The effect of ketamine upon norepinephrine and dopamine levels in rabbit brain parts. Ketamine (40 mg/kg, i.v.) significantly increased dopamine levels in the thalamus and hypothalamus brain areas, but not in the midbrain or caudate nucleus. The increase in dopamine occurred during the time when ketamine produced its maximal anesthetic action (10-30 min). Ketamine had no effect upon norepinephrine levels in whole brain or the select brain parts with the exception of caudate nucleus at any of the times studied. These results demonstrate an effect of ketamine upon dopamine levels in those brain regions previously suggested as the site of ketamine's anesthetic action.


Characteristics of the electrodermal response. A model for analysis of central sympathetic reactivity. Electrodermal responses (EDR) of the sympathetic-cholinergic sudomotor system were elicited in anaesthetized cats. Responses were evoked centrally from hypothalamic, medullary and spinal loci, by stimulation of the pre- and postganglionic peripheral nerves, and reflexly following stimulation of an afferent nerve. The response was found to be dependent upon innervation of both the median and ulnar nerves (approximately 40 and 60% respectively). Both the centrally and peripherally evoked responses were frequency-dependent when a maximal current was used. The EDR evoked peripherally or from the cervical cord reached its maximal amplitude at 10-16 Hz whereas the EDR evoked from the hypothalamus and medulla did not reach its maximal amplitude until 48-64 Hz. These responses are relatively independent of blood flow in that complete occlusion of the peripheral blood supply did not greatly alter the amplitude of centrally evoked responses. The results suggest that this sympathetic-cholinergic system may be a useful model system with which to study the actions of various adrenergic agents on the reactivity of central structures which regulate sympathetic nervous activity.


Haemodynamic changes during experimental tetanus toxicity in dogs. Haemodynamic variables were compared in control dogs, dogs with local tetanus toxicity and dogs with generalised tetanus toxicity. The results showed an increase in the inotropic and chronotropic activation of the heart in both groups of tetanus dogs, but there was no significant change in the mean systemic blood pressure and the common carotid occlusion reflex was unchanged. Spontaneous fluctuations in the systemic blood pressure were observed in some dogs with tetanus, and occurred more often in those with generalised tetanus. The modification of these fluctuations by beta-adrenergic blockade and diazepam, suggest that they are of autonomic neural origin. It is suggested that these changes in the cardiovascular system are the results of neurophysiological and biochemical changes in the sympathetic nervous system, which have been reported to occur in tetanus.


Effects of acetylcholine and atropine on the bile flow and biliary excretion of digoxin in the isolated perfused rat liver. The effects of acetylcholine (ACh). physostigmine, and atropine on bile flow and biliary elimination of digoxin were investigated using isolated rat liver perfusion. 1. ACh in the presence of physostigmine caused a temporary reduction in the bile secretion, while physostigmine alone had no effect on the bile flow. 2. The biliary concentration of radioactivity derived from 3H-digoxin was slightly decreased after an addition of physostigmine alone. This effect of physostigmine was not potentiated by ACh. 3. The addition of ACh decreased transiently the biliary elimination of digoxin, as a result of the reduced bile flow. 4. Atropine in the concentration range of 10(-6)-10(-5) M in the perfusion medium did not affect bile flow or biliary excretion of digoxin; repeated addition of atropine (2 X 2 X 10(-4) M) caused a choleresis lasting over the perfusion period. 5. This choleresis induced by atropine was associated with decreased concentration of tritium in the bile but slightly increased biliary elimination of total radioactivity. 6. The results allow us to draw the conclusion that ACh in the presence of physostigmine has an inhibitory action on bile flow and biliary elimination of digoxin in the isolated perfused rat liver.


[Clinical pattern of malignant brain tumors in patients over 50 years of age]. On the basis of a material of 180 cases from a hospital department of neurology the clinical course of malignant brain tumours in patients aged over 50 years was outlined. In 154 cases the clinical diagnosis was confirmed by histological investigations. The study showed that intracranial raised pressure syndrome was rather infrequent in this age group (5% in this material), with the exception of headaches. The most frequent manifestations were psychic changes and neurological deficit signs (hemiparesis). The course of the disease was frequently acute with rapid increase in the intensity of symptoms and signs. The cases unrecognized clinically accounted for 14.4% of this material. From the admission to the hospital a very rapid progression of manifestations was observed which seemed to be connected with association of blood flow disturbances.


[Manifestations of thalamic tumors in children]. On the basis of observation of 11 cases of thalamic tumours in children at various age the author discusses differences in symptoms and signs in relation to the same tumours in adults. The first pathological sign was most frequently hemiparesis without, however, typical characteristics of classical spastic hemiparesis. Later on various involuntary movements appeared, most frequently bilaterally. In half of these cases infection, vaccination, cranial trauma or excessive effort were the factors provoking the appearance of first symptoms. Typical symptoms of raised intracranial pressure developed late and were present in some cases only. The course of the disease was chronic, the survival time up to several years. The results of vertebral angiography were of decisive significance for the diagnosis. Carotid angiography showed only internal hydrocephalus without giving any more detailed clues as to the location of the process.


[Peripheral nerve conduction following recovery from Guillain-Barre syndrome]. The material comprises 10 cases with a history of Guillain-Barré syndrome within the last several years in which clinical investigations failed to demonstrate any abnormalities. Electrophysiological investigations of peripheral nerves including conduction velocity in motor fibres--maximal and minimal, sensory fibres, standardized terminal latency--showed presence of changes evidencing slight but persisting subclinical lesion to peripheral nerves, especially in subjects affected in early childhood. Slowing of conduction involved motor as well as sensory fibres in these nerves and was more pronounced in the ulnar nerve than in the remaining nerves (peroneal, axillary, musculocutaneous and facial).


