Computed tomography in cerebellar atrophic processes. Forty-six patients with cerebellar atrophy were identified by review of CT scans of 7,500 patients. Independent examination of a separate file of the same group disclosed 49 patients whose history indicated cerebellar degeneration. Forty-three patients were in both groups indicating excellent correlation between CT abnormality and clinical cerebellar signs. Three patients with CT cerebellar atrophy failed to show clinical cerebellar signs, and 6 had clinical signs without evidence of changes on CT. Specific anatomic correlation was suggested in 10 of 13 patients with predominantly midline cerebellar CT abnormalities, and in 3 with olivopontocerebellar degeneration clinically who showed brainstem and cerebellar atrophy.


Gray-scale ultrasound in 204 proved gynecologic masses: accuracy and specific diagnostic criteria. Gray-scale ultrasound results are evaluated in 182 women with 204 histologically proved gynecologic masses. Ultrasound provided information leading to the correct diagnosis in 56% of cases, contributory data in 23%, and nonspecific information in 14%. Errors occurred in 6%. A specific histologic diagnosis was possible in selected patients with simple ovarian cysts, cystadenomas, cystadenocarcinomas, dermoids, uterine fibroids, ectopic and molar pregnancies, missed abortions, and endometriosis. A characteristic but nondiagnostic ultrasound pattern was associated with carcinoma of the uterus, recurrent carcinoma of the ovary, and pelvic abscesses. A nonspecific pattern was common in tubo-ovarian abscesses.


Malapposition of the mitral valve: a two-dimensional echocardiographic sign of left ventricular dysfunction. A pattern of mitral valve closure (malapposition) was observed in 75 of 1,267 patients examined with two-dimensional echocardiography. Criteria defining malapposition are: (a) the mitral valve leaflets exhibit a reduced area of coaptation during systole, (b) the angle at the point of coaptation of the anterior and posterior mitral valve leaflets becomes progressively more obtuse, approaching 180 degrees, and (c) the atrioventricular groove, the coaptation point, and the basal portion of the aortic root lie along the same vertical line. Malapposition appears to be the common denominator of previously described M-mode abnormalities seen in altered left ventricular hemodynamics and dysfunction.


Gray-scale ultrasound diagnosis of peripheral arterial aneurysms. Diagnostic ultrasound is a feasible technique for demonstrating the presence of an aneurysm in the popliteal, femoral, iliac, and brachial arteries. All aneurysms were correctly identified and confirmed by arteriography, surgery, or examination of the amputated specimen. The popliteal artery in healthy volunteers had a mean size of 0.8 +/- 0.2 cm. Neither the age nor the sex of the patient influenced artery size. In patients with known abdominal aortic aneurysms of significant atherosclerosis, the popliteal size was within two standard deviations from the mean of normal popliteal arteries.


Critical evaluation of 99mTc glucoheptonate as a brain imaging agent. 99mTc glucoheptonate was used as a brain imaging agent in a consecutive series of 859 patients. Sensitivity was 94% in patients with proved CNS tumors. Static imaging of patients with infarction showed a sensitivity of 62%. When the perfusion study was included, this valve increased to 90%. Overall sensitivity was 83%, specificity 99%, and accuracy 95% without inclusion of perfusion results. When these results were included, overall sensitivity was 93%, specificity 99%, and accuracy 98%.


Radionuclide evaluation of pulmonary function following hemithorax irradiation of normal dogs with 60Co or fast neutrons. To assess the effects of therapeutic doses of radiation on regional pulmonary function, 28 dogs had serial chest radiographs and quantitative ventilation, perfusion, and aerosol studies at three-, six-, nine-, and twelve-month intervals after hemithorax irradiation with 60-Co-gamma photons or 15-MeV fast neutrons. Findings showed marked reductions in perfusion and aerosol deposition in the irradiated lungs of dogs in the high-dose photon and neutron groups and in the medium-dose neutron group. The effects of large photon and small neutron doses were similar (neutron RBE = 4.5). Radionuclide studies were found to be useful for detecting these alterations.


Skeletal scintigraphy following incidental trauma. The significance of antecedent trauma in skeletal scintigraphy was assessed in 503 patients, of whom 241 (46%) had prior fracture or tooth extraction. In patients with sufficiently accurate histories for site-by-site analysis, 33 of 131 fracture sites and 16 of 83 dental-procedure sites were positive scintigraphically. In general, the frequency of scan positivity diminished as the interval between trauma and scanning increased, but a significant number of patients showed prolonged uptake at fracture sites. Several patterns of uptake suggested trauma rather than metastatic disease. Knowledge of a history of trauma is often critical in bone scan interpretation.


Radiation and microwave therapy in the treatment of advanced cancer. Seventy-two patients with advanced cancer were treated with combinations of heat and radiation in two groups: (a) heat + radiation, and (b) radiation + heat. Of those treated with heat prior to radiation therapy, 32/60 (53%) experienced complete remission of symptoms. In the group exposed to heat after radiotherapy, 11/12 patients (92%) achieved complete remission. The authors present two cases and a review of the literature.


Low-dose preoperative radiation therapy in carcinoma of the supraglottic larynx. Seventy patients treated for all stages of carcinoma of the supraglottic larynx were analyzed retrospectively. A preoperative dose of 3,000--3,600 rads was given in 15 to 18 treatments over three to four weeks and surgery carried out four weeks later. The 5-year disease-free survival rates were approximately 75% in patients with early disease and 50% in those with more advanced disease. Survival with early disease was similar to that achieved by radical radiotherapy alone, while survival with advanced disease was similar to that achieved by surgery alone. These results suggest that low-dose preoperative irradiation is of limited value.


Rapid computation of diagnostic X-ray bremsstrahlung spectra. A method is described for rapid and accurate computation of diagnostic x-ray spectra. Accuracy limitations of Kramers' equation are overcome by providing intensity correction factors derived from published measured data. Use of a parameter based on the energy of the Kramers spectrum intensity peak permits deriving master factor curves which are remarkably independent of kVp, waveform and filtration. Computed and measured spectra generally agree to better than +/- 1 keV for beams generated at 100 kVp and below. Possible application of the method to higher energy diagnostic beams is discussed.


Absorbed radiation dose in mammography.

Absorbed radiation dose in mammography. Radiation dose from mammographic techniques was determined as a function of surface exposure, beam quality, and depth. Relative exposure vs. depth was measured in tissue-substitute materials by thermoluminescent dosimetry. The f-factors were calculated from elemental compositions of mastectomy specimens. Dose at depth depends on beam quality as well as exposure and tissue composition. Analysis of data from the ACS/NCI Screening Centers shows current average midbreast doses to be 25 times lower (film/screen) and 3 times lower (Xerox) than the 2 rads previously estimated. Quantitative risk indicators other than midbreast dose are also discussed.


The effect of lucanthone on the radiation response of intestinal stem cells in Chinese hamsters. Crypt microcolony assay was used to determine the effect of lucanthone on the radiation response of intestinal stem cells in Chinese hamsters . The Dq of the crypt microcolony radiation--survival curve was maximally reduced by 205 rads when lucanthone injection preceded irradiation by 10 hours and was reduced by 140 rads when injection followed irradiation by 5 hours. On simultaneous injection and irradiation, Dq was reduced by only 20 rads; when injection and irradiation were separated by approximately 30 hours, Dq returned to the control value. Lucanthone never affected Do. Thus at non-toxic concentrations, lucanthone reversibly modifies cellular ability to accumulate and repair sublethal radiation damage without affecting radiation sensitivity.


Computed tomographic diagnosis of osteomyelitis. Computed tomography (CT) was performed in conjunction with conventional radiography and radionuclide imaging in 22 children with known or suspected osteomyelitis. Preliminary findings suggest that when radionuclide scans are positive, CT can exclude or establish medullary involvement, differentiate between overlying soft-tissue and underlying bony abnormality, and clearly delineate the anatomy of the soft tissues.


The relation of liver fat to computed tomography numbers: a preliminary experimental study in rabbits. The relation of liver fat content to CT number was studied in 20 rabbits (17 experimental, 3 control), where fatty degeneration was produced by carbon tetrachloride (CCl4) ingestion. Liver scanning was performed before and 2--5 days after CCl4 administration.. Changes (decrease) in CT number were compared with triglyceride (TG), water, and protein content of resected livers. A decrease of 12--20 CT numbers (24--40 H) reflected a TG concentration of 20--40 mg/g.


Ultrasonic mammographic parenchymal patterns: a preliminary report. Ultrasound has been suggested as a lower risk alternative to mammography for detecting breast abnormalities. Mammograms and ultrasonograms of 32 women patients were compared, revealing three distinct ultrasonic parenchymal patterns which corresponded to previously reported mammographic patterns: fatty (N1), ductal (P1 or P2), and dysplastic (DY). These constitute a new system of parenchymal classification, to our knowledge.


Scintillation camera imaging with I-123. Iodine-123 produced from three different nuclear targets (Te-122, Te-124, and I-127) was evaluated for spatial resolution and sensitivity with an Anger scintillation camera. Te-122 targets generated a substantial amount of I-130, which necessitated use of a medium-energy collimator. Te-124 targets produced solutions with significant amounts of I-124. Shortly after the end of bombardment, a 4,000-hole (4KH) collimator was satisfactory; at 30 hours, a medium-energy collimator was required. High-purity I-123 from an I-127 target gave excellent spatial resolution when the 4KH collimator was used, but low-energy "foil" collimators were not adequate.


99mTc-IDA imaging in the differential diagnosis of acute cholecystitis and acute pancreatitis. 99mTc-IDA (99mTc-dimethyl-acetanilide-iminodiacetic acid) hepato-biliary imaging was evaluated for its efficacy in distinguishing acute cholecystitis from acute pancreatitis. In a retrospective review, gallbladders were demonstrated by 99mTc-IDA in 13 of 15 patients (87%) with acute pancreatitis. This is significantly higher than reports on the frequency of gallbladder filling with oral and intravenous cholangiography in the presence of acute cholecystitis.


A head holder for operative serial angiography. An apparatus was developed to combine two functions--a versatile neurosurgical head clamp and a compact film changer for operative serial angiography. The construction costs were +15,000, and provided a programmer, six cassettes, and attachments to position the film changer over much of the skull surface. Exposures are obtained by a mobile x-ray machine.


