupuncture technique. The indications and possibilities of this method are discussed.


Hearing testing in baby health centres: pilot scheme for evaluation of a new method. A new method of hearing testing has been evaluated on a trial basis in the Baby Health Centres of the Sydney Inner Metropolitan and Illawarra Health Regions, of New South Wales. This consists of earlier and more frequent testing with a newly devised range of auditory stimuli presented in front of the child, rather than behind the child. The reason for the change is that earlier detection leads to earlier treatment and improved speech. The new method will assess whether there is adequate hearing for speech development.


Who does what? Role definition in a psychiatric hospital. This is a report of an interdisciplinary workshop which was held to define the roles of different disciplines within a psychiatric unit. While the report emphasizes the medicolegal responsibility of the psychiatrists, we found, in a review of the knowledge background of the several disciplines, potentials for a further utilization of the knowledge which is acquired during their training. Meeting the patient's needs is the prime factor in determining the roles of the disciplines. The needs of the patient have expanded. Each discipline has both an exclusive role and an inclusive role. One important result of the workshop was the warmth and the esprit de corps that was felt afterwards.


Neurocysticercosis: an exotic disease presenting in Australian immigrants. Two cases of neurocysticercosis which occurred in migrant women are reported. This disease, produced from the larval form of the pig tapeworm, Taenia solium, is not endemic in Australia. It is prevalent in Latin America, India, parts of Africa and eastern Europe and some Mediterranean areas. Where the possibility of exposure to this parasite exists, neurocysticercosis should be considered in the differential diagnosis of late-onset epilepsy, hydrocephalus, focal fits, progressive dementia, and in spinal cord tumours.


Exposure of council and forestry workers to 2,4,5-T. The exposure of council and forestry workers to 2,4,5-T, a plant poison, has been monitored for a period of two years. It was found that the excessive urine levels of 2,4,5-T fell dramatically once the exposure was minimized. Therefore, the use of protective clothing and adoption of measures to prevent inhalation exposure are essential.


Death from bloat.

Death from bloat. A case is reported of acute gastric dilatation associated with chronic duodenal ulceration and pyloric stenosis. Death was due to mechanical impedance of venous return, resulting from grossly increased intra-abdominal pressure.


Lawnmower injuries.

Lawnmower injuries. Six cases of lawnmower injury are reported. The management of these injuries is discussed. The incidence of morbidity and mortality are emphasized in an appeal for education in the safe handling of these common domestic appliances.


Hodgkin's disease as a complication of Crohn's disease. A case of a patient with Crohn's disease who was treated with azathioprine, and developed intestinal Hodgkin's disease as a complication is described.


Six children affected by maternal alcoholism. Six children affected by the fetal alcohol syndrome (FAS) are described. Their ages vary from newborn to 15 years. All had multigravid, alcoholic mothers. All have the facial features of the FAS, and prenatal and postnatal growth retardation. Four have additional congenital anomalies, and at least four are mentally retarded. These children are described to increase awareness of the FAS in Australia, whose population has a high and changing pattern of alcohol consumption.


Compulsory blood alcohol testing of road crash casualties in Victoria: the first three years. The history, rationale and implementation of legislation for compulsory blood alcohol tests on adult road crash casualties presenting at Victorian hospitals are reviewed. Drinking drivers admitted to casualty departments can now be identified and prosecuted; doctors can obtain blood alcohol test results on road crash casualties without threat of litigation; drinking drivers with alcohol problems may be directed to appropriate re-education or rehabilitation programmes; the opportunity also exists for treatment of non-driver casualties with alcohol problems. In the first three years of testing, 27.1% of 21,863 male driver casualties had blood alcohol concentrations in  excess of the legal limit of 0.05 g/100 mL (11 mmol/L), and 13.7% had blood alcohol levels in excess of 0.15 g/100 mL (33 mmol/L); the blood alcohol levels in 8.7% of 9187 female driver casualties exceeded 0.05 g/100 mL, and in 3.7% exceeded 0.15 g/100 mL. Non-drivers had a slightly lower incidence of elevated alcohol concentrations. The implementation of further drink-driving countermeasures, expansion of services for the management of alcohol problems, and development of a national policy directed at prevention of alcohol abuse are recommended.


Alcohol and road safety: Geelong experience 1967 to 1978. This paper reviews the part which prior consumption of alcohol played in motor vehicular fatalities in Geelong and district between January, 1967, and June, 1978. There were 344 deaths of persons aged 17 years and older within four hours after the accident. Of 147 such victims who were aged 17 to 50 years and who were drivers of motor vehicles. 54% had a blood alcohol concentration (BAC) greater than 0.1 g/100 mL (22 mmol/L) at autopsy. Of 35 male pedestrians, 60% had a BAC greater than 0.15 g/100 mL (33 mmol/L) at autopsy, and 80% of such accidents occurred between 6 p.m. and 10 p.m. A high degree of sobriety was noted among all female road traffic victims. The increasing road toll related to motorcycle accidents and the problem of legal and illegal drug use are also briefly discussed.


Survey of 2144 cases of red-back spider bites: Australia and New Zealand, 1963--1976. An analysis has been made of 2144 consecutive cases of latrodectism (envenomation by the red-back spider, Latrodectus mactans hasselti) reported to the Commonwealth Serum Laboratories. In the last eight years, notifications have averaged 240 cases per annum. Bites, usually on the extremities (74%), occurred most frequently in the summer months, and in the afternoon or evening. Most victims (79%)  were aged between 18 and 50 years and 64.4% of them were males. Males are still often bitten on the genitals or buttocks (9.7% of cases). Local pain, redness and swelling were the most common symptoms, although significant pain was felt at other sites in 39% of the cases. The regional lymph nodes often became swollen and tender within 30 minutes. General effects included nausea, vomiting and sweating, but coma and respiratory  failure were very uncommon, probably because of use of specific antivenom. This was administered within 24 hours of the bite in 92%  of cases, and within two hours in 70%. Although 11 anaphylactic reactions (0.54%) were reported, no deaths resulted either from the venom or from reactions to the antivenom. Few delayed serum reactions (1.7%) were recorded. The action of the venom is described and the management of red-back spider bite is outlined.


Cancer of the pancreas in young adults.

Cancer of the pancreas in young adults. Two young women with cancer of the pancreas are described. The rising incidence and epidemiology of this cancer is discussed. The need for tissue diagnosis and some new aspects of treatment of pancreatic cancer relevant to these cases are presented.


Extensive damage to substantia nigra in chronic alcoholics. Neuronal depigmentation, necrosis, and increased pigment (melanin) and iron depositions in the perivascular spaces have been observed in the substantia nigra in chronic alcoholics. Eosinophilic nuclear inclusions, the significance of which remains unclear, were noted with an increased frequency within the nuclei of the substantia nigra neurons.


The changing scene: dieting, vitamins, analgesics, alcohol, smoking, and Hobart secondary school students. A comparison of the results of surveys conducted in 1971 and 1977 involving secondary school students in Hobart has been made. It revealed an increasing intake of alcohol and vitamins but a decrease in analgesic usage in both sexes. Female students were smoking more frequently and more heavily and more of them were on weight-reducing diets. These results indicate that the kinds of health education in use at present are not effective.


