Multiple forms of dextran-binding proteins from Streptococcus mutans. We have isolated a series of five proteins which appear to possess characteristic individual capacities for synthesizing dextrans and binding dextrans. Our suggestion that these proteins comprise an isozyme-like distribution of lectin and enzyme activities is, of course, very speculative and remains to be rigourously confirmed. However, the very identification of these several dextran binding proteins provides a biochemical basis to explain numerous observations suggesting that more than one mechanism for dextran binding is possessed by S. mutans (for instance: 24-27), especially the observations with mutants (24). These proteins probably are the molecular determinants of host infection by S. mutans and may prove to be potent immunogens for use in a vaccine. The presence of a dextran-binding lectin in S. mutans implicates this bacterial lectin in the earliest stage of infection: Attachment to host tissues. The multiplicity of proteins possessing characteristic dextran-synthesizing and dextran-binding capacities indicates the complexity of the adherence mechanisms evolved in S. mutans. Experiments with other bacteria (10-12, 28) suggest that bacterial lectins, in concert with host tissue carbohydrates, may be the molecular mediators of host recognition and subsequent initial attachment of bacterial cells to host tissues in non-pathogenic as well as pathogenic bacteria.


Dextran receptors as immunogens in caries prophylaxis. 1) Immunization of rats with dextran receptors appears to confer resistance to development of caries. 2) A significant negative correlation between antiserum titers and caries scores is observed in immunized rats. 3) Antiserum specific for dextran receptors does not inhibit in vitro adherence of live bacteria in sucrose supplemented media. 4) Free receptors can bind to dextran, thereby inhibiting its ability to induce bacterial agglutination.


Salivary immunoglobulins in diseases affecting salivary glands. Inflammatory disorders of the salivary glands cause marked abnormalities in secretion of immunoglobulins. The changes are reversible, however, in a relatively short period of time. More subtle changes in immunoglobulin transport are present in such diseases as Sjogren's syndrome and diabetes. No changes are discernable in alcoholic cirrhosis. Apparently salivary gland basement membranes are much more resistant to derangement than plasma membranes and the secretory IgA system can continue to operate in the face of numerous affronts. If nothing else these findings suggest that vaccination procedures in the region of the salivary glands may produce an inflammatory response, but it would be readily reversible. In addition, one could anticipate a functioning s-IgA system even in salivary glands with alterations in electrolyte transport. It is difficult to anticipate the situation in immunologically compromised patients, such as those on hemodialysis. Fortunately these patients represent a small population and for them at least, caries is a relatively minor concern.


Whole saliva proteases: development of methods for determination of origins. 1) Recognition and characterization of protease activities present in saliva by PAGE examination of substrate protein cleavage patterns appears possible. 2) BSA proteolysis by whole saliva is not due to activities present in the major gland secretions and may be due, in part, to the oral microflora.


Extrachromosomal gene systems in Streptococcus mutans. 1) Four of 86 S. mutans strains of human origin harbor a 3.6 Mdal multicopy plasmid while 2 of 13 strains of rat origin carry multiple copies of a 2.3 Mdal and 2.5 Mdal plasmid. 2) There is no evidence to support that any of these plasmids confers clinically or ecologically important phenotypes. 3) The restriction endonucleases Hind III and Bam HI cleave the 3.6 Mdal plasmid once, thus facilitating the use of this extrachromosomal element in gene cloning systems.


Bacterial adherence related to agglutination and surface film formation. 1) Film formation on glass and enamel surfaces tended to reduce the sorption of streptococci to these surfaces. When solutes with affinities for the test bacteria were used to produce the surface film, bacterial sorption to that surface was greater than to surfaces coated by indifferent solutes. 2) Streptococci in small aggregates sorbed to glass and enamel in numbers comparable to, of greater than, unaggregated cells. When the test suspension showed visible clumping, sorption was markedly impaired.


Chronobiologic optimization of aging.

Chronobiologic optimization of aging. Chronobiologic facts, concepts and methods are relevant to gerontology and geriatrics. Circadian and other rhythms are prominent sources of predictable variation requiring a reassessment of the "normal range" at all ages. Changes in the characteristics (e.g., the amplitude) of these rhythms during aging emphasize the need for careful evaluation of time dependency in research and clinical practice. Manipulation of periodic environmental factors that synchronize circadian rhythms can affect lifespans in plants and animals, further supporting the suggestion of an interaction between rhythms and senescence.


Neurologic complications of thyroid dysfunction. Until such time as results of more rigorous studies are available, the morbidity rates for thyroid dysfunction cited here must suffice. The 1955 to 1956 outpatient "incidence" for England and Wales was 1.1 per 1,000 for thyrotoxicosis and 1.7 per 1,000 for myxedema (18). United States in-patient "incidence" for 1971 was 0.16 per 1,000 for thyrotoxicosis and 0.13 per 1,000 for myxedema (25). The 1935 to 1967 average annual incidence of Graves' disease for females in Olmsted County, Minnesota, was 30.5 per 100,000 (10). Well over 50% of hyperthyroid patients have clinical evidence of mild or moderate muscle weakness. Usually this weakness is proximal, and electro-myography and muscle biopsy confirm the existence of myopathic process (Table 11). Severe muscular weakness of acute onset is relatively rare and is encountered in approximately 1% of hyperthyroid patients (11,17,40). Ophthalmoplegia and psychosis are reported 4% and 2% of patients, respectively (17). Myasthenia gravis, although well publicized, is estimated to occur in less than 1% of patients (3,30). TPP is virtually nonexistent in the West; in the Orient it is reported in 2 to 8% of hyperthyroid patients and is 20 to 60 times more frequent in the hyperthyroid male than in the hyperthyroid female (Table 12). The neurologic symptomatology of myxedema is more extensive, and agreement among the various series is poor. The only unselected series addressing itself to neuromuscular manifestations of myxedema that is suitable for citation is that of Scarpalezos et al. (36). This comprehensive study was done without apparent patient selection, and it reported 2% of patients with definite carpal tunnel syndrome, 6% with myopathy, and 18% with polyneuropathy (Table 13). Reported percentages of hypothyroid patients found to have neurologic manifestations of cerebellar dysfunction are extremely diverse: ataxic gait was reported in 5 to 32% (6,7,12,27) of patients and dysdiadochokinesia in 6 to 52% (7,12,27). Psychosis is encountered in 2 to 5% (6,14,17,27,39) of myxedematous patients, memory loss in 23 to 55% (6,14,27), and coma in less than 1% (27).


Prostaglandins: an overview.

Prostaglandins: an overview. Since their discovery more than 40 years ago, PGs have been shown to be present in many tissues. The 10 members of this family (PGA-PGI and TxA) that have been identified to date have been noted to have a wide variety of pharmacologic actions. Frequently, the actions of one PG are in direct opposition to those of another. This has led to the theory that PGs play an important role in maintaining homeostasis in many organ systems. Evidence accumulated indicates a major role for PGs in the regulation of blood pressure, the autonomic nervous system, blood flow and platelet aggregation. This is in addition to specific actions on other tissues such as the CNS and reproductive system. A summary of PG actions in humans is contained in Table 1. Unfortunately, the PGs have not been as useful therapeutically as originally hoped. Currently, they are being used to induce labor and to maintain the patency of the PDA. However, they still hold much promise and with the development of synthetic analogues and specific synthesis inhibitors, they should live up to this promise in the future.


Prostaglandins and gastrointestinal function. Much work has been done and much remains to be done in defining the role of the prostaglandins in the physiology and pathophysiology of the gastrointestinal tract. The following statements summarize the current knowledge of the prostaglandins in human gastrointestinal function: 1. Prostaglandins of the E type have been isolated from human gastrointestinal tissue. They are naturally occurring 20 carbon hydroxy fatty acids synthesized and degraded in the same intestinal tissue by a 15-prostaglandin dehydrogenase. 2. Prostaglandins E2 and PGF2alpha have opposing, dose-related effects on the lower esophageal sphincter and lower two thirds of the esophagus. Sphincter pressure is decreased and esophageal contractions are inhibited by PGE2, whereas sphincter pressure is increased and esophageal contractions are induced by PGF2alpha. 3. Basal and stimulated gastric acid secretion is inhibited by PGE and its methyl analogues, but not by PGF, in a dose-related, nonselective manner. Oral administration of PGE methyl analogues may be an effective mode of therapy in peptic ulcer disease. 4. The prostaglandins reduce absorption and induce secretion of electrolytes and water in the jejunum and ileum but not in the colon. This secretory effect has been implicated in certain pathologic conditions. 5. The prostaglandins appear to be vasodilators of the hepatic circulation. Prostaglandin E contracts the gall bladder, relaxes the sphincter of Oddi and inhibits isosmotic fluid transport. 6. Pancreatic secretion and insulin release are inhibited by the prostaglandins in vivo and secretion is stimulated in vitro. The actual role of the prostaglandins in insulin release is not known.


Stimulation of gastric acid secretion by dimaprit in unanesthetized rats. In unanesthetized rats, dimaprit and histamine given by intravenous infusion were about equipotent in stimulating gastric acid secretion. The maximal rate of acid secretion in response to dimaprit was significantly greater than to histamine but not significantly different from the response to pentagastrin.


Oxatomide protects Trichinella spiralis infected mice from lethal anaphylaxis. Infection with Trichinella spiralis in mice was accompanied by allergic sensitization as evidenced by anaphylactic death after intravenous injection of the antigen. Pre-treatment of the animals with oxatomide, a new orally active anti-allergic drug, resulted in significant protection of the animals; the lowest effective dose of the compound was 1.25 mg/kg orally. In contrast to cyproheptadine, oxatomide offered little protection against serotonin toxicity in mice. The present data suggest that, in this model of systemic hypersensitivity, the anti-anaphylactic effect of oxatomide can be attributed mainly to inhibition of release of allergic mediators.