[Value and limitations of the combined cyto-histological study of hematopoietic bone marrow. 200 cases]. Bone marrow was simultaneously obtained by aspiration and by biopsy in a series of 200 patients in order to evaluate the potential usefulness of pathological-anatomical examination (paraffin-embedding technique). Conditions studied included search for lymphomas (26.5%), multiple myelomas (24.5%) and metastases (7.5%) and the evaluation of myeloproliferative syndromes (17.5%) and other hematological disorders such as cytopenias, anemias and leukemias (24%). In 76% of the cases the two methods of evaluation were equivalent. Nevertheless, comparison of the cytological and histological methods provided a greater measure of diagnostic confidence. In 24 cases (12%) the bone biopsy was the only diagnostic procedure; these comprised partly dry aspirations and partly bone marrow smears in which the specific lesion was not represented. Bone marrow aspiration proved superior in 24 cases (12%) in view of the better detection of small and discrete malignant infiltrates and more detailed analysis of blasts and cytological changes in cell maturation. On the basis of the techniques employed in this series of 200 patients, a combination of the two investigations appears to be indispensable for the evaluation of lymphoand myeloproliferative syndromes, of cytopenias with or without fever of unknown origin, and in the search for metastatic disease.


[Goldenhar syndrome].

[Goldenhar syndrome]. The basic features of Goldenhar syndrome are preauricular appendices, epibulbar dermoids, vertebral and cardiac anomalies, and hypoplasia of the lungs. The syndrome appears to be caused by early damage during the first or second month of embryonic development. Prognosis is most often determined by the underlying heart disease. In the present study a 24-year-old female student is reported who exhibited a preauricular appendix on the right side, severe thoracic scoliosis, aplasia of the middle and lower lobes of the right lung, dextropositio cordis and an atrial septal defect with severe pulmonary hypertension. Cineangiocardiography revealed a mitral valve prolapse with slight mitral regurgitation and a dilated right ventricle with severe tricuspid regurgitation. Left and right ventricular function was slightly to moderately reduced. Selective coronary arteriography revealed a coronary fistula from an atrial branch of the left coronary artery to the right atrium. Symptomatic therapy with digitalis, anticoagulation and repeated venesection was initiated because of the severe hemodynamic findings. However, the patient developed syncope at increasingly frequent intervals and died 3 months after the initial examination.


[The rate of isometric inspiratory pressure change as a measure for the CO2 sensitivity of the respiratory center in patients with obstructive lung disease]. In healthy persons with and without loaded breathing, in asthmatics, and in patients with chronic obstructive lung disease (COLD) the rate of isometric inspiratory pressure development ([dp/dt]max) has been measured in order to assess the clinical significance of (dp/dt)max as an index of the motor output of the respiratory center in response to increased levels of carbon dioxide. During unloaded breathing normal subjects showed an excellent correlation between the ventilatory and the (dp/dt)max responses to CO2. Normal persons breathing through an external expiratory flow resistance, the asthmatics, and the patients with COLD had not only a blunted ventilatory response, but also a reduced (dp/dt)max response. The parallel changes observed in both variables indicate that under conditions of mechanical loading the (dp/dt)max does not exclusively reflect the motor output of the respiratory center, but is influenced by other factors such as the work of breathing and the mechanical efficiency of the respiratory pump. Accordingly, measurements of (dp/dt)max are of little help in deciding whether the development of CO2 retention in patients with obstructive airway disease is primarily due to increased mechanical load or to decreased sensitivity of the respiratory center.


[Fiber endoscopy and radiology in stomach ulcer, stomach neoplasms and hiatal hernia: questions, timing and value]. In 306 patients, fiberpanendoscopy and radiology were performed within a time interval of 7 days or less. In 196 cases, radiology was performed before endoscopy and in 110 cases after endoscopy. In cases with histologically unproven divergent findings, follow-up studies were performed. In the diagnosis of gastric ulcer and gastric cancer, endoscopy with biopsy was more accurate than radiology. In the diagnosis of hiatal hernia, radiology was more accurate. Important additional findings difficult or impossible to observe with endoscopy were present in 36% of the radiological examinations. Thus, the first examination should be endoscopy when ulcer or carcinoma is suspected. In patients with uncharacteristic epigastric symptoms, radiology should be performed first.


[Allergic aspects of juvenile asthma].

[Allergic aspects of juvenile asthma]. In children, wheezing is not necessarily related to allergy. Without being asthmatic, a child may suffer from asthmatiform dyspnea, especially in cases of respiratory infection. It may be difficult to decide whether the patient has benign "wheezy bronchitis" or is exhibiting the first symptoms of asthma. It appears that viral infections may play a significant role in the development of respiratory allergy in atopic subjects.


[Evaluation in hospital practice of Fecatest, a new laboratory method for the detection of occult blood in feces]. The clinical significance of the laboratory information provided by Fecatest, a new test based on a guaiac reaction for detecting occult blood in the feces, has been determined. In 93.8% of 243 patients with a lesion of the gastrointestinal tract diagnosed by endoscopy and/or radiology the test was positive; 88.5% of 148 patients in whom no lesion had been found by the same methods had a negative test. In vivo and in vitro comparison of the degree of sensitivity of Fecatest with Hematest and Haemoccult showed the following ratios: Hematest 5, Fecatest 3, Haemoccult 1. In point of sensitivity Fecatest thus comes between the other two tests investigated. It is concluded that Fecatest is a valuable tool in detecting lesions of the gastrointestinal tract associated with occult bleeding. The results show a better degree of clinical correlation between the test and the lesions in the gastrointestinal tract than with the other two. This view is further strengthened by the important practical advantages offered by Fecatest.


[Follicular carcinoma with sarcomatoid dedifferentiation or thyroid gland carcinosarcoma?]. Thyroid carcinoma may at times display unusual clinical and anatomo-pathologic behaviour. The case of a female patient associating goiter of long standing with a fulminating terminal course is presented. Since the patient was never treated, the evolution of her condition is thought to reflect the natural biologic behaviour of the disease process. Pathologic examination revealed the co-existence of both follicular and anaplastic carcinoma within the primary lesion. Moreover, metastases were either entirely follicular or poorly differentiated in structure, and occasionally even of striking sarcomatoid appearance. The possibility of carcinosarcoma was entertained but dismissed in view of the recent literature. Rather, the hypothesis of tumour dedifferentiation offers a more satisfactory explanation for the clinical course and pathologic findings.


[Comparison of the oscillatory measurement of airway resistance with plethysmography and spirometry in juvenile patients]. In 78 children (age 4 to 17 years, height 102 to 179 cm) with and without clinical signs of airway obstruction, spirometric and plethysmographic measurements were compared with the forced oscillation method for determination of resistance to breathing (Ros). Ros was measured with a recently developed apparatus (Siregnost FD5. Siemens) and showed a close correlation with resistance (r = 0.84; n = 78). The spirometric values did not, however, exhibit a definite relationship to Ros. This study demonstrates that airway obstruction in children can be equally well estimated by oscillatory and plethysmographic techniques. Compared with plethysmography, determination of Ros has the particular advantage of being better tolerated by young subjects.


Harmonic-sensitive neurons in the auditory cortex of the mustache bat. Human speech and animal sounds contain phonemes with prominent and meaningful harmonics. The biosonar signals of the mustache bat also contain up to four harmonics, and each consists of a long constant-frequency component followed by a short frequency-modulated component. Neurons have been found in a large cluster within auditory cortex of this bat whose responses are facilitated by combinations of two or more harmonically related tones. Moreover, the best frequencies for excitation of these neurons are closely associated with the constant-frequency components of the biosonar signals. The properties of these neurons make them well suited for identifying the signals produced by other echolocating mustache bats. They also show how meaningful components of sound are assembled by neural circuits in the central nervous system and suggest a method by which sounds with important harmonics (or formants) may be detected and recognized by the brain in other species, including humans.


Psychophysical evidence for a monocular visual cortex in stereoblind humans. Human observers who lack stereopsis reliably make eye-of-origin discriminations for grating patterns under conditions that render the performance of normal observers unreliable. This lends support to the view that stereoblind individuals possess proportions of monocular and binocular cortical cells similar to those of cats and monkeys deprived of early binocular visual experience.


Mammary cancer: selective action of the estrogen receptor complex. Progesterone receptors in the autonomous rat mammary tumor MTW-9B are reduced 80 to 90 percent after ovariectomy, but are not reduced if ovariectomized animals are given estrogen. Tumor growth, however, is independent of estrogen status and insensitive to pharmacological doses of estradiol. This represents an unusual system characterized by a selective action of an inducing agent on the genome.


Vomeronasal and olfactory system modulation of maternal behavior in the rat. The onset of maternal responsiveness by virgin female rats to foster pups was observed after (i) complete vomeronasal nerve cuts, (ii) partial olfactory bulb cuts, or (iii) the combined procedures. Although both vomeronasal nerve cuts and olfactory bulb cuts resulted in a more rapid onset of maternal care, relative to control animals with sham operations, animals sustaining the loss of both sources of olfactory input exhibited the shortest response latency. These findings are discussed in terms of the probable distinct functions of the two olfactory systems in the control of maternal behavior in the rat.


Fever and reduced iron: their interaction as a host defense response to bacterial infection. When rabbits are infected with Pasteurella multocida, the concentration of iron in their plasma decreases and their rectal temperature rises. To determine whether the rise in body temperature (fever) and the fall in plasma iron may be a coordinated host defense response, Pasteurella multocida were grown in vitro at various temperatures and iron concentrations. At afebrile temperatures the bacteria grew equally well at low or high concentrations of iron. However, when the temperature of the bath was raised to a febrile temperature the growth of the bacteria was inhibited by the low, but not the high, iron concentrations. These data support the hypothesis that one of the mechanisms behind the adaptive (or beneficial) role of fever is the reduced ability of pathogenic bacteria to grow well at elevated temperatures in an iron-poor medium.


Common origin of pigment cells.

Common origin of pigment cells. The fundamentally diverse vertebrate pigment cells, melanophores, xanthophores, and iridophores, contain pigmentary organelles known, respectively, as melanosomes, pterinosomes, and reflecting platelets. Their pigments are mealanins pteridines, and purines. Mosaic pigment cells containing more than one type of organelle have been observed and mosaic organelles containing more than one type of pigment have been discovered. It is proposed that the various pigment cells are derived from a stem cell that contains a primordial organelle of endoplasmic reticular origin. This primordial organelle can differentiate into any of the known pigmentary organelles.


Chemotactic factor-induced release of membrane calcium in rabbit neutrophils. The interaction of chemotactic factors (fMet-Leu-Phe and C5a) with rabbit neutrophils leads to rapid and specific release of membrane calcium, as evidenced by changes in the fluorescence of cell-associated chlorotetracycline. These two structurally different stimuli appear to interact with the same pool of membrane calcium.


