[Traumatic occlusions of the supraclinoid internal carotid artery]. The authors report two cases of post-traumatic occlusions of the internal carotid artery, located at the level of emergence or just above the emergence of this artery out of the cavernous sinus. Comparing those two cases with five others reported in the litterature, the authors try to explain their mechanisms of occlusion : thrombosis or embolism.


Chromosome aneuploidy associated with aging. A survey of previous studies of aneuploid chromosome aberrations associated with aging with a discussion of the present evidence for this as well as a discussion concerning cause and effect of aneuploidy and the need for further studies of aneuploidy as a possible aetiological factor in aging and dementia are described.


A preventive effect of potassium against fatal lithium intoxication in rats. The effect of potassium against lithium intoxication was studied in two groups of rats given food containing 100 mmol of sodium and 100 or 1,100 mmol of potassiam/kg dry weight. After 1 week 80 mmol of lithium chloride/kg dry weight was added to both diets. Four days later the body weight, serum lithium concentration, and urinary lithium clearance were all significantly higher in the high potassium group than in the other group. After 15 days the lithium clearance had fallen to one fifth in the lowest potassium group but was unaltered in the high potassium group. All rats in the low potassium group continued to lose weight and died of lithium intoxication within 20 days, while the rats given high potassium survived and gained weight. A high potassium content of the food was able to prevent a fatal lithium-induced loss of sodium and to maintain a normal lithium clearance. It is suggested that also a lithium-induced loss of potassium was counteracted.


Multiple drug interviews as a diagnostic technique: a clinical case study. Diagnostic information obtained from a single drug interview is subject to conscious and unconscious distortion by the patient and to interviewer effects. Rationales for the various provocative techniques are reviewed, with particular reference to the amphetamine psychosis and to state-dependent learning. A format for a controlled series of multiple provocative interviews which "triangulates" on the same clinical problem from several theoretical perspectives is proposed, and a clinical case is presented in which this format was employed. Used in this way, drug interviews may provide useful diagnostic information.


Administration of lithium to rats by different routes. Rats were given identical doses of lithium chloride, 4 mmol/kg body weight/day for 8 days, by different routes. Intraperitoneal administration led to a high serum lithium peak and the development of pronounced polyuria-polydipsia. Subcutaneous administration led to a lower serum peak and the development of less pronounced polyuria-polydipsia. Administration by gastric tube led to a nearly constant serum lithium concentration without any peak and the development of moderate polyuria-polydipsia. Our study shows that the route by which lithium is administered affects the lithium concentration pattern and may influence lithium effects.


Dopamine-beta-hydroxylase activity in serum and cerebrospinal fluid in neuropsychiatric diseases. A 24-hour rhythm in serum dopamine-beta-hydroxylase (DBH) activity in chronic schizophrenic patients showed a similar change as that in normal subjects: the highest activity during day time with a peak at 12.00 h and the lowest activity at night with a bottom at 24.00 hr, 4 h after sleep onset. Between a group of schizophrenic patients who have sleep disturbance and another group of patients who have normal sleep patterns, no significant difference was observed in the 24-hour rhythm in serum DBH activity. Very low but significant DBH activity was found in cerebrospinal fluid of neuropsychiatric patients, and the values were approximately 1/1,000 of the serum activity. A case after cerebral injury showed a high DBH activity in cerebrospinal fluid.


Lithium RBC/plasma ratio in subgroups of patients with affective disorders. The lithium RBC/plasma ratio was determined in 59 patients during prophylactic lithium therapy -- 10 cycloid psychotics, 28 unipolars and 21 bipolars -- as well as in 20 patients during lithium therapy in phase of illness -- 8 cycloid psychotics, 5 unipolars and 7 bipolars. The lithium ratio was found to be normally distributed both among patients in phase of remission and those in phase of illness. No differences in lithium ratio were found between patients in phase of remission and phase of illness, respectively. During prophylactic lithium therapy, no differences were found in the lithium ratio between patients in different diagnostic subgroups. In a correlation matrix, the lithium ratio was found to correlate to lithium in RBC but not to age, sex, type of illness, weight, lithium dosage, duration of treatment or level of lithium in plasma. The lithium level in RBC was determined only by the lithium level in plasma. Thus, the lithium RBC/plasma ratio does not seem to be of diagnostic value in affective disorders.