[Electroencephalographic studies of 100 cases of migraine (control groups included)]. The investigations were done in a group of 100 patients with migraine, 50 patients with chronic diseases of various organs and 50 healthy subjects. EEG investigations in patients with migraine were carried out several times, in controls only once. The records were interpreted according to strictly defined criteria separating normal from pathological (slightly, moderately and severely) records. In 35% of migrainous patients slight or moderate changes were found. The frequency of these changes was significantly increased in relation to healthy subjects and approached the frequency found in non-neurological cases. EEG changes in migrainous patients failed to demonstrate any specific features and failed to correlate with clinical findings. The analysis of 330 EEG records in 100 cases of migraine demonstrated that some records changed in time and that the number of records showing deterioration was greater than that of records showing improvement.


[Effect of phenactil (chlorpromazine) on cortical visual evoked potentials in clinically healthy subjects with normal and abnormal electroencephalograms]. The results of a study of averaged cortical visual evoked potentials in healthy subjects with abnormal EEG records and in subjects with normal EEG are presented. The investigations were performed at rest and after activation with chlorpromazine. The potentials were recorded from typical sites in the visual cortex (O2--CZ and O1--CZ). Stimulation with flashes at 1 c/sec., 40 msec. duration, 2000 lux light intensity at a distance of 60 cm from the eyes was applied. The pupils were dilated with homatropine. The mean amplitudes of potential components measured by the method peak-to-peak, the mean latency time, and the mean duration of components were measured. It was found that at rest the inter-group differences included an amplitude rise at the time of change of the specific part into non-specific and the change of the evoked potential to the after-discharge, and the duration of positive components in the non-specific part prevailed over the negative ones. Chlorpromazine changed somewhat the amplitude of components (fall in the specific part and rise in the non-spefific one) but the differences were statistically not significant. Similar changes were observed in the latency time of various components (prolongation of latency time of late components was statistically not significant). The results suggest differences in the reactivity of cerebral structures of these groups at rest as well as after chlorpromazine activation.


[Meningiomas of the posterior cranial fossa]. In a period of 3 years 12 patients with meningiomas of the posterior cranial fossa were treated surgically. The group included 2 cases of meningioma situated on the cerebellar convexity, 5 on the tentorium, 2 on the posterior aspect of the pyramid bone, 1 of Blumenbach clivus, 2 of foramen magnum. The neurological findings and pneumoencephylographic changes in cases of meningiomas of cerebellar convexity, tentorium and posterior aspect of the pyramid bone made possible the diagnosis of posterior fossa tumour and the diagnosis of meningioma was made possible by carotid and vertebral angiography. In the case of Blumenbach clivus meningioma and in foramen magnum meningiomas the neurological changes were characteristic of tumours at the craniovertebral junction. One meningioma growing through the tentorium was approached from the middle cranial fossa, the remaining ones from the posterior cranial fossa. The tumour could have been removed radically in 7 cases. In 5 cases only partial removal was possible. Three patients died, two after operations for tentorial meningioma and one after operation for Blumenbach clivus tumour. The results in the remaining cases were good.


[Osmotic serum pressure in patients treated with furosemide and hypertonic mannitol solution]. In patients with expanding intracranial lesion syndrome osmotic pressure of the serum was measured during administration of furosemide or 20% mannitol solution. Mannitol was administered by two methods: a) a dose of 1.5 g/kg during 3--4 hours, b) a dose of 1 g/kg for about 20 min. When mannitol was administered slowly the osmotic pressure of the serum at the end of infusion was 11--15% above the initial one and returned to the initial level 30--60 min. after the end of infusion. With rapid infusion the peak rise of pressure was observed after 30 min. usually after the end of infusion, and after one hour the pressure returned to values approaching the initial ones. Furosemide in a dose of 40 mg intramuscularly or intravenously caused slight changes of osmotic pressure reaching 13 mOsm/l.


[Cyst of cisterna ambiens: case report]. The authors describe a rare case of congenital cyst of cisterna ambiens treated surgically. Histological examination of cyst wall suggested that the cyst belonged to the group of developmental anomalies of the type of dysraphic intracranial cerebral herniae.


Age-dependent differences of distribution and clearance patterns in normal RIHSA cisternograms. In a retrospective study of 536 unselected consecutive RIHSA cisternographies a total of 84 cases with normal time-sequential scans were reviewed and, after dividing into three age groups, statistically elaborated with regard to the CSF pathways and flow rate. Our findings on a 5% level of significance are: 1) The total CSF flow and turnover depends on age; the highest rate of CSF flow is found in young patients (less than 25 years) and decreases constantly with increasing age. 2) In old patients (less than 50 years) the dorsal and lateral CSF pathways predominate over the frontomedial ones which are preferred in the younger age group (less than 25 years). 3). The washout of the basal cisterns and the clearance of the isotope over the convexities decreases significantly with increasing age. 4) The normal individual cisternographic variations and significant age-dependent differences agree with simultaneous encephalographic findings.