Local foveal inhibitory effects of global peripheral excitation. Global excitation produced by oscillating a peripheral square-wave grating back and forth through one-half cycle inhibits the visibility of an incremental test flash only when the flash is presented in the foveal region of the visual field. This finding is discussed in the context of the neurophysiological periphery effect and shift-effect and their possible role in saccadic suppression.


To know with the nose: keys to odor identification. Successful odor identification depends on (i) commonly encountered substances, (ii) a long-standing connection between an odor and its name, and (iii) aid in recalling the name. The absence of any one ingredient impairs performance dramatically, but the presence of all three permits ready identification of scores of substances, with performance seemingly limited only by the inherent confusability of the stimuli.


A regulatory locus for mouse beta-glucuronidase induction, Gur, controls messenger RNA activity. A regulatory locus in a higher organism has been shown to control a specific messenger RNA activity. The Gur locus in mice regulates the production of kidney beta-glucuronidase messenger RNA activity after induction of the beta-glucuronidase structural gene, Gus, by testosterone. beta-Glucuronidase messenger RNA was assayed by its ability to direct the synthesis of catalytically active murine beta-glucuronidase in Xenopus oocytes.


Thalamic projections to layer I of striate cortex shown by retrograde transport of horseradish peroxidase. The diffusion of horseradish peroxidase was restricted to layers I and II of the striate cortex in Tupaia glis and Galago senegalensis. In the lateral geniculate body of Tupaia labeled cells were found only in layer 3; some labeled cells were also found in the lateral nucleus. In Galago labeled cells were found only in layers 4 and 5 of the lateral geniculate body; a band of cells was also found in the pulvinar nucleus. These results support the distinction between two overlapping thalamic systems, a layer I and a layer IV system.


Osmotic shock prevents nuclear exchange and produces whole-genome homozygotes in conjugating Tetrahymena. Exposure of conjugating Tetrahymena to a hyperosmotic shock blocks the exchange of gametic nuclei and produces self-fertilized exconjugants that are homozygous for their whole genome. Cells are sensitive to this induction during a brief period after meiosis. The high efficiency of the treatment and the fertility of the progeny make this a useful method for the isolation of induced recessive mutations and enhances the value of Tetrahymena as an animal-cell model system in which genetic dissection is practical. The sharp peak of sensitivity is useful in the study of those cellular mechanisms responsible for the independent handling of several functionally distinct nuclei during conjugation.


Obesity genes: beneficial effects in heterozygous mice. The mouse mutant genes obese (ob) and diabetes (db) cause similar obesity-diabetes states in homozygotes. These obesity syndromes are characterized by a more efficient conversion of food to lipid and, once stored, a slower rate of catabolism on fasting. Heterozygous mice, either ob/+ or db/+, survived a prolonged fast significantly longer than normal homozygotes (+/+); this suggests that the heterozygotes exhibited increased metabolic efficiency, a feature normally associated with both homozygous mutants. The existence of this thriftiness trait, if manifested by heterozygous carriers in wild populations, would lend credence to the thrifty gene concept of diabetes. Beneficial effects of normally deleterious genes may have played a role in the development of diabetes-susceptible human populations, as well as having provided the survival advantage that has allowed both the development and successful establishment of species in desert and other less affluent regions.


Electroencephalogram correlates of higher cortical functions. By means of two-stage, nonlinear multivariate pattern recognition, electroencephalograms (EEG's) were analyzed during performance of verbal and spatial tasks. Complex scalp distributions of theta-, beta-, and, to a lesser extent, alpha-band spectral intensities discriminated between the two members of a pair of tasks, such as writing sentences and Koh's block design. Small EEG asymmetries were probably attributable to limb movements and other uncontrolled noncognitive aspects of tasks. Significant EEG differences beteeen cognitive tasks were eliminated when controls for inter-task differences in efferent activity, stimulus characteristics, and performance-related factors were introduced. Each controlled task was associated with an approximately 10 percent reduction, as compared with visual fixation, in the magnitude of alpha- and beta-band spectral intensity. This effect occurred bilaterally and was approximately the same over occipital, parietal, and central regions, with some minor difference over the frontal region in the beta band. With these controls, no evidence for lateralization of different cognitive functions was found in the EEG.


Human muscular dystrophy: elevation of urinary dimethylarginines. The amounts of the dimethylarginines NG,NG-dimethylarginine (DMA) and NG,N'G-dimethylarginine (DM'A) excreted in the urine of muscular dystrophic patients were examined and compared with the amounts excreted by normal controls, patients with other types of neuromuscular diseases, and patients with disuse muscle atrophy resulting from traumatic paralysis. The patients with muscular dystrophy excreted high concentrations of DMA and this urine showed high ratios of DMA to DM'A. This finding indicates a relation between protein methylation processes and muscular dystrophy.


Renal cell carcinoma.

Renal cell carcinoma. We reviewed the total experience with renal cell carcinoma at West Virginia University Hospital since its opening 15 years ago. While the conclusions are not new, our series of 89 cases reemphasizes the capriciously ubiquitous nature of the disease. Varied presenting signs and symptoms are commented upon, and an attempt to relate stage, grade, and survival rates is made.


Clear cell adenocarcinoma of the genital tract. Four cases of clear cell adenocarcinoma of the genital tract in young women are presented. All patients were treated with radiation therapy. Two of the patients subsequently developed chest metastases. Three patients have died of the disease, and the other is without evidence of disease. Two patients were treated with chemotherapy, and a positive response to the chemotherapy was observed. Because this is an aggressive disease, one should consider the use of chemotherapeutic agents as a part of the primary therapy.


Cancer in married couples.

Cancer in married couples. A review of 2,512 charts of cancer admissions in a small community hospital during a ten-year period revealed 19 married couples with cancer. Compared with other studies this number appears small. However, only 2% of our cases mentioned the spouse in the family histories, apparently because emphasis seems to be on genetics, not on environment. It was further noted that two out of 19 couples had the same type of cancer originating from the same organ, and ten pairs had tumors of the same histopathologic type. Cancer manifested itself in the wives a few years before the husbands, though the wives were younger.


Urologic manifestations of sickle hemoglobinopathies. We analyzed the renal radiographic changes in the sickle hemoglobinopathies in 92 patients, in 70 of whom the specific hemoglobin type was documented by electrophoresis. The following conclusions have been drawn: (1) Approximately 50% of patients with SS hemoglobin have renal enlargement (both on roentgenograms and at autopsy), while only a small proportion of patients with the other hemoglobinopathies show renal enlargement; (2) slightly more than one half of patients with each type of hemoglobinopathy have calyceal changes; and (3) these calyceal changes do not fall into a specific pattern with respect to hemoglobin type.


Menetrier's disease in children.

Menetrier's disease in children. Two new cases of Menetrier's disease in children are reported. The ten cases of this protein-losing gastropathy previously reported in the literature are reviewed. Clinical presentations, laboratory findings, possible causes, and comparison with the adult form of Menetrier's disease are discussed. Menetrier's disease in children may be more common than reported, as its symptoms are usually transient. The prognosis in children is excellent; therefore the distinction between Menetrier's disease in children and other protein-losing enteropathies is vital.


Hypochondriasis: difficulties in diagnosis and management. The hypochondriacal patient presents numerous frustrations for the physician. The typical hypochondriac is a middle-aged person dominated by a preoccupation with bodily symptoms. Bereavement, serious life failures, and severe blows to self-esteem put patients at high risk for somatization. Hypochondrisis has been cited as a symptom of masked depression, early paranoid schizophrenia, and dementia and/or delirium. A careful diagnostic work-up with attention to any correctable psychiatric illness sets the stage for regularly scheduled, long-term supportive therapy.


Intrauterine transfusion with continuous ultransonic assistance. This paper describes a technic of intrauterine transfusion using continuous real time ultransonic assistance and discusses complications of intrauterine transfusion. The advantage of ultrasound-assisted intrauterine transfusion in reducing fetal injury and radiation exposure is emphasized.


Dynamic hormonal tests in a case of premature ovarian failure. The case of a patient with premature ovarian failure and a history of polycystic ovarian disease was described. Dynamic gonadal and pituitary tests were done. Ovarian, adrenal, and peripheral veins were catheterized to determine the steroid secretion under HCG stimulation. In vitro studies of the capacity of ovarian steroidogenesis confirmed the refractory nature of the gonad. Lack of gonadal response, both in vivo and in vitro, to stimulation suggests a possible alteration in ovarian sensitivity to gonadotropins as a possible cause of premature menopause.


Asymptomatic esophageal carcinoma with esophagopulmonary fistula masquerading as a primary lung abscess. A 58-year-old man presented with the clinical signs and symptoms of a large right upper lobe lung abscess. His course was complicated by diffuse bilateral necrotizing pneumonitis, and death occurred as a result of massive aspiration of lung abscess contents into uninvolved lung. At postmortem examination, an esophageal carcinoma with a direct fistulous communication with the abscess cavity was present. Although rare, asymptomatic malignant esophageal disease should be considered in the differential diagnosis of a lung abscess which does not follow a typical course.


Coagulation defects associated with jejunoileal bypass and term pregnancy. A case is presented in which pregnancy occurred after jejunoileal bypass for treatment of obesity. The pregnancy was complicated by coagulation defects apparently on the basis of liver damage secondary to the bypass. Pertinent literature is reviewed, and the conclusion is reached that although the majority of patients becoming pregnant after jejunoileal bypass tolerated pregnancy well, hepatic disease may occur as it does in nonpregnant individuals.


Radiation therapy for early stage carcinoma of the glottic larynx. The results of radiation therapy of 79 patients with early carcinoma of the vocal cord are reported. Nine (13%) of the 69 patients with stage I disease had local recurrence, and two (20%) of the ten patients with stage II disease had local recurrence without local node metastasis. Subsequent control of radiation failure by surgical salvage was 100%. Close follow-up of the patients after radiation therapy and biopsy of suggestive areas are emphasized for early detection of residual or recurrent tumor.


Severe leukopenia secondary to carbamazepine administration. We have reported the first case of severe leukopenia, complicated by infection, associated with the use of carbamazepine. In the literature, most cases of leukopenia secondary to carbamazepine are transient and benign, but any increase in dosage of the drug warrants a close follow-up of blood counts even if previous blood counts were normal.


Mucous gland adenoma of the bronchus.

Mucous gland adenoma of the bronchus. Mucous gland adenoma of the bronchus is a truly benign bronchoid neoplasm which responds to simple surgical excision, sparing as much functional lung tissue as possible. The patient here reported is well one year after such treatment.


