Gastric polyps and precancerous mucosal changes after partial gastrectomy. Gastric polyps are considered to be rare. However, at endoscopy the prevalence of gastric polyps after partial gastrectomy was found to be 8.9% (30/336 patients) compared with 4.9% (20/407) in a clinical control material with a comparable age and sex distribution. Four patients with precancerous mucosal alterations were found in the operated group. Repeated endoscopic check-ups have at present been performed in 57.4% of these patients. In our experience the diagnostic accuracy with regard to malignancy is not entirely satisfactory. Histological examination of the surgical specimen from one of the 4 patients with precancerous changes showed a macroscopically invisible early carcinoma. Follow-up examinations (within 4 years) have in 5 out of 26 cases with sessile polyps disclosed carcinoma in 3 cases and precancerous changes or adenoma in another 2 cases. Careful re-examination of all patients with precancerous changes and gastric polyps is recommended.


Hemodynamic effects of phenoxybenzamine and volume replacement in segmental ischemia of the rat small intestine. Segmental ischemia of the small intestine in the rat was established by ligating the mesenteric arterial end arcades of 1/4 of the length of the small intestine. Regional and central blood flow was measured with the microsphere technique before and 2 h after induction of the ischemia. In one series of rats an i.v. infusion of 16 ml plasma per kg body weight (b.w.) was given during the experimental period, which maintained the central circulation. However, the impairment of blood supply to the whole small intestine caused by the segmental ischemia was not normalized. Two other series of rats were treated with either phenoxybenzamine alone, 3 mg.kg-1 b.w., or the same dosage of phenoxybenzamine plus plasma infusion (16 ml.kg-1 b.w.). The central circulation was deteriorated and the blood flow to the small intestine reduced in the rats receiving phenoxybenzamine alone. Both the central circulation and the blood supply to the non-ischemic parts of the intestine were maintained in rats treated with both phenoxybenzamine and plasma. Combined treatment with phenoxybenzamine and volume replacement thus seems to be valuable for limiting the secondary hemodynamic changes caused by segmental intestinal ischemia.


Hemodynamic effects of methylprednisolone in rats subjected to segmental intestinal ischemia. Massive doses of methylprednisolone were given to rats subjected to segmental intestinal ischemis. The central and regional blood flows were studied with the microsphere technique. Ischemia was induced by ligating the arteries to 1/4 of the length of the small intestine. In rats subjected to 2 h of segmental intestinal ischemia methylprednisolone seemed to prevent the decrease in blood flow, previously noted in untreated rats, in the regions where the arteries were not occluded. When adequate volume replacement was given in combination with methylprednisolone, the blood flow in the ischemic region showed a slight improvement. The edema in the ischemic segments tended to be less marked in rats treated with methylprednisolone.


Inflammatory tumours in the rectum clinically simulating cancer. Four patients were admitted to our department after discovery of a palpable mass in the rectal ampulla. All lesions were clinically interpreted as malignant neoplasms. Repeated examinations with biopsies showed nonspecific, inflammatory tumours in all cases. Inflammatory tumours of the rectum may occur in a number of diseases. The lesions in two patients may have their origin in the solitary ulcer of the rectum or colitis cystica profunda, while this diagnosis for certain was made in the fourth patient. The third described patient had a palpable mass in the rectal ampulla after a difficult urethral dilatation, and the mass gradually subsided without treatment. The clinical misinterpretation of inflammatory tumours as malignant neoplasms has been responsible for a considerable number of unnecessary surgical procedures.


Xanthogranulomatous pyelonephritis. A report of 2 cases. Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic pyelonephritis. The present author has found about 150 cases on going through the literature. The lipid filled "foam cell" is typical of the condition. The preoperative diagnosis is often renal carcinoma. The treatment is nephrectomy. It is important to make the diagnosis in order to avoid unnecessary radical surgery. A unilateral non-functioning kidney with urinary tract infection (with or without calculi) should lead to the condition being suspected. The prognosis is good. Two new cases that both illustrate the condition well are presented.


The frequency and significance of postoperative plantar vein thrombosis judged by the 125I-fibrinogen test. In 318 patients screening for the development of postoperative deep vein thrombosis was made with the 125I-fibrinogen test. In addition to the conventional measurements over the leg the planta pedis was also included. Of 221 legs with thrombosis 75 had an increased uptake in the planta pedis, but only in sixteen patients an isolated plantar thrombosis was found. In only eight of 70 thrombi there was evidence of a proximal extension of the plantar vein thrombosis. The time for the thrombosis debut did not differ between isolated plantar vein thrombi and more extensive thrombi; the majority beginning during the first four postoperative days.


Surgicel--an absorbable hemostatic material--in prevention of peritoneal adhesions in rats. Forty rats were laparotomized and subjected to a standardized cecal trauma. In half the number of the rats, the injured cecum was embedded in oxidized regenerated cellulose (Surgicel). In the remaining 20 rats, which served as controls, the cecum was left uncovered. The rats were sacrificed at 14 days after the operation and examined for intraperitoneal adhesions. Adhesions were significantly (p less than 0.001) less common in the group treated with oxidized regenerated cellulose. In a separate series eight rats were used for histological examination of the traumatized cecal wall. No macroscopic residuum of the implant was seen after one or two weeks. However, the histological examination demonstrated small remnants surrounded by ingrowing fibroblasts and inflammatory cells.


Gastric emptying in duodenal ulcer patients before and after truncal vagotomy with pyloroplasty and parietal cell vagotomy. The gastric emptying of a liquid test meal containing 99Tcm-sulphur colloid was studied with a gamma camera in 24 duodenal ulcer patients. Studies were made before surgery, randomly chosen between truncal vagotomy with pyloroplasty and parietal cell vagotomy, and six weeks and one year after. Large variations in the emptying patterns were observed both between patients and in the same patients. No consistent change in the distribution of patterns were found between the three observation times and between the two surgical procedures. An initial rapid emptying was found in several studies and was observed both before and after operation and did not seem to be related to type of surgical procedure or to individual patients. The method applied did not allow a detailed study of this initial phase, which appears to be of a higher significance for the over-all emptying characteristics than the late exponential emptying, on which earlier investigators have been focused.


Obstructive nephropathy with infection. A diagnostic pitfall. Four patients with indistinct abdominal symptoms associated with fever are presented. In all cases the diagnosis proved to be obstructive nephropathy with infection. The proper treatment of the patients was delayed, essentially because of a non-investigative diagnostic attitude. The necessity of making a correct diagnosis in the early course of an acute abdominal disease with fever is emphasised and some investigations that may be of great value for reaching a precise diagnosis are indicated.


Intussusception as a complication of partial gastrectomy. A case report. The causes of postgastrectomy syndrome are multiple and differ in their relative frequency. Among the more unusual is intussusception of the small bowel into the stomach or into the jejunojejunostomy. We describe a patient with acute retrograde intussusception of the efferent loop into the jejunojejunostomy occurring 14 months after partial gastrectomy with Billroth II anastomosis. Several theories regarding etiology are mentioned, among them functional causes, mechanical causes and derangements in stomal function. In our case, the circulatory derangement might possibly be a causal factor. The diagnostic problems are discussed, and the importance of early diagnosis is pointed out. A chronic form of intussusception is mentioned by several authors. Often the differential diagnosis is difficult, but epigastric pain, vomiting--ultimately of blood--and a palpable mass, constitute a classic triad. X-ray and endoscopy are supplementary aids to the diagnosis. Several types of operative treatment have been used, but no operative procedure seems to be fully effective as a safeguard against recurrence.


Influence of duodenal intrinsic factor on the absorption of labelled vitamin B12. The intrinsic factor activity of powdered hog duodenal mucosa was confirmed by measurements of the absorption of labelled vitamin B 12 (Schilling-test) in 7 cases of Addisonian pernicious anaemia. In view of the fact that, according to earlier studies of the authors based on a bacteriological test, human duodenal juice also exhibits an intrinsic factor activity, it is suggested that the duodenal intrinsic factor may be involved in the pathogenesis of pernicious anaemia. The results of the Schilling-test are critically reviewed in the  light of recent published evidence.


[A surgeon's experiences in the treatment of stress ulcer with cimetidine]. 61 patients with acute stress ulcers were treated with cimetidine. Additional surgical treatment was neccessary in 5 patients. 27 patients died from complications. In none of these patients the gastrointestinal haemorrhage caused the fatal outcome.


[Treatment of stomach ulcer and of Zollinger-Ellison syndrome with cimetidine]. The treatment of gastric ulcer by the H2-receptor-antagonist Cimetidine results in an ulcer healing rate of 60 to 80% during a 4 to 6 weeks therapy cure. In most studies Cimetidine is superior to placebo or equipotent to a high dose antacid regimen, the latter being accepted to be of beneficial effect on ulcer healing. In the Zollinger-Ellison-syndrome Cimetidine inhibits largely gastric acid hypersecretion and represents for the first time a true alternative to total gastrectomy.


[Treatment of acute leukemia in adults with cytosine arabinoside and thioguanine]. After treatment of acute leukaemia in adults with cytosine arabinoside and thioguanine complete and partial remission was achieved in 50% of cases. In view of short-lasting remissions achieved maintenance treatment with other cytostatic agents was necessary. The authors called attention to the fact that in the cases with remission the counts of granulocytes and platelets increased early during cytostatic treatment and the number of blast cells fell rapidly. In cases without response to this treatment these early signs of normalization of peripheral blood morphotic elements were not observed.


[Lysozyme activity (LZM) and unsaturated vitamin B-12-binding capacity (NZW vit B-12) in the serum following prednisone administration in patients with bone marrow aplasia with pancotypenia]. In 18 patients with bone marrow aplasia with pancytopenia lysozyme activity and unsaturated vitamin B12-binding capacity in the serum were determined. These investigations, together with determinations of peripheral blood polymorphonuclear count, were done again after prednisone administration. In all cases a significant fall was found in the NZW vit B12 and LZM activity in the serum. A slight rise in the polymorphonuclear count in the 24th hour of the study was associated with a rise in the NZW wit. B12 in the serum, and decreased LZM activity. This confirmed the previously demonstrated complex character of corticosteroid action on the system of polymorphonuclears. These results point also to the usefulness of determination of unsaturated vitamin B12-binding capacity for evaluating the value of the total granulocyte pool in granulocytopenia.


