[Burn injury of the child's hand].

[Burn injury of the child's hand]. The treatment of the burnt hand of a child requires careful consideration of both the physical and psychological aspects involved in this programme; measures such as physical therapy, which play an important part in the treatment of adults, are of less significance. Nevertheless, due to a very low incidence of complications eg. joint stiffness, the final results are very good. Generally the recommended approach to the treatment programme is to use the closed method (i. e. dressings), whereas in such cases care on a special unit employing the open method and a topical bactericidal agent is considered advisable. When the general condition of the child permits, the surgical treatment of a third degree burn should be carried out as early as possible, rather than waiting for spontaneous escharatomy and formation of granulation tissue. Immobilisation of a wound grafted with split-thickness skin should be obtained using KIRSCHNER wires or a hay-rake splint. An early date should also be set for secondary surgical procedures involving improvement of function. Depending upon the surgical findings, flaps or free grafts may be used. It is essential that flexor contractures in the region of the PIP joints be dealt with primarily, in order to prevent the secondary formation of button-hole deformities. During follow-up examinations, growth disorders of the phalanges may be seen. These may arise as sequel to arthrodesis, or trauma to epiphyses as a result of electrical current. On the other hand, disorders of growth may also be observed in purely thermal injuries -- these are mainly confined to growth in the length. Deviation from the central axis of the finger resulting from scar tissue contracture, was not observed among our group of patients.


[Impairment of the skeletal growth of the hands after electrical burns in childhood]. Fourteen children with electrical burns involving 33 fingers were followed for a period of more than 8 years. Primary treatment was conservative in 17 fingers, of which 11 required surgery at a later date. Adequate function was restored in 12 fingers after completion of this treatment and persisted for 8 years and more. In 5 fingers substantial joint deformities developed. For 16 fingers surgery was required as primary treatment. Bone involvement was present in 10 of these. Secondary surgery proved to be necessary in 2 fingers, on one aseptic necrosis necessitated replacement by a bone graft. All of the 16 fingers showed good function in the period under review. There was no radiological evidence of deformities, but growth was substantially slower than normal. Apparently coverage of exposed bone with well vascularized tissue improved local blood flow so that damage other than that originally produced by the electrical burns was prevented.


[2-stage flexor tendon transplantation]. Staged flexor tendon repair utilizing temporary silastic rod implants has proved to be an effective method for restoring the grip function of severely injuried hands. Since its inauguration by CARROLL and BASSETT in 1958 this method has been successfully practiced by numerous hand surgeons. In this review the patho-physiological principles of the development of the so-called "pseudo tendon sheath" are described. The various findings as far as the formation of the new tendon sheath is concerned, are presented. The theories about incorporation of the subsequent graft and its revascularization are described. Following a detailed description of the surgical procedure our own results with 272 silastic rod implants in 184 patients are presented. Because of the kind of patients selected for the procedure, excellent results were not obtained. However, in 62% of cases results were graded "good" and in 23%, "satisfactory", while 15% were "poor". It seems to be justified to utilize two-stage flexor tendon repair for restoring grip function in severely injured hands in spite of the considerably high technical requirements, the prolonged course of rehabilitation and consequently increased cost of treatment.


[Experiences with 2-stage flexor tendon transplantation]. Flexor tendon grafting in two stages, using silastic rods to prepare a new bed, is well known. In our opinion four indications are important: first -- loss of tendon and gliding surface due to infection or complex injuries; second -- lesions of the digital nerves; third -- defects of the skin and fourth -- replantation of amputated digits. We are convinced that two stage tendon grafting is a helpful concept for achieving reasonable functional results in special cases and complex injuries.


[2-stage flexor tendon transplantation: follow-up study results]. It is shown in 246 flexor tendon grafts in the so-called no man's land that autologous grafting in a single surgical procedure preserving the tendon sheath yields the best results, whereas good results can only be achieved by two operations after more extensive injuries of the sheath with or without accompanying injuries. For estimation of the results we developed our own scheme, because it seemed difficult to make reliable judgments when the rather divergent published criteria were applied.


[Neglected perforation of a plastic implant after flexor tendon injury]. The remarkable resistance to infection of the new tendon sheath induced by silicone rubber spacers is demonstrated in a case of a 36 years old woman who received a silicone rubber spacer after flexor tendon injury. The patient did not return for the planned tendon grafting in spite of repeated requests. After two years she came back with an ulcer on her finger tip where the silastic rod was visible. 6 months previously the rod had extruded and been lost, found again and replaced. No inflammation existed, except ulceration at the site of perforation. The ulcer healed within a few days after removal of the spacer and local irrigation. The patient refused any further treatment.


RNA synthesis in rabbit and rat kidney under experimental changes in erythropoiesis. RNA synthesis in rabbit and rat kidneys and erythropoietin level in plasma were studied under hypoxic stimuli (bleeding, phenylhydrazine and cobalt treatment, exposure to simulated altitude of 6000 m). An increase in renal RNA synthesis and in plasma erythropoietin activity was found. By using the "endocrine" kidney it was shown that 4-hr hypoxia produced a considerable increase in RNA synthesis both in the intact and in the "endocrine" kidney. The increase was correlated with the increase in the plasma titre of erythropoietin. The plasma titre of erythropoietin in rats having a single endocrine kidney also increased after 4-hr hypoxia. It is suggested that the renal biogenesis of erythropoietin under hypoxic stimuli involves, apparently, the mechanism of derepression of specific RNA synthesis.


Aplastic anaemia in Iraq. A prospective study. The problem of aplastic anaemia (AA) in Iraq has not been previously investigated. This paper describes 60 patients evaluated prospectively at the University of Baghdad Teaching Hospital during the period 1975--1978. Criteria for the diagnosis included pancytopenia and hypocellular or acellular bone marrow. A surprising finding at variance with published reports about the disease from other parts of the world was a 3 : 1 preponderance of males over females. A discernible aetiology of drug or chemical exposure was detected in half of the patients. Chloramphenicol, alone or in combination with other antibiotics, was thought to be responsible for marrow injury in 12 patients. The occurrence of AA seems to be on the rise in Iraq, probably as a result of the increased use of potentially toxic therapeutic agents and chemicals, and of the growing environmental pollution.


[Amniotic fluid and blood coagulation].

[Amniotic fluid and blood coagulation]. A study was made of the incidence and activity of coagulation factors in normal amniotic fluids. According to the results, two groups of amniotic fluid can be distinguished. To group A belong those that are transparent, showing an activity similar to Russell's viper venom. To group B belong the fluids that are milky and translucent. In this second category, factor VIII seems to be a necessary component in order to obtain maximal coagulation activity. The clinical consequences of these facts are discussed.


Sea-blue histiocyte syndrome with bone anomalies. Two sisters, now 29 and 24 years old, are described. They presented a congenital storage of, most probably, phospholipids in the histiocytes of the sea-blue type or blue pigmentophages. The granules of these cells showed a PAS positivity and strong positivity for acid phosphatase, but there were negative also for non-specific esterase, naphthol-AS-D-chloracetate esterase and iron acid also for urine mucopolysaccharide. The two cases differed from all the described cases in the absence of hepatosplenomegaly and in the presence of bone changes resembling late spondyloepiphyseal dysplasia or atypical dysostosis multiplex.


The uptake of 3H-dexamethasone during phagocytosis of Staphylococcus aureus by Human neutrophils. In the normal human neutrophil under basal resting conditions, cell-associated levels of 3H-dexamethasone (3H-DXM) increased in a linear fashion following addition of the drug. However, during phagocytosis of 14C-labelled Staphylococcus aureus (Staph. aureus), the intracellular 3H-DXM levels rose above basal concentrations in direct relation to the quantity of ingested organisms. The observation that the cell-associated activity of 3H-DSM rises in a parallel fashion to the quantity of ingested Staph. aureus must be recognized and taken into consideration as a variable, when assessing the results between resting and activated phases of neutrophil function in the presence of glucocorticoids.


[Prognosis of chronic lymphatic leukemia]. In a retrospective study 117 patients with chronic lymphatic leukaemia (CLL) were classified according to Rai and analyzed with regard to their survival time. With increasing severity of the stage of the disease the prognosis becomes worse. A change of the stage was always in the sense of progredience of CLL. Untreated patients had the longest survival time. Among the various forms of treatment, monotherapy with corticosteroids had the worst, local irradiation therapy the best prognosis.


[Chronic lymphatic leukemia and malignant tumors]. Ten of 117 patients with chronic lymphatic leukaemia (CLL) showed malignant tumours. In 2 cases a double carcinoma was diagnosed. The frequency of carcinoma increased with the progredience of the stage of disease classified according to Rai et al. The observations of the authors are compared with data published in the literature.


Quantitative thin-layer and high-performance liquid chromatographic determination of the diuretic agent 2-chloro-5-[44-hydroxy-3-methyl-2-(methylimino)-4-thiazolidinyl]benzenesulphonamide hydrochloride in serum and urine. Sensitive and specific thin-layer (TLC) and high-performance liquid chromatographic (HPLC) methods were developed for the determination of the diuretic agent 2-chloro-5-[4-hydroxy-3-methyl-2-(methylimino)-4-thiazolidinyl]benzenesulphonamide hydrochloride (HOE 740). HOE 740 can be determined in serum by HPLC. The detection is performed at a very short wavelength (202 nm), resulting in a detection limit of 10 ng/ml. By TLC only urine levels that are normally high can be determined directly (the detection limit is 70 ng/ml). For the determination of the lower serum levels it is necessary to convert the drug into its dehydration product, which has a higher absorbance and gives sufficient sensitivity (the detection limit is 10 ng/ml). Serum levels determined by the two methods correlate well. Some pharmacokinetic and excretion-kinetic data were computed using two-compartment open models.


Gas chromatographic and capillary column gas chromatographic--mass spectrometric determination of synthetic anabolic steroids. I. Methandienone and its metabolites. The determination of methandienone (I) (17 alpha-methyl-17 beta-hydroxyandrosta-1,4-dien-3-one) in human urine by gas chromatography and capillary column gas chromatography--mass spectrometry has been studied. After oral administration to man two major metabolites were detected, the structures of which have been identified as 17-epi-methandienone (II) and 6 beta-hydroxy-17-epi-methandienone (III). These metabolites are exclusively excreted in the unconjugated form. At least two more metabolites are extractable from the free fraction of the urine but no measurable amounts of I itself were found. The rate of metabolism and urinary excretion seems to be reasonably fast. The total amount of recovered I in the form of the metabolites II and III is about 5%. Extraction and clean-up procedures and chromatographic details are presented.