Improvement of depression and parkinsonism during ECT: a case study. Improvement in signs of parkinsonism and symptoms of depression was observed in a patient with Parkinson's disease who underwent a course of ECT for depression. Empirically this patient was observed by a blind rater to show a pattern of improvement in parkinsonian signs similar to that observed in parkinsonian patients treated with L-dopa. The time course of improvement of this patient's depression was also seen to parallel improvement in his Parkinson's disease. These results are consistent with the hypothesis that ECT increases catecholamine synthesis and more specifically would be evidence that ECT improves depression by increasing norepinephrine synthesis.


Duration of illness prior to hospitalization (onset) in the affective disorders. Onset defined as duration of illness prior to index admission was studied in manic and unipolar depressive patients. The manic patients were far more likely to have an acute onset when defined in this way. Of considerable interest is the fact that depression spectrum disease patients, i.e. those patients with a family history of alcoholism in a first-degree relative, were much less likely than other depressive patients to have an acute onset of their illness. In this case, the acute onset was defined as having occurred within 1 month of hospitalization.


Cerebral blood flow patterns studied by rheoencephalography in schizophrenia. Cerebral blood flow variation patterns have been studied in 20 control subjects and in 30 schizophrenics. This study demonstrates "hypofrontality" in schizophrenics and their lack of reactivity to strong verbal and somesthetic stimulations.


Plasma levels of imipramine in depression. Environmental and genetic factors. On the basis of tentative evidence obtained with 26 patients with unipolar affective illness, the variability in the response to imipramine is mostly due to interindividual differences in hydroxylating microsomal enzymes which are genetically controlled but whose activities are subject to modification by environmental factors such as overall pharmacological exposure and tobacco smoking. Additional significant pharmacodynamic variability (twofold) was found in the range of the volumes of distribution of imipramine in the patients. Clinical outcome was unequivocally related to plasma level. Unipolar nondelusional patients with levels less than 180 ng/ml had a low probability of recovery, while levels above 180 ng/ml were assoicated with a high probability of recovery. Unlike the findings of investigators working with nortriptyline, our data do not suggest an upper limit on plasma levels beyond which clinical response deteriorates. It appears that, on the basis of family studies, similar genetic characteristics are related to the ones controlling the pharmacodynamics will be the subject of further examination in our continuing studies.


[Recording of the electrophysiological activity of the locus coeruleus in the rat]. After having previously studied some histochemical and biochemical aspects of the noradrenalin-containing neurons of the rat locus coeruleus (LC), we intend now to record the unitary electrophysiological activity of these neurons. In the present paper, we try to define the experimental conditions allowing a reproducible recording of this activity. In agreement with other authors, we have shown that the neurons of the LC slowly discharge, at a frequency of 1-3/sec with an amplitude of 100-150 muV. This spontaneous activity is greatly reduced by low doses of norimipramine, a tricyclic antidepressant.


Visual averaged evoked responses in patients suffering from alcoholism. 26 alcoholic patients were investigated by means of visual averaged evoked responses (VAER) and the proneness to augment or to reduce the amplitude of VAER with increasing stimulus intensity was determined. The alcoholic patients were compared to a group of 40 patients with reactio neurotico-depressiva and a group of 28 healthy volunteers. The patients with alcoholism were found to be augmenters more often than might be expected from chance (22 of 26 patients) and these patients also differed significantly from both the other groups. The augmenter tendency, regarded as a relatively stable personality trait, due at least partly to genetic factors, is discussed, and the possible biochemical basis for the results is also discussed.


Blood platelet monoamine oxidase activity in schizophrenic children and their families. A preliminary study. In this study monoamine oxidase (MAO) activity was measured in blood platelets of 21 individuals (age 2 6/12-19 years) who were diagnosed at preschool age as schizophrenics; MAO activity was not significantly different from that found in normals. An insignificant correlation was found between MAO activity in patients and age; a similar correlation for normals was also insignificant. In a sample of 15 families, no significant correlation between MAO activity of patients and their parents was obtained.


