[Abnormal pulmonary vein outlet. Radiological aspects (author's transl)]. 6 cases of abnormal pulmonary venous outlet, 5 of them partial anomalies without cardiocirculatory symptoms, are reported. Diagnosis was formulated by means of angiocardiography resorted to on the basis of the radiographic picture: retraction of the right hemithorax (left in 1 case), heart attraction, pulmonary veiling, tomographic pictures of anomalous vessels.


[Anomalies of the vena cava inferior: report on four cases associated with congenital heart disease (author's transl)]. Infrahepatic interruption of the inferior vena cava with azygos continuation has been demonstrated by angiography in three patients; in a fourth case an anomalous venous channel connected the patent azygos vein and the inferior vena cava at the renal level. Cardiac defects were present in all cases.


On the classification of penis carcinoma and its 10-year survival. With respect to the primary tumor there is no difference between the proposal of the UICC and the Heidelberg version for TNM classification of the penis carcinoma. Clinically the Heidelberg scheme seems more practical, but there were no statistical differences between them. With respect to the prognosis for the patient,  the size and localization of the primary tumor are of secondary importance. What is important is the degree of tumor spreading in the lymph system. From this point of view, one needs only to differentiate between T1 (tumor restricted to the penis) and T2 (tumor extending the bounds of the penis). On the other hand, size, localization, and degree of infiltration of penis carcinoma do have different therapeutic consequences, so from this point of view the differentiation of the primary tumor from T1 up to T4 should be retained. With respect to the classification of the state of the corresponding lymph system it is our opinion that the UICC proposal is too differentiated and has little meaning. In its stead, the Heidelberg scheme is clear and simple. Any examiner can complete it. With the help of life tables extending beyond 10 years after diagnosis we were able to determine that 5 years is not a sufficiently long time to clsoe a case of penis cancer. Even with proper treatment, the patient may suffer up to 10 years or more from the disease. In patients aged between 50 and 59 years of age the cancer seems to grow faster; in spite of proper and intensive treatment those patients had a clearly limited life expectancy. In patients aged 60-69 and more so in those between 70 and 79 years of age the tumor seemed to grow slowly and often had no effect on the survival rate.


Treatment of penis carcinoma with interstitially administered iridium; comparison with radium therapy. The results of treatment of 30 patients with penis carcinoma cured with radium and 18 patients treated with 192Ir were compared. In both groups of patients, core assessed at 3 years was obtained for a similar percentage of patients (89% and 83%). After treatment with 192Ir, radiation necrosis was observed in 16%, and after treatment with radium in 50% of patients. In both groups a similar high percentage of patients (88%) with organs preserved after treatment was found. In group of patients treated with 192Ir the percentage of very good functional effects (69%) was much higher in the group of patients treated with radium (28%).


Endocurietherapy of penis cancer.

Endocurietherapy of penis cancer. Forty-five carcinomas of the penis have been treated with curietherapy using 192Ir to a dose of 6500 rad. With a minimum follow-up of 4 years, it appears that small lesions (less than 30 mm) have excellent local results (2 recurrences in 14 cases). With only a slight potential for lympatic extension, these patients are alive without evidence of disease after 4 years. The lesions of moderate size (30-40 mm) have a poorer prognosis because of more frequent lymphatic extention and disseminated metastases; in contrast, the local results are still quite satisfactory (4 recurrences in 24 cases). The large lesions (more than 40 mm) recur or necrotize (5 recurrences and 2 necroses in 7 cases). In conclusion, curietherapy of epidermoid carcinomas of the penis is an excellent primary treatment for small or moderate lesions (T1, T2, and T3a) if one wishes to avoid surgical mutilation.


Tumors of the epididymis.

Tumors of the epididymis. Tumors of the epididymis, both primary and secondary, whether benign or malignant are very rare. The elements of the spermatic duct system, whether inside the testis or outside it in the epididymis and spermatic cord, exhibit only 1/20th of that of the germinal epithelium. In accordance with the mesodermal, or mesothelial origin of the whole spermatic ducr system, tumors of the epididymis and spermatic cord are - with few exceptions - mesenchymal tumors, the most frequent of these being the so-called adenomatoid tumor, a benign slowly growing tumor. With regard to the relative frequency of the various extratesticular tumors, a British panel has shown that one quarter of its cases are adenomatoid tumors, a second quarter sarcomas of children and juveniles (rhabdomyosarcomas and embryonic sarcomas), a third quarter sarcomas of adults and aged, while the last quarter includes simple benign mesenchymal tumors, mixed tumors, metastatic tumors, and others. There is only one extremely rare epithelial tumor of the epididymis, the papillary cystadenoma, which seems to be a partial menifestation or forme fuste of Hippel-Lindau's disease. So far only 40 cases have been described in the world literature. Therapy of intrascrotal but extratesticular tumors always ought to be surgical: if the tumor proves to be benign, simple excision suffices. In cases of malignancy, immediate inguinal lymphadenectomy and - as with testicular tumors - lymphography followed by retroperitoneal lymphadenectomy. Whether one should, in principle, then continue treatment either chemotherapeutically or radiotherapeutically, or do so only when there is evidence of metastasis, is a question whiich still remains open.


Testicular cancer, histologic classification and staging, topography of lymph node metastases. From the clinical point of view, histologic classification is intended to give suggestions for therapy (therapeutic classification) and to provide the basis for an assessment of end results (prognostic classification). In adults, the essential therapeutic question is: seminoma (only seminoma) or non-seminoma? The frequency of seminoma among the germinal testicular tumours influenced by the subtlety of the histologic examination. The histologic report should include the MOSTOFI (25) classification and the prognostic group classification of DIXON and MOORE (7). Staging of testicular cancer and criteria for the comparison of treatment results are discussed. The topography of lymphatic metastases of testicular cancer was investigated. The great majority of testicular cancers metastasize regularly, i.e., primarily into the testicular lymph center and/or along the testicular vein, and only secondarily in other lymph nodes. This provides a foundation for the increasing tendency to modified bilateral retroperitioneal node dissection.


Surgical treatment of non-seminomatous germinal testes tumors. Surgical management of germinal testis tumors other than seminoma is presented. Phase I consists of removal of the primary tumor; phase II, the surgical removal of retroperitoneal metastatic disease, and phase III, surgical management of chest metastasis. Seventy-two patients were explored with the intent of performing a simultaneous bilateral retroperitoneal lymphadenectomy. Each had a radical orchiectomy prior to exploration. Seven patients were found unresectable because of extensive disease above the renal pedicle and lymphadenectomy was not performed. The remaining 65 were found resectable and a transabdominal bilateral retroperitoneal lymphadenectomy was done. Of this number, 20, or 30%, had metastatic nodes. No other treatment was used. All had a 3-year follow-up and 53 were followed for 5 years or more. The 3-year survivals for stage I is 93%, and for stage II, 75%. Survivals of 5 or more years in stage I are 86% and in stage II, 70%. Thus, this experience with pathologic stage II cases clearly demonstrates the capability of surgery as a primary treatment to control 70% of patients with retroperitoneal lymph node metastases. This surgical technique is therfore recommended as primary therapy in stage I and II non-seminomatous geminal testis tumors.


Retroperitoneal lymphadectomy: indications, complications and expectations. The use of retroperitoneal lymphadenectomy in the management of 152 patients with nonseminomatous germ cell tumors of the testis treated at Anderson Hospital has been reviewed. Complications consisting of wound infection (six cases), acute pancreatitis (two cases), lymphocyst formation (two cases), and chylous ascites (one case) developed in 6.4% of patients. Although ejaculatory impotence is common postoperatively, only 12 marriage units were desirous of having children and 7 of these have had uncomplicated and successful pregnancies. No instances of erectile impotence developed in this series. The indications for the procedure have been defined with regard to accurate staging, combined therapy, and, in selected instances of advanced disease, as a means of monitoring the effects of chemotherapy. The importance of this operative procedure in the multimodal management of patients with nonseminomatous germ cell tumors of the testis cannot be overemphasized.


The combined surgical and chemotherapeutic approach to non-seminomatous cancer of the testicle. Of 250 testicular tumors treated up to May 1975 233 (93.2%) were germ cell and 17 (6.8%) non-germ cell tumors. Reexamining the histology of the last 123 patients only 29.3% had pure seminomas and 70.7% had non-seminomatous tumors. The results of regimens of combined surgical (extended semicastration and lymphadenectomy) and chemotherapeutic (triple-drug as well as Ifosfamid in combinations with low-dose radiafor stage II (37.5%) and stage II (16.7%). There were good results after 96 transperitoneal bilateral lymphadenectomies. But even in stages II and III results were achieved which would not have been possible without lymphadenectomy. It is pointed out that in the future, with improvements in cytostatic therapy, even better results including treatment of stage IV tumors can be expected.


Chemotherapy of seminoma.

Chemotherapy of seminoma. 1. Seminoma may occasionally be rapidly growing, aggressive, radioresistant, and chemotherapy-resistant tumor. 2. Alkylating agents have had the greatest number of trials and have produced the best response rates in the management of seminoma, but a wide range of other agents warrants trials. 3. Adjunct chemotherapy is a logical consideration in patients with stage II and stage III seminoma.


Aspiration biopsy cytology of prostate carcinoma. Fine needle aspiration biopsy cytology allows safe morphologic tumor diagnosis in the prostate based on cytologic and histologic criteria. Specific technical difficulties of the procedure are not greater than in surgical pathology. The standardized equipment developed by FRANZEN is recommended. Aspiration biopsy is atraumatic and without complications. The method introduces a new clinical approach to the application of recent advances in cell research. Among other improvements, aspiration biopsy may falicitate cytologic classification of prostate carcinoma. The method should be adapted to screening programs.


Estramustine phosphate therapy in carcinoma of the prostate. Estramustine phosphate, a nor nitrogen mustard derivative of estradiol 17-beta-phosphate, was introduced in the treatment of prostatic carcinoma in 1966. Until March 1975, 466 patients have been reported on this treatment in open clinical trials: 82% of the patients were in stage IV. In 402 patients, nonresponsive to previous estrogen therapy, signigicant improvement occurred in 55%. In 64 previously untreated patients there was a favourable response in 83%. Side-effects were mainly bone marrow suppression. liver disturbance, thrombophlebitis following intravenous injection, and gastrointestinal troubles, mainly following oral administration. A prospective, randomized study comparing oral estramustine phosphate and conventional estrogen therapy in carcinoma of the prostate is in progress.