Study of binding of low-molecular-weight ligand to biological macromolecules by high-performance liquid chromatography. Evaluation of binding parameters for two drugs bound to human serum albumin. The binding to a biological macromolecule (human serum albumin, HSA) of small molecules (two drugs: warfarin and furosemide) has been studied by high-performance liquid chromatography. Two methods have been used and compared: frontal analysis and the Hummel and Dreyer methods. The association parameters of each of the two drugs on HSA were determined. The results obtained are in good agreement with those previously published using other techniques. The competition of these two drugs for the same site on HSA has also been shown.


Enantiomer labelling, a method for the quantitative analysis of amino acids. Enantiomer labelling a method for the quntitative analysis of optically active natural compounds by gas chromatography, involves the use of the unnatural enantiomer as an internal standard. With Chirasil-Val, a chiral stationary phase that is thermally stable up to up to 240 degrees, the enantiomers of amino acids and a variety of other compounds can be separated and quantitated. Incomplete recovery from the sample, incomplete derivatization, hydrolysis and thermal decomposition of the derivative and shifting response factors can be compensated for by adding the unnatural enantiomer. The accuracy of amino acid analysis by enantiomer labelling is equal or superior to that of hitherto known methods. The procedure affords a complete analysis of peptides with respect to both amino acid composition and the optical purity of each amino acid.


High-performance liquid chromatographic investigation of the amino acid, amino sugar and neutral sugar content in glycoproteins. A methods for the simultaneous separation and determination of amino acids, amino sugars and neutral carbohydrates is described. Stepwise elution systems with sodium citrate and borate buffers have developed for the ion-exchange liquid chromatographic separation of amino acids and sugars, using 8-micrometer particle size resins and the Stein and Moore and orcinol colorimetric method for detection. With the aid of this system, the direct quantitative comparison of sugars and amino acids by liquid chromatography becomes possible for the first time.


Separation and detection of small amounts of catecholamines by high-performance liquid chromatography. The effects of mobile phase pH, flow-rate, column temperature, etc., on the separation of catecholamines by high-performance liquid chromatography (HPLC) on Zipax SCX and Zorbax ODS columns were investigated. Fluorimetric detection methods based on post-column reaction using trihydroxyindole and o-phthalaldehyde methods were employed and the results are compared. Optimal reaction conditions ensuring a high sensitivity of the fluorimetric detection were established. Based on the results, a new HPLC system utilizing the trihydroxyindole method has been produced on a trial basis. The favourable detection limits (ca. 20--30 pg) achieved permit highly accurate and selective assays for noradrenaline and/or adrenaline in tissues and urine.


Reversed-phase systems for the analysis of catecholamines and related compounds by high-performance liquid chromatography. Phase systems using alkyl-modified silica as an absorbent, used as much and as a support for dynamically coated ion exchangers, were investigated for their capability in separating catecholamines and related compounds. Simple reversed-phase adsorption chromatography with C8-bonded silica is not able to separate these compounds very well because of (i) the very small retention of the more basic compounds in circumstances where the acidic compounds are well separated, (ii) bad peak shapes and (iii) low column efficiences, although the last drawback can be circumvented by the addition of inorganic anions to the eluent. The addition of a dynamically coated cation exchanger, sodium dodecylsulphate (SDS), to the eluent not only brings about drastic changes in the selectivity, but also makes available an additional degree of freedom for influencing the selectivity. The retention of the basic solutes increases upon addition of SDS and the retention becomes inversely proportional to the counter ion (Na+) concentration. Further, it was found that columns previously loaded with SDS can be used with SDS-free eluents when a pre-column, loaded with SDS, is used or with eluents containing a very small amount of SDS (less than 0.001%, w/v). These SDS-coated phase systems behave similarly to phase systems containing SDS in the eluent and show a better column stability and UV background.


Critical evaluation of sampling and gas chromatographic analysis of halocarbons and other organic air pollutants. Problems connected with the analysis of ultra-trace amounts of halocarbons in air are discussed in terms of trapping procedures, interferences and chromatographic columns. A suitable column for the qualitative and quantitative analysis of C1-C2 halocarbons is described, and examples of applications are given. High-efficiency micropacked columns have been used for the analysis of hydrocarbons in the open atmosphere.


[Tocolysis in pregnancy and labor].

[Tocolysis in pregnancy and labor]. For tocolysis in pregnancy and labour the authors have used Dilatol (Bufenin) since 1970 and Partusisten since 1976. In 1977 tocolysis was applied in 354 pregnant women (10.6%) : 63 (17.8%) were give tocolytics for premature pain, 18 (5.1%) for the premature rupture of the fetal membranes, and 273 (77.1%) for prophylactic reasons, mostly following cerclage and in cases of multiple pregnancy. In the therapeutic use of tocolysis in 63 women, pain disappeared in 46 of them and they continued to be treated in the out-patient unit; 17 women continued being treated with tocolytics until the beginning of premature labour.20


[Somatic maturity of girls in relation to serum hypophyseal hormone values]. FSH, LH, PRL (prolactin), HGH, and TSH values were determined in 101 girls ages 11--15. The values were expressed in SI units and compared with the degree of pubertal development assessed according to Tanner's classification. The results have shown that the RSH values are the higher, the higher degree of the girls' maturity. Their even increase is characteristic. LH also increases wtih the degree of maturity but there is a pronounced increase of its values in pubertal stages III and IV. Pre-menarcheal prolactin ranged between 7.86 and 12.67 microgram/l and was lower than in the luteinic phase of the cycle after menarche. HGH gradually goes up with maturity, reaching its highest values in the fourth development stage after Tanner. TSH values proved more or less similar, without changing with the degree of maturity. It is evidenced that TSH is significantly correlated with LH before menarche but later there is no correlation at all. OH proved correlated with weight, height, and age. Other parameters observed did not show any correlation with the degree of sexual maturity. In the group of girls in the post- menarcheal phase (N = 49) the results are classified by the physiological phases of the cycle in three subgroups. It has been shown that FSH and LH in all three phases of the cycle were higher than in the pre-menarcheal phase. FSH was higher in the first two phases of the cycle than in the third one. LH values were highly dispersed in all three phases of the cycle. Prolactin was somewhat higher (14,05 micrograms/l) in the luteinic phase. The HGH and TSH level was subject to no changes in the course of the menstrual cycle.


[A technic of cord traction in the third state of labor]. The authors draw attention to certain complications and the retention of amnionic membranes in the uterus during the classical cord traction in delivery. They propose a modified way of the traction of the untied umbilical cord by moving the cord and the uterus to the left and right in addition to the dorsal, horizontal, and somewhat vertical cord raction, and continuing doing so until the delivery of the placenta at the vulva. The number of complications with this way of conduction delivery is significantly lower, on the P 0.001 level. No retention of amnionic membranes has been observed.


[Pathologic changes of the placenta in normal labor]. A total of 73 placentas of at-term newborns with a normal course of pregnancy and delivery were morphologically examined. In 6 of them unexpected extensive changes were evidenced: placentitis in 5 cases (3 suppurative) and the hyaline thrombosis of numerous blood vessels in one case. On the basis of these observations the authors recommend systematic pathohistological examinations of the placenta also in so-called normal deliveries.


[Value of thyroid function tests after long term hormone therapy]. Estrogens are known to change the level of specific circulating proteinthyroid binding globulin (TBG). In view of this, a study was conducted of the effect of some hormonal oral contraceptives on the thyroid function by using routine procedures: thyroid scintigraphy, protein bound iodine (PBI), determination of thyroid hormones thyroxine and triiodothyronine. No statistically significant difference was found between the experimental (N = 84) and the control (N = 34) group.


[Sterilization of women by laparoscopic electrocoagulation of the ovarian duct]. The authors present eleven women sterilized by the bicoagulation technique which has considerable advantages over formerly used electrocoagulation methods. The intervention is of short duration (10 to 15 minutes) and no complications were observed.


[Enterobius vermicularis and pollen granules in cytologic gynecologic smears]. The presence of the eggs of Enterobius vermicularis in cytologic gynecological smears is described, as well as the granules of pollens whose presence in cytologic smears is of no significance from the clinical standpoint but they may become a diagnostic problem, because by their size and appearance they may at first sight misleadingly be considered as the eggs of a parasite.


[Prolactin and human reproduction].

[Prolactin and human reproduction]. Prolactin was isolated and identified as a separate pituitary hormone distinct from human growth hormone. Since that time a rapidly expanding literature has accumulated on the physiology of pituitary prolactin secretion in normal and pathologic conditions. Currently the physiology and pathophysiology of pituitary prolactin secretion are under intensive investigation. Development of sensitive, specific radioimmunoassay for prolactin and improved roentgenographic techniques have increased the diagnostic acumen for incipient pituitary microadenomas. Dynamic function tests of prolactin secretion have not helped to distinguish whether a patient has a microadenoma or not. The basal prolactin level is probably the most useful single investigation for diagnosis a pituitary tumour. If women with pituitary tumours have ovulation induced with bromocriptine therapy, then there is a considerable risk of rapid enlargement of the tumour with the development of serious visual field defects often during the last trimester. The precise level of the risk is not clear, but is probably not great. The introduction of bromocriptine has heralded a major change in the menagement of the hyperprolactinaemia-hypogonadism syndromes and resulted in safer and easier treatment of many cases of infertility, menstrual disorders and, to a lesser extent of impotence. At present, bromocriptine therapy is the treatment of choice for hyperprolactinaemia.


[Wrapping in abduction of newborns in maternity wards]. Triple prevention of the congenital dysplasia of the hip comprises detection in newborns, general wrapping in abduction, and detection in infants. It starts already in obstetric institutions and is legalized as an obligatory form of health protection of the population. Baby-packages for prophylactic wrapping with the thigh in abduction and flexion, are provided for each newborn free of change and distributed in the maternity wards. Already in prenatal consultations and later in the maternity ward mothers are taught how to apply wrapping in abduction to normal children and how to use therapeutic pants in children suspect of a pathologic hip.