Cardiobacterium hominis endocarditis.

Cardiobacterium hominis endocarditis. A case of Cardiobacterium hominis endocarditis involving a prosthetic heart valve is reported, and 12 previously reported cases are reviewed. This gram-negative rod grows slowly in blood cultures and is readily suppressed for long periods of time by token antibiotic administration. It should be considered as a causative agent in culture-negative cases of endocarditis and also when a gram-negative rod is isolated which is sensitive to all antibiotics. The treatment of choice is penicillin.


Adynamic ileus complicating colonoscopy. A case of adynamic ileus of the colon and small bowel complicating colonoscopy is reported. The patient recovered with conservative management. Possible pathogenesis of this rare complication is discussed.


The safe time limit of temporary clamping of cerebral arteries in the direct surgical treatment of intracranial aneurysm under moderate hypothermia. Of 274 operated cases of cerebral aneurysm, temporary occlusion of the cerebral arteries was used in 215 cases (79%). Of the 215 cases, 177 (82%) showed no sequelae. The maximum safe time limit for temporary occlusion at the bilateral A1 portion of the anterior cerebral arteries was 48.5 min at 26 degrees C, 47 min at 27 degrees C, and 42 min at 28 degrees C; at the M1 portion of the middle cerebral arteries, it was 30 min at 26 degrees C, 35 min at 27 degrees C, 36 min at 27.5 degrees C, 40 min at 30 degrees C and 19 min at normothermia; and at the dominant A1 portion, in cases of hypoplasia at the contralateral A1 portion, it was 82 min at 26 degrees C, 86 min at 27.5 degrees C, and 63 min at 28 degrees C. Consequently, when performing direct surgery on aneurysms of the anterior communicating artery, unilateral clamping of the A1 portion prevents rupture during surgery and has the advantage of prolonging the occlusion time. Neurological sequelae may have been caused by the temporary occlusion of the cerebral artery in one case, and by the temporary occlusion or the surgical operation in six cases. Of the 22 fatal cases, only one was thought to be due to the temporary occlusion of the cerebral artery. Intermittent release of the clamping for 5 to 10 min is considered to be effective in prolonging the safe time limit of temporary clamping of the cerebral arteries in surgery of cerebral aneurysm under moderate hypothermia.


Glucose-containing oligosaccharides in normal human urine. Normal human urine was treated with cetylpyridinium chloride (CPC), and the CPC-supernatant was passed through columns of Dowex 50 X 2 (H+ form) and Dowex 1 X 2(Cl-form) in succession. The concentrated effluent containing neutral saccharides was then gel-filtered through a column of Sephadex G-10. The resulting effluent was divided into 5 subfractions (SFs. 1-5). Comparison of hexose contents of the subfractions indicated that healthy individuals regularly excreted neutral oligosaccharides in urine with a similar pattern regardless of age or sex. Component A isolated from SF2 was characterized as glucosylgalactose by paper chromatography before and after acid hydrolysis of the intact one and its reduction product.


Peripheral nerve structures of experimental diabetes rats and the effect of insulin treatment. The peripheral nerves of alloxan and streptozotocin diabetes rats six months after the induction of diabetes were morphologically investigated. The effect of insulin treatment was also examined. Prominent segmental demyelination and remyelination were observed in both alloxan and streptozotocin diabetes rats by isolated nerve fiber studies. Axonal degeneration and globular swelling were also recognized in some nerve fibers. Transmission electron microscopic findings were characterized by the figures of destructed myelin sheaths and axons. Reduplication and thickening of basal lamina of vasa nervorum were noted in the diabetes rats. Scanning electron microscopy revealed three dimensional architectures of degenerated nerve fibers and rough surface of Schwann cells in the diabetes rats. Insulin treated diabetes rats showed less structural changes of nerve fibers. It was indicated that the peripheral nerve lesions of experimental diabetes rats were caused by metabolic impairment of both axons and Schwann cells. Insulin treatment seemed to be effective on the experimental diabetic neuropathy.


Influence of red light and pattern on photic driving. The photic drivings (PDs) in response to the following visual stimuli were studied in 108 cases, of which 84 (78%) were epileptics; ages ranged from 5 to 57 years old. An intermittent photic stimulation (IPS) of 5 cycles/sec by a stroboscopic light was given to the subjects with eyes closed and open. Following these stimuli, red-flicker and flickering-pattern of 5 cycles/sec and 20 cd/m2 were given successively to the subjects with eyes open using a "visual stimulator". The PDs evoked by IPS to the eyes closed and those by red-flicker were similar in the wave form and amplitude. In most of the cases, however, both stimuli failed to evoke apparent PDs (over 25 muV in amplitude), i.e., in 81% and 72%, respectively. IPS to the eyes open and flickering-pattern showed comparable effects in evoking PDs; they evoked high amplitude PDs (over 50 muV in amplitude) with a frequency of 19% by the former and 28% by the latter. In 95 out of 108 cases, both IPS to the eyes closed and red-flicker failed to evoke apparent PDs. In rare cases, IPS to eyes closed evoked high amplitude PDs; in 7 out of these 8 cases, red-flicker also evoked high amplitude PDs. In 18 out of 20 cases in which high amplitude PDs were evoked by IPS to the eyes open, flickering-pattern was also effective in evoking high amplitude PDs. Based on these findings, similarities between IPS to the eyes closed and red-flicker, and similarities between IPS to the eyes open and flickering-pattern in evoking PDs are discussed. It is concluded that flickering-pattern and red-flicker are superior to IPS to the eyes open and closed, respectively, for examining the low frequency PDs.


Falsely high urinary catecholamines induced by labetalol. A preoperative patient with pheochromocytoma was satisfactorily treated with oral labetalol, while a conspicuous increase in urinary output of catecholamines (CA) and of vanillylmandelic acid (VMA) was observed after labetalol therapy. Exaggerated increases in urinary CA and in VMA were also confirmed in normal volunteers immediately after oral labetalol. These effects of labetalol on urinary CA and VMA, however, were proved to be largely due to the interference with the usual photometries rather than due to its stimulation of CA release. Therefore, it should be emphasized that clinical evaluations of CA and its metabolites must be performed before labetalol therapy to avoid an erroneous diagnosis of pheochromocytoma.


Effects of unilateral and bilateral invasion of thalamic pulvinar for pain relief. Thalamic pulvinotomy has been performed on 32 patients in severe chronic pain and a follow-up study was made. Among 10 patients with whom unilateral invasion was made, 4 were "excellent" in relieving pain, 2 "good", 2 "fair" and 2 "poor". Among 22 cases of bilateral invasion 17 were "excellent", 2 were "good", and 3 were "poor". Thus, in the cases of bilateral invasion effects of the operation were more prominent than in the cases of unilateral invasion. Further, transient psychic symptoms following the operation has been analysed in relation to position of pulvinar destruction and to underlying diseases.


Changes in thyroid hormones by treatment with aspirin and prednisolone in subacute thyroiditis with hyperthyroidism. Thyroid functions were studied in 11 patients with subacute thyroiditis accompanied by signs and symptoms of hyperthyroidism, and were compared with 13 patients with untreated thyrotoxicosis in which serum T4 was elevated to the identical level. Serum T3 was also elevated in subacute thyroiditis but to a significantly lower extent than in thyrotoxicosis. Therefore the ratio of T4/T3 was significantly higher in subacute thyroiditis than in thyrotoxicosis. Although duration of thyroid swelling was shorter in the group treated by prednisolone than by aspirin, the accelerated ESR, thyroid tenderness and fever subsided almost similarly in the two groups. Serum T4 and T3 levels declined more rapidly in treatment with prednisolone compared with aspirin. In patients treated by aspirin initial increase in T3 level occurred transiently with simultaneous decrease in the T4/T3 ratio. These changes suggest the increase in peripheral conversion of T4 to T3. Even in severe cases of subacute thyroiditis associated with hyperthyroidism, aspirin treatment is an effective therapy and there is no recurrence following withdrawal of the medication.


Dynamics of upper urinary tract during pacemaker blockade induced by pentobarbital. The transport efficiency of the dog's pelviureteral system was examined during pacemaker blockade induced by pentobarbital. For an analog representation of transport efficiency, changes in balance level between the input and the output were registered and recorded on a polygraph together with perfusion rate, renal pelvic pressure, ureteral electromyogram and bolus volume. Pentobarbital dramatically blocked the pacemaker activity of the renal pelvis, and the ureter simultaneously became aperistaltic. During the period of pacemaker rest, the balance level was maintained at a high level in all dogs studied, indicating that a part of the perfusion fluid was accumulated in the pelviureteral system. Furthermore, the accumulated fluid overflowed through the aperistaltic ureter as a free flow. These results are discussed in relation to the transport efficiency of normal peristaltic transport.


Effect of tolbutamide on plasma catecholamine in insulin dependent diabetics. In 4 cases of insulin dependent diabetics, blood levels of glucose, C-peptide reactivity (CPR), free fatty acid, and catecholamines were followed after the intravenous tolbutamide response test. Plasma CPR was low and did not respond to tolbutamide injection, and blood levels of glucose and free fatty acid did not change during the test. Fifteen min after the tolbutamide injection, plasma epinephrine plus norepinephrine and norepinephrine levels fell to 87.5% and 67.4% of the initial values, respectively. These results suggest that decrease in the blood glucose and free fatty acid levels usually observed after tolbutamide injection is not the direct action of drug, but is secondary to insulin secretion, and tolbutamide-induced decrease in catecholamines may contribute to the secretion of insulin from the pancreatic beta-cells.


Ex vivo intra-arterial infusion of microencapsulated mitomycin C into dog kidney. Microencapsulated Mitomycin C with ethylcellulose was infused into isolated dog kidneys through the renal artery. The capsules were lodged mainly at cortico-medullary junction, where the drug was released from the capsules. Vascularity of kidney was reduced moderately.