Urinary kallikrein excretion and plasma DBH activity in hypertension. Many factors are to be considered in maintaining normal blood pressure. Authors study the behavior of urinary kallikrein (U.K.) and plasma dopamine-beta-hydroxylase (DBH) activity in various forms of hypertension. The values of U.K. excretion in normals were 20.5 +/- 1.8 E.U./24 h. In essential hypertensive patients (9.4 +/- 2.0 E.U./24 h) U.K. decreased, while in secondary hypertension it was significantly higher (33.8 +/- 3.0 E.U./24 h). Plasma DBH activity in essential hypertensive patients (17.72 +/- 2.33 I.U./ml) was similar to controls (20.22 +/- 1.39 I.U./ml); in secondary hypertension the mean values of plasma DBH were decreased (12.31 +/- 2.55 I.U./ml). No correlation between U.K. and plasma DBH activity was observed in normals and in various forms of hypertensive patients. U.K. seems a more reliable factor than plasma DBH in defining the different types of hypertension.


Relationship between oedema and plasma exudation in rat paw carrageenin inflammation. High (500 microgram) and low (100 microgram) doses of carrageenin produced different temporal extravasation of plasma protein when injected into the rat paw. High doses caused a continuous extravasation parallel to the oedema increase. With low doses, main exudation occurred during the first 2 h and was minimal when the oedema was maximal (4th hour). Pre-treatment with indomethacin (2 mg/kg/i.p.) was effective in reducing oedema and protein extravasation for both doses of carrageenin. Indomethacin given 2 h after carrageenin had no effect upon the oedema caused by the low doses, but was effective with the high doses of carrageenin. The anti-oedematogenic effect of a non-steroid anti-inflammatory agent, such as indomethacin, was related to its effect upon plasma exudation, i.e. the agent was effective when there was a correlation between increment of oedema and plasma extravasation. The continuously increased plasma extravasation indicated the continuous presence of an active damaging stimulus. Our results explain several apparently contradictory observations reported in the literature.


Carrageenan oedema in copper-deficient rats. Carrageenan-induced hind paw oedema has been studied in rats deprived of copper for different lengths of time. A common feature observed in normally fed and copper-deficient rats was the rise of serum copper levels occurring between 10 and 24 h after the injection of the irritant. After 1 month of copper-deficient diet no differences are seen in the oedema developed by controls and copper-deprived animals, while after 3 months the oedema developed by copper-deficient rats was significantly greater compared with the controls.


Effect of pulse dose cyclophosphamide on the anamnestic immune response in NZB/W mice. Mice exhibiting a spontaneous SLE-like lethal autoimmunity (female NZB/W hybrids) were given monthly doses of cyclophosphamide (CPA) 240 mg/kg p.o. starting at four months of age. Antibodies to DNA and sheep red blood cells (SRBC) were measured as well as general well being of the mice. The CPA-treated group demonstrated a marked increased in survival compared to the untreated controls with reduction of anti-DNA antibody levels but only a slight inhibition of the anamnestic response to SRBC immunization.


The effect of variation in perfusion pressure on the capillary blood flow (microflow) in the cerebral cortex of the isolated cat's head preparation. The results of the present experiments show that capillary blood flow in the cerebral cortex fluctuates, whether the cat's head is supplied by the animal's intact circulation or by an artificial circulation system. These variations in blood flow last about 5 to 15 min and range from about 10% below to 10% above the mean. When the perfusion pressure is gradually reduced from 140 mmHg to 60 mmHg, the cortical microflow and the electrical activity of the brain remain almost constant. However, a reduction in perfusion pressure of this magnitude causes a 75% fall in total blood flow through the isolated head.


The consumer of therapy in mental health. The current emphasis on consumer advocacy and accountability in health care has implications for the practice of occupational therapy in mental health. The consumer movement that gained national attention during the 1960s was marked by the passage in 1962 of a congressional bill that affirmed the consumer's right to safety, the right to be informed, the right to choose, and the right to be heard. These four rights, as well as the concept of client self-determination (seen as an additional right of the client to determine his or her own participation in the evaluation and treatment process), can be applied to occupational therapy practice. Occupational therapists must begin to address the aspects of accountability to the consumer by understanding both the concept and the principles of consumerism and the consequences of focusing on the patient or client as consumer. Therapists must then attempt to apply these principles to practice. Principles of consumerism can be incorporated into practice in clinical, administrative, and educational settings.


The interest check list: an empirical assessment. The empirical structure of the five a priori categories of the Neuropsychiatric Interest Check List was assessed by using factor analysis. Items from the Physical Sports and Cultural/Educational categories functioned as hypothesized, whereas those from the Manual Skills and Activities of Daily Living categories overlapped. Items comprising the Social Recreation category failed to cluster together in a meaningful way.


Relocation stress and the elderly.

Relocation stress and the elderly. The stress of relocation for an elderly person can lead to increased physical and psychological problems, serious illness, and even death. A number of factors have been identified that appear to contribute to this stress. Occupational therapists who work with the aged have the training and skills needed to modify many of these factors and thus minimize their potentially harmful impact. A review of the literature on relocation stress and the application of this information to occupational therapy is presented.


General systems theory: implications for theory and action in occupational therapy. This paper presents a description of the transformation of science under General Systems Theory, and the relationship of this transformation to the field of occupational therapy. Changes in scientific methods of proof and in scientific laws that underlie theory are discussed. The paper presents a scale for recognizing complexity in phenomena and for analyzing the appropriateness of theories designed to explain the phenomena. It also presents the theory of open systems as an alternative to mechanistic explanations of human behavior.


An unusual case of IgE myeloma.

An unusual case of IgE myeloma. A further case of IgE myeloma in a 65 year old woman was described. An unusual picture was found in the urine where two IgE fragments, namely an incomplete Fc fragment and an IgE specific Fab fragment were excreted. The clinical picture supports the suggestion that IgE myelomas are very heterogenous.


Regional deposition of inhaled 137 Cs-labeled monodisperse and polydisperse aluminosilicate aerosols in Syrian hamsters. Two groups of eighty Syrian hamsters were exposed to aerosols of 137Cs-labeled fused aluminosilicate particles. One group was exposed to a monodisperse aerosol with AMAD (activity median aerodynamic diameter) of 1.53 micron and sigma g (geometric standard deviation) of 1.15. The other group was exposed to a polydisperse aerosol with AMAD of 1.87 micron and sigma g of 1.46. After exposure, the hamsters were killed and carefully dissected and tissues were assayed for 137Cs to determine regional deposition of the inhaled aerosols. The relative lung deposition was similar for the two groups and was estimated as 9.5% of the inhaled aerosols. The right apical lobe consistently contained more activity and the right cardiac and right diaphragmatic lobes less activity on a per gram lung weight basis than the total lung.


Hydride generation atomic absorption spectrophotometry for determination of arsenic in hair. A modified hydride generation, atomic absorption spectrophotometric (AAS) method for the analysis of total arsenic in hair has been developed to evaluate occupational exposures to arsenic. Hair samples are processed by a multi-step cleaning procedure to remove all external arsenic contamination prior to digestion in a nitric-sulfuric acid mixture. The resulting solution is diluted to volume with distilled water and subsequently analyzed by arsine generation and AAS using an argon-hydrogen entrained air flame. Recovery data indicate that the method is quantitative for the determination of arsenic with a recovery of over 90% and a detection limit of 0.02 microgram.


Analysis of charcoal tube samples for carbon disulfide using a photoionization detector. A gas chromatograph equipped with a photoionization detector was used to detect carbon disulfide eluted from charcoal tubes with acetonitrile. Overall sampling and desorption efficiency for carbon disulfide was found to approach 100 percent when compared to a liquid impingement, colorimetric method. A relative standard deviation of 4.78 percent (sampling plus analysis) was observed when the method was applied to a synthetic test atmosphere of 10 parts per million carbon disulfide. Sensitivity of the proposed method will enable concentrations of 0.10 ppm CS2 to be determined in a 10 liter air sample. The photoionization detector offers several advantages over other detectors, namely ease of operation and greater sensitivity.


Laboratory evaluation of a recording respirable mass monitor. A laboratory evaluation was conducted of an impaction-beta detection recording respirable mass monitor (RRMM), a prototype of the commercial RDM-301 manufactured by GCA Corporation. Areas investigated were the effect of dust concentration, size distribution, and sampling time on the accuracy and precision of the RRMM instrument when compared with personal gravimetric samplers. Results showed a good linear correlation between 1 and 20 mg/m3. However, the RRMM underestimated the gravimetric concentration when a significant mass of submicrometer particles was present. A commercial RDM-301 was also tested, and a decrease in precision was observed with decreasing concentration for a set sample time.


Variable-cut particle-size classification by opposing jets. A new technique of aerodynamic particle-size classification has been developed utilizing axisymmetrically-opposed air jets. For a fixed geometry the cut size can be varied from 0.8 to 3.6 micrometer by changing the jet flow rates. Future designs are expected to extend the useful particle-size range. Particles remain airborne after size separation, permitting the use of continuous, automated methods for analyzing the particle concentration and chemical compositon.


Respiratory response of guinea pigs to ozone alone and with sulfur dioxide. This study was designed to utilize our guinea pig bioassay method for irritant response to address the question of whether or not ozone and sulfur dioxide appeared to react to form sulfuric acid in the respiratory tract. Animals were exposed to 0.2, 0.4, and 0.8 ppm of each gas alone and to the combination at concentrations of 0.4 and 0.8 ppm. In these experiments sulfur dioxide alone produced no statistically significant alterations in respiration. All concentrations of ozone produced an increase in respiratory frequency. At the two higher concentrations the increase in frequency was accompanied by a decrease in compliance. The response to the combinations was the same as the response to those levels of ozone alone. No sulfuric acid was detected in the chamber atmosphere. The biological data suggest that none was formed in the lung.


Levels and chemical composition of cotton gin dust. Dust levels were determined in the three principal work areas of five high-capacity, saw-type cotton gins processing spindle-picked cotton. Dust levels measured by the vertical elutriator, OSHA personal and stationary personal samplers averaged 0.66, 0.96 and 0.87 mg/m3, respectively. Gross chemical analyses of dust samples collected indicated that the composit0n of the dust was highly variable and different for the principal work areas within each gin -- 15 to 53% ash, 2 to 5% moisture, 8 to 18% protein, 19 to 55% cellulose and 8 to 16% water-extractable constituents. Major elements were silicon, potassium, aluminum, calcium and magnesium.