[Prolonged survival with weekly peritoneal dialysis in chronic uremic patients]. We show our experience in 12 patients treated during a year with weekly intermittent dialysis whit a rigid catheter for 36 hours a week. Patients were on a diet of 50 g. of proteins a day, normocaloric without sodium or fluid restriction. They received supplementation whith iron, calcium, vitamins B, C and folic acid, anabolic hormonal and, in some cases, furosemide hypotensives and antibiotics. Patients received the procedure for a mean of 8 months. The results show the following mean values: blood pressure: 143 +/- 12/99 +/- 3 mm. Hg., plasma urea 208 +/- 62 ng./dl.; creatinine 21 +/- 2 mg./dl., hematocrit 25 mm. and 8.0 g. hemoglobin. There was light increase of glucose, K, P, Mg, alkaline phosphatase. Na, CO2, proteins cholesterol, albumin and Ca keep in normal values. Nine patients passed to hemodialysis after a mean period of nine months and three of them received a kidney transplant. Three are still in peritoneal dialysis, one of them for 18 months. We compared our results with a similar group of patients who were treated with non-regular peritoneal dialysis. Our group had less cardiovascular complaints, or infections and keep more adequate body weight, and also got more survival in better conditions with less days in hospital, they received less blood transfusion. We concluded that weekly peritoneal dialysis is an alternative method of treatment in uremic patients for longer period of time even though frequently paracentesis.


[Use of a temporal cardiac pacemaker in patients undergoing a major non-cardiac surgery]. This is a report of the use of transvenous temporal pacemaker in 18 patients, with an average age of 59.3 years, that under want non cardiac major surgery. They did not have cardiac simptoms but had conduction abnormalities in the preoperative electrocardiogram. A pacemaker was implanted as a prophylaxis against arrythmia during the transoperative and postoperative periods. There was no incidence of transoperative arrythmia. Three patients died in the immediate postoperative period, two due to duffuse carcinomatosis and one due to diabetic acidosis. The average duration of the implanted pacemaker was 12.7 days, and three patients required a permanent pacemaker. Case five is exemplificative of the benefits of the temporal pacemaker, he had a preoperative electrocardiogram showing trifascicular block, he was taken to the operating room and anesthesia was induced, the patient had a cardiac arrest but recovered without secuela; latter on a temporal pacemaker was inserted and the patient had surgery without cardiac problems.


[Renal dysplasia and bilateral cystic kidney of a lengthy development]. A case is presented of a 54 year old male patient, admitted to the hospital because of indolent abdominal growth limited to the upper and lower left abdominal quadrants with out genitourinary symptoms of ten years duration. The intravenous pielogram showed that the left kidney was enlarged and of cystic appearance with functional exclusion, the right also had multiple cystic cavities. The selective renal arteriography confirmed the above findings. At surgery it was found a huge left cyst, of 20 X 20 cm., with thin walls and dysplastic changes, the ureteropyelic junction was atresic. A survey of the literature is done, stressing the fact that the coexistence of cystic kidneys with dysplastic changes is frequent in the pediatric age, existing few case reports in adults. Brief considerations are made of this nosologic entity and the outline for proper diagnosis and treatment are made.


[Inhibition of EA and EAC rosette formation by sera of patients with vesical schistosomiasis]. Circulating immune complexes were investigated by the E.A. and E.A.C. rosette inhibition test in sera samples from patients infested by Schistosoma haematobium. About 60% of the patients demonstrated significantly higher inhibition values than controls. The material inhibiting E.A.C. rosette formation was precipitated by 3.5% polyethilene glycol, thus excluding the role of C3 fragments and suggesting that inhibition was due to immune complexes.


[Comparative evaluation of three techniques of passive haemoagglutination for the determination of HBsAg (author's transl)]. The AA. studied the reaction of indirect haemoagglutination for the determination of HBsAg in 157 sera from patients with viral hepatitis, with 3 differents commercial tests based on the agglutination by HBsAg, respectively, of sheep, turkey and human erythrocytes sensitized with antibody to HBsAg. All three techniques showed a high sensibility comparable to that of the RIA. Regarding specificity the best results were obtained with the turkey and human erythrocytes, while the sheep erythrocytes because of the presence of some aspecific positivity, need a confirmatory test.


[Monitoring of high-risk pregnancies (author's transl)]. The AA. have monitored 202 patients affected by several pathological conditions and at different stages of their pregnancies. Among them, 173 were pregnancies without complications. Monitoring was performed on the basis of the following 3 indices: HCS radioimmunological assay, total plasmatic estriol, and vaginal cytology. Results show, as demonstrated in the graphs and the final discussion, that already within the first weeks of gestation the pathological cases under observation presented marked modifications of the indices studied when compared to controls.


[Primary alcoholic cardiac disease and alcoholic liver disease. Anatomopathological study]. In order to find out if there is an association between alcoholic heart disease and alcoholic liver disease, and to discover the prevalence and characteristics of anatomical findings in the heart at alcoholic subjects, a prospective study was realized during the autopsies of patients younger than 60 years old, who had died with alcoholic liver disease not associated with an obvious heart disease. A second group of subjects containing similar characteristics of the first group, only without a past history of alcoholism nor liver disease, were used as controls. The comparison between the two groups in respect to: age, nutritional status, macroscopic and microscopic findings of the heart, frequency and degree of atherosclerosis revealed no statistical difference. In conclusion, we submit that the subjects who had died from liver disease also presented myocardial alterations, but that these did not differe from those observed in the control subjects.


[Variable behavior of urinary hydroxyproline in breast cancer with osseous metastases]. Serial estimations of the hydroxyproline (OHP) excretion during chemotherapy were performed in 24 women bearing advanced breast carcinoma with skeletal metastases. There was a significant correlation between sensitivity of the metastases to treatment and OHP content of urine. Many factors, including age of patients, type, number and extent of metastases, don't influence OHP excretion. The estimation of the urinary OHP levels, with the changes after antiblastic treatment, can be useful in prognostic evaluation of the metastatic breast cancer.


[The use of electropherogram in a clinical setting (author's transl)]. The AA. have spent several years working on the correlation between EPG patterns and diagnosis upon discharge. They then attempted to codify those abnormalities which were statistically related to different illnesses. This codification should not be considered definitive; however, it can be suggestive of further studies especially for those hospitals equipped with a computer which can correlate EPG patterns with the initial diagnosis or the diagnosis on discharge.


[A study of biochemical parameters in 94 athlets of Marcialonga (author's transl)]. Twenty biochemical parameters have been studied in 94 athlets of Marcialonga in basic conditions and after 30 min from the end of the competition. Urea, uric acid, creatinin, total proteins, albumin, sodium, calcium, phosphorus and several enzymes (AST, ALT, LAD, CK and ALP) have shown statistically significant increasings. It is, above all, clear the increasing of CK. On the contrary triglycerides have undergone a significant decreasing. The AA. try to explain the results obtained, considering some pathogenetic theories.


[Incidence of salmonellosis in the Province of Trento in the past 3 years]. 72 strains of Salmonella, belonging to 23 different serum types have been isolated during the last three years. These strains come from adult patients admitted to the Infective department of St. Chiara hospital in Trento and from three asymptomatic carriers found among the hospital staff, who have been regularly submitted to microbiological checks. Among the most frequent strains the AA. have found: S. enteritidis and S. typhi murium. Salmonellas, never isolated before, have spread, but they have shown poor adaptation to the environment: among these S. panama, S. infantis, S infantis, S. münchen. S. wien has not found, in the Province of Trento, environing conditions fit for its colonization. S. agona has shown a certain tendency to create a situation of asymptomatic carrier.


[Radioimmunological determination of circulating thyroid hormones]. In our study of the thyroid function, the methodological aspects and clinical significance of TSH, T4, T3 and their respective free fractions (FT4 and FT3), are examined. The RIA of TSH is the best for the diagnosis of hypothyroidism and also for the evaluation of the effect of thyroid hormone substitution therapy. This, united with T4 and T3 assay, allows a total evaluation of the thyroid state. The new method, recently introduced, for direct assay of free fractions, using a chromatographic separation of Sephadex LH 20, is extremely useful for follow-up of patients with thyroid disfunction.


Preoperative assessment: the excretory system. The majority of anesthetics are nephrotoxic in that they depress, usually temporarily, renal hemodynamics and functions. The author briefly reviews renal anatomy and physiology; the relevance of laboratory data associated with excretory function; the effects of abnormal values on the body including electrolytes, cardiac status and acid base balance; and the overall impact of these alterations on the anesthetic management of the surgical patient.


Uncovering preoperative anxiety.

Uncovering preoperative anxiety. The Q-Sort is one method of assessing a patient's preoperative anxieties. In this article, the authors examine the method as a simple and direct way of identifying fears which can complicate the administration of anesthesia.


A stucy of enflurane biotransformation and fluoride ion nephrotoxicity. Enflurane, like methoxyflurane, has been reported by some to cause renal failure, secondard to inorganic fluoride ion metabolism. In this article, the author examines some of the evidence both for and against these findings.


[Blood component transfusion in Croatia]. Blood component therapy has been wildly accepted all over the world due to the better effects achieved in treating the patients, its safety and economy. In SRH it is replacing whole blood transfusions rather slowly as can be seen through five years of production and utilisation of blood derivatives. In 1974-1978 period a number of donations in Croatia increased to 27 per 1.000 inhabitants, but it is still very far from optimal 40-60 donations per 1.000 inhabitants. In that period the production of albumin increased 5 times, of immunoglobulins 10 times and factor VIII 10 times. In 1978 per 1.000 inhabitants, 2,1 1 of plasma were fractionated, 53 gr of albumin and 23 ml of imunoglobulins were used plus additional 6.200 units per one haemophiliac. These quantities are not sufficient to cover the needs of the health service in SRH. To overcome the shortage it is necessary to increase the number of donations, to augmant the average amount of donation to 450 ml., to increase the number of plasmapheresis and to use blood component therapy on a larger scale. Only after obtaining 10-12 1 of plasma for fractionation per 1.000 inhabitants optimal quantities of derivatives can be secured.