Preoperative parathyroid identification by ultrasonic scan. A preliminary report of the use of ultrasonic scans to locate parathyroid tissue before neck exploration is presented. Three patients suffering from hyperparathyroidism had abnormal parathyroid tissue located before surgery. These findings were confirmed at operation. The role of ultrasonic scans of the neck before exploration is discussed.


Open assessment of fenoterol (Berotec) in severe asthmatics in general practice. An open clinical trial to establish the efficacy of fenoterol (Berotec) aerosol bronchodilator was conducted on 11 severely affected asthmatic patients in a Sydney general practice. Berotec was found to be an effective bronchodilator with a very rapid onset of action. Over 60% of the maximum response from a single puff dose was evident one minute after inhalation. Berotec also has a long duration of action, as there was statistically significant bronchodilator effect six hours after inhalation, and even at eight hours after inhalation, improvement on baseline values was demonstrated. Berotec appears to have significant advantages over other bronchodilators.


Diagnosis of breast cancer before operation. Fifty clinically malignant breast masses were biopsied in the consulting room with a large bore needle to provide a histological diagnosis before definitive treatment was planned. A correct diagnosis was made for all but one of 39 carcinomas, and for all 11 benign masses. This is, therefore, a useful method of confirming the diagnosis when breast cancer is suspected, but other methods (including open biopsy) are more suitable when breast cancer is to be excluded.


Terbutaline sulphate nebulizer solution: a dose-response study. A dose-response study of terbutaline nebulizer solution has been performed in nine convalescent asthmatic patients. Both 5-mg and 10-mg doses administered as a wet aerosol resulted in effective bronchodilatation, but the higher dose caused a mild tachycardia.


Retrospective survey of neurotraumatic admissions to a teaching hospital: comparison of data on head injuries after 10 to 16 years. A retrospective survey of 1100 patients with head, spine, and cord injuries who were treated in The Prince Henry Hospital, and The Prince of Wales Hospital, Sydney, from January, 1960, to December, 1965, was published in The Medical Journal of Australia during 1967 and 1968. The present series of admissions from January, 1975, to December, 1976 comprises 179 head injury patients. The epidemiological data related to head injuries and specified in the two series are compared in the available details. The pattern of change in the structure of neurosurgical services is evaluated in relation to the ever-increasing neurological trauma on the roads of New South Wales. Growing numbers of patients with serious head injuries are treated in district and country hospitals in areas where neurosurgical consultative services cannot be obtained. The standards of treatment of these patients are unknown, and cannot be evaluated. The need for planning for better standards of care in district and country hospitals is stressed. A permanent system of statistical monitoring of all neurotrauma across the State is advocated. Organization of permanent postgraduate training courses in the management of acute neurotraumatic admissions, readily available to all those treating head injuries in the country hospitals is considered as a basic and imperative requirement.


Removal of duodenal foreign body with endoscopic snare. The extraction of a thermometer wedged in the duodenum, which utilized fibrendoscopic techniques, is described. A brief review of methods which are available to the endoscopist to retrieve ingested foreign bodies is presented.


Occult carcinoma of the lung presenting as spontaneous pneumothorax. The fortuitous discovery of a microscopic focus of poorly differentiated adenocarcinoma at the site of air-leak in a patient who had presented with spontaneous pneumothorax is described.


Galactosaemia: case for neonatal screening illustrated by recent Australian experience. The varied presentation and clinical features of classical galactosaemia are illustrated by the case histories of seven babies born in Western Australia since January, 1962, and of two babies born in South Australia in whom diagnosis was made as a result of adding galactosaemia to the Guthrie screening programme in October, 1974. All were shown to have a severe deficiency of galactose-1-phosphate uridyl transferase in their red blood cells. We compare our findings with those in 10 galactosaemic babies born in Victoria over a similar period, and show that in both groups these were two main modes of onset: acute and insidious. Jaundice and Escherichia coli infection were prominent in the 13 babies with an acute onset of galactosaemia, while poor weight gain, intermittent vomiting and cataracts were features of the five babies with an insidious onset. An enlarged liver was usually found in both groups. We discuss the various approaches to neonatal screening of galactosaemia in the light of experience in Massachusetts and South Australia. The use of cord blood can be expected to lead to diagnosis before babies with acute onset become ill, while the use of blood collected at five days for the Guthrie test avoids the collection of another routine sample for a relatively rare disorder. The result of red cell transferase assays of parents and siblings of our patients are discussed in relation to their implication for genetic counselling. The relevance of antenatal diagnosis to the prevention of possible intrauterine damage to an affected fetus is pointed out.


Incidence of alpha-thalassaemia in Australian population of Mediterranean origin. Cord blood from 6578 neonates of Mediterranean origin born at The Royal Women's Hospital, Melbourne, over a five-year period was screened for alpha-thalassaemia by haemoglobin electrophoresis for haemoglobin Bart's (Hb Bart's), and 47 cases of the abnormal haemoglobin were detected (an over-all incidence of 0.71%). Hb Bart's was detected in Turks (2.9%), Cypriots (2.8%), Egyptians (2.0%), Lebanese (0.8%), Greeks (0.7%), Italians (0.5%), and Yugoslavs (0.2%). The mean level of Hb Bart's for the group was 4.6%. Four cases of alpha/beta thalassaemia were also detected during this survey.


The wider spectrum of child abuse.

The wider spectrum of child abuse. Child abuse encompasses many facets aside from the acts of physical violence which have generally attracted attention. Sexual misuse of children often goes unrecognized, yet its effect on the mental health of the victim may be considerable; it may or may not be accompanied by violence, and it generally occurs within a setting of serious disturbance in the family. Clinical details of nine sexually abused children are described, and they serve to illustrate how this form of abuse may prevent. The management of these cases is discussed. Sexual abuse of children is a family problem and therefore must be the concern of the family doctor.


Hypospadias in the true hermaphrodite.

Hypospadias in the true hermaphrodite. A case is reported of a six-year-old boy who, after several attempts at the repair of hypospadias, was investigated urologically, and was found to be a true hermaphrodite. The necessity of investigation of the genitourinary tract before undertaking the repair of hypospadias is emphasized.


Eleven cases of sickle cell disease in Sydney. Eleven cases of sickle cell disease within the Sydney area are described. Eight of these are of homozygous sickle cell anaemia, and three are of the sickle cell-thalassaemia disease. The racial origin is Lebanese Moslem in five cases, Greek from the mainland or Cyprus in four, and Portuguese, French, and Spanish in two sisters: consanguinity occurred in the latter family, and in three of the five Lebanese Moslem families. The age of patients at diagnosis ranged from five months to 22 years, and the clinical severity from very mild to very severe, with a wide spectrum of clinical manifestations. It is concluded that sickle cell disease is already a significant health problem within the Sydney area, and likely to increase in incidence with increasing migration from endemic zones.


Campylobacter enteritis in South Australia. Campylobacter jejuni was isolated on coproculture from 13 of 224 patients with suspected infectious diarrhoea whose faecal specimens were examined during a three-month period. These organisms were not isolated from 530 specimens received from asymptomatic and healthy individuals. Diarrhoea and cramping abdominal pain generally lasting two to three days were the major symptoms, though occasional patients had a more prolonged illness. Ingestion of campylobacter resulted in enteric infection with increasing numbers of campylobacter in the stool. Clinical laboratories should attempt to isolate these organisms from patients with diarrhoea.