[Glutathione reductase activity in erythrocytes of rats with transplantable Morris 5123 hepatoma]. The activity of NADPH- and NADH-dependent erythrocyte glutathione reductase was determined in rats with Morris 5123 hepatoma at different stages of tumor development (10, 20, 30 and 40 days after transplantation). During the early stage of tumor growth the activity of glutathione reductase with either of these coenzymes was increased. In the late stage of the disease the activity of NADPH-dependent glutathione reductase fell below control values. The obtained results are discussed in the light of previous observations on the effects of this neoplasm on the metabolism of erythrocytes.


[Activation-dependent characteristics of the electroencephalogram during visual information processing: II Results of an automatic amplitude analysis based on momentary values of signal voltage (author's transl)]. EEG was recorded in 16 Ss. under conditions of a modified "Konzentrations-Leistung-Test" including four levels of performance (balanced change-over design), and histograms of the momentary values of the signal voltages (derivation F3/01) constructed for frequency bands 4...8 Hz, 8...13 Hz and 13...26 Hz. The type of performance affected significantly standard deviations and the excesses in all frequency bands (multivariate analysis of variance, F-Test). Similar to the results of an interval analysis (Activ. ner. sup. 18, 1976, p. 244), the differences in mean values indicated the preponderant relevance of perceptual factors (NEWMAN-KEULS-Test). Four characteristics showed a significant activation dependence: the standard deviations of the amplitude distributions in the frequency bands 4...8 Hz and 13...26 Hz, corresponding to the root-mean--square values of the signal voltages, as well as the excesses in the frequency bands 8...13 Hz and 13...26 Hz. Only and amplitude of the theta waves were influenced notably by mental arithmetics, significantly though only when this was done under conditions of time stress.


Dissociation between motor potential and contingent negative variation after lesions of some basal ganglia in man: electrophysiological study of torticollis. Studied slow cortical potentials associated with voluntary movements ("readiness potential", RP and "motor potential", MP) and discrimination tasks (contingent negative variation", CNV, "expectancy wave", EW) in 11 normal subjects and 11 patients with torticollis (every person going through 2 experimental sessions). The following was found: 1. In torticollis-patients, the RP appeared as a complex, irregular wave with low--voltage, ataxic course. 2. The mean amplitude of the RP was significantly lower in the torticollis-group than in the control group. 3. The mean amplitude of the late positive component P2 of the MP was also significantly lower in torticollis-patients than in controls. 4. The CNV showed a high-voltage course in patients with torticollis. 5. The mean amplitude of the CNV was significantly higher in torticollis--patients than in controls. 6. The mean amplitude of the late positive component P2 after the resolution of the discrimination task was also higher in the torticollis--group than in the control group, but the difference did not reach the level of significance.--This marked dissociation between the adynamic RP-MP field generators and the very responsive CNV field generators is being interpreted partly as an electrophysiological symptom of impairment in programming and performance of sequential motor acts (in the case of the RP-MP), partly as a disruption of the control of emotional and affective processes, as well as non-specific (extralemniscal) afferences (in the case of the CNV) resulting from a basal ganglia lesion in torticollis.


Heart involvement in hepatolenticular degeneration. The case of a 10-year-old boy with a mild abdominal form of hepatolenticular degeneration, showing clinical, laboratory and histological manifestations of heart involvement is reported. The microscopical examination of myocardial fragments collected by intracavitary puncture biopsy, using hematoxylin-eosine and the histochemical method with rubeanic acid, showed a medium degree of myocardial damage and the presence of copper deposition in the tissue. Copper concentration on a myocardial biopsy fragment was almost 10 times the normal heart content. Comments are made on the relationship of the clinical, laboratory and pathological findings with the degree of copper storage on the myocardium.


Progressive supranuclear palsy: electomyographic examinations of eye muscles. Electromyographic examination of vertical and lateral extraocular muscles was carried out in five patients suffering from progressive supranuclear palsy, and incapable of performing voluntary vertical eye movements. No evidence of a lower motor neurone lesion or paradoxical innervation of eye muscles was noted. Reciprocal inhibiton of antagonist vertical muscles though present in oculocephalic (doll's head) stimulation, was incomplete on attempted voluntary movement. This factor is held to be the probable immediate cause of the vertical gaze palsy.


Hyperthyroidism as a cause of persistent choreic movements. A patient is described who had thyrotoxicosis more than 30 years ago and suffers since that time from presistent choreic movements. This case suggests for the first time that chorea induced by hyperthyroidism may outlast the endocrine disorder and become irreversible.


Methylcholanthrene induced murine primitive neuroectodermal tumor: ultrastructure and nuclear RNA polymerase activity. The histology, ultrastructure, and nuclear RNA polymerase activity are described in a murine primitive neuroectodermal tumor derived by serial transplantation from a tumor originally induced with methylcholanthrene and classified as an ependymoblastoma. The light microscope and ultrastructural studies show that this tumor does not contain the distinguishing morphological features of differentiated ependymal cells which are also commonly seen in human ependymomas. One outstanding feature is the size and number of the nucleoli. The mean number of nucleoli/nucleus is 4 which is two to four times that of the normal neuroglial cell. The nucleolar diameter is about twice that found in normal neuroglial cells. The nucleolar diameter is about twice that found in normal neuroglial cells. The nuclear RNA synthesizing activity is the highest of the chemically induced animal tumors we have studied. The alpha amanitin inhibition is the lowest seen in any of these tumors which suggests that RNA polymerases inhibited by alpha amanitin contribute less to the total nuclear RNA synthesis. Adriamycin significantly inhibits the nuclear RNA polymerase activity of this tumor.


Flow-through cytometry of meningiomas and cultured meningioma cells. Flow cytometric techniques were used to compare the DNA content, size and viability of meningioma cells obtained directly from surgical specimens with the same cells after a period of culture. Cells isolated from the original meningiomas and cells in primary culture was similar with regard to size and DNA content, regardless of the histologic subclassification of tumor. The cell populations were essentially diploid with a small proportion of tetraploid cells. Viable cells were smaller and more uniform in size than the nonviable cells. An increase in the number of cells having an elevated DNA content was seen with cultures repeatedly transferred. The latter results suggest that any transfer of information from long-term cultured meningioma cells to the in vivo situation must be done with caution.


The perineurial and blood-nerve barriers in experimental diabetes. The permeabilities of the blood-nerve barrier and the perineurial barrier were investigated in alloxan and streptozotocin diabetic rats and in the mutant diabetic mouse [C57BL/Ks(db/db)]. In the mouse model both fluorescence and electron microscopic techniques were employed using Evans blue albumin (EBA) and horseradish peroxidase (HRP), respectively, as exogeneous tracers. In the rat models only HRP was used. Tracers were applied locally around the sciatic nerve in order to investigate the perineurial barrier, and systemically to detect changes in the blood nerve barrier. None of the models was found to show increased permeability across either of the barriers.


Redirected perforant and commissural of connections of eutopic and ectopic neurons in the hippocampus of methylazoxymethanol-acetate treated rats. In an earlier study, it was reported that clusters of ectopic neurons developed postnatally in the hippocampus of rats which were exposed to Methylazoxymethanol acetate (MAMac) during fetal development (Singh, 1977b). This paper describes the perforant tract and commissural connections of hippocampal eutopic and ectopic neurons. These connections were traced with a reduced-silver method (Eager, 1970). Two observations of significance were made: (i) Ectopic neurons misplaced in stratum radiatum received terminals from axons in the perforant tract. The upper boundary for these redirected fibers was stratum pyramidale--approximately 350 mu outside the normal boundary which is situated near the hippocampal fissure. (ii) Ectopic neurons received a dramatically reduced commissural projection, compared with eutopic pyramidal neurons in Ammon's horn. Eutopic neurons in the hippocampus were found to receive afferent perforant tract and commissural fibers in the same way--i.e., density and distribution, as in control rats.


Melanotic neuroectodermal tumor of infancy with highly differentiated neural component. Light and electron microscopic study. A pigmented tumor was removed from the maxillar alveolar process of a 5-month-old boy. It was examined by light and electron microscopy and a diagnosis of melanotic neuroectodermal tumor was made. In addition to connective tissue, three main cell types were identified: undifferentiated (stem) cells, melanocytes, and nerve cells with processes forming an abundant neuropil. Numerous axo-dendritic and occasional axo-somatic synapses were observed. The neural component demonstrated better differentiation in this example than in any reported so far.


[Amyotrophic lateral sclerosis with degeneration of thalamus and substantia nigra (author's transl)]. A 40-year-old man suffering from amyotrophic lateral sclerosis with symmetrical degeneration of the thalamus and the substantia nigra is reported. The distribution pattern of the  thalamic degeneration in the present case was characteristic in that the Nucleus centralis was the severest affected of the thalamic nuclei. As far as we know, there is no such case of amyotrophic lateral sclerosis in the literature. Nosologically, this case may represent a form of combined heredosystemic degeneration.


Schwann cells and peripheral nervous system myelin in the rat retina. Within the retinal nerve fiber layer of a 6-week-old Sprague-Dawley rat, scattered aggregates of PNS myelinated axons have been found and described. We believe this is likely to represent a normal but rare phenomenon in the rat.


Ribosome-submembranous density complex. A new specialized cell unit. Ultrastructural study of a malignant meningioma revealed an organelle complex composed of: (1) A band-like densification of the cell cytoplasm adjacent to and in contact with the cell membrane. (2) An arciform filament immediately subjacent to it, with concavity directed away from the cell membrane. (3) A row of regularly spaced ribosomes located in the concavity, but at some distance from the arciform filament. (4) A pericellular condensation of interstitial ground substance. Occasionally, a second, thinner filament was seen "threading" the ribosomes together. Its morphology was consistent with that described for messenger RNA . It is suggested that the ribosomes are engaged in the synthesis of proteins for other portions of the organelle complex and that the ultimate role of the specialized unit would be that of an attachment device.