[Transfusion-infusion methods in the treatment of acute poisoning]. For modern acute poisoning management there are several therapeutic transfusion-induced methods (forced diuresis, haemodialysis, peritoneal dialysis, haemoperfusion, plasmapheresis, exsanguino-transfusion, blood and blood component transfusion, intravenous solution infusion etc), each of them  having their advantages, disadvantages and limitations. No one of these methods is so efficacious enough that its application could be justified in all poisonings. However, some of them are considered to be method of choice in the treatment of certain acute poisonings.


[Burkitt's lymphoma].

[Burkitt's lymphoma]. The paper presents two patients with malignant lymphoma of Burkitt's type. Initial localisation of the disease on the mandible, early dissemination in the central nervous system and bone marrow infiltration with appearance of characteristic Burkitt's type blast cells enabled us to bring the diagnosis. Rapid fatal evolution of the illness in spite of the applied therapy point of the diagnosis of this rare type of malignant lymphoma.


[Primary cutaneous malignant lymphoma -- Sézary syndrome]. The paper presents a girl with cutaneous lymphoma. The onset of the illness was two years ago, and followed by cutaneous lesions, typical Mycosis fungoides and Sêzary's syndrome. After a year, the neoplastic cells penetrated into the peripheral blood, and the development of Sézary's variant of Mycosis fungoidses, was shown. The clinical development of the disease, and the application of hystopathological and laboratory investigations, proved that it was the Sézary's syndrome. When the adequete cytostatic therapy, and radiotherapy, was applied, according to the protocol for curing the malignant non Hodgkin lymphoma, the clinical and haematological remission of disease was performed.


[Distribution of the MN blood group in 2249 members of the Yugoslav army]. M and N antigenes of 2249 members of JNA were investigated. Fenotipe MM was found in 23,08%, NN in 22,54% and MN in 54,38% of the examinated persons.


[HBsAg in members of the Yugoslav army -- volunteer blood donors]. By electrophoresis immunoprecipitation and reverse passive haemaglutination was examined the incidence of HBs-antigencarriers in order to evaluate their suitability for use in the institutions for blood transfusion. It was shown that by EIP was discovered 1.52 per cent and by reverse passive haemaglutination 3.15 per cent HBs-Ag positive blood donors, by which the greater sensitivity of the RPHA method was emphasized. In the paper was discussed also the case of posttransfusion hepatitis, that occurred after prostatectomia associated with the transfusion of eight units of HBs-nontested blood out of which the one was received from HBsAg-positive donor.


Influence of whole-body mechanical vibration on altitude convulsion threshold. Altitude convulsion threshold was used for determining the maximal hypoxic tolerance of the mouse during whole-body transverse vibration. Elevation of the lung weight-body weight ratio was taken as evidence of lung edema. It was observed that vibration of 8 cps at 2 mm displacement (peak to peak) or 4 cps at 4 mm displacement did not affect the altitude convulsion threshold and the said ratio. On the other hand, vibration of 12 cps at 2 mm displacement, or 8 and 12 cps at 4 mm displacement caused an increase in a altitude convulsion threshold as well as lung edema. The possible mechanism of these changes is discussed.


Iontophoresis of enkephalins potentiates evoked field potentials in the in vitro rat hippocampus. Effects of iontophoresis of an active opioid peptide, D-Ala2-Met-enkephalinamide (2dA), on evoked field potentials were studied in the hippocampus in vitro preparation. Population spike responses which correspond to the summatory firing of the pyramidal neurons were recorded with glass microelectrodes from the CA1 cell layer. It is found that 2dA greatly enhanced the amplitude of population spike. The excitatory effect was opiate-specific, because it was antagonized by iontophoretically applied naloxone, a potent narcotic antagonist. On the contrary, an inactive enkephalin analog, N-acetyl-(D-Ala2, Lys3)-Met-enkephalinamide, was without effect. It is concluded that opioid peptides exert a specific excitatory action on the pyramidal neurons in the in vitro hippocampus.


Vascular reactivity of isolated perfused kidneys from normotensive, renal hypertensive and spontaneously hypertensive rats. By means of an isolated kidney perfusion technique, reactivities of renal body vessels to electrical stimulation of renal plexus and intravascular administrations of low dosed norepinephrine and epinephrine were determined in the spontaneously hypertensive rats of Wistar strain, normotensive Sprague-Dawley rats and Sprague-dawley rats with renal hypertension of the same sex and as equal as possible with respect to age and body weight. The basal vascular resistance as indicated by the perfusion pressure caused by the same rat of perfusion was significantly higher in the renal hypertensive group. Both electrical stimulation of the renal plexus and intravascular administrations of catecholamines caused a rise of perfusion pressure. Analysis of the dose-response relationship reveals that in the dose range used, the sensitivities to electrical stimulation and to norepinephrine are significantly higher in the normotensive than the hypertensive groups. The results indicate that structural change in the blood vessels is more important than the adrenergic actions of low intensity in the cause of high resistance of blood flow in hypertensive subjects at least in the kidney.


Problems or assessing the genetic impact of mutagens on man. Available human data, of the kinds needed to assess the genetic harm to man from possible changes in his mutation rate, currently suffer from major limitations. In particular there is uncertainty about a) the total amount of hereditary disease, b) the fraction of this that is mutation-related and therefore likely to be increased in frequency as a result of exposures to elevated levels of environmental mutagens, and c) the severities of the mutation-related conditions and the collective public health importance of any anticipated increases in their frequencies. Standards of protection against environmental mutagens cannot be set on the basis of laboratory data alone, and more effort on the part of geneticists will need to be directed towards quantitative assessment of the impact of the mutagens in terms of human disease. The needs for relevant human data, and various deficiences in the statistical information that is currently available, are discussed.


Lateral element cross connections of the synaptonemal complex and their relationship to chiasmata in rat spermatocytes. Observations are presented in support of the hypothesis that at meiotic prophase a reciprocal crossover is accompanied by a crossover of the lateral elements of the synaptonemal complex, SC (Moens, 1974). Rat spermatocyte nuclei in developmental stage VII (Clermont, 1972) of the seminiferous epithelium cycle, but not pachytene nuclei in stages I to VI, were found to have SC modifications in the form of a cross connection between the lateral elements. In structure these crossover elements, CO elements, resemble the lateral element. It is found in a variety of positions, usually more or less perpendicular to the SC but also slanted or parallel along the central element or detached from the SC. Reconstructions of entire nuclei indicate an average of one such CO element per SC and a nonrandom distribution of CO elements among the SCs. Because the crossing-over of lateral elements produces a 180 degree twist or removes a 180 degree twist, the pattern of SC coiling was examined. Coiling starts in early pachytene prior to CO element formation. At stage VII one nucleus had a total of 78 coils, all counter clockwise, and another nucleus had 97 such 180 degree coils. It is noted that if SC coils are associated with the process of crossing-over, then the regulation of crossover distribution such as chiasma position interference has an explanation in the structure and behavior of the SC.


Correlation between direct and maternal genetic effects on body weight in mice. A new method to estimate the correlation between additive direct genetic effects (Ao) and additive maternal genetic effects (Pm) on body weight was devised to apply to crossfostering data in mice. The correlation between Ao on body weight at 42 days (adult age) and Am on body weight at 12 days (preweaning age) was estimated as 0.561. The nature of this correlation was defined genetically.


Electrophysiologic findings and prognosis in Bell's palsy. Electrophysiologic investigations were carried out on 45 patients with Bell's palsy at periodic intervals after the onset of paralysis. It was found that there was a good correlation between prognosis in Bell's palsy and the amplitude of evoked motor response obtained after six or more days of clinical paresis. When the average amplitude of evoked motor response was within normal limits (i.e., 504 mu V or greater), complete recovery with no residual deficits took place two to six weeks after the onset of facial palsy. When the evoked motor response was absent in all three major branches of the facial nerve, indicating complete nerve degeneration, electromyographic signs of recovery were apparent by the third of fourth month after the onset of paralysis. In these cases, recovery was relatively slow and incomplete, with some degree of residual deficit and synkinesis. Maximal return of voluntary facial movement was established 8 to 12 months after the initial symptom. When the mean amplitude of evoked motor response was below the lower limit of normal (i.e., less than 504 mu V), electromyographic signs of recovery were noted within 1 to 3 months, depending on the amplitude values. The final outcome of this intermediate group was similar, but not identical, to that of the previous group. The prognosis of facial paralysis in Bell's palsy was thus found to be directly related to the mean amplitude of evoked motor response, regardless of the extent of clinical paralysis.


HLA, anti-DNA, and complement in myasthenia gravis. Twenty-seven patients (18 females and 9 males) with myasthenia gravis were HLA-A, -B, -C, and -D typed, and the results were analyzed with relation to evidence of immunodeficiency, thymic disease, and associated autoimmune processes. An association of A1, B8, and DRW3 appeared to identify a group of 8 females with higher mean anti-DNA, lower mean C4, and lower mean E. coli antibody titer than other females in whom CW4 (with or without BW35) was common (6 of the remaining 10 females were in this category). Antiacetylcholine receptor (anti-AChR) autoantibody and reduced serum IgM and isohemagglutinin titers were not clearly related to particular HLA specificities. These results suggest that HLA-A1, -B8, -DRW3, and -CW4 may be related to associated phenomena rather than playing a major role in the development of anti-AChR and myasthenia gravis.


Elements in muscle measured in vivo and in vitro with X-ray spectrometry. Calcium, iron, copper, and zinc concentrations in muscle were measured in vivo by x-ray spectrometry (XRS). The undersurface of the tongue was examined in cardiomyopathic and in normal hamsters. Values were compared to in-vitro analyses of various muscles from the same groups of animals using XRS and chemical analysis. Blood tests as well as histologic and histometric examinations were also performed. The correlated results show that XRS is a relatively sensitive and practical method for measuring chemical elements in muscle, and that it could be developed into a useful clinical test in certain neuromuscular and myocardial diseases. An interesting incidental finding was that, though all the examined muscles of myopathic animals had pathologic changes, only the tongue and myocardium, which are composed exclusively of red fibers, showed excessive calcium accumulation. This suggests either that the basic genetic aberration is not directly related to the oxidative metabolism, or that white muscles have a more efficient system for dealing with calcium overload.


