Glue-sniffing in a young child.

Glue-sniffing in a young child. A case of cerebral depression due to glue-sniffing in a 4-year-old child is presented. This practice, which is confined mainly to older children and teenagers who are socially or emotionally deprived, can have fatal complications.


Median age of death as an index of mortality. The median age of death has been used as an index of mortality in South Africa. In cases where there is high infant mortality, the median age of death is too sensitive and its use is best avoided.


Genetic markers and leprosy in South African negroes. Part I. Serum protein polymorphisms. The phenotype frequencies of the serum protein polymorphisms Hp, Gc, Tf, Gm and Inv were determined on a sample of 250 South African Negroes with leprosy. These results were compared with data derived from 918-977 (depending on the polymorphism tested) healthy Negro controls of similar geographical and ethnic origin, in order to determine whether or not any association existed between specific phenotypes and the occurrence of leprosy. The data derived from the present study were also compared with those of similar comparative analyses on African and non-African populations. Because of the contradictory results between samples with regard to the polymorphisms Hp, Gc and Inv, an association of any of these phenotypes with leprosy appears to be highly improbable. With regard to the polymorphisms Tf and Gm, however, such associations cannot be ruled out. The questions arising from the results are discussed.


Cerebrospinal fluid acid-base balance in patients with severe injuries living at an altitude of 1 660 metres. Cerebrospinal fluid (CSF) acid-base balance in 40 control subjects and 40 patients with head injuries was studied at an altitude of 1 660 m. The patients with head injuries showed a significantly lower CSF pH associated with a fall in CSF bicarbonate and an elevation of CSF lactic acid. The cause of these observations is unclear, but it is proposed that this may be related to the relative hypoxaemia associated with an altitude of 1 660 m.


Acute renal failure after use of radiographic contrast media. The nephrotoxic effects of radiographic contrast media (RCM) used for excretory urography and angiography are described in 9 patients. These effects are usually temporary and reversible, but may be permanent. Predisposing factors resulting in renal damage are identified and discussed. These include diabetes, dehydration, myelomatosis, chronic renal failure of many causes and repeated administrations of contrast media with a short period. Suggestions are made in order to reduce the incidence and severity of functional renal impairment after administration of contrast media.


Commercial heparin solution investigated in vitro after reported impaired nerve function in a patient. Exposure to commercial heparin solution caused rapid conduction failure in frog sciatic nerve preparations. The toxic substance was not the heparin itself, but the 0,5% phenol preservative. Phenol solutions with concentrations between 0,1% and 5% caused a dose-dependent nerve failure, which manifested as a progressive decline in compound action potential amplitude. Care must be taken in the administration of any solution preserved with phenol, to prevent nerve damage.


Pancreatitis in Natal. An autopsy study. A retrospective study of autopsy material at King Edward VIII Hospital, Durban, has revealed a 9-fold increase in the incidence of pancreatitis during the past 25 years in Black South Africans. It is suggested that this is the result of changes in drinking habits brought about by the general availability of all forms of alcohol, especially liquor with a high alcoholic content.


Hyperinfection with Strongyloides stercoralis. A report of 3 cases. Three patients with chronic diarrhoea, paralytic ileus and malabsorption are reported. At postmortem examination Strongyloides stercoralis was shown to be the aetiological agent in each case. Factors involved in hyperinfection with Strongyloides are discussed and the means of clinical recognition of this syndrome are emphasized.


The use of hyperbaric oxygen as an adjunct in the treatment of radionecrosis. The rationale leading to the use of hyperbaric oxygen (HBO) in the treatment of radionecrosis is described. Between January 1975 and February 1977, 13 patients received HBO at Groote Schuur Hospital for radionecrosis, and the response is evaluated in terms of pain relief and wound healing. The implications of these results are discussed.


Prostaglandin E1 in infants with pulmonary atresia. Infants with pulmonary atresia are frequently dependent upon the patency of the ductus arteriosus for adequate pulmonary blood flow. Endogenous production of a dilator prostaglandin probably maintains patency of the ductus in utero. Infusion of prostaglandin E1 (PGE1) 0,1 microgram/kg/min was used in 6 infants with pulmonary atresia to increase pulmonary blood flow and systemic oxygenation. The infusion improved the clinical condition of the infants and diminished the degree of central cyanosis. In 3 cases serial measurement of systemic arterial oxygen tension showed a sustained increase. There were no deleterious side-effects. During cardiac catheterization and preparation for operation, PGE1 provides a valuable means of maintaining pulmonary blood flow in infants with pulmonary atresia and a ductus arteriosus.


Management of blunt pancreatic trauma. A report of 3 cases. Three cases in which the sole injury was a major pancreatic laceration secondary to closed abdominal injury are presented, and the literature on major closed injuries of the pancreas is reviewed. The diagnosis, surgical management and complications of closed injuries of the pancreas are discussed. Delay in diagnosis, inadequate surgery and failure to recognize common complications of pancreatic injury are responsible for the current high mortality rates for this form of closed abdominal trauma.


Management of urinary bladder cancer.

Management of urinary bladder cancer. A series of 231 patients, 198 males and 33 females, suffering from primary urinary bladder cancer and treated by various combinations of surgery, radiotherapy and cancer chemotherapy, was categorized into 4 treatment groups, analysed and compared with those recorded in the literature. Patients in stages T1 and T2, if treated adequately, have an excellent and good prognosis respectively, while those in stages T3 and T4, unfortunately the majority, have a prognosis that is decidedly disappointing. Haematuria is of the greatest significance and should be investigated without delay if symptoms in patients in early stage T1 are to be diagnosed, treated and cured. In a review of the aetiology, smoking, among possible predisposing factors, poses the greatest hazard for the general population. A strong plea is made that smoking never be started, or if started, that it be given up immediately, if the health of the nation is to be our prime concern.


Normal values for haemoglobin concentration and red cell indices in preschool children on the Highveld. Data on haemoglobin concentration, red cell count, packed cell volume, mean cell volume, mean cell haemoglobin and mean cell haemoglobin concentration for 'normal' children aged 1-4 years living on the Highveld (altitude 1400-1800 m) are presented in yearly age groups. The children were defined as normal on the basis of having growth attainment and iron, folate and vitamin B12 nutrition within accepted normal limits. The results obtained differ from the standard reference values published for children resident at sea level. It is suggested that the mean (+/- 2 SD) ranges presented be used as normal ranges in the population studied.


Modern psychiatry in a general hospital. An analysis of 3526 patients referred to the psychiatric unit of a general hospital from 1 January 1975 to 31 December 1977 is presented. The method of classification used was that of the revised Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association and the 8th revision of the International Classification of Diseases. A striking feature of this survey was the low prevalence of schizophrenia (9,8%). A noticeable trend was that more patients seemed to have less incapacitating psychiatric conditions. An exciting new facet of psychiatry is the increasing number of patients without apparent psychiatric illness who are referred to the unit. These include patients referred by colleagues for preliminary screening before organ transplantation, sex change operations, cosmetic surgery, sterilization and termination of pregnancy. Recommendations are made with regard to the role of psychiatric units in general hospitals.


Cardiac failure in a case of aneurysm of the vein of Galen associated with diffuse meningeal angiectasia. A case of aneurysm of the vein of Galen associated with diffuse meningeal angiectasia is described and compared with a similar reported case. The current literature dealing with arteriovenous malformation of the vein of Galen in young children is reviewed. The need for proper clinical and angiographic examination of all newborn infants with congestive cardiac failure due to extracardiac causes is stressed. Attention is drawn to the association of meningeal angiectasia with arteriovenous malformation of the vein of Galen.


Cardiac tamponade with superior venacaval obstruction. A case report. A case of a pericardial tamponade with progressive superior venacaval obstruction indicating the presence of a neoplasm is presented. The patient developed an acute life-threatening pericardial tamponade for which she underwent thoracotomy. When the tamponade was released, she developed sudden acute superior venacaval obstruction which necessitated the insertion of a Dacron graft between the right innominate vein and the right atrium. The anaesthetic management and the physiology of the haemodynamics are discussed.


[Traumatic Herpes hominis infection during rugby (Herpes venatorum). A discussion of four cases]. Four cases of traumatic Herpesvirus hominis infection of the skin sustained during rugby are described. Attention is drawn to the importance of Herpesvirus infection of the eye, both primary and secondary, whether from self-inoculation or exogenous infection. The diagnosis must be correct so that specific treatment with idoxuridine may be considered and harmful treatment with corticosteroids may be avoided. Personal contact should be avoided during active infection. Epidemiological data show that an increasing percentage of young adults are susceptible to primary Herpesvirus infection. We are aware of undiagnosed cases and expect an increasing incidence of this type of infection.


Transanal anastomosis in the treatment of low rectal strictures due to tribal enemas. Enema administration is common in Black tribal communities. In the urban environment, toxic and corrosive ingredients may be used which can lead to severe complications. The diagnosis and principles of treatment of complicated proctocolitis of enema origin are discussed. The management of 2 patients who developed long stricutres extending low into the rectum is described. After subtotal rectal and sigmoid resection, continuity was successfully restored using a transanal sleeve anastomosis. Subsequent continence was normal in both patients.


Anaesthetic induction for caesarean section with etomidate compared with thiopentone. Anaesthesia for caesarean section demands a technique that provides perfect narcosis without neonatal depression. To date, no ideal induction agent has been found for obstetric anaesthesia, although thiopentone is still considered the safest. A new agent, etomidate (0,3 mg/kg) has been studied in a group of parturients who underwent elective caesarean section in the left lateral tilt position. The results obtained are compared with those from a similar series, in which the management was identical, except that anaesthesia was induced with thiopentone 3,5 mg/kg. The infants in the present series were usually extremely lively after delivery, and generally sustained respiration in a shorter time than those after thiopentone. In addition, maternal-to-fetal base excess gradients were narrower with etomidate than with thiopentone. Thus etomidate may offer some advantage over thiopentone for anaesthetic induction at elective caesarean section, and appears worthy of further trial.


Stature and weight of Coloured primigravidas in Cape Town. The stature and weight of Coloured primigravidas delivering at term in Cape Town were investigated. When compared with White mothers they were found to be significantly shorter, lighter and thinner. It is postulated that both childhood undernutrition and an inadequate diet during pregnancy are responsible for these findings.


Placental size at birth.