Radiation necrosis of the brain. Neuroradiological considerations with computed tomography. In cases with radiation necrosis of the brain, conventional neuroradiological examinations usually demonstrate only an avascular mass lesion impossible to differentiate from intracerebral tumor or hemorrhage. Computed tomography, performed in addition to angiography in three cases, consistently demonstrated the radiation necrosis as a low density area exhibiting enhancement following infusion of contrast medium. The importance of recognizing radiation necrosis as a differential diagnosis to brain neoplasm is emphasized.


Some aspects of the venous drainage dynamics with tumors at the base of the skull in the anterior and middle fossae. Some alterations in the dynamics of the venous drainage with tumors at the base of the skull in the anterior and middle fossa are described as seen on the angiogram.


Intracranial infections: investigation by computerized axial tomography. The value of computerized axial tomography (CAT) in the management of intracranial infections is described and the findings compared with those of other conventional neuroradiological investigations. The most important contribution is in the diagnosis and localization of cerebral abscess. CAT provides not only information of the nature of the lesion but also the number of loculi and the presence of multiple lesions; it is the investigation of choice for follow-up of patients with cerebral abscess treated either by operation or conservatively. CAT is invaluable in the investigation of other infectious conditions affecting the intracranial structures, especially when patients present with a focal neurological deficit and it is vital to exclude an abscess.


Cerebral abscess with special reference to the angiographic changes. From 1961 to 1973 forty patients with surgically confirmed intracranial abscesses had preoperative cerebral angiography. The findings were abnormal in all cases but one. In 20 patients (50%) the primary diagnosis was a space-occupying lesion. In 19 patients (47.5%) an abscess was suggested by the presence of a capsule, the only finding definitely diagnostic of an abscess. Subtraction technique provided essential information in detecting the capsule. Angiography proved indispensable in suggesting the nature of the lesion.


Tumours aneurysms.

Tumours aneurysms. Intracranial aneurysms commonly present with subarachnoid hemorrhage. Rarely, they may attain a large size and manifest exclusively as intracranial space-taking lesions. We have collected a series of 48 cases of large aneurysms; 47 of them have been previously unpublished. To our knowledge, this is the largest series on this subject.


Carotid and vertebral vascular changes with primary calcium oxalosis. Primary calcium oxalosis is a rare, inherited metabolic disease that is associated with calcium oxalate deposits in both renal and extrarenal tissues. An unusual angiographic appearance results from subintimal oxalate crystal deposition.


[Changes in plasma insulin and growth hormone after intravenous glucagon in hepatic cirrhosis]. Decreased increases in blood sugar by comparison with control subjects was noted in patients with cirrhosis of the liver after i.v. administration of 1 mg glucagon. Insulin secretion was similar to that observed in the controls. Basal GH values were higher in the liver patients, whereas after glucagon they displayed a gradual and progressive increase with a peak at 60'. No significant differences in GH pattern were noted in the two groups, however.


[Aspects of phosphorus and carbohydrate metabolism in amyotrophic lateral sclerosis]. The behaviour of glycaemia, insulinaemia, phosphoraemia, somatotropinaemia,free glycerol and triglyceridaemia was studied in six patients with A.L.S. following sugar load (1 g/Kg) in fasting. The results of glycaemia and insulinaemia were in tune with published data which have pointed to reduced sugar tolerance and reduced insulin secretion in patients with A.L.S. In the present experiments, particularly significant were the phosphoraemia responses. The failure of inorganic phosphorus values to fall after glucose loading suggests that the glycidic intolerance of these patients is related above all to a reduction in functioning muscular mass rather than to insufficient insulin secretion. The reduction in nervous tissue may also be of importance in this sense. In fact, not all biohumoral parameters investigated were similar to those of diabetes because the behaviour of somatotropinaemia, free glycerol and plasma triglycerides was normal. The changed behaviour of phosphorus would thus indicate altered glucose uptake at peripheral tissue level.


[The possible epidemic recrudescence of swine-like influenza virus type A]. An account of the effects of recent influenza epidemics is given from the medical standpoint, and also with respect to their social and economic repercussions. The part played by air travel in the carriage of such epidemics is also examined. The immunity of the population of Rome towards an A strain swine fever (A/New Jersey 8/76) is assessed in the light of personal research.


[Value of the method of Cerasi and Luft in checking the progression of metabolic disorders in childhood]. The method of Cerasi & Luft was evaluated after 6 months and 1 yr of dietary management in 7 children with familial diabetes and/or very slight clinical and laboratory symptoms, and one obese girl. There was a marked reduction in the blood insulin area in the obese subject, whereas the remainder of the series displayed stationary pictures. It is felt that the method deserves emphasis on account of its constant evocation of a reproducible response and the possibilities of interpretation that it offers in the field of paediatrics.


[Comparative evaluation of the results obtained with the Cerasi and Luft method and the OGGT in children]. Results obtained with Cerasi & Luft's method and OGTT in subjects with a historical, clinical and laboratory suspicion of dysmetabolism were compared. It was found that: 1) obese subjects showed increased blood sugar and insulinase areas by comparison with normal controls; 2) subjects of normal weight displayed: a) a mean increase in blood sugar areas by comparison with normal controls; b) less evident changes in blood insulin areas; in these subjects, it was also noted that, c) an early-phase secretion irregularity detected with Cerasi & Luft's method did not involve changes in the oral loading pattern displayed by subjects classed as normal by means of such method; d) in subjects classed as "chemical diabetics" by OGTT, the response to glucagon after venous loading was defective. In border-line cases, early-phase changes were observed in the venous curve after oral glucose, whereas the response to glucagone remained efficient. It is felt that OGTT is an effective means in the diagnosis of infantile dysmetabolism. Attention is also drawn to the possibilities offered by the method of Cerasi & Luft in the detailed and specific appraisal of insulin secretion.