Respirator protection factors: Part I -- Development of an anthropometric test panel. Respirators are currently approved by testing them on a number of subjects without specifying facial sizes. Anthropometrically designed test panels were developed that represent the majority of the working population in terms of relevant facial measurements.


Evaluation of workers exposed to elemental mercury using quantitative tests of tremor and neuromuscular functions. Workers exposed to metallic mercury vapor were subjects for tremor, EMG, and psychomotor tests. Regression analysis revealed statistically significant trends in these test results related to workers' urine mercury histories. Effects were subclinical, functionally insignificant and most associated with those workers whose urine mercury had exceeded 0.5 mg/L in the previous year. In agreement with previous reports, effects were reversible upon reduction of mercury exposure.


Evaluation of a fluorescent dust tracer technique in cotton ginning. A technique employing a fluorescent tracer for following the break-up and dispersion of cotton trash has been developed. Senescent cotton leaves were treated with a fluorescent dye, pulverized to match the same particle size distribution as naturally occurring leaf in raw seed cotton and uniformly incorporated into the seed cotton mass prior to processing in a saw-type micro-gin. A control lot was similarly processed, excluding any dye. Airborne samples collected from the major fugitive dust emission points by standard techniques, macro trash samples collected from four locations, and the final condensed lint product clearly show that the use of such tracers is not only feasible but highly useful in determining the locations where respirable dust is emitted. From the fraction of labelled tracer material found at any site, the relative amounts of both total and respirable dust emissions of that plant component can be estimated from the known masses of dyed material added to a given mass of seed cotton. Estimates of the relative severity of fugitive dust emissions from various processing steps in a cotton gin are presented based on vertical elutriator, high volume and multistage cascade impactor sampler data.


Distinguishing between malignant and cirrhotic ascites by computerized step-wise discriminant functional analysis of its biochemistry. This study was designed to evaluate the ability of a specifically programmed computer to select those biochemical substances most capable of distinguishing "cirrhotic ascites" from "malignant ascites". After simultaneously performing selected biochemical and electrophoretic studies on fresh unstored serum and ascites of 23 patients with documented cirrhosis and 18 patients with proven malignancies, computerized step-wise discriminant analysis of the multiple input revealed that the serum-to-ascites LDH ratio was able to distinguish "cirrhotic ascites" from "malignant ascites" with greater than 86% accuracy. Assignment to proper groups was increased to 89% with the addition of the ratio to serum total protein-to-ascites total protein. The predictive value of a positive result was 100%; specificity was 100%; the predictive value of a negative result was 85%. This type of computer analysis also permits incorporation of both additional cases and new substances thus increasing predictability and reducing type II statistical errors.


Elevated serum amylase activity in the absence of clinical pancreatic or salivary gland disease: possible role of acute hypoxemia. Elevated serum amylase activity, in the absence of clinically apparent pancreatic or salivary gland disease, has been observed in many seemingly unrelated conditions. In a search for common etiological factors to account for hyperamylasemia in these conditions, a retrospective analysis was performed. Eighty-four episodes of hyperamylasemia (greater than 300 I.U./l. Phadebas method) occurring in 75 patients over a one-year period ending in June, 1975 were assigned to one of two groups. Group 1 consisted of 56 (67%) episodes of hyperamylasemia with clinical pancreatitis. Group 2 consisted of 28 (33%) episodes of hyperamylasemia in the absence of clinical pancreatitis. Hypoxemia (pO2 less than 75 mm. Hg.) was found in 9/15 patients in Group 2 who had arterial blood gases measured. To assess the possible relationship between acute hypoxemia and amylase activity, a prospective study was initiated. Patients with known causes of pancreatitis or renal failure were eliminated. Hyperamylasemia was found in 3/8 hypoxemic patients. This raises the possibility that acute hypoxemia alone or in combination with other factors may raise serum amylase activity, possibly through ischemic injury to the pancreas or salivary glands or other amylase containing tissues.


Intra-arterial tissue adhesives for medical splenectomy in dogs. Transcatheter intra-arterial tissue adhesives are effective agents for producing medical splenectomy in dogs. Because of the rapid polymerization of the tissue adhesive, localized occlusion of the splenic artery mimicking a surgical ligation can be achieved leaving the intrasplenic vessels patent. Splenic infarction without evidence of infection was accomplished.


Gastritis polyposa in a gastroenterostomy anastomosis. Review of the literature finds a strong point made for polyps of the stomach to be considered as "sentinels" of malignancy. The controversy over the transformation of gastric polyps into malignant tumors is coming to an end. Apparently, everyone agrees with a high incidence of malignant transformation in adenomatous polyps. The recent case report by Papp and Joseph of a hyperplastic polyp with malignant changes, seems to demonstrate that all polyps can undergo neoplastic transformation. We believe that every gastrectomized patient should be gastroscoped once a year, even with an absence of symptoms or lack of x-ray findings. Any polyp, adenomatous or hyperplastic, should be removed endoscopically and studied histopathologically for possible association with or development of carcinoma.


Choledochal cyst presenting as acute pancreatitis: evaluation with endoscopic retrograde cholangiopancreatography. A unusual case of choledochal cyst in an adult presenting as acute pancreatitis is described. Subsequent evaluation by ERCP revealed two atypical features, involvement of the cystic duct (proximal dilatation) and a long (six times normal) intrapancreatic common channel, which may be etiologically related to the pancreatitis.


Cholecystokinin cholecystography in the diagnosis of acalculous extrahepatic biliary tract disorders. Cholecystokinin cholecystography represents a study designed to identify patients with acalculous extrahepatic biliary tract disorders. In this study, a positive cholecystokinin cholecystogram (CCK-GB) was defined as both reproduction of the patient's biliary tract-type pain plus one or more of various roentgen abnormalities. Using these criteria, 20 patients had a positive CCK-GB. After failure of medical management, 19 of these patients came to surgery. Seventeen of 18 available for follow-up were cured of their biliary tract pain by surgery. Follow-up of this group of patients has ranged from one month to 60 months. In view of our findings plus those in other reported series, we conclude that CCK-GB provides a reliable study for the diagnosis of acalculous extrahepatic biliary tract disorders.


The clinical course of subacute hepatic necrosis. The clinical course is reported in 17 patients in whom the histological picture of subacute hepatic necrosis ("bridging hepatitis") was found on needle liver biopsy or at autopsy. The patients' ages ranged from 10-71 years, 12 patients being less than 40 years old. Ten patients were males. Jaundice lasted 2-4 months in nine cases and over six months in two, one of the latter having developed cirrhosis. In five patients a relapse of jaundice occurred within three months. Hepatitis B antigen was found in one of 13 patients tested. Two patients died in fulminant hepatic failure, one developed cirrhosis. These three patients and an additional two received prednisone therapy. Twelve of the remaining patients were followed for periods of 8-81 months; an additional two patients' follow-up was incomplete. None developed clinical evidence of chronic liver disease, and laboratory data at the last examination were normal except for slight elevation of alkaline phosphatase in six cases. Repeat biopsies showed persistent hepatitis in one case, slight portal fibrosis in one, cirrhosis in one and at autopsy in a patient who died of unrelated causes two years after hepatitis no evidence of chronic liver disease was found. This relatively good outome of subacute hepatic necrosis is probably due to the young average age of the patients, and the low incidence of B hepatitis in this series.


An epidemic of veno-occlusive disease of the liver in Afghanistan. Pathologic features. A large outbreak of veno-occlusive disease occurred in Afghanistan in which approximately 7,800 in a population of 35,000 subjects were estimated to have been affected. It was caused by consumption of wheat flour heavily contaminated with seeds of a plant of the heliotropium species. These were found to contain pyrrolizidine alkaloids, chiefly heliotrine. Fourteen percutaneous liver biopsies, representing different stages of diseases and liver tissue from eight autopsies were studied. Morphological changes in the liver were characteristic. Centrilobular hemorrhagic necrosis was followed by occlusive changes in the hepatic veins, finally resulting in nonportal cirrhosis. The sequence of changes observed suggests primary parenchymal injury and possibly obstructive lesions at the sinusoidal level. Collagenization of the sinusoids and reorganization of the lobular reticulin begin early in disease. Occlusive changes in the efferent veins apparently follow.


Sclerosing cholangitis associated with ulcerative colitis. Light and electron microscopy studies. The light and electron microscopy findings of liver biopsies from four patients with sclerosing cholangitis and ulcerative colitis are described. The main histologic feature was mesenchymal proliferation involving phagocytic, fibroblastic and immunocytic cells suggestive of an immunologic type of liver injury which may attack bile duct epithelial cells. Other histologic features, included the presence of myelin fibers in both hepatocytes and bile duct epithelial cells and an abundant amount of lysosome-like structures. The significance of these findings is discussed.


Angiography in chronic pancreatitis and pancreatic cancer. A critical evaluation. A critical "blind" evaluation of 129 randomly selected angiographic examinations was carried out including 37 control patients, 58 patients affected by proven chronic relapsing pancreatitis and 34 patients with cancer of the pancreas. In 48.5% of the control patients a completely normal angiographic picture was found. The false positives were found in 10.8% of chronic pancreatitis and in pancreatic carcinoma in 5.5% of the cases. Equivocal signs were found in 35.2%. The percentage of the false negative results in chronic pancreatitis was 34.4% (of which 8.6% were suggestive of pancreatic cancer). In pancreatic cancer positive results were seen in 70.6% of the cases. The percentage of the false negatives was 26.5% (suggestive of chronic pancreatitis); equivocal signs were found in 2.9% of these patients. Notwithstanding the not-negligible percentage of errors, angiography can be usefully employed in diagnosis of pancreatic disorders.


Blood kallikrein. Kinin system in acute pancreatitis. Three chief components of the kallikrein-kinin system (kallikrein, kininogen, kininase) were studied in the blood of 42 patients with acute pancreatitis. Significant increase in content of kallikrein, decrease in level of kininogen, and increase of kininase activity were observed. The highest values for kallikrein, kininogen and kininase activity were found in patients in whom acute pancreatitis was accompanied by hemodynamic changes.