Placental size at birth. The placentas of 1,081 infants born to Coloured primigravidas in Cape Town were examined. The values for gross and trimmed placental weight, chorionic surface area and thickness are given for each week of gestation from 32 to 41 weeks. These results indicate the pattern of placental growth and provide a basis for further studies to evaluate deviations of intra-uterine growth in this population.


Ear symptoms in temporomandibular joint disturbances. The symptoms related to temporomandibular joint disturbances in 530 cases are reviewed. A possible anatomical explanation for the middle ear symptoms related to disturbance of the temporomandibular joint is presented.


Cerebral revascularization by extracranial-to-intracranial anastomosis. Four cases are presented in which a superficial temporal artery was anastomosed to the cortical branch of the middle cerebral artery. The surgical technique is described. The indications and contraindications and results of the procedure are briefly discussed by referring to recent publications on the subject.


Anastomosis of the superficial temporal to the middle cerebral artery in the management of an intracranial aneurysm. A case report. A patient with a subarachnoid haemorrhage due to a large right-sided internal carotid artery aneurysm presented unusual problems in management. Direct obliteration of the aneurysm was not possible, while ligation of the internal carotid artery as an alternative form of treatment necessitated the provision of an alternative collateral blood supply to the right cerebral hemisphere, the anterior circle of Willis being deficient. This case illustrates a new surgical technique which has a place in the management of selected cases of cerebral ischaemic disease.


The aetiology of partial deafness in childhood. Two hundred and twenty-three White children with partial hearing loss in three special schools in South Africa for the hard-of-hearing child were investigated. Twenty-four children (11%) had an identifiable genetic syndrome, 52 (23%) had familial deafness, 17 (8%) had significant additional non-otological abnormalities, and in 55 (24%) a firm history of an acquired cause was available. The proportions of these aetiological categories are similar to those which we have encountered in profoundly deaf children. It is of practical significance that 18 of the children had middle-ear abnormalities which could very likely be corrected by surgery. It is strongly recommended that every child with impaired hearing should have a comprehensive clinical and otological assessment and thereafter undergo periodic diagnostic review.


Immediate physiotherapy in perforating wounds of the pleural cavity and underlying lung. Patients suffering from uncomplicated pneumothorax, haemothorax or haemopneumothorax of clinical significance are treated with fluid replacement, intercostal under-water drainage, antibiotics and routine physiotherapy. The commencement of routine physiotherapy may be delayed 8-60 hrs depending on the time the patient is admitted and arrangement of 'out-of-hours' physiotherapy services, but immediate physiotherapy produces superior results from every point of view.


Leiomyoma of the vagina.

Leiomyoma of the vagina. Eight cases of leiomyoma of the vagina are described. Most were diagnosed clinically as lesions other than leiomyomas, and the correct diagnosis was made only after histological examination. The tumours were most commonly situated on the anterior wall of the vagina, varied from 1 to 3 cm in diameter, and were all treated by simple excision. No recurrence was recorded in a follow-up period that varied from 8 months to 20 years.


Infant feeding practices in South Africa. An appraisal of their significance to health. During the last half century, in most Western populations, including Whites in South Africa, there has been a very marked fall in frequency and duration of breast feeding. The same trend is also being observed in South African Blacks, Indians and Coloureds. For White infants, bottle feeding is responsible for significantly enhanced morbidity. For the other populations mentioned, bottle feeding, compared with breast feeding, is associated with considerably enhanced morbidity and mortality. Reasons for the decline in breast feeding are discussed, as well as the attempts made at remedial measures. An urgent statement by paediatricians, which should provide guidance to be given at hospital, clinic and home on the benefits of breast feeding, the correct preparation of commendable bottle feeds, and also the appropriate time for introduction of solid foods, should be issued with the maximum of publicity.


Obstructive sleep-induced apnoea due to bilateral recurrent laryngeal nerve palsies. A patient with obstructive sleep-induced apnoea due to bilateral incomplete recurrent laryngeal nerve palsies is described. The sleep apnoea syndrome is briefly reviewed and the potentially fatal complications are emphasized.


Duchenne's dystrophy associated with unusual musculoskeletal abnormalities. A case report. A case of Duchenne's pseudohypertrophic muscular dystrophy allied with previously unreported musculoskeletal abnormalities is reported. Some of the more characteristic features of Duchenne's dystrophy are reviewed from the literature.


Depressed skull fracture in the newborn. A report of 3 cases. Three cases of depressed skull fractures in neonates are reported. Two of the fractures were related to birth trauma, but the third probably occurred antenatally. Treatment differed in all 3 cases. One baby underwent surgical elevation of the fracture, and another vacuum elevation, while the third received no treatment. We stress the fact that non-surgical elevation of depressed skull fracture may be successful and preferable to more drastic surgical procedures.


Proliferating tricholemmal cysts. A case report. Attention is focused on an uncommon, but well-defined clinical and histological entity, which is still often misdiagnosed as a squamous carcinoma. The case described in this article supports the concept that the origin of the cyst is from the outer hair sheath. The importance of some form of irritation which stimulates proliferation of the epithelium is also mentioned.


Experimental infection of the chimpanzee urethra and pharynx with Chlamydia trachomatis. An isolate of Chlamydia trachomatis obtained from a man with nongonococcal urethritis was used to produce experimental urethral and pharyngeal infections in chimpanzees. After urethral inoculation of 8 X 10(1) inclusion-forming units (IFU), infections were established in three of three animals; urethral discharges developed in two. The infections persisted for five to nine weeks. Larger inocular (7 X 10(2) and 1 X 10(5) IFU) produced pharyngeal infections in two animals. The third animal's pharynx was not infected by 1 X 10(5) IFU. Chlamydial complement-fixing antibodies increased significantly in sera of two of three animals. This study provides an animal model for study of mucosal infection by C. trachomatis. The relative resistance of the chimpanzee pharynx to infection parallels clinical observations in man.


The beneficial effect of 1% 5-fluorouracil in 70% ethanol on therapeutically refractory condylomas in the preputial cavity. The effect of two daily applications of 1% 5-fluorouracil (5-FU) in 70% ethanol on penile condylomas was investigated in 65 men. Complete cures were obtained in 37% and marked regression in 42% of the patients. The most pronounced effect was seen on warts in the preputial cavity and on the adjacent foreskin, where the efficacy of 1% 5-FU in ethanol was comparable to that of 5% 5-FU cream. However, the pronounced side effects observed with use of the 5-FU cream were reduced to negligibility by use of an alcoholic vehicle for the drug. Patients who have therapeutically refractory condylomas in or near the preputial cavity should receive one or more courses of treatment with 1% 5-FU in ethanol. With regard to meatal warts, the effect of two daily applications of 5% 5-FU cream for two weeks was found to be therapeutically inferior as compared with results of previous studies in which the same treatment was extended for three to four weeks.


A clinic-based system for monitoring the quality of techniques for the diagnosis of gonorrhea. The author describes a clinic-based system that monitors the quality of techniques for diagnosis of gonorrhea by continuous comparison of the results of gram-strained smears of urethral and cervical specimens with the corresponding cultures. Discrepant results are immediately reviewed. During a two-year period, the system detected two defects in culture incubation, visual defects in a laboratory technician, and three unexplained reductions in cultural sensitivity. The system motivates clinicians and laboratory technicians to maintain a high level of quality control. In 11,474 comparisons of urethral smear and culture results, there was agreement in 96.9% while the smear alone was positive in 1.6% and the culture alone in 1.5%. Review of positive-smear-negative-culture discrepancies indicated that most smears judged "false-positive" were so classified on the basis of false-negative cultures. In study of 1,331 women, the endocervical smeras identified 60% (273/455) of those with positive culture discrepancies. Many of these may have represented false-negative cultures.


Etiologies of postgonococcal urethritis in homosexual and heterosexual men: roles of Chlamydia trachomatis and Ureaplasma urealyticum. Before treatment for urethral gonorrhea, Chlamydia trachomatis was isolated from 18% and Ureaplasma urealyticum from 37% of 121 men. C. trachomatis was recovered from none of 18 homosexual men who had gonorrhea and from 22 of 95 heterosexual men who had gonorrhea (P less than 0.05). After treatment with a penicillin, postgonococcal urethritis occurred significantly more often in heterosexual than in homosexual men (P less than 0.002). Postgonococcal urethritis developed in all men from whom C. trachomatis was isolated. Among men without U. urealyticum infection, postgonococcal urethritis was significantly associated with C. trachomatis infection (P less than 0.02). Among men without C. trachomatis infection, postgonococcal urethritis was less closely associated with U. urealyticum infection (0.1 greater than P greater than 0.05). Postgonococcal urethritis was least frequent among men who had neither C. trachomatis nor U. urealyticum infection.


Beneficiaries affected by the annual earnings test in 1975. Every year a number of social security beneficiaries lose some or all of their benefits because of the earnings test. This article describes those affected in 1975--who they were, how much they earned, and how much they lost in cash benefits. The relationships between certain beneficiary characteristics--such as age, sex, race, primary insurance amount, family status, and type of employment--and the amount of earnings and lost benefits are examined. About 1.3 million retired workers aged 62--71, or one-seventh of all such persons on the rolls, were affected by the earnings test. Relatively fewer women retired workers than men incurred benefit losses because relatively fewer women worked and those who did had lower earnings. Black retired workers and those of other minority races had lower earnings than did white retired workers. About 335,000 dependent and survivor beneficiaries lost benefits because of their earnings. This total included 135,000 widowed mothers, or about one-fifth of all such women on the rolls.


Older workers uninsured for retired-worker benefits. This article estimates the number of persons who have worked in employment covered by the social security program but not enough to meet minimum requirements for retired-worker benefits. On the basis of a sample of persons near retirement age in 1973, it was found that about 70 percent of these persons are women, that they have worked an average of about 8 quarters, and that many of those ineligible have had no work in covered employment since 1950. An estimated 12 percent of men and 29 percent of women aged 57--64 in 1973, with some covered employment in the period 1937--73, will be ineligible for retired-worker benefits. When only those with more recent covered employment are considered, the percentage ineligible declines. Thus, of those who have worked since 1950, 6 percent of the men and 20 percent of the women will not qualify.