[Rehabilitation of rheumatoid arthritis and ankylosing spondylitis: a study of the pre-requisites (author's transl)]. Rheumatoid arthritis/chronic polyarthritis and ankylosing spondylitis belong to the most common inflammatory rheumatic diseases. Owing to their progressive character they can result in morphological and functional defective conditions making rehabilitation procedures necessary. In contrast to other diseases calling for rehabilitation treatment the rehabilitation of these two diseases is in the majority of cases a life-long process, during which a change in rehabilitation goals and procedures is not seldom. Hence, rehabilitation is a dynamic process which requires flexible adjustment. A positive rehabilitation outcome is dependent upon the following factors: (1) the patient's disease (duration, stage, type of affection, progression, inflammatory and immunological activity, general condition and drug tolerance), (2) the patient's personality (age, intelligence, motivation), (3) the patient's home and vocational environments. In addition to technical pre-requisites, which are also important, the following medical ones have to be outlined: early diagnosis and initiation of therapy and the availability of a comprehensive treatment programme embracing drug, surgical, physical and balneological therapies, also as an in-patient. A further pre-requisite is the high rheumatological qualification of the responsible physician, who must maintain good contacts with the other members of the rehabilitation team. In the long run, this qualification can only be achieved with the provision of adequate training programmes, and if rheumatology is accepted as an independent discipline.


[Some thoughts on the adaptation of technical aids for children with cerebral palsy (author's transl)]. The technical aids used by children undergoing inpatient treatment at a centre for the cerebral palsied were critically assessed over a one-year period. Of the evaluated technical aids 50% were optimal for the child under consideration, the remainder was inappropriate for one or more reasons. The most frequent amongst the non-optimal were either not medically prescribed or adequately adapted and tested. The children in question are hence threatened with unnecessary deformations, an insufficient utilisation of their development potential and a lower degree of independence. Also, the financially responsible agencies have to cope with considerably larger expenditures.


[Total aphasia and speech therapy: a case history (author's transl)]. The medical profession and therapists continue to believe that total aphasia is untreable. A case report is used to demonstrate the diagnostic features of aphasia and describe the course of the impairment from the complete loss of speech, via the learning of highly automated expressions to the aquisition of single words which the patient uses independently in the different contexts. This development involves all language functions equally. The therapy is based on conventional methods, deblocking stategies, speech therapeutic talks - principal item of the treatment - and dialogue exercises carried out under normal conditions. The problems relating to deblocking methods are discussed. A description is made of the methods which have been developed from a combined audiovisual, tactile and writing motoric speech activation programme. The article presents the linguistic signs of the syndrome in an advanced stage and demonstrates the development of the thinking structure and the psychic problems with the help of the tree drawings.


[Clerical work therapy at a psychiatric hospital - a hitherto neglected rehabilitation aid (author's transl)]. As a rule, rehabilitation programmes provided at state psychiatric hospitals and sheltered workshops in the Federal Republic of Germany suffer from a lack of training possibilities for patients from commercial, administrative and clerical occupations. The situation is the same for school pupils and students. With the introduction of a work therapy concentrating on clerical activities into the rehabilitation programme of a psychiatric hospital, patients from jobs requiring particular intellectual skills can benefit from an appropriate and graded programme designed to re-develop previously trained skills, orient in a new occupational field and provide the opportunity of trying out jobs. In particular cases this therapy also assumes the function of a useful form of occupational therapy and enlarges the range of available occupational and work therapeutic methods.


Induction of hemosome formation and hemoglobin biosynthesis in HeLa cells. Tissue cultures of HeLa cells in Hank's medium suspension, previously mixed with a solution containing reticulocyte polysomes and/or free globin, hemoglobin and blood plasma from bled rabbits, were homogenized, and an electrophoretic pattern of hemoglobin band was obtained from the supernatant; hemoglobin denatures under the tissue culture conditions. HeLa cells show typical hemosomes, identidical to those found in immature erythrocytes of embryos, and adult mammals with hemolytic anemias. When HeLa cell suspensions are mixed with solutions void of anemic blood plasma, or containing normal rabbit blood plasma, anomalous organelles are formed in the cells, and no hemoglobin biosynthesis occurs.


[The effect of ethanol-applications on uric acid-metabolism in minipigs (author's transl)]. The effect of several drugs on minipigs was examined over a period of upto 3 months. The drugs applied were: ethanol, etacryn acid (per os), ethanol, maleic acid, physiological NaCl--solution (by infusion). The creatinin-, uric acid-, lactat- and haematocrit-values of the serum and blood as well as the creatinin- and uric-excretion were followed. For ethanol and maleine acid an increase of the creatinin- and uric acid-excretion was found. This was accompanied by an increase of the haematocrit value. If the diuresis was augmented by certain substances, a more or less pronounced uricosuria was found. The measured values will be discussed, especially how the renal function may be involved.


Impulse activity in afferent vagal C-fibres with endings in the intrapulmonary airways of dogs. We recorded impulses from afferent vagal C-fibres (conduction velocities 0.8-2.4 m/sec) arising from endings in the lungs of anesthetized dogs with open chest. Endings were of two types ('pulmonary' and 'bronchial') distinguished by their response and accessibility to capsaicin and phenyl diguanide injected into the right or left atrium. 'Pulmonary' endings, stimulated only by capsaicin and accessible through the pulmonary circulation, have been described previously. 'Bronchial' endings were stimulated by both capsicin and phenyl diguanide and were accessible through the bronchial circulation. Eight of 28 'bronchial' endings were located in large airways within 4 cm of the hilum, and two were in small airways near the edge of the lung. The precise location of the remaining 'bronchial' endings was not determined but we think that many were in the airways. 'Bronchial' endings had a sparse and irregular spontaneous discharge. They were stimulated by the inhalation of 5% histamine aerosol, the evoked discharge having no obvious relation to the phase of ventilation. A few were weakly stimulated by hyperinflating the lungs; deflation was without effect. The function of these endings is unknown.


Patterns of bulbar respiratory neurons during and after artifical hyperventilation. Single bulbar respiratory unit activity was recorded in urethane-anesthetized rabbits. During artificial ventilation, reflex contractions of the diaphragm were elicited by the forced deflations of the respirator. Out of 44 neurons, four I, one E and two EI units exhibited a shift of their discharge relative to the contractile phase of the diaphragm, compared to normal respiration. During hypocapnic apnea, some I, IE and E neurons became silent. Other cells belonging to all phase types, however, continued to fire tonically at a rate less than the peak rate in normal bursts. When rhythmic respiration resumed after termination of the apneic pause, five (I, IE and E) units exhibited a transient phase shift of their burst discharge compared to normal respiration. The results of simultaneous recordings of two neurons belonging to different phase types are compatible with the assumption that inspiratory units are periodically inhibited by inspiratory-expiratory cells.


Theoretical analysis of independent VA and Q inequalities upon pulmonary gas exchange. A 10-compartment model is used to study the effects independent regional inequalities in ventilation (VA) and blood flow (Q) upon overall gas exchange in the lung. For the particular distribution considered, it is demonstrated that unequal ventilation always gives rise to a greater degree of hypoxaemia than unequal blood flow, and that these differences become more marked when minute volume is high. In contrast, hypercarbia is more pronounced in situations where blood flow is unequal; however, the differences diminish with increases in minute volume. Increases in cardiac output are found to have a lesser effect upon the gas exchange process. The reasons for the findings are explained by reference to the gas dissociation curves, the spread of VA/Q ratios, and the weighting influence of regional blood flow. The apparent disparity of the present results with those obtained by assuming a log normal distribution of the respiratory parameters (VA and Q) are reconciled.


Role of prostaglandins in alveolar hypoxic vasoconstriction. The role of prostaglandins as mediators of alveolar hypoxic vasoconstriction was investigated in dogs with the use of the prostaglandin synthesis inhibitors, aspirin and indomethacin. Alveolar hypoxia was induced by inserting double-lumened endotracheal tube into the carina and ventilating one lung with nigrogen while maintaining normal systemic oxygenation with 100% O(2) ventilation to the other lung. Relative perfusion to each lung was determined with 133Xenon and external counters. Infusions up to 25 mg/kg of indomethacin and up to 250 mg/kg of aspirin did not block the shift in perfusion from the alveolar hypoxic lung. In fact, the shift in perfusion from the alveolar hypoxic lung was slightly augmented by aspirin (P = 0.03). Thus, no positive role was demonstrated in the dog for prostaglandins in producing the vasoconstriction of alveolar hypoxia.


Morphology of branching trees related to entropy. Analyses of river systems by geomorphologists have suggested that for minimal entropy production in the movement of water down the river the fall in altitude should be equal in each order of branching of the tributaries. In this paper the same concepts have been applied to the bronchial tree and pulmonary arterial tree, assuming that the energy associated with pressure difference is analogous to that associated with altitude difference in rivers. The morphology of the bronchial tree is such that, given laminar flow or air, the calculated pressure difference across each order is equal. This may indicate that the bronchial tree is designed for minimal entropy production. In the arterial tree, however, this result is not obtained, probably because we do not know how to calculate the pressure drop in blood flowing through a branching system. It is therefore not currently possible, on the basis of this approach, to say whether the pulmonary arterial tree is designed for minimal entropy production or not.


Postnatal growth of the dog's bronchial tree. Polyester resin casts of the bronchial tree were made from the lungs of four Labrador dogs which weighed 0.5, 3.4, 7.5 and 30.0 kg, respectively. The branching trees were ordered by the method of Strahler and plots made of number, mean diameter and mean length of branches in each order. The four length plots were found to lie parallel to each other, as did three of the four diameter plots. When data are divided by the cube root of body weight the length plots almost coincide, as do the diameter plots. This indicates that the bronchial tree grows in constant proportion to the cube root of body weight.


Quantitative lung morphology in newborn mammals. We have examined the lungs of eleven species of newborn mammals by quantitative morphometric techniques and related the findings to body weight (BW) and O(2) consumption (Vo2 is found to be proportional to BW(0.88); this exponent is significantly greater than the value of about 0.73, repeatedly found for adult mammals. Lung volume (LV) is essentially proportional to BW, and neonatal alveolar size - as indicated by mean chord length - is nearly constant among species and independent of BW. Thus the respiratory surface area (SA) is not proportional to Vo2, as in adult mammals, but to Vo2(1.23). Neonates of small species have lower SA/Vo2 ratios than adult mammals, possibly owing to constraints of surface forces on alveolar size. Newborn members of larger species have SA/Vo2 values in excess of the adult range. Published data on human newborn lung dimensions suggest that the human infant may have an unexpectedly low SA/Vo2 value in relation to BW. Whether this is a valid finding, or whether it derives from methodological differences between studies cannot be ascertained from the available data.