Neocortical reactivity to peripheral stimuli in neurotics. The averaged photic-evoked responses (APER) and their dispersion pattern (DP) were investigated in tired subjects, neurotics and patients with neurotic syndromes. The appearance of an ample late negative deflection (N3) followed by a deep positive one (P3) of APER and of an atypical DP in tired subjects, neurotics and in patients with neurotic syndromes, may be considered signs of tiredness and of attention lability. A lengthening of the latencies and decrease in amplitude of different APER components, found in neurotics and in patients with neurotic syndromes only, indicated abnormalities in the function of neuronal structures involved in the organizations of responses to peripheral stimuli.


Constitutional predisposition to central nervous system (CNS) disease determined by tests of lateral asymmetry. A preliminary report. Three factors in combination cause diseases of the central nervous system (CNS): specific etiological agent, physical stress and a general constitutional predisposition to CNS diseases. Research has tended to focus on the first to the disregard of the second and third factors. A newly developed test of functional body asymmetry, however, may have application to the elucidation of the role of physical stress and the constitutional predisposition to CNS diseases. In the present study, neurophysioligcal tests of lateral asymmetry in hand preference and thumb opposition rotation divide the normal population equally into a pure dominant group and a cross-dominant group. Neurological interviews with each group show cross-dominant normal subjects to be more vulnerable to physical stress factors such as overexertion and sleep disturbance. In a previous sutdy applying the same tests, patients with manifest primary diseases of the CNS such as parkinsonism showed cross-dominance in more than 90% of cases. These results with cross-dominant normals and CNS disease patients suggest that cross-dominance indicates a constitutional predisposition to CNS diseases. They also suggest that cross-dominant normal individuals are vulnerable to pysical over-exertion and the specific etiological agent responsible for a distinct CNS syndrome. As far as temporal order is concerned, since it is present in 50% of the normal population, cross-dominant laterality would appear to be a condition prior to any disease process rather than a consequence of CNS disease.


[Morphology and physiopathology of Billroth I gastroduodenostomy]. 97 patients subjected from 1 to 7 years previously to partial gastric resection by gastroduodenostomy (Billroth I) have been studied endoscopically and radiologically. Acid secretion after pentagastrin injection has also been determined. The most frequent mucous alterations identified by endoscopy were erosions in the stomach residue with inflammatory granulation in the anastomosis region. Recurrent ulcers were observed in 3% of cases. Acid secretion was reduced in 87% by comparison with the preoperative picture. The quantity of residual recretion depended on the greater curvature of the residual stomach. Radiological studies highlighted functional modifications indicative of organized motility in the residual stomach and pseudopyloric function at anastomosis level making coordinated draining possible.


[Problems in emergency surgery: ligation of the hepatic artery]. Reference is made to the literature data and a personal series for the proposal of ligation of hepatic artery as a useful means of controlling: 1) massive haemorrhage following certain forms of liver trauma; 2) haemorrhage following lobectomy or atypical subtotal resection; 3) post-traumatic haemobilia. It is a valuable alternative to lobar resection which, in spite of its over 50% mortality, is still the treatment of choice in serious lesions, especially if these are associated with lesions of the suprahepatic veins or cava, or massive crushing of the parenchima. Haemorrhagic shock following liver damage is usually met by reduced portal and increased hepatic artery flow. It is obvious that ligation of the hepatic artery leads to considerable ischaemia and hypoxia. This disadvantage can only be offset by massive replacement transfusions, protracted parenteral feeding (fasting leads to maximum oxygenation of the portal blood), and intravenous glucagone, to improve the overall liver blood flow and the oxygen saturation of the portal blood.


[A new operation for reconstruction of the digestive tract after total gastrectomy]. A new type of gastroplasty to be employed following total gastrectomy is proposed. A retrocolic loop is anastomosed, Roux fashion, end to end to the duodenum; the stump of the oesophagus is then anastomosed end-to-side to the same loop. This new technique offers advantages which are described. Postoperative pictures of two patients are presented.