Conservation of genes coding for proteins synthesized in human mitochondria. Proteins synthesized in mitochondria of 27 different human cell lines, identified by labeling with [35S]methionine in the presence of cycloheximide, have been enumerated and their electrophoretic mobilities determined by sodium dodecyl sulfate-polyacrylamide slab gel electrophoresis and fluorography. Twelve bands were observed in all cell lines. In 24 cell lines, the electrophoretic mobilities of the proteins were the same regardless of race, sex, tissue of origin, cell type, viral transformation, or premature biological aging syndromes. The patterns obtained for the remaining cell lines, HeLa, KB, and Hep-2 were identical. These cell lines showed one protein component that was absent in the 24 others, and lacked a component present in these cell lines. Since it has been previously asserted that KB and Hep-2 are HeLa cells, the data indicate that one basic pattern exists in human cells with a variant of unknown origin occurring in HeLa cells.


Kinetics of human chromosome loss from 3T3-human hybrid cells. Human chromosomes were lost from populations of 3T3-HeLa and 3T3-diploid human fibroblast (HF) hybrids with similar first-order kinetics. Whereas loss began immediately in 3T3-HF hybrids, there was a lag of 5-10 cell divisions before chromosome loss began in 3T3-HeLa hybrids. Human chromosome loss was not affected by aminopterin selection, the use of polyethylene glycol rather than Sendai virus as fusagen, or by the presence of one or two 3T3 genomes. However, when cell division was retarded by growing 3T3-HF hybrids in low serum or at low temperatures, fewer human chromosomes were lost. This suggests that cell cycle traverse is important in chromosome loss. The distribution of human chromosomes among hybrid metaphases indicated that gradual chromosome loss occurred in all hybrids rather than extensive loss from a portion of the hybrids. During the period of chromosome loss, increased numbers of individual asynchronously condensed human chromosomes were randomly distributed among hybrid metaphases.


A murine cell possessing a dominant mutation affecting the regulation of interferon production: characterization by intraspecific hybrids. Using intraspecific hybrids, we have demonstrated the dominant nature of two phenotypic markers present in a mutant mouse 3T6 cell line, designated 3T6-VrB2. These are, resistance to virus infection (Vr) and semiconstitutive synthesis of interferon (IFsc). Hybrids were formed by polyethylene glycol-mediated fusion between 3T6-VrB2, or its parent 3T6, and 2TG0-13, a triply marked derivative of mouse 3T3 cells. When tested for the Vr marker, 3T6-VrB2 X 2TG0-13 hybrid clones displayed a level of resistance to virus infection which was equal to or greater than that of 3T6-VrB2. Similarly, when tested for the IFsc marker, these hybrid clones were found to possess the capacity to confer an interferon-induced antiviral state in mouse L929 cells upon cocultivation. By comparison, clones derived from 3T6 X 2TG0-13 fusions produced high levels of virus and failed to confer an interferon-induced antiviral state in L929 cells.


Inverse relationship between galactokinase activity and 2-deoxygalactose resistance in Chinese hamster ovary cells. Galactokinase activity is reduced in 12 independent clones of Chinese hamster ovary cells resistant to 2-deoxygalactose. The frequency of resistant colonies is increased with chemical mutagens. The resistant phenotype is stable in the absence of selection. There is an inverse correlation between the levels of galactokinase activity and the cloning efficiency in deoxygalactose. Cells with high resistance have 1% or less of the enzyme activity observed in the parental cells; while cells with low resistance have 10-30% galactokinase activity. Studies with tetraploid hybrid cells reveal that resistance to deoxygalactose is a recessive trait and that cells with high resistance do not complement those with low resistance. In cell lines with low resistance, the Km for galactose, Ki for deoxygalactose, Km for ATP, and thermolability were not significantly altered compared to sensitive parental cells. Although the possibility of mutation at the structural gene locus has not been ruled out, the reduced enzyme activity may also be due to mutation at a regulatory site which affects the number of galactokinase molecules per cell.


Vascular malformation of the posterior corpus callosum: surgical treatment. Arteriovenous malformations in the vicinity of the splenium are a rare cause of subarachnoid bleeding. They are usually unaccompanied by neurological deficits. Three such cases are described and methods of identification and surgical approach discussed. Total extirpation is believed to be the treatment of choice.


Granulomatous angiitis of the central nervous system with an unusual angiographic feature. The case of a patient with granulomatous angiitis of the central nervous system is presented. This patient displayed the distinctly unusual feature of intracranial aneurysms. The possible etiology of granulomatous angiitis as well as its histopathologic, pathophysiologic, and angiographic features are discussed.


Forces applied by nasal speculums during transsphenoidal operations. The forces exerted by nasal speculums were measured during the transsphenoidal approach to the pituitary. The highest forces were found to occur at the beginning of surgery when the speculum had been spread to the desired opening (reaching 42 kg). This force decreases during surgery due to the time dependent motion of the biological structure distant from the applied pressure (relaxation). The amount of relaxation that occurred was measured but was found not to be high enough to indicate damage to the tissues adjacent to the speculum. It is also concluded that this type of instrument was underdesigned for its intended function.


Deep seated giant arteriovenous malformations in infancy. Two patients with arteriovenous malformations draining into the deep venous system of the brain are presented. Both were diagnosed in infancy. One of the patients required a ventriculo-peritoneal shunt to control his obstructive hydrocephalus. Six months later, the AVM was surgically attacked in an attempt to control the progressive heart failure. The other, treated without a shunt, required digitalis to control the progressive heart failure. The clinical presentation and the characteristics of arteriovenous malformations of the vein of Galen and treatment are discussed.


Intracranial pressure with intracerebral hemorrhages. Intracranial pressure was recorded continuously during an average of 15 days in 17 patients suffering from primary intracerebral hemorrhage. In 12 cases the highest pressures were recorded just after the stroke; then the intracranial pressure decreased and became normal in an average of 20-30 days. Other patterns of evolution were less often observed: a rapid and lethal elevation of pressure in one case, a constantly low pressure in two, and a stagnant evolution with moderate hypertension in two others. Secondarily developing intracranial hypertension was never observed during the monitoring period. Evacuation of the clots was performed in six patients. This only slightly shortened the course of the increased intracranial pressure. It is concluded that intracerebral hematoma appears as an expanding lesion only during the time of its formation. The prognosis depends more upon the destructions by the hemorrhage than upon the increased pressure. Nevertheless, true hypertension is possible. Knowledge of intracranial pressure in the course of intracerebral hemorrhage is important in deciding whether the treatment is to be surgical or conservative. Measurements of the intracranial pressure in our practice has reduced the number of interventions, with identical or slightly improved results.


Treatment of intracavernous extensions of pituitary adenomas. Two cases of pituitary adenomas invading the cavernous sinus are presented. The technique of radical extirpation of intracavernous tumor is described. Clinical, radiologic and pathologic features diagnostic of invasive adenomas are discussed, as well as alternative treatments. Craniotomy for radical resection is recommended as primary treatment for tumors which can be identified preoperatively as invasive tumors.


Dural arteriovenous anomaly fed by ethmoidal arteries. A case of arteriovenous anomaly of the left ethmoidal groove, exclusively fed by both ophthalmic arteries and draining into the anterior segment of the superior sagittal sinus through a dilated bridging vein of the prefrontal cortex, is reported. Onset of symptoms was with an acute spontaneous intracerebral hematoma. The relation of this anatomo-clinical entity to other intracranial dural arteriovenous lesions is discussed, as well as its pathophysiology and its surgical management.


Primary calvarial hemangioma: angiographic study. Two cases of primary hemangioma of the calvarium are reported. Preoperative diagnosis was easily made in both cases because of the typical roentgenographic presentation. Clinical and radiological aspects of this vascular benign tumor of the skull are discussed.


Limitations and pitfalls of computed tomography in the evaluation of craniocerebral injury. The deficiencies of cranial computed tomography in the evaluation of craniocerebral injury may be categorized as: problems with the patient (cervical spine injury, motion artifact, airway control, head tilt, metallic foreign bodies); the incomplete scan; failure to determine the attenuation coefficient; failure to perform contrast enhancement; and failure to perform cerebral angiography. Increased awareness of these shortcomings of computed tomography and the selected use of cerebral angiography will ensure more accurate detection of the various abnormalities encountered in traumatic pathology.


Effect of 4-methylumbelliferyl-beta-D-xylopyranoside on the morphology of embryonic cartilage in limb bud cultures. Limb buds of 11-day-old mouse embryos were cultured for six days in the presence of 0.1, 0.5 or 2 mg/kg 4-methylumbelliferyl-beta-D-xylopyranoside. A dose-dependent decrease in chondrogenesis could be observed in preparations stained with methylene blue and cleared. A reduction or even disappearance (after 2 mg/kg) of intercellular spaces and a change in shape and size of chondroblasts was striking in the light microscopical picture. The electron microscopical findings reveal a decrease in the number, size, and electron-density of the ruthenium-red-positive proteoglycan granules as well as an alteration in the collagen morphology. Up to 1,000 A thick fibrils occur which partly show a so-called continuous cross-striation. In addition, bundles of thin (50-100 A) collagen filaments without cross-striation occur. The number, distribution and packing density of the cell organelles in the chondroblasts are very variable. The vacuoles of the Golgi apparatus are dilated. These effects may be attributed to the xyloside-induced alterations of proteoglycans.


Triploidy in human abortions.

Triploidy in human abortions. Seven triploid embryos and fetuses, six spontaneously aborted and one resulting from pregnancy interruption are described. A wide range of malformations, from amorphous, nodular embryos, to apparently normal phenotypes were observed. The degree of hydatid degeneration in the placentae ranged from minimal to severe. In several cases large, atypical cells were present in the villous stroma. There was no apparent correlation between the degree of placental lesion and fetal malformations. It is suggested that termination of triploid pregnancies is determined more by the degree of placental damage rather than the severity and type of fetal anomalies.


Development in the first half of gestation of genetically abnormal human fetuses. Linear measurements, total weight and organ weights were determined for 24 second trimester human fetuses with a cytogenetic or metabolic defect. The three fetuses with trisomy 13 or 18 tended to be smallest in all parameters. This data should be of value to other laboratories interested in human fetal growth. It demonstrates that the intrauterine growth retardation reported at term in cytogenetically abnormal newborns is already manifested at the eighteenth to twentieth week of gestation.