F- and M-wave conduction velocity in amyotrophic lateral sclerosis. The F-wave was used to estimate motor nerve conduction velocity (MNCV) along the proximal segment of the fastest axons of the deep peroneal nerve (anterior-horn cells to knee) in 13 patients with amyotrophic lateral sclerosis (ALS) and in 21 age- and sex-matched control subjects. Measurements were based on the shortest latency of 100 F-waves obtained after supramaximal stimulation at the ankle and knee. The MNCV was estimated with the F-wave and conventional M-response methods in the distal segment (knee to ankle) of the nerve. Our results showed that proximal-nerve conduction is faster than distal conduction both in control subjects and in ALS patients. In ALS, there was a moderate reduction of MNCV, which was of equal degree in both the proximal and distal segments of the deep peroneal nerve. In control subjects and in ALS patients, no statistically significant difference was found between the MNCV estimated for the knee-to-ankle segment by conventional means and that obtained by the F-wave method. This indicates that the F-wave of shortest latency is conducted by the fastest surviving motor fibers, as in the initial components of the M-response--demonstrating that it is legitimate to make direct comparison of F- and M-latencies in estimating the proximal MNCV.


Probable hypothyroid myopathy: glycogen-deficient type 2b fibers. Described herein is a case of hypothyroid myopathy with selective atrophy and glycogen depletion of type 2b fibers shown by light and electron microscopy. Although the pathogenesis of such findings is obscure, it is possible that hypothyroidism in conjunction with a superimposed process might explain paradoxically glycogen-deficient fibers.


Experimental immunity against trypanosomiasis in sheep. Three groups of male sheep were used. Group one was not inoculated; group two was inoculated with T. rhodesiense homogonate and group three with T. rhodesiense "fraction 3". Subsequently they were challenged with 1 x 10(6) T. vivax. Group inoculated with T. rhodesiense fraction 3 had high IgG levels and parasitemia was absent.


Tropical vasculitis and tuberculosis.

Tropical vasculitis and tuberculosis. Attention is drawn to the association of Tropical aortitis, or vasculitis with active or previous tuberculous infection. This suggests that the two diseases may be related. It is recognised that environmental factors may be important since the incidence of this complex appears to be high in the indigenous populations of Southern and Central Africa and uncommon in people of African origin in industrialised nations. Unlike classical Takayasu's arteritis, there does not appear to be any preference for young people or for females.


A review of 79 cases of eclampsia at University Teaching Hospital, Lusaka. Seventy-nine cases of eclampsia (incidence 0.22%) are reviewed. The corrected maternal and perinatal mortality rates were 12.6% and 28.3%. Maternal and perinatal mortality were directly related to number of fits, severity of eclampsia, delay in onset of treatment, and duration of labour. Whereas the maternal mortality was 23 per cent in patients delivered vaginally and 8.6 per cent in patients delivered by caesarean section, the perinatal mortality was almost the same in both types of delivery.


Hepatic bruit in Hodgkin's disease.

Hepatic bruit in Hodgkin's disease. Two cases of stage IV B Hodgkin's disease of the mixed cellularity type are described who had loud hepatic bruits. This physical sign is previously described only in cases of hepatocellular carcinoma and acute alcoholic hepatitis. The aetiology of the bruit in one of the cases is probably arteriolar compression by tumour tissue.


Diagnosis of venous thrombosis using 125 I-fibrinogen in Zambia. Fibronogen labelled with I125 iodine has been used as an epidemiological tool to study deep vein thrombosis (DVT) in Lusaka, Zambia. Twenty highly selected patients were studied; data was complete in 18. Six were positive. None had clinical evidence of DVT and pulmonary embolism. However the results, which should be interpreted with much caution, remain to be confirmed and their clinical significance determined.


Treatment with oxidized cellulose of the resection surface of the lung. Segment resection was performed in 15 dogs. The resected surface was covered with absorbable cellulose bioplast (Surgicel)R and fixed by the tissue adhesive Histoacryl-N-Blau. The results were checked by gross and microscopic examinations which showed that the gradually absorbed material had been replaced by a layer of connective tissue. The method is recommended for use in human operations.


Perinatal and neonatal mortality and morbidity in Lusaka, 1976. A prospective study of perinatal and neonatal mortality and morbidity at the University Teaching Hospital (UTH), Lusaka for 1976 is presented. The early neonatal mortality of the babies born in hospital was 28.7 per 1000 live-births; it was 239.96 per 1000 admissions of those born outside the hospital. The still-birth rate in the hospital-born babies was 25.2 per 1000 deliveries; the perinatal mortality was 53.3 per 1000 deliveries; and the neonatal mortality in the hospital-born was 31.1 per 1000 live-births. The cause of death were asphyxia, infections could injury, respiratory distress syndrome, congenital malformation and intracranial haemmorrhage. If the perinatal and neonatal mortality and morbidity are to be reduced, much effort and co-operation of all concerned with the health of the expectant mother, and her child are required. Records of birth-weights, stillbirth, and causes of deaths in the University Teaching Hospital (UTH) for the year 1976 have been analysed. The aim is to provide a basis for future comparisons and improvement of the care given to newborns.


Serum immunoglobulin levels in the Zambian African. Serum immunoglobulin concentrations were determined in 121 Zambian in-patients suffering from different acute and chronic disorders. The immunoglobulin response was similar to that observed in other patient populations.


An unexpected foreign body in the oesophogus: a case report. An unusual case of foreign body in the oesophagus is reported. A history of dysphagia was absent although oesophageal obstruction was total; the retained foreign body was vegetable matter. An unusual radiological appearance, "the inverted wine-glass sign" is described. Pure water depletion was diagnosed there being dehydration combined with hypernatraemia (Na = 164MEq/L), normokalaemia (K+ = 4.2mEq/L), and acidosis (Serum bicarbonate = 10 mEq/L), as well as uraemia (220 mg%), and haemoconcentration (haemoglobin=18.5g%). Treatment with oesophageal lavage and intravenous fluids was successful.


Menstrual regulation by mean of endometrial aspiration. The results of menstrual regulation performed in 181 cases of supposed pregnancy are described. In 166 cases (92%) pregnancy could be interrupted without dilatation of the os uteri and only in 15 cases (8%) was it necessary to dilate the cervical canal by 8.5--9.0 H units. The majority of pregnancies was interrupted by means of vacuum aspiration and only in 15 cases was curettage performed because of a supposed residue. In the postoperative period slight blood discharge occurred in 2 cases and in 1 case the choriodecidual residue had to be removed by curettage one week after vacuum aspiration. The advantage of the method are particularly remarkable in the interruption of the first pregnancy since it can be carried out without an injury to the cervical canal.


Chronic cystic masthopathya: twenty-five years experience. The pathology and clinical aspect of chronic cystic mastopathy are discussed on the basis of experience gained in 338 cases. The condition was unilateral in 88.7% and bilateral in 11.3% of the cases. More than 50% of the patients belonged into the 40 to 49 years age group. In 5.3% transformation into cancer was observed. In 25.6% of the cancer cases the matopathic change was also detected. Fifty-nine patients had to be operated twice, 26 three or more times. The operation consisted of excision; in two cases mastectomy had to be performed. Of the patients, 95% were followed up; 21% continued to complain of slight pain in the breast.


Incidence of peptic ulcer in the Zambian African - a radiological study. Five hundred and sixty-eight (568) consecutive barium meal examinations have been studied. 152 showed peptic ulcer. There were 146 duodenal and six gastric ulcers. Eight were post-bulbar ulcers, and multiple ulcers were seen in only 4. Clinically, none had pancreatic adenoma. The ratio of male to female was as follows:- referral 4.7 to 1.0; of those who had peptic ulcer, 4.1. The incidence of peptic ulcer was equally distributed in all social classes.


Formation of cholesterol gallstones: the role of metabolic factors and of congestion. Cholesterol gallstones were induced in mice by means of a lithogenous diet. Some of the animals were given in addition morphine regularly. The ten-week experiment was concluded with operation. Lithogenesis was recorded, the volume of the gallbladder was measured, the bile collected for analysis and a specimen was taken from the liver for histologic examination. In the animals fed the lithogenous diet were only gallstones found. The occurrence of cholestasis was unequivocally be proved by the volume of the gallbladder and the microscopic examination of the bile sediment in the group treated with morphine. Metabolic factors seem to play the primary role in the formation of cholesterol gallstones; cholestasis is of secondary importance.


[Similarities between human fetal glia cells and glioma cell type in tissue cultures]. Comparative studies were carried out on cell cultures of human fetal brain tissue and of gliomas of different tissue structures. In the cultures of fetal brain tissue maintained for 180 days, four cell-types could be distinguished: 1 large polygonal cells showing epithelial type growth; 2 groups of small round cells; 3 bipolar spongioblasts; and 4 giant astrocytes. The monolayers consisting of large cells formed a nursing layer for the small round cells and could be considered neuroepithelial cells. The small round cells forming groups were regarded as immature gliacytes which created migrational forms by means of active motion. The bipolar spongioblasts were considered a variant of the immature gliacytes. The giant astrocytes displayed the lowest plasticity; their appearance was interpreted as a true differentation and not simply as a change in form of one of the cell types. The cells of the fetal brain tissue could not be identified with the cells of the adult human brain. Still, all the four cell types appeared in the cultures of gliomas with different textures and different degrees of malignity. It seems that with respect to gliogenesis, among the four described cell types the immature gliacytes are of the greatest importance.


[Clinical studies of Magurlit granulates]. The possibilities of dissolving by means of medication uric acid and uric acid-calcium oxalate calculi are discussed. The biochemical causes of uric acid lithogenesis was studied. Due to successful pharmacotherapy the number of operations has greatly diminished in recent years. On the basis of experience gained with various citrate mixtures the authors claim that Magurlit is the most advantageous litholytic drug. Due to its magnesium and vitamin B6 content it is also suitable for the dissolution of uric acid calculi containing calcium oxalate in diffuse distribution, i.e. for the prevention of the development of stones of this type.


Conjoint twins (1).