[Preliminary observations on the behavior of immunoglobulins in diabetics treated by different methods]. IgG, IgM and IgA values were determined in 45 diabetic patients of various ages and both sexes (30 treated with oral hypoglycaemising drugs and 15 with insulin). A marked departure from normal serum IgA values in subjects receiving oral hypoglycaemising preparations for at least 4 yr was the only alteration worthy of note.


[Diabetes, obesity and adenocarcinoma of corpus uteri]. Diabetes and obesity were noted in 21.3% and 42.3% respectively of 94 patients with adenocarcinoma corporis uteri. Hypertension and ovarian or mammary neoplasia were also common. Obese and diabetic subjects proved more sensitive to treatment with high doses of medroxyprogesterone acetate. Screening for precancerous states or carcinoma of the endometrium in obese and diabetic women is suggested.


[Lymphoscintiscanning with colloidal Tc 99m in pediatrics]. Lymphatic scintigraphy has proved a useful addition to radiological lymphography in oncological diagnosis in paediatrics. In cases studied comparatively with the two techniques, scintigraphy has been found to offer good resolution capacity also. The radioisotope method demonstrated its greatest value as a control examination for judging results obtained after surgery or radiation. In doubtful cases it was possibile to repeat the examination after a short time in order to evaluate the development of the lymph node lesion. The technique is easy to carry out in paediatric age: 0.5 ml of colloidal Tc with specific activity from 0.3 to 0.5 mCix are injected subcutaneously, mixed with 75 U of hyaluronidase between the Ist and IInd interdigital space to highlight iliac and para-aortic lymph nodes. The useof 99mTc is of special interest because it has made irradiation of these small patients negligible.


[Achilles reflexogram and hemodynamic parameters in the evaluation of thyroid function]. Among the numerous techniques designed to explore thyroid function, two which examine important peripheral aspects are considered: Achilles osteotendinous reflectivity (determination of contraction time and relaxation time of the gastrocnemius muscle) and the response of the cardiovascular system to thyroid hormones (determination of the time of onset of Korotkoff's sound and that of the brachial sphygmic wave). Comparison of the results obtained with these two techniques in a group of 60 euthyroid subjects, 17 hypothyroid and 25 hyperthyroid cases, shows that the techniques are comparable as regards precision, reproducibility, and sensitivity and are of indubitable importance for the assessment of thyroid function through the study of two of its peripheral aspects.


[Use of radioactive isotopes in the diagnosis of pulmonary tumors. Analysis of the results of 18 anatomically verified cases]. 18 cases of anatomically verified lung cancer were studied scintigraphically with microspheres of human albumin labelled with 99Tc, mercury bichloride (197Hg) and citrate of gallium (67Ga), to assess the diagnostic value of this technique. Using albumin microspheres, changes in the scintigraphic picture were obtained in 100% of cases, but inferior results were obtained with the two other tracers (gallium 75% and mercury bichloride 58.8%). The poor specificity of scintigraphy with albumin, which was changed in numerous non-neoplastic pathologies, removes all significance from this apparently brilliant result. From an overall assessment of all three scintigraphies, no increase in positivity percentages is obtained; the agreement of all three with respect to the neoplastic nature of the condition is however very good. Although possible conclusions are less favourable than those reported by other workers, the investigation with radioisotopes plays an important rôle in the diagnosis of lung tumours, in view also of its harmlessness and tolerability, although it is not enough on its own for diagnosis. Large series and constant anatomical and histological monitoring are needed before any definitive assessment can be attempted of the diagnostic value of this method.


[Preliminary results of an epidemiological survey for diabetes]. Mass screening for diabetes in a factory employing 464 subjects by means of a 75 g oral glucose tolerance test and measurement of blood sugar with Dextrosix reagent strips read on a reflectance meter is reported. Values of 120 mg% or over were noted in 10.34% and values in the range 110 to 120 mg% in 7.76%.


[Clinical considerations on retroperitoneal liposarcoma. Report of 2 cases]. Liposarcoma is one of the more common tumours of the soft retroperitoneal tissues. It usually occurs in aged subjects and displays a marked contrast between its malignant histological picture and its protracted, poorly symptomatic clinical picture. Eventually, compression or invasion of nearby organs appears, whereas the patient's general condition is not affected. Two personal cases are described.


[Clinico-radiological and functional aspects of respiratory syndromes caused by collagen diseases]. The clinical and radiological features in 100 patients with collagen diseases (rheumatoid arthritis, lupus, sclerodermia, dermatomyositis, and panarteritis nodosa) were compared with respiratory performance. 56 patients were drawn from the series of Pende et Al. and 44 from a personal series. The results are set out in tables and graphs. It was found that lung lesions due to collagen disease have no special clinical and radiological features. Respiratory performance is that of a restrictive syndrome that gradually progresses from A.R. to E.S., S. and P.M., accompanied by obstruction of the large airways, as shown by hyperinsufflation in sclerodermia and reduced specific conductance in rheumatoid arthritis.