The effect of carbon monoxide on glucose metabolism and growth of rat embryos. Rat embryos at days 11-12 of gestation cultured for 18 hours in vitro respond to reduced oxygen or to elevated levels of CO. Glucose consumption and lactate production increase while the growth rate decreases. The ratio of lactate produced to glucose consumed increases to values characteristic of earlier, more anaerobic, embryos. It is suggested that most of the energy consumed by the embryo goes to support growth and that the change in glucose metabolism results in a decrease in available energy which decreases the growth rate. The response to reduced oxygen levels is more marked than the response to elevated levels of carbon monoxide and we interpret the result to imply that oxygen transport in these embryos is primarily via solution rather than via combination with hemoglobin.


Induction of cleft palates: effects of triamcinolone acetonide on transcription in isolated nuclei. The effect of triamcinolone acetonide on the transcriptional activity in nuclei isolated from maternal A/J mouse livers and embryonic maxillary processes (EMP) has been studied. Triamcinolone acetonide (TAC, 13 mg/kg body weight) was administered to A/J mice on day 12.5 of gestation, and the mice were sacrificed at different time periods following injection. We find a significant increase in transcription in liver nuclei, and a decrease in this activity in nuclei from embryonic maxillary processes in response to TAC at 16 to 20 hours following injection. With the drug alpha-amanitin we show that the effect of TAC on transcription in EMP cannot be due to fluctuations in the concentration of endogenous RNA polymerase B. This is further substantiated by studies on the transcription of EMP-nuclei in the presence of exogenous DNA template. Relative to controls, the data demonstrates that the concentrations of RNA polymerases A and B in EMP-nuclei remain unchanged in response to TAC. Conversely, stimulated liver nuclei result in significant increases in the concentrations of RNA polymerases A and B. We therefore propose that in embryonic maxillary processes TAC induces changes in the chromatin template which may interfere with normal development.


Embryotoxic effects of methylmercuric chloride administered to mice and rats during orangogenesis. Pregnant C57BL mice were given a daily dose of 7.5, 6.0, 5.0 or 2.5 mg/kg methylmercuric chloride (MMC) orally from the sixth through the thirteenth day of pregnancy. Pregnant Wistar rats were given a daily dose of 7.5, 5.0 or 2.5 mg/kg MMC orally from the seventh through the fourteenth day of pregnancy. Fetal examinations were performed on days 18 and 20 in mice and rats, respectively. In mice, the dose of 7.5 mg/kg was embryocidal. The dose of 6.0 mg/kg also caused a high incidence of fetal death, decreased fetal weight and a marked increase in malformations. A dose of 5.0 mg/kg caused a decrease in fetal weight and a marked increase in the incidence of malformations. The most common malformations were cleft palate and fused thoracic vertebrae. In rats, the dose of 7.5 mg/kg caused a high incidence of fetal death and malformations. The most frequent malformations were cleft palate, generalized edema, brain lesions and wavy ribs. A dose of 5.0 mg/kg caused  a significant decrease in fetal weight and a significant increase in the incidence of malformations.


Effect of maternally administered sodium nitrite on hepatic erythropoiesis in fetal CD-1 mice. A commonly used food preservative, sodium nitrite, was administered to pregnant CD-1 mice at a concentration of 0.5 mg/mouse/day. Embryotoxic and teratogenic effects on the hemopoietic tissues and skeletons of their offspring, were evaluated. Fetal mortality, resorptions, the mean number of offspring per litter, the mean weight per embryo and the incidence of skeletal malformations, were not significantly different from controls. Hemopoietic cell suspensions, prepared from the livers of treated and control 14-, 16- and 18-day embryos, were cytocentrifuged onto microscope slides and differential counts were performed after staining with benzidine and Wright-Giemsa stain. The results indicate that maternally administered Na nitrite, stimulates fetal hepatic erythropoiesis. This was manifested in a statistically significant increase in the percentage of polychromatophilic erythroblasts and  mature erythrocytes at 14 and 16 days of gestation, respectively. The possibility that Na nitrite may induce fetal methemoglobinemia is discussed and mechanisms responsible for the observed erythroid stimulation, are considered.


Teratogenic potential of ethanol in mice, rats and rabbits. Pregnant CF-1 mice, Sprague-Dawley rats and New Zealand white rabbits were given 15% ethanol in their drinking water during the period of major organogenesis, from day 6 through 15 of gestation in mice and rats and days 6 through 18 of gestation in rabbits. Maximum blood alcohol levels, measured in non-pregnant animals, were about 200 mg percent in mice and 25-50 mg percent in rats and rabbits. Maternal toxicity in the form of decreased liquid intake and decreased maternal body weight occurred in all species during the experimental period. A significant increase in the incidence of external or soft tissue alterations was not observed in the alcohol-exposed groups of any species, but a significant increase in minor skeletal variants was observed in mice and rats. These were probably due to retarded fetal growth rather than to a specific effect of the ethanol. Teratogenic effects were not observed in any of the three species.


A model of the mechanism controlling neuromuscular activation during ambulation based on feedback control hypothhesis. As tested by many investigators, locomotor performance at steady state does not involve high conscious systems but takes place almost automatically. A great number of experiments on animals seem to demonstrate that the afferent proprioceptive signals play an important role in locomotion and that the higher nervous centers act in order to activate the lower control systems. On the basis of previous findings, we hypothesized that the descending signal from the higher nervous centers can lower the threshold of intervention of the proprioceptive signals on the alpha-motoneurons. The influences of the afferent signals on the various muscles enable them to realize the pattern of the basic muscular activity that we can record from walking subjects. A simulation of the model of human locomotion has been implemented on a digital computer and the theoretical results are compared with the experimental findings.


Measuring the stimulating energy threshold in living tissues. The paper summarizes the various methods of measuring the stimulation threshold in living tissues and emphasizes the usefulness of energy measures. An analog instrument for the direct measurement of the energy threshold is proposed and some experimental results obtained by its clinical application are reported.


The effect of location of muscle spindle on the predicted reflex control of muscle length. The location of muscle spindles is such that the length transduced by their end-organs may not represent the total 'origin-to-insertion' length of the muscle. The tendons at least lie in series with the spindles. Using a muscle model based on biceps brachii in man, a length-control senrosystem utilizing feedback either from the total muscle length, or from the 'internal length' of the contractile central region, is modelled on the analog computer. The difference in the nature of the closed-loop regulatory system thus achieved is demonstrated. Anomalous behavior is seen, in that as the length feedback becomes effective the total system response approaches that of a simple mass/spring system in one instance.


EEG evoked response, P300 and CNV during processing of sentence information: clinical application. Evoked response, P300 and CNV were investigated in the condition in which the subject was required to make a differential response to the acoustically and visually presented sentence with or without meaning, and he was able to determine whether the sentence had a meaning or not by understanding the key information. In healthy persons, P300 amplitude to the beginning of information and to the key information were larger than those to the others. P300 latency to the key character was longer. CNV appeared at the beginning of information and continued. The difference between CNVs produced by meaningful and meaningless sentences was observed after the key information. In aphasia, the difference between CNV's was not observed. In auditory agnosia, the difference between CNVs was not observed to acoustic sentences, but appeared to visual sentences. These results suggest that evoked response, P300 and CNV can be useful for assessing recognition of sentences.


Electrical impedance brain scanner: principles and preliminary results of simulation. In previous studies, the authors have shown the importance of impedance recording by stereotactic procedures for brain tumor detection. In this study they report the principles and the first results of an attempt to obtain the impedance value of any given point inside the brain by an external way. The experimental device is mainly made of a set of 128 electrodes, surrounded by an electrode guarding monitored by an operational amplifier the purpose of which is to made the electric field uniform and to enable a focused measure of the impedance by each of the 128 electrodes. The effect of this electrode guarding is demonstrated, and the present sensitivity of the prototype is shown on various obstacles. conductive or non-conductive; the influence of an impedance barrier on this sensitivity is the project of an impedometric scanner is described, and the problems due to the non-linear propagation of electric currents and to the anisotropic properties of the brain tissue are evaluated.


[Toxicologic study of a fluorescent tracer: rhodamine B]. The use of the rhodamine B as fluorescent tracer in hydrology ask the question of its possible toxic effects in the environment. This study aspire to specify and to complete the results of the former works by the successive examinations of the activity of the rhodamine B in regard to the "daphnies test", its DL50 on the rat and on the mouse, and its cutaneous tolerance. The obtained results confirm the former remarks and express that the solutions of the rhodamine B show any more immediate risks as soon as they appear no more coloured (higher dilutions 1.10(-7)). However it remains to evaluate its long-term carcenogenic activity.


[Toxicity of the pesticide nabam as a function of dietary protein content in the rat]. With the object of studying a possible toxical potentialization between a food pollutent and the diet compoundings, rats fed on a diet with variable protein amounts, were administered a pesticide belonging to the Dithiocarbamate family : Nabam. Animals have been fed for 28 days after they have been weaned with diets containing 0-3.5 - 9 - 26 and 81% proteins in casein form. DL50 is significantly lowered in rats fed 0 - 3,5 and 81% protein diets compared with DL50 estimations in rats normally fed. Toxical clinical signs are fundamentally the same ones in all rats of the six groups : stimulation followed by a depression of the central nervous system, severe inflammation of the gastro-intestinal tractus, significant renal necroses. The intertime between poisoning and death seems not to be influenced by the diet protein amounts and is only due to the Nabam dose.


[Relase of organochloride pesticides during acute weight losses (author's transl)]. The increase of blood organochloride pesticide levels and the urinary excretion have been determined in 4 human subjects undergoing a caloric restriction sequence (500 total K. calories per day) followed by a total starvation period of 36 hours. The severe lipolysis due to the caloric restriction causes an important liberation of fat-soluble pesticides especially DDT and DDE (30 ppb of total DDT equivalents) and an increase of urinary excretion (15 ppb of total DDT equivalents).


Methaemoglobinemia induced by nitric oxide in whole blood. Quantitative relationship. We studied in vitro the effects of nitric oxide (NO) in human and rat blood and in human erythrolysate. Using NO in the tonometric technique allows to predict through an experimental model the amount of methemoglobin formed. At known oxygen and carbon dioxide pressures, methaemoglobinemia is all the more important as NO concentration is great and tonometry duration is long. Moreover methaemoglobin concentration is greater in saturated (P02 congruent to 500 Torr) than in desaturated blood (P02 congruent to O Torr) while only slight changes occur for small P02 variations. Thus the study of the oxygen dissociation curve should be possible in presence of NO. Methaemoglobin is responsible for the drop in the oxygen combining capacity and thus impairs blood oxygen transport. Results are similar in human and in rat blood.


