[Proskinetic symptoms in motor psychosis as accentuating personality traits]. Proskenetic symptoms have been observed by the authors in a study of motility psychosis. However, these proskinetic symptoms appeared to be a character trait of an infantile personality rather than a condition following as a consequence of psychosis. The question is raised as to whether proskinetic symptoms (and catatonic symptoms) may be considered accentuating personality traits.


[Structure of patient council].

[Structure of patient council]. This article discusses the conceptual relationship of different groups in a sociotherapeutically oriented hospital prior and subsequent to the establishment of a patient council. The observations made in this connection and reported by the authors in their present paper are supplemented by an attempt to outline the prospects of sociotherapeutics and a description of the particular structure of a sociotherapeutically oriented hospital. Approaches to more effective process control in the use of small groups in the wards are described in the final section of this paper.


Dissociation of self-reported and observed pleasure in depression. Anhedonia, or the inability to experience pleasure, is an important component of depressive symptomatology. Observer ratings of positive affect and self-ratings of pleasurable experience were collected from ten depressed inpatients and ten ward staff members during the patients' base-line, medication-free period. Depressives were observed to display significantly lower degrees of positive affect than the normal group, but they reported significantly higher degrees of experienced pleasure. The normal group displayed positive affective behavior that was consistent with self-reported data. Thus, normal subjects showed synchronous, or associated self-reported and observed activity, whereas depressives appeared to be dissociated along those same dimensions. A dissociation also appeared in self-reports of positive versus negative mood states, suggesting the existence of a malfunction in these normally inhibitory affective mechanisms.


Weight and circadian luteinizing hormone secretory pattern in anorexia nervosa. In previous studies we had established that emaciated women with active primary anorexia nervosa (AN) had immature 24-hr luteinizing hormone (LH) secretory patterns. In this study, we have examined the circadian LH patterns of eight women with AN who had partially or fully recovered their ideal weights. Three of the women were studied before and after weight gain and five women were studied only after the appearance of binge-eating and consequent weight gain (by history). Our findings are: (1) The adult (mature) circadian LH secretory pattern was not present in women who had partially or totally achieved ideal weight but who otherwise remained symptomatic; (2) those women who showed both weight gain and normalization of LH pattern were also symptomatically improved in other respects; (3) the degree of immaturity of pattern did not correlate reliably with the duration of illness, the degree of fatness, or the extent of deficit from ideal weight; (4) the mode of illness onset and the type of secretory pattern were not related; and (5) the return of menses did not show a simple relationship to weight, fatness, or maturity of LH pattern.


Antecedent psychological factors in the onset of vasovagal syncope. Broad psychosocial antecedents for 18 aviators with vasovagal syncope are compared with 31 controls. The immediate thoughts, fantasies, and feelings of the fainters are examined in detail. The fainters had significantly more job dissatisfaction than the controls. The presyncope fantasies of the fainters confirm Engel's observations of the immediate psychological context for vasovagal syncope (anticipation of bodily harm, denial of fear, and submission to a threat), and extend his formulation to include psychological harm in the form of humiliation, embarrassment, and loss of prestige.


Anorexia nervosa. Commitment to a multifaceted treatment program. Anorexia nervosa, a complicated and serious illness, warrants the comprehensive use of several treatment modalities: behavior therapy, individual psychotherapy and family therapy. Singular use of and of these three have resulted in high mortality rates. The importance of legal commitment in dealing with this illness is also discussed.


The heart image as a model to internal-organ body image. We show that there is indeed an internal-organ body image: the heart. Using questionnaires and drawings, we compared a group of healthy subjects, a group of acutely ill cardiac patients and a group of chronic cardiac patients. A constant body image emerged which was not influenced by heart disease. It seems to us that this approach can serve as a model of further studies of internal-organ body image.


Alexithymia. II. The association with unexplained physical distress. Unexplained physical distress, when associated with alexithymia, becomes a diagnostic puzzle leading to prolonged investigation, ineffective treatment, and psychiatric referral. The persistent, often almost indescribable quality of the distress suggests a central disturbance of the mechanism of pain experience involving the limbic system and the endogenous opiates.


Implications from an unusual case of multiple psychosomatic illness. A 40-year-old patient who developed over her lifetime an unusually large number of psychosomatic illnesses is presented. She manifested in succession, bronchial asthma, peptic ulcer, regional ileitis and anorexia nervosa. In addition to the factor of multiplicity of illnesses, this series of illnesses is of special interest because the association of a classical psychosomatic illness with anorexia nervosa has not been reported previously. In order to take advantage of the unusual series of illnesses in one patient, I utilized a novel investigative approach. Basing myself upon the supposition that the fundamental make-up of the personality remains fairly constant over time, I criss-crossed bits of established knowledge from one illness to another. In this way, I was able to derive various implications with respect to the psychodynamic, the cognitive-perceptual and the hypothalamic levels of functioning in all the illnesses.


Psychosomatic studies of Japanese youth under social changes. An overview. Psychosomatic studies of adolescent patients were conducted at the Kyushu University Hospital. Among many adolescent psychosomatic disorders, the incidence of irritable colon syndrome ranked first. The dynamic mechanisms and therapeutic results of these patients were introduced. Next, an epidemiological study showed that the frequency of constipation and diarrhea rapidly increases over the period from junior high school to senior high school. Through matched pair studies conducted with high school students, significant interrelationships were proven to exist among the occurrence of diarrhea and constipation, awareness of illness and psychological factors.


[Investigation of drug users reported to the juvenile court of Rome]. After illustrating the new set of rules in matter of stupefacient and psychotropic drugs, introduced in Italy on December 1975, and the duties assigned by the law to the judicial power, the findings are set forth here of an investigation carried out on 40 youths whose addiction to the use of drugs had been reported to the juvenile court of Rome up to April 30, 1977. Anamnestic, social, judicial and clinical data on such subjects were obtained. Even with the obvious reservations resulting from the extremely small sample, some findings are observed that appear to be significant: a considerable portion of the minors addicted to the use of drugs was the recipient of other interventions by the juvenile court in the civil, administrative and criminal sphere; for the males, the prevailing anamnestetic and social data correspond to the characteristics of the other subjects, with whom the court usually deals at the "re-educational" or criminal level, while, with regard to females, the picture is remarkably different. The use of heroin seems to be wide-spread among the males, where also prevail previous hospitalizations caused by the use of drugs. The Authors advocate a new and more extensive verification, to be carried out after a period of time.


[Notes on some self-induced diseases in prison communities]. The self-induced and simulated diseases in prison communities are numerous and not always easy to detect. This is, at any rate, a peculiar phenomenon that also involves other closed communities external to the prison environment, such as those of the large built-up areas, of the factories, of the schools, of the barracks, etc... As a rule, recourse is had, in the latter, to self-induction and simulation to achieve economic or absenteeistic purposes. In prison communities, self-induction and simulation are instead implemented in order to escape the rigours of the law and detention itself. It is an unquestionable fact, however, that nowadays this phenomenon is regressing, chiefly thanks to the coming into force of law No. 354 of July 26, 1975 on the penitentiary System, that is certainly determining radical improvements within the prisons.


Endoscopic retrograde cholangiopancreaticographic aspects of choledocholithiasis and its sequelae. 100 patients with a known history of choledocholithiasis were selected. The main reasons for performing ERCP were the presence of severe jaundice or insufficient information obtained with intravenous cholangiography. Analysis is made of the various complications due to the presence of common bile duct stones. A surprisingly high incidence of choledochoduodenal fistulas was seen; two types of such fistulas can be recognized. A brief discussion is given of etiological factors involved. ERCP is also very useful in the evaluation of surgical anastomosis and complications due to surgery such as narrowing or complete ligation of the common bile duct. Finally, pancreatitis, another complication of choledocholithiasis, is evaluated with ERCP, showing the importance of reflux from the common bile duct into the pancreatic ducts in the etiology of this condition.


Characteristics and diagnostic approaches in the detection of nonapparent bronchogenic carcinoma. Bronchogenic carcinoma without parenchymal changes, located within normal hilum and mediastinum, does not show in routine chest X-ray. The value of tomography is demonstrated.


Angiographic features of compression of the axillary artery by the musculus pectoralis minor and the head of the humerus in the thoracic outlet compression syndrome. Case report. Discussion of the humeral head compression and the pectoralis minor compression as a possible reflection of the thoracic outlet compression syndrome. Pictures of both compressions on the axillary artery are presented.


Some pseudotumors and pitfalls in ultrasound. A collection of pseudomasses and pitfalls in abdominal ultrasound are reviewed. This article discusses the way in which to avoid misinterpretation in these cases. Some anatomical variations and accidental configurations are mentioned.


Hepatobiliary scanning with 99mTc-pyridoxylidene glutamate. A retrospective study investigating the criteria for differentiation between intrahepatic and extrahepatic obstruction. In 70 99mTc-pyridoxylidene glutamate (PG) studies with verified diagnoses, the following scan patterns were found. (1) Normal: within 30 min of PG injection the scan reveals the liver, hepatic ducts, common bile duct, gallbladder and flow to the intestine; after 2 h the liver had a higher concentration of activity than the hepatic ducts or the common bile duct. (2) Complete extrahepatic obstruction: no hepatic excretion to the intestine is observed 18-24 h after PG injection, nor is activity observed in the hepatic ducts, common bile duct and gallbladder. (3) Incomplete extrahepatic obstruction: intestinal activity is observed within 18-24 h of PG injection; after 2 h the concentration of activity in the hepatic ducts or the common bile duct exceeds that in the liver (regardless whether activity is or is not demonstrated in the gallbladder). (4) No extrahepatic obstruction: serum bilirubin normal or increased; intestinal activity is observed within 18-24 h after PG injection, and activity is demonstrable during this period somewhere in the hepatic ducts, the common bile duct or the gallbladder; after 2 h the concentration of biliary activity should not exceed that in the liver. (5) If excretion to the intestine is observed within 18-24 h of PG injection without demonstrable activity in the hepatic ducts, common bile duct or gallbladder, then it is impossible to differentiate between (3) and (4).