Effect of histamine on the length-tension properties of guinea pig trachealis muscle. The isotonic length-tension properties of excised live guinea pig trachealis muscle have been determined as a function of histamine concentration. Over the range of histamine concentrations studied, a family of curves corresponding to the total and active tensions were obtained. Reciprocal plots of the tension-concentration data revealed a length dependence of the affinity constant of histamine for its receptor The tensions and lengths below resting were considered to be of special importance because of the role of muscle contraction in airway closure. A mechanochemical model for shortening and reelongation of the trachealis muscle during anaphylaxis has been proposed on the basis of this data. By comparing the force-length properties of the muscle at the lowest histamine concentration, it was suggested that the formation of a histamine-Ca++ receptor complex causes an increase in the rigidity of the muscle membrane. The complete range of lengths, tensions, and concentrations must be employed in order to propose a mechanism of action from mechanical data alone.


Selected oxygen transport parameters in captive elk. Five captive elk (cervus canadensis) were immobilized with a mixture of etorphine HC1-acepromazine maleate, and measurements were taken of selected oxygen transport paraments. Heart mass/body mass, hematocrit, hemoglobin, blood volume, mean corpuscular volume and airway resistance were measured and the values compared to other ungulates. It was concluded that the O2 transport system of elk is not as well developed as that in pronghorn but is superior to that found in the goat or ox.


Role of pulmonary stretch receptors during breathing in rabbits, cats and dogs. In order to mimic and then modify the input to the respiratory centre from pulmonary stretch receptors, the central ends of the cut cervical vagus nerves were electrically stimulated with a frequency determined by transpulmonary pressure through a voltage to frequency converter. At appropriate end-expiratory stimulation frequency and gain of the voltage to frequency converter, such stimulation restored the pre-vagotomised patterns of breathing in rabbits, cats and dogs. Mimicking the changes in activity from pulmonary stretch receptors that would be produced by such manoeuvres as hypercapnia, inflations and deflations, reproduced the responses in inspiratory duration that occurred with natural stimuli in the same animals with intact. There were some differences between the responses of expiratory durations to the natural and mimicked interventions; these may be related to the presence of increased expiratory muscle activity in the former. The results demonstrate that transpulmonary pressure-controlled stimulation of the afferent vagus nerves is a satisfactory method of mimicking and controlling the pulmonary stretch receptor feedback mechanism in studies on the control of breathing.


[Quantitative study of the peripheral nerve in semi-thin section by the Nomarski interference contrast technic]. The Normarski interference-contrast microscope is well suited to observations of transverse thick sections of epon-embedded peripheral nerves. The quantitative study of myelinated fibers is possible on photomicrographs with a final magnification of X 500. The induced distorsion is very small as compared with the results obtained by conventional bright field and positive phase contrast optics. The comparative study of the same field with the three devices allows a better interpretation of marginal pictures.


[A new case of chronic progressive bulbo-pontine paralysis and deafness]. The author reports a new case of chronic progressive bulbo-pontine paralysis with deafness. This case differed from other cases previously published on the basis of the later age of onset of labio-glosso-laryn-geal paralysis, by the absence of any vestibular changes despite bilateral involvement of the acoustic centres and above all by the normality of deep tendon reflexes. The author feels that chronic progressive vulvo-pontine paralysis with deafness is a specific individual condition, worthy of consideration as an autonomic clinical entity.


[Muscular atrophy associated with a contralateral parietal lobe lesions. Apropos of 2 cases]. Two cases of parietal lobe tumours with contralateral muscle atrophy are discussed. Muscle biopsy demonstrated selective atrophy of Type II fibres. E.M.G. shows brief small polyphasic potentials. At autopsy in the second case no neurological lesion was found outside the brain, muscles and pyramidal tract.


[Headache simulating meningeal hemorrhage]. That migraine can present with a severe headache of sudden onset mimicking that of subarachnoid hemorrhage--the so-called "complicated migraine with meningeal manifestations" of Pearce and Foster--is not readily appreciated. Over the past three years, seven patients have been referred to us with a presumable diagnosis of subarachmoid hemorrage. In each one of these patients, the clinical features (an explosive headache, relapsing in three, and a normal neurological examination) together with appropriate laboratory investigations (cerebro-spinal fluid analysis, electroencephalography, echoencephalography, brain scan, arteriography, pneumoencephalography) have ruled out the diagnosis of subarachnoid hemorrhage, as well as less common causes of explosive headaches such as ball-valve tumors of the ventricular system, intra-cerebral hemorrhage, hemorrhage into a tumor. In three out of these seven patients, there was no history of migraine. Bening explosive headaches mimicking subarachnoid hemorrhage, occurring in patients with or without antecedents of migraine, are not as unusual as one might conclude from a review of the literature. Proper recognition of this syndrome is important since it might help to sort out those patients with explosive headaches who need not be submitted indiscriminately to risk-fraught procedures.


[Recording of visual evoked potentials in the diagnosis of multiple sclerosis]. The authors report the results of recording EVP obtained by pattern reversal in 20 controls and 43 patients with "established", "probable" or "possible" MS on the basis of MacAlpine's criteria. Whilst the latency of the wave 1 of the EVP appeared stable in the controls (107.5 msec +/- 7.46), lengthening of the latency of the EVP was seen in 77p. 100 of cases, confirming involvement of the visual pathways, though bulbar neuritis had been known clinically in only 28 p. 100 of patients. The value of this method of recording EVP in contributing to the diagnosis of DS is discussed.


[Centro-pontine myelinolysis associated with diffuse lesions of the white matter. Water-electrolyte disturbances associated with diuretic therapy]. The authors report a case of centropontine myelinosis associated with demyelinising lesions of the tectum mesencephali, the cerebellum, the central grey nuclei and the white matter of the hemispheres. This case is compared with similar observations already studied in the literature. From an aetiological standpoint, attention is drawn to the apparent causative role of diuretic therapy which had resulted in severe water and electrolyte disturbances.


[Renal pancreatic venous anastomosis: anatomical, clinical and radiological study]. Abnormalities in the left urinary tract have been observed secondary to pancreatopathies. Venous connections between the distal spenopancreatic venous bed and the left adrenal-renal venous system have been demonstrated by cast corrosion technique and by radiographic studies in the cadaver. In all of our anatomic studies, except on one occasion, numerous venous connections between the portal and systemic veins were demonstrated. The intravenous pyelogram and particularly nephrotomography have great value when pathology of the body and/or tail of the pancreas is suspected. Indirect sign on the left renal vein thrombosis on the left side may suggest the presence of a pancreatopathy. With acute and chronic pancreatitis, pseudocyst of the pancreas, and pancreatic carcinomas, we have noticed changes in the left urinary tract.


A review of the findings on computed cranial tomography following intravenous contrast media. The diagnostic contribution of contrast enhancement by intravenous injection of meglumine diatrizoate was assessed in 121 patients who received both plain and contrast enhanced cranial CT scans. The use of contrast enhancement was found to provide both an increased sensitivity in detection of lesions and some improvement in pathological differentiation of lesions. The use of contrast enhancement in addition to plain CT scans increases the reliability of CT scans in excluding such conditions as neoplasms, abscesses, and vascular malformations. Because the use of contrast medium is associated with morbidity (and significantly extends the length of the total study), the decision to employ contrast enhancement must be based upon a careful evaluation of the clinical, other radiological, and plain CT findings in the individual patient.


Cerebral angiography in acute cerebral infarction. Cerebral angiography in the acute phase of clinically diagnosed stroke syndromes was evaluated in a prospective study of 104 consecutive patients over an eight month period at the Massachusetts General Hospital to determine the diagnostic yield. Of 68 patients subsequently documented to have retinal or cerebral hemispheric infarction, 63 (92.6%) had angiographic demonstration of occlusive lesions which appeared to correlate with the clinical deficit. These results are discordant with prior angiographic reports, 2,17,18,20 suggesting that delayed carotid artery angiography fails to show occlusive lesions (embolic) which may be shown acutely.


Adult respiratory distress syndrome.

Adult respiratory distress syndrome. The authors correlated and presented clinical, radiological and pathological findings in 6 patients with Adult Respiratory Distress Syndrome (ARDS): It is a distinct syndrome with characteristic clinical, radiological presentations and pathological findings. It is a unique response of lung to a variety of primary insults. If unrecognized, patients with this syndrome are often fatal. Its possible pathognesis is discussed.


The radiographic wall-signs of ovarian dermoids. Ovarian dermoids posses a distinct fibrous capsule which may be recognized radiographically by virtue of the contrasting effect of the greasy dermoid matter and the surrounding peritoneal fat. Part or all of the wall may be outlined in some projections even when the dermoid contents are not radiolucent enough to be recognized as such. Occasionally the wall of a dermoid cyst, heavily calcified or ossified, may be easily recognized radiographicaly.


Ultrasonic localization for renal biopsy in infants and children. The authors describe a simple method of sonographic localizaiton for renal biopsy in unanaesthetized pediatric patients. Adequate biopsies have been obtained in 6 of 7 patients who ranged from 2 months of 8 years in age.


Epidermoid inclusion cysts of the phalanx, radiological and clinical correlation. A patient with an epithelial inclusion cyst of the distal phalanx has been presented. The radiographic and clinical findings have been described and are felt to be pathognomonic. The importance of recognizing its benign nature has been stressed.


Toxopachyosteose diaphysaire tibio-peroniere (Weismann-Netter-Stuhl syndrome): two case reports. Two patients with the Weismann-Netter-Stuhl syndrome are presented, one with classic and widespread findings, the other with minimal changes. Subsequent to its initial description in the French literature seven cases have been reported in English. The syndrome is characterized by anterior bowing of the tibia and fibula with posterior cortical thickening and trabecular irregularity in the region of bowing. Other long bones may be similarly affected. Scoliosis and pelvic findings are frequent. Short stature is usually present. The syndrome appears to be a generalized diaphyseal dysplasia.