Characterization, composition and determination of the sugars in ricinotoxin from Ricinus communis L. seeds. The purified ricinotoxin from Ricinus communis L. seeds appears to be a glycoprotein. Either paper or gas-liquid chromatographic methods indicate that only mannose and N-acetyl-glucosamine are present in significant amounts. Quantitative determination shows that one mole of ricinotoxin contains 15 mannose residues and 8 N-acetyl-glucosamine residues.


[Toxicological studies on dichloromethane, a solvent simulating carbon monoxide poisoning (author's transl)]. Acute oral and inhalation toxicity of dichloromethane was investigated in both male and female Sprague-Dawley rats. Oral LD50 was found to be 1.72 ml/kg for males and 1.06 ml/kg for females. LC50 was found to be 18 100 PPM (1 X 6 hours) for both male and female rats. Acute oral intoxication is characterized by severe vascular changes and depression of the central nervous system accompanied by gastro-intestinal hemorrhagy. A similar CNS depression is also found in acute intoxication by inhalation. The nature of the symptoms as well as the sequence of physiological (hypotension, hypothermia) and biochemical events observed (high COHb level, etc.) indicate that the combined action of dichloromethane and its metabolite, carbon monoxide, are responsible for the development of vascular and CNS disturbances and subsequently the sudden death of the animals.


[Toxicity of lead nitrate to the carp (Cyprinus carpio L.). Effect on respiratory metabolism and histological structure of gill lamellae (author's transl)]. Oxygen uptake of gills was estimated after lead poisoning of the Carp. Histological structure of gill lamellae was also examined. Oxygen uptake quickly decreased after two weeks then increased again in long term poisoning without total recovery. On the other hand, desquamation of the gill epithelium was observed as well as proliferation of mast cells probably loaded with lead. The return to clean water for eleven weeks, allowed the lamellar epithelium recovery but not the mast cells elimination.


Residues of organochlorine pesticides in human fat in Belgium. In 1975, 60 samples of human body fat taken during the course of routine examinations by pathologists were analysed for organochlorine pesticide residues. The mean detected concentrations are 1.36 ppm for HCB, 0.76 ppm for betaHCH, 0.38 ppm for heptachlor epoxide, 0.26 ppm for dieldrin, 6.50 ppm for ppDDE, 0.27 ppm for ppDDD and 1.52 ppm for ppDDT. By comparing these results with earlier studies in 1969 and 1966 a decrease in the total HCH and ppDDT content and an increase in the dieldrin and heptachlor epoxide content is observed. HCB was not determined in earlier studies.


[Iatrogenic ergotism. Apropos of a case]. A 36 year-old woman was given Ergotamine Tartrate 4.5 mg p.d. during seven days, after an abortion (a still birth). Subsequently she developed a generalised arterial spasm of the limbs producing a feet necrosis. A transmetatarsal amputation was performed. This observation and 63 others cases in the litterature call attention to the potential dangers of the ergot derivatives (ergotamine tartrate), even at normally accepted therapeutic doses. Arteriolar thrombosis and subsequent tissular gangrene can be presented by early administration of heparin, dextran infusions and, possibles, hyperbaric oxygen. Among the vasodilatation drugs, only sodium nitroprussiate seems to be effective.


Fatal poisoning with a plant protective containing monocrotophos, dodine and dinocap. The toxicological findings after fatal poisoning with a plant protective containing monocrotophos, dodine and dinocap are described and discussed. While monocrotophos could be measured in all tissues and in blood 12 microgram/g, lung 13 microgram/g, brain 13 microgram/g, kidney 11 microgram/g, liver 1.8 microgram/g), measurable amounts of dodine (detection limit approx. 3 microgram/g) and dinocap (detection limit approx. 4 microgram/g) were not detected in these materials. The gastric contents contained 52 mg of monocrotophos, 7.5 mg of dodine and 20 mg of dinocap.


[A rapid and simple method for the qualitative and quantitative determination of hexapropymate in biological fluids and organs (author's transl)]. The method is based mainly on the extraction of the substance by a small volume of organic solvent from an alkaline medium containing a fairly important amount of inorganic salt. The extract is then subjected to thin layer and/or gas chromatography. The authors present also the relative frequency that they met on hexapropymate intoxications together with the concentrations in blood obtained in cases accompanied with deep coma.


[Metabolic transformations of the trimethyl - 3,5,5, cyclohexene-2, one-1 (isophorone) (author's transl)]. In the rabbit, isophorone alpha is partly eliminated, unchanged in the expired air and in the urine and, for another part, metabolized in the organism and excreted in the urine. The metabolites which have been characterized are : dimethyl-5,5, cyclohexen-1, one-3, carboxylic-1 acid, deriving from isophorone by methyloxidation, isophorol (trimethyl-3,5,5 cyclohexen-2, ol-1) formed by the reduction of the ketonic group into a secondary alcohol and eliminated as a glucuronide, dihydroisophorone (trimethyl-3,5,5, cyclohexanone) proceeding from the hydrogenation of the cyclohexen cycle and cis and trans trimethyl-3,5,5, cyclohexanols-1. These latter compounds, found in small quantities, are very likely issued from dihydroisophorone which is transformed in the organism into isophorone alpha and cis and trans trimethyl-3,5,5, cyclohexanols-1, according to a process of dismutation.


The passage of N-nitrosodimethylamine into eggs. Detectable amounts of carcinogenic N-nitrosodimethylamine (NDMA) were found in eggs for approximately 8 to 14 days following oral administration of a single dose of NDMA to laying hens.


[Nutritional and toxicological impacts of administered inorganic tin for six months in rats (author's transl)]. An experimentation  of intoxication by stannous chloride has been realized in the rat. Two groups of animals have been fed ad libitum, during six months, with a diet containing respectively 0,4 and 0,8 g of tin (SnCl2) for 100 g of dry food. By gamma radioactivity measurements (with 113Sn used as a tracer), it results that this metal does not practically clear the digestive barrier. All the treated animals are characterized by a ponderal evolution obviously lower than temoins. At the end of treatment, tin entails a significative diminution of hematocrit, hemoglobin and serous iron, particularly at the highest dose studied. The essential impact remains that tin induces a total irritation of gastro-intestinal tract, proved by histological investigations.


Technique for multi-view radionuclide angiography. A new method utilizing computer subtraction allows 2 separate radionuclide angiograms to be performed during a single laboratory visit. Two separate intravenous injections of the radionuclide are given so that the patient's head can be imaged in 2 different projections. Background activity from the first injection is subtracted by the computer to allow good resolution of blood flow following the second injection. A static brain scan is performed after the second injection. Although single-view radionuclide angiography is widely used in the diagnostic evaluation of the brain, the addition of a second projection provides additonal important diagnostic information. The views obtained, however, must be determined individually for each patient on the basis of the clinical history and neurologic signs. The selection of appropriate views, the diagnostic quality of the studies, and the practical clinical application of this technique are illustrated by 2 case reports.


Cerebral blood flow and metabolism in man following cardiac arrest. We measured cerebral oxygen extraction, cerebral blood flow(CBF), and cerebral metabolic rate (CMRO2) in comatose patients during the first 60 hours after resuscitation from cardiac arrest. Each patient was studied 2 or 3 times. CBF was determined by a modification of the Kety-Schmidt method using inhaled Xenon133. Over the study period jugular venous oxygen tension and saturation rose, while the oxygen content difference between arterial and jugular venous blood fell, indicating a progressive increase in the ratio of CBF to metabolism CBF and CMRO2 measurements confirmed this. Between 2 and 6 hours after resuscitation both measurements were severely but proportionately depressed to less than 50% of normal. After 6 hours CBF was increased disproportionately to CMRO2 so that a relative hyperemia developed and persisted for the duration of the study. Although regional inhomogeneity of flow and regional ischemia cannot be ruled out, we have found no evidence for global cerebral ischemia between 2 and 60 hours post-resuscitation as an explanation for failure of recovery. In man following cardiac arrest restoration of levels of global cerebral blood flow, which can be considered adequate relative to the depressed metabolic state of the tissue, is achieved within 2 hours of resuscitation.


Trends in mortality from cerebrovascular diseases in the United States, 1960 to 1975. A long-term decline in death rates from cerebrovascular diseases in the United States accelerated in 1969, with a further increase in the rate of decline after 1972. This break in the pattern of the mortality curve for stroke was observed in all 4 major sex-color groups, and affected all age groups in which a significant number of stroke deaths occur. The decline for non-whites was relatively and absolutely greater than for the comparable white sex. If the 1960 rates had persisted in 1975, 87,600 more lives would have been lost to cerebrovascular diseases. Although there are no data documenting a declining prevalence of hypertension in the population, detection, treatment and control of hypertension have improved markedly over recent years. A concomitant decrease in the severity of epidemic respiratory infection may have contributed to the improvement in recorded death rates from stroke. Mortality from all major cardiovascular diseases has demonstrated a parallel downward trend. Continued emphasis on public health efforts to detect and treat hypertension and other known cardiovascular risk factors can be expected to result in further improvement in cardiovascular mortality.


Cluster headache, hemicrania, and other head pains: morbidity of carotid endarterectomy. Carotid endarterectomy has become a widely used approach to the treatment of cerebrovascular disease. In spite of increasing experience, a significant and varied morbidity remains attached to the procedure. A poorly recognized complication is postoperative headache. In a series of 57 endarterectomies in 50 patients, 24 patients experienced postoperative headaches encompassing the entire spectrum of vascular headaches: nonspecific diffuse headaches, severe hemicranias, cluster headaches occurring early and delayed, chronic paroxysmal hemicranias, carotidynia, and Eagle's syndrome. Five patients had hemicranias, and all were homolateral to the endarterectomy. Therefore, we hypothesize that the spontaneously occurring hemicranias, the counterparts of postsurgical headache syndromes, also may be due to some overt or occult injury or disease of the carotid vessels or carotid sheaths in the regions from the carotid bifurcation to the base of the skull.