Metastatic bone involvement in gynecological malignancies. 4 patients in whom ante mortem diagnosis of bone metastases was made, suffering from primary carcinoma of endometrium, cervix, ovary and vulva, respectively, are herein presented. The different routes of spread of these tumors, as well as a review of the incidence of bone metastases in gynecological malignancies are discussed.


[Cyclothymia and the brain stem. The question of symptomatic cyclothymia on the basis of observations in insufficiency of the basilar arterial system]. Seven patients with an insufficiency in the basilar arterial system showed a typical endogenous depression. We assumed that the temporal coincidence of neurological and psychial syndromes was not accidental but both were caused by a circulation disturbance in the cerebral stem structures.


Relationship between presumed etiological factors and clinical picture in 100 schizophrenic males. The schizophrenic syndrome, in one form or another is a result of combinations of genetic, organic and psychosocial factors. 100 schizophrenic males were studied and etiological factors such as schizophrenia or affective illness in direct relatives, brain damage or temporal lobe epilepsy, an over-protective parent or latent homosexuality were isolated. The findings show a relationship between these etiological factors and the clinical picture and course and an attempt is made to use the etiological factor in classifying schizophrenia.


Status within the family and early life experiences in patients with affective disorders and cycloid psychosis. The family constellation and early childhood experiences have been investigated in 534 in- and outpatients (21 male and 323 female). The series comprised the following diagnostic subgroups: bipolar (n = 195) and unipolar (n = 175) affective psychotic disorders, non-psychotic depressive syndromes (n = 94) and cycloid psychosis (n = 70). A 34-item questionnaire was constructed for the purpose of the present investigation relying upon information about meaningful variables in the relevant literature. Five main areas (status within the family, separation and loss, disturbing life experiences, acts of violence, and somatic factors) were covered in the study. Female patients have been found to be over-represented in regard to many variables. Few inter-group differences were found. This finding would suggest that negative, early childhood experiences are shared by most psychiatric patients and are not specific for any of the disorders which have been taken into account in the study.


[Psychic disturbances in patients with cervical intervertebral disk changes and cervical osteochondrosis]. The paper is concerned with the investigation of 51 patients with alterations of cervical intervertebral disks and cervical osteochondrosis who have undergone surgical intervention. The examination included a psychiatric interview as well as the application of paper pencil tests. Seventeen patients indicated symptoms of an endogenous depression. The group of depressed patients offered a significantly slow onset of cervical symptoms and, in the period after the operation, complained more often than the group without depressive symptoms. The psychological test revealed an increased tendency of inhibition and anxiety of the depressed group. Lastly, methodical problems are discussed concerning the evaluation of the lapse of psychic conduction as tension over a long period.


Can childhood schizophrenia develop out of hospitalism? Out of 59 childhood schizophrenics examined, 11 had fallen ill as early as within the first years of their lives. Seven of these had been confined to a hospital or a similar institution when the illness set in. Two other children were congenitally blind or deaf and, owing to this fact, were largely deprived of communication with their environment. It was possible to diagnose schizophrenia even though the patients were mentally retarded. It seems that lack of communication within the first years of life can not only produce mental retardation but also provoke childhood schizophrenia.


The Scandinavian concept of reactive psychosis, schizophreniform psychosis and schizophrenia. A diganosis commonly used in the Scandinavian countries, reactive psychosis, is described. Systematic personal follow-up studies from Scandinavia have clearly demonstrated that the clinical and social course is more favourable in this diagnostic group than in schizophrenia, while the course in schizophreniform psychoses in between. The Scandinavian concept of schizophreniform psychosis and of schizophrenia is presented and discussed.


[Simple method for producing 13NN and 15OO by proton bombardment of aqueous phase (author's transl)]. A simple method has been developed for the production of 13NN and 15OO by proton irradiation of aqueous solutions. 90 mCi of 13NN was obtained in a 200 ml. of He by using 1.0M NH4CI solution at pH 11 as the target with 10 min irradiation of 15 MeV, 10 microamperemeter protons. 80 mCi/min of 15OO was continuously obtained in a 200 ml of O2 by using pure water as the target with 40 MeV, 2 microamperemeter protons. The radiochemical purity of these short-lived radioactive gases obtained by this method was greater than 99.9% by passing through a single absorber.


Effect of addition of inorganic acids or alkalis on gelation of polyvinyl alcohol aqueous solution by gamma-ray irradiation.--Color development with iodine--. Below the critical concentration of polyvinyl alcohol, the effect of inorganic acids or alkalis on gelation of polyvinyl alcohol aqueous solution was investigated by color development with iodine after gamma-ray irradiation. The absorbances of the polyvinyl alcohol-iodine complex decreased remarkably in the presence of nitric or perchloric acid. These acids decompose and form oxygen or hydrogen peroxide which oxidize the polymer and leads to a fading of the color. On addition of sulfuric, phosphoric and hydrochloric acids, the absorbances decrease in the order that agrees with that of the acidity of these acids at the same molarity. In the alkaline solution the absorbances decrease by the addition of sodium hydroxide and aqueous ammonia in the order that agrees with that of the basicity of these alkalis. These results indicate that the gel formation is caused by the radiolysis of water. As a result of chemical analysis, these additives are considered not to be attached to the polymer.


[An evaluation of inhalation and perfusion scintigraphy with 81mKr (author's transl)]. As 81mKr is a radioactive noble gas which has a very short half-life of 13 seconds, it leads no environmental contamination in a laboratory room. Because of its low radiation dose in the human body, it had many merits in routine tests of the inhalation and perfusion scintigraphy, which were very useful extremely in infants, old men and severe patients in need of cooperation. The studies with 81mKr were, either, useful as a load test, since these could repeatedly readily, evaluate the ventilation and perfusion dynamics before and after administration of drugs and show the distribution of the ventilation and perfusion correspond to the various lung volume level.


[Duodenopancreatic lesions in abdominal injuries. Clinical and therapeutic considerations]. The frequency of duodeno-pancreatic lesions in abdominal or thoraco-abdominal trauma hospitalized in the surgery clinic of the Emergency Hospital from Bucharest between 1960 and 1975 was of 0.57%. In the present study are stressed the important factors which influence the outcome of the interventions (age, the interval from the accident to hospitalization and that from hospitalization to surgery). The causes are described, that have generated abdominal trauma with duodeno-pancreatic lesions the intensity and the extension, the localization of the lesions, as well as the importance of the association with lesions of other organs. An analysis is made of the interventions that have been made, in which the type of duodeno-pancreatic lesion was taken into account, as well as the variety of the procedure applied, from the simple draining of the pancreatic lodge, and of the peritoneal cavity, to complex interventions including exeresis of the duodenum or of the pancreas. To conclude the authors show that duodeno-pancreatic lesions are of considerable severity and are one of the causes of high mortality. These lesions also represent a serious test for the surgeon when one has to make a decision on the technique to be performed during the intervention. These lesions are also very demanding from the viewpoint of the surgeon's technical capability.


[Posterior (retrovascular) mediastinocervical goiters]. Three cases are presented of endo-thoracic goiters with posterior, retro-vascular developement, a very rare variety of the mediastino-cervical goiter. The anatomic pathways are described, along which this variety of goiter can migrate inside the thorax, as well as the radiologic signs which allow to make a diagnosis. In view of making a choice of the access route the importance of the diagnosis is particularly stressed, before surgery is attempted. It is also demonstrated that the best route is the vertical cervicosternotomy of the partial type (the Welti technique), completed by antero-lateral thoracotomy in the III-rd right intercostal space.


[Multiple colonic cancers: simultaneous and successive]. The authors attempt an approach of a controversial problem of contemporary surgery and stress the following significant aspects:--the frequency of multiple colon cancers is of 3%, approximately 25% of the cases being associated with benign proliferative lesions:--the intra-operatory diagnosis of multiple colon cancers is difficult (3 out of 12 cases); intrasurgical exploration may give rise to problems in connection with the insufficiency of the exploration, or the inaccessibility of unique tumors, thus existing the risk of leaving in place a developing tumor, that can be discovered at a new intervention (one case); the operability of multiple colon cancers is similar to that of the unique malignant lesions, depending on the extension, the variety and the focal distribution of the neoplastic lesions.


[The healing process of local lesions. Heterocollagen (Pancol) in the treatment of wounds]. Pancol is a drug used for dressing wounds, its activity sharply differing from that of other agents used for local treatment of wounds. It has an activating, regulating effect, permitting the natural processes to develop, without altering them. The results, often spectacular under clinical conditions, are explained by histologic-microscopic investigations. The multiple aspects of its effect, the complexity of the local biological phenomena to which an equivalent complexity in the action of the Pancol corresponds, demands competence and experience in its application.


[Urinary carcinoembryonic antigen in patients with urothelial tumors. Correlations with the stage of the disease and the modal chromosome number]. The carcino-embrionary antigen was estimated in 26 patients without malignant diseases (15 with inguinal hernia and 11 with urinary lithiasis--all of them before surgery), and in 47 patients with urothelial tumors. The direct radioimmune technique was used (a commercial kit from France /CEA IRE SORIN/) applied to isolated samples of sterile urine obtained at 12 hours. It was noted that:--patients without urologic disturbances had values under 1.5 micrograms in 12 hours in 93.4% of the cases;--in 44% of patients with non-malignant urological diseases (urinary lithiasis) the antigen values ranged between 1.5 and 3.0 micrograms in 12 hours;--patients with urothelial tumors had high values of the urinary carcinoembrionary antigen, in the range between 1.92 and 162.5 micrograms;--concentration of the urinary carcino-embionary antigen increases with the stage of the disease, with tumor polyploidia and in tumors with a high degree of anaplasia;--10--14 days after the removal of the tumor the values of the carcino-embrionary antigen show a significant decrease, even after total cystectomy but with cutaneous uretherostomy.


[Influence of small bowel resections on some aspects of digestive secretions in rat (author's transl)]. Some aspects of the digestive secretions both in intact rats (control group) and in rats with resection of 50% and 80% of the small intestine starting from ileocecal valve have been studied. In every animal, the volume of duodenal content, total content of bile salts and amylasic activity have been analysed under the following experimental conditions: fasting, feeding with two diets containing 4% and 20% of fat, and intravenous injections of pancreozymin (2 UI/kg). Total content of bile salts and amylasic activity decrease in resected rats under fasting and feeding. This decrease is greater when larger portions of the intestine are removed. Rats injected with pancreozymin react in a similar way. The amylasic activity decrease in the resected rats indicates a pancreatic hypofunction caused by the resection and cannot be compensated by administration of pancreozymin. Measurements of seric cholesterol show that a 50% resection causes a decrease form normal levels and a 80% resection makes it significant.