Effect of vehicle on pilocarpine-induced ocular hypotension. The effect of 1.4% polyvinyl alcohol and castor oil vehicles on pilocarpine-induced hypotension was studied in 50 patients with open-angle glaucoma. Diurnal tension curves showed that the mean intraocular pressure was lower and the maximum diurnal variation smaller during the treatment with oily drops of 2% and 4% pilocarpine instilled 2-3 times daily than when 2% and 4% pilocarpine in polyvinyl alcohol was instilled 3-4 times daily. The differences were statistically significant. In long-term treatment no marked pilocarpine tolerance developed in cases treated with oily drops of pilocarpine. It is concluded that in the treatment of patients with open-angle glaucoma, the hypotensive effect of pilocarpine in an oily vehicle instilled 2-3 times daily is greater and more even than that of pilocarpine of corresponding strength in polyvinyl alcohol administered 3-4 times daily.


Effect of vehicle on pilocarpine-induced miosis. To determine the effect of 1.4% polyvinyl alcohol (PVA) and castor oil vehicles on the pilocarpine-induced miosis, we studied the miotic effect of 2% pilocarpine-PVA and oily drops on 4 young and 10 elderly people and the miotic effect of 4% pilocarpine-PVA and oily drops on 13 elderly people. The miosis developed fast within 15 min, and maximum miosis was rached within 1 h. Oily drops of pilocarpine induced stronger maximum miosis than corresponding PVA-drops. The pupil remained contracted to less than 50% of its starting diameter after pilocarpine-PVA drops for 3-4 h and after oily drops for 9 h and returned to its starting diameter after pilocarpine-PVA drops 9-10 h and after oily drops 20-24 h following administration. The difference in the effect between pilocarpine-PVA and oily drops was independent of the subjects' age.


Disciform detachment of the macula. III. Secondary to inflammatory diseases. The association of inflammatory diseases with disciform macular detachment is described in three patients. The first patient with seropositive syphilis developed juxtapapillary choroiditis, disciform detachment of the left macula progressing to a wide-spread area with atrophy of the choriocapillaris and pigment epithelium, corpuscular aggregations of retinal pigment, and white fibrous tissue between the choroid and retina. The second patient with fever, anorexia, fatigue, elevated erythrocyte sedimentation rate and pulmonary changes developed choroiditis with disciform detachment of the left macula, one month later choroiditis with disciform detachment of the pigment epithelium in the right fundus, and two months later serofibrinous pleurisy which improved with tuberculostatic therapy suggesting tuberculous aetiology. The third patient, with puerperal sepsis in her past medical history, had peripapillary atrophic scars in both eyes with choroidal neovascularization and disciform detachment of the macula in the left eye.


Lenticonus anterior and Alport's syndrome. Six patients, from five families, five males and one female, suffering from lenticonus anterior are presented. Furthermore, all suffered from chronic nephritis and nerve deafness and must be considered cases of Alport's syndrome. As all cases with lenticonus anterior which have been published within the last 13 years likewise were affected with nerve deafness and/or chronic nephritis, the assumption is submitted that lenticonus anterior exists exclusively as a part of Alport's syndrome. It is pointed out that four patients had a weakened bilateral macula reflex with changes in pigmentation. Attention is drawn to the fact that patients with lenticonus anterior often have a cornea astigmatism of 2-3 D. A complete table of all reported patients with anterior lenticonus is presented.


Optic disc cupping and prematurity. Large cups as a possible low birth weight sequel. In a previous ophthalmic study of ex-prematures around the age of 10 years it was accidentally found that cupping of the optic disc was significantly more pronounced in children of a low birth weight (less than 2000 g) than in full-term controls (Fledelius 1976). This was true for cup size (cup/disc diameter ratio) as well as depth (as indicated by a visible cribriform plate). The present analyses make up an extension of the above study, with additional calculations based on some of its data. Within the ex-prematures (n = 268) the cup size did not seem to be related to birth weight, sex, or visual acuity. Eyes with myopia of prematurity were not especially 'loaded' with large cups. For the whole sample (including the 187 full-term control there was a weak association between cup size and refraction (and axial eye length). Larger cups occurred relatively more often in myopic eyes. Possible mechanisms behind early changes in disc are discussed (astroglial hypothesis--distension of disc--loss of retinal nerve fibers). It is felt that this new observation--large disc cupping as a possible low birth weight sequel--has to be substantiated by further clinical evidence, as statistical type 1 error (mass significance) cannot be ruled out.


Ophthalmic artery pressure during retrobulbar anaesthesia. Ophthalmic artery pressure recordings were performed before and after retrobulbar injection of 4.5 ml Xylocain-Exadrin by the use of Stepanik Arteriotonography. A 50% reduction in ophthalmic artery pulse pressure was found, which correlates well with the corresponding reduction in corneal indentation pulse amplitudes demonstrated by dynamic tonometry. The results demonstrate a shift from pulsatile towards non-pulsatile ocular blood flow. In two of the eight patients a pronounced reduction was also found in ocular perfusion pressure, indicating that retrobulbar anaesthesia may be hazardous in certain cases by initiating a major reduction in ocular blood supply. In order to minimize this hazard in eyes especially vulnerable to a reduction in ocular perfusion pressure, such as glaucomatous eyes, it is probably safest to perform retrobulbar anaesthesia with 2-3 ml of Xylocain 1% without the use of Exadrin (epinephrine).


Uveitis in rabbits with pleural effusion disease. Clinical and histopathological observations. Pleural effusion disease (PED) is a generalized infection of laboratory rabbits caused by a virus-like agent. The disease was first described in the late sixties as a mortality problem among rabbits used for the propagation of Nichols' pathogenic Treponema pallidum in Scandinavian laboratories using the T. pallidum immobilization (TPI) test for the serological diagnosis of syphilis. The iridocyclitis, described as a manifestation of PED, has been studied in detail in rabbits experimentally infected with the PED agent. All rabbits surviving the acute phase of infection developed a non-pyogenic, non-granulomatous anterior uveitis during the "viraemic" stage of infection. The ocular signs of disease culminated between days 3 and 6 and disappeared within 2 to 3 weeks. No recurrence of uveitis was observed during a 6-months observation period, nor by subsequent subcutaneous re-inoculation of the PED agent. Histologically, the uveal reaction was mild and regressed almost completely within 4 weeks. Discrete choroidal inflammatory foci occurred in some of the re-inoculated rabbits, but without changes in the anterior eye segment. The uveitis of pleural effusion disease in rabbits seems to be caused directly by the virus-like agent. It might possibly serve as a simple and reproducible model in further uveitis research.


Visual evoked responses to pattern-reversal stimulation in patients with amblyopia and/or defective binocular functions. The visual evoked responses to monocular and binocular pattern-reversal stimulation were recorded in ten normal subjects and in ten cases with amblyopia and/or defective binocular functions. Seven of the ten patients showed a considerable amplitude asymmetry to monocular stimulation or lack of normal increase of amplitude to binocular stimulation. Two patients displayed prolonged latency on stimulation of the amblyopic eye.


Binocular interaction studied with visual evoked responses (VER) in humans with normal or impaired binocular vision. In an attempt to evaluate binocular functions in an objective manner, visual evoked responses (VER) were recorded in sixteen subjects, six with normal binocular functions and ten with various degrees of squint and binocular impairment. The two eyes were stimulated monocularly or dioptically with a polaroid checker board pattern viewed through rotating polaroid discs. The rate of pattern reversal was 7 per sec for one eye and 10 per sec for the other, allowing stimulus locked responses to be recorded from each eye individually, even during dioptic viewing. In normal subjects the VER of each eye to binocular stimulation were reduced to half or less of the monocular value. The reduction was much smaller in humans with impaired binocular vision, at least for the dominant eye. In stereoblind subjects the response of the dominant eye was the same for monocular and binocular stimulation. The VER changes might reflect binocular interaction in visual cortex neurons, which probably are binocular in normal subjects but driven only from one eye in stereoblind subjects.


Some observations on visual evoked responses (VER) to dichoptic stimulation. The possibility that the interocular depression of VER seen with dioptic stimulation, might reflect alternate suppression or binocular rivalry, unnoticed by the test subjects, was investigated in VER experiments using dichoptic stimulation with patterns of dissimilar form. Red and blue grating and checker board patterns were produced on a colour TV screen. Appropriate filtering allowed the two eyes to be stimulated separately. Provided the patterns were dissimilar enough to produce binocular rivalry, no interocular depression was noticed in the VER. The interocular depression became larger as the patterns were made similar in size and reached a maximum for patterns identical in shape. Thus the interocular depression of the VERs reported for dioptic stimulation did not seeem to be related to binocular rivalry. The results also give electrophysiological support to the notion of spartial frequency and orientation selective channels in the human visual system.


The effect of 1alpha-hydroxycholecalciferol on the healing of experimental fractures in adult rats. Unilateral tibial fractures were produced in adult, 1-year-old, male Sprague-Dawley rats. The animals were then treated for 6 weeks with daily doses of 2.5 micrograms, 1.25 micrograms or 0.125 microgram 1alpha-hydroxycholecalciferol (1alpha-OH-D3). The aim of the investigation was to study the effect of this treatment on the healing process of the fracture and on the composition of the fractured bone. The general effect of 2.5 micrograms of 1alpha-OH-D3 was a significant loss of body weight (20 per cent) and hypercalcaemia. The lower dose levels, however, did not affect the body weight, and with a dose of 0.125 microgram the serum calcium level did not increase significantly. The healing rate of the fractures increased in all treatment groups as compared with the controls. The water content of the fractured tibias increased in the rats treated with 2.5 micrograms doses but decreased in the other groups. On the other hand the mineral content increased in the groups treated with 1.25 micrograms and 0.125 microgram doses and decreased in the largest dose group. Furthermore the amount of organic material per wet weight increased with the 2.5 micrograms dose and was mainly unchanged in the other groups. The hydrated bone density and the cortical thickness of the tibia increased most significantly in the group treated with 0.125 microgram but the trabecular bone area of the periosteal callus did not increase significantly. The conclusion is drawn that treatment with small doses of 1alpha-OH-D3 has a beneficial effect on the healing rate and on the mineralization of the fracture callus, and on cortical bone formation.