Effects of anticoagulants in an animal model of septic cerebral embolization. The effect of anticoagulation on lesions caused by cerebral emboli of different types was studied in 57 dogs. The resultant arterial and parenchymal lesions were assessed by pathologic and angiographic studies. Embolization with emboli that caused little or no inflammatory response in the artery (12 dogs) was not associated with hemorrhagic infarcts or with subdural or subarachnoid hemorrhage; furthermore, treatment with anticoagulants (9 dogs) did not change the character of the lesions. Embolization with emboli that caused arteritis, that is, bacterial contamination or presence of lead chromate in the embolus (21 dogs), was associated with hemorrhagic infarcts, focal subarachnoid hemorrhage, and increased incidence of acute subdural hemorrhage. Treatment with anticoagulants (16 dogs) was associated with a further increase in the incidence of subdural hemorrhage.


Effects of reduced regional or body temperatures on responses of pial arterioles. We have investigated the effects of a reduced regional or a reduced body temperature, on pial arteriolar response to a variety of vasoactive stimuli. This has been done by studying the effects of these stimuli on groups of mice with different body temperatures, or with different temperatures of the artificial cerebrospinal fluid (CSF) irrigating the pial surface. Responses in mice with body temperatures of 30 degrees or 22 degrees C showed little or no difference from responses in mice with body temperatures of 37 degrees. This was so whether the surface irrigant was maintained at 37 degrees or at 23 degrees. On the other hand, significant reductions in pial vascular responses were observed when mice with "CSF" temperatures of 22 degrees were compared with those having "CSF" temperatures of 37 degrees. The data suggest that regional cooling is more effective than cooling the body in reducing the response of pial arterioles. The data also indicate that marked reductions in body temperature would have to occur before a detectable effect on pial vascular responses is produced, at least in mice anesthetized with urethane.


Cerebrovascular evaluation: assessment of Doppler scanning of carotid arteries, ophthalmic Doppler flow and cervical bruits. In 38 patients who underwent cerebrovascular evaluation followed by angiography the Doppler ultrasound scanning technique was found to be an excellent screening procedure for detecting marked stenosis (greater than 50%) or occlusion of the internal carotid artery (93% correlation). It is noninvasive, easily reproducible and can be performed by a qualified technician. The major problems are: the inability to detect ulcerated plaques without marked stenosis, the requirement for patient cooperation (lying still for periods of 15 minutes), and the fact that it assesses only the extracranial circulation. Screening with just the directional ophthalmic Doppler flow signal yielded a high percentage of false negatives (13%). The presence of a cervical bruit may indicate an underlying stenosis of the internal carotid artery, but may also be due to stenosis of the external carotid artery or other factors such as increased blood flow, vessel tortuosity, etc. (12% false positives). Absence of a cervical bruit does not exclude internal carotid artery disease (ulcerated nonstenotic plaque or occlusion).


The mathematics of repeat abortion: explaining the increase. In any given population, an increase in the proportion of repeat abortions, and a repeat-abortion rate that is substantially higher than the first-abortion rate, can be anticipated to occur over a number of years after abortion has been legalized. These are the findings of an analysis of repeat abortion for a population of women aged 15--44, using simple mathematical models based on the assumptions that the risk of abortion is constant over time and independent of prior abortion experience. The data generated by the models explain both the rapidly increasing percentage and the high rate of repeat abortion following legalization and refute assertions that making abortion widely available discourages the practice of contraception.


The role of family planning in recent rapid fertility declines in developing countries. World Fertility Survey data for ten developing countries are used to examine the respective roles of development and family planning in influencing the regulation of fertility. The findings show that high proportions of women at all socioeconomic levels in the countries studied wanted no more children, including large proportions among rural, poor, and uneducated women with few children. The data also show that despite the limitations of underdevelopment, in countries with strong family planning programs knowledge and use of contraception was high. These findings confirm that there is a large unmet demand for family planning and point to the importance of continued allocation of funds to support service programs.


Relation of marital separation and divorce to suicide: a report. This paper examines the relation of marital separation and divorce to suicide. The persons studied are applicants to the Benjamin Rush Center, the crisis clinic division of the Didi Hirsch Community Mental Health Center/Los Angeles Psychiatric Service. The sample consists of 238 subjects, of whom 39, or 16.4% were suicidal, and 23 had made one or more suicide attempts at some prior date. Those seriously discussing separation, but not actually separated, tended to be less frequently suicidal than the long-term separated/divorced (.05 less than p less than .10). The study further examined the relationship of important events and interspouse transactions to suicide potential. Significant associations were found in the relationship of suicide potential to verbal attack by spouse (p = .03), vacillation in the last two weeks (p = .02), and vacillation since the first serious discussion of divorce (p = .02). Several other associations approached statistical significance. The authors believe that the findings in regard to vacillation and interspouse aggression are especially interesting and merit further study.


A model study of why some intracranial aneurysms thrombose but others rupture. A perspex model of a dog aortic trifurcation was machined to scale and perfused with steady flow from a constant pressure reservoir. The tail artery was plugged to produce a flow model of an intracranial saccular aneurysm. At all flow rates, no flow occurred beyond 2.5 tube diameters of the tail artery down-stream from the mouth of the aneurysm. This was assumed to explain why large aneurysms thrombose. Measurements of velocity fluctuations were made with a hot film anemometer and recorded on tape. Frequency analysis showed that the peak frequency was a function of flow rate, and suggested that eddies were shed from the origin of the aneurysm. This was presumed to be an artifact due to sharp entrance produced by machining the perspex. The total energy at any one point in the aneurysm was independent of the size of the aneurysm but increased with flow rate. The maximum fluctuations were comparable in the center and in the sides of the aneurysm, but were less on the top and bottom of it (assuming the central plane was in the plane of the trifurcation). This difference presumably would be less if the aneurysm were spherical rather than cylindrical.


Suicide potential and behavior in children ages 4 to 12. From a population of 662 children 12 years of age and under, seen at the UCLA Neuropsychiatric Institute, during the years 1970 to 1974, 34 severely depressed children were identified who were also self-abusive and/or suicidal. Case study revealed fragmented, pathological homes, where the children's affect disorders and behaviors were symptomatic of acute family breakdown, marital disharmony, and observed and experienced violence, both verbal and physical. Follow-up on all available children, at least three years posttreatment, revealed that no child had committed suicide. Treatment evaluation by the parents was highly positive, with the great majority of children showing fair to good recovery and adjustment.


Effect of an acute increase of the intravascular pressure on the blood-brain barrier: a comparison between conscious and anesthetized rats. Conscious rats and rats under nitrous oxide anesthesia were subjected to blood pressure elevations by injection of epinephrine, bicuculline and amphetamine. Mean arterial pressure was measured from a chronic indwelling cannula in the aorta in awake rats. The protein leakage in the brains was studied using Evans blue and 125IHSA. Conscious animals developed less blood-brain barrier dysfunction than anesthetized ones. The largest difference was obtained with amphetamine and the smallest with epinephrine. Possible explanations to the results are discussed.


Similarities and differences in precipitating events between black and anglo suicide attempts. The rapid rise in suicide among young Blacks in American the past decade is of increasing concern to mental health practitioners and suicidologists. While there are some similarities among suicide attempts by Blacks and Whites, the pattern is that Black suicide attempters are distinctly more youthful. This exploratory study tests the hypothesis that the precipitating events for young Blacks who consider, plan, and attempt suicide is more likely to be "the loss or threatened loss of a love partner in the context of a negative value-orientation and intragroup pressures" than among Anglo suicide attempters. Specific strategies are recommended that use a family perspective for assisting Blacks who consider, plan and attempt suicide.


Ergotamine and cerebral blood flow.

Ergotamine and cerebral blood flow. We measured the cerebral blood flow (CBF) of 16 patients by the xenon-133 intracarotid method before and after the intramuscular injection of ergotamine tartrate. The regional and hemispheric CBF was unaltered, even in 3 migraneurs in who ergotamine relieved the headache. Ergotamine tartrate in therapeutic doses has no effect on the cerebral circulation.


Computerized axial tomography in brain death. Two patients with the diagnosis of brain death were evaluated with computerized axial tomography (CAT). After intravenous infusion of 30% Conray there was no visualization of the intracranial vasculature (circle of Willis). The second patient also had an isoelectric EEG. A third patient with an intracerebral lesion similar to the other cases but without diagnosis of brain death, showed good visualization of the circle of Willis. Therefore, contrast-enhanced CAT scans can be used as another diagnostic aid to confirm brain death.


Indomethacin prevents impaired perfusion of the dogs's brain after global ischemia. Compression ischemia of the central nervous system (CNS) in heparinized dogs caused areas of diminished cerebral blood flow measured by 14C-antipyrine autoradiography. Intravenous infusion of indomethacin (1.5 or 4.0 mg/kg) approximately 1 hour before ischemia eliminated the circulatory defects. Prophylactic inhibition of prostaglandin synthetase may promote postischemic perfusion of the CNS by preventing vasoconstriction and by anti-hemostatic effects on blood.


Detection of antibodies by enzyme-immunoassay in human schistosoma mansoni infections: a clinical and chemotherapeutic study. Sera from patients with S. mansoni infections, before and six weeks after successful treatment with hycanthone, were examined for antibodies reacting with S. mansoni adult worm antigen, employing the enzyme-linked immunosorbent assay (ELISA) technique. 50 local individuals who had no schistosomiasis and 48 patients with S. haematobium infection were studied for comparison. All sera from untreated patients gave positive results. Significantly higher levels of antibody were given by sera from patients with visceral enlargement than by those from patients without visceral enlargement. A rise in antibody levels was seen in 87% of treated patients and the post treatment values of antibody were significantly higher than those obtained before treatment (p less than 0.001). 94% of sera from patients with S. haematobium infection gave a cross-reaction but with a significantly lower antibody values than for the homologous infection. A weakly positive reaction was obtained in 16% of controls and the actual values of antibody were much lower in this group than in the S. mansoni and S. haematobium groups.


Antibody activity in stick-ELISA as compared to other quantitative immunological tests in sera of echinococcosis cases. Antibody activity in sera of 43 cases with cystic and 5 cases with alveolar echinococcosis was determined against hydatid fluid and extract of E. alveolaris. The results with Stick-ELISA were compared to those obtained with complement fixation and indirect hemagglutination. Results in ELISA were determined in stepless fashion and expressed as multiple of normal activity (MONA). Sensitivities of the different tests with reference to their respective ranges of nonrelevant activities were 95% in ELISA, 95% in indirect hemagglutination and 90% in complement fixation as determined with sera from cystic echinococcosis cases and their homologous antigen. Employing homologous and heterologous antigens, none of the three immunotests allowed the species specific diagnosis of cystic echinococcosis cases, whereas most cases of alveolar echinococcosis could be recognized by their predominant homologous antibody activity in ELISA and complement fixation.