[Bile composition in patients with high risk of cholelithiasis]. Clinical and epidemiological experience has shown that some subjects, such as diabetics and cirrhotics, are particularly prone to cholelithiasis. The cause of this association was sought, with particular reference to the biliary lipid pattern, since this was considered as a pathogenetic factor in high-risk patients of this kind. It was found that diabetics, like subjects with biliary lithiasis, have a high biliary cholesterol saturation index; this was not the case in cirrhosis. This increase was apparently due both to a fall in bile acids and an increase in bile cholesterol. On the other hand, no significant difference was found between diabetics and controls as far as the pool of bile acids was concerned. No important differences in bile acid pattern were noted. Deoxycolate tended to increase in subjects with cholelithiasis and fall (along with lithocolate) in those with cirrhosis. These findings were, however, devoid of statistical significance. The high incidence of cholelithiasis in diabetics is physiopathologically confirmed by significant "lithogenic" changes in bule lipid composition, whereas the high incidence in cirrhosis is not open to this explanation and probably rests on a different pathogenetic basis. The importance of bile saturation is clear, however, together with its therapeutic and prophylatic implications (chenodeoxycholic acid). The possible influence of unknown factors cannot be ruled out.


[Tumors of the head of the pancreas. Echographic diagnosis]. The diagnostic possibilities in cancer of the head of the pancreas offered by radiography, angiography, isotopic and endoscopic investigations (with respective accuracy percentages) are examined and a new technique based on the use of ultrasounds is presented. Echography exploits the different structures of tissues by reflecting the ultrasound beam which strikes them in a different way, providing a bidimensional tomographic picture of the surface explored with echostructural profiles and characteristics of the organs. The personal series, together with pictures and percentages of correct diagnosis, is presented. It is concluded that the technique is one of the most suitable for exploring the pancreatic region.


[Clinical and metabolic aspects of juvenile myocardial infarct]. A clinical and metabolic study of 61 patients with myoocardial infarct before the age of 40 yr showed a high frequency of familial involvement, particularly in subjects with type IIA and IIB hyperbetalipoproteinaemia. Excess weight and arterial hypertension were rare, while premonitory angina was absent in 59%. Four subjects were diabetic. Oral glucose tolerance was normal in 14 and of diabetic type in 26 of 40 patients examined; the insulin response pointed to insulin-resistance. Dyslipidaemia was noted in 45%, including type IIA and IIB hyperbetalipoproteinaemia in 27%. Distribution of the frequency of infarct in function of cholesterolaemia classes gave a bimodal curve indicative of distinct normo- and hypercholesterolaemic groups within the series. Reduced glucose tolerance was more frequent in patients with low blood cholesterol. This suggests that reduced tolerance and high blood cholesterol are independent risk factors in coronary disease. No relation between the clinical and metabolic data could be ascertained.


[Use of glucagon in the treatment of severe contractile insufficiency of the myocardium]. Glucagon hydrochloride has been used to treat severe contractile insufficiency of the myocardium. The drug was administered to cardiopathic patients who had been admitted to the intensive care unit. Results in the various groups examined were satisfactory, particularly in cases of patients with valve diseases and with chronic pulmonary heart and cardiac insufficiency recalcitrant to digitalis therapy. No important side-effects were noted.


[Behavior of plasma/insulin, somatropin and NEFA after intravenous administration of tolbutamide in hepatic cirrhosis]. Cirrhotics presented higher insulin production, in the presence of a drop in glycaemia significantly less than controls, following 1 g of tolbutamide i.v. The drug also brought on a rapid drop in NEFA and a rise in plasma growth hormone. The pathogenesis of altered glucose tolerance in liver cirrhosis is discussed.


[Prevention of migraine. Observations on the possibilities offered by some polypeptides]. A biological preparation containing 110a-130a polypeptide fractions with recently discovered antiserotonin and anti-bradykinin activity was employed in the prevention of migraine crises. The overall results were good in trials both versus placebo and using various doses and periods of treatment. Crises were even prevented in a case of cluster headache. Treatment with standard courses giving high doses concentrated in time was apparently successful in antagonising serotonin and bradykinin action on peripheral receptors.


[Therapy of psoriasis].

[Therapy of psoriasis]. The possible methods of treating psoriasis and results obtained are reviewed and the superior effectiveness of an approach reported in recent literature, an association of methoxalene per os and broad ultraviolet rays, is pointed out. In almost all cases submitted to such "photochemotherapeutic" treatment, regression of diffused lesions was rapid and complete with no systemic toxic effects or secondary skin alterations. On the basis of recent personal experience, it is stated that similar results may be obtained by the photochemotherapy of psoriasis with appropriate doses of Trisoralen per os and sunlight.


[Hypercalciuric and hyperparathyroid renal lithiasis]. Idiopathic hypercalciuria was noted in 10% of a series of 1635 subjects with renal lithiasis. Eight-day administration of thiazide diuretics as a test for the discovery of latent hyperparathyroidism in idiopathic hypercalciuria is described. In 6 cases diagnosed in this way, surgery disclosed the presence of a parathyroid adenoma. Resection was followed by persistent hypercalciuria and, in some instances, renal lithiasis activity. The pathogenesis of associations of these frequently observed diseases is examined.


[Current aspects of iatrogenic lesions of the bone marrow]. An overall study, accompanied by some statistics, is presented of delayed bone marrow injuries caused by drugs, such as chloramphenicol, phenylbutazone, oxyphenbutazone, gold salts, sulphamides and diphenylhydantoin. Unanimous agreement as to the aetiological interpretation of isolated cases, the seriousness of marrow damage, and the results obtained by treatment can be observed in various countries. The available epidemiological data are incomplete, though they point to a parallel between the appearance of panmyelopathy after chloramphenicol and the consumption of this drug. First noted in the U.S., this relationship later became apparent in several European countries and eventually in West Germany. Frequencies range from 1 per 6,000 to 1 per 36,000 subjects treated in California, Hamburg and Sweden.