Hypothalamic hypernatremia due to volume--dependent ADH release, and its treatment with carbamazepine and clofibrate. A 23-year-old man, diagnosed as having a pituitary adenoma at the age of 17 and received an operation 1 month ago showed a fluctuating hypernatremia and hypodipsia. The water deprivation, water load and hypertonic saline infusion tests were carried out. After a 14-hr water deprivation test, plasma osmolality was 310 mOsm/kg, plasma ADH was 1.5 microunits/ml, and urine osmolality was 591 mOsm/kg. On the water load test subsequently performed, the plasma osmolality decreased to 297 mOsm/kg, but the urine was still hypertonic. Infusion of 2.5% saline solution elicited paradoxically a marked diuresis and dilution of urine despite the elevàtion of plasma osmolality. On the treatment with carbamazepine and clofibrate, the urinary osmolality increased, the hypernatremia was normalized, and a marked natriuresis was elicited with a gain in body weight. These results suggested that the secretion of ADH is regulated by changes in blood volume rather than by the plasma osmolality in this patient. The hypernatremia may be explained as a disturbance or lack of osmoreceptor function for ADH release and the loss of thirst sensation, though the volume receptor still remains functioning for ADH secretion. Depletion of the extracellular fluid volume may be another contributing factor to the elevation of serum sodium level by enhancing the reabsorption of sodium from renal tubules.


Sympatho--adrenergic neural control of the sphincter of Oddi of the cat and the dog. The presence of adrenergic axons within the sphincter of Oddi of the cat and dog was demonstrated using the glyoxylic acid-induced fluorescence histochemical method. After vagotomy (in cats), no reduction was observed in the number of the adrenergic axons or in the fluorescence intensity. It is concluded that the sphincter of Oddi receives direct adrenergic neural control derived from the sympathetic plexuses and ganglia, whereas the vagal contribution of adrenergic axons is negligible, if it exists at all.


Effect of sex steroid hormones on the serum prolactin concentration. Changes in serum prolactin concentration were investigated in women taking an oral contraceptive pill and patients treated with combined estrogen-gestagen regimens for uterine endometriosis. The serum prolactin value increased more than twice the initial level one week after the beginning of medication and continued to increase over succeeding three weeks, and it returned to the normal value at one week after discontinuation of the medication. The results obtained demonstrate that an inverse correlation of prolactin and gonadotropin secretions occurred during administration of the steroid sex hormones as seen in post partum period or patients with galactorrhea-amenorrhea. Side effects which may be associated with such combined steroid hormone has also been discussed.


Regional lymphadenectomy and tumor curability in C3H/He mice transplanted with MH 134. In order to elucidate the effect of surgical removal of the regional nodes on the immunological defence of the host against the tumor, as well as on the cure rate of C3H/He mice transplanted with MH 134, three separate experiments were carried out, and the following results were obtained: 1) The cure rates of mice treated by removal of the primary tumor with regional lymph nodes were significantly lower than that of mice treated by simple amputation without regional lymphadenectomy. 2) It was demonstrated by a bioassay of the regional node that viable tumor cells presented in the nodes prior to the operation disappeared after removal of the primary tumor, whereas in 60-Co irradiated mice prior to the tumor inoculation, such phenomena were not observed. 3) Observation utilizing in vivo neutralization revealed that regional lymph node cells were capable of interfering with growth of tumor cells. These findings suggest that removal of the regional nodes impairs the restraint to the growth of residual tumor after the removal of the primary tumor, and this is probably due to a derangment of the immunologic response of the host.


Suppressive effect of catecholamines on 19-S antibody formation in mouse spleen fragments in vitro. Spleen fragments of Balb/C mice were immunized with sheep red blood cells in vitro and hemolytic plaque forming cells (PFC) were assayed on the 5th day of immunization. Epinephrine in culture medium diminished the number of PFC dose-dependently over the range from 10(-6) M to 2.7 X 10(-4) M. Incubation with 9 X 10(-5) M epinephrine diminished PFC response only when the epinephrine was present on the first day of the culture. No suppression was found for treatment during any other 24-hr periods. Three beta-adrenergic stimulating catecholamines, epinephrine, isoproterenol, and norepinephrine, suppressed PFC response in similar degree. It is concluded that beta-adrenergic stimulation suppressed 19-S antibody formation mainly by inhibiting induction of immune response.


Cross reactivity of schistosome antigens between Schistosoma mansoni and japonicum. Fifty six patients with chronic Schistosomiasis japonica were given skin tests with preparations made of Schistosoma mansoni and Schistosoma japonicum. There was a high, significant positive correlation between the results of both antigens. Among 47 serum samples tested with indirect hemagglutination (IHA) 27 had the antibody titer 1:16 or higher, which was diagnostically significant in combination with positive skin test results. The results indicate a definite cross reactivity of japonicum and mansoni anitgens in patients with Schistosomiasis japonica.


Radioimmunoassay of main urinary metabolite of prostaglandin F2alpha in patients with diffuse interstitial fibrosing pneumonitis (DIFP) and other respiratory diseases. Radioimmunoassay of 5alpha, 7alpha-dihydroxy-11-keto-tetra-norprosta-1,16-dioic acid, main urinary metabolite of prostaglandin F2alpha (PGF2alpha-MUM), was performed in patients with various respiratory diseases including diffuse interstitial fibrosing pneumonitis (DIFP, fibrosing alveolitis). Twenty-four hr excretion of PGF2alpha-MUM in patients with primary lung cancer, pulmonary fibrosis secondary to collagen diseases and stationary DIFP was normal. On the other hand, 24 hr excretion of PGF2alpha-MUM in patients with carcinomatous pleuritis was high and that in patients with aggravating DIFP was markedly high. There was no correlation between serum LDH levels and 24 hr excretion of PGF2alpha-MUM.


An experimental study of the spread of tumor cells through the lymph node. Intralymphatic inoculation of rat ascites hepatoma AH 130 was carried out to elucidate the function of the regional lymph node as a barrier against tumor spread. Tumor cells reaching regional lymph nodes decreased in number 48 to 72 hr after inoculation. Ten percent of tumor cells injected into lymphatic vessels appeared in the thoracic duct within 3 hr after injection. Bioassay tests revealed that transnodal tumor cells were viable in the thoracic duct.


Recent experiences with the Mustard procedure for the complete transposition of the great arteries by means of "bypass hypothermia". This paper presents our recent results of the Mustard procedure (intra-artrial baffle operation) for the complete transposition of the great arteries performed in 24 infants and children during the past 6 years at the Tohoku University Hospital. All intracardiac repairs were performed using "bypass hypothermia" (surface-induced deep hypothermia, circulatory arrest, and limited cardiopulmonary bypass). The hospital mortality rate was 8% in patients with simple transposition without pulmonary hypertension (Group I, one death in 12 patients), 50% in patients with ventricular septal defect (VSD) and pulmonary hypertension (Group II, 3 deaths in 6 patients), and 20% in patients with VSD and pulmonary stenosis (Group III, one death in 5 patients). Various types of longstanding dysrhythmia were found in 6 out of 18 long-term survivors, and subsequent pace-maker implantation was necessary in one infant. Postoperative pulmonary venous obstruction occurred in 3 infants, and surgical relief of the obstruction was successfully undertaken in 2 of them. Prevention of postoperative dysrhythmia, pulmonary venous obstruction, and possible brain damage are also discussed.


Echocardiographic evaluation of pulmonary hypertension by oxygen inhalation method. The ratio of the right ventricular preejection period to the right ventricular ejection time was calculated from the echocardiogram of the pulmonic valve before and after inhalation of a high concentration of oxygen in pulmonary hypertensive patients. The results showed that this non-invasive method could differentiate pulmonary vascular disease from non-pulmonary vascular disease and hence useful for evaluating the change of the pulmonary vascular bed in the pulmonary hypertensive patients.


[Treatment of thyrotoxicosis with 125-iodine: results in 93 patients 3 to 5 years after treatment, and comparison with 131-iodine therapy (author's transl)]. 93 patients were treated with 125-iodine for thyrotoxicosis with a small thyroid (less than or equal to 60 gr) and without palpable nodules in the years 1972--1974. The patients were assayed by: clinical examination, radioiodine-three-phase-study and assay of hormones in the serum: thyroxine, triiodothyronine, triiodothyronine-resin-uptake and thyrotropine. The dosage was individually calculated according to the radioiodine uptake, the thyroid weight and the effective half life time of the radioiodine in the thyroid. In 60 patients the thyrotoxicosis was controlled by a single application, and in further four patients two applications eliminated the thyrotoxicosis. Two out of fifty patients with a follow up between 4 and 5 years are hypothyroid. Compared to 131-iodine therapy in a similar group, the incidence of hypothyroidism is lower after 125-iodine treatment. Only long term follow up will show, whether this advantage of 125-iodine in a very selected group of thyrotoxic patients remains. These results have encouraged us to proceed with this trial.


[Application of the NSD-concept for the ascertainment of tolerance doses in the region of the lung (author's transl)]. A clinical application of the NSD-concept using iso-ret plans for the recording of radiation pneumonitis is reported. The conditions of an ascertainment of tolerance values for single organs by help of the Ellis formula are discussed. Of the examined patients with Hodgkin's disease who had been exposed to irradiation of the unaffected mediastinum, 42% suffered from radiogenic lung complications. The calculated iso-ret plans reveal a limitation of the pneumonitic shadow zone identical to the 1200-ret isoline. The data in literature are in accordance with these results.


[Measurement on a 42-meV betatron with regard to the radiological protection of patients (author's transl)]. In order to examine the side radiation field of X-rays from the 42-meV Siemens betatron, transverse and depth dose distributions were measured in the phantom with LiF dosemeters. The influence on the dose distribution exerted by the kind of radiation and its energy, the rotation angle of the patient's table, and the field dimensions was determined. The quality of the side radiation and the effect of additional lead shieldings were examined. The dose distributions can be calculated approximately by means of an exponent which can be used in order to estimate the surface dose for all desired irradiation conditions and to determine any distances from the field edges.


[Influence of a titanium plate on the depth dose distribution in 60Co-treatment (author's transl)]. The influence of a titanium plate on the dose distribution in 60Co-treatment has been calculated and compared with measurements. The maximum dose enhancement in front of the titanium plate can be 16%.


Determination of continuous neutron energy spectra for dosimetric purposes. The energy distribution of 3H(d, n)4He neutrons from a neutron therapy facility has been studied in different depths in a lucite phantom with two methods. Thin foils of 8 different target materials with well-known excitation functions and reaction thresholds between 1.8 and 12.6 MeV for the reactions to be observed have been activated. Secondly, recoil proton spectra have been measured with a small stilbene crystal. In both cases neutron energy spectra have been determined with unfolding methods. The two techniques are compared with respect to the application in neutron dosimetry and for monitoring purposes in neutron therapy.