Changes in calcium and hydroxyproline content of cortical bone after compression and neutral plate fixation. Calcium and hydroxyproline content of intact rabbit tibio-fibular bone was assay chemically 1 day to 36 weeks after compression and neutral plate fixation with a 4-hole stainless steel ASIF/DCP plate. During the first three postoperative weeks calcium content of the cortical bone decreased by an almost significant amount (P less than 0.05); thereafter, calcium values remained subnormal but did not differ significantly from initial postoperative values. Hydroxyproline content increased steadily throughout the experiment (P less than 0.001). The changes in chemical composition of the bone were of the same magnitude after compression and neutral plate fixation. The results suggest that the cancellous transformation of cortical bone, known to take place under rigid plates, reflects an active remodelling process of the bone in which the calcium and hydroxyproline content changes only slightly.


Studies on mechanical strength of bone. I. Torsional strength of normal rabbit tibio-fibular bone. A method is described for testing torsional strength in small cortical bones at low velocities. The linearity and precision of the testing equipment, and the effect of the dimensions and chemical composition of the bone on torsional properties are analysed. Rabbit tibio-fibular bones exhibited right-to-left differences in energy absorption capacity (up to 10.0 per cent), torsional rigidity (7.1 per cent), torque moment at fracture (6.3 per cent) and angular deformation (5.7 per cent). The scatter in energy absorption was more dependent on differences in angular deformation (strain) than on differences in torque moment (stress). No statistically significant dominance of either side could be observed. The biomechanical properties of the bones were dependent on the body weight of the test animal and the transverse dimensions of the bone, but were not influenced by the small variations measured in the chemical composition of normal bone.


Studies on mechanical strength of bone. II. Torsional strength of cortial bone after rigid plate fixation with and without compression. Biomechanical properties of intact rabbit tibio-fibulae were investigated with torional loading 1 day to 36 weeks after fixation using 4-hole stainless steel ASIF/DCP plates with and without compression. During the first 12 weeks energy absorption and torque moment increased slightly as a result of subperiosteal new bone formation following application of the plates. There was a concomitant increase in the yielding properties of the bone, reflecting progressive porotic transformation. Thereafter, up to 36 weeks postoperatively, the values for energy absorption, torque moment and angular deformation gradually declined in both groups of bones. The differences between normal control bones and plated bones at 36 weeks were 70.1, 53.0 and 26.3 per cent, respectively. The decay of torsional strength was the same whether or not compression was used in the plate fixation. The results suggest that even in normal bone rigid plates induce a considerable loss of strength due to the cancellous transformation they are known to cause in cortical bone.


Methods for testing the mechanical properties of the rat femur. A modular apparatus to measure the bending and torsional properties of the rat femur is presented. Both intact femur diaphyses and diaphyseal fractures in different phases of healing can be tested. It is also possible to measure the bending-strength of the distal femur metaphysis and the epiphyseal plate. The apparatus can be used to investigate the effect of drugs and hormones on the remodelling of the rat femur.


Effects of oxytetracycline on the mechanical properties of bone and skin in young rats. The influence of the tetracycline antibiotics on growing bones has been disputed. In the present study 58 young male rats were given intraperitoneal injections twice a day for 2 weeks; half of the rats received oxytetracycline and the other half placebo. The concentration of oxytetracycline in plasma was comparable with therapeutic levels in man. Compared with the control animals the oxytetracycline rats had, at the end of the medication period, a significantly lower weight (7 per cent), shorter bones (1--2 per cent), lower bending strength of both the tibia diaphysis (9 per cent) and the distal femur metaphysis (22 per cent) and even lower tensile strength of intact (17 per cent ) and sutured (27 per cent) skin. The effect oxytetracycline seems to be reversible as no differences between the two groups could be detected 1--3 weeks after the end of medication.


Osteomyelitis after operative fracture treatment. A report of 62 cases treated with radical surgery and lincomycin (Lincocin). During the years 1967--1975 a total of 62 patients were treated for postoperative osteomyelitis. The lower extremities had been fractured in 89 per cent of the cases and 54 per cent were closed injuries. The fractures, mostly caused by traffic accidents and falls, had been immobilized by plates in 30 and by intramedullary nails or pins in 25 patients. Staphylococcus aureus was cultured in 80 per cent, 68 per cent of them were resistant to penicillin, but in 84 per cent the organisms were highly lincomycin sensitive and only three patients with four osteomyelitic lesions presented lincomycin resistance. The treatment consisted chiefly of sequestrectomies and saucerizations supported by 3--12 months of lincomycin treatment. In 30 operations a closed irrigation-suction technique was used, perfusing the wound with lincomycin solution. Stable implants should be left in place until the fracture is clinically solid whereas unstable osteosyntheses should be replaced by rigid internal or extraskeletal fixation. At follow-up, the results were judged as good in 74 per cent, fair 8 per cent and poor 18 per cent. The amputation rate was 13 per cent. Plates should not be used in the treatment of comminuted tibial fractures with considerable soft tissue damage.


Content and synthesis of nucleic acids in the cartilage in chondromalacia patellae. The content and the synthesis of nucleic acids in chondromalacian, osteoarthritis and normal cartilage was compared. The chondromalacian cartilage differed from osteoarthritis in that the content of nucleic acids was less. Also, the cell density was less in chondromalacian than in normal cartilage as opposed to previous findings in osteoarthritis. The synthesis of DNA was greater in chondromalacian than in normal cartilage but less than in osteoarthritis. With regard to the RNA synthesis, however, the chondromalacian cartilage showed a higher rate than both normal and osteoarthritic cartilage.


The penetration of cefazolin, erythromycin and methicillin into human bone tissue. The penetration of cefazolin, erythromycin and methicillin into normal bone was studied in 20 patients undergoing surgery for fracture in the trochanteric region of the femur. The antibiotic concentrations were determined in serum, bone marrow, and cancellous and cortical bone. For all three antibiotics the bone marrow concentrations were of the same order of magnitude as the serum concentrations. In the eight patients receiving erythromycin, detectable concentrations were found in all the cancellous bone specimens (ranging from 1/7 to 1/2 of the serum concentration) and in three cortical bone specimens (ranging from 1/50 to 1/5 of the serum concentration). In the six patients receiving cefazolin, a detectable concentration was found in only one cancellous bone sample. In the six patients receiving methicillin, detectable concentrations were found only in the blood contaminated specimens of one cancellous and two cortical bone samples. However, by the method used, the recoveries of standard solutions of methicillin in cancellous and cortical bone were about 50 per cent and 15 per cent, respectively.


Methylmethacrylate hypersensitivity in a patient with cemented endoprosthesis. A case report. A case of methylmethacrylate monomer hypersensitivity in a 76-year-old patient with a cemented endoprosthesis is reported. The accuracy of the method for preoperative testing of a patient's sensitivity is discussed.


Amputation after development of collateral circulation. An arteriographic study in rabbits. The vascular changes in the amputation stump after amputation on an extremity which is vascularized by collaterals were studied by arteriography in adult rabbits. Amputation on the crus immediately after ligature of the femoral artery caused a retardation in the development of collaterals and a protracted vasoconstriction in the amputation stump. Osseous plugging of the medullary cavity in the amputation stump counteracted the vasoconstriction, and the development of collaterals was improved. When amputation on the crus was performed 3-6 days after ligature of the femoral artery, immediate function of the collaterals and a rapid dilatation of the arteries in the below knee amputation stump were seen, and 3--4 weeks postoperatively arteriovenous shunts developed in the stump. Amputation 7--10 weeks after ligature of the artery involved a more pronounced shunt development in the amputation stump. After amputation on the femur only slight differences were observed in the development of collaterals and the vascularization in the amputation stump compared with findings after amputation on the crus.


Pneumatic tourniquet and limb blood flow. The response of limb circulation to tourniquet ischaemia in the hind limb of the rabbit was studied. Muscle blood flow was evaluated by means of a local isotope technique using Xe133 as the tracer and the changes occuring after tourniquet ischaemia of 60--180 minutes duration were investigated. The results obtained suggest that even when the tourniquet time is extended to 3 hours, no blood flow occurs in the limb distal to the tourniquet when the cuff is inflated to 300 mmHg. In all animals a hyperaemic reaction was noticed after releasing the tourniquet, and peak reactive hyperaemia was registered 1 minute after the return of circulation. The magnitude of the reactive hyperaemia was independent of the length of tourniquet time. The hyperaemia was regularly of short duration and peak flow values were reached in 1 minute with the flow returning to normal or subnormal values after 5 minuutes. Phlebography studies in 12 rabbits after 120--240 minute tourniquet blockade showed only one thrombosis in a deep popliteal vein after the 240-minute tourniquet time.


Larsen's syndrome. Report of three cases in the one family, mother and two offspring. Three cases are presented of the very rare Larsen's syndrome, being only the second report in the literature of concomitant involvement of parent (the mother in this instance) and offspring (two children) (see also Haberman et al. 1976). The only therapeutic procedure that is applicable, i.e., surgery, has given only mediocre results over an evolutive period of 8 to 9 years (in case C). We have not been able to demonstrate analytical or histological abnormalities that might provide a diagnostic clue, so that the aetiopathogeny of the disorder remains unknown.


Percutaneous pinning of supracondylar fractures of the humerus. Six cases of supracondylar fracture of the humerus in children were treated by closed reduction and percutaneous pinning with two Kirschner wires inserted laterally through the capitellum of the humerus. This treatment has the same advantages as the commonly used percutaneous pinning with crossed Kirschner wires inserted through the epicondyles of the humerus, and it further eliminates the risk of damaging the ulnar nerve by the insertion of the medial Kirschner wire.


Spondyloysis. The role of the posterior elements in resisting the intervertebral compressive force. Compressive tests were carried out on cadaveric lumbar intervertebral joints, before and after the neural arch was fractured. The results show that although the neural arch can play some part in resisting the intervertebral compressive force, there is no bony contact between the downward projecting tips of the inferior articular processes and the laminae of the vertebra below.


Instability of the proximal tibio-fibular joint. The proximal tibio-fibular joint consists of a joint cavity surrounded by a joint capsule (diarthrosis) forming a rather rigid joint. In patients who complain of pain and instability in the knee, the cause may sometimes be found in laxity of the proximal tibio-fibular joint. In these cases the abnormal movements of the fibular head are palpable and visible and can be demonstrated on X-ray films. The disease is not well known and is often overlooked. It can be differentiated by palpating the fibular head. In two patients the pain and disability were so severe that fusion of the proximal tibio-fibular joint was undertaken. This treatment seems to have been successful.