Spontaneous external biliary fistula in a patient with heroin addiction. Spontaneous external biliary fistula, once common, is now a rare clinical entity. A patient with this lesion is described and attention is drawn to the fact that this rare condition is still being seen in certain patients with neglected cholecystitis. Heroin addiction was thought to have modified his response to gallbladder disease and contributed to the perforation. Diagnosis was suspected on physical examination and confirmed by spontaneous discharge of stones and fistulogram.


The transjugular route as an alternative to direct percutaneous needle biopsy of the liver. Transjugular liver biopsy was attempted in 32 cases of hepatocellular dysfunction with hemocoagulation disorders, ascites or marked obesity. A catheter was inserted in the right internal jugular vein and advanced into a hepatic vein under fluoroscopic control. A long needle was passed through the catheter and into the liver parenchyma for the biopsy. Diagnostic specimens were obtained in 28 instances (88%). The procedure was always well tolerated and no complications occurred. The transjugular approach offers a safe, practical alternative for liver biopsy in cases where direct percutaneous puncture is contraindicated.


Osteomalacia and celiac disease: response to 25-hydroxyvitamin D. In this 54 year old woman with celiac disease, osteomalacia developed while she was on a gluten-free diet which had caused regression of her steatorrhea. She was not responsive to large doses of parenterally administered dihydrotachysterol and calcium, but she was responsive to the oral administration of 25-hydroxyvitamin D3 (25-OHD3). The data suggest that 25-OHD3 is the treatment of choice for patients with vitamin D deficiency due to intestinal malabsorption.


Controlled oxygen administration in acute respiratory failure in chronic obstructive pulmonary disease: a reappraisal. Controlled oxygen therapy may aggravate carbon dioxide retention during acute exacerbations of chronic obstructive pulmonary disease (COPD). Of 50 consecutive patients with COPD and acute respiratory failure, 13 required intubation because of carbon dioxide narcosis. With discriminant analysis of their arterial oxygen tension (PaO2) and pH on admission, a diagram separated patients into those at high risk and those at low risk for carbon dioxide narcosis. This diagram was then used to predict carbon dioxide narcosis in 73 patients with COPD and acute respiratory failure who were treated with controlled oxygen. In 16 of these patients carbon dioxide narcosis developed. Thirteen (81 per cent) were predicted by the diagram to be at high risk for this complication. Only two (4 per cent) patients judged by the diagram to be at low risk for carbon dioxide narcosis required mechanical ventilation. Utilizing an oxygen tension (PO2), carbon dioxide tension (PCO2) diagram a patient's ventilatory response was compared to that of ambulatory patients with COPD. These data suggest that hypoxemia and acidosis are more discriminatory for "carbon dioxide narcosis" than hypercapnia.


Gallium scanning for the detection of abdominal abscesses. The use of gallium scanning for the diagnosis of abdominal abscesses was studied in 59 cases in which the diagnosis was verified by laparotomy or autopsy. In 23 of the cases the patients were subsequently found to have abdominal abscesses and 11 patients had abdominal malignancies. Excluding the latter group, the scan was specific for abscess in 86 per cent of the cases and sensitive for abscess in 67 per cent. Recent abdominal incisions, concurrent intestinal, hepatic, biliary and pancreatic inflammatory conditions, without abscess, seldom caused gallium accumulation. False-negative scans (18 per cent) occurred more frequently than false-positive scans (8 per cent) and were seen in patients with large (often palpable) masses of short evolution and with secondarily infected lesions such as hematomas and pseudocysts. The gallium scan was of little help in the search for abdominal lesions in patients with obscure febrile illnesses without abdominal symptoms or signs.


Recent experiences with nocardial infections. A review of Nocardia isolates at two Kansas City hospitals from 1968 to 1976 revealed isolates from 42 different patients. Data were available for analysis from 36 patients. According to strict criteria, only 17(47%) were infected. Infection increased from zero to one yearly from 1968 through 1973 to five and seven in 1974 and 1975, respectively. Commensal isolates varied from zero to five yearly with no recent increase. Analysis of underlying disease and predisposing factors suggests that bronchopulmonary abnormalities predispose to colonization but infection is unusual without immunosuppression. Primary nocardial infection without known underlying disease accounted for only 4 of the 17(24%) infections. Fever and leukocytosis were not helpful in distinguishing nocardial infection from colonization. A history of prior steroid use and a smear showing gram-positive filamentous organisms correlated highly with infection. Mortality correlated with pulmonary and brain involvement, prior use of steroids, and inappropriate therapy. Nosocomial infection was noted in five patients with a mortality of 60%. Overall mortality was only 29%.


Operant conditioning and assessment of stereopsis in young children. Stereposis was assessed in 94 children ages 2--5 yr using random-dot stereograms (RDSs) and operant conditioning. After five traditional screening tests of stereopsis, all children were trained to perform a match-to-sample discrimination task involving RDSs with and without lateral disparity. An added feature of the operant RDS task was the availability of monocular cue-fading for children who failed initial RDS testing. The operant RDS test facilitated stereopsis-based responding more than the traditional clinical tests did. This finding is interpreted as indicating the importance of such factors as attention, motivation, and language ability in the assessment of stereopsis in young children.


A retrospective comparison of functional renal failure in cirrhosis treated by conventional therapy or the peritoneo-venous shunt (LeVeen). Between 1973 to 1976, 12 ascitic cirrhotic patients with a mean plasma creatinine (pCr) of 4.4 +/- 3.0 mg/dl) were treated conservatively. During the same period 11 cirrhotics with ascites (pCr 4.3 +/- 2.8 mg/dl) were treated with LeVeen peritoneal jugular shunt. In the medically treated group mean survival was 2.4 +/- 2.7 weeks after detection of pCr elevation greater than 2.3 mg/dl. The 11 surgical patients with pCr elevation above 2.3 mg/dl survived a mean of 21.8 +/- 34.5 weeks after surgery. Four patients survived more than six months. The LeVeen shunt also resulted in significant weight loss, reduction in blood urea nitrogen (BUN), elevation of serum sodium, and increase of renal clearance of sodium. In appropriately selected patients it reverses the hepato-renal syndrome.


A polycarbonate ophthalmic-prescription lens series. Improvements in polycarbonate material, production techniques, and scratch-resistant coatings, combined with a process-oriented design, have resulted in a precision lens series. Surface quality is comparable to that of untreated glass ophthalmic lenses. The repeatability of the process results in closely controlled axial power and off-axis performance. For most lens prescriptions, the ANSI Z80.1 optical-center specifications for prescription accuracy are maintained through a total field of view of 40 deg for an 8-mm range of center-of-rotation distances. Off-axis astigmatism is controlled for near-point seeing. The lenses are both lighter and thinner than those of crown glass. A scratch-resistant coating reduces the reflections normally associated with high-index (1.586) materials. Impact resistance exceeds that required by ANSI Z80.7 and is many times that required by ANSI Z80.1.


Glucose therapy of recurrent lactic acidosis. Lactic acidosis not associated with hypoxic states has a high morbidity and mortality. Treatment of this condition has been supportive and the etiology poorly understood. We report a case of recurrent lactic acidosis in a patient with renal and hepatic insufficiency with hypoglycemia which was repeatedly reversed by restoring the glucose concentration to normal. This case and several others in the literature suggest a mechanism for the development of type II B hyperlactatemia and new approaches for therapy.


Case report: factors involved in the production of the presystolic murmur in a patient with mitral stenosis and atrial trigeminy. Correlation of echocardiographic, phonocardiographic, and hemodynamic data. The study of a patient with mitral stenosis and periods of atrial trigeminal rhythm afforded an opportunity to test some factors important in the production of the presystolic murmur. The echocardiogram and phonocardiogram were correlated with hemodynamic data obtained both with the patient at rest and with right atrial and ventricular pacing. The results showed that atrial contraction was a major determinant in the production of the presystolic murmur and seemed to exert an even greater influence than did either the end-diastolic pressure gradient across the mitral valve or the duration of the preceding RR interval. Corollaries from this study may have practical application for the clinician in his bedside physical examination. The data suggested that the production of the presystolic murmur in our patient might have been related to geometrical shifts of intracardiac anatomical structures resulting from changes in the left ventricular end-diastolic distending pressure.


The discrepancy between retinoscopic and subjective refraction: effect of light polarization. To identify the surface from which the retinoscopic reflex originates, retinoscopy was performed on 305 eyes of various ages with polarized and depolarized light. The discrepancy between retinoscopic and subjective refraction measures in the two conditions shows that two fundus reflective layers contribute to retinoscopy: a specularly reflecting layer presumably at the retina/vitreous interface and a diffusely reflecting layer near the pigment epithelium. In young eyes the retina/vitreous interface predominates; the other predominates in older eyes.


Eye movements, scanpaths, and dyslexia.

Eye movements, scanpaths, and dyslexia. The oculomotor performance of 25 dyslexic and 19 normal children was evaluated to determine whether or not dyslexia involves deficits in oculomotor function or visual perception. When the children were required to follow a meaningless target or to solve pictorial tasks, the two age-matched groups could not be differentiated. When they were required to read selections commensurate with their measured reading level, the dyslexic children were markedly different on a number of parameters. It appears that the dyslexic's difficulty lies beyond visual perception, perhaps in the language area itself. The dyslexic's characteristic deficit seems to involve the integration of visual input into the language-acquisition function.


Case report: invasive pulmonary aspergillosis in a nonimmunosuppressed patient. A patient with no known underlying immunosuppressive disorder who developed invasive pulmonary aspergillosis is described. A review of the English literature revealed ten other presumably nonimmunosuppressed patients with invasive aspergillosis. All had evidence of necrotizing pneumonitis with frequent cavity formation. Nine of the 11 patients died without the diagnosis of aspergillosis having been entertained. Invasive pulmonary aspergillosis does occur in the nonimmunosuppressed host and should be considered when an etiologic agent is not readily identified in a patient with rapidly progressive diffuse necrotizing pneumonitis.