Clinical concepts of contrast enhancement in computed cranial tomography. Infusion of intravenous contrast medium with computed cranial tomography must be utilized judiciously. It is indicated to improve the detectability of lesions and to assist in differntial diagnosis.


Extrarenal pelvic hydronephrosis: report of five cases. Five patients are reported with uretropelvic obstruction and hydronephrosis in which the renal pelvis is predominantly involved. Because of the extrarenal position of the pelvis in these patients, its dilatation is apt to cause distortion and displacement of the calyces and infundibulae simulating an intrarenal mass. Calyceal and infundibular dilatation is much less apparent and general renal outline and cortical thickness is better preserved in these patients than in those with classical hydronephrosis. Careful attention to radiographic technique including delayed films, ultrasonography and occasional arteriography should prevent any confusion with a solid mass lesion.


Carotid--cavernous fistula--iatrogenic carotid--cavernous fistula due to thrombectomy with a Fogarty catheter. Removal of thrombus from a totally occluded internal carotid artery with a patent siphon by means of a balloon-tipped Fogarty catheter has been an acceptable technique. There have, however, been five reported cases of carotid-cavernous fistula following this procedure (Barker et al., 1968; Davie and Richardson, 1967; Motarjeme and Keifer, 1973; Newton and Potts, 1974). The purpose of this report is to add a sixth case to the literature and to suggest that this surgical method be abandoned.


Pulmonary disorders associated with Sjogren's syndrome. Pulmonary disorders occur in 25 to 47 per cent of the patients with Sjogren's Syndrome. These are of two types: 1. related to the major connective tissue disorders which commonly accompany this syndrome, and 2. secondary to the peculiar underlying pathology of Sjogren's Syndrome i.e. sicca disorders of the lung. The latter is the more frequent type, occurring mainly in patients with protected sicca complex unaccompanied by a systemic connective tissue disorder, and consists of chronic bronchitis, subsegmental atelectasis, pneumonia, bronchiectasis, lymphoproliferative pulmonary infiltrates and chronic interstitial pneumonitis which may lead to pulmonary fibrosis. 21 cases of Sjogren's Syndrome, 9 of whom had evidence of pulmonary abnormality, are presented, including a case of interstitial pneumonitis leading to diffuse interstitial pulmonary fibrosis. A review of the literature is included.


[Evaluation of multiple myeloma with bone scintigraphy using Tc 99 diphosphonate. Review of the literature]. Bone Scanning using 99m Tc-Diphosphonate is another diagnostic modality in the evaluation of multiple mieloma which allows the identification of bone lesions not demonstrable by conventional radiography. The use of 99m Tc-Diphosphonate is more convenient and less harmful than other radioactive isotopes utilized before.


Improved musculoskeletal angiography with large volume contrast injection and priscoline. Previously published studies of musculoskeletal angiography have not discussed the technical details of how the angiograms were performed. In the present report, two series of 57 consecutive angiograms were compared with respect to radiologic quality and clinical usefulness. The second series differed from the first in closer consultation between angiographer and orthopaedist and the use of intra-arterial Priscoline, large volume contrast injection, multiple views, geometric magnification, and photographic subtraction. These efforts were rewarded by greater vascular detail and better delineation of tumors on the angiograms. Especially with respect to soft tissue lesions, the surgeon found the studies more accurate and more useful in planning surgical management.


Metastases in colo-rectal carcinoma by isotope bone scanning. Eight of ten cases of colo-rectal cancer having positive radionuclide bone scans were observed in a Radiation Oncology Clinic in one year. Eight were referred to the institution after treatment elsewhere. In a series of fifty cases with their definitive therapy and evaluation at this institution, 33% of those with bone scans were positive. Review of recent literature shows that 50% of colo-rectal carcinoma have positive bone scans, usually following a multiple and widespread distribution including ribs, pelvis, vertebrae, skull or extremities. These studies indicate that bone scanning may greatly increase precision in staging of colo-rectal carcinoma and aid in the recognition of the truly localized primary lesion. The mechanism of spread of bone metastases in colo-rectal carcinoma was presumably through Batson's plexus.


Significance of vascularity of the breast: a quantitative approach using xeromammography. Vascularity of the breast was assessed from Xeromammograms by calculating the venous diameter ratio (ratio of the diameter of the largest vein in either breast to the diameter of a comparable vein in the opposite breast) for 60 patients (32 carcinomas and 28 benign conditions). Vein diameter was easier to measure on Xeromammograms than on conventional mammograms. If the venous diameter ratio was 1.4:1, or greater, the possibility of malignancy was increased.


A new low dose mammography technique.

A new low dose mammography technique. Reduction of radiation dosage to patients undergoing mammography is very important, especially when large-scale screening projects for early detection of breast carcinoma are considered. A new low dose mammographic technique employing Kodak XG film and Industrex F2 intensifying screen in a vacuum package has been evaluated in 533 patients. This Kodak system was found to provide excellent diagnostic quality image, and to be an acceptable technique for mammography.


Protracted arthritis in familial Mediterranean fever. A review of the files of familial Mediterranean fever (FMF) confirmed the rarity of patients suffering protracted arthritic attacks and the propensity of the joints, in general, to recover. While 70% of those afflicted suffered bouts of synovitis, only 57 patients (5% of the FMF-population) experienced protracted attacks involving a total of 84 joints, 36 of them knees and 25 hips. Functional and, usually, anatomical integrity was regained in all but 27 joints. Of the 27 joints producing residual incapacity, 21 were hips. Seven hips showed roentgenologically typical aseptic necrosis of the femoral head and 14 only sclerosis and narrowing of the joint space. Eight hips eventually required total prosthetic replacement. We suggest that the poor prognosis of the hip, in contrast to other joints affected by protracted FMF-arthritis, is related not directly to the metabolic aberrration underlying the disease but to attenuation of the arterial blood supply of the femoral head by synovial exudation. Early aspiration of exudate could alter the prognosis by preventing the complication of aseptic necrosis.


Night medication in rheumatoid arthritis: II. Combined therapy with indomethacin and diazepam. Seventeen of eighteen patients hospitalized for active rheumatoid arthritis completed a three-day randomized, double-blind comparison of 100 mg indomethacin, 100 mg indomethacin with 10 mg diazepam and matching placebo as night medication. The results showed a consistent pattern in the four functions measured--pain, morning stiffness, sleep score and patient preference. In each, indomethacin proved superior to placebo and the combined therapy better than indomethacin alone. From this it has been concluded that the combination of indomethacin and diazepam should now be considered the treatment of choice for maximum control of night pain and morning stiffness in rheumatoid arthritis.


Reumatoid arthritis in Iraq.

Reumatoid arthritis in Iraq. Altogether 198 patients (149 female and 49 male) with rheumatoid arthritis, 133 classical and 65 definite by A.R.A. diagnostic criteria, have been studied in Baghdad. The disease pattern and the joint distribution are similar to those in Europe but the disease appears to be generally less destructive; hands are involved more often than the feet, and rheumatoid nodules, severe systemic upset and extra-articular manifestations appear to be less common.


Lactoferrin in synovial fluid.

Lactoferrin in synovial fluid. The synovial lactoferrin (LF) concentrations of 59 patients with active rheumatoid arthritis were determined. The median value of LF was 4.64+/-3.59 mg/100 ml, but in degenerative arthropathy the levels of the metal-protein were much lower and often not titratable. These variations in the LF concentration explain the low blood-iron levels in inflammatory states, even when the concentration of the metal-protein is not statistically correlated in inflammatory tests, IgG, complement fractions (of the normal or alternate pathway), or variations of other protein fractions of leucocyte origin.


HL-A as a diagnostic aid in incomplete rheumatic syndromes. Incomplete Reiter's syndrome (ICRS) and incomplete Behçet's disease (ICBD) have many similar clinical features, making the diagnosis difficult. The association of RS and BD with different HL-A antigens is a help in differentiating between the two diseases. Eight patients with incomplete rheumatic syndrome are described. The results of HL-A typing suggest that five patients had incomplete RS and the other three incomplete BD. The value of tissue typing in the correct diagnosis of incomplete rheumatic syndrome is stressed.


Haemopexin behaviour in an acute hyperhaemolytic crisis secondary to favism (erythrocyte glucose-6-phosphate dehydrogenase deficiency). The behaviour of serum haemopexin was studied in patients with hyperhaemolysis after ingestion of fava beans. The linear increase in this substance after a crisis is particularly emphasized. This finding is of special importance for G-6-PD subjects with various haematological disorders.


Oestrogen receptors in relation to human breast cancer. Work leading to the concept of hormone responsiveness of human breast cancer and current views of the mode of action of oestrogens in target tissues are reviewed. Results of oestrogen receptor assays are considered in relation to clinical response to tumours to endocrine therapy and difficulties encountered in the interpretation of receptor determinations are discussed. Recent work on the distribution of different forms of the oestrogen receptors in human tumours and their relation to clinical response may lead to better selection of patients for endocrine therapy. Results of receptor assays in male patients with breast cancer, in benign breast tumours and in malignant tumours at sites other than breast are reviewed, and work on receptors for hormones other than oestrogens is discussed briefly. Further work is needed on the integrity of the receptor mechanism in tumour cells and on the effects of hormone treatment. Methods for the separation and estimation of oestrogen receptors in human tumour tissue are reviewed and discussed. Errors arising during collection, storage and analysis are considered. Different ways of calculating and expressing results of these assays are mentioned. It is suggested that more accurate determinations of oestrogen receptors may lead to better discrimination between hormone responsive and unresponsive human breast tumours.


Evaluation of the operative parameters for a human prolactin radioimmunoassay in serum. A sensitive homologous radioimmunoassay (RIA) for human prolactin (hPRL) was evaluated. The experimental parameters of this double antibody solid phase (DASP)-hPRL-RIA are discribed. The RIA measures concentrations of hPRL as low as 1 ng/ml of human serum and allows repetitive measurements and accurate delineation of serum hPRL. The assay is specific for hRPL; only HGH shows a weak cross-reaction. The antigen recovery tests are quantitative. The serum concentrations of hPRL in a group of randomly selected male and female individuals averaged 6.7 +/- 3.3 ng/ml, respectively. In a chronobiological study performed on 21 subjects (5 male and 16 female), a statistically significant rhythm with a 24-h period was detected.