Physician heal thyself?

Physician heal thyself? Eighteen drug-dependent medical practitioners were studied, and the results of their treatment were compared with the results of the treatment of non-doctor patients of similar age. The result of this comparison lent support to the suggestion that doctors who develop a dependence on drugs tend either to become abstainers or to die.


Intentional chloroquine overdosage.

Intentional chloroquine overdosage. Twenty-six episodes of intentional chloroquine overdosage are documented. The over-all mortality rate of 19%, and 50% incidence of cardiac arrest for ingestion of 2.25 g or more of chloroquine base indicate the risk of overdosage. Life-threatening cardiac arrhythmias may be the first sign of overdosage. However, gastrointestinal and neurological symptoms generally precede this sign. Early recognition and attempts to decrease drug uptake are important as current therapy after absorption of the drug is inadequate.


Emergency treatment of severe hypertension with intravenous labetalol. The effects of intravenously administered labetalol on blood pressure and pulse rate were examined in 17 patients with severe hypertension. Prompt and sustained falls in supine blood pressure and pulse rate occurred in ten patients (responders), but seven patients showed little or no change in either measurement (non-responders). Labetalol had a more marked effect on standing than on supine blood pressure. Only two of the responders, but all of the non-responders were concurrently receiving antihypertensive drugs. Plasma renin activity, plasma renin concentration and plasma angiotensin II concentration fell slightly over the one-hour period of observation in ten patients in whom serial measurements were made, but the changes were independent of the blood pressure response.


Myocardial perfusion scanning with thallium--201 for the non-invasive diagnosis of coronary artery disease. Thallium--201 myocardial perfusion scanning has been evaluated in Australia in patients with coronary artery disease. Myocardial scans reliably detect both acute myocardial infarction and the transient myocardial ischaemia of angina pectoris. The non-invasive nature, ease of study, and the ability to scan patients with conventional cameras makes thallium--201 an attractive additional diagnostic agent for patients with suspected coronary artery disease. Although thallium--201 reliably indicates perfusion defects in the myocardium, its diagnostic use at the moment should be reserved to clarify such diagnostic problems in patients with coronary artery disease which cannot be satisfactorily explained by conventional investigation.


Cerebral arteritis associated with heroin abuse. A twenty-year-old man suffered a left homonymous hemianopia after self-administration of heroin. Investigations revealed right occipital infarction with angiographic changes of arteritis in the posterior cerebral arteries.


Continuous time-dependence in computed tomography. Computed tomography is sensitive to changes in the imaged distribution during acquisition of the projection data. Previous investigations have emphasized discrete or discontinuous changes in the imaged object. Recent advances have motivated our investigation of object time-dependence characterized by a continuous function in time at each point. Formal mathematical and computer simulation approaches have been developed, and are presented along with simple examples of their applications. Further applications in three distinct ongoing studies are outlined.


Resolution and contrast reduction.

Resolution and contrast reduction. Lack of resolution (unsharpness) can reduce contrast in diagnostic radiography if the proper conditions of magnification and unsharpness are met. To describe this phenomenon, a modification of the contrast reduction factor (CRF) was introduced which used the response function of a semi-opaque edge to predict contrast reduction for small bar-shaped objects. To predict CRF, unsharpness is employed as a single-term description of resolution and is obtained experimentally from the edge response function. The unsharpness term is defined as the distance over which the response goes from 16.5% to 83.5% of the maximum. Measured and predicted CRFs were compared and the CRF concept was found to be an excellent predictor of contrast reduction. The individual components of unsharpness were determined experimentally and the sum-of-squares rule predicted adequately their combination. Three methods to measure unsharpness were compared: (a) the ICRU prescription using pinhole radiographs of the focal spot, (b) one-dimensional integration of the focal-spot pinhole radiograph, and (c) the unsharpness term produced by a semi-opaque edge. The latter two were measured using a microdensitometer.


An improved image algorithm for CT scanners. A common artifact in CT head-section images is a cupping or broad "whitening" effect near the skull which is due at least in part to the polychromaticity of the x-ray beam. In this paper, a general method is presented for removing this artifact empirically by a combination of two approaches. The gross cupping is removed by modifying the raw transmission data prior to reconstruction. The residual whitening near the bone is removed conveniently by modifying the reconstruction filter function. Examples of the modifications are shown using the AS&E CT scanner. The method convolves or deconvolves the CT image with an appropriate point spread function. Since the filter-function modifications are done conceptually in real space rather than in frequency space, the details of the modifications are more easily understood.


Microwave interrogation of dielectric targets. Part II: by microwave time delay spectroscopy. A method is described which overcomes the problems of multipath propagation and range ambiguity that is suffered by the single-frequency continuous-wave microwave-imaging system described in part I. This technique is essentially a variation of chrip radar techniques, which have been adapted to time delay and attenuation measurements through a target. The feasibility of discriminating between paths whose differential time delay is on the order of 100 ps is demonstrated. Further, the need for small physical aperture in the transmitting and receiving antennas is demonstrated.


Proton spin-lattice relaxation time study in tissues of the adult newt Taricha granulosa (Amphibia: Urodele). Nuclear magnetic resonance (NMR) pulse techniques were used to obtain values for the spin-lattice relaxation time (T1) of whole blood, plasma, blood cells, in vitro liver samples, and live and necrotic tail samples for adult Taricha granulosa. The T1 for whole blood is (0.80 +/- 0.01) s, for plasma (0.76 +/- 0.02) s and for blood cells (0.83 +/- 0.01) s, and did not change over several hours of measurement. The necrotic liver gave a single T1 of (0.28 +/- 0.02) s within the first 20 min of excision with a gradual increase over the next 3.5 h. Live and dead tail samples gave two T1 values: a short T1 of about 0.15 s remaining essentially constant and a long T1 starting at 0.68 s and increasing to 0.9 s during the 5 h of the experiment.


Use of a pencil-shaped ionization chamber for measurement of exposure resulting from a computed tomography scan. A simple method of comparing and/or monitoring the radiation output level of a Computed Tomography (CT) system, using a specially developed pencil-shaped ionization chamber, is presented. When the measurement is made with a phantom for the period of one tomographic scan, the result can be interpreted as the average exposure along the chamber axis resulting from the entire series of scans to be performed by the CT system. An interesting feature of this method is that no detailed knowledge of the beam distribution or slice thickness is necessary in order to measure the radiation output level, to compare the performance of CT systems or the estimate patient's exposure for a particular combination of CT operation parameters.


Determination of effective energies in CT calibration. The effective energy of a polychromatic beam for a Computed Tomography (CT) scanner can be measured directly only with difficulty. However, a linear relationship exists between the measured CT numbers and corresponding attenuation coefficients of known materials at the effective energy of the x-ray beam. The effective energy can then be determined by searching all energies for the best linear correlation between the CT numbers and the attenuation coefficients. This can be performed by two methods: graphically, by means of choosing visually the straightest of the fitted lines or, mathematically, by maximizing the correlation coefficient. The energy corresponding to the optimal fit is therefore selected as the effective energy. The latter method was implemented by computer and demonstrated by scanning the AAPM phantom, which contained known materials, and determining the effective energies and the relationship between the linear attenuation coefficients and CT numbers for three commercial units.