[Variations in electrocardiogram QRS-T (author's transl)]. The variations in QRS-T configurations in both standard and precordial leads from control rat electrocardiograms are analysed in this study. The durations of the above mentioned QRS complex, T and Q waves and the QT interval are also described. Many of the observed differences in rat electrocardiograms are due to a series of factors that may include recording equipment, anaesthesia used, dorsal or ventral position of the animal, age weight, sex and litter. The influence of all these parameters has been taken into account in the course of this research work. The electrocardiograms shown in this work were carried out as part of a project in which these patterns would later be compared with those obtained from rats in which ischemia has been induced by means of isoproterenol.


[Electrolytic and electrocardiographical correlations under 7% oxygen in nitrogen in dogs (author's transl)]. Electrolytic concentrations in plasma and electrocardiographic parameters in dogs have been studied by means of lineal and canonical correlations, after the animals have been submitted to 7% oxygen in nitrogen for three hours. At the end of hypoxia there appeared hypokalemia, increased T wave potential, low R wave and enlargement of ST segment and PQ interval. The coefficients of lineal correlation between Mg++ levels in plasma and R wave potential and those of Na+ and QRS interval were reversed at the final stages of hypoxia.


Alternance of states within the sleep wakefulness cycle. An approach to its study. Intrinsic and dynamic aspects of the sleep-wakefulness cycle (SWC) are studied. From a dynamic point of view, results indicate a tendency to maintain vigilance (alerta wakefulness-W-and drowsiness-D) or sleep (slow sleep-SS-and paradoxical sleep-PS). Transitions from vigilance to sleep are more probable than the reverse. Drowsiness plays an important role as a distributor stage in the SWC of the normal cat since the same probabilities of passing from it to W than to SS exist. Furthermore transitions from sleep (SS and PS) were more frequently observed to D than to W.


[Electrophoretic pattern and activity of lactate dehydrogenase in Discoglossus pictus (Otth) and Rana ridibunda (Pallas) skeletal muscle and heart (author's transl)]. The electrophoretic isozyme patterns, total and specific activity of lactate dehydrogenase on skeletal and cardiac muscles in Discoglossus pictus and Rana ridibunda have been studied. The isozymes were separated out in polyacrylamide gels. The LDH activity bands were developed selectively. The percentage of the H subunits are significantly higher in Discoglossus than in Rana, probably becuase Rana is subjected to more severe anaerobic conditions during the hibernation time.


[Hypophyso-gonadal function in infancy. From newborn to puberty (author's transl)]. Serum levels of testosterone, follicle stimulating hormone and luteinizing hormone have been measured in 216 healthy children (104 boys and 102 girls) divided in 9 groups from newborn to puberty. Testosterone serum concentrations were significantly higher in boys than in girls during the first 4 months after birth. Testosterone values were highest in 1 to 2 month old boys. Serum concentrations of both FSH and LH changed in different patterns in both sexes. During the first 4 years FSH concentrations were significantly higher in girls than in boys. During the first 4 months, however, LH concentrations were higher in boys than in girls.


[Effects of postural changes and volume depletion on renin-angiotensin system (author's transl)]. The effects of orthostatism and furosemide tests on different parameters of renin-angiotensin system have been studied in 14 normal human subjects.  Both tests produced a significant increase in plasma renin activity and plasma renin concentration. Plasma substrate concentration was slightly, but significantly, increased on the furosemide test. Plasma aldosterone rose in both tests, while aldosterone urinary excretion decreased after orthostatism and increased after furosemide.


[Granulopoiesis in mouse lymphatic nodes (author's transl)]. Granulopoiesis in lymph nodes of 4 to 12 days old mice is described. Granulopoietic activity is found mainly in the medullary cords around postcapillary venules, where granuloid cells in various stages of development can be observed.


[Myelopoiesis in lymph nodes of mice treated with trypan blue (author's transl)]. When mice are injected with trypan blue inside the peritoneal cavity immediately after birth, a delay of the lymphocyte colonization and an enhancement of the lymph node myelopoiesis are observed. In normal mice some granulopoiesis takes place in lymph nodes between 4th and 12th days after birth, but after trypan blue treatment granulopoiesis increases and erythroid colonies appear. These findings indicate that the blockade of RES enhances the hemopoiesis in lymph nodes.


Utilization of pyruvate, alanine and glutamate by isolated fat cells and their effects on glycerol metabolism. To study the metabolic interactions of different substrates in adipose tissue in vitro, isolated fat cells from fed rats were incubated in medium containing either (U-14C)-pyruvate, L-(U-14C)-alanine, L-(U-14C)-glutamate or (1(-14)C)-glycerol, and supplemented or not with 5 mM glucose or with non-radioactive pyruvate, alanine or glutamate (2 or 10 mM). The utilization of pyruvate for CO2 or fatty acid formation was greater than that of alanine and glutamate, both in the absence and presence of glucose. Glucose enhanced the formation of fatty acids from all the labelled substrates, decreased the synthesis of glyceride glycerol from pyruvate and glycerol, and enhanced it from alanine and glutamate. Pyruvate and glutamate enhanced the utilization of glycerol by the adipocytes and these effects were significantly reduced in the presence of glucose. Thus, the metabolic fate of the glycerol taken up by the cells varied according to the nature of the available substrates.


Effects of glucose on the metabolization of fructose and glycerol by isolated adipocytes from rat. Isolated white fat cells were incubated in medium containing (14C)-fructose (UL), supplemented with either 1 or 5 mM fructose, in the presence or absence of 5 mM glucose. The utilization of fructose for the formation of CO2, fatty acids or glyceride glycerol was very much dependent on its concentration in the medium. It was significantly inhibited by glucose only at fructose concentration of 5 mM. When the cells were incubated in the presence of (1(-14)C) glycerol, fructose produced a significant increase in the conversion of the tracer to CO2, fatty acids and glyceride glycerol, while glucose produced an increase in the formation of both CO2 and fatty acids, but a significant decrease of glyceride glycerol from the same labelled precursor. Glucose causes the effects of fructose, enhancing the uptake of labelled glycerol by the cells, to disappear.


[Modulating effect of the salivary glands upon differentiation and maturation of taste bud cells in the rat (author's transl)]. It is currently considered that the sensitive nerves of the papillary plexus are solely responsible for the normal differentiation of taste bud cells in the circumvallate papillae of the rat. The effect of syallectomy on taste bud cells was studied. Evaluation of results was performed through cell counts. The results demonstrate that the major salivary glands are quite important in both differentiation and maturation of taste bud cells.


Drug-induced contractile responses in the isolated posterior communicating cerebral artery of the cat. The isolated posterior communicating cerebral artery of the cat has been shown to have the ability to produce a contractile response to the following drugs; norepinephrine (NE), tyramine (Ty), 5-hydroxytryptamine (5-HT), histamine (H), acetylcholine (Ach) and potassium (K+). The changes in the contractile response were dose-dependent. The order of potencies of these vasoactive agents with respect to ED50 was: 5-HT greater than NE greater than Ach = H = Ty greater than K+. With regard to their ability to induce maximal contractile responses the order was: H = Ach greater than 5-HT = Ty greater than NE = K+. These results show that cerebral arteries are more sensitive to 5-HT than to NE, as opposed to extracranial arteries in which NE is generally the most potent vasoconstrictor agent.


[Larynx resistance produced by upper respiratory airways stimulation (author's transl)]. Larynx resistance changes during the respiratory cycle at rest and after mechanical stimulation of the epithelium on different zones of the upper airways (extrathoracic trachea, glottis, nasopharynx) were studied in the dog by isolated glottis in situ technique. In reposed breathing, the increase in larynx resistance always started when inspiratory airflow reached its maximum value. Resistance remained high during expiration and had its lowest value when expiratory airflow decreased towards zero. The electromyogram reading for the abdominal muscle evinced low or no activity during the smaller larynx resistance period. The extrathoracic trachea mechanical stimulation with cough response was determined by a significant decrease of larynx resistance. There was also a significant increase in expiratory airflow and abdominal pressure. Inspiratory and expiratory total lung resistance values were both significantly increased with regard to reposed breathing. Mechanical larynx stimulation determined reflexive closing of the glottis, expiratory apnea, minimal abdominal pressure. No potentials were formed in the expiratory abdominal electromyogram. The response was similar to a spontaneous swallowing. Larynx resistance reached its minimal value before the expiratory airflow reached zero. Mechanical nasopharyngeal stimulation significantly increased larynx resistance.


[Bronchopulmonary influences in larynx resistance (author's transl)]. Larynx resistance changes have been studied in the dog by means of in situ isolated glottis technique. Bronchiolar tone changed through isoprenaline and histamine administration, and after recurrent and vagus nerve bilateral section. Isoprenaline administration (0.1 mg/kg) was followed by larynx resistance decrease, expiratory duration increase, and expiratory abdominal pressure decrease with regard to respiration preceded by rest. Cough response by mechanical tracheal stimulation and glottis closing by larynx stimulation were abolished after isoprenaline administration. Histamine administration (0.1 mg/kg) was followed by larynx resistance increase, expiratory duration decrease, expiratory abdominal pressure increase, and expiratory abdominal pressure/maximum expiratory airflow relation increase. Larynx resistance decreased after recurrent nerve bilateral section, and increased later when vagus nerves were sectioned.


Prevention, diagnosis and treatment of carbon monoxide poisoning in an East-Slovakian ironworks. The development of industry brings an increase in number of industrial poisonings by carbon monoxide. To treat these the East-Slovakian Ironworks has organised preventive measures. Instructive cases are illustrated. Measurement of carbon monoxide--haemoglobin in the laboratory gives an objective index for the degree of poisoning and the progress of treatment. The authors used cobaltous nitrate (0.13 mol/l) for control of the method. The best treatment was found to be hyperbaric oxygen in combination with multi-vitamin treatment. In some cases cardiorespiratory and antibiotic treatment is also necessary.