Preoperative diagnosis of Meckel's diverticulum with 99mTc-pertechnetate. 99mTc-pertechnetate scintigraphy of the digestive tract was performed on 4 children with intestinal bleeding. Two of them showed a focal uptake in the right lower abdominal quadrant and a diagnosis of bleeding Meckel's diverticulum was confirmed by surgery. This procedure being easy to perform, non-invasive and remunerative, should be systematically applied in paediatric intestinal bleeding.


[Spinal subarachnoid hemorrhage in a case of stenosis of the aorta (author's transl)]. A case of aortic coarctation was reported. This vascular malformation caused a dilatation of the vessels of the thoracic segment of the spinal cord, subarachnoid hemorrhage and paraplegia. These pathological alterations are due to cystic arachnoidal modifications.


[SI-units in radiotherapy and radiation protection (author's transl)]. A review is given about SI units as they will be used in future in radiotherapy and health physics. The paper includes conversion tables for the units used in these fields and presents some somments on possible difficulties by using these units in practical work.


Inhibition by somatostatin of gastrin release and gastric acid responses to meals and to pentagastrin in man. The inhibitory actions of intravenous somatostatin on the gastric secretory responses to pentagastrin (1.5 microng/kg-h i.v.) and to a meal (10% peptone, pH 5.5) were studied in six healthy subjects. Meal-induced gastric acid output was estimated by means of a modified Fordtran and Walsh method of intragastric titration. Somatostatin (5 microng/kg-h; cyclic form) significantly inhibited the total 1-hour acid response to pentagastrin by about 70% (inhibition of pepsin secretion: about 70%) and that to a test meal by about 75%. During the last 30 min of somatostatin infusion the pentagastrin-stimulated secretion of acid was significantly reduced by about 90% (inhibition of pepsin output: about 85%) while the corresponding figure in the test with meal-induced secretion was about 95%. Serum gastric--elevated in response to the test meal--was found to be merely lowered by about 30% during somatostatin infusion. Consequently, it is tempting to assume that inhibition of human gastric acid secretion by exogenous somatostatin largely results from a direct antisecretory effect upon parietal cells and, only to a minor extent, from an indirect action via reduction of gastrin release.


Plasma secretin concentration and pancreatic exocrine secretion after intravenous secretin or intraduodenal HC1 in anaesthetized pigs. The concentration of immunoreactive secretin in arterial blood and the exocrine pancreatic secretion were measured during intraportal infusion of secretin in doses of 0.03, 0.06, 0.1 and 3.0 clinical units kg-1 h-1, and during intraduodenal instillation of 50 ml 0.1 mol 1(-1) HC1. The lowest dose of exogenous secretin to significantly increase secretin concentration in blood was 0.03 clinical units kg-1 h-1, which was a subthreshold dose of exocrin pancreatic secretion. A linear relation was found between the dose secretin and the secretin concentrations measured. On the basis of secretin concentrations, release of secretin during instillation of HC1 was estimated to be 0.22 clinical units kg-1 h-1. Maximum pancreatic bicarbonate secretion was obtained with a dose of 1.0 clinical units kg-1 h-1, and the minimal effective dose was between 0.06 and 0.1 clinical units kg-1 h-1. On the basis of the flow rate of pancreatic juice and the pancreatic bicarbonate output, secretin during instillation of HC1 was estimated to be 0.3 clinical unit kg-1 h-1. It is concluded that the radioimmunoassay used has the sensitivity and accuracy necessary for measurements of secretin concentrations in plasma during physiological conditions.


Coenzyme-A-dependent esterification of cholesterol in intestinal mucosa from guinea-pig. Influence of diet on the enzyme activity. Guinea-pig intestinal mucosa contains a microsomal enzyme which catalyses the esterification of cholesterol. The enzyme is CoA-dependent and probably an acyl-CoA-cholesterol acyltransferase (ACAT) (E.C. 2.3.1.26). The apparent Km for the CoA in the combined enzyme reaction is 3.3 x 10(-5)M. The specific activity of cholesterol esterification is about five times higher in young suckling animals than in ordinary fed adult animals. Feeding fat and fat/cholesterol diets increases the activity two- to five-fold. Concomitantly the fat/cholesterol fed animals get a marked accumulation of free and esterified cholesterol in mucosal cells.


The prognosis of chronic aggressive hepatitis. A clinical and morphological follow-up study. In a follow-up study of 85 patients with chronic aggressive (active) hepatitis (CAH) repeated liver biopsies and/or autopsy liver sections were available in 74 cases. The median time of observation was 45 months. Cirrhosis was demonstrated in 38 patients, and cirrhosis was suspected in a further five cases. Fifteen patients showed convincing histological improvement; and the remaining 16 still had chronic hepatitis. Twenty-six patients died during the observation period, seven of these of liver failure after development of cirrhosis. The clinical follow-up of the 59 survivors (median observation time 69 months) showed biochemically active liver disease in 11 cases, all having cirrhosis or chronic aggressive hepatitis in the last biopsy. The clinical findings were correlated with the morphological follow-up diagnosis and the immunosuppressive treatment. Comparison of the initial histological, clinical, and serological variables was made in two well-defined follow-up groups. There were more females, and marked portal inflammation, abnormal bile duct epithelium, and circulating autoantibodies occurred more frequently in the group with later development of cirrhosis than among the patients with subsequent morphological improvement. The results thus suggest candidates for thorough follow-up and more intensive immunosupressive or other treatment.


Serum immunoglobulins and organ non-specific antibodies in diseases of the liver. Serum immunoglobulins and C3 levels, auto-antibodies to smooth muscle (SMA), mitochondria (MA), and nuclei (ANA), rheumatoid factors (RF), HB-antigen and HB-antibody were studied in 9 groups of liver disease. Hypergammaglobulinaemia was a prominent feature in most groups, IgG being particularly raised in active chronic hepatitis, IgM in primary biliary cirrhosis, and IgA in alcoholic liver disease, respectively. IgE was often increased in alcoholic liver disease and was frequently low in hepatic tumours, whereas IgD showed no typical pattern in any liver disorder. SMA was most frequently found in active chronic hepatitis (68%), and MA  in primary biliary cirrhosis (58%), while ANA was detected in 50% of the patients with active chronic hepatitis. However, a pronounced over-lap of tissue antibodies was observed among the various groups of liver disease, particularly in active chronic hepatitis and primary biliary cirrhosis. The concurrent presence of SMA and ANA was most frequent in active chronic hepatitis. It was not excluded that antibody titres might have provided better diagnostic discrimination, since titration of antibodies was not performed. Low C3 levels in active chronic hepatitis were correlated with low levels of other liver-synthetized proteins, and no evidence was found of increased consumption by immunologic reactions.


Chronic hepatic encephalopathy. A psychometrical study. Psychometric tests were performed in 41 patients with cirrhosis of the liver and suspected hepatic encephalopathy and compared with EEG-examinations and clinical investigations. Marked intellectual impairment was noted frequently even when the clinical investigation was normal. This difference was mainly due to the preserved verbal ability of the patient. The etiology of the cirrhosis did not influence the test results. Male cirrhotic patients with and without alcoholism showed significantly more intellectual impairment then alcoholics without cirrhosis. Patients Patients with constructed porto-systemic shunts showed only slightly reduced intellectual ability compared to those without shunts.


Influence of age and stomach function on serum vitamin B12 concentration. Serum vitamin B12 (B12), maximal gastric acid output (MAO), and B12 absorption were determined in 82 subjects, age 32 to 85 years, who had normal absorption of radiocyanocobalamin. In 46 of the patients the gastric intrinsic factor (IF) was also measured. Serum B12 concentration and MAO varied widely in all age groups from abnormally low to definitely normal. The mean values for serum B12 and MAO, however, declined very similarly with advancing age owing to an increased incidence of low values for these two measurerment in the aged. There was no significant fall in the mean B12 absorption or IF secretion as a function of old age. Achlorhydric and hypochlorhydric patients invariably had lower mean serum B12 concentrations than those with adequate MAO. Conversely, patients with normal MAO all had normal serum B12 levels. Serum B12 concentration, although correlating with both MAO and IF secretion, showed a closer relationship to the former than to the latter. These findings suggest that the stomach, aside from producing the IF, plays an important role in maintaining a normal serum B12 concentration.


Dynamics of antral and fundal gastritis in an Estonian rural population sample. The random population sample collected from an Estonian rural district, and in which antral and fundal gastritis was studied by means of direct vision biopsy technique, was subjected to stochastic analysis identical to that performed earlier on a Finnish representative population sample. Antral gastritis started at an earlier age than fundal gastritis. The antral and fundal age-dependent score lines, which illustrate the dynamic behaviour of each population sample as a whole, nearly meet at later age, indicating that the progression of fundal gastritis is more rapid than that of antral gastritis. The prevalence of fundal gastritis was somewhat lower in this material than in the Finnish rural population sample. However, the age-adjusted score values did not significantly differ in these population samples.


e System and intrahepatocelullar HBcAG and HBsAG in HBsAG positive patients with liver diseases and healthy carriers. Patients with hepatitis-B surface antigen positive liver diseases and healthy carriers were studied for the presence of e-antigen and anti-e as well as for intrahepatocellular HBsAG and hepatitis-B core antigen. The e-antigen was demonstrated in 9 out of 12 patients with chronic perisitent hepatitis, in 15 out of 39 patients with chronic active hepatitis, in 3 out of 40 patients with acute type B hepatitis, and in 2 out of 9 patients with a protracted course of type B hepatitis. No e-antigen was found in healthy HBsAG carriers nor in patients with complete recovery from type B hepatitis one year after onset of the disease. Anti-e was detected in 24 out of 61 healthy HBsAG carriers with a normal liver histology and in one patient with a mild form of a chronic persistent hepatitis. The presence of e-antigen in serum was highly associated with the presence of HBcAG in the nuclei of the liver cells. Twenty-seven out of 29 e-positive patients had HBcAG in the liver cell nuclei. In contrast, none of 20 patients with anti-e in serum had HBcAG in the liver cells.


Colonic propulsion in diverticular disease, idiopathic constipation, and the irritable colon syndrome. Colonic intraluminal pressure and intestinal transit were examined in diverticular disease, idiopathic constipation, and the irritable colon syndrome. Small bowel transit was normal. Total gastrointestinal transit was prolonged. Colonic transit showed an equal delay in all segments, expedited by bran. In constipation, transit was the more prolonged, but in the irritable colon syndrome, pressure was more affected. Diverticular disease patients showed features resembling each of these two groups. Pressure and transit showed an inverse relationship maintained after bran.