Development of optical process for accessing three-dimensional patient topology. A commercial optical system developed by Solid Photography, Inc., has been used to generate precise paraffin--polyethylene tissue compensators. A program with the objective of constructing a medical facility has been undertaken to access patient topology for treatment planning, tissue-compensator fabrication, and patient positioning verification on the treatment table. Currently, patients are taken to a specially equipped studio where a series of microprocessor-controlled reticles are projected on the surface to be analyzed and photographs are taken automatically for computer processing. The topology data then drives a machine tool to sculpt the tissue compensators and may be transmitted via acoustic-coupled terminals to a treatment-planning computer at the Medical Center. The tissue compensators have been found to conform accurately to patient contours. At present, data bases can be generated to accommodate volumes of approximately 70,000 cm3.


A single-switch control for wheelchairs and other equipment. In cerebral palsy, hand function may be severely curtailed. In some cases, the sole operable device may be a single switch of special design. In such cases, electronic scanning, actuation, and error correction may be necessary. This paper describes such a system, which is in use for typing and for control of an electric wheelchair.


Measurements in microscopic images: an inexpensive device for semi-automatic analysis of microscopic images. Measurement of histological and cytological parameters can be performed much faster and more accurate by means of a semi-automatic device that is described in detail. The system consists mainly of a medium-sized computer and one or more peripheral terminals. Each terminal incorporates a special measurement table for data acquisition, a keyboard for manual data input, and an interface. The software program for the evaluation and storage of the digital data is simple to write and offers a high degree of flexibility to the user. The system can be operated in real time.


Computer angiography: a new tool for x-ray functional diagnostics. The method of functional imaging is applied to x-ray angiograms. Functional images are generated by inserting at each point of an x-ray image a computed grey or colour value proportional to a dynamic parameter (such as blood velocity) instead of the recorded x-ray absorption value. For this purpose a new system for angiographic image processing has been developed. First results show that the method which we have called Computer Angiography is a tool to extract more information about the blood dynamics in organs in an easier and faster way than with the conventional angiographic technique.


Instability of photomultiplier tubes and consequences for accuracy of radioactivity measurements. The gain instability of some types of small photomultiplier tubes has been studied. The variation of gain with time was measured with the aid of a pulse-height-variation meter especially developed for this investigation. It was found that a stepwise change in the count rate led to a time-dependent change in the gain of the tube; the over-all change in gain sometimes amounted to several percent. This change in gain leads to a change in the measured count rate and hence to errors in the measurement of radioactivity. The magnitude of these errors depends on the energy resolution of the detector, which in turn depends on the energy of the radiation. The gain instability of the photomultiplier tube can lead to serious errors in dynamic tracer studies. It is recommended that the stability of each tube should be checked by means of a device like that used in this study.


Simulation of blood flow by a hydrodynamic generator. Physiological flows are produced by a volumetric gear pump. The motor-pump group is controlled by an amplifying comparator, and produces a flow whose rate follows the control signal. This signal is delivered by a synthetizing generator and its shape, amplitude, and frequency are adjustable. This hydrodynamic generator supplies a test bench on which the modifications of flow patterns induced by models of vascular stenoses are studied. The study of the velocity distribution has been effected with a pulsed-Doppler ultrasonic velocimeter.


Incidence and treatment of budding yeasts in canine otitis externa. Budding yeasts were present in the majority of cases of otitis externa examined. A reddish-brown, dry, waxy discharge was the typical exudate. A successful treatment of yeast-infected ears was multiple otic lavages using a combination of an aqueous solution of poloxamer-iodine and application of an antifungal-antibiotic-corticosteroids ointment.


Recombinational repair of alkylation lesions in phage T4. I. N-methyl-N'-nitro-N-nitrosoguanidine. Treatment of phage T4-host adsorption complexes by MNNG increased recombination between two rII markers by about three-fold. Temperature sensitive mutants defective in genes 32, 46 and 47, which cause reductions in recombination at semirestrictive temperature, proved to be substantially more sensitive to MNNG at such temperatures than wild-type phage. In addition, the recombination defective mutants xm(uvsX) and y10(y) were sensitive to MNNG than wild-type, whereas mutants defective in genes 45 and denV, which are apparently not involved in recombination, were not MNNG sensitive. These findings suggest that a recombination pathway involving the products of genes 32, 46, 47, uvsX and y is employed in repairing MNNG-induced lethal lesions. This mechanism is effective in cells infected by single phage, implying post-replication recombinational repair between daughter chromosomes. MNNG-induced lesions are subjects to multiplicity reactivation, but mutants defective in genes 46 to 47 showed the same degree of multiplicity reactivation as wild-type phage. The gene 32 and gene 47 recombination defective mutants were tested for their effects of MNNG-induced reversion of an rII marker. No reduction in induced reversion was found. Thus, it appears that the postulated recombinational repair pathway employing the products of genes 32 and 47 does not contribute substanitally to induced mutagenesis.


Characterisation of ribosomes from drug resistant strains of Schizosaccharomyces pombe in a poly U directed cell free protein synthesising system. Mutants of Schizosaccharomyces pombe were isolated as resistant either to trichodermin or to anisomycin. Growth tests showed that the majority of mutants isolated were cross resistant to both drugs and also to cycloheximide. A limited genetic analysis showed that mutants at least four loci, tri3, tri4, ani1 and ani2, had this phenotype as was also the case for mutants at three cycloheximide resistant loci, cyh2, cyh3 and cyh4 reported previously (Ibrahim and Coddington, 1976). Allelism tests showed that the tri3, ani2 and cyh4 strains were allelic. A mutant at another trichodermin resistant locus, tri5, was cross resistant to anisomycin but sensitive to cycloheximide. Ribosomes from wild type and selected strains were analysed in a poly U directed cell free protein synthesising system. Three strains, cyh1-C7, ani1-F1 and tri-N15 (probably a tri5 allele) possessed ribosomes which were more resistant than the wild type to the drugs used in their isolation. In each case the site of the resistance was in the 60S subunit. Ribosomes from the cyh2, cyh3 and cyh4 strains were as sensitive to cycloheximide as those from wild type.


Isolation and partial characterization of a mitochondrial deoxyribonucleic acid-protein complex from sea urchin embryos. Lysis of mitochondria from sea urchin embryos with Triton X-100 led to a complete conversion of DNA-containing mitochondrial residues into protein-DNA complex with a density higher than 1.22 g/cm3 in sucrose solutions. This complex banded isopycnically in metrizamide gradients at a density of 1.26 g/cm3. Exposure to mixtures of Triton X-100 with Tween 80 resulted in progressively less delipitated and disorganized mitochondria over Tween/Triton weight ratios from 1 to 2, with the retention of the starting buoyant density in sucrose of approximately 1.16 g/cm3 at Tween/Triton ratios above 2.5. The DNA-internal protein complex sedimented with the bulk of the surviving mitochondrial structure under all conditions studied. No free DNA could be detected under any conditions of membrane removal.