Cone arthrodesis of the first metatarsophalangeal joint. An operation for arthrodesis of the first metatarsophalangeal joint described previously has been performed on 85 toes in 68 patients over a 20-year period. The notes and X-rays have been reviewed to determine the incidence of bony fusion and to find out whether the operative position was maintained until union occurred. Arthrodesis was achieved in 83 (97.6 per cent) of the toes operated on. Where there had been no previous surgery to the metatarsophalangeal joint the incidence of bony union was 100 per cent. As determined by certain defined criteria there is a strong indication that the technique maintained the operative position until bony union occurred.


Reflex bradycardia: a grave complication of oesophageal atresia repair. Among 39 infants operated upon for oesophageal atresia in newborn age, 5 presented attacks of reflex bradycardia during meals. One patient died at the age of one and a half years. Four patients became symptom-free on atropine treatment. They are healthy and develop satisfactorily.


The fetal alcohol syndrome: symptoms and pathogenesis. The symptoms of the fetal alcohol syndrome and their frequency of appearance are described based on 41 reports in the literature and on own observations. Experimental evidence is presented proving the lack of cytotoxicity, mutagenicity and teratogenicity of alcohol itself and the intensive cytotoxicity, mutagenicity and teratogenicity of acetaldehyde. Responsibility for the fetal alcohol syndrome is ascribed to acetaldehyde at maternal blood concentrations surpassing 35 micrometer and it is suggested that the raised acetaldehyde level is due to an inherited or acquired defect of mitochondrial aldehyde dehydrogenase. Prospective mothers displaying acetaldehyde levels exceeding 30 micrometer after a drink should be advised against bearing a child.


Ambiguous genitals and the choice of gender. In 8 children with ambiguous external genitals, sex chromosome, hormonal and histological examinations were performed. On this basis the registered sex and the surname of the child were changed from the registered male to female in 3 cases and from female to male in one case. Diagnosis and the decision about the gender are urgent tasks, since prolonged waiting may have serious consequences in psychosexual development.


The 1-hour D-xylose test in the diagnosis of villous atrophy. The results obtained in 40 cases of intestinal mucosal biopsy and parallel 1-hour D-xylose test are presented. Of 40 patients, 15 had subtotal villous atrophy, while in 25 the villous structure was intact. Among the 15 patients with villous atrophy 10 gave D-xylose values of less than 20 mg per dl. In the control group all D-xylose values were above 20 mg per dl.


The Hungarian congenital malformation monitoring system. The Hungarian Congenital Malformation Monitor has been operating since 1973 in order to detect the temporal and regional clusters of 12 indicator congenital malformations as early as possible. This Monitor takes part in the International Clearinghouse for Birth Defects Monitoring System. Three continuously increasing trends were detected in 1973--1976. They may be connected with the more complete notifications, although the increase of limb reduction deformities are only partly explained by this factor. Transitional (quarterly) significant clusters were observed in the case of anencephaly (1974, IV), spina bifida (1974, II; and 1975, III; 1976, III), cleft lip +/- cleft palate (1974, III). The possibility of three technical biases (changes in diagnosis, notification and evaluation of the given congenital malformation) has to be excluded before accepting the fact of a real epidemic. Subsequently, a case-control epidemiological study by personal interviews and with matched controls has to be performed.


Histochemical study on lipid metabolism in acute myocardial infarction. As a part of the series of studies on lipid metabolism in ischemic myocardium, the present study was attempted to analyse 29 infarcted hearts with acute or scar lesions by a routine histopathology and lipid histochemistry. The time after the onset of attack till death ranged from one day to years. Sixteen were of the acute form, less than 2 month-old, and 13 were of the chronic scarred form. Within the first day, fat deposition appeared in the survived muscle cells around the infarcts reaching the peak from 2 days to one week, but necrotized cells never contained fat droplets. Macrophages in granulation tissue in periphery of the infarcts tended to have significant fat droplets usually in 10 days to one month. Fat disappeared from the survived muscle cells and also from the scar later than 2 months. The survived cells around the infarcts might be degenerated with fat, probably triglyceride, which accumulated by a relative ischemia not severe enough to produce coagulation necrosis, and they bear some relationship with extension or limitation of size of infarcts.


The mediation of macrophage reaction in inflammation, with special reference to IgG-derived chemotactic factor. Three different macrophage chemotactic factors were separated from hypersensitivity skin lesions induced by DNP-ascaris extract or PPD. The amount of each factor seemed to be changeable according to the nature of inflammatory stimuli. The chemotactic activity of the factor a was completely absorbed by anti-IgG and anti-light chain antibodies, while that of the factors b and c was not absorbed by the antibodies. The factor a was produced from IgG by neutrophil neutral serine protease resembling elastase but failing to digest elastin-orcein; its chemotactic generation was accompanied by release of dialysable peptide(s) from the IgG molecule, suggesting a minor structural change of the IgG molecule. Production of leucoegresin or lymphocyte chemotactic factor by neutrophil neutral thiol protease from IgG molecule was discussed.


Malignant pheochromocytoma arising in the organ of Zuckerkandl--a clinicopathological study. An autopsy case of malignant pheochromocytoma arising in the organ of Zuckerkandl is reported, of which distant metastases were found in the liver and lymph nodes. The biochemical and electron microscopic findings from the tumor tissue showed noradrenaline-secreting type. It was revealed that sex ratio in malignant pheochromocytoma was more prominent in the female, and the frequency of extra-adrenal origin was higher in malignant pheochromocytoma than in benign one from comparative study of reported cases of malignant pheochromocytoma.


Infantile convulsion suspected of pyridoxine responsive seizures. A 6-month-old boy, having suffered repeated convulsive siezures since birth, died of severe epilepsy, the disease remaining unknown. However, when a brother, born after the death of the present case, displayed the same clinical symptoms and was diagnosed clinically as having pyridoxine dependent convulsion, the deceased became suspected of having been a case of familial pyridoxine dependency. Pathologically, bilateral cerebellar hemorrhages were found accompanied by subdural and subarachnoidal hemorrhages. Histologically, neuronal loss and diffuse astrocyte hyperplasia were found in the brain: Beside marginal gliosis, proliferations of astroglia and glial fibers were found, especially in the pons, medulla oblongata, and cervical cord, although the fibrillary gliosis may be representative for a physiological intermediate state. Foamy cells were found in the lymph nodes, but not in the brain. Observed in the kidneys were substances deposited in the glomeruli and Bowman's capsules and materials in the tubular lumen.


Disseminated atypical mycobacteriosis in a child--a case of Mycobacterium sculoflaseum. A case of disseminated mycobacterial disease caused by mycobacterium sculoflaceum is presented in a three-year-old female. Atypical acid-fast organisms were found in cultures from the tissue of lymph node and bone marrow, gastric juice and feces. Histologically the mesenteric lymph nodes contained numerous large macrophages which had large numbers of acid-fast bacilli. Caseation necrosis was absent. Distinguishing features are the extensive involvement of lymph nodes and bones and the preference for intracellular presence of acid-fast bacilli. Up to the present in Japan there are only 17 reported cases of atypical mycobacteriosis in children.


Pseudosarcomatous carcinoma of the esophagus--reference to its histogenesis. A case of pseudosarcomatous carcinoma of the esophagus with metastasis to lymph node was presented and the literature was reviewed briefly. Transition from carcinomatous to sarcomatous picture was noted and the presence of tonofibrils and desmosomes was demonstrated by electron microscope in the cells with sarcomatous features. These findings suggested an epithelial origin of the sarcomatous component in pseudosarcomatous carcinoma.


Letterer-Siwe disease with lipid-containing vacuolated cells--an autopsy case. A case of Letterer-Siwe disease of a 1-year-2-month-old boy, which clinicopathologically satisfied 7 out of the 8 characteristics of the disease by Siwe's criteria, excluding pathologic changes in the bone is reported. The vacuolated histiocytes appeared in the proliferating reticuloendothelial cells in this case; the cells were positive by general fat reaction; the fats consisted of cholesterol fats, phospholipids and neutral lipid. Electron microscopy showed the occurrence of lipid droplets with cholesterol crystals and atypical form of Langerhans cell granule. Granulomatous changes were found in the lymph nodes and spleen, and this case was also similar in part to chronic granulomatous disease; however, celoid and lipofuscin pigments were negative in the proliferating cells. Cytomegalic inclusion disease as a complication was found in the lungs and intestine, and bilirubin stones in the liver.


Chronic lymphocytic leukemia showing pituitary tumor with massive leukemic cell infiltration, and special reference to clinicopathological findings of CLL. An autopsy case of a 33 years old doctor with chronic lymphocytic leukemia (CLL) was reported. Two remissions were noted with chemotherapy and irradiation. The special characteristic of this case was the tumor formation in the sellar fossa similating a pituitary tumor which was considered as a type of meningeal leukemia, showing visual disturbance. Leukemic cell infiltration was hardly observed in any other organs. From the analysis of five cases of CLL, the author proposes that CLL may be classified into two types: the one is the severe type showing a short clinical course and the other is a mild one, showing a long clinical course. Details such as histopathological findings, cause of death and clinical findings were discussed.


Endolymphatic stromal myosis with autoradiographic observation. A biopsy case of endolymphatic stromal myosis, a rare neoplasm of the uterus, which occurred in a 33-year-old female was described. The histology was typical and resembled stromal cells of proliferative phase endometrium. The tumor extended in the endometrium and diffusely infiltrated into the myometrium and the parametrium. However, 3H-thymidine labeling index was low suggesting slow growth of the tumor.


Pathological studies on atrioventricular conduction disturbances. A histopathological study was made on 150 autopsied hearts according to the method of Lev in order to investigate the correlation of conduction disturbances with the branching pattern of the bundle branches. Subsequently, the study of bundle branch block and A-V block cases revealed that no explicit correlation existed between histopathological changes and functional disturbances nor between disturbances in conduction (i.e. breakdown of the physiological mechanism) and histopathological findings.