Treatment of retained bile duct calculi with T-tube infusion of sodium cholate and heparin. A series of 26 patients with retained radiolucent bile duct calculi diagnosed at postoperative cholangiagrophy through the T-tube is presented. All patients were treated with infusion of 15-20 g sodium cholate in 1000 ml saline and 20,000 units of heparin in 1000 ml saline per 24 hours. In 19 of 26 patients (73 per cent) the calculi disappeared. No complications were encountered. This treatment is recommended prior to reoperation in all patients with retained radiolucent bile duct calculi diagnosed by postoperative cholangiography through the T-tube.


Frequency of gallstone disease in a well-defined Swedish population. A prospective necropsy study in Malmö. In a necropsy series from Malmö of 2,218 subjects above 20 years of age, and composing 88.2% of all persons above 20 who died that year in Malmö, the frequency of diseases of the gallbladder and bile ducts was studied. The frequency of gallstone disease (gallstone at necropsy or postoperative state) was 44%; 32% for males and 57% for females, with a maximum frequency for males of 57% in the 90-99 year age group and for women-about 63%-in all age groups above 70. Of subjects with cholecystolithiasis 27% had 1 stone, 36% 2-10 stones, and 8% had more than 100 stones. The same proportion-about one-fifth--of both men and women with gallstone disease had been operated upon, and in 11% of the operated cases stones were found in the remaining bile ducts. Chronic cholecystitis was noted in 17% of the cases. Cancer of the gallbladder was observed in 20 subjects with marked female preponderance. Cancer of the bile duct was noted in 12 cases. In 3.2% of the cases with gallstone disease this disease had been the cause of death (chief or contributory).


Acid secretory responses to histamine, pentagastrin, and feeding before and after vagal denervation of fundic pouches in cats. Dose-response curves for acid output to histamine, pentagastrin and feeding were determined in cat before and after vagal denervation of the fundic pouch. Before denervation, the maximal response to the three stimulants was equal. Denervation reduced the acid response to histamine by decreasing the secretory capacity, and to pentagastrin by decreasing both the secretory capacity and sensitivity of the oxyntic glands. In this respect the effect of local and truncal vagotomy is equal in cats. The reduction of the response to feeding was greater than to histamine and pentagastrin. In the denervated pouch, the maximal response to feeding amounted to two-thirds of that to histamine and pentagastrin. This demonstrates that feeding does not release enough gastrin to induce maximal rate of acid secretion in the absence of vagal impulses. Nevertheless, feeding and pentagastrin produced equal maximal responses before denervation. This suggests that vagal impulses during feeding produce greater enhancement than basal vagal tone of the acid response to submaximal doses of gastrin.


Rectal mucosal adrenergic innervation and enterochromaffin cells in ulcerative colitis and irritable colon. Rectal mucosal biopsies of 13 patients suffering from ulcerative colitis, 7 patients presenting symptomatology typical of irritable colon, and 7 control persons were studied by the recently introduced glyoxylic-acid-induced fluorescence histochemical method. In ulcerative colitis, compared to control specimens: 1) the density of the adrenergic nerve network was significantly pronounced; 2) the mean diameter of the varicosities and the proportional share of large varicosities were increased, as well as the number of varicosities per a given length of an axon; 3) the intensity of the fluorescence of varicosities of comparable size was significantly increased; 4) the number of enterochromaffin cells was significantly decreased. In irritable colon, compared to control specimens, the number of enterochromaffin cells was significantly increased. These findings suggest that biogenic amines are somehow involved in both ulcerative colitis and irritable colon. The fluorescence histochemical method used was found sensitive, specific, and suitable for comparative studies on human clinical material.


Diabetes and hypoglycemia in chronic pancreatitis. Fifty-nine patients with chronic pancreatitis were studied in retrospect. The incidence of overt diabetes was high, 36/59. Half of the diabetics were insulin-dependent, and among these labile diabetes with hyperglycemia and high amounts of glucose in the urine was not uncommon. Hypoglycemic episodes were noted in 14 of the 18 insulin-treated patients, and in 3 patients severe hypoglycemia was believed to be the cause of death. Mechanisms leading to such disastrous hypoglycemia are discussed, and a hypothesis regarding lack of glucagon as the cause of severe hypoglycemic attacks was experimentally tested by measuring pancreatic glucagon in plasma in two patients with pancreatic diabetes and severe brain damage following hypoglycemic coma. Low basal glucagon values were found, and the normal rise upon insulin-induced hypoglycemia was not seen. From these results it may be justified to suggest, firstly that glucagon should be used in the management of severe hypoglycemia in chronic pancreatitis, and secondly that a certain degree of hyperglycemia should be allowed in the treatment of diabetes in these patients.


Effects of cholecystokinin on the motility of the distal duodenum and the proximal jujunum in man. Electrical spike potentials and intraluminal pressure variations were recorded in the distal part of the duodenum and proximal part of the jejunum in 5 normal human subjects before and after a bolus injection of cholecystokinin. A considerable increase in activity was observed in the jejunum after the hormone, whereas there was no response in the distal duodenum. Absence of reaction in the proximal duodenum and an increase in the motility in the distal ileum has previously been demonstrated after cholecystokinin administration. It is concluded that the human duodenum differs from the rest of the small intestine in its reaction to cholecystokinin. The change in reaction appears to occur on a level with the ligament of Treitz.


[Ways for the evaluation of the infectivity of HBS-Ag positive subjects]. It is highly desirable for the subject with HBsAg-positive blood and his contacts to be aware of the attendant infectivity. It appears that only blood containing DANE particles is infective. Today it is known that the blood of patients with chronic active hepatitis, of HBsAg-positive patients under immunosuppression, and during the early phase of acute viral hepatitis, contains large amounts of DANA particles. Therefore, from clinical data and histological evaluation of the liver it is possible to deduce the level of infectivity risk in a given patient. It is still an open question whether DNA-polymerase, HBc-antigen or the E-antigen provide helpful information on the infectivity of HBsAg blood.


[Epidemiology of amebiasis and of tropical malaria]. The steady growth of intercontinental travel is causing an increasing incidence of tropical diseases in Switzerland. Malaria and amebiasis deserve special attention, due to their frequency and potential fatality. The epidemiology, clinical findings, diagnostic approach, and current treatment of malaria and amebiasis are briefly reviewed. If these infections are recognized in time and treated according to modern standards, fatal outcome is extremely rare.


[Dihydralazine-induced acute hepatitis with IgM deficiency]. Two patients with IgM-deficiency developed acute, recurrent HB3-Ag negative hepatitis with bridging necrosis following ingestion of low daily doses of dihydralazine. The association between the drug and the liver disease appears probable, as recurrence of hepatitis followed each exposure. One patient developed high titers of antimitochondrial antibodies and the other low titers of antibodies against smooth muscles. The relationship between IgM-deficiency and dihydralazine hepatitis is not clear. Investigation of patients with IgM-deficiency for drug hypersensitivity and liver disease may provide additional information.


[Liver damage caused by adelphan].

[Liver damage caused by adelphan]. Hepatic damage due to Adelphan or to one of its two components (Rauwolfia alkaloids [Reserpin] and 1,4-dihydrazinophthalazine [Nepresol]) has not thus far been described. A patient is presented who repeatedly reacted to Adelphan with fever, chills and hepatic damage. Adelphan should therefore be added to the list of drugs which may cause hepatic damage.


[Clinical study of the biological availability of lanatoside C and digoxin in long-term tests]. The bioavailability of digoxin and lanatoside C from tablets and dragees and from solutions of the two substances has been investigated intraindividually in patients on maintenance therapy. Plasma levels and urinary excretion were analyzed by radioimmunoassay. Both plasma concentrations and urinary excretion were significantly higher after digoxin tablets (1.5+/-0.17 ng/ml; 0.15 mg/24 h) than after lanatoside C dragees (0.98+/-0.15 ng/ml; 0.1 mg/24 h). When equimolar solutions of both drugs, corresponding to 0.5 mg digoxin, were given, plasma concentrations and urinary excretion after digoxin (1.6+/-0.08 ng/ml; 0.14 mg/24 h) were again significantly higher than after lanatoside C (1.18+/-0.09 ng/ml; 0.1 mg/24 h). These results suggest that while the absorption of lanatoside C is lower than that of digoxin, it is better than has been generally assummed. The variability in the absorption of lanatoside C between patients is no greater than with digoxin.


[Effect of the angiotensin antagonist saralasin on blood pressure and hemodynamics in patients with terminal renal insufficiency]. The angiotensin antagonist saralasin was infused both before and 10 hrs after dialysis in 10 hypertensive and 4 normotensive patients hemodialyzed for terminal renal failure. A significant increase in mean arterial pressure (MAP) and total peripheral resistance (TPR) without change in cardiac output measured by impedance cardiography were observed during the first few minutes of saralasin infusion. MAP and TPR decreased during the second half of the infusion in 4 hypertensive patients and remained at the preinfusion levels in 6 hypertensive and 4 normotensive patients. Plasma renin activity (PRA) was significantly higher in patients in whom MAP fell both before and after hemodialysis. There was a significant correlation between PRA before saralasin and the fall in MAP and TPR. The fall in MAP in 4 of 10 hypertensive patients demonstrates that inappropriately high renin and angiotensin levels are involved in the pathogenesis of hypertension in some patients with terminal renal failure. Volume factors are probably of primary importance in the other patients.


[Familial primary chronic type ventilation]. Primary hypoventilation (Ondine's curse), due to diminished sensitivity ofthe respiratory center to CO2, is very rare. Up to now only a few patients have been observed, ten of whom were children. Familial occurrence was reported in 1976 for the first time. The cases are described of a 10-year-old girl and her mother who both showed the typical clinical and pathophysiological symptoms. Our own observation also suggests that this unknown defect of respiratory regulation could be inherited. Sedation, anesthesia, or severe respiratory tract infection are life-threatening situations in these patients. Pulmonary hypertension and right heart failure are possible long-term complications.