[Electroencephalographic observations after therapy with vincristine (author's transl)]. A direct cytotoxic effect of vincristine on the neurons, especially the cerebral cortex is discussed in the literature. In 188 patients treated with vincristine we saw no so called "Vincristine-induced Encephalopathy". In 67 children investigated 5 weeks up to 2 years after the last vincristine-injection we found no changes in EEG-tracings which could be discussed as vincristine-induced.


[Blood lipids in juvenile diabetes mellitus in respect to sex, age, body weight, duration of illness, quality of control and amount of insulin required (author's transl)]. Postprandial lipoproteins, serumcholesterol and serum triglycerides were measured in 76 patients with juvenile diabetes mellitus. The lipoprotein pattern was pathological in 37% [type II (Frederickson) 20%; type IV 17%]. Serum cholesterol was not significantly elevated when compared with normals, but was positively correlated with the duration of the disease. Serum triglycerides were significantly elevated compared with normals.


[Hyperosmolar nonketotic diabetic coma. Treatment with continuous low-dose insulin infusion (author's transl)]. We report the case of a boy aged 9 1/2 years with hyperosmolar, nonketotic diabetic coma. He was not known to be diabetic prior to the onset of coma. Pathogenetic aspects of this rare manifestation of juvenile diabetes are discussed. It is dangerous to decrease osmolarity too rapidly during infusion of very hypotonic solutions. Treatment with continuous low-dose insulin infusion may cautiously be tried.


[Copper and zinc in cerebrospinal fluid of children with neurological diseases (author's transl)]. We examined CSF copper and zinc concentrations in 30 children with acute febrile illness and meningism (control group) and in 37 patients with shortlasting seizures, febrile or not, and acute viral meningitis. The trace elements were quantitatively measured by means of atomic absorption spectrophotometry. 1. It was shown that the concentrations of copper and zinc in CSF remain constant during childhood.--2. No increase could be found in the concentrations of copper and zinc in CSF caused by the neurological diseases of our patients. These data suggest that permanent cerebral lesions as a consequence of shortlasting seizures and viral meningitis would be very unlikely and that a transient dysfunction of metabolism does not liberate copper- and zinc-metallo-proteins in CSF. 3. There was no correlation between the protein concentration in CSF and copper and zinc concentrations in CSF.


Expression of TEM-induced damage to postmeiotic stages of spermatogenesis of the mouse during early embryogenesis. II. Cytological investigations. After treatment of postmeiotic stages of spermatogenesis of the mouse with TEM (0.2 or 0.4 mg/kg), dose- and stage-of-spermatogenesis-dependent frequencies of cytogenetic aberrations can be observed in early embryos. The frequencies of first-cleavage metaphases exhibiting structural aberrations (all of the chromosome type), the frequencies of 2 cell embryos and of 4--8 cell embryos containing nuclei accompanied by micronuclei or nuclei connected by bridges show a close correlation to frequencies of preimplantation loss of embryos recorded in a dominant lethal test. The frequencies of morulae/blastulae exhibiting blastomeres with micronuclei show a close correlation to the frequencies of total (pre- and post-implantation) loss of embryos. This indicates delayed expression of TEM-induced chromosomal damage which could persist undetected in very early stages of embryogenesis.


Effect of continuous gamma-radiation on the stem and differentiating spermatogonia of the adult rat. Sprague-Dawley rats were irradiated continuously (60Co, gamma) at a dose-rate of either 1 (0.0007 rad/min), 3 or 6 rad/23-h day for monthly intervals of 1 to 6. At one month after irradiation, counts of differentiating spermatogonia (A1 and A4) were reduced to a level that remained essentially unchanged during the succeeding 5 months of irradiation. The magnitude of the irradiation effect was greatest at stage 1 of the spermatogenic cycle where numbers of differentiating spermatogonia were reduced to 50% of control by 1 rad/day and to 30 and 20% of control by 3 and 6 rad/day, respectively. Number of stem spermatogonia was not significantly affected by 1 rad/day (P greater than 0.10). At 3 and 6 rad, however, number of stem cells declined from 80% of control at 1 month to 60 and 40% of control at 6 months, respectively. At a dose-rate of 1 rad/day there was neither a reduction in number of A1 spermatogonia per clone nor significant evidence of necrosis among either stem or differentiating spermatogonia; therefore, a reduction of stem-cell mitotic activity appears to be the principal effect of continuous low-level irradiation on spermatogenesis in the rat.


Fungi in libraries: an aerometric survey. The possible role of fungi as allergic contaminants in book collections has been investigated in eleven University of Michigan Libraries. Air in the stacks of each of the eleven libraries was sampled on three occasions (2 or 4--10 minute samples on each occasion) with Andersen Volumetric viable particle samplers. Books were handled during sampling in half the samples each day. In addition on each sampling day a location in the same building away from book storage and an outdoor location were sampled. Library spore levels were generally low. Outdoor levels consistently exceeded indoor levels. Air conditioned (AC) libraries had lower spore levels and indoor/outdoor ratios than conventionally ventilated (CV) libraries. Handling books during sampling increased spore counts in all libraries, but strikingly in CV libraries. Fungus taxa recovered were similar to those encountered in domestic interiors and outside locations in our area. The overall low spore levels and lack of a distinctive library mycoflora suggest that other sources should be sought for library-based respiratory symptoms.


The dysgonic strain of Microsporum canis. The dysgonic strain of Microsporum canis is described. The colony consists of fascicles of very wide hyphae with short compartments and close branching. Lateral branches often themselves remain short and fail to branch, and many are reflexive, growing in the opposite direction to the parent hypha. Mycelium of three types was noted, dysgonic, apparently normal, and forms intermediate between the two. Change from one form to another occurred in a cyclial manner, the transition from dysgonic to apparently normal being abrupt while that in the reverse direction was gradual. The strain was extremely unstable, both in primary isolations from cats and in subculture. Numerous sectors of other readily recognisable strains were produced, including the typical M. canis and various atypical strains previously obtained from human sources. These strains rapidly submerged their parent colonies and were much more likely to be obtained by subculture from a primary isolation plate than was the dysgonic strain itself. The relationships of the various strains to each other in the saprophytic and parasitic phases are discussed.


Subcutaneous cystic granuloma caused by Phialophora verrucosa. A case of subcutaneous cystic granuloma caused by Phialophora verrucosa was reported. The patient was 21-year-old Japanese female with systemic lupus erythematosus (SLE) who had received prolonged steroid therapy. P. verrucosa has occasionally been isolated from patients as one of etiological agents of chromomycosis. There have been, however, no paper published to report an isolation of this fungus from subcutaneous cyst or abscess of a patient. This case is the first report of subcutaneous cystic granuloma induced clinically by P. verrucosa.


Coccidioides immitis endospores: phagocytosis by human cells. Phagocytosis of killed endospores by glass adherent peripheral human mononuclear cells was studied. Phagocytosis continued through 30 minutes of incubation. No difference in rates of ingestion could be detected when cells from coccidioidin-reactive and nonreactive subjects were compared although both groups ingested endospores more avidly than latex particles.