[Isolated obliteration of the popliteal artery. Angiographic, functional and surgical considerations]. 31 patients suffering from isolated obliteration of the popliteal artery were selected for reporting from a series of 1500 peripheral angiographies. It is pointed out that the lesion is due principally to a segmentary localization of atherosclerosis. A case of adventitial cyst and one of muscular pincer syndrome have also been encountered. Attentive study of angiographic pictures showed up a number of behaviour modalities of the collateral circulation. The surgical approaches available in such circumstances are also reported.


[Laparosplenectomy in 104 cases of Hodgkin's disease]. A series of 104 laparosplenectomies for Hodgkin's disease was carried out over a period of 4 years. Splenectomy was considered indicated in all cases observed, independently of the clinical situation; preference was, however, reserved to patients in whom the disease was just at the beginning and not yet treated. In such patients, the purpose of the intervention was to pinpoint the degree of development of the disease which would then dictate the chemo-radiological therapeutic protocol. The theoretical bases of the method are illustrated along with its aims and the simple technical features of the surgery. Intraoperative findings are discussed and compared with previous clinical and radiological data, and immediate results are reported.


[Acute esophagitis and gastritis caused by caustic acids]. 9 cases of caustic ingestion are reported and the diagnostic and therapeutic problems of the consequent gastritis and oesophagitis conditions discussed. In the case of small quantities of acids at low concentrations, the immediate steps are largely medical and conservative, their purpose being to monitor complications. In cases of massive ingestion, surgery should be as early as possible to avoid secondary lesions to the surrounding viscera and serious electrolytic imbalances; the limit for action with a relatively favourable prognosis is within 5 hours and removal of the damaged segments must be radical and extensive.


[Internal drainage of the thoracic duct in the surgical treatment of cirrhotic ascites. 3-year follow-up]. The results of reimplantation of the thoracic duct carried out in 22 patients suffering from cirrhotic ascites refractory to medical therapy are presented and analysed. 3-year survival was 54,5% with disappearance of the ascites in 83% of cases. Other conditions being equal, these results are superior to those obtained with porto-systemic shunt.


[Pancreatic function after subdiaphragmatic vagotomy]. After brief mention of certain aspects of pancreatic secretion and having stressed the importance of nervous and humoral regulator systems, the results of a study of pancreatic secretion function in vagotomized patients are reported. It was shown that the majority of distribances occur at an early stage and tend to reduce as time goes on as a result of the compensation mechanisms which gradually set in. A small percentage of vagotomized patients remains, however, in whom slight disturbances continue. These are not enough to constitute a contraindication to the use of vagotomy as an alternative technique in the surgical treatment of gastroduodenal ulcer.


[Experimental evaluation of mesenteric flowmetric changes induced by eating and digestion under normal conditions and after vagotomy and gastric resection]. Reference is made to recent data concerning the regulation of mesenteric haemodynamics by enteric hormones. Changes in mesenteric circulation in the course of altered intestinal hormonal secretion were examined. The results showed that a real connection exists between such secretion and the regulation of mesenteric haemodynamics, since flowmeter changes were noted after surgical operations performed on experimental animals.


[Colonoscopy in the long-term follow-up of surgical anastomoses of the large intestine]. On the bases of personal experience the importance of endoscopic examination of the colon in the follow-up of patients who have been subjected to resection of the large intestine is emphasized. Fibercoloscopy permits direct observation of "high" surgical anastomoses, which are inaccessible for examination with rigid rectosigmoidoscope, and thus opens the way to precise diagnosis and a correct therapeutic approach.