Peracute and acute death from ischaemic heart disease within 4 days of onset of symptoms. Post-mortem examination was made of 136 patients who died of ischaemic heart disease from within a few minutes to 4 days after the onset to symptoms. Acute myocardial infarction was detected by means of the histochemistry of dehydrogenases in 102 cases (75%); in 34 cases(25%) no infarction was found, but the presence of coronary obstruction together with clinical symptoms justified the diagnosis of acute coronary insufficiency. Fifty-six of the infarctions occurred within 2--3 h after the onset of ischaemia, 24 within 4--5 h, 12 within 6--24 h, and 10 within 1--4 days. The chances of recovery increased if the patients survived for 24 h. The period of 5 h after the onset of ischaemia appeared especially important; 80 of 102 patients with acute myocardial infarction died during that  period. Thirty-one of 34 patients with acute coronary insufficiency and 60 of 102 patients with acute myocardial infarction died peracutely, i.e. within a few minutes to 2 h after the onset of symptoms. In the patients of the latter group the onset of symptoms must have been delayed, otherwise none of these patients could have appeared in the category of peracute death. This delay was more obvious in the patients with acute myocardial infarction localized in the area supplied by the left descending artery. The occurrence of peracute deaths could not be correlated witha particular localization of area of infarction. The causes of coronary obstructions and the role of dynamic disturbances of coronary perfusion in the pathogenesis of coronary insufficiency and myocardial infarction and discussed.


Effects of dopamine on haemodynamics and myocardial energetics in man: comparison with effects of isoprenaline and L-noradrenaline. The effects of dopamine (DOPA) on haemodynamics, coronary blood flow and myocardial oxygen requirements were compared with those of L-noradrenaline and isoprenaline (isoproterenol) in patients after open-heart surgery, performed because of mitral valvular and congenital heart disease. The patients were in low cardiac output state but not in shock. DOPA increased heart rate less than isoprenaline, averaging 22 and 31 beats/min, and was less arrhythmogenic. DOPA increased mean arterial pressure by an average of 7 mmHg, whereas isoprenaline had little effect; noradrenaline uniformly increased all measurements of arterial pressure. DOPA and isoprenaline increased cardiac index by an average of 1.01 and 0.94 1 min--1 m--2; noradrenaline did not significantly improve peripheral perfusion. DOPA and isoprenaline decreased systemic vascular resistance by an average of 465 and 549 dynes s cm--5; noradrenaline increased resistance in all patients. For similar cardiac outputs average urine flow increased more with DOPA (75 ml/h) than with isoprenaline (28 ml/h). DOPA increased coronary blood flow and myocardial O2 consumption by an average of 28 and 3.60 ml min--1 100 g--1, noradrenaline by 16 and 1.93 and isoprenaline by 62 and 4.25 ml min--1 100 g--1 respectively. Arterial--coronary sinus O2 differences remained unchanged (normal) with DOPA and noradrenaline and decreased with isoprenaline on average by 1.10 ml/100 ml. Myocardial lactate utilization was normal before and during catecholamine administration. It is concluded that, in its haemodynamic effects, DOPA is intermediate between noradrenaline and isoprenaline. The effects of DOPA on coronary blood flow and myocardial O2 consumption are closer to those of noradrenaline than of isoprenaline. DOPA increase coronary blood flow according to myocardial metabolic demand; it is not a potent primary coronary vasodilator. DOPA, although increasing myocardial O2 consumption more than noradrenaline, is by far less O2-demanding than isoprenaline. DOPA appears to be the superior vasoactive agent among the three catecholamines for the treatment of low cardiac output state in patients with preserved coronary reserve.


Effect of haemodilution on experimental cerebral oedema in cats. The effect of haemodilution with Dextran 60 on experimental cerebral oedema produced by the modified method of Ishii, Hayner, Kelly & Evans (1959) is described. The intracranial pressure was measured from the cisterna magna or epidurally in the parieto-occipital region. In the group of cats subjected to haemodilution, with a haematocrit of 27.20 +/- 1.48%, the intracranial pressure first increased by 500% and, after 1.5 h, began to fall gradually so that at the end of the experiment it was only 160% of initial value. In the other experimental group in which haemodilution with a haematocrit of 27.40 +/- 1.14% was started after 6 h of the experiment, the intracranial pressure gradually fell for the next 6 h from 350% of initial value of 200% of initial value after 12 h. It was concluded that haemodilution slows down the development of cerebral oedema, and can be employed in the treatment of fully developed oedema.


Problems of continuous Pa, O2 monitoring by means of indwelling intra-arterial electrodes. Continuous monitoring of intra-arterial PO2 has many advantages in intensive care. However, there are some problems which have prevented the routine use of this method until now. A commercially available polarographic oxygen electrode was tested in vitro. Continuous PO2 monitoring was performed in vivo in 63 adult patients. The electrode is suitable for intensive care with regard to handling, dimensions, biocompatibility, mechanical stability, electrical safety, sensitivity, flow dependency, response time and costs. It should be improved with regard to the instability of the measuring properties and its non-linearity in hyperoxia. Serious complications of continuous PO2 monitoring were not observed. In view of the specific properties of the polarographic electrode and the contraindications of arterial cannulation, the continuous intra-arterial PO2 measurement has proved to be a valuable, safe and simple technique of monitoring, especially for short-term changes of arterial PO2.


Cutaneous respiration in seven sea-water teleosts. The oxygen consumption of excised skin (MO2 is.cut.) and the normal cutaneous oxygen uptake by the skin in situ from the external medium (MO2 ext.cut.) were investigated in seven species of teleosts in normoxic sea water: butterfish (Pholis gunnellus L.), cod (Gadus morhua L.), five-bearded rockling (Ciliata mustela L), shanny (Blennius pholis L.), flounder (Platichthys flesus L.), sole (Solea solea L.) and eel (Anguilla anguilla L.). In the butterfish, cod and rockling, all the oxygen absorbed by the skin is consumed by the skin tissue itself, whereas in the other species there is a net inward transcutaneous oxygen flux. The gain of oxygen through the skin is obtained either by a low MO2is.cut. (shanny, flounder) and/or by high MO2ext.cut. (sole and eel). The blind side of the sole is particularly efficient in oxygen uptake. The results are discussed in relation to the biota of the different species.


Role of H1 and H2 receptors in increased small airways resistance in the dog. The relative importance of H1 and H2 receptors to central and peripheral airways resistance in the anesthetized intact dog lung were determined through the use of pharmacologically specific antagonists during graded intravenous infusions of histamine. The indirect effects of infused histamine were also tested via alpha and beta adrenergic blockade (alpha + beta blk) and post-ganglionic parasympathetic blockade (vagal blk). We measured pulmonary resistance (RL), dynamic compliance (Cdyn), thoracic gas volume (Vtg), and partitioned oscillatory pulmonary resistance (RLosc) into a peripheral (Rp) and central component with an intrabronchial catheter. Infused histamine caused a significant increase in RL, primarily the result of the increase in Rp, with substantial dose-dependent reductions in Cdyn, and increases in Vtg. These effects were not altered by vagal blk, were increased by alpha + beta blk, and were completely prevented by H1 receptor blockade, but not by H2 receptor blockade. We conclude that histamine infusion causes bronchoconstriction in the canine lung, primarily in peripheral airways (less than 3 mm diameter), by its direct action on H1-type receptors.


Even distribution of 133Xe bolus inhaled at residual volume in healthy subjects. We selected from among 46 healthy students (22 to 31-yr-old) 7 subjects (group A) in whom the normalized height of phase IV (height of phase IV/phase IIIx100), after inhaling a bolus of He at RV, was very small (10%). We compared them with 6 subjects (group B) selected on the basis of a tall phase IV (78%, A vs. P P less than 0.005). Age and height were comparable, but weight was lower (P less than 0.05) and RV/TLC ratio (but not other spirographic indices) was larger (P less than 0.025) in group A. The average amplitude of cardiac oscillations was 4 times higher in group B (P less than 0.005). He closing volume, but not closing capacity was less in group A (P less than 0.05). A bolus of 133Xe inhaled at RV was nearly uniformly distributed in group A while producing a large vertical gradient in group B. The difference between groups A and B may reflect a difference in the mechanical properties of the chest  wall leading to a less complete empting of the lung in the former group.


Laryngeal effects and respiration in the suckling opossum. Electromyogram (EMG) activity of the posterior cricoarytenoid (PCA muscles were active, but was otherwise closed. Larynx closure may contribute to the end-inspiratory pauses often observed in the intact animal. During inhalation of an asphyxiant test gas in place of room air, PCA and diaphragm activity generally increased; and increases in anesthesia decreased the EMG activity of both muscles. Water on the larynx transiently abolished both PCA and diaphragm discharge; but EMG activity returned to the PCA muscles before the diaphragm. Further, reactivation of the diaphragm was not always accompanied by a synchronized burst of PCA activity. Therefore, it is possible under some conditions to dissociate the motor outputs from the PCA muscles and diaphragm in this immature mammal.


Chest wall configuration in supine man: wakefulness and sleep. We measured the anteroposterior and lateral diameter of the rib cage (RC), the anteroposterior diameter of the abdomen (ABD) and the cranio caudal abdominal dimension during breathing in supine posture, in order to analyze the shape of the chest wall in both awake and sleep conditions. By comparing the active breath holding and relaxation curves, it appeared that during activity of the respiratory muscles the RC is both expanded and distorted at the highest volumes and mainly distorted at the lowest volumes. During sleep the abdominal protrusion is smaller and the lateral sides of the rib cage expand more than during wakefulness. This might explain the higher rib cage motion during sleep found by some authors who measured the rib cage circumference and not confirmed by others who measured only its anteroposterior diameter. The motion of the rib cage is similar during sleep and wakefulness, its lateral parts leading the anteroposterior ones, showing that the pattern of motion of the rib cage is not affected by the different activation of the respiratory muscles. The possibility of a distorsion within the front part of the rib cage has been also discussed.