Microsporum racemosum. Second clinical isolation from the United States and the Chicago area. The second clinical isolant in the United States and the Chicago area of the dermatophyte Microsporum racemosum has been made. The circinate macropapular lesion was on the dorsum of the right hand. It was vesicular with an erythematous border, was pruritic and developed rapidly to 5 cm in diameter. Within 48 hrs of the institution of systemic griseofulvin therapy and topical Burow's solution (1:20) symptoms subsided. Both this patient and the one reported by Daum and McCloud (4) live on the mid-northwest side of Chicago. So far the fungus has not been isolated from soil in the area.


[Organochlorine insecticide residues in tobacco and tobacco products. 1. Analytical method]. An analysis method for quantitative serial estimation of organochlorine insecticide residues in tobacco is reported. This method is based on an hexane extraction followed by column chromatographic clean-up and preseparation as well as qualitative and quantitative gas chromatographic analysis. The following 16 substances are analyzed: HCB, alpha-HCH, lindane, heptachlor, aldrin, heptachlor epoxide, o,p'-DDE, p,p'-DDE, O,P'-TDE, p,p'-TDE, o,p'-DDT, dieldrin, endosulfan, beta-endosulfan and endosulfan sulfate. In a sample of 5 g of tobacco there can be detected: HCB, alpha-HCH, lindane, heptachlor, aldrin, heptachlor epoxide--o,oo1 ppm; o,p'-DDE, p,p'-DDE, dieldrin--o,oo3 ppm; o,p'-TDE, p,p'-TDE-- o,o1 ppm; o,p'-DDT, alpha-endosulfan, beta-endosulfan--o,o2 ppm; endosulfan sulfate--o,o3 ppm; p,p-DDT--o,o5 ppm.


[Organochlorine insecticide residues in tobacco and tobacco products. 2. Residue levels in raw tobaccos used in the DDR]. The levels of insecticide residues in GDR and imported leaf tobaccos are reported. With our analysis method 16 chlorinated hydrocarbons can be analyzed. No DDT was found in tobaccos from the People's Republic of Corea. The mean DDT level of tobaccos from Hungary was lower than 0,1 ppm, the possibly value of the future tolerance. With few exceptions samples of other countries contained less than 1 ppm of the total DDT-group. Only a cigar tobacco from Paraguay showed a very high residue level of 7,20 ppm. Except this sample the residue values are to be attributed to the DDT persistence in soil and the relatively high intake by tobacco, since with the exception of few countries no DDT is anymore used with tobacco. The lindane concentration was very low in all tabaccos. In some tobaccos traces or only very small quantities of other organochlorine residues were detected.


[Determination of trace elements in dietary fats and emulsifiers by flameless atomic absorption spectrophotometry. 1. Determination of the ionogenically bound heavy metals copper, iron, nickel, zinc, lead and cadmium in dietary fats]. The knowledge of the trace metal contents in dietary fats is of considerable interest from the viewpoints of food hygiene and and storage stability. In the framework of the present paper, it is dealt with the determination of the ionogenically bound heavy metals copper, iron, nickel, zinc, lead and cadmium by means of flameless atomic absorption spectrometry (AAS). Problems related to trace analysis in dietary fats are discussed. Problem-oriented surveys in the form of tables inform about:--analytical conditions of the AAS technique,--metal contents as compared to data with the approved standard method,--contents of the ionogenically bound toxic trace elements cadmium, zinc and lead in samples of various dietary fats currently used in the German Democratic Republic.


[Uptake of utilizable food energy by light-weight and heavy-weight rats fed a low-fat or high-fat diet]. The uptake of utilizable dietary energy (DE) as affected by diet (containing 3 or 50% (w/w)fat), body mass (BM) and age was investigated in male Wistar rats. In comparing heavy-weight animals fed the high-fat diet (HFD) with light-weight animals fed the low-fat diet (LFD) (differences in BM up to 60%), it was found that the uptakes of DE calculated on animal were significantly higher (up to 55%) in the HFD animals than in the LFD animals; but there were no significant differences when the uptakes of DE were calculated on 100 g BM. Thus, the LFD rats (the diet of which contained a high proportion of protein (70% (w/w)) exhibited no reduced uptakes of utilizable DE as compared to HFD rats. Of the heavy-weight LFD animals and the light-weight HFD animals which showed virtually no differences in BM, the HFD animals take up more utilizable DE (per animal or per 100 g BM) than the LFD animals. This difference, which amounts to 60%, is statistically significant. The comparison of the uptakes of DE/animal/100 g BM by light-weight rats with those by heavy-weight rats fed the same diet showed that the uptakes by the heavy-weight animals were in most cases significantly greater. Consequently, the greater BM of the heavy-weight animals of the respective diet groups must be attributed to more efficient utilization of feed. This is also indicated by the fact that the light-weight HFD animals excret more fat in the faeces than the heavy-weight animals. The amount of fat excreted by the HFD animals  is some 10-fold greater than that excreted by the LFD animals. However, when the amount of excreted fat is expressed in % of ingested dietary fat, the fat excretion is of the same order of magnitude on both diets.


Folding and association of oligomeric enzymes. The spontaneous structure formation of oligomeric enzymes consists of the consecutive 'folding' and association of the constituent polypeptide chains. Whether catalytic function is an intrinsic property of the folded monomers may be determined using kinetic reconstitution experiments. It is shown that full activity requires association; the correct assembly of subunits depends on their proper folding. The native structure is determined as the kinetically accessible state of lowest free energy.


Chemical structure and biological activities of lipid A's from various bacterial families. The endotoxic principle of lipopolysaccharides (LPS) is localized in their lipid A component. Biological effects of LPS on, for instance, body temperature, blood pressure, and blood picture, are also induced by free lipid A. In contrast to the great variability of the 0-specific chains, the chemical structure of lipid A is much more constant. It is common for Salmonella and similar for other genera of the Enterobacteriaceae. Recently, a number of lipid A's have been recognized that exhibited distinct structural features compared with Enterobacteriaceae. These lipid A's were found to be also distinct with regard to some of their biological properties.


[C13/C12 Ratios in human urinary calculi]. Oxalate, uric acid, and phosphate stones have been analyzed for their carbon isotope composition. The oxalate stones show delta13C values between -17.0 and -19.5%, the uric acid stones between -14.9 and -19.4%, and the phosphate stones between -13.0 and -23.9%. It is proposed that endogenic rather than exogenic sources are responsible for the 13C/12C ratios of the stones. The isotopic composition of the phosphate stones seems to be influenced primarily by bacterial activity.