[Classification and pathogenesis of thrombohemorrhagic events connected with surgery. Intravascular coagulation in surgery]. This disorders secondary to haemostasis which complicate surgery can be clinically subdivided into haemorrhagic and thrombotic complications. Haemorrhagic complication may present as a generalized haemorrhage that almost always occurs in the infra-operative period, or as a localized haemorrhage (mainly at the level of the gastroenteric tube). As this is seen in the postoperative period it can be defined as late. Thrombotic complication may present with a picture of phlebothrombosis, usually clinically evident at the lower extremities, or with a clinical picture of sudden occlusion of pulmonary circulation, namely pulmonary embolism. Pathogenetically, these two groups of complications may now be lumped together in view of the fact that surgery always causes stress in haemostatic function with thus reaches a condition of largely atent balance but which may be upset in either of two possible directions: hypohaemostatic or haemorrhagic on the one hand, and hyperhaemostatic and thrombotic on the other. The point in common is represented by the activation of the clotting system (platelet component included) followed or accompanied by anticlotting mechanisms (mainly the fibrinolytic). Whether the complication will be thrombotic or haemorrhagic depends on the prevalence of the former of the latter. These conclusions are based on an experimental clinical analysis of the phenomena that occur within the haemostatic function throughout the surgical process but principally at the operating stage itself, and are indirectly confirmed ex juvantibus in the proven effectiveness of heparinic prophylaxis. Therapeutic and prophylactic approaches are put forward on the basis of this unified pathogenetic concept.


[The herniotomy operation in the treatment of congenital inguinal hernia]. --203 cases of congenital inguinal hernia operated with Mitchell-Banks technique have been studied. Just over half the patients were less than 1-year old; 48% were males; right inguinal hernia (53%) predominated, while 13% presented bilateral hernia. Post-operative hospitalization was 1-3 days in 73% of cases. Fever was observed in 86% of the children but it never lasted more than 2 days. 81 patients presented scrotal haematoma. Mortality was nil. Long-term follow-up showed that only 1% had suffered a recurrence. As a result of all these advantages and the low hospitalization (one day surgery), the technique is recommended for the treatment of infant inguinal hernia.


[Clinical contribution to the study of pheochromocytomas]. 6 cases of suprarenal phaeochromocytoma were operated on at the Department of Special Surgical Pathology and Clinical Propaedeutics of the University of Turin between 1954 and 1975. The age of the patients was between 32 and 53, 5 cases being male and 1 female. Personal data are compared with larger series and mention is made of the importance of certain pharmacological tests and new radiological techniques for the diagnosis of tumour nature and localization. An atypical case in which exact clinical classification was only possible histologically a posteriori is discussed. Immediate and long-term results were good. Although not all patients presented normalised pressure values, the disappearance of hypertensive crises and normalization of glycaemia and urinary catecholamines were constant observations.


[Acute renal failure and acute abdomen]. A series of patients with acute renal failure (ARF) and acute abdomen collected by the St. John the Baptist Hospital's Nephrology and Dialysis Division over the period 1970-75 is examined. A high rate of mortality was noted, due to causes that were mostly independent of ARF Death was often related to failure to resolve acute abdomen. The progression of ARF appeared to be related to that of the abdominal affection with prompt resolution of the latter. These findings suggest that constriction of the afferent arteriole may offer a partial, functional basis for ARF with the corollary that it has a good chance of being reversed, even after protracted periods of anuria. Renal complications associated with disseminated or localised intravascular coagulation appear to be rare. Treatment was best directed to early and frequent dialysis, with surgical resolution whenever indicated, irrespective of the presence of ARF.


[Flowmetric changes induced by glucagon in the mesenteric artery region during experimental hemorrhagic shock in dogs]. The pharmacological action of glucagon in the regulation of systemic and mesenteric district haemodynamics, in line with the approach that has come to the fore in recent years for treating haemorrhagic shock with vasodilators, suggested a study of the effects of glucagon on mesenteric haemodynamics during haemorhagic shock in dogs. It was shown that the infusion of glucagon increases mesenteric arterial flow and peripheral resistances are reduced without particular systemic modifications.


[Acute pancreatitis. Review of cases and considerations on personal experience]. A series of cases of acute pancreatitis treated between 1-XI-1972 and 1-XI-1975 is presented. A division is made between cases acute ab initio and postoperative pancreatitis, the latter further subdivided into pancreatic necroses, oedemas, and slight affections. The question of diagnosis is examined and elements indicative of prognosis are stressed. Results obtained in the surgical and medical management of 59 ab initio, 3 necrosis, 11 oedemas, and 79 slight involvement cases are described.