Conjoint twins (1). Two cases of Conjoined twins are reported. The etiology, incidence, diagnosis and management are discussed. It is suggested that if conjoined twins are diagnosed before labour, of if there is dystocia, Caesarean section is the treatment of choice.


[Total reconstruction of the lower lip]. In cases the entire lower lip was extirpated because of lip cancer and in 13 of these patients immediate restitution was performed by the slightly modified method of Grimm. The experience gained with this method is analysed. The fact that beside an acceptable function of the lip the oral orifice has not narrowed is considered the main advantage of the method.


Radionuclide angiocardiography, a noninvasive method for evaluating left ventricular ejection fraction and regional wall motion; comparison with contrast left ventricular angiography. The efficacy of gated synchronous acquisition (GSA) after cardiac blood pool labelling in assessing left ventricular function (ejection fraction and regional wall motion) was evaluated in 31 patients within 24 hours of contrast left ventricular angiography. With the R-wave of the electrocardiogram as a physiologic marker, radionuclide data recorded into an on-line computer allowed construction of cardiac blood pool images during sequential periods of the cardiac cycle. The images, of high count density, have good spatial resolution and can be viewed repetitively in real time in a cine mode. The ejection fractions calculated from the left ventricular time-activity curves corrected for background activity correlated well with the ejection fractions determined from dimension analysis of the contrast left ventricular angiograms (r = 0.87). The results were highly reproducible (r = 0.97). Results of analysis of left ventricular wall motion were similar with the two types of angiograms in 26 of the 31 subjects. GSA is a simple, safe means of evaluating left ventricular ejection fraction and regional wall motion noninvasively.


Carcinoma of the gallbladder in a population of Southwestern American Indians. The clinical and pathological characteristics of gallbladder carcinoma were studied in a group of 56 Southwestern American Indian patients. This is the third most common malignant tumor among American Indian females in a population served by the New Mexico Tumor Registry accounting for 8.5% of specific cancer diagnoses by site. Carcinoma of the gallbladder is relatively more common within the Indian population than among Spanish Americans or Anglos living in this area. This is true for both sexes. No significant differences in average age at diagnosis, ratio of female to male patients, signs and symptoms, stage at diagnosis or survival were detected in comparison with studies pertaining to gallbladder carcinoma in non-Indian populations. A squamous cell carcinoma component was unusually common however, and carcinoma in situ or atypical adenomatous hyperplasia of the mucosa was frequently documented adjacent to invasive carcinoma. Although gall stones were present in tumor containing gallbladders in 93% of cases, elective cholecystectomy for cholelithiasis is probably not a practical means of prevention of this tumor in view of the unusual frequency of cholelithiasis in Indian women. Pharmacological conversion of bile to a non-lithogenic form may deserve consideration as prophylaxis against both cholelithiasis and carcinoma of the gallbladder in this population.


Multicentric bowen's disease of the genitalia: spontaneous regression of lesions. The phenomenon of multiple lesions of Bowen's disease appearing on the genitalia of young adults is becoming increasingly recognized. We have seen two patients who had genital lesions with histologic features of squamous carcinoma in situ, but with an entirely different clinical appearance. In both patients, varying degrees of spontaneous regression occurred. A conservative approach to management of these lesions is suggested.


Quantitation of dexamethasone in biological fluids using high-performance liquid chromatography. A sensitive and specific method for the quantitation of dexamethasone in plasma and urine is described. The specificity of the method is obtained using adsoprtion chromatography on a high-performance liquid chromatograph. The dexamethasone is detected with a variable-wavelength UV detector. An internal standard technique is used for quantitation of dexamethasone with a minimum sensitivity of 15 ng. Preliminary results of the application of the method to pharmacokinetic studies of dexamethasone in humans are reported.


Simple, rapid and micro high-pressure liquid chromatographic method for the simultaneous determination of tolbutamide and carboxy tolbutamide in plasma. A rapid high-pressure liquid chromatographic (HPLC) assay is described for the quantitative analysis of tolbutamide and its major metabolite, carboxy tolbutamide in plasma. An aliquot (25--100 microliter) of plasma was prepared for chromatography by deproteinization as follows. One volume of plasma and 2.5 volumes of acetonitrile were vortex mixed for a few seconds and then centrifuged for approx. 1 min. A 50-microliter sample of the clear supernatant was injected into the chromatograph. A mu Bondapak C18 reversed-phase column was used with a mobile phase acetonitrile--0.05% phosphoric acid (45:55) at a flow-rate of 1.5 ml/min. The column effluent was monitored by a variable-wavelength UV detector set at 200 nm. Tolbutamide and its metabolite had retention times of 5.75 and 3.25 min, respectively. The procedure yuelds reproducible results with sensitivity adequate for routine clinical monitoring of plasma levels or for single-dose pharmacokinetic studies. A number of commonly used drugs do not interfere with the method. A single plasma sample can be analyzed in approx. 9 or 10 min.


Determination of molsidomine in plasma by high-performance liquid column chromatography. A high-performance liquid chromatographic method is described for the analysis of the anti-anginal compound 5-ethoxycarbonyl-3-morpholinosydnonimine (Molsidomine) in human and dog plasma. The drug was extracted from plasma into chloroform and the analysis was carried out on a reversed-phase column, the column effluent being monitored by UV absorption at 312 nm. The method is sensitive (2 +/- 0.3 ng/ml) and specific. The method was applied to a study in which human volunteers received an aqueous solution of the drug and then, on a separate occasion, a tablet formulation. Peak plasma levels of 20--30 ng/ml (tablet) and 10--19 ng/ml (aqueous solution) were obtained following a 2-mg oral dose.


Depersonalization and temporal disintegration in acute mental illness. The authors assessed the relationship between depersonalization (defined by self-estrangement and body image diffusion) and temporal disintegration (impaired goal-directedness and temporal indistinction) in 37 acutely ill hospitalized psychiatric patients. Substantial correlations were found between these two phenomena, confirming previous work. The finding that body image diffusion is positively correlated with temporal disintegration suggests that distortions of personal space accompany distortions of personal time.


On depersonalization in adolescence: a consideration from the viewpoints on habituation and 'identity'. Depersonalization occurs in many psychiatric states but its origins are unknown. It is suggested that feelings of unreality may be unusually common in adolescents. Certain speculations are offered concerning the genesis of a sense of unreality. The neurophysiological mechanisms governing the perception of 'familiar' or 'strange' are seen to be the key to this experience. They involve the matching of events in the outer world against inner organizations of previous experience. These mechanisms are likely to be disturbed through epilepsy or other disorders of the temporal lobe, in which abnormal perceptions of strangeness and familiarity are frequently found. It is suggested that the matching process extends to include social situations, and that where an individual's identity is undeveloped or fragmented a sense of strangeness may result. The concept of identity is briefly discussed in order to distinguish it from 'self' and 'ego', and to intimate its possible fragmentation in adolescence. Finally, some reference is made to management and, in particular, to the use of the peer group.


[Addiction in women. Observations on the psychic and social situation of women admitted to the addicts ward of a provincial government mental hospital (Landeskrankenhaus) (author's transl)]. The article describes a ward for the admittance of female addicts in a provincial government mental hospital (Landeskrankenhaus). Addiction is interpreted as the sequel of a severe psychic disturbance (manifested as depression in most of the women) in conjunction with socially disturbed conditions (lack of social function, familial upsets). Possibilities of treatment in a provincial government hospital are limited. The essential therapeutic chance is offered by a firmly patterned ward structure and by creating an "antidepressive environment" which meets to a certain extent the patient's innate craving for security and her need "to belong", while at the same time promoting her own initiative and sense of responsibility.


Application of portable cardiopulmonary bypass to emergency instrumentation. Although most emergency conditions may be reversed with standard treatment protocols, mechanical cardiopulmonary bypass may be utilized to resuscitate highly selective patients who are in extremis. The addition of a battery mode to drive the pump oxygenator allows for portability from one area of the hospital to another. With the extensive availability of pump teams for elective heart surgery, cardiopulmonary bypass is applicable to patients with emergency conditions.


[Neo-natal neutropenia induced by anti-NA 2 allo-immunization. Serological and clinical study of 2 cases in a family]. A severe neutropenia in a 2 day old newborn drew attention to anti-HLA and NA 2 antigranulocytic antibodies in the maternal serum. Close supervision from birth of a younger sibling demonstrated a neutropenia on the 5th day of life. Serological investigation showed the anti-NA 2 antibody to be responsible in both cases. A good result with total blood replacement of leucocyte-free blood in the second case would advocate this treatment in cases of severe immunological neutropenia.


[Ideas and theories in the new psychotherapies in the U.S.A]. A primary concern with man's fragmentation and alienation from himself and others. A concept of pathology which reflects the loss of self or congruence with one's experiences and the resultant blocking and diminution of one's potentialities. A concept of cure which means authenticity, spontaneity and self-actualization. A primary mode of change via immediate experiencing i.e. intense feeling of one's sensory, bodily and/or spiritual dimensions. A primary therapeutic task of providing an authentic and permissive atmosphere for mutual interaction or dialogue. A primary focus upon the phenomenological moment. A treatment model of therapist to client within the egalitarian framework of a "human alliance". A doctor/patient relationship which is a real, here-and-now encounter. A primary therapist role of mutual interactor and acceptor. A primary therapist stance which is involved and real. A primary tool or technique of encounter (and/or intensification of feelings via methods of emotional flooding for intense abreaction, or methods of meditation for profound rest). A primary treatment length which is shortterm and intense.


[Clinico-neurohumoral interrelationships in neuroses]. The paper is related to studies of the sympathico-adrenal activity, hypophysisadrenal and entero-chromaphine systems in patients with hysterical and phobic neuroses. They detected certain regularities in the initial activities of these systems as well as of their reactivity depending upon the character of the functional symptom, psychological personality traits and cerebral dysfunctions.