Drug-induced lysosomal changes and nephrotoxicity in rats. Lysosomal involvement in renal tubular lesions was studied mainly by electronmicroscopy after single and repeated administrations of cephacetrile, cephalothin, cephaloridine, gentamicin or leupeptin and combine administrations of cephalothin and gentamicin or gentamicin and leupeptin in female Wistar rats. Large cytosomes of high density were increased due probably to either reabsorption and secretion of drugs or their metabolites. These cytosomes displaying acid phosphatase activity were demonstrated histochemically and were identified as heterolysosomes. In rats treated with cephaloridine, gentamicin or leupeptin, disruption of lysosomal membrane was noted and regional cytoplasmic destruction was seen in the vicinity of the disrupted heterolysosomes. Necrotic epithelial cells and renal insufficiency were observed in these animals. On the other hand, neither destruction of lysosomes nor cell lesion was found in rats treated with cephacetrile or cephalothin. It was speculated that lysosomal destruction might be the cause of the cell lesions found in cephaloridine, gentamicin or leupeptin treated rats.


Morphological studies of the spleen in splenomegalic liver cirrhosis comparing with the spleen in idiopathic portal hypertension (so-called Banti's syndrome without liver cirrhosis). Morphological changes of the spleen in splenomegalic liver cirrhosis (SLC) were studied. Comparisons with the normal spleen and the spleen of idiopathic portal hypertension (IPH) were made by (1) light microscopy with histometry, (2) scanning electron microscopy (SEM) with histometry, and (3) SEM of the spleen vascular replica. Histometrical studies by light microscopy showed that in both SLC and IPH, the white pulp volume was decreased in random units of splenic tissue but increased in the whole spleen, whereas the red pulp volume was increased both in random units of splenic tissue and in the whole spleen. The increase in the total volume of the white pulp was less marked in SLC than in IPH. SEM histometry demonstrated in the red pulp an increase in small venous sinuses and narrowing of the Billroth cord in SLC and IPH. Narrowing of the Billroth cord was more marked in SLC than in IPH. SEM of the white pulp showed channels formed by reticulum cells around the central artery in SLC and IPH. The channels are thought to correspond to so-called "follikuläre Fibroadenie" or periarterial fibrosis. The spleen vascular replica demonstrated open arterial termination into the tissue spaces in the Billroth cord in SLC, IPH and the normal. Venous sinuses were arranged in bundles in SLC and IPH.


Congenital dilatation of intrahepatic bile ducts associated with hepatic fibrosis and medullary sponge kidney--reconstruction and microdissection study. An autopsy case of a four-year-old female with congenital dilatation of intrahepatic bile ducts with bilateral medullary sponge kidney is presented. The liver and kidney were investigated by reconstruction with serial sections and the kidney was also studied by microdissection. In this case the dilatations of collecting tubules and intra- and extrahepatic bile ducts were observed. We regard these lesions as developmental anomalies since these sites of both organs are excretory ducts derived from the endoderm. The liver cirrhosis observed at autopsy had developed in the course of the disease because the liver architecture was well preserved in the biopsy material. The patient had fatal cholangitis without cholelithiasis.


Fusiform aneurysm of basilar artery associated with bilateral choroidal cysts. A case of large fusiform aneurysm of the basilar artery and bilateral choroidal cysts in the lateral ventricles is reported. The pathogenesis of the choroidal cysts is briefly discussed.


Cemented tungsten carbide pneumoconiosis. An autopsy case of cemented tungsten carbide pneumoconiosis, the first lethal case in our country, is presented. A 28-year-old woman, who had been engaged in grinding presintered metallic matrix for four years, developed respiratory symptoms. X-ray examinations were indicative of interstitial pulmonary fibrosis. Corticosteroid therapy revealed only little effect. She expired five years after the onset of the symptoms. Postmortem examination showed nonspecific interstitial pneumonitis resulting in marked lung fibrosis. Ultrastructurally, crystals were observed in cytoplasm of presumable macrophages in the fibrotic lung tissue. Electron probe microanalysis of the lung tissue showed the presence of tungsten and other constituents of tungsten carbide except for cobalt. Metal analysis demonstrated a large amount of tungsten in the lung. Cobalt was detected tenfold of the normal value in the bone. In pathogenesis of the pneumoconiosis in the cemented tungsten carbide workers, toxicity of cobalt is most suspectable, and in addition, individual susceptibility may be also important.


Fulminating lactose-positive Vibrio septicemia. Recently cases of tissue invasion by as yet unnamed marine vibrios which were morphologically and biochemically similar to both Vibrio parahemolyticus and V. alginolyticus, but not identical with either of them, have been described. We have seen a patient who had serious widespread tissue infection with a halophilic, Gram-negative bacterium which was isolated from blood and leg lesions. The organism had the characteristics of the genus Vibrio, and lactose fermentation and ONPG reactions were positive. It also had a lower tolerance for sodium chloride in the nutrient broth compared with the above two vibrios. The isolate seems identical to the lactose positive (L+) Vibrio described by HOLLIS et al. (1976). Tissue infection resulting in severe necrotizing cellulitis and vasculitis was demonstrated at autopsy.


Congenital hepatic fibrosis. A case report with study of three dimensional reconstruction of serial sections of the liver. A patient who developed pancytopenia and hepatosplenomegaly with portal hypertension is described. Liver wedge biopsy at the time of operation showed typical histology of congenital hepatic fibrosis. Renal surgical biopsy revealed tubular ectasia. A continuous anastomosing network of the biliary tree was observed by reconstruction of serial sections of the liver. Some parts of the network were dilated and no isolated bile ducts were present.


Diffuse infantile fibromatosis.

Diffuse infantile fibromatosis. A boy 15 months old with diffuse infantile fibromatosis in the thigh is reported. A rapidly growing tumor in the right thigh was the only clinical manifestation, suggesting a malignant soft tissue tumor. Macroscopically, the lesion in the medial vastus muscle with an illdefined border gave a pepper and salt appearance. Histologically, the lesion was characterized by an abnormal proliferation of fibroblasts accompanied by some fibrosis, infiltration of chronic inflammatory cells, formation of lymphoid follicles, proliferation of capillaries and the presence of a small number of mature fat cells. No evidence of recurrence is found at present one and half years after operation.


Sarcomatous variant of malignant histiocytosis; a case report and review of the literature. The case is that of a 21-year-old female with mediastinal and subcutaneous, tumors composed of sarcomatous growth of poorly differentiated histiocytes defined by enzyme histochemical staining, ultrastructural observation and detection of surface markers. At autopsy neoplastic cells in the solid tumor became less cohesive and pleomorphic with erythrophagia, while features in the lymph node draining from the tumor was compatible with the criteria of malignant histiocytosis. The place where such a sarcomatous variant of malignant histiocytosis should be placed within other histiocytic tumors is discussed and the literature reviewed.


Malignant pituitary chromophobe adenoma in an infant accompanying diabetes insipidus. This report deals with a 1.5-year-old male infant terminating in viral pneumonia and "diabetes insipidus". The autopsy revealed malignant pituitary chromophobe adenoma, invading the wall of the third ventricle, extending to the periventricular-, dorsomedial- and ventromedial area, skipping to the lateral area adjacent to the optic nerve, and permeating into the subarachnoid space of the cerebrum. At the onset of disease polydypsia and polyuria were marked followed by interstitial pneumonia with high fever, and later generalized tonic convulsion terminated in death. This case is peculiar in at least two respects. Firstly, this is the youngest reported case of malignant chromophobe adenoma. Secondly, the manifestation of diabetes insipidus is rare in chromophobe adenoma. The malignant adenoma probably occurred from the primitive gland rest of chromophobe cells in the posterior lobe becoming malignant during the course of growth development and destroyed the cells of the posterior lobe, resulting in diabetes insipidus.


Changes in the convulsion threshold and in the level of brain biogenic amines in rats chronically treated with phenobarbital or diazepam. In experiments on 72 male Wistar rats, chronically treated with phenobarbital and diazepam, studies are made of the change in the convulsion threshold after sound stimulation during treatment and after withdrawal of the drugs. The level of biogenic amines in the brain at the end of the treatment (60th day) and after withdrawal of the drugs (3rd day) was also determined. The convulsion threshold was found to be considerably lower on the 3rd day after drug withdrawal in rats treated with phenobarbital and to a lesser extent (also on the 3rd day) in rats treated with diazepam. Serotonin level is considerably lower in both groups of animals. The significance of the disturbed correlation between serotonin and noradrenaline and particularly the sharp decrease of the serotonin level for the appearance of intensified convulsion activity is discussed.


Character of the spike activity on both sides of duodenal transection depending on the regeneration of the intrinsic nervous system. Experiments are carried out on dogs with transection of the duodenum followed by end-to-end anastomosis and chronically implanted silver ball-shaped electrodes on the muscle wall of the stomach and on the segments of the duodenum proximal and distal to the transection. Dissociation of the spike activity of the two duodenal segments is established after the operation. As early as the second week after the transection, parallel with this single group of spike potentials propagating through the anastomosis are also observed. With increasing the time interval from the operation propagation of the spike activity along the length of the muscle occurs more and more frequently. The difference in the percentage of spike activity of the two duodenal segments is greatest during the first and second months after the operation. At the beginning of the third month it decreases gradually to reach 10 per cent approximately during the fifth month after the operation. In preliminary vagotomized dogs the difference in the percentage of the spike activity is maintained around 20-30 per cent. In dogs with definitely separated segment of the duodenum this difference becomes great and there are no tendencies towards reduction even in the sixth month post operation. Histological studies of the material taken from the area of the anastomosis of animals at different post-transection periods, subjected to silver impregnation after the method of Bielschowsky-Gross, show regeneration of the severed nerve bundles of plexus myentericus Auerbachi. The restoration of the spreading of the spike activity along the length of the duodenum is associated with restoration of the nerve structures in the muscle wall of the duodenum.


Cholinergic mechanisms in the learning and memory facilitating effect of the central stimulants. II. Influence of anticholinergic agents on the learning and memory facilitating effect of strychnine. In experiments involving training of albino rats in a maze it has been found that strychnine (1 mg/kg) introduced 5 min before or immediately after training, improves learning and retention. Upon blocking of the central muscarine-sensitive cholinergic structures (scopolamine 2 mg/kg) and of the nicotine-sensitive structures (spasmolytin 20 mg/kg), the learning and memory facilitating effect of strychnine is not manifested. The realization of the learning and memory facilitating effect of strychnine requires optimum functional level of the activity of the central cholinergic system.