[First results of mammography with a screen film (author's transl)]. In order to find a convenient, "dose sparing" mammography method, 152 breasts were examined comparatively with a conventional film without intensifying screens (Definix Medical of Kodak) and with a screen film (screen: MR 50, film: Mammoray RP 3 PE FW of Agfa Gevaert). The quality of the low-dose pictures was generally satisfactory. With regard to the exposure to radiation of the breast which is considerably lower if a screen film is used, it seems necessary to develop an automatic exposure control for this method, to further ameliorate films and screens, and to optimize the technical conditions for mammography. The authors underline the possibility to use simultaneously the oblique exposure methods, which would be a further step towards a reduction of the dose.


[Recovery and cycle progression in multicell spheroids after fractionated gamma-irradiation and combined hyperthermic treatment (author's transl)]. Spheroids of V79 cells were subjected to fractionated irradiation with two doses of gamma-radiation. In addition, a two hours hyperthermic treatment at 42 degrees C immediately following the first dose was applied. Cycling and resting cells of this in-vitro tumour model were then assayed for survival as function of the fractionation interval. In parallel, changes in cycle progression between the doses were measured by means of cytofluorometry. As main proliferative effects induced by this combined radiation and heat treatment transient S-phase blocking of cycling and recruitment of resting cells were observed. The split-dose survival curve displayed considerable synergistic action of heat and radiation and a six hours delay of Elkind-recovery in both cycling and resting cells.


[Influence of local hyperthermia induced by micro-waves and X-rays on the Walker carcinoma of the rat (author's transl)]. The authors studied the influence on the solid Walker carcinoma in the rat exerted by a slight local hyperthermia induced by micro-waves, which was applied alone and combined with X-ray irradiations. It could be demonstrated that the tumor has the same temperature as the sub-peritoneal region. Thus the final temperature reached by the treatment with micro-waves can be exactly controlled. Heating up to 41 degrees C for 30 minutes produces an increase of the survival rate of animals with tumors of 2 to 6 grams from 17% to 27%, whereas the healing rate is 57% after an X-ray irradiation with 1130 rad and 75% after the combined treatment. Each of the three therapy methods produces a significant prolongation of the survival time of the dying animals. The disadvantages of an anisologic tumor-host system are discussed on the basis of the results achieved.


Post-irradiation kinetics of the C3H/He mouse mammary carcinoma as regards tumor volume regrowth time and cell loss. The reoxygenation kinetics of the third generation C3H/He mouse mammary carcinoma has been studied and related to the time for 50% of irradiated tumors to regrow to the initial volume at irradiation (TRT-50) and to changes in tumor cell numbers. The experimental results suggest the following conclusions: (1) Fluctuations in TRT-50 values after two-dose irradiation under aerobic conditions are due to reoxygenation. (2) Since the TRT-50 after a second irradiation under hypoxic conditions remains independent of intervals between two doses for at least 3 days, repopulation and synchronization of surviving cells between irradiations is minimal. (3) A decreased cell number and/or cell loss from irradiated tumors is an important factor in tumor reoxygenation.


Studies of the activity of cytosol on the mixed disulfide bond formed by proteins and radio-protector mercaptoethylguanidine. The cytoplasm of normal and tumorous rat liver cells contains a heat-resistant active compound with reducing ability to break the mixed disulfide bond of albumin-14C-mercaptoethylguanidine. The reducing activity of  cytosol is destroyed by 1000 krd 60Co-gamma-ray doses in diluted solution. In vivo supralethal irradiation of rats does not affect the activity of cytosol prepared from liver cells.


The effect of postirradiation application of aspartic acid salts on hemopoietic recovery in sublethally X-irradiated mice. The effect of aspartic acid salts, especially of K and Mg aspartates, on certain hematological changes in the peripheral blood and hemopoietic organs of sublethally X-irradiated male mice of the strain C57Bl/10 was investigated. Salts of aspartic acid were administered in tap water after irradiation. A favorable effect of aspartic acid salts on erythropoietic recovery and on regeneration of thymus weight was found during the first two weeks after irradiation.


Metabolism of some kava pyrones in the rat. 1. The metabolism in rats of several kava pyrones from Piper methysticum Forst. was studied. The compounds were the 5,6-dihydro-alpha-pyrones, dihydrokawain, kawain and methysticin, and the alpha-pyrones, 7,8-dihyroyangonin and yangonin. 2. Approx. half the dose (400 mg/kg, p.o.) of dihydrokawain was found in the urine in 48 h. About two-thirds of this was hydroxylated metabolites (three mono- and three di-hydroxylated derivatives), of which p-hydroxydihydrokawain was the most abundant. The remaining third consisted of metabolites formed by scission of the 5,6-dihydro-alpha-pyrone ring and included hippuric acid (9--13% dose). 3. Lower amounts of urinary metabolites were excreted when kawain was given, but both hydroxylated and ring-opened products were formed. 4. Methysticin gave rise to only small amounts of two urinary metabolites formed by demethylenation of the methylenedioxyphenyl moiety. 5. Urinary metabolites of the alpha-pyrones, 7,8-dihydroxyangonin and yangonin, were formed via omicron-demethylation. No ring-opened products were detected. 6. These lipophilic kava pyrones have extremely low solubility in water, which would be expected to reduce their absorption rates and appears to be responsible for the variable and low extent of metabolism observed.


The N- and alpha- C-oxidation of N,N-dialkylanilines by rabbit liver microsomes in vitro. 1. A method for the determination of N,N-dialkylanilines and their metabolites by g.l.c. is described. 2. N-Demethylation and N-oxidation are important routes of metabolism of N-alkyl-N-methylanilines. 3. N-dealkylation, except the removal of a N-t-butyl group, occurs during the metabolism of N,N-dialkylanilines. 4. N-oxidation was found with N,N-dimethyl and N,N-diethylaniline and all N-methyl-N-alkylanilines examined except N-methyl-N-t-butylaniline. 5. A good correlation was found between the hydrophobic bonding constant (pi) and the extent of demethylation of a series of N-alkyl-N-methylanilines.


Head-space gas-chromatographic analysis of vinyl chloride monomer in rat blood and tissues. 1. A method for measuring vinyl chloride monomer (VCM) concn. in rat blood and tissues is described, using a head-space g.l.c. technique with flame ionization detector. The method is sensitive to 5 ng/ml VCM in blood and 30 ng/g in tissues. 2. VCM disposition was determined in rat blood, liver, kidney, brain and lung at different intervals after administration of 1--10 mg VCM/kg i.v. and 10 mg/kg orally. 3. VCM distributed rapidly in the organism after i.v. administration; it was eliminated rapidly and was no longer detectable at 15 min for the highest dose and at 4 min for the lowest. VCM was absorbed rapidly when given orally and tissue concn. were measurable for longer than after i.v. treatment. For both routes, VCM concn. in liver and lung decrease faster than in other organs, suggesting that these organs play a role in VCM elimination.


A population and familial study of the defective alicyclic hydroxylation of debrisoquine among Egyptians. 1. Debrisoquine hydroxylation exhibited profound variation in 72 Egyptian volunteers. 2. The frequency distribution histogram of the metabolic ratio (ratio unchanged drug: 4-hydroxy metabolite in 0-8 h urine) was polymodal. 3. From family data it was possible to define more clearly than before the heterozygous characteristics. 4. Egyptians appear in general to be more extensive oxidizers of debrisoquine than do English subjects. 5. Ramadan fasting was found to lower the absorption of debrisoquine.


[Predisposing factors in candidiasis].

[Predisposing factors in candidiasis]. The Candida mycosis is an infection by Candida albicans and other Candida species. This disease is not initiated by contact of Candida with the normal skin and mucous membranes or by invasion into the healthy host. On the contrary the presence of predisposing factors is important to Candida mycosis. These predisposing factors are considered as an impairment of local and/or general immunity and transform the opportunistically pathogenic character of the fungus into a parasitic one. Thus the host's defence mechanisms alone favour the development of Candida mycosis.


[Disseminated granuloma annulare].

[Disseminated granuloma annulare]. Disseminated granuloma anulare is a very rare form of this disease. Usually, the skin is involved on light-exposed areas. Most of the lesions are papules. The granulomas lie subepidermal in the upper part of the dermis. The reason for the publication of a typical case of a 57-year-old woman lies in the difficulties of the clinical and histologic diagnosis. Most of the patients are women in the 4th and 7th decade. Often there is an association with diabetes.


[Value of the de Kleyn symptom in diagnosing vertebro-basilar insufficiency]. A total of 540 cases with cerebral vascular disorders examined otoneurologically were analyzed. The observed patients were treated in the Research Institute of Neurology. In 62 patients (11,5%) the De Klein symptom was detected. A comparison of the otoneurological rheoencephalographic and neurological symptomatology gives grounds to evaluate the De Klein symptom, encountered in different degrees of circulatory insufficiency in the vertebro-basillar system, as one of the early signs of vascular decompensation in initial forms of cerebro-vascular insufficiency, marking its diagnostic significance.


[Memory disorders in vascular lesions of the brain]. The authors studied clinical and psychological features in disorders of memory due to vascular brain lesions. With the aid of pyktograms the character of activities of the examinees during the process of perception and differences in disorders of moderation in patients with lesions of the frontal and occipital parts of the brain were demonstrated. It is established that in the initial stages of the mnestic process the leading role is played by frontal lobes, while in latent reproductivity the significance of occipital brain areas increases.


[Secondary, reactive hypertensive states ("pseudohypertensive crises") in ischemic stroke]. There are frequent cases in clinical practice of ischemic strokes with a development of secondary, reactive increase of arterial pressure. In order to correctly interpret such cases and differentiate them from genuine hypertensive crises of certain importance is a detailed case history and observation of the dynamics of arterial pressure during the first hours and days of the stroke. An explanation of the pathogenesis of such reactive hypertensions can be given having in view the results of experiments in forming a socalled cerebro-ischemic hypertension in animals, as well as observations concerning the influence of irritations in the different brain areas on the arterial pressure.


[Serotonin and ATP metabolism in the thrombocytes of patients with different stages of cerebrovascular disorders of the ischemic type]. The patients with ischemic lesions of brain circulation showed marked biochemic changes of blood platelets. Obviously it plays an important role in the development of the given pathology. In the acute stage of the stroke there was a decrease of serotonin and ATP content in platelet which gradually increased along with the development of the disease. In the period of the residual phenomena the level of the studied indices appeared significantly increased in comparison with the normal one. In the patients with transferred lesions of the brain circulation at the acute stage serotonin and ATP content was not below the normal level. Later on the increase of these parameters took place and in the period of the residual phenomena theirlevel in platelet did not differ from serotonin and ATP content in blood platelets of the patients with the ischemic stroke.