Comparison of different methods for the detection of intestinal protozoa and helminths in stool. A total of 1428 stool specimens were examined to evaluate the usefulness of different methods of detecting intestinal protozoa and helminths. The following methods were compared: a combination of routine laboratory methods (Normal saline, Lugol's solution and Iron-haematoxylin), the MIF technique (Mertheolate-iodine-formaldehyde) and the MF-Heidenhain method for protozoa. The Telemann method and MF-Telemann method for worm eggs. The MIFC technique for both protozoa and worm eggs. According to the criteria: diagnostic yield, accuracy, simplicity, time consumption and cost, it is concluded that the MIFC method is superior to the other methods used in this study.


A method of mass cultivation of Toxoplasma gondii in cell culture. Large quantities of Toxoplasma gondii were cultivated in human larynx carcinoma cells (H.Ep 2, heteroploid). Virulent Toxoplasma gondii, strain RH, which were obtained from the peritoneal exsudate of mice 2 days after infection served as inoculum. As culture medium for the cells and for growth medium, Minimum Essential Medium (MEM) supplemented by 5% foetal calf serum and 200,000 IE/1 Penicillin plus 20 mg/1 Sulmycin was used. 2--3 days after inoculation, 150--200 times the amount of the inoculated Toxoplasmas could be harvested in one or several harvests.


Electron microscopical studies on onchocerciasis. I. Mesenchyme reaction in untreated onchocercal dermatitis and ultrastructure of the microfilariae. Skin biopsies of 22 untreated Liberian patients suffering from onchocercal dermatitis were studied by electron microscopy. The microfilariae tend to accumulate in the upper dermis, without eliciting a cellular reaction. Occasionally macrophages or mast cells are found in the neighbourhood of the microfilariae. The most conspicuous changes concern the presence of perivascular infiltrates, comprised of lymphocytes and macrophages, with a varying admixture of plasma cells. Only exceptionally the macrophages show an increase in number and size of their lysosomes and pseudopodia as well as prominent strands of ergastoplasm indicating an activation. The endothelial walls of the dermal vessels are swollen. The amount of mast cells in the upper dermis is increased. Ultrastructural features of the microfilariae are described, especially the cuticle, muscles, central undifferentiated cells and cephalic region. When comparing these findings with the literature on the fine structural morphology of the Latinamerican form, no differences can be found.


The distribution of the simulium damnosum complex in West Africa with particular reference to the onchocerciasis control programme area. A chromosomal identification of the Stimulium damnosum complex larvae collected from areas within and outside the Onchocerciasis Control Programme (OCP) area  revealed six species of the complex. Five of these (S. sirbanum, S. damnosum s.s., S. soubrense, S. yahense, S. squamosum) were observed within and south of the OCP area. S. sanctipauli was found exclusively outside the OCP zone. S. sirbanum: Predominated in the Sudan Savanna, spread into the Guinea and transition zones but was almost absent in the forest region. S. damnosum s.s.: Abundant in the Guinea Savanna; was well represented in the Sudan Savanna while smaller populations penetrated the forest region. S. sanctipauli: Identified almost exclusively from the forest zone; a few savanna foci were found on the upper course of the Sassandra R.  in the Ivory Coast and on the Volta R. within the coastal savanna strip in Ghana. S. soubrense: Recorded from the forest, transition and Guinea Savanna zones; northern limits were established at the Léraba Bridge on the Upper Volta/Ivory Coast border. S. yahense: Predominantely distributed along creeks and small rivers in the forest region; a few records within the Guinea Savanna were found on the upper reaches of the Sassandra valley. S. squamosum: Observed in small rivers in the forest zone; extensively colonised heavily shaded or forested areas within the Guinea Savanna but in the Sudan Savanna only two records were observed near Bobo-Dioulasso in Upper Volta.


Use of morphological characters in the study of Simulium damnosum s.l. populations in West Africa. Morphological characters were tested which could be used to compare and to associate Stimulium damnosum s.l. populations reinvading the area of the Onchocerciasis Control Programme in the Volta River basin with those of potential source areas. The savanna cytospecies S. damnosum s.str. and S. sirbanum could be distinguished from the forest species S. sanctipauli, S. soubrense and S. yahense by the size and shape of the antennae and the colour of the basal wing tufts. Wing tufts of S. squamosum were of variable colour. Results did not confirm morphological keys for the complex which used counts of maxiillary teeth to separate S. damnosum s.str. and S. sirbanum, and numbers of spinules on the radial vein of the wings to separate S. yahense and S. squamosum. Populations of the S. damnosum complex could be characterised by morphometric methods. Measurements of the length of the thorax provided a rapid and easy means to distinguish different populations. The length of the thorax was positively correlated with the  length of the wings. By using several measurements in combination populations could be more clearly characterised.


Light trap studies on Simulium damnosum s.l. in Northern Ghana. The results of light trapping S. damnosum s.l. in northern Ghana during both the wet and dry season are given. It is considered that some flight activity takes place throughtout the night at both seasons. Flies in different physiological states behave differently and gravid females and newly emerged flies appear to be strongly phototactic. There is little evidence to suggest that light trapping is likely to be useful for the capture of blood engorged flies and for the routine monitoring of S. damnosum populations. Further work on the use of light traps in Stimulium studies is required.


[Nutritional status and health status of under-fives of the Mentawai island Sipora (Indonesia) (author's transl)]. Weight, Height, head circumference, chest circumference, arm circumference and triceps skinfold of 223 children under 5 years from the small Mentawai island Sipora/Indonesia have been measured and related to international standards. Beginning from standard values, the anthropometric data decrease during the first 2-3 years, rising again in the following years. Weight for age is 72% of standard at 24 months and 83% at 5 years, height for age 89% at 30 months and 92% at 5 years, weight for height of the boys 82% at 12 months, of the girls 79% at 24 months and 94% for both at 4-5 years, chest/head ratio 95% at 12 months and 100% at 3-5 years. Arm circumference is 83% at 18 months 100% and above already at 3 years. Therefore, fold regains after the minimum of 90% at 18 months and above already at 3 years. Therefore, muscle growth would predominantly be reduced. The weight gain follows approximately the 3rd centile of english girls with a clear depression between 9 and 30 months. The birth weights of 476 children are 3230 g (boys) and 3120 g (girls). Perinatal mortality is low (2.9%), mortality during the first 5 years between 15 and 24%. In the health centre charts of 126 children under 5 years of a selected village (93% of that age group) 463 treatments in 5 years are recorded. The most frequent diagnoses are diseases of the respiratory tract (38% of all treatments), followed by malaria (23%), diarrhoea (19%), ascaris and hookworm infections (7.6%) and skin conditions (6%). Tuberculosis was the cause of treatment in 1.3%. In spite of the temporary growth retardation, as indicated by the anthropometric values, no cases of clinical Protein-Energy-Malnutrition have been observed. Malaria seems to be holoendemic, since all 223 children had a palpable spleen.


[Effect of cadmium ions on cell division in the root meristem of Crepis capillaris (L.) Wallr]. Germination of seeds in cadmium chloride solution resulted in certain disturbances in nuclear division and stopped cytokinesis. Cystein added to cadmium chloride solution decreased the number of these disturbances. The effect of cadmium ions is supposed to be associated with the SH-groups blocking in contractile proteins of cellular spindle or in enzymes responsible for mitosis.


[Cytogenetic studies of lambs with congenital developmental anomalies]. Cytogenetic researches of the bone marrow cells in eight newborn lambs with different innate anomalies showed that they had a normal karyotype, 18.4 +/- 0.47% aneuploid, 1.31+/-0.08% polyploid cells and 0.97+/-0.16% cells with spontaneous chromosomes aberrations, which corresponds to analogous indices in normal lambs.


[Cytogenetic effect of the action of fotrin on domestic swine]. The paper deals with in vivo studies of the cytogenetic effect of the photrin alkylating agent on the bone marrow cells of piglets. A high frequency of chromatid exchange output and non-random length localization of the individual chromosomes breaks are determined. The specific influence of chemical mutagens is discussed.


[Evaluation of the mutagenic activity of chemical substances in an in vitro human peripheral blood lymphocyte culture after their activation in the body of mammals]. To evaluate mutagenic activity of human metabolites a method is suggested for treating the culture of human lymphocytes with whole mammalian blood after their exposure to a chemical. This method was used to study the cytogenic activity of cyclophosphamide metabolites available in blood of CBA female mice after intraperitoneal injection of different doses of the chemical.


[Data on the X-sex chromatin content and cytokaryometric characteristics of the cells of human amniotic fluid and of provisory and definitive organs]. In different zones of the aminion there is a different amount of cells with X-chromatin containing nuclei. Four types among most common cells of amniotic fluid are described. The sizes of cells, nuclei and nucleoli in different zones of the amnion, amniotic fluid, fetal cheeck mucous and fetal urina are compared. The material taken by biopsy from provisory organs is suggested to be used for cytogenetic studies.


Diffuse pleural mesothelioma in Trieste. A survey based on autopsy cases. Records of necropsies performed at the Institute of Pathological Anatomy and Histology of the University of Trieste during the period December 1 1971-December 31 1977 have been reviewed. Cases with a necropsy diagnosis of pleural tumor or lung sarcoma were reexamined. Twenty-six cases were accepted as definite diffuse pleural mesothelioma. Occupational history was indicative of asbestos exposure in 22 cases, with 12 patients having worked in shipyards. The high incidence of diffuse pleural mesothelioma in the Province of Trieste is emphasized.