Influence of the CSF bicarbonate concentration on the ventilatory response to CO2 in relation to the location of the central chemoreceptors. In anaesthetized cats, in which the cerebrospinal fluid bicarbonate concentration was varied by a ventriculocisternal perfusion technique, the ventilatory response to CO2 during hyperoxia could be satisfactorily described by VE = S(PCSFCO2 -B). Both the slope S and the intercept B were positively and linearly related to the CSF bicarbonate concentration. Assuming that the PCSFCO2 is equal to the PCO2 in extracellular fluid, it can be shown that VE is a linear, but not a unique function of the [H+] at the site of the chemoreceptors; the slope of this relation varies with the bicarbonate concentration at that site, possibly due to chemical complex formation between HCO-3 and Ca2+ or Mg2+. Changes in the B-value were related to the location of the central chemoreceptors with the models of Pappenheimer and Berndt aand their coworkers. It was found that changes in the CSF bicarbonate concentration are reflected for 60 per cent at the site of the central chemoreceptors, and that this was independent of the cerebral perfusion. Using Berndt's model a distance between CSF and central chemoreceptors of approximately 100 micron was found; this calculated distance is relatively insensitive to relationship (logarithmic or not) between ventilation and H+ concentration and to changes in cerebral perfusion, owing to the approximate nature of the diffusion model.


Are avian intrapulmonary CO2 receptors chemically modulated mechanoreceptors or chemoreceptors? Openings of paleopulmonic parabronchi in paralyzed, unidirectionally ventilated geese were photographed through small holes in the birds' mediodorsal secondary bronchi during single-unit recording from intrapulmonary CO2 receptors. Changes in the discharge frequency of the receptors as fractional CO2 concentration of ventilating gas was alternated between 0 and 0.05 were compared with the changes in cross-sectional areas of randomly selected parabronchial lumina. Intrapulmonary CO2 receptors, similar to those found in other avian species, are also present in geese. Changes in intrapulmonary CO2 concentration greatly influenced the discharge of these receptors but did not induce movement of parabronchial smooth muscle in this region of the lung. If most of the receptors are located in the paleopulmonic parabronchi, as currently appears to be the case, we must conclude that changes in receptor discharge in response to changes in intrapulmonary CO2 concentration do not result from mechanical distortion of the receptors induced by smooth muscle contraction; intrapulmonary CO2 receptors appear to be true chemoreceptors.


Quantitative anatomy of the lungs of the red-eared turtle, Pseudemys scripta elegans. Morphometric and sterological methods were employed to evaluate the anatomical gas-exchange potential of the lungs of the fresh-water turtle, Pseudemys scripta elegans. The total lung volume and lung wet weight increase with the 1.4 power of body weight. Right and left lungs are similar in size and shape, containing a tissue-free central lumen, which occupies 55 per cent of the maximally inflated lung. The remainder is parenchyma, composed of 90 per cent air and 10 per cent tissue, with an effective surface-to-volume ratio of 18 cm-1. The anatomical diffusion factor (ADF), or the ratio of respiratory surface area to mean diffusion distance in lung tissue, is 1 order of magnitude lower than in the mammalian lung. Taking interspecific differences in O2 consumption into account, the degree to which the lungs are exploited, deltaPtO2, is similar in Pseudemys and in mammals at basal, resting and exercising states.


Gas exchange in the carp gills in normoxic and hypoxic conditions. Respiratory exchange measurements in a teleost fish, Cyprinus carpio, in normoxic and hypoxic conditions are presented. Oxygen pressure in the dorsal aortic blood in normoxic carp was much lower than that in most of teleosts and elasmobranchs in similar conditions. The most evident physiological adjustment to the hypoxic condition was the increased ventilation due to an increased frequency of operation of the branchial pump. Increased perfusion at the gills played a small role in the physiological adjustments.


Stratification of inspired air in the elongated lungs of the carpet python, Morelia spilotes variegata. Using lung gas tensions via a triple lumen catheter to monitor ventilation distribution (VA) and radioactive techniques to study blood flow distribution (Q), the distribution of ventilation to perfusion ration (VA/Q) was studied in the elongated alveolar lung of the Carpet Python, Morelia spilotes variegata. In the resting, sleeping and agitated states both alveolar oxygen (PAO2) and carbon dioxide tensions (PACO2) were 'stratified' (unevenly distributed) within the alveolar lungs at end inspiration, during breath holding for up to 6 minutes and, when VA was low, at end expiration. The blood flow was also stratified. The degree of stratification of VA was influenced by the rate and depth of breathing and the length of the breath hold which preceeded the gas sampling. Similar results were obtained with a glass lung model. In both resting and sleeping states VA/Q ratios were similar over the proximal 75% of the alveolar lungs whereas VA nearly always exceeded Q over the distal 25%. The anatomic features of the lung are proposed as a possible mechanism for maintaining a uniform VA/Q distribution. Since the anatomical arrangement places the heart at the apical regions of the lungs, absence of cardiac mixing, combined with low respiratory rates, enables stratification to continue for very long periods within the aveolar lungs of the snake.


A reappraisal of boundary conditions assumed in pulmonary gas transport models. Solutions of the classic pulmonary gas transport equation are presented in which a true 'no-flux' boundary condition is specified throughout the respiratory cycle. For the particular models studied it is demonstrated that diffusive mixing is incomplete at end expiration, and that such stratified inhomogeneities give rise to a realistic alveolar plateau for a simulated N2 washout test. The reasons for the disparity of the present findings with those obtained by contemporary workers are explained by critically examining the boundary conditions conventionally assumed at the alveolar wall.


Respiration in man affected by TVR contractions elicited in inspiratory and expiratory intercostal muslces. Vibration-induced effects on respiration in man were studied by recording the electrical activity (EMG) from the intercostal muscles and the diaphragm. The vibration was applied in an upper thoracic region where inspiratory muscle activity prevailed or in a lower thoracic region where expiratory muscle activity prevailed. The effects were also studied by recording the movements of the thorax and the respiratory air flow. Sustained vibration in the upper region enhanced the activity of the underlying inspiratory muscles and caused an expansion of the rib cage whereas it had little or weak effects on diaphragm-activity or on expiratory intercostal muscles. Sustained vibration in the lower region enhanced the activity of the underlying expiratory muscles, often inhibited the inspiratory activity and caused a depression of the rib cage. It also tended to inhibit the diaphragm activity. It was also found that bilateral vibration, timed by the respiratory movements and alternating between upper and lower regions could aid or counteract the ventilation if it was applied respectively 'in phase' or 'out of phase' with the rhythmical contractions in the underlying muscles. The motor responses described are largely explicable in terms of tonic vibration reflexes (TVR) arising in the inspiratory and expiratory intercostal muscles underlying the vibrators.


Ventilatory response to CO2 in birds. I. Measurements in the unanesthetized duck. Ventilation and blood gases were measured in unanesthetized ducks at various levels of inspired CO2 partial pressure (PICO2). Ventilation was markedly augmented with increasing PICO2, whereas arterial and mixed venous PCO2 stayed essentially constant up to a PICO2 of about 20 torr and changed only slightly between that and the highest level tested (34 torr). After carbonic anhydrase had been blocked, blood PCO2 was elevated at all levels of PICO2 but the ventilatory response to increases in PICO2 were attenuated. The response to CO2 in the normal bird (before administration of acetazolamide) shows similarities to that in mammals. Qualitative differences between both classes of vertebrates after blockade of carbonic anhydrase may, however, suggest differences in their systems that control ventilation.


Ventilation response to CO2 in birds. II. Contribution by intrapulmonary CO2 receptors. The CO2 sensitivity of intrapulmonary CO2 receptors (IPC) in the duck was studied, before (Control) and after blockade of carbonic anhydrase by Diamox, by recording single unit afferent activity in the vagus nerve. During Control, IPC activity decreased with increasing airway CO2 concentration. After Diamox administration, the discharge from IPC was higher at all levels of airway PCO2, and the receptors' CO2 sensitivity was markedly attenuated. Comparing these results with measurements on ventilation and blood gases of the duck under similar experimental conditions (Powell et al., 1978b) suggests that IPC play a role in the adjustment of ventilation to altered concentrations of inspired CO2; IPC may thus be a significant component in the control of breathing under physiological conditions.


[Sex-linked hydrocephalus: anatomical study (author's transl)]. Anatomical study of the brain of a boy with sex-linked hydrocephalus (Bickers and Adams, 1949) reveals complex malformations with agenesis of interhemispheric commissures, but without aqueduct stenosis. Discussion of these findings and of the relevant literature leads to the conclusion that, in this condition, hydrocephalus may be a primary consequence of brain malformation, and aqueduct stenosis, if present, a secondary phenomenon.


[Eales's disease with neurological involvement (author's transl)]. A moroccan male aged 26, with Eales's disease since 6 years, develops a low thoracic level paraplegia over 2 months. Examination then also points out an horizontal nystagmus. CSF changes are important: 292 cells/mm3 (96 p. 100 lymphocytes), 3,80 g/l proteins. Slight improvement is obtained by corticosteroid therapy. This case is compared with those of the literature, mostly myelopathies. The pathogenetic problems of immuno-allergic type are discussed.


[A test of progressive enrichment of visual information (results in 102 patients with cerebral lesions) (author's transl)]. A new test is reported in which probabilistic activity is imposed on the subject in order to identify the visual stimuli presented to him. The test was validated in 109 normal subjects. When applied to 102 patients with focal cerebral lesions it demonstrated that all lesions of the right hemisphere provoked erroneous or delayed responses and that only lesions in the left occipital region produced the same effects.


Quantitative histology of the normal sphenoidal sinus. From 32 normal sphenoidal sinuses in 16 patients the mucosa was removal at autopsy, stained by the PAS-alcian blue whole mount method, and the density of goblet cells as well as of mucous glands was determined. The median density of goblet cells was 6200 cells per mm2, without statistically significant differences between the walls. The median density of glands was very low, 0.06 gland/mm2, highest in the anterior wall which has 0.1 gland/mm2 and lowest in the posterior wall which has 0.05 gland/mm2. The total gland count was less than 50 in 94% of the sinuses, 51--80 in 4%. The glands were small, tubulo-acinous. Hence, the production of mucus by the glands is entirely negligible in relation to that of the goblet cells.


Acute necrotizing rhinitis in man.