Case report: hypoparathyroidism and iron storage disease. Treatment with 25-hydroxy-vitamin D3. A patient in whom hypoparathyroidism developed as a complication of posttransfusional iron storage disease is described. The hypoparathyroidism occurred after more than 15 years of receiving blood transfusions at frequent intervals. In this patient with thalassemia major the serum PTH levels were undetectable. 25-hydroxy-vitamin D3 corrected the hypocalcemia that was resistant to vitamin D2, probably due to the associated liver dysfunction. Other cases reported in the literature are reviewed. It is suggested that hypoparathyroidism occurs more frequently than usually suspected in patients with iron storage disease.


Applications of catastrophe theory to optometry. Catastrophe theory, a recently developed area of mathematics, is used to model two aspects of visual behavior. Visual behavior measured in a patient undergoing phorometry and the visual behavior of some patients with anomalous retinal correspondence undergoing the Walraven technique are characterized as catastrophes.


Optical image quality in the peripheral retina. A double-pass, photoelectric, ophthalmoscopic method was used for objective study of the variation in image quality across the retina in terms of the reflected image of a fine line, the line-spread function. Radial and tangential line-spread functions have been studied with active and paralyzed accommodation at eccentricities up to 45 deg. With large pupils, the retinal image quality remained relatively constant over the central 20 deg of field and deteriorated at larger field angles. The results are discusssed with respect to field curvature, peripheral acuity, and peripheral refraction.


The AO SR IIItm Subjective Refraction System: comparison with Phoropter measures. Subjective measures of refractive error were obtained on 530 eyes using the AO SR III Subjective refraction System (operated by a trained secretary) and using a phoropter (operated by optometrists and optometry students) in a clinical setting. Comparison of these measures from the present study and from a previous study by Bannon leads us to conclude that the SR III instrument is capable of estimating refractive error with good agreement with conventional refractive methods. Comparison with the Acuity Systems 6600 Auto-RefractorTM was also made.


Case report: intestinal bypass and severe coagulopathy. A 29-year-old woman, two years post-ileojejunal bypass, developed a serious coagulopathy. Studies utilizing heparin, epsilon-aminocaproic acid, and plasma, in vivo, indicated that the coagulation abnormalities were multiple in origin. Correction of most of the abnormalities permitted revision of bypass which led rapidly to total permanent correction of the coagulopathy.


Random-dot-stereogram performance by strabismic, amblyopic, and ocular-pathology patients in an operant-discrimination task. Stereopsis performance was assessed in 88 optometric patients using an operant match-to-sample discrimination task involving random dot stereograms (RDSs). All normals passed the RDS test, and all constant strabismics without amblyopia, microtropes, and amblyopic strabismics failed. Only a portion of anisometropic amblyopes, intermittent strabismics, and ocular-pathology patients passed. The findings were interpreted as indicating that stereopsis with a RDS may be better predicted and explained in terms of binocular fusion and bifoveal alignment than by visual acuity.


Central versus peripheral vision: evaluation of the residual function resulting from a uniocular macular scotoma. This paper examines the contribution of the macular region to visual function. Several test targets were used to measure visual performance within 10 deg of the center of the fovea for normal observers and for an observer with a uniocular central 6-deg scotoma. We conclude that the nature of the test target is more important in the measurement of parafoveal than central vision and that the macular region contributes significantly to the visibility of objects as large as 2.5 deg.


A second-generation interactive classroom television system for the partially sighted. This paper describes the various parts of a new interactive classroom television system (ICTS) that is being used by partially sighted elementary school children. This ICTS permits children to view one of seven separately controlled TV screens and thereby be in continuous visual communication with their teacher, classmates, and classroom. Comments are made on the advantages of educating partially sighted children separately from normally sighted children.


Color-naming evidence for tritan vision in the fovea. A color-naming task was used to assess color vision in the fovea and parafovea. Like traditional psychophysical procedures, color naming showed that short-wavelength vision is suppressed centrally. The anatomical and physiological mechanisms underlying tritan foveal vision are discussed.


Accommodation dynamics I. Range nonlinearity. We show the presence of a new nonlinearity in accommodation dynamics. Positive accommodation is slower when the eye is operating in the near range; conversely, relaxation of accommodation is apparently slower during work in the far range. Latency of accommodation is unaffected by working range. This new dynamic range nonlinearity has been defined in connection with a continuing research study of accommodation responses in normal subjects and in clinic patients. Instrumentation and analysis procedures are described.


Clinical assessment of the tilt aftereffect. When a subject monocularly views a bar grating that is oriented counterclockwise from vertical, and then immediately looks at a vertically oriented grating, he/she perceives it rotated clockwise. This tilt aftereffect occurs when the adapting and test targets are viewed by the same eye (direct effect) or opposite eye (interocular transferral effect). An apparatus has been developed to measure the tilt aftereffect in a clinical setting and to use such measures in assessing the prognosis for functional correction of strabismus on the assumption that the transferred tilt aftereffect is an indicator of the percentage of binocularly driven cortical neurons. Results from six normal and two strabismic subjects are presented.


Reexamination of the relationship between the surface integrated electromyogram (IEMG) and force of isometric contraction. The integrated electromyogram (IEMG)--force relationships were studied in 26 physically active young men across the entire domain of forces in the elbow flexor group. All possible error factors (fatigue, muscle length, and co-contraction) were controlled to the greatest extent possible. The experimental conditions were more clearly defined than in previous experiments. The results confirm earlier observations of a linear relationship between IEMG and isometric force, under these experimental conditions and using a unipolar lead system. Highly significant correlations were found. Possible methodological error factors were studied. Bipolar recording produced a curvilinear, relationship which may explain some of the discrepancies of results reported in the literature.


Walking patterns of men with parkinsonism. Interrupted-light photography was used to record the simultaneous displacement patterns of multiple body segments of 44 patients with parkinsonism during free-speed and fast walking to quantitatively characterize their gait peculiarities. The patients were categorized into three disability groups according to their independence in activities of daily living. Their measurements of walking performance were compared to those of normal men. The gait components of the patients, which related systematically to the degree of disability, were: step lengths, vertical excursions of the head, extension of the hip and knee of the backward-directed limb at the onset of contralateral weight bearing, toe-floor distance at the onset of weight bearing, and rotation of the thorax.


Brushing and physiological arousal.

Brushing and physiological arousal. Short-term (GSR orienting response) and longer-term changes in skin conductance were used to test the widely held belief that brushing enhances physiological arousal. Although the whirling brush did not make contact with the skin of control subjects, the degree of arousal produced by the incidental visual, auditory and social stimuli did not differ significantly from that produced by the actual brushing of experimental subjects.


Accuracy of extrapolating a pointer into perceived and imagined space. The authors investigated the ability of people to extrapolate lines in tridimensional space: an experimenter pointed at variously located targets, and the subjects tried to identify them. In an experimental condition, the subjects sat with their backs turned to the target objects, which they had previously inspected during a brief learning period; in two control conditions the targets were in front of the subjects and clearly visible. Overall error (difference in degrees of pointer angle between correct and judged targets) was no worse for objects imagined behind the head than for visible targets, about 2.7 degrees (root-mean-square) in both cases. Variable error was 29% greater for the imagined objects, but constant error was greater on the matched control targets. Some qualitative differences, in constant error patterns, were also found. With due allowance for these differences, the results strongly indicate that imagined space is functionally continuous with perceived space in the representational system.


Identification of words and letters within words. Three experiments were designed to examine the way letters are identified when they are presented within the context of a word. The first two experiments demonstrated that identification speed is facilitated if the within-word letter position of the target location. If the locational information is specified before the word is displayed (e.g., it is always the first letter), but if the locational information is presented along with the display (e.g., the target position is underlined) reaction time is considerably slower. A model of the identification process was described which assumed that subjects first identify the word, then analyze the contents of all the letter positions in order to encode each letter. Finally, the identification can occur when subjects shift their attention to the target location. If the locational information is given before the display, the attention shift can occur as the letter positions are being analyzed and encoded, but the shift must be delayed until after the analysis if the locational information is part of the display. An implication of the model is that prior to identifying the contents of the target position, the subject should always have an encoding of all the letters in the word, and the results of the third experiment supported that expectation.


Effects of level of acoustic stimulation on locomotor activity in the gerbil. Two experiments dealt with the behavioral responsiveness of the Mongolian gerbil to the onset, offset, and intensity of auditory stimulation. In Experiment I, the presence of background noise, relative to a condition of silence, was found to facilitate rate of shuttle activity in the gerbil. Also, both incremental and decremental shifts in noise intensity produced immediate increases and decreases, respectively, in activity level. Experiment II revealed that the relationship between shuttle-activity level and background noise intensity was nonmonotonic over the 60-90 dB range, with optimal facilitation manifested at 80 dB SPL. A similar trend was observed with running-wheel activity. Finally, in both experiments substantial habituation of general activity was obtained. The results were discussed in terms of theoretical conceptions of the energizing properties of environmental stimulation (e.g. , arousal theory, stimulus intensity dynamism) and psycho-physiological reactions of the gerbil to auditory stimulation.


Directional effects of size change on the comparison of visual shapes. Recent studies have investigated the effect of an irrelevant size change on reaction time in tasks involving comparison of same or different shapes. In most cases, however, studies have examined simultaneous presentation or else successive presentation where the second stimulus was always larger than the first. In the present study, subjects made same-different shape judgments on successively presented closed geometric forms, where the second form was smaller than, larger than, or the same size as the first. Comparison reaction times were observed to increase with increasing size difference regardless of the direction of size change (i.e., when the second figure was either larger or smaller than the first). In addition, the effects of size change were identical for both "same" and "different" responses. These findings were seen to support an analog normalization process in which subjects mentally equate the figures for size before comparing their shapes. The relation of these results to previous data is discussed.


The central tendency effect in stimulus generalization: the effect of sex of subject. Eighty male and 80 female college students were shown a stimulus light of 525 nm, following instructions to remember it, and then were immediately tested for generalization (recognition) with a successively presented set of stimuli including 525 nm and six longer wavelength values. Subjects rated each test stimulus on a 6-point scale ranging from "surely same" as the original stimulus to "surely different." Both men and women showed a central tendency shift. Although the stimulus perceived as most likely to be the original (the mode) shifted to 545 nm in both groups, the men showed a greater mean shift than the women. Shifting was nearly complete in both groups within the first series of test stimuli with the men shifting faster. These findings replicate a 1972 report by Giurintano of greater central tendency shift in men than in women in a line angle generalization task, challenging an assumed analogy between our generalization task and the rod-and-frame test, in which women typically show the greater distortion. The analysis of central tendency shift within the first test series reveals that it occurs much earlier than previously believed.