[Thyroid neoplasms before and after the prophylactic supplementation of table salt with iodine]. Fifty years ago Switzerland was known to be an endemic goiter area. Iodine deficiency has since been abolished by supplementation of table salt with iodine and increasing consumption of imported food. On the basis of the large number of specimens in the University Institute of Pathology in Zürich, an attempt has been made to determine whether morphological aspects of malignant thyroid tumors have changed in the intervening perified according to the WHO nomenclature of 1974. Comparison of these results with those of a similar study covering the period from 1962 and 1973 showed that the relative incidence of some tumor types definitely changed following the introduction of iodine prophylaxis. Follicular and anaplastic carcinomas have decreased in number, while papillary carcinomas are nowadays more frequent. The sex-ratio distribution has also been modified, female patients being now in the majority. Altogether the proportion of differentiated carcinomas has increased during the period from 1962 onwards, and their far more favourable prognosis will probably lead to retrogressive mortality rates for malignant thyroid tumors.


[Inside and outside particulate pollution of a locality]. The present study of the suspended matter concentration within and outside premises has shown: that inside premises, the filtrating effect of the walls during non-occupation periods (week-end) is apparent, thus the inside concentration remains below the outside concentration; that during the hours and the days when the premises are occupied, the inside concentration is significantly above the outside concentration; that the increase in concentration may be expressed by an "occupation index" depending on the number of people within the premises; that chemical composition and grain size spectrum undergo changes which seem to indicate the appearance of less acid particles which contain more ammonia and nitrates and less SO4, Ca, Fe and Pb than those to be found outside. These particles seem to originate from condensation and recent abrasion. This final point of the conclusions, based on preliminary experimental evidence, has not the pretention to be definite.


Environmental asbestos pollution related to use of quarried serpentine rock. Crushed serpentinite quarried in Montgomery County, Maryland, has been extensively used for paving roads and other surfaces. The mineral assemblage includes antigorite or lizardite as well as chrysotile and tremolite. Air samples taken in the vicinity of serpentine-paved roads show that chrysotile concentrations are about 10(3) times greater than those typically found in urban ambient air in the United States.


Pathogenic amoebas from brackish and ocean sediments, with a description of Acanthamoeba hatchetti, n. sp. Acanthamoeba culbertsoni was isolated from a sewage-spoil dump site near Ambrose Light, New York Bight. A second species, Acanthamoeba hatchetti, n. sp., was isolated from Brewerton Channel, Baltimore Harbor, Maryland. Both species killed laboratory mice after infection by the intranasal route.


Radioimmunoassay for abnormal hemoglobins. A sensitive and specific radioimmunoassay has been developed for the identification or quantification of the human hemoglobin variants S, C, D-Los Angeles, E, G Philadelphia, Russ, O Arab, Beograd, J Paris I, G San Jose, Q Iran, Korle Bu, and F Malta I. In the immunoassay, monospecific antibody preparations are used which recognize the single amino acid substitution in the variant polypeptide chail and do not cross-react with normal hemoglobins or hemoglobin variants containing a different amino acid exchange at the same position.


Potential operating region for ultrasoft x-ray microscopy of biological materials. Calculations are presented which indicate an extensive suboptical region in the microscopy of biological materials in their natural state which is accessible to ultrasoft x-ray transmission microscopy. Throughout most of the region, radiation dosage levels to the specimen are lower than in electron microscopy.


Synthetic peptides form ion channels in artificial lipid bilayer membranes. Ion permeability of cell membranes is considered to be mediated by ion channels. The synthesis and testing of four peptides having the sequence (Leu-Ser-Leu-Gly)n and expected to form beta126,6-helical ion channels in lipid bilayer membranes is reported. The two peptides capable of forming helices four turns in length have been demonstrated to form ion channels in an artificial lipid bilayer membrane system. The ion selectivity of the channels is consistent with the predicted beta12-helical model in which ions traversing the channel are coordinated by serine hydroxyl groups arrayed in the interior of the channel.


Laser fluorimetry: subpicogram detection of aflatoxins using high-pressure liquid chromatography. The use of high-pressure liquid chromatographic separation in conjunction with laser-induced fluorescence detection permits the analysis of trace fluorescent species at new limits of sensitivity. This technique was applied to the carcinogens aflatoxins B1, B2, G1, and G2, which were linearly quantitated to 7.5 x 10(-13) gram. The procedure consists of forming more fluorescent aflatoxin derivatives, eluting the aflatoxins from a reverse-phase column, focusing the 325-nanometer output of a helium-cadmium ion laser into a suspended droplet of the eluent, and measuring the resulting fluorescence using phase-sensitive detection.


Monomeric forms of the acid ionophore lasalocid A (X-537A) from polar solvents. X-ray structural analyses have been carried out on the free acid of lasalocid A (X-537A) and on the sodium salt, both crystallized from methanol solution. In each case the structure is monomeric with one molecule of methanol complexing to the free acid and to the salt.


Increasing photosynthesis by inhibiting photorespiration with glyoxylate. Glyoxylate treatment doubles net photosynthetic carbon dioxide fixation by tobacco leaf disks because inhibition of glycolate synthesis by glyoxylate results in decreased photorespiration. These observations show that photorespiration can be metabolically regulated and suggest that genetic or chemical alteration of pool sizes of certain metabolites can produce plants with increased photosynthesis.


Persistence of Hong Kong influenza virus variants in pigs. The A/Hong Kong/1/68 (H3N2) influenza virus which has not been isolated from man for several years, was recently isolated from pigs in Hong Kong. Influenza viruses similar to A/Victoria/3/75, which are currently circulating in man, were also isolated from pigs. Both above-mentioned viruses could be transmitted readily from pig to pig in experimental studies. The isolation of influenza viruses similar to A/Hong Kong/68 from pigs in 1976 suggests that pigs may serve as a potential reservoir for future human pandemics as well as a possible source of genetic information for recombination between human and porcine strains of influenza virus.


Tumor antigen and human chorionic gonadotropin in CaSki cells: a new epidermoid cervical cancer cell line. Epidermoid cervical carcinoma cells (CaSki line) have been established in continuous culture. When leukocytes from cervical cancer patients were incubated with CaSki culture fluid concentrates, inhibition of leukocyte migration was observed in more than 70 percent of the patients tested. By contrast, significantly less inhibition was observed with normal donor leukocytes or leukocytes from patients with other types of cancer. These results were consistent with the expression of tumor-associated antigen by CaSki cells. Analysis of the serum from the donor of the cell line at the time of tumor biopsy, and of CaSki culture fluids, demonstrated the presence of the beta subunit of human chorionic gonadotropin.


Steroid contraceptive use and cervical dysplasia: increased risk of progression. In a prospective study of women with dysplasia of the cervix, there was an increase in severity of dysplasia and of conversion to cancer in situ in users of the contraceptive pill compared with users of other contraceptive methods. There was a delay in this adverse response. Nonreversal of dysplasia within the first 6 months of pill use is predictive of progression after prolonged exposure.


Motor vehicle fatalities increase just after publicized suicide stories. The average increase in motor vehicle fatalities is 9.12 percent in the week after a suicide story. The more publicity given to the story, the greater the rise in motor vehicle deaths thereafter. This rise apparently occurs because suicide stories stimulate a wave of imitative suicides, some of which are disguised as motor vehicle accidents.


Somatostatin: analogs with selected biological activities. [D-Cys14]-Somatostatin is the first analog of somatostatin found to be more potent in inhibiting glucagon and growth hormone secretion that it is in inhibiting insulin secretion. [D-Trp8]-Somatostatin is eight to ten times more potent than somatostatin in inhibiting insulin, glucagon, and growth hormone secretion. [D-Trp8, D-Cys14]-Somatostatin is more potent than [D-Cys14]-Somatostatin, but retains its relative selectivity in being a more potent inhibitor of the secretion of glucagon and growth hormone than of insulin.


Somatostatin: electron microscope immunohistochemical localization in secretory neurons of rat hypothalamus. Somatostatin, the hypothalamic hormone which inhibits the secretion of growth hormone by the pituitary, has been localized in the rat hypothalamus by using electron microscope immunohistochemistry. Somatostatin occurs in secretory granules (80 to 110 nm in diameter) of a few neurons located in the hypothalamic periventricular nucleus. These observations establish the identity of neurosecretory neurons involved in the regulation of adenohypophyseal secretion.


Birth order and intellectual development: the confluence model in the light of cross-cultural evidence. For Israeli eighth-grade students of Asian-African origin, achievement decreases as a function of birth order in small families and increases as a function of birth order in large families. This finding cannot be accounted for by differences in developmental rate or size of birth intervals. It can be accounted for by considering the effect of external influences, such as schooling, on intellectual development.


Cannabinoids inhibit testosterone secretion by mouse testes in vitro. Addition of delta-9-tetrahydrocannabinol or cannabinol to an incubation medium containing decapsulated mouse testes caused a significant reduction in the accumulation of testosterone in the medium. This result suggests that the reported effects of cannabis on male sexual and reproductive function may result from direct inhibition of testicular steroidogenesis by both psychoactive and nonpsychoactive constituents of marihuana.


Suppression of sympathetic nervous system during fasting. Two days of fasting in rats significantly reduces the turnover of norepinephrine in the heart. In contrast to the effects of ganglionic blockade in fed controls, similar blockade in fasted animals is without significant effect on [3H]-norepinephrine retention or endogenous norepinephrine in the heart. These data are consistent with suppression of centrally mediated sympathetic activity in the fasted state. The decrease in norepinephrine turnover during fasting is completely reversed by 1 day of refeeding.


2-Deoxy-alpha-ecdysone from ovaries and eggs of the silkworm, Bombyx mori. From ovaries dissected from developing and emerged adults of the silkworm, Bombyx mori, two substances having high molting hormone activity were isolated. One of these was identified as 2-deoxy-alpha-ecdysone by means of high-pressure liquid chromatography and mass spectrometry. Although this compound had previously been isolated from the fern Blechnum minus and postulated to be the precursor of alpha-ecdysone, it had not been obtained from insect material. The compound is also contained in the form of a conjugate in ovaries as well as in diapausing silkworm embryos.


Cardiac glycosides in the defensive secretion of chrysomelid beetles: evidence for their production by the insects. The defensive secretions of some chrysomelid beetles belonging to the genera Chrysolina, Chrysochloa, and Dlochrysa contain complex mixtures of cardenolides. The spectral data for some of these compounds suggest that they are monohydroxylated digitoxigenin derivatives linked to a pentose (such as xylose or arabinose). Evidence indicates that the beetles do not sequester these steroid glycosides from their host plants.


Freeze-fractured purple membrane particles: protein content. Optical diffraction and image reconstruction can be used to correlate the electron microscope image of the biological membrane with its electron density projection. Such correlation shows that a single purple membrane particle contains 9 to 12 protein molecules--63 to 84 transmembrane alpha helices--a complexity two to ten times greater than that previously suggested for membrane particles.