Autophagy in dedifferentiating newt iris epithelial cells in vitro. The ultrastructure of dedifferentiating iris epithelial cells of adult newts was studied in vitro, under the conditions which allow subsequent conversion into lens cells. The dense population of melanosomes which characterize the normal differentiated cells are progressively lost before the cells convert into lens cells. The loss of melanosomes is accompanied by the appearance of a layer of material of intermediate density surrounding the melanosomes. Subsequently vacuoles of various sizes appear in which melanosomes, ribosomes, and multivesicular bodies are sequestered. Further observations suggest that these affected organelles are destined for exocytosis. The cytochemical test for acid phosphatase is positive in the immediate vicinity of melanosomes, in the melanosome clusters, and in the multivesicular bodies. On the other hand, normal iris epithelial cells in situ are negative to the acid phosphatase test. The results are interpreted to indicate that autophagy and exocytosis of melanosomes and other organelles occur during the dedifferentiation of iris epithelial cells.


The effects of marijuana: a social psychological interpretation. BECAUSE OF MARIJUANA'S apparent widespread and growing use, and possible future decriminalization, there is understandable concern about the effects of marijuana on behavior. However, in any serious deliberation about effects on behavior, two divergent views are equally unacceptable: that of the naive medical moralizer, who believes that marijuana turns people into vicious criminals; and that of the uncritical humanist, who holds that it affects everyone differently. The first position, characterized here as medical, moves from drug to behavior as though the latter were wholly physiological and a more or less predictably invariant function of the former. The second position, uncritical humanism, views the world as a composite of more of less free human elements which remain inscrutable and unpredictable, regardless of whether any individual is straight or high. Somewhere between these antipodal positions of absolute uniformity and absolute uniformity and absolute diversity lies the reality of patterned variability--i.e., types of users and types of effects of use. Situational factors such as when, where, with whom, and the like are admittedly important, but I propose here to limit attention to the user as social psychological actor in order to reduce analysis to a manageable number of parameters.


Short-term treatment of phobia through eidetic imagery. This paper presents a relatively new approach to the treatment of phobia. The technique is based on the special attributes of eidetic images. A discussion of relevant eidetic concepts and eidetic methodology is followed by two case histories that illustrate the therapeutic use of eidetic imagery.


[Psychopathology of stealing acts without substantial personal enrichment (author's transl)]. On the basis of a descriptive study of eight cases, four different types of stealing act without substantial personal enrichment are determined: 1. Stealing for substitutional sexual satisfaction 2. Stealing as a reaction to relieve strong emotions 3. Stealing during a state of disturbed consciousness 4. Stealing from psychotic motives. In this context terminologic and diagnostic problems are dicussed. Stealing acts without substantial personal enrichment are classified as a subgroup of pathologic stealing.


Loxapine succinate as a neuroleptic agent: evaluation in two populations of elderly psychiatric patients. Loxapine succinate, a newly developed neuroleptic drug, was administered to two groups of geropsychiatric patients: (a) 12 with psychosis and organic brain syndrome, and (b) 14 with chronic schizophrenia. After a two-week baseline period, loxapine was given for 12 weeks. The moderate therapeutic effect of loxapine in the "responders" was similar to that of other neuroleptic drugs. The therapeutic dosage range was found to be from 10 to 80 mg daily--about half that used for younger patients. The chief side effects were drowsiness, mild extrapyramidal symptoms, and a slight increase in blood pressure.


Dementias.

Dementias. Senile dementia of the Alzheimer type is becoming one of the most common of the malignant diseases as our society ages. Currently, research has identified several pathophysiological changes, including the bihelical filament and the loss of the enzyme choline acetyltransferase from the cortex. Although genetic factors play some role in this disease, the important environmental risk factors have not yet been identified and there is, at present, no specific treatment. The second most common cause of dementia, cerebrovascular disease, produces dementia only when there is destruction of brain tissue, as in individuals who have multiple strokes or who have hypertensive vascular disease leading to multiple lacunae. In both multi-infarct dementia and in the lacunar state, hypertension appears to play a greater role than it does in other forms of vascular disease. Many of the other causes of dementia, including normal pressure hydrocephalus, CNS infections or tumors, metabolic disorders produced by thiamine or vitamin B12 deficiency or thyroid dysfunction, are often reversible. Every patient, whatever the age, with a developing dementia deserves a thorough workup to identify these treatable disorders.


Secondary mania: manic syndromes associated with antecedent physical illness or drugs. While mania usually occurs as a phase of manic-depressive disease, it can occur in association with organic dysfunction--medical and pharmacological--in patients with no history of affective disorder. In reviewing the literature, we have found that mania occurs secondary to drugs, infection, neoplasm, epilepsy, and metabolic disturbances. These cases are best considered secondary manias. They suggest that mania--like, for example, hypertension--is a syndrome with multiple causes and that with further research many manic syndromes currently considered primary will be shifted into the secondary category. Furthermore, the concept of secondary mania casts doubt on any unitary or single-agent hypothesis of the etiology of mania and supports the notion of a continuum of psychopathologic syndromes. Clinicians are alerted to the existence of this syndrome and are urged to screen for it when conditions warrant.


In vitro reconstitution of calf brain microtubules: effects of macromolecules. A comparative study has been carried out of the ability to reconstitute into microtubules of tubulins prepared by the Weisenberg and the cycle procedures. It was found that further purification of cycle tubulin by phosphocellulose chromatography made its ability to polymerize identical with that of Weisenberg tubulin. By adding to either tubulin the isolated proteins which copurify with tubulin in the cycle prodecure, it is possible to reduce their critical concentrations of microtubule formation to a value identical with that of cycle tubulin. It was demonstrated quantitatively that the effect of these nontubulin proteins could be mimicked by a variety of polycationic molecules, the most effective one being poly(L-lysine). A possible mechanism is described by which growing microtubules could be stabilized by subsequent addition of the nontubulin proteins. The conclusion is drawn that, at present, it is not known whether the proteins which copurify with tubulin are specific components of the microtubule system, or simply artefactually coprecipitated impurities.


Left ventricular function in massive pulmonary embolism. Serial echocardiographic and angiographic measurements of left ventricular function were obtained in a patient with massive pulmonary embolism before and after pulmonary embolectomy. These data suggest that left ventricular dysfunction secondary to right ventricular failure is the results of markedly decreased left ventricular filling in this settings.


Haemaphysalis (Rhipistoma) eupleres (Ixodoidea: Ixodidae), a parasite of the Madagascar falanouc (mongoose): new data and male identity. Haemaphysalis (Rhipistoma) eupleres Hoogstraal, Kohls and Trapido 1965, was described and partially illustrated from a single damaged female from the falanouc, or small-toothed mongoose, Eupleres sp., from an unstated locality in Madagascar. Data are here presented for two collections (9 males, 17 females) from two localities in Tamatave Province, one from E. goudotii Doyère, the other from an unstated host. The male is described and illustrated; a complete female is illustrated.


Spatial behavior of schizophrenic and non-schizophrenic psychiatric patients. The spatial behavior of schizophrenic and non-schizophrenic psychiatric patients (n equal to 64) was assessed as subjects seated themselves for an interview. The methodology employed was one for which normative data were already available. Results indicated no differences in the seating selections of the patient groups, although the spatial behavior of the patient groups differed from that of normals. The results are interpreted in terms of factors generally associated with patient status rather than uniquely associated with a particular diagnosis.


Characteristics of the microvillus brush border of human placenta: insulin receptor localization in brush border membranes. Insulin receptor characteristics were examined in purified brush border membrane from the syncytiotrophoblast of the normal human placenta and quantified during membrane preparation. Insulin receptor concentration was enriched 10- to 15-fold in this preparation, and insulin receptor specific activity followed closely the enrichment values for microvillus plasma membrane markers, alkaline phosphatase, Ca2+- and Mg2+-ATPase, and 5'-nucleotidase during cell fractionation. Insulin receptor concentrations and marker enzyme analyses were compared in whole homogenate, mitochondrial, microsomal, and microvillus fractions, and these fractions were characterized by SDS-gel electrophoresis. Microvillus insulin receptor interactions were dependent on time, [125I]iodoinsulin concentration, protein, and unlabeled hormone concentrations. Competition studies with porcine insulin and [125I]iodoinsulin for this receptor revealed a curvilinear Scatchard plot. Insulinase was demonstrated at 37 C but was minimal at 24 C in the microvillus fraction. Electron microscopy of the microvillus membrane preparation revealed its composition to be mainly spherical closed membrane vesicles and brush border fragments. Sodium dodecyl sulfate polyacrylamide and isoelectric focusing gels of membrane fractions were compared. Actin was tentatively identified as a major microvillus membrane protein and was further fractionated: beta-Actin and gamma-actin were present in approximately equal concentrations. The localization of the insulin receptor in the microvillus brush border of the human placenta suggests that this receptor interacts with maternal, rather than fetal insulin.


Predictive experimental animal tumor models: a concept. As an introduction to the session on Animal Tumor Models, a concept of animal model systems in presented that differentiates between models of organ-related diseases such as prostate or bladder cancer and models of a certain class of neoplasms found within a specific organ disease. Thus defined, no one animal tumor can completely represent and be predictive for a disease entity, no more so than can a single clinical experience with prostate cancer, e.g., be representative of all clinical cases. Rather, a block of animal tumors originating from a specific organ that reflects a spectrum of carefully defined growth patterns and reactivities best mimics the overall responses obtained clinically. Because immunotherapy is most logically visualized and applied in an adjuvant mode, its effectiveness as a therapeutic modality is vulnerable to the vagaries of individual tumor response to a primary modality. Therefore, the selection of appropriate tumor models for developmental studies in immunotherapy is critical, and the need for well-defined and characterized test systems in terms of chemotherapy and radiation responsiveness is emphasized.


Experimental immunity against trypanosomiasis. 9 groups of 6 female rats were used in an experiment using fraction 3 of Trypanosoma rhodesiense. 500 microgram gave 100% immunoprotection and 1000 and 1500 microgram gave 66% immunoprotection when challenged with 5 X 10(2) T.brucei. 2  groups of 10 female rats were tested for a short period inoculation immune response. In this, 750 microgram of fraction 3 of T.rhodesiense gave 70% immunoprotection when challenged with T.brucei.