Acute necrotizing rhinitis in man. The clinical picture and the course of the acute necrotizing rhinitis in man is described in its different stages. Necrotizing rhinitis seems to be a significant factor in the etiology of some disturbances of the nasal respiratory function and of the ciliary activity of the nose, of atrophic rhinitis and of dry pharyngitis, in some cases of intranasai adhesions and of permanent mucosal defects of the septum. To our knowledge these defects have not been reported in the literature in the past, but are apparently not too rare.


The effect of breath holding, hyperventilation, and exercise on nasal resistance. A group of 51 patients was studied by a technique of active posterior rhinomanometry that assessed the influence of breath holding, hyperventilation, and exercise on nasal resistance. Breath hodling of 30 seconds or longer produced a decrease in nasal resistance in most of the subjects tested. Hyperventilation had variable effects on nasal resistance, and exercise consistently decreased nasal resistance. These observations are consistent with the proposed effect of chemoreceptor stimulation on nasal airway resistance.


[Duplication of the anus and rectum in an adult. Report of 1 case]. It is reported a case of duplication of the anus and rectum. A 48 year old man, had two functioning rectae, one ending in its normal anatomical topography and the functioning but nor functional supernumerary rectum exteriorized in the left gluteal region trough a rudimentary anus. Histological studys demonstrated a rudimentary sphincter in the ectopic anus, and focal carcinamotous transformation of one of the four adenomatous polyps, encountered protruding through the normally located anus. The anal anomaly was associated with partial agenesis of the sacrum, absence of coccyx, sacral anterior meningomyelocele and hypoplasia of the twelve right rib. The frequency of the anomaly, its histology and embriology, as well as its classification within the malformations of the terminal gut, were revised in the medical bibliography. It is concluded that this type of anomaly has not been classified or describe, before.


[Esophageal moniliasis].

[Esophageal moniliasis]. Esophageal moniliasis is found rarely. It has been described mainly in chronically ill patients, who receive antibiotics and corticoesteroids. Early diagnosis and treatment betters their prognosis. Nine patients, 5 males and 4 females were studies in Hospital General del Centro Medico Nacional in Mexico City. Their agesranged from 26 to 77 years, with a mean of 49 years. All patients were chronically ill and 7 of them were treated in the intensive care unit. Three had disphagia, 3 retrosternal pain, and 2 gastrointestinal hemorrhage. Eight patients had high W.B.C., 3 irregular filling defects on X ray studies, and on endoscopy, all showed a pseudomembranous white yellowish exudate, underneath it the mucosa was inflamed, irregular and bled scantily. In 5 out of 9 patients biopsy and a smear confirmed the diagnosis. Eight patients treated with nystatin were cured. This disorder must be suspected in patients with disphagia and retrosternal pain; esophagoscopy is the prefered procedure to establish this diagnosis.


[Meso-renal derivation. A surgical alternative in the treatment of portal hypertension]. Meso-renal shunt (MRS) has been designed for patients with biliary cirrhosis and portal hypertension, in whom the derivation of the portal flow must be done prior to the biliary surgery. We performed the MRS in five patients. In three due to secondary biliary cirrhosis, one case due to criptogenic cirrhosis and the last presenting cavernomatous degeneration of the portal vein. After the MRS one patient died 33 days later due to acute liver failure and hepatorenal syndrome. Of the survivors three are enjoying normal lifestyle, one of them was underwent colecistectomy and coledocostomy without any surgical problems. One patient was lost to follow up out presenting at that time chronic porta-systemic encephalopathy. When necessary the MRS may offer a satisfactory choice, since can be performed far from the subhepatic area, thus allowing to perform further biliary surgery.


[Clinical radiographic features of basilar impression (author's transl)]. After a review of the literature and an analysis of the clinical and radiographic features of basilar impression (b.i.) the authors describe 27 personal cases. In 6 b.i. was present in its pure form and in 21 it was associated with other anomalies at the cranio-vertebral junction. Because of the frequent misdiagnosis with multiple sclerosis or other chronic neurologic diseases and because of the possible improvement of symptoms following decompressive occipital craniectomy and cervical laminectomy, the importance of a correct and complete radiographic study of the cranio-vertebral junction in these cases is stressed.


[Studies of the expectancy wave (CNV) in patients with interruption of the thalamo-prefrontal interconnnection pathways caused by psychosurgical prefrontal lobotomy operations]. Frontal and vertex CNVs were studied in 8 selected nonschizophrenic patients subjected to unilateral or bilateral extensive prefrontal lobotomy. The dorsomedial thalamo-frontal pathways had been severed and their regeneration must be considered impossible. Standard CNV task (S1-S2-R) was followed in order to elicit CNVs from the frontal areas anterior to the line of sections and at Cz. In 7 out of 8 patients it was quite easy to evoke CNV with almost normal features and equal latencies in each case from all the cortical areas explored. These results show that CNV formation is not grossly altered in the prefrontal areas which have been irreversibly deprived of normal bi-directional mediothalamic-frontocortical connnections. This suggests that the role of the dorsomedial thalamo-frontal pathways are not essential in the genesis of the frontal CNV in humans. These findings would suggest that the CNV is a diffuse electrical event essentially related to a unitary cerebral process mediated fundamentally by nonspecific ascending meso-diencephalic reticular systems. The differences in morphology and polarity of the CNVs detectable in various brain structures are presumably related to their intrinsic anatomo-functional characteristics and to the method commonly utilized in recording the CNV.


Radioimmunoassay of 8-arginine-vasopressin (antidiuretic hormone) in human plasma. A radioimmunoassay for 8-arginine-vasopressin (AVP) measurement in human plasma has been developed and evaluated, using a commercial preparation of an antibody of AVP. Detection limit of the assay was 0.4 pg. A simple acetone extraction procedure gave a recovery of 65% of added [125I]AVP. The overall sensitivity in the assay was 1.0 pg/ml when 2 ml plasma samples were extracted. The antigenic sites of the employed antibody seemed to be a combination of amino acid residues in the tripeptide tail and the pentapeptide ring. This can explain that the antibody was almost completely insensitive to chemically or enzymatically degraded AVP. The inter-assay coefficient of variation for the control plasma pools averaged 17%. A good correlation to plasma osmolalities above 290 has been found. AVP level in recumbent subjects (n = 8) with plasma osmolalities in the normal range was 2.8 +/- 1.0 pg/ml (mean +/- SD) and in ambulatory subjects (n = 10) on ad lib. water intake 4.5 +/- 1.9 pg/ml (mean /+- SD).


Cardiac effects of thoracic epidural analgesia before and during acute coronary artery occlusion in open-chest dogs. The effects of thoracic epidural analgesia (TEA) on myocardial performance and metabolism and on the severity of an acute myocardial ischaemia, were studied in eight anesthetized open-chest dogs. TEA reduced mean arterial blood pressure (AP) by 26%, heart rate (HR) by 20%, left ventricular dP/dt by 37%, and myocardial oxygen consumption by 27%. Although arterial concentrations of free fatty acids, glucose and lactate were unchanged, their myocardial uptake was reduced in proportion to the reduction in mechanical activity of the heart. Acute ischaemic injury was estimated from epicardial ECG recordings 10 min after occlusion of a branch of the left anterior descending coronary artery. In seven of eight dogs TEA caused a substantial reduction in the severity of the acute myocardial ischaemic injury. In the eight dogs investigated, the sum of ST segment elevations in epicardial ECG recordings was reduced from 34.0 +/- 3.4 to 23.3 +/- 2.8 mV (mean +/- SEM, P less than 0.01). After restoration of AP and HR to control values with phenylephrine and atrial pacing, the favourable effect of TEA on myocardial ischaemic injury was abolished. It is concluded that TEA effected a reduction in the severity of myocardial ischaemia in open-chest dogs, mainly through reduction of myocardial mechanical activity with consequent reduction of myocardial metabolism.


Reproducibility of work performance at serial exercises in patients with angina pectoris. The reproducibility of serial upright exercises in patients with ischaemic heart disease was tested. Five short term exercises (4--8 min) with continuous load increase and with 30 min rest intervals between tests were used. No tendency to change was found concerning work time to appearance of angina (APT), maximal working time (MWT) or time for disappearance of angina after exercise (DPT). The coefficient of variation was low for APT and MWT but considerably higher for DPT, being 9, 5 and 27%, respectively. MWT was considered as the end-point of choice. The ST depression at MWT showed no tendency to change and the variation was moderate (14%), while at APT and DPT the variation was high (52%), but, likewise, with no tendency to change. The maximal heart rate increased slightly and significantly (P less than 0.001), while the maximal blood pressure was constant throughout tests, thus the maximal rate pressure product tended to increase. This indicates a slight improvement of the myocardial performance at serial exercises, which, however, does not affect the reproducibility of the anginal reaction.


Exercise energy expenditure in extreme obesity: influence of ergometry type and weight loss. Bicycle and treadmill exercise tests including oxygen uptake (VO2) and heart rate (HR) determination were carried out on a total of thirty patients with obesity, seventeen of whom were reinvestigated after weight loss. During both types of work VO2 for a given load was higher when compared to healthy controls. The increase of VO2 was more marked when cycling was performed in sitting position than in supine. The mechanical efficiency of sitting bicycle exercise averaged 17.8% and was negatively related to the percentage overweight; the slope of the VO2/load regression line was slightly less in comparison to the controls, while no such difference was found during treadmill walking. After weight reduction the VO2/load regression line was skifted downwards, the slopes being unchanged, thus the mechanical efficiency improved. This study not only confirms the observation of a low mechanical efficiency of obese subjects but also demonstrates that the change is quantitatively related to the overweight. The lowered efficiency was caused by body mechanical factors and there was no support for an abnormal muscular efficiency. Exercise tests should be combined with VO2 determination, if used to assess the circulatory capacity of obese subjects.


Prevalence of primary Raynaud phenomena in young females. A questionnaire concerning Raynaud's phenomenon was sent to eighty-five females (aged 21--50 years) working as physical therapists at municipal hospitals in Copenhagen. Fifteen of sixty-seven healthy young females (22%, 95% confidence limits 13--34%) were classified as having Raynaud phenomena in its primary form. Twenty-four persons underwent a detailed clinical investigation with measurement of blood pressure at the arm and fingers with cuff techniques. Cold provocation test on one finger was carried out after moderate body cooling. Of eight subjects being classified from the questionnaire as having Raynaud phenomena, six showed closure of the digital arteries at the local cold provocation, and all had an exaggerated response. A group complaining of cold fingers showed a greater reduction in finger blood pressure during local cooling than the normal group, but none showed closure. A questionnaire can separate the groups if Raynaud phenomena is defined by appearance of white and dead fingers on cold exposure with frequent cold or bluish fingers.