Androgen concentration in motor neurons of cranial nerves and spinal cord. After injection of [3H]dihydrotestosterone, a major testosterone metabolite, radioactivity is concentrated in nuclei of certain cells in the midbrain, pons, medulla oblongata, cerebellum, and spinal cord. While there is some overlap between androgen and estrogen target neuron distribution, certain motor neurons appear to be selectively labeled by androgen; in contrast, estrogen localization prevails in sensory neurons. These results may help to explain why male sexual behavior in some rodents is not fully activated with dihydrotestosterone alone but in addition requires estradiol, a testosterone metabolite.


Stereopsis in the falcon.

Stereopsis in the falcon. Stereoscopic depth perception is demonstrated in the falcon, a non-mammalian with binocular vision. This result complements recent physiological evidence for binocular interaction in the bird visual system, and suggests that stereopsis may be a general attribute of vertebrate vision and not an exclusive product of mammalian evolution.


Homosexual rape and sexual selection in acanthocephalan worms. Acanthocephalan males have cement glands associated with the vas deferens, secretions from which seal the female vagina with a cap after copulation and so prevent subsequent insemination. Homosexual rape results in the male victim having the genital region sealed off with cement and effectively removed from the reproductive population. Sperm and cement are transferred to females during copulation, but apparently only cement is transferred to males during homosexual rape. Acanthocephalans conform to a parental investment model, and we interpret the evolution of the cement gland and sexual behavior as the result of sexual selection.


Morphine and enkephalin: analgesic and epileptic properties. Systemic and intracerebroventricular administration of analgesic doses of morphine resulted in large increments of spontaneous multiple unit activity in the periaqueductal gray matter of the awake rat. Intracerebroventricular injection of methionine enkephalin gave analgesia in only 8 of 19 rats, but in all 8, and in no others, increased periaqueductal multiple unit firing was also seen. These findings support the view that the periaqueductal gray matter is actively involved in endogenous mechanisms of analgesia. A striking observation was that enkephalin caused electrographic and behavioral epileptic phenomena in most animals. This observation together with other recent findings suggests that endogenous enkephalin may play some role in epileptogenesis.


Efferent optic nerve fibers mediate circadian rhythms in the Limulus eye. When the horseshoe crab is kept in constant darkness, the lateral eye produces larger electroretinographic and optic nerve responses at night than during the day. These circadian rhythms are mediated by synchronous bursts of efferent impulses in the optic nerve trunk. The endogenous efferent activity appears to increase both the gain and the quantum catch of the photoreceptors.


Toxic hepatitis in black patients in natal. The clinical and pathological features of toxic centrilobular zonal necrosis in Natal Blacks are described. It is suggested that this condition may be caused by the toxic action of Callilepis laureola (known to the Zulu as 'impila'). This plant and other herbs are used by many Blacks for self-medication or are prescribed by herbalists and witchdoctors.


Bence Jones myelomatosis and intravenous pyelography. The consequences of intravenous pyelography are described in 3 patients with unsuspected myelomatosis. One patient died, and 1 surviving patient showed unusual solubility of Bence Jones protein to acid pH in vitro. The urine of a third patient was negative for Bence Jones protein. Simple chemical screening of urine, to detect Bence Jones protein, is essential before patients undergo urography.


Serum levels of 25-hydroxycholecalciferol as a diagnostic aid in vitamin D deficiency states. The measurement of serum levels of 25-hydroxycholecalciferol in the diagnosis of rickets is discussed in the light of recently acquired knowledge of vitamin D metabolism. A useful clinicopathological classification of rickets is presented and various aetiological mechanisms are discussed.


Sick leave--honour or expediency?

Sick leave--honour or expediency? Experience has shown that doctors tend to be overgenerous when awarding sick leave. Quite rightly their first consideration is their patient, but frequently too little thought is given to the overall effect that excessive absence because of illness may have have on the patient, on the company in which he works, and on the country as a whole. Economically, these effects may be profound. A tempered industrial viewpoint is put forward and South African law regarding sick leave is outlined. A plea is made to doctors to safeguard their sick leave notes, prescription pads or letterhead paper, to award sick leave on merit, giving legible sick leave notes containing the necessary information, and to the profession not to overlook the wider aspects of the matter.


Studies on Bermuda grass pollen allergens. Two allergens, BGP-1 and BGP-2, were identified in crude Bermuda grass pollen extract. BGP-1 was a major allergen and elicited a skin reaction in all subjects sensitive to the crude extract, whereas BGP-2 was a minor allergen and elicited a reaction in only 75% of such subjects. Calibrated column chromatography was used to determine the molecular weights and Stokes radii of the allergens. For BGP-1 they were 30 000 daltons and 24,3 X 10(-8) cm respectively and for BGP-2 they were 14 000 daltons and 18,1 X 10(-8) respectively. The sedimentation coefficient (S20,w) of BGP-1 on sucrose density gradient ultracentrifugation was 3,1 and on iso-electric focusing its iso-electric point was found to be pH 5,4. The reason why only certain individuals sensitive to BGP-1 are sensitive to BGP-2 is discussed. It is possible that the former is a dimer of the latter.


Tuberculosis of the breast.

Tuberculosis of the breast. Twenty-one cases of mammary tuberculosis are reported and the attendant clinical and histological difficulties described. It is probable that contemporary clinicians would now make the clinical diagnosis of breast abscess or carcinoma. Furthermore, the histological features (without demonstration or culture of the organism) may be confused with those granulomatous epithelloid reactions seen in mammary duct ectasia (comedo cell mastitis, plasma cell mastitis) and in traumatic fat necrosis.


The changing epidemiology of serum albumin levels in Southern Africa. It is generally accepted that serum albumin levels are the best criterion of protein nutritional status. In order to investigate this situation in the Black populations of South Africa, serum albumin concentrations were determined in several hundred normal individuals during each of three large-scale epidemiological surveys. The populations, who lived at very different socio-economic levels, were a tribal Xhosa group, a rural Tswana community and a sample of the detribalized urban population of Soweto. In each group males and females had similar serum albumin levels, which decreased with advancing age; however, there were significant overall differences between each of these populations (P less than 0,05). In distinction to the findings in other surveys, the rural group had the highest serum albumin level, while the tribal population had the lowest. It is apparent that the semi-westernized rural Tswana group enjoy an adequate standard of protein nutrition, the urban community is in a marginal situation, and the tribal Xhosa group is seriously undernourished.


The perinatal infective environment and infants of very low birth weight. Evidence of an infective environment was frequently found in infants weighing less than 1 500 g at birth. Bacterial cultures from multiple sites bore no correlation to pus cells in the gastric aspirate or to placental histology. Positive cultures of ear swabs correlated with mortality, as did placental infection. The presence of pus cells in the gastric aspirate was related to histological evidence of placental infection. The duration or rupture of membranes and the serum IgM levels were not significantly associated with other findings.


Familial hyperchylomicronaemia in four families. Problems in diagnosis, management, and aetiology reviewed. We report on the clinical and biochemical findings of 8 patients with familial hyperchylomicronaemia (type I hyperlipoproteinaemia) from 4 separate kindreds. The diagnosis is generally easily established by the presence, in standing plasma, of a creamy chylomicron layer over a clear infranatant and by the large predominance of triglycerides over cholesterol in the plasma. Additional aids are the presence of chylomicrons on lipoprotein electrophoresis and the markedly reduced liberation of lipolytic activity into the plasma of these patients, after the administration of heparin. Difficulties in diagnosis may arise in patients on reduced fat diets, resulting in an increase of very low density lipoproteins and a type IV or V phenotype. The precise nature of the primary genetic defect remains to be established but the disorder appears to be aetiologically distinct from type IV or V hyperlipoproteinaemia. Reduction of chylomicron, and hence of triglyceride values in the plasma, is wholly dietary.


Portal vein thrombosis in adults.

Portal vein thrombosis in adults. Idiopathic thrombotic occlusion of the extrahepatic portal vein is one of the commonest causes of portal hypertension in adult Blacks. The condition occurs more frequently in men and may be accompanied by evidence of minor functional impairment of the liver. Associated pancytopenia is quantitatively related to the degree of splenomegaly. Assessment of a spectrum of variables of blood coagulation and fibrinolysis, while failing to shed light on  the possible pathogenesis, does suggest a rational basis for thrombolytic therapy.


Cavernous haemangioma of the spleen. A case report. Splenic cavernous haemangioma is a rare cause of splenomegaly. It is a benign tumour which has seldom been diagnosed pre-operatively, because the clinical presentation is usually atypical. This is reflected in a patient who presented with splenomegaly, and in whom cavernous haemangioma of the spleen was diagnosed only after operation.


Clinical experience with the contraction stress test. During a period of 16 months, 1 170 contraction stress tests (CST) were performed on 767 women who were at high risk of losing their babies. The tests were positive in 42 patients, of whom 29 were subsequently delivered by caesarean section. Fetal distress, which necessitated caesarean section, occurred in 5 of 6 cases of intra-uterine growth retardation in which labour was induced. Abruptio placentae caused the intra-uterine death of 4 fetuses, 3 of which died within 7 days of a negative CST. The low perinatal mortality rate of 13 demonstrates the reliability of the CST in the evaluation of placental function in obstetric patients who are at high risk.


Pressure necrosis of a caesarean section scar with exteriorization of the gravid uterus. A case report. A case of pressure necrosis of a caesarean section scar with protrusion of the gravid uterus through the wound is described. We can find no mention of a similar case in the literature. The management during the pregnancy presented some alarming problems, all of which were overcome, and the pregnancy was terminated by caesarean hysterectomy at 38 weeks. A healthy baby was delivered and the mother recovered.


Perinatal mortality in Cape Town.

Perinatal mortality in Cape Town. Perinatal mortality in Cape Town has progressively decreased in all racial groups over the past 60 years. The perinatal mortality rate for Coloureds and Blacks, however, remains at 20 per 1 000 more than for Whites. While the stillbirth rate approximates the early neonatal death rate in Whites, the stillbirth rate for Coloureds and Blacks is double the rate for early neonatal deaths. Although there is a significantly higher early neonatal death rate for Coloureds and Blacks, the major component of perinatal loss is stillbirth and 80% of stillbirths occur before the onset of labour. Focus should be on the detection of the fetus at risk, with, perhaps, earlier intervention.