Release of noradrenaline by labetalol in the rat anococcygeus muscle. The effects of labetalol on the accumulation and spontaneous release of (--)-[3H]noradrenaline, and on contractile responses to exogenously applied (--)-noradrenaline were studied in the isolated anococcygeus muscle of the rat. 1. Labetalol (3 x 10(-7)--10(-4)M) inhibited the accumulation of (--)-[3H]noradrenaline. 2. Labetalol (10(-6)--10(-4)M) and guanethidine (6 x 10(-6) M) increased the spontaneous release of [3H] following incubation of the muscle with (--)-[3H]noradrenaline. Nortriptyline (10(-6) M) had no effect on the spontaneous release of [3H], antagonised the increased release of [3H] produced by 6 x 10(-6) M guanethidine but not that observed with 10(-5) M labetalol. Labetalol (5 x 10(-6) M) markedly increased the loss of tritiated deminated metabolites with little change in the loss of (--)-[3H]noradrenaline. 3. Labetalol (10(-7)--10(-5)M), alone or in the presence of 10(-6) M nortriptyline, had no effect on contractile responses to (--)-noradrenaline. 4. Following pretreatment with 6-hydroxydopamine (10(-3)M for 3 h) to deplete endogenous noradrenaline stores, labetalol (10(-7)--10(-5) M) inhibited responses to exogenously applied (--)-noradrenaline. 5. These results suggest that, in the rat anococcygeus muscle, labetalol is a noradrenaline releasing agent and an alpha-adrenoceptor antogonist.


Tetrahydronorharmane (tetrahydro-beta-carboline), a physiologically occurring compound of indole metabolism. In the present paper a sensitive method is described to measure tetrahydronorharmane (THN) in the urine of man and rats as well as in the forebrain of rats. The compound is extracted into diethyl ether, separated by thin layer chromatography (TLC), acetylated with radiolabelled acetic anhydride and further isolated by two-dimensional TLC development. The existence of THN in urine of man was proven by using chromatography with different solvent systems, cocristallisation, isotope dilution technique as well as mass-spectrometry. The amount of THN in the urine varied over a wide range. With the same method it was demonstrated that THN occurs also in the forebrain of rats. The concentration increases after loading with tryptamine. The findings are discussed in view of the hypothesis that THN acts as a compound modulating neuronal mechanism.


The effect of papaverine on local tissue PO2 and microflow in cat brain cortex. The effect of intracarotid and intravenous administration of papaverine on local tissue PO2 and  microflow in the cat's brain surface was studied. Local tissue PO2 was measured with a multiwire surface electrode polarographically, and microflow by local hydrogen clearance method. The intracarotid infusions were made for 1, 2 and 5 min with doses of 0.1, 0.2 and 0.5 mg/kg/min papaverine, and the intravenous ones for 5 min with doses of 0.2, 0.5 and 1 mg/kg/min. The  continuous intracarotid infusions showed that papaverine in the doses used distinctly increased local tissue PO2 and microcirculation of the brain surface. With the doses applied, systemic arterial pressure (SAP) changed little. It slightly decreased only during the 5 min infusions containing 0.5 mg/kg/min. The duration of the effect increased with increases in the duration of the infusion and of the dose. The maximum duration was observed with 5 min infusions and lasted for 10--15 min after drug administration was discontinued. During the i.v. infusions, tissue PO2 and microflow rose less than with intracarotid ones. No redistribution of capillary flow was observed.


Homotaurine and muscimol mimic taurine and GABA effects on muscle tone and temperature regulation. Taurine, homotaurine, GABA and muscimol, given intraventricularly to the conscious, unrestrained  rabbit cause hypothermia and a reduction in skeletal muscle tone. Taurine and homotaurine desynchronize areas of the motor and limbic cortices, with GABA and muscimol synchronize both tracings and markedly depress the arousal reaction following external stimuli.


Metabolism of phenacetin and N-hydroxyphenacetin in isolated rat hepatocytes. The fate of phenacetin and some of tis metabolites have been examined in isolated rat hepatocytes. The overall pattern of metabolism was similar to that found in vivo by others. The major metabolites of phenacetin were paracetamol, free and conjugated, and phenetidine, and about 10% was lost. No N-hydroxyphenacetin was found, but experiments with N-hydroxyphenacetin as substrate showed that at low concentration (as might be formed from phenacetin) it disappeared very rapidly from cell suspensions. N-hydroxyphenacetin was metabolized to its conjugates, and to paracetamol, phenacetin and phenetidine, with a large proportion unaccounted for. With all substrates, increasing concentration resulted in a decreased percentage being metabolized, indicating that the metabolic pathways were saturable. Relatively more phenetidine was found at high phenacetin concentrations, however, apparently because phenetidine is an intermediate metabolite whose own elimination was slowed relatively more than its formation. N-hydroxylated arylamines were toxic to hepatocytes in a dose-dependent manner, suggesting that these cell suspensions could be used to test for hepatotoxicity.


Chemotactic effects of the complement-derived peptides C3a, C3ai and C5a (classical anaphylatoxin) on rabbit and guinea-pig polymorphonuclear leukocytes. The complement-derived peptides C3a, C3ai and C5a (= classical anaphylatoxin) were purified from hog serum and examined for chemotactic activity on rabbit and guinea-pig polymorphonuclear leukocytes (PMN) with the Boyden chamber technique (with filters of 3,0 micrometer pore size). When media containing albumin or serum were used all peptides induced chemotaxis of both cell species. Only C3a showed a pronounced species dependence in that it was much more active on rabbit than on guinea-pig PMN. No gross differences were found between the influence of 0.5% BSA and 10% heated (56 degree, 30 min) homologous serum added to the medium. In the absence of protein chemotaxis did not occur.


Crude substance P from brain contains a cholecystokinin-like peptide. The subfractions Fa, Fb, and Fc of crude substance P (SP) preparations made from human and bovine brains were analysed for SP and the COOH-terminal octapeptide of cholecystokinin (CCK-8). The  methods were specific radioimmunoassays (RIAs) for SP and CCK-8, and bioassays on isolated organs of the guinea pig: the ileum, the gallbladder and the field-stimulated vas deferens. 1. In bioassays of synthetic peptides the vas deferens reacted specifically to SP and the gallbladder to CCK-8. 2. RIAs and bioassays revealed unequivocally that most of SP-like activity was present in Fb, while Fc contained mainly CCK-8-like activity. Varying results were obtained with Fa. 3. The pharmacologically active principle of Fc is CCK-8 or a closely related peptide. Earlier results concerning the pharmacological and neurochemical properties of Fc must be ascribed to this peptide.


[Intracrânial venous sinus thrombosis (22 cases) (author's transl)]. The authors report 22 cases of intracranial venous sinus thrombosis and study what is new about that old pathology. Sagittal superior sinus is still the most touched one, followed by the lateral sinuses. Half of the cases are traumatic: their clinical picture consists either of benign intracranial hypertension, either of intracranial hypertension and neurological signs. Puerperal thrombosis of the sinuses have quite disappeared and have been replaced by thrombosis in women taking oestro-progestional agents, whose clinical picture is absolutely the same. Infectious thrombophlebitis are quite less frequent than intracranial abcesses, whose diagnosis must be made first. About diagnosis, the certitude is still given by bilateral carotid arteriography which demonstrates the thrombosed sinus, whereas cerebral scintigraphy shows whether their is an adjacent infarction of venous origin or not. Treatment is a medical one. It consists rather of methods to reduce cerebral volum, aiming at maximal use of collateral varices. Heparin should be used only if there is no cerebral infarction of venous origin. Total mortality is 27% and among survivals there are few sequels. Prognosis depends on the thrombosed sinus, on the rapidity for clinical signs to appear and especially on the anastomotic venous collateral ability demonstrated by carotid angiography.