[Anaesthesia for cesarean section in a patient with acute viral hepatitis (author's transl)]. Acute viral hepatitis is hazardous in the obstetric patient because of associated multi-system involvement which may include coagulation defects. The fetus may be compromised by maternal complications as well as by high levels of indirect bilirubin which crosses the placenta. Cesarean section is frequently indicated for fetal distress or failed progress of labor. An elderly primigravida with severe acute viral hepatitis complicated by gastrointestinal bleeding, hypofibrinogenemia, thrombocytopenia and prolonged prothrombin and partial thromboplastin times required emergency cesarean section. Clotting factors were replenished prior to surgery. General anesthesia with low-dose ketamine induction and high inspired oxygen fraction was considered the method of choice for the specific maternal and fetal problems.


[Anaesthesia and intracellular distribution of cerebral hexokinase (author's transl)]. The purpose of the present investigation was to demonstrate how the intracellular distribution of hexokinase was influenced by anaesthetics. The experiments were carried out using mice in vivo and the isolated perfused rat brain. Thiopentone (100 mg/kg i.p.) produced an increase of soluble hexokinase activity in brains of mice which were removed from the skull in 45 s to 120 s. A solubilization of hexokinase activity was demonstrable in the surgical stage of anaesthesia, when the animals awoke redistribution to control values was measurable. A dose dependent influence of thiopentone on hexokinase distribution was demonstrated in the isolated perfused rat brain. When the thiopentone concentration in the perfusion medium was increased (0.05-0.8 mM) the soluble hexokinase activity was elevated while the EEG activity was reduced up to isoelectricity.


Prevention of stroke in high risk patients undergoing general anaesthesia. The anaesthesiologist is primarly involved in the management of the stroke prone patient undergoing surgery. Preoperative assessments, per and post-operative management of such patients are discussed.


[Malignant hyperthermia. Report on a case successfully treated by procaine infusion (author's transl)]. A case of malignant hyperthermia with muscle stiffness is described. An early diagnosis, along with procaine infusion, and an energetic unspecific treatment helped to cure this patient.


[Cardiac tamponade after perforation of ventricle by central venous catheters and transvenous pacemakers (author's transl]. Two cases of cardiac tamponade after perforation of the right ventricle by central venous catheter and transvenous pacemaker are reported. The apex of the right ventricle represents a "locus minoris resistentiae" for a perforation because of its thin wall and frequent infiltration of fat with relaxation of the small muscle bundle. An analysis of 41 heart perforations by central venous catheters and 47 by transvenous pacemakers from the literature demonstrates the particularly high mortality of the perforation by a central venous catheter referring to the possible production of hydropericardium. We think that extreme carefulness in the use of catheters, knowledge of the danger and vigorous treatment could reduce the mortality.


[A method for the simultaneous placement of two central catheters - via one internal jugular vein (author's transl)]. A method for the simultaneous placement of a vena cava-catheter and a Swan-Ganz-catheter using two different approaches to one internal jugular vein is described. The advantages of this procedure in the management of patients undergoing cardiac surgery are discussed.


[The Draeger-Flaschenpaket - a portable emergency equipment for continuous support with gases for anaesthesia (author's transl)]. The Dräger Flaschenpaket for immediate supply of oxygen and nitrous oxide may be used in operating theatres or during the transportation of artificially ventilated patients. The equipment may be used with two oxygen bottles or one oxygen and one nitrous oxide bottle (bottle size in each case 2 1). A quick connection between the tubes of the anaesthesia apparatus or respirator and the equipment is ensured. The portable equipment may be stationed in operating theatres, in intensive care and in shock units.


[The development of the adrenal cortex in pig (Sus scrofa domestica). (A contribution on the development of the fetal interior zone of the adrenal cortex in pig) (author's transl)]. The adrenals of pigs have been investigated histologically and histochemically during different periods of time pre- and postnatally. The pig (Sus scrofa domestica) shows a proper fetal cortex in the prenatal development of the adrenal gland. This involves slowly during the last quarter of pregnancy. A weight reduction is not noted thereby. Just before delivery the adrenal cortex of the pig has been subdivided into a zona arcuata and zona fasciculata. The zona reticularis develops only postnatally.


[The system of blood vessels in the glandular and muscular stomach of the chicken (author's transl)]. The vascular system of the stomach of the chicken was investigated by means of corrosion preparations as well as by light- and electronmicroscopic methods. The main vessels form a) an Intermuscular Plexus the outer longitudinal and inner circular layers of the muscle wall in the glandular stomach and b) a Subserous Plexus in the muscular stomach. In the glandular stomach the Interglandular Parietal Arterial Plexus I, situated below the Lamina muscularis mucosae I arises from the arteries which pass through gaps in the muscle wall. This Plexus I produces another plexus, the Interglandular Arterial Plexus II, located on top of the Lamina muscularis mucosae I. Both arterial plexuses are accompanied by venous plexuses, which convey the blood into a Subglandular Venous Plexus. -The vessels of the muscular stomach provide the predominant supply of blood to the muscle wall. The mucous membrane of the muscular stomach is vascularized far less than the one in the glandular stomach. -The hemodynamic relationships of the vessels of the hen's stomach and the significance of the fine structure of the subepithelial capillaries and venules for the exchange of materials are discussed.


[Integrations of increase functions according to the L. v. Bertalanffy conception of organic growth (author's transl)]. The Bertalanffy (1941, 1949) conception of the change of organic mass M with time t as given by the difference dM/dt = aMm-bMn is transferred to the shap dW/dt = kWm(En-Wn) with W being an element of growth, i.e. length, weight or population and E its final value after reaching adultness. The integration of this expression, resulting in the growth function W, can be performed globally only for m=1. In other cases the integrals become individual with quite different solutions, some of them being presented here for means of comparison. The results show that many growth functions exclude W = 0, and all reach the final value W = E after infinite time although with quite different degrees of approximation. Moreover the graphs allow a survey as to which results this type of growth function can yield. Finally the mathematical deficiencies give rise to investigate modified types of increase functions.


Amniochorionic bands and adhesions with fetal deformities. The amniochorionic bands and adhesions in 2 malformed human fetuses are described. The anencephaly, left harelip with grossly distorted face, and rudimentary right upper limb of case 1, and multiple pits and cavities in the liver of case 2, are directly attributable to membranous adhesions. The toughness of the bands is indicative of their mesoblastic (chorionic) origin. The histolytic effect on the liver of case 2 may suggest a contact with the trophoblastic cells. The exomphalos of case 1, and extroversion of cloaca with other caudal defects of case 2, are possibly due to vascular and mesodermal deficits imposed by single umbilical artery.


[Two anatomical observations of a non-recurrent laryngeal nerve (author's transl)]. 2 cases are described of a right recurrent nerve with abnormal origin and path. Frequency: 0,8%. Both cases ware associated with the presence of an A. lusoria. In the first case, the "non-recurrent" recurrent nerve reached the thyroid gland by its superior pole, in the second case by its inferior pole. In the latter case, there was a close relation between the nerve and the branches of the inferior thyroid artery. The consequences are discussed in relation to the surgical techniques.


[Light and scanning electron microscopical studies of the soft palate and the tongue in Bombina variegata L (author's transl)]. The soft palate and the tongue of adult Bombina variegata L. were studied by means of light and scanning electron microscopy. In the palate numerous taste-disks were found prominent by their polygonal surface structures. These are caused by longer microvilli at the margins of the different cells of the taste-disk or by deepened margins of the polygonal cells. The surfaces of the cells are slightly convex and are covered by numerous microvilli. In the tongue primarily fungiform papillae were observed (with the exception of the margins were taste-disks similar to those found in the palate were present). Their taste-disks also present polygonal structures, their epithelial cells are characterized by microridges while those of the epithelial folds surrounding the fungiform papillae own microvilli. As special formations within the taste-disks small knob-like protrusions between polygonal cells were found.


Fine structure of the rabbit submandibular gland during the embryonic development. The development of the submandibular gland has been examined in rabbit embryos from the 22nd day to the birth. The 2 main types of secretory cells, which synthetize dense serous granules or large pale mucous granules can be identified from the 24th day of development. A third type of cells, characterized by granules having different densities, has been identified in the preterminal tracts. The possibility that these cells are similar to some small cell with an highly dilated endoplasmic reticulum found in adult rabbit submandibular glands is discussed.


Right Müllerian duct in the domestic fowl during postnatal ontogenesis. In this study the postembryonal changes of the right Müllerian duct are investigated. This structure was found in all female broilers of the hybrid combination Ross 1 as well as in hens of the female line of parent stock for the production of this hybrid. A thready structure of the length of several millimeters observed in one-day-old females develops in chicks into a long, thin-walled ampula filled up with clear liquid. In mature hens this rudiment is markedly long and its shape is rather different. In some cases the Müllerian duct was divided into several parts which might be compared with individual parts of the left oviduct.


Histochemical studies on the long term prostaglandin treatment on adrenal delta5-3beta-hydroxysteroid dehydrogenase and glucose-6-phosphate dehydrogenase activities in rats pretreated with estradiol dipropionate. Long term Prostaglandin E2 treatment stimulates adrenal weight and steroid output. Indirect studies with histochemical localization of steroidogenic enzymes and hepatocyte glycogen content revealed that in state of adrenal suppression, PGE2 fails to elicit a positive change in steroid output from adrenal cortex, although apparently increases the enzymatic staining reactions. This suggests that the action of Prostaglandin on adrenal steroidogenesis is a pharmacologic one rather than a physiologic response.


The functional anatomy of the olfactory organs in a hill-stream fish Garra mullya (Ham.). Functional anatomy of the olfactory organs in a hill-stream fish, Garra mullya has been described with special reference to its mode of life. It is a macrosmatic fish with a predominantly developed olfactory faculty.