[Longitudinal study in children with the nephrotic syndrome and minimal glomerular lesion]. Twenty-one children with idiopathic nephrotic syndrome and minimal changes on renal biopsy  were  followed during all the disease. The average of follow-up was 37 months, with a range from 12 to 124 months. Recurrent proteinuria was the most important feature during the follow-up; 14 out of the patients showed frequent relapses, but only 2 patients showed major complication (peritonitis, septicemia) during relapses. Frequent relapses appeared most frequently in patients who began the disease before their fourth birthday, showed allergic history, had hypertension and red blood cells in urine, or had recurrent infections and finally, in those where proteinuria reappeared soon after prednisone therapy was ended. Prednisone alone was successful to induce remission, but it did not prevent frequent relapses. The association clorambucil-prednisone allowed lengthening of the period of remission and possibly for this reason the rate of relapses fell during the first 37 months of the follow-up. There are no signs which permit to predict the length of the disease and the frequent relapses can occur even after many years from the beginning of the disease. Special care of these patients avoids major complications.


A case of coccidioidomycosis in Australia. We report what we believe to be the first case of coccidioidomycosis to be diagnosed within Australia, and emphasize the dangers of handling Coccidioides immitis in the laboratory.


Testosterone metabolism in patients with advanced carcinoma of the prostate: a comparative in vivo study of the effects of oestrogen and antiprolactin. In the light of the high incidence of cardiovascular side effects with oestrogen therapy in patients with prostatic cancer, other medications altering androgen metabolism are under investigation. The influence of the anti-prolactin bromocriptin (CB157) on plasma kinetics of testosterone and on endogenous hormones was studied and compared with the effect of ethinyl oestradiol in 25 patients with prostatic carcinoma. Bromocriptine significantly suppressed both prolactin and testosterone, inhibited the transfer of androgen from the inner pool into the deep compartment and favoured its degradation. Ethinyl oestradiol decreased testosterone, LH and FSH, and prolonged the biological half-life of testosterone. The effects of bromocriptine on androgen metabolism might be of therapeutic value in patients with prostatic carcinoma.


Evaluation of tumour extension by whole body scanner. Fifteen patients with urinary bladder carcinoma were examined by computerised tomography parallel with conventional urography before, during and after radiation therapy. Computer tomography gave better diagnostic information in the cases in which the tumour had encroached upon, or was growing outside the bladder wall, and was equally as valuable as urography when it was located wholly within the bladder. The scans were of great value as a guide in the planning of computer-aided radiation therapy.


[Thormboembolisms and heart ruptures in myocardial infarct]. An analysis of the incidence of thromboembolism and heart ruptures with reference to different causative factors was conducted on the basis of 585 patients dying of myocardial infarction during the recent 30 years (autopsy data) and 1417 patients with myocardial infarction (298 mortality cases among them) hospitalized during the recent 10 years. A reduction of the incidence of thromboembolism and an increase of the incidence of heart ruptures in the recent years were revealed. Thromboembolism and heart ruptures play an important role among the causes of mortality in myocardial infarction. The development of thromboembolism in myocardial infarction is favoured by the macro-focal nature of the heart lesion, repeated necroses of the myocardium, localization of infarction in the posterior and posteriolateral zones, old age of the patients (over 60), presence of diabetes mellitus and acute cardiac aneurysm. Thromboembolism occurs with the same incidence rate within the initial 7 days, and later during the acute phase. Thrombi are most often found in the cardiac cavities, pulmonary, renal and splenic vessels, in the cerebral, mesenteric and other vessels. Heart ruptures are favoured by the macro-focal nature of the cardiac lesion, localization of the infarction in the anterior and anteriolateral zones, old age (over 60), presence of acute cardiac aneurysm. Most frequently the ruptures are observed in primary myocardial infarction within the initial 5--7 days of the disease. The use of anticoagulants in myocardial infarction decreases the incidence of thromboembolic complications and heart ruptures.


Internal-external control and drug use among junior high school students in a rural community. Internal-external (I-E) control and current drug use were assessed among rural junior high school students. As expected, a negative relationship was found between internal control and drug use quantity-frequency. Correlations involving I-E control and drug use outcomes, while in the expected direction, were not significant. Data from the junior high sample were compared with previously collected high school data, and it was found that while overall patterns of use were similar for the two groups, the junior high students report lower quantity-frequency and more social complications.


[Complications of local use of hydrocortisone and their prevention]. Since 1966 to 1976 3694 patients were treated for deforming arthrosis (4953 joints) with local periarticular novocain-hydrocortisone blockades supplemented with intramuscular injections of rheopyrin (pyrabutanol). The method proved to be highly effective, being not inferior to intraarticular injections of hydrocortisone suspension. Only in 8 patients phlegmons occurred, the excision of which resulted in prompt recovery. Hydrocortisone injection in the articular cavity is inherent in the development of grave complications  (28 observations), which resulted in amputation of the extremity in 3 patients and in lethal issues--in 6.


[Surgical tactics in sharp-point foreign bodies of the gastrointestinal tract]. The author reports his observations of 92 patients who swallowed sharp-pointed foreign bodies. It is concluded that the absence of the displacement after barium suspension administration should be considered an indication to surgical intervention in uncomplicated cases. The withdrawal of sharp-pointed objects by means of a fibrogastroscope is hazardous in case of their penetration in the gastric wall.


[Teratoid formations in the pararectal cellular tissue in adults]. Since 1955 to 1975 the authors observed one hundred sixty patients with teratoid formations of the pararectal cellular tissue. Under consideration are diagnostic methods used nowadays clinically and the problems of the differential diagnosis as well. The authors point out the basic principles of surgical treatment of the pathology involved. The authors' experience with surgical treatment and the complications observed are analysed. It is felt that this pathology is encountered much more frequently, than it was previously supposed.


[Reinfusion of blood in emergency surgery of severe injuries]. The immediate results of blood reinfusion in 357 patients with wounds and closed injuries of thoracic and abdominal organs are analysed. The data obtained evidence the rationality of reinfusion in urgent surgery for injuries. Reinfusion enables adequate replenishment of blood losses to be terminated more rapidly and physiologically.


Serum concentrations of orally administered diphenylhydantoin in dogs. Diphenylhydantoin was found to have a short half life and poor gastrointestinal absorption in dogs. Consequently, serum content after single or repeated oral dosage of 10 mg/kg of body weight did not exceed a concentration of 2 microgram/ml. To achieve a postulated effective plasma concentration of diphenylhydantoin, oral dosage of at least 35 mg/kg of body weight 3 times daily seems necessary.


Counselor effectiveness in a methadone maintenance program. Counselor effectiveness for 253 heroin addicts in a methadone maintenance program was studied. The results of patient urinalysis for heroin use was chosen to assess counselor effectiveness. No significant differences in heroin use were found for the following groups of patients: 1. Those with multiple ex-addict (EA) counselors. 2. Those with multiple nonaddict (NA) counselors. 3. Patients with time periods with EA counselors followed by time periods with NA counselors, or vice versa. 4. Those with a single NA counselor. 5. Those with a single EA counselor. Patients with no counselor for one-third or more of each study period were found to have a significantly greater percent of urines positive for heroin.


Illicit drug use and consumption of alcohol, tobacco, and over-the-counter medicine among adolescents. Over 9,000 junior and senior high school students in 79 schools in 10 cities completed an anonymous questionnaire concerning use of and attitudes toward licit and illicit drugs. Single and multivariate analyses indicated strong and statistically significant relationships between the consumption of alcohol, tobacco, and over-the-counter medicines and experience with illicit drugs. Also, the user of illicit drugs is also a relatively frequent user of licit drugs--alcohol, tobacco, and over-the-counter medications. The user is more likely than the nondrug user to be a "trier," if not a consistent consumer, of a variety of different substances. The patterns of relationships held across cities, types of schools, and age levels, and distinguished between those ever using illicit drugs vs never using them, present vs former users, and single vs polydrug users. Various alternative explanations are discussed.


The occupational determinants of chronic disabling pulmonary disease in rubber workers. Chronic respiratory disease is among the three leading causes of premature retirement due to work disability. The association of occupational exposure and smoking history as potential determinants of pulmonary disability retirement were examined. A cohort of 4302 male, hourly rubber workers actively employed at the Akron plant of a large rubber company on January 1, 1964 was identified and followed for ten years. During the period, 1964-1973, 73 workers terminated gainful employment with a pulmonary disability retirement. Work and smoking histories for these cases and two age-race-sex matched control groups were ascertained. Cases spent significantly greater durations of time employed in curing preparation, curing and finishing and inspection work areas. Each of these areas involves exposures to particulate material and/or solvents. Significant risk of developing a pulmonary disability was associated with smoking and exposure to dust and fumes, generally, and talc and carbon black more specifically. Smoking and occupational exposures were found to interact in their association with pulmonary disability retirement among these rubber workers.


Male parental behavior in a captive group of lowland gorillas (Gorilla gorilla gorilla). In this captive gorilla group, which resembled the central core of the free-ranging gorilla groups, the adult male exhibited a persistent interest in infants. His affiliation patterns with particular infants were directly related to his affiliation patterns with the infants' mothers. The data suggest that development of strong affiliation bonds with particular females may be a strategy uded by dominant males, in addition to ostracism of nondominant males, to increase paternity confidence. By investing relatively more in those offspring to whose mothers he is more strongly bonded, the male increases the probability of investing in his own offspring.


The distribution of multiple sclerosis in Sardinia. The incidence of M.S. in Sardinia has been found to be the highest in Southern Italy. On "prevalence day", October 21st, 1971, the incidence was 12.48/100,000 inhabitants, whereas the rates in Campania and in Puglia, (regions of Southern Italy at the same latitude as Sardinia) the rates were 3.3 and 4.0 respectively. In the present study, a significant female predominance was found, the rates for women and men being 15.88 and 9.03 respectively. The incidence of MS in the study area was found to be significantly higher both in areas with a cool humid climate and in communities with the lowest socioeconomic conditions. A significantly higher incidence was computed for communities with less than 5,000 inhabitants. MS incidence had no correlation with the occupational status and dietary habits, which are uniformly distributed throughout the island. The disease started at au average of 27.3 years and its duration on "prevalence day" was 13.4 years. The age of onset was found to be low in comparison with other population studies in Europe and in North-Central Italy. The age-specific curves of onset and on "prevalence day" showed two peaks, one in the second-third decade and one in the forth-fifth decade. Most of the patients with an earlier onset showed a complete disappearance of the symptoms after the first bout.