[The liver and metabolism of drugs].

[The liver and metabolism of drugs]. Even if all problems of liver metabolism have not yet been clarified, it is nevertheless established that medicaments induce enzymes in the hepatic cells which influence the metabolism of drugs. Because their effect is unspecific, these enzymes can catabolize many drugs with different structures. About 200 substances are known which induce such enzymes. Among them, for example, is phenobarbital. It is therefore used in the treatment of some forms of icterus with free bilirubin and for Cushing's syndrome. But enzyme induction can also lead to acute intermittent porphyrias and disturbances of the phosphorus-calcium metabolism. Extreme catabolism of a drug can be caused by overinduction of enzymes due to the administration of several incompatible medicaments.


[The secretin test with the standard dose and high dose in chronic pancreatitis]. Sequential standard (1.0 U/kg) and augmented (4.0-5.0 U/kg) secretin response of the pancreas has been briefly compared in normal subjects and in pathologic series. The results of sequential testing led to the conclusion that, for clinical purposes, the standard test is sufficient for the diagnosis of well established pancreatic pathologies causing gross destruction of the parenchyma, while the augmented test is of particular value when the response to 1 U/kg produces equivocal results, since a higher stimulation enhances the masked secretory deficiency. The application of the augmented stimulus in alcoholic patients suggested the hypothesis that the post-secretin response pattern of minimal pancreatic inflammatory pathology is hypersecretion. Repeated observations in alcoholic hypersecretors will provide physiologic data elucidating the evolution of pancreatic pathology towards the end stages of chronic pancreatitis.


[Water and potassium metabolism changes]. The disturbances of water and electrolyte metabolism in the body can be subdivided into three large groups: 1) disturbances of free water which are related to the whole body water and are always coupled with changes in the osmolality of the internal environment and also of the interior of the cells (hypertension due to loss of water, hypotension in water intoxication); 2) isotonic changes of the volume of the extracellular fluid-oedema or extracellular dehydration. The latter are always coupled with a hypovolaemia and with a danger to the circulation which may end in shock. There is also a cumulative loss of potassium as a result of the dehydration reaction; 3) disturbances of the intracellular water metabolism which are associated with disturbances of the potassium metabolism. These may have grave consequences for the function of striated and smooth muscles, for the function of the nerves and various enzyme systems. Since the disorders of the extracellular water balance are generally best known, the attention is principally drawn in this paper to the hypertonic dehydration and the status of the potassium metabolism. The symptomatology of both conditions is discussed, and also their diagnosis with the simplest laboratory effort not associated with great loss of time (which is essential if valuable time is not to be lost before the laboratory results can be obtained). The theoretical considerations are supplemented with clinical examples and explanations of the treatment.


[Electrolyte changes in acute renal failure]. One hundred and fifty two patients out of two hundred and forty six with acute renal failure (A.R.F.) were selected because of a more complete study of the serum and urine electrolytes have been performed. All patients had acute parenquimatous renal failure (no pre or postrenal failure) most likely due to tubular or cortical necrosis. No acute or chronic glomerulopathies were included. The patient sample comprehended seventy three males and seventy nine females with ages between fifteen and eighty five years old. They were divided in four groups according with the primary disease: A) Medical cases (63 patients), B) Obstetrical and Gynecological (40 patients), C) Postraumatic (25 patients), and D) Postsurgical (24 cases).


[Emergency stiuations connected with electrolyte disorders. Special aspects]. Electrolyte-induced situations which are dangerous to life usually result from disturbances of the extracellular volume (ECV), osmolarity, the potassium level or the acid-base equilibrium. In recent years (thanks to the wide spread use of hormone therapy for mammary carcinoma) severe hypercalcemia has increased in importance as a life-threatening complication, while hypocalcemia, at least in adults, should only very seldom lead to unexpected emergencies. As long as serious clinical symptoms do not suggest an emergency, assessment of the threat to the patient as a result of the existing electrolyte disturbance often causes some difficulty. Besides the extent of the deviation from normal, the rate of development of the disturbance determines the resulting danger: chronic hypo-osmolarity, and especially hyperosmolarity are occasionally tolerated without symptoms while acute disturbances of the same or a less extent lead to severe central nervous symptoms. A similar state of affairs is also true of the emergency situations arising from disturbances of the acid-base equilibrium, among which the respiratory disorders are particularly important clinically. In the case of threatening disorders of the potassium metabolism, the accompanying circumstances (digitalis, simultaneous disorders and treatment of the acid-base equilibrium) often determine the clinical significance and danger to the patient. Clinical symptoms, anticipation ("expecting the unexpected"), prevention and treatment of emergency situations of fluid volume, osmolarity, potassium and acid-base equilibrium are the subjects of this paper.


[Hyperosmolar comatose states].

[Hyperosmolar comatose states]. A recently determined entity, hyperosmolar coma is a good example of a clinical candition attributable to a fundamental alteration, namely extracellular hyperosmolarity. The principal stages in its history are summarised. The laws governing osmosis are recalled and the various features of the sndrome are studied. Attention is drawn to the clinical peculiarities (skin dehydration), biological features (record glycaemia value), and EEG data noted in 17 cases treated in a resuscitation centre over a period of seven years, along with the treatment employed-this being still a matter of debate. Reference is also made to 52 cases of acute drunkenness in a study of the relation between blood alcohol values and plasma hyperosmolarity.