[Uptake of peroxidase by activated nerve cells of the hypothalamus (author's transl)]. After thirst or adrenalectomy followed by dehydration electron microscopy reveals an activation and an increased uptake of peroxidase in the nerve cells of the supraoptic, paraventricular, ventromedial and praemamillar nuclei. The amount of peroxidase which is taken up runs parallel with the activation of the corresponding nerve cells. After rehydratation the activity of the nerve cells and the uptake of peroxidase decrease. The incorporation of the enzyme by the nerve cells differs depending on the region investigated: After thirst peroxidase is taken up especially by the nerve cells of the supraoptic and paraventricular nuclei. After adrenalectomy, however, this is true for the ventromedial and praemamillar nucleus. In the magnocellular nuclei peroxidase is preferentially incorporated by the perikarya, whereas in the parvocellular nuclei the uptake of the enzyme predominates in the dendrites. Within the nerve cells peroxidase is only seen in heterophagic bodies. The ependyma above the paraventricular nucleus takes up peroxidase in low amounts via the cell membrane which borders the III. ventricle; high amounts are incorporated by the lateral and basal plasmalemma.


[Increase functions of the type dW/dt = k Wm (E--W)n and their integrals (author's transl)]. In a preceding paper increase functions have been treated following the Bertalanffy conception of organic growth given in the transformed shape as dW/dt = k Wm (En--Wn). As the growth functions gained by integration reach the final value E only for t leads to infinity, the increase function is changed to dW/dt = k Wm (E--W)n. Now integrations yield growth functions with asymptotic behaviour W leads to E as well as such reaching W = E in finite time, and are so better corresponding with natural development. The mathematical treatment shows a broad variety of resulting integrals given as graphs, some of them having chances as possible growth functions. Future investigations into increase functions should be focussed to the aim of choosing an ansatz allowing allround integrations leading to a variation of the parameters (m and n) in the growth function proper. This would mean avoiding a series of structurally different integrals without continuous transition between them and could be an aggravating mathematical simplification.


Statistical analysis of muscle fibre types from four human skeletal muscles. The joint distributions of the different muscle fibre types were investigated in human diaphragm  temporalis, gastrocnemius and soleus muscles. (1) "Independence" was found between "white and intermediate" fibres in the diaphragm muscle; "red and intermediate" fibres in the temporalis muscle and "red and white" fibres in the soleus muscle. (2) An almost "linear relationship" was observed between red and intermediate fibres in both the diaphragm and soleus muscles and red and white fibres of temporalis muscle. (3a) In the diaphragm and soleus, the distribution of intermediate and red fibres exhibited large variation between different samples; unlike that shown by the white fibres. (3b) In the temporalis large variation was evident in the distribution of white and red fibres between samples; the intermediate fibre type showed minimal variation. (3c) No particular relationship was evident between different fibre types of the gastrocnemius muscle. The distribution of muscle fibres in all the 4 human muscles is "singular trivariate normal".


[Histotopics of lysosomal enzymes in the epididymis of the tom-cat (author's transl)]. The histochemical localization of 6 lysosomal enzymes was studied in the epididymis of adult tomcats. A weak to distinct reaction for acid phosphatase, leucyl-amino-peptidase and non--specific esterase could be observed in the epithelium of the ductus epididymidis in all three segments. Among the glycosidases, N-acetyl-beta-glucosaminidase displayed the strongest activity. alpha-man and alpha-fuc could not be demonstrated. For N-Acetyl-beta-glucosaminidase, beta-Galactosidase, acid phosphatase and non-specific esterase, an increase of enzyme activity from the initial segment towards the terminal segment was seen. Intracellularly, the maximum of enzyme activity of those four enzymes was supranuclear. This histochemically enstablished pattern of enzyme activity in the epididymis of the tomcat was compared with those of other mammals. The possible functions of enzymes in the epididymis was briefly discussed.


[Radiologically detectable modifications in the cartilaginous parts of the first pair of ribs in connection with age, sex and the cartilaginous part of the other ribs (author's transl)]. 2154 thorax radiograms of 1099 male and 1055 female patients with transformations of the costal cartilage were analysed and statistically evaluated in dependence on age. The calcification of the cartilage parts of the first rib was observed on both sides in the same way and concerning the frequency there were no sex conditioned differences. In the age group between 35 and 45 years more than 95% calcifications have been demonstrated. Men show more frequently advanced stages and types of calcification than women. In complete or heavy calcified cartilage zones disconnections in form of splitted parts without calcium have been observed. The lower cartilage skirt is regarded as the localization of the beginning of calcification. The other costal cartilages will be calcified later and less rapidly than the first costal cartilage. Significant differences of type and localization of the calcification were found between men and women. Physiological processes of ageing and mechanical stress as the prevailing calcification-causing factors are discussed.


The activity of the metaepiphyseal chondrocytes in the humerus of growing mammals. In the postnatal period of development of animals there have been established differences in the length of the distal and proximal metaphyses, as well as in the biosynthesis of sulphated proteoglycans and collagen proteins by chondrocytes. The local peculiarities of the functional and reproductive activity of chondrocytes exert influence upon the histological structure of metaphyses. The locomotive function with its certain supporting-power loads on various joints is supposed to be the main cause for these changes.


[Increase functions of the type dW/dt=ktp(E-W)n and their integrals (author's transl)]. In 2 previous papers increase functions of the v. Bertalanffy (1941) type dW/dt = kWm (En--Wn) and a modified form dW/dt = kWm (E--W)n were treated, both yielding a variety of integrals resp. growth functions, most of them reaching the final value W = E after infinite time. Now an ansatz with better integration conditions dW/dt = ktp (E--W)n is presented implying t also on the right side of the basic equation and giving only two types of growth functions determined by n = 1 or 0 less than n less than 1. In the first case there appears a slightly generalized Janoschek (1957) growth function with W leads to E for t leads to infinity but a rather good position of the turning point, i.e. the abscissa of maximum increase. In the second case the result is a growth function with a definite time to reach adultness, thus being better suited to natural conditions. Graphs show the flexibility of the 2 solutions and their increase functions, including an example for practical application.


Quantitative studies on the nervus stapedius of the mouse with the electron microscope. A nerve fiber count analysis was performed with the electron microscope on the nerve to the stapedius in seven mice. On an average, 77 (81%) of the total nerve fibers (95) were myelinated and 18 (19%) unmyelinated. The  nerve consisted mostly of large myelinated fibers, minor diameters of which measured 3-4 micrometer most frequently like the large fiber zone of the motor root of the facial nerve and the facial trunk. The nerve fibers to the stapedius come from the large fiber zone of the facial nerve trunk.


[Peroxidase distribution pattern and cochlear microphonics in the impulse-noise exposed cochlea of the guinea pig (author's transl)]. Morphological findings evidenced the impulse noise trauma primarily a mechanical lesion of cells. The loss of mechanically damaged sensory cells results in the initial decline of cochlear microphonics. Due to mechanical lesions many sites of leakage in the wall of the cochlear duct give way to the diffusion of components of either lymph, which will produce a general functional disturbance associated with additional decline of microphonics. The functional restoration of the inner ear requires the previous repair of the endo/perilymphatic barrier.


A comparative study of the forebrain of 4 species of South American birds. The brains of the swift Streptoprocne zonaris, the flycatcher Tyrannus melancholicus, the tanager Ramphocelus dimidiatus and the finch Oryzoborus angolensis were compared with respect to the hyperstriatum accessorium, hyperstriatum dorsale, hyperstriatum ventrale, neostriatum, ectostriatum, paleostriatum augmentatum and paleostriatum primitivum. In each of these brain parts the average number of cells and the average cell size were calculated, and the species were compared with respect to the same part of the brain. Some of the data suggest that the density and size of cells are correlated with behavior (e.g. feeding behavior), but such correlations should be confirmed with electrophysiological studies as well as cytoarchitectural studies of more species which exhibit similar feeding behavior.


Hemodynamic effects of phentolamine in valvular abnormalities. Seven patients with mitral insufficiency and seven patients with aortic insufficiency were studied by right and left heart catheterization. Hemodynamic observations were made during a control period and during the infusion of phentolamine. Significant declines in the pulmonary artery mean pressure, left ventricular end diastolic pressure, peripheral resistance, and arteriovenous oxygen difference were seen in both groups. The cardiac index increased significantly in the two groups. Phentolamine therapy produced favorable hemodynamic effects because of its vasodilating action as well as its positive inotropic effects.


Surgical treatment of thoracic aneurysm in a hemodialysis-dependent patient: a case report. A 53-year-old woman who was on hemodialysis underwent the resection of an aneurysm of the descending thoracic aorta as well as graft replacement. The operation was performed with the aid of femoro-femoral bypass perfusion and an artificial kidney inserted on the venous side of bypass line. Although the perfusion time was short, the uremic metabolic substance was efficiently removed, resulting in easy management after surgery.


Water buffalo (Bubalus bubalus Arnee) allotypes: identification of a multiple allelic system. This paper describes two allotypes of water buffalo controlled by two codominant allelic genes. The third allele is a null allele and behaves as a recessive one. The two detectable serum antigens are termed A1 and A2 and the third one (as yet undetectable) A0. The A1 antigen was recovered in the third peak and A2 antigen in the first peak following gel filtration through Sephadex G-200. The A1 antigen is common to water buffalo and cattle; the frequency of the corresponding gene (A1) was the same in both species.


The major histocompatibility complex of sheep (OLA) and two minor loci. Among 11 lymphocyte factors defined in sheep, 9 are the products of multiple alleles at 2 closely linked loci: OLA-A and OLA-B. A tenth factor is the product of a gene at a third locus: OL-X probably on the same chromosome, but in this case very distant from OLA. The last factor is the product of a gene at a fourth locus: OL-Z, independent of OLA-A and B.


Genetic variants of hemoglobin in canine erythrocytes. Genetic polymorphism of hemoglobin was found in the erythrocytes of dogs of seven Japanese native breeds by using starch gel electrophoresis. Analysis of parentage records of the dogs revealed that the phenotypic variation of hemoglobin is controlled by one autosomal locus with two codominant alleles, HbA and HbB. the allele HbA occurred only in Japanese native breeds except Shikoku. The frequency of HbA in the Japanese breeds was low and 0.08. All the dogs belonging to 25 European breeds and 5 oriental origin (except Japan) breeds examined in this experimnets had the homozygous genotype constitution HbB/HbB.