Raynaud phenomena and finger systolic pressure during cooling. Finger systolic pressure (FSP) can be measured after finger cooling with a water perfused double-inlet-plastic cuff on the midphalanx of a finger and a mercury-in-rubber strain gauge on the outer phalanx. After finger cooling to 20, 15 and 10 degree C eighteen females with primary Raynaud phenomena had a significantly greater reduction in FSP than twenty-two normal females, but only eleven of the eighteen females (60%) with Raynaud phenomena showed digital arterial closure. Standardized body cooling for 20 min before finger cooling enhanced the reaction in both groups. As only females with Raynaud phenomena showed digital artery closure, the diagnostic value of a combined finger and body cooling test in primary Raynaud phenomena is high. The reproducibility of the test is acceptable.


Plasma C-peptide in uraemic patients.

Plasma C-peptide in uraemic patients. The kidney has been suggested as the main organ for the degradation of C-peptide. This hypothesis was tested in subjects with normal fasting blood glucose concentration and varying degrees of renal failure. Forty-nine subjects with endogenous creatinine clearance ranging from 0--25 ml/min were studied. The basal steady state concentrations of C-peptide (CP) and the immunoreactivity of insulin (IRI) were determined in plasma from fasting patients. The average IRI was similar to that found in normal subjects while a higher CP was found in all patients but two. The average CP in the nephrectomized patients was six times higher than the mean CP in normal subjects (0.35 pmol/ml). There was a significant inverse correlation between clearance and CP (r = 0.51, P less than 0.001) with the highest CP in nephrectomized patients. It is concluded that the increased CP in renal failure, and especially the markedly increased CP in the nephrectomized group supports the hypothesis of the kidney being the organ mainly responsible for the degradation of C-peptide also in man.


Simultaneous blank correction in a turbidimetric continuous flow system for immunochemical quantitation of plasma proteins. By shortening the reaction time by polymer enhancement, it was possible to introduce a line for automatic blank correction in a turbidimetric continuous flow system. The turbidity resulting from the reaction was measured by a simply constructed photometer, the serum turbidity being subtracted by the reference photoelectric cell and the resulting net signal amplified by means of the recorder's stepwise electronic amplifier. Serum transferrin values obtained by this method correlated well with values obtained by estimating blank in separate runs, and with values given be electroimmune assays.


Intravital microscopy of the microcirculation in man during and after experimentally controlled ischemia. In man, using a skin tube chamber technique, microvascular reactions during and after complete experimental ischemia was studied by intravital microscopy. During 1 and 2 hour ischemia the trapped blood cells did not adhere to each other or to the vascular walls except for RBCs which formed rouleaux. Reflow after 1 and 2 hour ischemia was rapid with a hyperemic reaction and a transient increase in WBC stickiness. Thus, a mild and reversible inflammatory reaction was provoked by the short ischemic insult. During 6 hour ischemia most of the blood cells maintained their integrity. However, in a few vessels the RCSs formed homogeneous masses indicating hemolysis of some of the RBCs. There was also marked diapedesis of RBCs and increased WBC stickiness, but the platelets did not react to form thrombi. After the 6 hour ischemia reflow occurred in all vessels and the homogeneous masses seemed to cause only a temporary hindrance to reflow. The final outcome of the 6 hour ischemic insult was uncertain since in one of the two experiments there was a complete circulatory standstill 24 hours after the ischemia while in the other there was an almost normal blood flow.


Preliminary report on experimental free autografts of skeletal muscle to the myocardium. In three greyhounds, free grafts of pronator teres muscle from the foreleg were applied to the left ventricular myocardium, and showed successful gross and microscopic survival of the graft six months later. The free grafts of skeletal muscle were transplanted as complete muscle bellies two weeks after preliminary denervation by median nerve neurectomy, and at the time of suture to the myocardium, the central end of the divided left phrenic nerve was implanted into the graft. The animals were normally active and preserved normal electrocardiograms after grafting. The use of such grafts in clinical cases of generalized myocardial degeneration or major infarct is considered.


The healing process of transplanted digital tendon sheath synovium. Experimental autoradiographic studies in chickens. The present investigation is a sequel to a previous report on the composition and fate of the pseudo-sheath formed by secondary healing, and of free tendon sheath autografts covering defects in the digital tendon sheaths of chickens (Eiken & Rank, 1977). Autoradiography was used to determine graft survival and cell regeneration. The distribution of labelled cells indicated that the granulation tissue of secondary healed defects formed around implanted Silastic rods consists of fibrous scar tissue. The tendon sheath autografts, on the other hand, were found to survive, demonstrating a well-preserved synovial surface. These findings probably imply new concepts of tendon surgery. The Silastic rod induced some foreign body reaction in the healing synovium. It is assumed that this reaction is reversible, but this could not be established in the present investigation. Further study is being made of this problem.


Sunlight and incidence of cutaneous malignant melanoma. Effect of latitude and domicile in Sweden. The relationship between tumour incidence rate and habitation patterns was investigated in 3289 patients registered between 1959 and 1968 as cutaneous malignant melanoma in the Swedish Cancer Registry. A linear correlation analysis between latitude and melanoma incidence rate in various regions showed a coefficient, r, was -0.74, which implies a decreasing incidence with increasing latitude. This result supports the hypothesis that ultraviolet irradiation is the predominant cause of melanoma. However, considerable deviations from the regression line were seen in some regions. Moreover, a comparison between town and country indicated melanoma incidence increased with population density, an increase not explained by overdiagnosis and thus not in agreement with the working hypothesis of UV-irradiation as the predominant cause of melanoma. Increase of foreign travel, as estimated by passport issue, may explain the overrepresentation of melanoma in some regions namely city and county of Stockholm, city of Malmö and Göteborg county. As foreign travel in Sweden generally means sunshine trips, this town versus country paradox may also be explained on the basis of increased irradiation, as may the anomalies observed in some counties. A regression analysis of the epidemiological index for UV-irradiation and melanoma incidence, adjusted for foreign travel, demonstrated a close agreement with the results of the latitude gradient analysis.


Prognostic factors in cutaneous malignant melanoma in stage I. A clinical, morphological and multivariate analysis. In a retrospective study of 324 cutaneous malignant melanomas in stage I, treated during the years 1959-74, the influence of different morphological and clinical factors on the prognosis was investigated. 223 patients with melanoma in levels II-V, observed for more than five years, were subjected to a multivariate analysis. 180/223 were in levels III-V. The age of the patient, the location of the tumour, its diameter, thickness, infiltration level, presence of ulceration and mitotic activity were shown to be of significant importance for the five-year survival of the 223 patients. Analysis limited to levels III-V disclosed that the diameter and the thickness of the tumour but not the infiltration level significantly influenced the prognosis. However, the sex of the patient, the histogenetic type of the tumour, the cross-sectional profile, vascular invasion and degree of lymphocytic infiltration did not correlate with survival.


Secondary palatal repair by the island flap technique. A follow-up study. The island flap technique was applied to the secondary repair of 57 cleft patients with persisting open nasality and no velopharyngeal closure. A follow-up investigation showed that closure was achieved in about 50%, and the degree of nasality in spontaneous speech diminished in about 70% of the patients. The general quality of speech was postoperatively good in about 50%, but on the other hand fully normal only occasionally. The island flap secondary repair should probably be reserved for selected patients having a tight, short but mobile velum and relatively slight nasality. Failures of this method can still be improved by a traditional upwards based pharyngeal flap.


Congenital choanal atresia. Etiology, morphology and diagnosis in 82 cases. A follow-up study on 82 patients with congenital choanal atresia revealed that the malformation was twice as common in females as in males and occurred on the right side only in 56% of the cases. The family histories, however, revealed no obvious hereditary trend, and a chromosome analysis showed no abnormalities. Additional malformations were observed in 49% of the patients, but with no constant pattern substantiating a syndrome. The findings of the present study indicate that the atresia may result from a persisting bucconasal membrane. In about 50% of the patients the nasal cavity was funnel-shaped with a posterior narrow end, but the height of the palatal vault did not differ from the normal. The frequency of otitis media and sinusitis was high, 31% and 21% respectively.


Growth in width of the dental arches after partial extirpation of the mid-palatal suture in man. During the last 27 years 35 children with choanal atresia were operated by a method which entails a resection of the posterior 2/3 of the mid-palatal suture. In order to evaluate the consequences of this resection the width of the dental arches was measured in 320 individuals including 55 operated and unoperated patients with choanal atresia. Extirpation of the mid-palatal suture during growth resulted in a frequency of cross-bite of 52% and a significant reduction of the width of the upper dental arch and the maxilla. The findings may indicate that the growth in this specific suture is highly autonomous. Growth appeared to proceed far beyond childhood.


A comparative study of gonial angle and growth of the lower third molar in cleft lip and palate. An orthopantomographical study. In children and young adults with cleft lip and palate, the gonial angle, the angle between the lower second molar and the mandibular plane, the angle between the longitudinal axes of the second and third molars as well as the timing of the development of the third molar were investigated on the right and left side from orthopantomograms. The results were compared with the corresponding results in a noncleft Finnish material. The series consisted of 100 randomly selected subjects aged from 10 to 24 years, 57 males and 43 females. One to three orthopantomograms were available for each subject, totalling 201. The results were examined in a cross-sectional and longitudinal material. The right and left gonial angles were not found to differ in the different cleft groups. Among subjects with cleft lip and palate the gonial angle was found to be larger in the different age groups than the corresponding values in the comparison material. In both materials, the gonial angle was found to decrease between the ages of 10 and 15 years. In males with cleft lip and palate the decrease in this angle, however, continued up to the age of 19. The anterior angle between the longitudinal axis of the lower second molar and the mandibular base line was about 10 degrees larger than in the comparison material, being slightly larger than that in the Angle's Class III occlusion type in the comparison material. When examined by degrees of development the development of the lower third molar was delayed approx. 0.9 years in males and 1.6 years in females compared with the corresponding times in the comparison material.