[Free serum amino acids in the acute period of cerebral stroke]. A comparative study of free aminoacid content in the blood of 27 patients will brain hemorrhages and 32 patients with brain infarctions was conducted during the first 12 hours of brain stroke. A comparison of the data obtained with the results of a study of 16 normals and 24 patients with atherosclerosis and hypertensive disease demonstrated changes in the aminoacids spectrum which is characteristic for a hemorrhagical and ischemic stroke. The differences in the content of 10 aminoacids are shown. The achieved results are discussed in the light of their differential diagnostic significance.


[Vegetative disorders in the clinical picture of temporal lobe tumors]. Permanent and paroxysmal vegetative disorders were detected in 68,8% of the cases with temporal brain tumors. The intensity of the vegetative disorders was determined by intralobal localizations of the tumor, by the phase of the tumorous process and the histological structure of the neoplasm. Electrophysiological (rheographical) studies of cardiovascular changes detected in most cases marked to a varied extent regional cerebral and systemic disturbances of hemodynamics. Analysis of the cardiac activity demonstrated an increase in the physiological asynchronism of the systolic phases in the right and left ventricles, due to a pronounced disturbance of the right ventricle contractility.


[Syndromologic independence of amentia]. On the basis of long-term clinical observations of patients with amentive states within the framework of somatogenic, infectious, intoxicational, vascular exogenous-organic, reactive and schizophrenic psychoses the author attempts to claim the nosological independence of the amentive syndrome. The paper contains data on the nosological specificity of the modified syndrome in various disorders. The independence of the amentive syndrome is also grounded by clinico-pathological data (EEG and biochemical).


[Initial disorders and premorbid personality characteristics in delusional psychoses]. In compliance with a special list of standartized signs, the nozological and typical differences in initial and premorbid personality traits were studied. These symptoms were correlated in 407 patients with delusional psychoses in the framework of schizophrenia, symptomatic disorders and epilepsy. The signs were assessed in accordance to the degree of their probability. The report contains a description of the most probable traits having a prognostical and differential diagnostical significance.


[Clinical limits of schizoid psychopathy]. The paper deals with a study of 130 patients with psychopathy (among them 50 with schizoid psychopathy and 80 with other forms of psychopathy). The examined contingent demonstrated a similarity in the clinical picture with schizophrenic patients. The purpose of the study was to differentiate schizoid psychopathy from the sluggishly developing variants of schizophrenic and from schizophrenoform symptoms in the clinical picture of other forms of psychopathy. The main stages of schizoid psychopathy formation as well as the clinical symptoms, which may be assessed as differential criteria, are described.


[Interepisode periods in schizoaffective psychoses]. A total of 107 patients with 2--10 attacks of schizoaffective psychosis were studied by a clinico-catamnestical method. The following 3 main variants of the disease are distinguished: cyclothymolike, typical schizoaffective and drawing near shift-like schizophrenia. Clinical types of remissions, typical for schizoaffective psychosis are described: hyperthymasthenic, asthenic, thymopathical and psychopathlike. In the late stages of the disease the duration of lucid periods in most of the cases is shortened while the quality of the remission is lower. At the same time of process-symptoms, which are mainly determined by affective pathology, and not personality abnormality, lead to a disadaptation of the patients.


[Variations in the course of adolescent attack-like schizophrenia in the light of long-term follow-up]. By means of clinico-catamnestical examination, all schizophrenic patients who were admitted for the first time to the clinics of the Institute of Psychiatry from 1962--1965 were eventually studied. The disease in adolescnecy manifested with an acute florid attack. The studies detected a significant percentage (42,0%) of cases with a favorable outcome, following the adolescent period and a markedly reduced clinical picture of the successive attacks. The quality of the remissions was better and there was a good sociolabor adaptation of these patients. The paper contains a description of the typology of the different development of adolescent attacklike schizophrenia, based on the differences in the degree of the process progression. The traits of the initial stages, the picture of the manifest attacks and eventual remissions in each of the variants of schizophrenia were reconstructed. The question of grounded decisions concerning the prognostication on the basis of such studies is set forth.


[Endocrine syndromes in schizophrenia in the light of pathologoanatomic studies]. A study of the endocrine profile (all glands of endocrine secretion) in 33 cases of schizophrenia, where the autopsy was performed not later than 6 hours after death, permitted the author to distinguish 4 syndromes: normal functional activity (24%), hypofunction (30%), the stress-syndrome (33%) and dysfunction (12%). It is stressed that their formation is effected by several factors: the age of the patient, duration of illness, medication, cause of death, etc. The found changes in the glands are less severe in comparison to the previously described changes seen in senile dementia. These changes are considered in the aspect of pathomorphosis of schizophrenia.


Normalization of the insulin sensitivity and the cellular insulin binding during treatment of obese diabetics for one year. The relative importance of the insulin resistance, the decreased cellular insulin binding and the relative insulin deficiency in the pathogenesis of diabetes mellitus in obese subjects has been studied. Ten obese diabetics were studied before and during treatment for 1 year with a 1200-1500 kcal's diet. No change was found in the insulin response to iv injection of glucose during treatment (P greater than 0.1), whereas the insulin sensitivity was normalized after 1 year (P less than 0.01). In parallel to the clinical normalization and the improvement of the insulin sensitivity the insulin binding to monocytes was normalized (P less than 0.01). We conclude that both the insulin resistance and the relative insulin deficiency are of decisive importance in the pathogenesis of diabetes mellitus of the obese. The insulin receptor defect seems to be one of the major factors responsible for the insulin resistance.


Steroid excretion in anorexia nervosa patients. Seven anorexia nervosa (A.N.) patients had reduced urinary excretion values of tetrahydrocortisone (THE), androsterone (A) and 5alpha-tetrahydrocortisol (5alpha-THF). THE to tetrahydrocortisol (THF), A to aetiocholanolone (Ae) and 5alpha-THF to THF ratios were all significantly reduced. Six A.N. patients had oral metyrapone tests with quantitatively normal but delayed urinary 3alpha,17alpha,21-trihydroxy-5beta-pregnan-20-one (THS) response. The steroid determinations were done by capillary gaschromatography, which proves to be of value in the study of the above mentioned metabolic abnormalities.


The specificity of the human uterine receptor. The aim of the present study was to assess the contribution of different parts of natural and synthetic steroid molecules in their binding to high affinity oestradiol receptor preparations obtained from whole human uteri. Fifty-five compounds were used in the study of which 38 contained the steroid nucleus. The affinity (in terms of association constants) of the compounds for the receptor was determined from competitive studies with radioactive oestradiol. As a consequence the compounds could be grouped according to their association constants for the receptor. The contribution of the individual functional groups of the steroid molecule to the binding process was analysed. The preliminary quantitative evaluation of the contribution was derived from the equation: log K=logdeltaKs + sigmalogdeltaKF where K8 is the contribution of the basic 1,3,5-(10)-oestratriene skeleton, KF the associated functional groups and K the affinity constant for the entire molecule. The main positive contribution in the binding is provided by skeleton and the 3-hydroxyl group. It is concluded that functional groups present at either the 3 or 17 position act independently of each other in the binding process. The possible synergism between the functional groups and the steroid skeleton is discussed.


Progesterone and 20alpha-hydroxysteroid-dehydrogenase regulation in the corpus luteum of the pregnant rat. Female Wistar rats were mated and passively immunized against bovine luteinizing hormone (bLH) between days 7-12 of gestation. In a first series of experiments the effect of simultaneous progesterone treatment on the histochemically detectable activity of 20alpha-hydroxysteroiddehydrogenase (20alpha-OHSD) in the corpora lutea of pregnancy was evaluated. In other experiments the exact time course was established between the first histologically demonstrable signs of termination of pregnancy and the appearance of 20alpha-OHSD activity in corpora lutea of pregnancy. It was found that progesterone substitution not only prevented the deleterious effects of the anti-bLH-serum on gestation but also the re-appearance of 20alpha-OHSD activity in the corpora lutea of pregnancy up to day 12 of pregnancy. Moreover in animals injected with anti-bLH-serum from day 7 on and sacrificed on days 8-12, signs of foetal destruction clearly preceded the pathological re-appearance of 20alpha-OHSD activity by 2-3 days. These results support previous findings on a direct or indirct role of progesterone in the complex regulation of 20alpha-OHSD activity. Possible mechanisms of action are discussed.


In vitro C-20, 22 desmolase regulation of pregnenolone supply in first trimester human placenta. Homogenates of first trimester human placentae were incubated with [26-14C]chloresterol. Using reverse-isotope dilution analysis [14C]isocaproic acid was isolated and characterized. A progressive increase in [14C]isocaproic acid formation with increasing gestation suggestive of a regulatory mechanism at the C-20, 22 desmolase site in the supply of placental pregnenolone was noted.


Renal handling of homologous radioiodinated thyrotrophin in the rat. Previously, TSH metabolism and tissue distribution in the rat were studied using heterologous hormone and/or unphysiological doses. We injected iv [131I]rTSH (S.A. 100 micronCi/microgram) in physiological doses (10 ng) to KI blocked male rats. Two to 180 min after which TCA precipitable 131I was measured in the kidney, liver, muscle, fat and testis. The highest TCA precipitable radioactivity concentration, peak value 12% at 30 min; organ/blood ratio, 16, was found in the kidney. With the kidney validated as the major site of localization of TSH, the renal localization and handling of [125I]rTSH was studied by autoradiography. Radioactivity was confined to the cortex. Two to 30 min samples showed 125I in Bowman's space and luminal parts of the proximal tubular cells while samples from 60 to 180 min revealed activity in contraluminal areas, suggesting glomerular filtration and tubular re-absorption. Gel-filtration of supernatants of kidney homogenates revealed progressive diminution of the TSH peak and the appearance of a smaller MW peak. We conclude that (1) the kidney is the major site of localization and metabolism of homologous TSH, (2) the renal handling of TSH involves both glomerular filtration and tubular re-absorption.


A methodological study in measuring T3 and T4 concentration in red and white skeletal muscle and plasma of euthyroid rats. T3 and T4 concentrations were determined in plasma and red and white skeletal muscle of the rat. Because of the small tissue samples (+/- 300 mg), the ultra-sensitive Wick radioimmunoassay (RIA) for serum was adapted for determination in ethanol extracts. The dilution curves of the plasma and tissue extracts showed excellent parallelism with the standard curves for both T3 and T4. The mean T4 level found in female rats (n = 6) was 22.6 +/- 5.2 ng/ml in plasma and did not differ significantly between red (1.85 +/- 0.28 ng/g) and white (1.90 +/- 0.25 ng/g) skeletal muscle. The mean T3 level in 11 normal female rats was 0.629 +/- 0.0098 ng/ml in the plasma and was significantly higher in the red muscle (2.07 +/- 0.26 ng/g) than in the white muscle (1.65 +/- 0.20 ng/g). The higher T3 levels found in the red muscle as compared with the white muscle may help to elucidate the different responsiveness of these muscle types observed in altered thyroid states.