[Clinical significance of the tests used in the diagnosis of pancreatic diseases]. Different methods available for investigating patients for pancreatic disease are discussed. They first include measurement of pancreatic enzymes in biological fluids. Basal amylase and/or lipase in blood are truly diagnostic in acute pancreatitis but their utility is low in chronic pancreatic diseases. Evocative tests have been performed to increase the sensitivity of blood enzyme measurement. The procedure is based on enzyme determination following administration of pancreozymin and secretin, and offers a valuable aid in diagnosis of chronic pancreatitis and cancer of the pancreas. They are capable of discerning pancreatic lesions but are not really discriminatory because similar changes are observed in both diseases. The measurement of urinary enzyme levels in patients with acute pancreatitis is a sensitive indicator of disease. The urinary amylase excretion rises to abnormal levels and persists at significant values for a longer period of time than the serum amylase in acute pancreatitis. The fractional urinary amylase escretion seems to be more sensitive than daily urinary measurement. The pancreatic exocrin function can be assessed by examining the duodenal contents after intravenous administration of pancreozymin and secretin. Different abnormal secretory patterns can be determinated. Total secretory deficiency is observed in patients with obstruction of excretory ducts by tumors of the head of the pancreas and in the end stage of chronic pancreatitis. Low volume with normal bicarbonate and enzyme concentration is another typical pattern seen in neoplastic obstruction of escretory ducts. In chronic pancreatitis the chief defect is the inability of the gland to secrete a juice with a high bicarbonate concentration; but in the advanced stage diminution of enzyme and volume is also evident. Diagnostic procedures for pancreatic diseases include digestion and absorption tests. The microscopic examination and chemical estimation of the fats in stool specimens in different conditions of intake are still important screening tests. Isotopic estimates of steatorrhea and distinction between labeled triolein and oleic acid absorption do not provide greater diagnostic discrimination than traditional procedures. 131I labeled proteins permit a good evaluation of a negative nitrogen balance. Sophisticated procedures to estimate exocrine pancreatic insufficiency are based on the study of endoluminal digestive processes at several times and different level of the small intestine. They permite esclusion of extrapancreatic factors interfering in digestion and absorption functions. The endocrin pancreatic function is evaluated by mean of oral tolerance test an radioimmunoassay of blood insulin. It is generally agreed that "diabetes" caused by insulin deficiency and digestion and absorption defects are the result of diffuse pancreatic destruction. Many methods are now available investigating patients with pancreatic disease but the single use of one of them is never satisfactory...


[Renal water-electrolyte excretion and its control mechanisms. Current status of knowledge]. The literature on hydronatriuresis control processes operating at the level of individual renal functional units and of the organ as a whole is analysed. 1) Elementary sodium salt and water tubular transport mechanisms. In converting the filtrate into urine, the kidney expends metabolic energy: this is used in the (active) transport of sodium salts; (passive) transport of water takes place along the osmotic gradients created by salt transfer. The proximal tubules reabsorb the sodium bic-rbonate actively. The reabsorption of the osmitic equivalent of water has the effect of concentrating NaCl in the tubular fluid. An important role in the reabsorption of NaCl is played by passive diffusion from the lumen to the interstitial fluid; the remainder is transferred actively, perhaps by an electrically neutral pump. With respect to the other nephronic segments, the proximal tubule has a relatively high passive permeability to water and salts: active transport here must not surmount high friction resistances nor take place against important concentration gradients. The low permeability of the distal nephron, on the other hand, increases the energy cost of salt transport; for the same reason, important electrochemical gradients are created and the composition of tubular fluid is drastically altered. 2) Elementary mechanisms of tubular potassium transport. Potassium is reabsorbed actively along the whole nephron by a luminal pump. The proximal tubules and Henle loops promote practically complete absorption of filtrated potassium. The distal tubules and collectors have the two-fold capacity of secreting and reabsorbing cation: the quantity of potassium excreted with the urine depends on the degree of excess of the secretion process. At distal tubular level, potassium secretion is a passive phenomenon dependent on the favourable transluminal gradient of the cation's electrochemical potential. 3) Renal function and volume homoeostasis of extracellular fluid. The organism's sodium content is largely controlled by renal excretion of sodium; homoeostasis of the sodium mass guarantees volume homoeostasis of the extracellular fluid through thirst and osmotic secretion of ADH. Extracellular fluid volume errors are picked up by the organism to the extent to which they translate themselves into pressure variations in the low pressure vascular system or into variations in haematic constituent concentration within the vascular sector, produced with velocities independent, at least in the short term, of the volume of extracellular fluid. In control of natriuria are the glomerular filtrate, intrarenal distribution of blood flow and tubular reabsorption of sodium; in its turn, the latter is subject to nervous and hormonal influences and influences from the physical environment surrounding the nephrons...


[Fibrinolytic activity of the human brain after contusive injuries]. Histochemical and biochemical evaluation of cerebral tissue fibrinolysis following cranioencephalic trauma was studied in 20 cases seen at necropsy, with varying periods of survival after injury. Fibrinolysis was mainly located at the vasal intima and was very intense in areas rich in vascularised connective tissue, such as the dura mater. Its activity diminished soon after injury to reach minimum values during the first day. Thereafter it remained at very low levels in sites with gross lesions, whereas it returned to nearly normal values elsewhere on the 2nd or 3rd day. Attention is drawn to the territorial character of this pattern. Extension of these results to the fields of diagnosis and treatment, however, is considered premature.