[Radio-anatomical study of the main trunk of the middle cerebral artery (author's transl)]. This work corroborates anatomical data well known since G. Lazorthes about the main trunk of the middle cerebral artery. The data are interesting in various fields: Sylvian aneurysms, big sphenoïd ridge meningiomas, extra-intra cranial micro neurosurgical anastomoses. This work is based upon 280 angiographic pictures, 20 dissections of brain arteries and 12 plastic injections of the brain arterial vascular tree. The most important data to point out are variations of length and of division (no division, simple bifurcation, trifurcation or multiple divisions), variability in the central arteries and some rare anomalies like accessory middle cerebral arteries and duplication.


[The pseudo-vascular syndrome of intracrânial metastases (author's transl)]. Our statistic consist of 162 cases of metastatic tumors of the brain (M.T.B.), of which 120 verified under surgery or at autopsy, and 42 diagnosed in the pre-operative phase and not undergone surgery. The pseudo-vascular form has been found in 58 cases (36%). If we only consider the supratentorial localizations, this percentage rises to 43,5%. This onset of symptomatology is quite predominant in males (52 cases 42%) compared to females (6 cases: 16%). The MTBs that in our statistics produce a greater frequence of pseudo-vascular forms are the MTBs of melanomas (66%), those of unknown origin (42%) and those of pulmonary origin (35%). These neoplasms are distinctly more frequent in males. On the contrary the mammary metastases responsible for most of the female MTBs originate to a pseudo-vascular form in only 22% of the cases. The etio-pathogenetic mechanism is double; it may be the manifestation either of arterial occlusion by neoplastic cells (embolia neoplastica attiva) or of disruption of the vascular wall and hemorrhage. As far as the diagnosis is concerned this syndrome can be quite easily recognised only when an extraneuraxial tumor is found, especially with a marked neuraxial tropism.


[Doppler ultrasound diagnosis of extracrânial carotid stenoses (author's transl)]. Percutaneous measurements by Doppler ultrasound techniques over the supratrochlear, supraorbital and common carotid arteries may detect the presence of a stenosis in the internal carotid artery between the bifurction and the branching of ophthalmic artery. Out of 200 patients examined by Doppler ultrasound 60 patients underwent carotid angiography and the angiographic data were compared with the noninvasive results. The diagnostic accuracy was 85% in cases with stenoses greater than 50% and occlusions; in cases with stenoses of greater than 50% it was 78%. Occlusions could always be verified. Doppler ultrasound is very valuable for follow-up examinations after reconstructive procedures of the internal carotid artery. In 30 patients we were able to objectively document the normalisation of circulation in successfully operated cases by pre- and post-operative examinations.


[Levels of axial lesion in severe head injuries (author's transl)]. Over the past few years considerable amount of clinical syndromes describing brain stem levels of lesion were reported. This work was undertaken to establish, if possible, a simplification of criterions of axial lesions in head injuries. 125 patients with severe head injuries were strictly selected. Statistical analysis of careful examination of clinical pattern was performed and correlated, when possible, with anatomical lesions. Only four homogeneous groups were isolated:--group I represents the cortico-sub-cortical level,--group II représents the diencéphalie level,--group III represents the upper brain stem level with two subdivisions dependent upon the mechanism of herniation : central or uncus,--group IV represents the lower brain stem level.


[The value of the study of brain stem reflexes in coma (author's transl)]. A better clinical assessment of the comatose state is obtained by the study of brain stem reflexes. Systematic research of the fronto orbicular, pupillar, corneal, masseteric, vestibulo-ocular, oculo-cardiac, palmo-mental and cornéo mandibular reflexes has enabled characterization of functional levels. Degree of comatose stade and other usual physical symptoms have been correlated. Hence brain stem injury and course is followed in acute coma. Six functional levels permit assessment of cranio-caudal disintegration of brain stem functions. According to our opinion, diencéphalo-mesencephalic level is of bad prognosis in the course of follow-up.


[Traumatic quadriplegia and vertebral thrombosis (author's transl)]. The case of traumatic thrombosis of the vertebral artery in a 14 year old boy with quadriplegia is related. They were neither spinal fracture nor blockage at the Queckenstedt test and the spinal fluid was normal. The clinical recovery was poor but a partial revascularisation of the thrombosed vessel was observed. Physiopathological, clinical and therapeutic aspects of the traumatic thrombosis of the vertebral arteries and also literature data are under consideration.


[Angioscintigraphy of the aortic arch and the origin of the cerebral vessels in cerebro-vascular diseases (author's transl)]. Gamma-angioscintigraphy of the cerebral vessels starting from the aortic arch localises better the level of an eventual vascular lesion preventing a "false positive" aspect, possible by the usual technique as in the case reported. By starting the examination at the level of the aortic arch or by the use of a diverging collimator it is easy to decide of the necessity of an angiographic study, simple carotidography or angiography of the aortic arch and its branches.


[Relationship between the afferent artery and the site of neck of anterior communicating artery aneurysm, and hemodynamics in the anterior part of the circle of Willis (author's transl)]. Of 346 patients with direct intracranial surgery for an aneurysm of anterior communicating artery that we have experienced from June 1961 to September 1975, 213 patients having sufficient data were selected to study a relationship between hypoplasia of the A1 of the anterior communicating artery, and sites of an afferent artery and a neck of an aneurysm. 1. Ninety seven of 182 patients who had had the bilateral angiography before surgery had hypoplasia of the right A1, 90 of which (92%) had an afferent artery of an aneurysm only in the left A1. All 29 patients with hypoplasia of the left A1 had an afferent artery of an aneurysm only in the right A1. An afferent artery was limited to the dominant A1 in about 95% of them. 2. Angiography revealed that of 204 patients in whom the neck of an aneurysm in the anterior communicating artery was confirmed, 140 patients had hypoplasia of a unilateral A1. The neck of an aneurysm was located at the bifurcation of the dominant A1 and the anterior communicating artery in 48 of the 140 patient (34.3%), at the bifurcation of the non-dominant A1 and the anterior communicating artery in 14 patients (10.0%), and in the anterior communicating artery itself in 78 patients (55.7%). Cerebral angiography revealed that the neck of an aneurysm was more than 3 times greater at the bifurcation of the dominant A1 and the anterior communicating artery than at the bifurcation of the non-dominant A1 and the anterior communicating artery. 3. The above findings suggest that hemodynamics in the anterior part of the circle of Willis may participate in the initiation, growth, and rupture of an aneurysm of the anterior communicating artery.


[The fine structure of cell processes in astrocytoma (author's transl)]. Astrocytes, in normal tissue, may be characterized by their extensive processes which may be cylindrical in part but are sheet-like at their periphery where they serve to cover other structures. It becomes of interest ot determine the morphology of astrocytic processes after neoplastic transformation. We, therefore, examined the fine structure of 14 cases of astrocytomas. In general the fine structure of the cell bodies and the interior of the processes are fundamentally similar to those of normal or developing astrocytes. Differences are apparent at the cell periphery. These include less well developed cell junctions and usually only poorly formed peripheral expansions of the processes. Most sections through the processes appear round or oval rather than laminar in normal astrocytes. They often consist of small microvilli or pseudopodia-like protrusions. Whether these changes are due to the immaturity of the cell or to the lack of appropriate nearby target cells is not known.