Cholinergic mechanisms in the learning and memory facilitating effect of the central stimulants. III. Influence of the anticholinergic agents on the learning and memory facilitating effect of amphetamine. In experiments involving training of albino rats in a maze it has been established that amphetamine in a dose of 0.5 mg/kg introduced 15 min before learning has almost no effect, in a dose of 2 mg/kg it slightly deteriorates learning and retention, while in a dose of 1 mg/kg both learning and retention are markedly improved. However, introduced immediately after training, all three doses tested improve retention upon testing 24 hours and 14 days after training. Upon blocking of the central muscarine-sensitive cholinergic structures (scopolamine 2 mg/kg) and of the nicotine-sensitive structures (spasmolytin 20 mg/kg), the learning and memory facilitating effect of amphetamine is not manifested in the two experimental setups (introduction before and after training). The results resemble the case of independent administration of cholinolytics only, i.e. complete blocking of learning and memory induced by scopolamine and considerable deterioration induced by spasmolytin. The results obtained show that the realization of the learning and retention facilitating effect of amphetamine requires optimum functional level of the activity of the central cholinergic system.


Influences between the contingent negative variation and the preceding readiness potential. Contingent negative variation (CNV) is a slow negative shift in the potential, developing in the period of association between the warning and the imperative stimulus. The readiness potential (RP) resembles the CNV in morphology and amplitude and appears before the performance of a voluntary action. When RP precedes the appearance of the warning stimulus, CNV amplitude reaches considerably lower values. This phenomenon could be explained with the assumptions about a common neuronal pool of McAdam (1971) and with the "ceiling" hypothesis of Hamilton et al. (1973). The aim of the present study is to examine the effect of time intervals with different duration between RP and CNV. A decrease in the amplitude of CNV following RP has been found, without statistically significant differences depending on the interval between them. A more significant influence is observed on CNV morphology: in addition to a decrease in the amplitude, there is also a transition from type B to type A CNV when it is preceded by RP. Under conditions of a more complicated task involving combination with CNV, the RP itself shows lower values compared with the case of independent generation. This gives grounds for the conclusion that the complexity and the complex requirements of the task determine the value of the negatively directed slow-potential changes.


Interaction of visual evoked potentials in groups of stimuli with different interstimulus intervals in cats. I. Experimental design. Dispersion analysis. Quantitative estimation of excitability is performed at present in a pair of stimuli by studying the so-called recovery cycles. Random mixing of the interstimulus intervals and their appropriate grouping (grouped pairs) can provide new information about the course of excitability in time. An experimental setup is described in which by planning of the experiment (BIB-design) the interstimulus intervals are randomized and all components of the evoked potentials (EP) are placed under equal conditions with respect to the influence of the preceding intervals. The effects of the interstimulus intervals simultaneously on different components of visual evoked potentials in cats are estimated by means of dispersion analysis. The results show the existence of a significant effect only on definite amplitudes of the EP (predominantly with great latencies). The interactions of the effects of definite interstimulus intervals are determined, which permits the assumption of an interaction among different components of EP.


A rapid and sensitive assay for monoamine oxidase activity. Based on the Berthelot reaction, a new sensitive and rapid procedure for monoamine oxidase (MAO) determination with substrate tyramine has been developed. The saturation with oxygen and the separation of ammonia from the substrate were omitted. At the end of incubation the samples were deproteinized with ethanol and consecutive centrifugation. The newly-formed ammonia is converted into the coloured compound indophenol, using the procedure of Fenton (1962). The indophenol concentration, respectively NH3 is determined by spectrophotometry at 625 nm, and calculated by comparison with a set of standard amounts of NH3. The enzyme activity is expressed as nanomoles ammonia, formed by 1 mg protein for 1 min. The method was tested for studying the relationship between the enzyme activity, time of incubation and protein concentration, as well as the effect of pargyline. The kinetics of MAO, using both liver and brain mitochondria as enzyme material was also studied. Considering the specificity, simplicity, versatility and rapid performance, the new method showed several advantages in comparison with the other known methods for MAO determination.


Mean energy imparted in relation to the focus to object distance. The relationship between the energy absorbed by the patient at the exposure of a radiographic image and the focus to object distance is analysed. It is found that the mean energy imparted, or the integral absorbed dose, is the same irrespective of the focus to object distance when the energy fluence and the field size are both normalized at the film plane. When the field size is kept constant within the object whilst the focus to object distance is varied a limited increase in the mean energy imparted occurs when the focus to object distance is decreased; this statement is valid for the focus to object distances which are usually applied in diagnostic radiology. When estimating radiation risks the importance of the focus to object distance is found to be of limited interest.


Arterial and venous blood pressure and blood flow following femoral angiography with a new non-ionic contrast medium. An experimental investigation in dogs. At femoral angiography in dogs the effects of a new non-ionic contrast medium (C29) were compared with those of one non-ionic medium (metrizamide) and one ionic medium (meglumine/sodium diatrizoate) in current use. In the leg subjected to angiography the pressure gradient over the peripheral vessels decreased and the femoral blood flow increased. The changes induced by the ionic medium were significantly greater than those induced by metrizamide and C29, whereas no significant difference between the two non-ionic media was recorded.


Effect of intra-arterial CO2 insuffflation on occlusive arterial disease in the lower leg. Twenty patients with a mean age of 79 years were followed over a period of 6 months after intra-arterial insufflation of CO2 in the lower extremity. All patients had severe peripheral occlusive arterial disease caused by atherosclerosis and were scheduled for amputation. A significant increase of the distal perfusion pressure was obtained in the majority of the cases resulting in pain relief and healing of ulcers and gangrenes.


Preoperative infusion of mitomycin-C in the bronchial artery in squamous cell carcinoma of the lung. Bronchial angiography was performed in 9 patients with squamous cell carcinoma of the lung. The tumor-feeding vessel was identified and infused with 10 mg of mitomycin-C (MMC) diluted in saline. At operation after 28 to 48 days complete remission of the tumor had occurred in 2 patients, almost complete in one, partial remission in 2 and a marked regression in 2. In 2 patients no change was noted. No side effects except moderate malaise and slight fever occurred.


Myelography in lumbar spondylolisthesis. Radiography and myelography of 41 patients with lumbar spondylolisthesis and radicular syndrome were analysed. The L5 olisthesis in several aspects differed from the L4 olisthesis. Root pocket amputation was the most common explanation for the radicular syndrome but sometimes present without clinical signs. In this series disc herniation was uncommon and its diagnosis difficult. Total or subtotal block of the subarachnoid space was also uncommon but this diagnosis enforced the indication for decompressive operation.


Quantitative cisternography.

Quantitative cisternography. By quantitative cisternography using a stationary detector system with correction for tissue background, an exponential elimination of 131I-HSA from the basal cisterns was demonstrated, allowing calculation of a biologic half time (BHT) of the clearance curve of a satisfactory level of reproducibility. 'Normal' range of BHT was calculated. Demented patients had significantly longer BHT. In 4 patients with normal pressure hydrocephalus prolonged BHT turned normal after shunting, paralleled by marked clinical improvement, in contrast to previous findings in 4 patients with presenile dementia. The method is now being modified employing 111In-DTPA and a computer assisted gamma camera for regional dynamic analysis.


Lung ventilation-perfusion scintigraphy in pulmonary embolism. Diagnostic specificity compared to pulmonary angiography. In 53 patients with possible pulmonary embolism, pulmonary abnormalities of 133Xe ventilation and 99Tcm albumin microsphere perfusion scintigraphy were compared with absence or presence of pulmonary emboli documented by concurrent pulmonary angiography. It was found that patients with combined scintigraphy considered as unlikely for pulmonary embolism (ventilation defect larger than perfusion defect) or indicative of pulmonary embolism (ventilation defect smaller than perfusion defect) provide high diagnostic specificity. Patients with equal ventilation-perfusion abnormalities (possible pulmonary embolism) require further evaluation by pulmonary angiography to ascertain diagnosis. Importantly, diagnostic accuracy, using ventilation-perfusion scintigraphy and the quantified method of evaluation delineated, is preserved in patients with severe congestive heart failure.


Ultrasonography and angiography in the diagnosis of abdominal aortic aneurysm. A material of 130 consecutive patients with clinically possible abdominal aortic aneurysm was reviewed. All of them were examined by ultrasonography and 23 by abdominal aortography as well. Ultrasonography revealed aortic aneurysm in 42 patients. The management of this entity and the value of different diagnostic methods are discussed. The importance of ultrasonography as a non-invasive and accurate diagnostic aid is emphasized.


Left ventricle of the heart on conventional lateral chest films. Segments of the left ventricular circumference were visible within the radiologic image of the heart on conventional full size lateral chest films of 122 patients; in 75 the findings were confirmed by cardioangiography. The presence of the epicardial fat layer and the locally varying thickness of the heart in the direction of the radiation are considered as main factors in the demonstration of the left ventricular outline. The clinical significance of the findings in shortly discussed.


Effect of meglumine metrizoate and metrizamide on the microcirculation. Animal experiments. Physiologic saline, meglumine metrizoate (Isopaque) and metrizamide (Amipaque) were injected into the ear artery of Wedder rabbits. The effect on the microcirculation in previously inserted ear chambers was recorded by cinematography. Following injection of the contrast media, the circulation was slow, followed by a phase with arteriolo-venular shunting and poor capillary circulation.


Effect of ionic and non-ionic contrast media on whole blood viscosity, plasma viscosity and hematocrit in vitro. The effect of the ionic contrast media diatrizoate, iocarmate and metrizoate and the non-ionic metrizamide on whole blood viscosity, plasma viscosity and hematocrit was investigated. All the contrast media increased whole blood and plasma viscosity and reduced the hematocrit. The whole blood viscosity increased with increasing osmolality of the contrast medium solutions, whereas the plasma viscosity increased with increasing viscosity of the contrast medium solutions. The higher the osmolality of the contrast media, the lower the hematocrit became. The normal shear-thinning (decreasing viscosity with increasing shear rate) property of blood was reduced when contrast medium was added to the blood. At 50% volume ratio (contrast medium to blood), the ionic contrast media converted the blood into a shear-thickening (increasing viscosity with increasing shear rate) suspension, indicating a marked rigidification of the single red cell, while the non-ionic contrast medium still produced shear-thinning, indicating less rigidification of the red cell (p less than 0.01).