Production and characterization of antisera to synthetic 1-34 human parathyroid hormone fragments: possible implications for the correctness of proposed structures. Antisera were raised to 1-34 hPTH-B and to 1-34 hPTH-N. In the assays utilizing antisera to 1-34 hPTH-B the relative affinity of 1-84 hPTH was correlated with the activity displayed by 1-34 hPTH-N. The activity of 13-34 hPTH-B was always higher than that of 1-12 hPTH, but both peptides displaced most of the radioiodinated 1-34 hPTH-B from the antiserum. This may be due to the fact that the 1-12 and 13-34 fragments contain a homologous sequence: 6--10 (-GlN-Leu-Met-His-AsN-) and 29--33 (-GlN-Leu-Val-His-AsN-). It was possible to develop a heterologous radioimmunoassay using anti-(1-34 hPTH-B) antiserum and [125I]1-34 hPTH-N with favourable properties: complete cross-reactivity of 1-84 hPTH and high sensitivity (less than 10-14 mol/tube). All antisera to 1-34 hPTH-N were characterized by a high reactivity towards 1-34 bPTH and a higher avidity for 1-84 hPTH than for 1-34 hPTH-B. In all assays using either antisera to 1-34 hPTH-B or antisera to 1-34 hPTH-N 19-24 hPTH-B was completely inactive. In accordance with our previous observation that position 30 in native hPTH is probably occupied by an aspartic acid residue, the present study seems to indicate that position 28 or 30 is indeed represented incorrectly by the structure of 1-34 hPTH-B.


Neuronal degeneration in the brain of the brindled mouse. An ultrastructural study of the cerebral cortical neurons. The brindled mouse (Mobr) is a neurological mutant mouse with clinical and biochemical features closely similar to Kinky hair syndrome (KHS) in humans. Neuronal degeneration in the cerebral cortex and thalamic nuclei was the constant neuropathological lesions in the CNS of the male hemizygotes of this mutant (Yajima and Suzuki, 1978). Ultrastructurally, many cortical neurons contained enlarged mitochondria with prominent tubular or vesicular cristae, which were similar to those described in the Purkinje cells in the human KHS (Ghatak et al., 1972) and in the rat brain with copper deficiency (Prohaska and Wells, 1975). Such mitochondria were observed not only in the degenerating neurons but even in the otherwise normal-appearing cortical neurons, suggesting that the mitochondrial damage possibly related to the deficient activities of the copper containing enzymes (cytochrome oxidase, etc.) preceded the neuronal degeneration. Many mitochondria in the severely degenerated neurons contained numerous electron dense spicules of possible calcium. Although rare, similar morphological alteration of neuronal mitochondria was also noted in the female heterozygotes, indicating the presence of possible subclinical defect in copper transport in the heterozygotes as well.


De- and remyelination and onion bulb in cerebrotendinous xanthomatosis. In a case of cerebrotendinous xanthomatosis (CTX), confirmed biochemically and histologically quantitative histological studies of the biopsies sural nerve revealed significantly higher incidence of de- and remyelination and onion bulb than in controls. The density of total myelinated fibers fell within the range of controls, although the density of large myelinated fibers seemed to be slightly decreased. It was suggested that the preferential involvement of the myelin sheath and Schwann cell may exist in CTX.


Lymphatic efflux of intracerebrally injected cells. Following intracerebral injection of labeled erythrocytes, lymphocytes and/or peritoneal macrophages, cervical and inguinal lymph nodes were subjected to histologic examination. Labeled cells of all cell types were found in the cervical lymph nodes, but they were not observed in the inguinal lymph nodes. No labeled cells were demonstrated in the lymph nodes following intravenous injection of cell suspensions. It is assumed that an efflux of cells occurs in the perineural spaces of the exiting nerve fibers. The anatomic relationships were discussed.


Adult ceroid-lipofuscinosis (Kufs' disease) in two brothers. Retinal and visceral storage in one; diagnostic muscle biopsy in the other. Two brothers developed a neurological condition characterized by homochrony and homotypy: the first symptoms in both were generalized epileptic seizures, occurring at about the same age (30 years in the elder, 32 years in the younger), followed by a cerebellar syndrome with myoclonic jerks and some extrapyramidal symptoms. The elder of the two boys died at the age of 33 years. Histology showed extensive storage of ceroid-lipofuscin in the central nervous system (curvilinear bodies), in hepatocytes, in heart muscle and in the retina. In the younger boy, still living, a muscle biopsy (peroneal muscle) revealed accumulation of membrane-bound osmiophilic inclusions with curvilinear profiles. Retinal storage in Kufs' disease has never been documented. Muscle biopsy as a diagnostic tool for Kufs' disease has not been reported.


Experimental hypokalemia: ultrastructural changes in rat gastrocnemius muscle. Early ultrastructural changes are studied in rat gastrocnemius muscle during experimental hypokalemia. Vacuolization of muscle fibers is shown to originate in the terminal cisterns of the triads. Important degenerative changes are present in peripheral axons and neuromuscular junctions.


The immunocytochemical localization of GFA protein in experimental murine CNS tumors. Immunocytochemical localization of GFA protein in formalin-fixed, paraffin-embedded tissue sections by the peroxidase-antiperoxidase method of Sternberger was used to study experimental murine CNS tumors. Transplacental tumor induction in rats by ethylnitrosourea produced oligodendrogliomas and mixed gliomas in the cerebrum and spinal cord, and malignant Schwannomas of the trigeminal nerve. A methylcholanthrene-induced mouse "ependymoblastoma" inoculated intracerebrally in normal and in toxoplasma-infected mice was also studied. A positive reaction of GFA protein antibody was seen in the astrocytic portion of the mixed gliomas; the oligodendrogliomas, the malignant Schwannomas and the mouse "ependymoblastoma" were negative. Staining for GFA protein delineated the astrocytic reaction of neural tissue adjacent to the tumors. The reaction was markedly intensified in the brains of mice infected with toxoplasma. Additionally, ependymal cells near the tumors stained positively for GFA protein; normal ependyma at a distance from tumor remained negative. The technique, which combines a high degree of specificity with great sensitivity and is readily adaptable to routinely processed tissue, should prove a valuable tool in experimental oncology of the central nervous system.


An automated hearing screening technique for newborns. 11 182 newborn infants have had their hearing thresholds screened by automatically recording crib motion before and after a test sound. An inexpensive motion transducer translates the baby(s) movements onto a multichannel strip-chart recorder (batch testing) or a single channel recorder (individual testing). Records are read off-line and scored positive if there is a change in movement within 2.5 sec after the test sound. "Passing or failing" a baby requires about one minute's clerical scoring time, and is therefore both economical and simple. We have detected 33 neonates with serious hearing losses and perhaps missed one on long-term follow-up. This amounts to a deafness incidence of 1:329 live births. In the Intensive Care/Premature nurseries the incidence is 1:62.


Limb input to the cat vestibular nuclei. The input from fore- and hindlimbs to the vestibular nuclear complex (VNC) was investigated in awake cats. Electrical stimulus was given to the sciatic, radial and vestibular nerves bilaterally and single unit responses were recorded in the VNC with extracellular technique. The position of the microelectrode was histologically confirmed. All four major vestibular nuclei received fore- as well as hindlimb input. Forty per cent of the neurons with limb input also received vestibular afferents. No major distinguishing features appeared between the different nuclei with regard to response characteristics. Certain differences in laterality of response, quantitative fore-hindlimb ratio and somatosensory-labyrinthine convergence were observed however. Response latencies to sciatic and radial nerve stimuli always exceeded a 3 msec and were grouped around 8 and 16 msec. A third population of vestibular neurons had latencies over 20 msec. Both excitatory and inhibitory responses were recorded, with the latter not always following an activation. The findings illustrate the complex nature of the ascending pathway to the VNC and the integrative properties of this complex.


The tracheal mucosa microvasculature and microcirculation. Intravital microscopic observations in rabbits and a histologic study in man. A method for the intravital microscopic study of the tracheal mucosal microcirculation in the rabbit is described. A low tracheostomy is performed for ventilation, while a hole cut in the ventral portion of the trachea cranial to the tracheostomy is used for observations. The trachea is immobilized by a fixation device. Microscopic observations are made with a Leitz stereo microscope. The microvasculature of the rabbit tracheal mucosa is characterized by centripetally arranged arterioles which subdivide into a fairly sparse capillary network at the mucosal surface. The capillaries drain into venular networks at different levels of the mucosa and collect finally into circumferentially arranged veins which run mainly between the cartilages. For comparative purposes the microvasculature of the human tracheal mucosa has been analysed in clarified (Spalteholz) preparations. This investigation shows that the microvascular architecture is principally the same in the human and rabbit tracheal mucosa. There is, however, a much denser capillary network in the human tracheal mucosa.


Surgery of the mixed laryngocele.

Surgery of the mixed laryngocele. The authors first of all consider the classification of laryngoceles, their pathways of spreading, their statistical incidence, etiopathogenesis and their main clinical aspects. Next, they report on the most important surgical techniques proposed to date by the various experts for the three anatomical variants of laryngocele. As regards more particularly the mixed type, which seems to be the most frequent, the authors raise some objections to the classical methods. In fact, the latter do not always allow a satisfactory result to be achieved, and in this connection reference is also made to negative experiences reported by some authors. They go on to suggest, for mixed laryngocele, a new technique of combined exheresis by way of the external lateral approach and laryngofissure. The authors illustrate in detail the method proposed and report the case of a patient suffering from a voluminous bilateral laryngocele of mixed type, on whom they operated by applying the new technique, with very satisfactory results.


Function of submaxillary gland following iatrogenic damage to chorda tympani nerve. Flow rate, protein and amylase content of submaxillary saliva were determined before and after iatrogenic damage to the chorda tympani nerve during otosurgery. Parallel to these investigations, gustatory function was checked. Chronic otopathy itself did not lead to a disturbance of either the sense of taste or the function of the submaxillary gland in any of the 14 patients. On the other hand, the flow rate of the affected gland dropped after chorda division (8 patients) and after chorda stretching (6 patients), and the protein concentration of the saliva was increased while the concentration of amylase remained unchanged. Dysgeusia was always observed after chorda division but only once among 6 cases of chorda stretching.