Percutaneous anaesthesia for some minor surgical procedures. The anaesthetic effect of four different formulations of ketocaine intended for use in connection with minor surgical excisions in man after epicutaneous application has been studied. Following an introductory pin-pricking study and operations on 60 patients, one of the formulations used has been found clinically preferable to the others. Of 20 patients anaesthetized with this formulation, 16 could be operated without complementary anaesthesia. Because of uncertainty as to the depth of anaesthesia, the described method of anaesthesia is limited in minor surgical excisions to use mainly in relatively superficial operations.


Percutaneous anaesthesia for dermabrasion. An epicutaneously applied solution--A 2358, (Ane-Pad)--containing ketocaine has been used to bring about anaesthesia for dermabrasion in 20 cases. The time of application was 60 min and the amount of ketocaine applied varied from 0.8 to 2.5 g. In order to ensure good contact between the compresses containing the anaesthetic solution and uneven or concave skin surfaces, pressure was applied with the aid of foam plastic. Erythema and oedema were noted as unintended effects. They did not present an inconvenience during the operations or postoperatively. The operation proved to be completely painless for 15 of the patients. None of the remaining 5 patients required complementary anaesthesia, but in one case a slight sensation of pain was evident locally and in 4 cases the patients experienced an intense sensation of warmth.


Psychological assessment before and after augmentation mammaplasty. Twenty patients selected for augmentation mammaplasty paid for by the Health Service, were evaluated pre- and postoperatively by psychological and psychiatric examinations. Some 70% deviated from the normal psychological picture, with symptoms of remarkable similarity. The follow-up investigation one year after the operation revealed an unchanged basic personality structure, but the alteration to the breasts had relieved the patients from their previous distress and shyness and made them feel less inhibited. An attempt was made to predict the benefit each patient would gain from the operation, and the results were usually found to exceed the expectations. Only one patient was disappointed. In no case had the operation aggravated the preoperative psychological condition. Preoperative psychiatric examination of such patients would probably not provide any better selection.


The reflex theory of speech perception.

The reflex theory of speech perception. The perceptual confusions among Chinese consonants are analyzed and a comparative study is made for several languages, and then a reflex theory is presented. The results show that: (i) the distinctive features of speech are important perceptual cues, of which the manner of articulation is the more important one, (ii) the feature systems are different for different languages, (iii) the social characteristics of language i.e., linguistic constructions, strongly influence speech perception which is of a unitary process based on the physical characteristics in combination with the social characteristics of speech. The principal features of Chinese consonants and its capability to transmit information are given. It is shown that the construction of Chinese syllables is good for the syllable articulation.


[Postmortem examination of the fundus oculi in forensic medicine]. After an analysis of the literature, the author reflects on the problem to what extent the ophtalmologist can at present assess, based on a post-mortem examination of the ocular fundus, the time of death in cases where a team of specialists decides whether resuscitation may be terminated after clinical death of a patient where an organ is foreseen for transplantation, and in forensic and criminal medicine some time after death. The author is convinced that post-mortem ophtalmoscopy performed by a specialist is a valuable contribution to contemporary and future forensic medicine.


Kyphosis in childhood and adolescence.

Kyphosis in childhood and adolescence. Kyphosis has become an increasingly important problem to the surgeon interested in the management of significant spinal deformity. As scoliosis has become better understood, the more difficult problems have become apparent and one of the most difficult of these is kyphosis. Kyphosis is the deformity which can produce paraplegia if it progresses to a significant degree and remains untreated. Contrary to scoliosis, in which bracing and posterior fusion alone are usually quite sufficient, kyphosis sometimes responds to bracing and other times it does not. If surgical treatment is necessary it quite often requires an anterior fusion. The purpose of this presentation is to give an overall review of the various etiologies of kyphosis and the current status of management of these various problems.


An anterior distractor for the intraoperative correction of angular kyphosis. A new device for the intraoperative anterior correction of angular kyphoses is presented. It functions on the turnbuckle principle. Preliminary results have shown excellent corrections without complication. It is not an implant.


Energy expenditure during walking in patients with scoliosis. The effect of the Milwaukee brace. Oxygen uptake during treadmill walking was measured in 8 scoliotic patients with idiopathic curves ranging from 25 to 60 degrees. The patients were fitted with a Milwaukee brace and the test was repeated within 2 or 3 days to study the effect of the brace on energy expenditure, mechanical work, and ventilatory function. The total oxygen uptake was not systematically affected by wearing the brace. When the weight of the brace was included, the oxygen uptake/kg body weight decreased in most of the patients at low walking speed in spite of an increased lift work. The positive influence on energy expenditure was interpreted as a stabilizing effect of the brace on the spine. This effect was not consistent at moderate and high speeds of locomotion, where both a decrease and an increase in oxygen uptake/kg were observed. Heart rate increased significantly during walking at high speed with the brace, while a slight but significant reduction of the tidal volume was found during walking at low speed.


Pathology and pathogenesis of lumbar spondylosis and stenosis. Study of autopsy specimens of the lumbar spine makes it possible to construct a spectrum of pathologic change. Progressive degenerative changes in the posterior joints lead to marked destruction and instability. Similar changes in the disc result in herniation, internal disruption, and resorption. Combined changes in posterior joint and disc sometimes produce entrapment of a spinal nerve in the lateral recess, central stenosis at one level, or both of these conditions. Changes at one level often lead, over a period of years, to multilevel spondylosis and/or stenosis. Developmental stenosis is an enhancing factor in the presence of a small herniation or moderate degenerative stenosis. Lesions such as major trauma, spondylolisthesis, those following spinal fusion, Paget's disease, and fluorosis, on occasion act directly to produce central or lateral stenosis.


Exposure of the vertebral bodies of the proximal lumbar segments. Some anatomic points. The fascial structure of the left retroperitoneal region of the abdomen and its surgical anatomy are reviewed. The findings correlate with those of Tobin and Baumann. The muscular interval between the quadratus lumborum and the psoas muscle is elaborated upon as a useful route for entrance into the retroperitoneum. The occasional but significant occurrence of the artery of Haller is mentioned. The author's recommendation for exposure of the upper segments of the lumbar spin L1 through L3 is through a posterolateral abdominal incision with resection of the medial half of the twelfth rib (depending on the configuration of the twelfth rib) and oteotomy of the tip of the L1 transverse process as the routes of exposure of the proximal segments of the lumbar spine.


The biomechanical advantage of lordosis and hip extension for upright activity. Man as compared with other anthropoids. The mechanics of the muscle-ligament system for a weight lift in man is described. The adaptations of the human spine and the hip to this mechanism are indicated. The efficiency of this mechanism in the human is compared with other primates showing the vast superiority of man in this aspect over his nearest relatives.


Complications of water-soluble contrast lumbar myelography. Review of the literature and case report. A historic review of the development of water-soluble contrast materials for lumbar myelography is presented. This is followed by a discussion of their advantages and complications, as well as a case report of convulsive segmental myoclonus, hypotension, and death after myelography associated with the use of dimeglumine locarmate (Dimer-X). A new nonionic material, metrizamide (Amipaque), is discussed, and its current clinical status is summarized.


Intradural herniation of lumbar intervertebral discs. A case of intradural rupture of a lumbar intervertebral disc is reported, and the literature is reviewed. The majority of intradural disc herniations occur at the L4--5 level. These patients usually have neurologic deficits more severe than those found in the much more common extradural disc herniations. The myelographic picture varies from an irregularly marginated intradural lesion overlying the disc space to a complete block. The common factor allowing intradural disc herniation is probably dense adhesions between the dura and the posterior longitudinal ligament, preventing the more common lateral extradural disc herniation. Intradural disc herniation should be included in the differential diagnosis of lumbar intradural lesions causing nerve root or cauda equina compression.


High amputation of the sacrum for extirpation of tumors. Principles and technique. A detailed description is given of the principles and surgical technique for extensive resection of the sacrum, including an adjacent part of each ilium, for radical removal of tumor. Two levels of sacral amputation are discussed: between S1 and S2 (through the canals of the S1 nerves) and through S1 (above the canals of the S1 nerves), with or without inclusion of the rectum in the specimen. The former level permits the preservation of the S1 nerves; the latter does not. Important pathoanatomic facts are discussed. The effects of these operations on the urogenital and anorectal function and on the stability of the pelvic girdle are briefly reviewed. Five illustrative cases are reported with comments on the results.


Therapeutic abortion on psychiatric grounds. Part I. A local study. A study of 197 women referred for termination of pregnancy on psychiatric grounds was undertaken from February 1974 to May 1975 at a specially established clinic in the Department of Psychiatry, Groote Schuur Hospital, Cape Town. The personal, social and specifically psychiatric information collected from this study, which included both women who were refused and those granted termination on psychiatric grounds, was analysed. We gained enough data to focus on the psychosocial and 'hard' psychiatric data, to statistically compare the two groups, and to isolate variables which appeared to have influenced decision-making. Eighty per cent of the women were followed up for 12 - 18 months.


Functional hypoparathyroidism in infantile hypocalcaemic stage I vitamin D deficiency rickets. Nine infants with stage I rickets were found to have an inappropriate functional hypoparathyroidism with severe hypocalcaemia. Possible mechanisms, therapy and prevention are discussed.


Review of Southern African scorpions and scorpionism. Medically important scorpions are discussed in terms of their venom, methods of envenomation and distribution in relation to the pattern of human population density dispersal. Notes on the treatment of scorpion sting and the identification of important species are provided.


[Wilson's disease in a black patient. Case report and brief literature review]. A Black patient with Wilson's disease is described. Clinical symptomatology and laboratory findings are reported and diagnosis, pathology, clinical picture and treatment of the disease are discussed.


Multiple serous effusions complicating pre-eclampsia. A case report. A patient with multiple serous effusions and the nephrotic syndrome complicating the middle trimester of pregnancy is described. Rapid resolution of the effusions after delivery and exclusion of other causes of serous effusions and nephrosis make pre-eclamptic toxaemia the most likely cause. Anasarca can be a feature of this disease and there are a few reports of patients in whom clinical ascites has occurred. Our patient was exceptional in that pleural and synovial effusions into the knee joints were also present.