Genetic variation of some aldehyde-oxidizing enzymes in the mouse. 1. Twenty-six strains of mice were surveyed by starch gel electrophoresis for genetic variation of four liver enzymes; aldehyde dehydrogenase, aldehyde oxidase, xanthine oxidase and formaldehyde dehydrogenase. 2. A variant of aldehyde dehydrogenase was found in strains ICFW, IS/Cam, NZB, NZW, Simpson and Schneider. A variant of aldehyde oxidase was found in CE. A possible variant of xanthine oxidase was found in SF/Cam. 3. The gene determining the electrophoretic variant of aldehyde oxidase is either the same as, or very closely linked to, the Aox gene which determines aldehyde oxidase activity.


A new allele in the prealbumin system of horse serum markers. A family study of an index case in the Arabian breed of horses demonstrated the presence of a new allele in the prealbumin (Pr) system of electrophoretically determined markers in horse serum which, when homozygous, results in the absence of any recognizable zones in the Pr region. The symbol PrO is proposed for this allele which has an estimated frequency in Arabian horses of 0.09.


A state-wide survey of hospital policy and practice concerning cigarette sales. This study was conducted to determine the current practices and problems with regard to the sale of cigarettes in the approved hospitals of Indiana. A questionnaire was sent to all approved hospitals within the state asking each hospital administrator to respond to specific questions concerning cigarette sales policy and practice. After an initial waiting period, a follow-up letter was sent to each nonresponder. Finally, a response rate of 99 per cent was achieved. It was found that approximately 58 per cent of respondents sold cigarettes, with the majority selling cigarettes both over the counter and through vending machines. However, among the 42 per cent of the sample not selling cigarettes, the vast majority (82 per cent) indicated that no problems were encountered with their no-sales policy and practice. On the basis of both a review of literature pertaining to the potential dangers of ambient cigarette smoke and the findings of this study, the writers concluded that a no-cigarette-sales policy in hospitals is reasonable, feasible, and desirable.


Reversible impairment of the adherence of alveolar macrophages from cigarette smokers. The nylon fiber adherence in vitro of alveolar macrophages (AM) from cigarette smokers was uniformly decreased. The mean adherence of AM from 16 cigarette smokers was 53 +/- 3.0 per cent, compared to a mean adherence of 77.2 +/- 1.7 per cent for AM from control nonsmokers. The defect was not present after the subjects quit smoking, was not a result of factors in lavage fluids from smokers, and was not apparent in polymorphonuclear leukocytes. The morphologic features of the surface of AM were examined with scanning electron microscopy to determine whether morphologic changes paralleled the decreased adherence of AM from smokers. Marked alterations in the surface of AM from cigarette smokers, which could affect the ability of AM to adhere optimally, were demonstrated before attachment to the fiber. In summary, there exists a reversible, intrinsic defect in the structure and adherence of AM from cigarette smokers that may influence their function and may accout, in part, for the increased yield of AM from the lavage fluid of cigarette smokers.


Influence of beta-2 agonist aerosols on pressure-volume characteristics of the lungs. The effects of inhalation of a beta-2 adrenergic compound (fenoterol) on the expiratory pressure-volume curve of the lung were studied in 11 normal subjects. In particular, the dose dependence and the time course of this effect were determined, and they were compared to the characteristics of the bronchodilator action. Analysis of the results showed that (1) despite a decrease in esophageal tone, lung recoil pressures at all lung volumes were decreased by these compounds, (2) this change, in contrast to bronchodilation, was observed only when high doses were inhaled, and (3) this effect appeared rapidly and elapsed after approximately 30 min, whereas bronchodilation remained stable for at least 2 hours. Additional studies with intravenous infusion of the drug indicated that the effects of beta adrenergic agonists on the pressure-volume characteristics of the lungs are related to the amount of the drug delivered to the peripheral segments of the lung. These findings suggested that large doses of beta-2 agonist aerosols can cause sufficient relaxation of the contractile elements of the lung parenchyma to produce alterations in the static elastic properties of the lungs. In contrast to bronchodilation, which results from a topical action of inhaled particles, these alterations are probably a systemic effect of these aerosols, related to the quantity of the drug absorbed into the circulation.


[Ileocaecal valve incompetence. A new syndrome (author's transl)]. Out of series of 237 colonic aganglionisms (1965--1977) 32 cases (13%) showed a clincial, radiological and manometric syndrome of "incompetent ileocaecal valve". Symptoms were vomiting, constipation with bouts of diarrhea, incomplete intestinal obstruction and failure to thrive. Sixteen cases were under P-3 weight percentiles. Initial diagnosis were aganglionism (10 cases), hiatal hernia (4 cases) and N.E.C. (1 case). Seventeen patients were explored through an iliac incision in the first three months of life. Ileocaecal continence was minimal (less than 25 cm. of water pressure). Ilocaecoplication was performed and completed with internal sphincterectomy (10 cases), colostomy (1 case) and caecostomy (3 cases). This new syndrome has been experimentally studied, but its etiology remains obscure. It introduces a bad prognostic component in aganglionism. Ileocaecoplication, a very simple operation, can be a lifesaving procedure.


[Pulmonary gas exchange in newborns with congenital diaphragmatic hernia (author's transl)]. In 20 newborns with congenital diaphragmatic hernia the state of the pulmonary function was studied through the blood gas values (PO2 and PCO2 on breathing air and 100% oxygen spontaneously or with mechanical ventilation). The group of survivors presented a normal or slightly altered pulmonary function, whilst in the group that died the pulmonary function was severely altered. Up to now, and in accordance with the results obtained, none of the proposed hypothesis (pulmonary atelectasis, extra-pulmonary right-to-left shunt, pulmonary hypoplasia) explain this alteration in a satisfactory manner. From the prognostic point of view, if the levels of gases are spontaneously normal or with administration of oxygen and/or assisted, ventilation a level of PO2 higher than 230 and of PCO2 lower than 70 is obtained, prognosis is excellent. If these levels are not obtained the prognosis is nearly always fatal and the value of the intervention questionable.


[Necrotizing enterocolitis and its surgical management. Study of 35 cases]. Thirty five cases of necrotizing enterocolitis, seen in the past five years in this clinic, are reviewed. Twenty four cases were seen up to December 1977 and eleven cases from January to March 1978 due to a neonatal I.C.U. epidemy. The relationship between some of the accepted perinatal pathogenic factors and the development of necrotizing enterocolitis is analyzed. The temporal relationship of the time of diagnosis to the onset of treatment is an important consideration for the prognosis. We propose surgical treatment if after eighteen hours of treatment there is no improvement. A guideline for the early treatment and surgical indications of acute necrotizing enterocolitis, is suggested.


[Sequelae of necrotizing enterocolitis in newborns (author's transl)]. The authors report a new aspect of NEC which can be at the origin of symptoms appearing late in the clinical course. These sequelae, consisting of colic strictures, can be observed in all patients both medically and surgically treated. The five cases presented were observed among the 21 medically managed of which they represent 23.8%. None of the ten operated patients presented sequelae. All strictures were located in the colon, always in coincidence with the original topography of pneumatosis. Multiple strictures were observed in one patient.


[Neonatal functional intestinal obstruction of unknown etiology (author's transl)]. Three cases of newborn intestinal obstruction without obvious organic cause are reported. Narrow left colon (Davis's syndrome), small colon, megacystis and intestinal hypoperistaltism (Berdon's syndrome) and segmental bowel dilatation (Swenson's syndrome) were the diagnoses. Through a review of the literature a possible interrelationship among these three clinical entities at the level of an abnormal myenteric plexus neuronal function is discussed.


[Traumatic amputation of the testicle. Successful reimplantation using microsurgery (author's transl)]. A case of traumatic amputation of the left testicle with complete avulsion of the spermatic cord in a three year old boy is presented. A successful reimplantation was performed using microsurgical technique. We believe this is the first case reported in the world Literature.


[Omphalopagus conjoined twins with successful surgical separation (author's transl)]. The authors present an observation of omphalopagus conjoined twins with successful separation. They comment on the etiopathogenic factors, obstetrical problems, investigation of the extent of the union and operative timing.


[Respiratory distress syndrome and pulmonary congenital malformations (author's transl)]. The present report is based on three infants with respiratory distress syndrome due to congenital lobar emphysema in two and cystic adenomatoid malformation of the lung in the third. The serious worsening of the respiratory distress in two children prompted a partial pulmonary resection within the first 24 hours of life. A brief description of the clinical, radiological and pathological characteristics of this anomalies is included. Our three patients remain asymptomatic showing a normal development, after a follow-up period of five months in one child and just over two years for the other two. Any neonate showing progressive respiratory distress should have a chest X-ray taken to rule out a lobar emphysema or a severe malformation of the lung leading to abnormal ventilation. The management in this cases should be the immediate resection of the affected pulmonary lobes.


[Gastric duplication with two cysts (author's transl)]. Gastric duplications are rare. The case of a two-year-old girl with double cystic tumors, and a wide connection with the stomach and duodenum, is described and commented upon. A partial resection with excision of the mucosa in the zone closely adhering to the duodenum, and "capitonage" of the raw surface was necessary. A year and a half later, the girl experiences no problems, and the radiological study is practically normal.


[Gonadal tumors in children (author's transl)]. Four cases of gonadal tumors in infancy were treated in the Service of Pediatric Surgery of the Hospital Infantil "Virgen de la Arrixaca", Murcia, during the first two years of surgical work. One of them is a Leydig cells testicular tumor, the second is a ovary tumor of the granulosa and the last two cases were ovarian cysts, one of them associated with precocious puberty. The clinical features, diagnostic and therapeutic problems of these tumors are reviewed.


[Hemihypertrophy and functioning adrenal tumor (author's transl)]. The case of a secreting adrenal tumor in a seven month old hemihypertrophic girl is described. Some features of hemihypertrophy and its relationships with the E.M.G. Syndrome and abdominal tumors are commented upon. The reported case is a typical association of malformation with tumor and recalls the close relationship between teratogenesis and oncogenesis.