6-phosphogluconate dehydrogenase, glucose-6-phosphate dehydrogenase, glucose-6-phosphate isomerase, and hexokinase activity ratios in some human tumor cytosols. The ratios of some key enzymatic activities of carbohydrate metabolism have been measured in human tumor cytosols. The activities of whole hexokinase (low Km, EC 2.7.1.1 and high Km, EC 2.7.1.2), 6-phosphogluconate dehydrogenase (EC 1.1.1.43), glucose-6-phosphate dehydrogenase (EC 1.1.1.49) and glucose-6-phosphate isomerase (EC 5.3.1.9) change according to a biochemical pattern coherent with cell growth requirements. 6-phosphogluconate dehydrogenase activity was in each sample tested higher than glucose-6-phosphate dehydrogenase activity; this indicates that 6-phosphogluconate, a powerful inhibitor of glucose-6-phosphate isomerase, is unlikely to accumulate and inhibit this enzyme and glucose-6-phosphate channelling into glycolysis.


[Cause of the change in the type of structural chromosomal mutations in the cell transition from the G1 to the S phase]. Cessation of exchange interactions among chromosomes and change of the chromosome type of aberrations for chromatid type were found on the model of the Crepis capillaris germinating seeds sychronized with 5-fluor-2-desoxyuridine at the end of G1-beginning of S-phase and then exposed to X-ray irradiation.


Alternative methods of diagnosis and staging of bladder cancer. A survey of the conventional diagnostic measures in bladder carcinoma is given. The importance of additional methods, such as pelvic arteriography and phlebography, lymphography and lymphoscanning is evaluated.


Malignant lymphoma, Burkitt's type: histologic report of two cases in Italy. Two cases of undifferentiated Burkitt's type malignant lymphoma with prevalent ovarian localization and observed in Italy are described histologically. Some brief considerations about the extra African diffusion of this lymphoma are pointed out.


A casual finding of primary splenic Hodgkin's disease in a case of traumatic rupture of the spleen. A case of 15-year-old male with traumatic rupture of the spleen is reported. Patterns of Hodgkin's lymphoma were found in sections of the spleen. Lymph nodes were not involved. Ten years after the splenectomy the patient is alive and well.


The WHO histological classification of urinary bladder tumours. The WHO histological classification of urinary bladder tumours was formulated to promote better international communication and more reliable statistical comparisons. The axes of classification concern histological type, grade of anaplasia and growth pattern.


The value and present indications of staging laparotomy in Hodgkin's disease. From December 1971 to December 1976 224 patients with Hodgkin's disease underwent diagnostic laparotomy and splenectomy under a multidisciplinary protocol of treatment. In 149/224 (66.5%) the clinical stage of the disease was confirmed, whereas in 75/224 (33.5%) it was modified after surgery. In 7.6% of the patients (17/224) there were postoperative complications. One patient died of myocardial infarction. The rate of complications in the last 100 cases was 5%. Preoperative patient selection, excluding those definitely in stage IV, is of relevance, and it can be done by iliac crest biopsy and laparoscopy. Although a better exploitation of some diagnostic procedures (lymphangiography, laparoscopy) and the expanding use of chemotherapy may reduce in the future the need for staging laparotomy and splenectomy, diagnostic laparotomy is still indicated for the selection and preparation of patients for radiation therapy in stages I, II and III.


The role of exfoliative cytology in the management of bladder carcinoma. Cytological analyses of bladder washings from 974 patients with disorders of the urinary tract are reported. The cytological findings were compared with the clinical and histological diagnoses. The histological grading of bladder tumours was based on the classification proposed by Bergkvist et al. No false positive diagnosis of malignancy was made in the 320 patients without tumour growth. The five cases with positive cytology had histologically verified carcinoma in situ. The frequency of cytological diagnosis of cancer increased with the histological grade of malignancy in the 428 patients with bladder neoplasm. Carcinoma was graded in smears according mainly to the degree of epithelial atypia. A comparison with the histological grading was attempted. Of 226 cases of bladder carcinoma treated with supervoltage irradiation, 108 had persistence or recurrence of carcinoma. The clinical diagnosis was cytologically confirmed in 92 per cent of these cases.


Thyroid cancer in childhood.

Thyroid cancer in childhood. From 1956 to 1975 21 patients (13 females and 8 males) with thyroid cancer developed by age 14 have been observed at the Istituto Nazionale Tumori of Milan. Follicular adenocarcinoma was diagnosed in 4 cases and papillary adenocarcinoma in 17. Five patients (24%) had been given previous cervical irradiation for benign conditions. At admission lung metastases were evident in 2 patients (one affected by follicular and the other by papillary adenocarcinoma). All patients were submitted to surgical treatment, which in most cases consisted in total thyroidectomy plus elective lymph node dissection; serious postoperative complications were not observed. External irradiation was given to 4 patients, since surgery had not been radical. Radioiodine treatment was performed in the 2 patients with lung metastases: in the patient with follicular adenocarcinoma metastases disappeared after 131I treatment, whereas in the other one they still persist unmodified 10 years later. A local recurrence occurred in 3 cases and pulmonary metastases in one: all of them made an apparent recovery after surgical and/or radioiodine treatment. All patients are alive and, except one, without evidence of disease after a follow-up period from 14 months to 21 years. Although differences in evolution have been noted according to the histotype, the prognosis of thyroid cancer in childhood is good, even if distant metastases are present.


Cellular cytotoxicity in transitional cell carcinoma of the human urinary bladder - a summary. The cytoxicity in vitro fo peripheral blood lymphocytes from patients with carcinoma of the urinary bladder (TCC-bladder) against allogeneic target cells from established cell lines was studied by the 51Cr-release assay. Lymphocytes from both untreated and treated TCC-bladder patients have a significantly elevated mean cytotoxicity to TCC-bladder target cells. Tumour cell destruction by lymphocytes from TCC-bladder patients shows a clear disease related specificity. In TCC-bladder patients a superimposed cytotoxicity exists, probably reflecting reactions against one or several tumour - associated antigens. In treated patients this cytotoxicity may be masked by higher incidence of cross reaction.


Carcinoma of the bladder - radiotherapy. Differentiated transitional cell carcinoma responded better to radiotherapy than anaplastic or squamous cell carcinoma. Five year survival was higher in low stage than in high stage carcinoma, and higher in papillary than in solid carcinoma. Tumour control, but also complication rate, increased with higher radiation dose. With the introduction of a two volume irradiation technique, a large tumour dose can be given with a minimum of complications.


Treatment of bladder cancer at the Rotterdam Radiotherapy Institute (R.R.T.I.) with special reference to bladder radium implantation and preoperative radiotherapy followed by cystectomy. Between 1950 and 1972, a total of 2,031 cases of bladder cancer were treated in the R.R.T.I. The policy differed according to size and stage of the disease as well as to the general condition of the patient. Best results were achieved by radium implantation of solitary lesions less than 5 cms in diameter. Preoperative radiotherapy followed by cystectomy was the treatment of choice for cases of T3 category. The remaining T1 and T2 cases were treated surgically, while T4 cases were managed with external irradiation alone.


Radical cystectomy with or without planned preoperative irradiation in the treatment of bladder cancer. A retrospective analysis of 342 patients with carcinoma of the bladder treated by radical cystectomy at Memorial Sloan Kettering Cancer Center with or without planned preoperative irradiation revealed that preoperative irradiation significantly improved survival of patients with deeply infiltrating tumours (pathological Stage B2 and C), and reduced the prognostic importance of distinctions between pathological B1 and B2 neoplasms. Preoperative irradiation had no discernible effect on the survival of patients with superficially infiltrating neoplasms.


Bladder carcinoma treated by preoperative radiotherapy followed by cystectomy. In 1969 a clinical trial was started where patients with bladder carcinoma stage T2 and grade 3 were subjected to preoperative radiotherapy followed by cystectomy. The survival rate in this series was higher than in a previous series of comparable patients who were given full irradiation without cystectomy.


Lymphatic network of kidney. II. Effect of diuretics on intrarenal renin release. The individual effects of chlorothiazide, furosemide, and mannitol on renin activity in renal lymph have been studied in dogs. Elevation of renin activity in lymph is noted following infusion with either chlorothiazide or furosemide, while a reduction of renin activity in renal lymph is noted after mannitol infusion. The importance of elevated sodium levels in the proximal end of the distal tubule and its effects on renin release in kidney interstitium is stressed. More work is advocated to elucidate fully the role of renin when released intrarenally.


Thoracoabdominal-median sternotomy for resection of primary adrenal carcinoma extending into inferior vena cava and hepatic vein. A technique utilizing a combined thoracoabdominal-median sternotomy approach is described for stimulatenous resection of a large adrenal cancer occluding the inferior vena cava and extending into the left hepatic vein. This technique is useful in removint an extensive extension of a renal or adrenal cancer into the inferior vena cava.


Role of renal biopsy in end stage renal failure. The role of renal biopsy in 46 patients with end stage renal failure was assessed. Renal tissue was obtained by open renal biopsy in 24 patients, by needle biopsy in 5, and at bilateral nephrectomy in 17. In 4 patients the renal biopsy specimens showed advanced changes that could only be diagnosed as "end stage kidney". In 42 patients (91 per cent), a precise renal diagnosis was made. In 20 patients (43 per cent) the prebiopsy clinical impression differed from the histologic diagnosis. In the 29 patients undergoing renal biopsy, minor postoperative morbidity occurred in 5. We conclude that a renal biopsy in patients with end stage renal failure will result in a change in clinical diagnosis in a significant number of patients and can be performed with low morbidity.


Autosuturing device in intestinal urinary conduits. The autosuturing device has been used to close the base of 41 urinary intestinal conduits: 12 colonic, 25 ileal, and 4 jejunal. The techniques are described. There were no urine or bowel leaks, although in one postoperative gastrointestinal bleeding occurred in association with a partial small-bowel obstruction probably related to the stapled enteroanastomosis. Use of the instruments reduced peritoneal contamination and facilitated conduit manipulation. Operating time was reduced. Four patients have passed stones composed of struvite and apatite with staples embedded within. The autosuturing device should be considered an alternative rather than a substitute for conventional proximal conduit closure and bowel anastomoses.


Quantitative nuclear cystogram. Aid in determining spontaneous resolution of vesicoureteral reflux. The quantatitative data derived from serial nuclear cystograms over a five-year period in 37 children were compared with the clinical course. A direct correlation (92 per cent) between an increasing bladder volume at which reflux occurs was observed in the clinically stable group. In the clinically unstable group, there was a 75-per cent correlation of an unchanged or decreasing bladder volume at which reflux occurs. The quantitative nuclear cystogram provides an objective as opposed to subjective data base for management of patients with vesicoureteral reflux.