Facial bone scintigraphy. II. Diagnostic potential in neoplastic and inflammatory lesions. From a series of about 200 facial bone scintigraphies, 32 patients were selected to demonstrate the uptake of 99Tcm-diphosphonate in various inflammatory and neoplastic diseases in the sinuses and oral cavity. The method was found of value in separating patients with inflammatory involvement of the bone from those without, as well as in assessing possible bone involvement in malignant lesions.


Mucosal protection during irradiation of exteriorized rat ileum. Effect of hypoxia induced by starch microspheres. Transient hypoxia induced by intra-arterial injection of degradable starch microspheres was used for protection of exteriorized segments of the rat ileum. Microscopic evaluation of the injury to the mucosa gave a dose modification factor of 0.44 +/- 0.04, which corresponds to an oxygen enhancement ratio of 2.30. A similar factor was also found from measurements of the mucosal weight. No significant development of mucosal oedema could be demonstrated, neither in protected nor in non-protected segments.


Biogenic amine response to whole body irradiation. Prevention by APTH. 60Co whole body irradiation with 154.8 mC/kg (600 R) resulted in a mortality of 50 per cent within two weeks. Administration of 1-acetyl-3-phenylamidine thiocarbamide hydrochloride (APTH) 30 min before irradiation prevented this mortality. Irradiation eliminated neurosecretory material from the perikaryons of the supraoptic and paraventricular neurons, whereas APTH counteracted this action. APTH also increased the synthesis of bioamines (5-hydroxytryptamine, catecholamine and acetylcholine).


Relation between severity of thyrotoxicosis and response to 131I therapy. The relation between the severity of hyperthyroidism and response to 131I therapy was tested in a group of 45 patients 6 to 12 months after therapy. At following treatment 7 patients were hypothyroid, 13 euthyroid and 25 hyperthyroid. The absolute iodine uptake and gland size was significantly higher in the hyperthyroid group compared with the other groups. The radiation dose was similar in the groups, but the ratio between dose and uptake was significantly lower in the hyperthyroid group.


Familial antithrombin III deficiency as pathogenesis of deep venous thrombosis. A family including 18 members with decreased antithrombin III (AT III), measured with both a biological and an immunochemical method, is described. The pattern found on crossed immunoelectrophoresis, using heparin in the agarose in the first run, was normal, though the peaks were low. This suggests decreased synthesis of a normal protein in the affected members. AT III deficiency occurred in both the paternal and the maternal branch, of the above 18 persons had had at least one thromboembolic episode. Some of the episodes had been precipitated by the presence or occurrence of some predisposing event or circumstance. This suggests the possible occurrence of a gene making some of the maternal family members more susceptible to certain trigger factors, such as surgery, infection, pregnancy, and the puerperium. The mode of inheritance filled all the criteria for autosomal dominant transmission. Prophylactic treatment, preferably oral anticoagulants and/or dextran, is recommended for all persons with a low AT III concentration in any situation known to increase the predisposition to thrombosis. The effect of heparin in these patients is impaired since the heparin co-factor, which is identical with AT III, is lowered.


The effect of the converting enzyme inhibitor SQ 20.881 on kinins, renin-angiotensin-aldosterone and catecholamines in relation to blood pressure in hypertensive patients. Nine sodium replete hypertensive patients with normal or high plasma renin activity (PRA) were given SQ 20.881, 1 mg/kg intravenously BP fell significantly within 20 min and reached its lowest level after 60 min. Blood kinins showed a minor but significant decrease after 60 and 105 min. Plasma angiotensin II was markedly reduced after 15 and 60 min. PRA was significantly increased after 15-105 min. Plasma aldosterone was reduced at 60 min in eight patients and slightly increased in one. Plasma noradrenaline increased after 15 min, whereas adrenaline decreased after 60 min. These results indicate that the reduction of BP following inhibition of converting enzyme by SQ 20.881, 1 mg/kg, is not related to reduced degradation of kinins but rather to decreased formation of angiotensin II. Angiotensin II appears to be of importance for the maintenance of BP in sodium replete hypertensive patients with normal or high PRA.


Interaction by cholestyramine on the uptake of hydrocortisone in the gastrointestinal tract. An absolute reduction of the plasma cortisol levels and a delay of the peak concentrations were recorded in 10 healthy subjects, when a bile-sequestering anionic exchange resin, cholestyramine, was given prior to a single oral hydrocortisone dose, indicating that the resin interferes with the uptake of a neutral sterol in the human gastrointestinal tract. The possibility of a direct binding of drug to resin is supported by the affinity of hydrocortisone to cholestyramine in vitro, which was uninfluenced by the presence of sodium taurocholate. Cholestyramine significantly delayed the gastric emptying of a glucose solution, indicating that the resin not only decreases but also delays hydrocortisone absorption. Careful supervision is recommended when treatment with cholestyramine is given concomitant to neutral sterol drugs.


Properties and latencies of potentials evoked in postganglionic sympathetic nerves by electrical stimulation of aortic, sinus and hypoglossal nerves in cats. The properties and latencies of potentials evoked in cardiac (CN) and renal (RN) sympathetic nerves by electrical stimulation of the sinus, aortic and hypoglossal nerves were studied in cats. Electrical stimulation of the sinus nerve evoked only excitatory responses in the sympathetic nerves. Electrical stimulation of the aortic nerve fibers evoked excitatory or inhibitory responses in sympathetic nerves. It was possible to evoke 4-5 Hz oscillations in CN and RN after electrical stimulation of the aortic and sinus nerve.-It is suggested that electrical stimulation of the baroafferents is partially responsible for "post-excitatory inhibition" in CN and RN. The central transmission time was the same for the aortic and sinus chemoreceptor reflex and for the somatosympathetic reflex. This period was shorter than the central transmission time of the aortic nerve baroreceptor reflex.


Effects of lesions in the amygdaloid nucleus centralis on acquisition and retention of avoidance reflexes in cats. Acquisition and retention of bar-press avoidance responses after lesions of the lateral part of the amygdaloid nucleus centralis were investigated in 17 adult male cats. The lesions were administered either 10 days (5 cats), or 35 days (7 cats) before training. The remaining 5 cats served initially as intact controls and then, after extensive training, were given similar lesions to test for the effects on retention of the task. The lesions resulted in both retarded avoidance acquisition and a decreased proportion of short latency responses. A short post-operative pause resulted in stronger lesion effects on the length of training and deterioration in short-latency response performance, but a smaller effect on the increase in intertrial responding than was found after a long post-operative pause. The lesioned cats showed more oscillations between runs of escape and avoidance responses than normal, control cats. The immediate effect of lesions on well-trained avoidance reflexes consisted of a decrease in avoidance performance and marked prolongation of escape latencies. The deterioration in short-latency avoidance responding was irreversible in spite of extensive post-operative retraining.


Effect of bilateral suprasylvian ablation on fear behavior elicited by hippocampal stimulation in cats. Fear responses elicited by electrical stimulation in the dorsal and ventral hippocampus of cats, and the conditioned fear behavior established by pairing this stimulation with a neutral stimulus disappeared after bilateral ablation of the suprasylvian gyrus. The same reactions were not affected when the ectosylvian gyri were removed. The suprasylvian ablation did not impair conditioned classical defence reflexes when a noxious stimulation of the hind limb was used as an unconditioned stimulus. It is suggested that the suprasylvian association area plays an important role in fear produced by hippocampal stimulation but not in pain responses elicited by a noxious peripheral stimulus.


Can alternative schools succeed where Benjamin Spock, Spiro Agnew, and B. F. Skinner have failed? This study sought to determine whether student behavior was as great a problem in a sample of 18 California alternative high schools. As a result of on-site observations and interviews with students and teachers, the authors concluded that discipline rarely was a major concern in the alternative schools. General agreement existed among both students and teachers. Fourteen possible reasons to account for the basic finding were hypothesized. The reasons included small school size, flexible schedules, frequent informal interaction between students and teachers, and fewer rules.


Counterattack on juvenile delinquency: a configurational approach. This report on the Michigan Youth Services boys camping program suggests substantial attitudinal and behavioral improvement by all groups of participants. Squads strategically "mixed" with achievers, pre-delinquents, expelled/suspended, and wards of the court attended an intensive encampment for one week at Wurtsmith Air Force Base. Emphasis was placed on exposure to vocational opportunities, health care. recreation, fellowship, and leadership. From 1971 to 1973, 590 boys participated in this Air Force Community Action Program. Some suggestions are included for those attempting to evaluate the effectiveness of youth programs.


Are we helping?

Are we helping? Sometimes adolescents who could mature on their own become "psychiatric patients" because psychiatrists take them into treatment. In the process, some may be victimized by being made more dependent than necessary. Others may be helped, although they could have survived without therapy. A few are able to extract themselves after minimal contact has resolved their most critical problems. To be truly helpful, psychiatrists must be able to discern and support appropriate efforts by the adolescent to accomplish his/her own maturing and to resist holding on inappropriately.


Youth in crisis: dimensions of self-destructive conduct among adolescent prisoners. Self-mutilation and attempted suidcide among adolescent prisoners are explored in relation to concrete coping tests posed in prison and to self-esteem problems posed by failure of external (family) and internal (peer) support systems. Crisis sequences are traced using verbatim excerpts from interviews with self-destructive prisoners and conceptualized in terms of enduring adolescent needs and concerns. Some general observations regarding strategies of intervention with crisisprone prisoners are included.


Identity diffusion and psycho-social defense mechanisms. This paper attempts to delineate behaviors that can function as "psycho-social" defense mechanisms to ward off temporarily the anxiety and uncertainty of identity diffusion. Four categories are outlined: I. Escapes from identity uncertainty (e.g., immersion in intense immediate experiences); II. Adopting temporary substitute identities (e.g., purchasing items with "ready-made personas"); III. Acting to strengthen temporarily a weak identity (e.g., through risk-taking); IV. Striving to make an identity out of the meaninglessness of identity diffusion itself (e.g., through pointless fads). It is then suggested that one reason for youthful drug abuse is that drugs are so well-suited for providing most of these temporary defenses.