An evaluation of preinduction scoring systems. A double-blind clinical study of five preinduction scoring systems was undertaken to determine the accuracy of clinical usefulness of each system as applied to a diverse group of patients. When strictly applied, all five systems were found to be as accurate and useful as it was originally claimed they were. However, when applied without regard to each author's prerequisites, none of the five scoring systems was found to be reliable. A series of preinduction score modifiers is presented which, when applied to any of the preinduction scoring systems, will reliably predict the outcome of induction of labor, with a 50% induction failure rate in patients with lower third scores, a 10% failure for middle third scores, and essentially a 0% failure in the upper third scores.


Diuretic drugs and pregnancy.

Diuretic drugs and pregnancy. Perinatal mortality and delivery patterns are compared for 4035 gravidas who were prescribed diuretic drugs during pregnancy and 13,103 gravidas who were not. Diuretic drugs were prescribed primarily for edema; gravidas with hypertensive disorders were excluded. The 2 groups, differing in both condition and drug excluded. The 2 groups, differing in both condition and drug usage, had significantly different gestational age distributions. The gravidas prescribed diuretic drugs delivered infants of higher mean birthweight and had significantly higher incidences of induction of labor, stimulation of labor, uterine inertia, and meconium staining. Their perinatal mortality rates also tended to be higher. The findings support the contention that higher risk is associated with one or more factors differentiating the 2 groups, namely, edema, undefined factors associated with edema, or the consumption of a diuretic drug.


The effect of internal fetal monitoring on maternal infection following cesarean section. A retrospective review of 300 cesarean sections was performed. Patients with internal fetal monitoring were at no greater risk for infection than were those patients with labor and rupture of membranes but without internal monitoring. However, the combination of rupture of membranes and labor was a major risk factor for both the frequency and severity of maternal infection after cesarean section. Once membranes are ruptured, we find no contraindication to the use of internal monitoring.


Fetal biparietal diameter as a predictor of a mature lecithin/sphingomyelin ratio. The records of 148 patients who had undergone simultaneous determination of fetal biparietal diameter and lecithin sphingomyelin ratio were reviewed. The results of the lecithin sphingomyelin determination could not be predicted with an acceptable degree of accuracy utilizing the fetal biparietal diameter. When patients were grouped by maternal disease, no significant difference between diabetic and control patients was noted. Other subgroups were too small to allow a valid statistical comparison.


Correlation between morning urine estriol concentration and 24-hour estriol excretion. In an attempt to circumvent the need for 24-hour urine collections for estriol analyses in assessment of fetal status, the possibility of using morning urine samples was investigated. Results indicate 1) good correlation between 24-hour estriol excretion and morning estriol concentration, and between corresponding E/C ratios, 2) similar morning and 24-hour estriol concentrations, 3) high dependence of estriol and creatinine excretion on 24-hour urine volume but not on morning volume, 4) larger variations in 24-hour than in morning urine volume, and 5) better consistency of values in morning than in 24-hour samples in pathologic pregnancy. The use of serial morning urine concentrations at least as an outpatient monitoring procedure is suggested.


Isolation of Mycoplasma from the placenta after cesarean section. Placentas obtained at cesarean section were cultured for Mycoplasma and other microorganisms in 123 randomly selected patients in order to evaluate the incidence of Mycoplasma, to identify factors which may contribute to their presence, and to correlate their presence with the occurrence of postpartum infection. Twenty-eight placentas (22.8%) yielded Mycoplasma positive cultures. The incidence of Mycoplasma in the placenta was significantly higher in patients with ruptured membranes. The incidence of postpartum fever was significantly higher (P less than 0.01) in cases positive for Mycoplasma as compared to cases in which the placenta was negative for Mycoplasma. Findings were similar for both groups with regard to the incidence of unexplained postpartum fever. The results of this study suggest that Mycoplasma may be considered a relatively frequent pathogen and should be considered a possible cause of postpartum fever.


Initiation of human parturition. V. Progesterone binding substance in fetal membranes. This study was undertaken as part of an investigation of the potential role of progesterone metabolism within fetal membranes in the initiation of human labor. The results of this study provide evidence that a progesterone binding substance is present in amnion and chorion laeve during the last few days of pregnancy. This substance binds progesterone, cortisol, and 5alpha-dihydroprogesterone but does not bind 20alpha-hydroxy-4-pregnen-3-one, R 5020, or dexamethasone. We conclude that this is a previously undescribed progesterone binding substance and propose a possible mechanism by which this substance may be involved in the initiation of human parturition.


A rapid screening technic for detection of Y chromosomes. A rapid, simple method for screening individuals at high risk for the presence of Y chromosomes is described. The correlation with actual sex using probability tables from Baye's formula have shown to be accurate, when used with a 99% confidence limit. This procedure can be utilized in the investigation of amenorrhea or may be used as a screening method prior to expensive and time-consuming karyotyping procedures.


The retained cervical stump. A 25-year experience. During a 25-year period on one service at the Mayo Clinic, 262 cervical stumps were removed surgically: 208 vaginally and 54 abdominally. In this series, 46 patients had malignancy of the cervical stump. When a cervical stump is present, it most often can be expeditiously removed during the course of additional vaginal repairs with extremely few risks and complications, and low morbidity.


Pelvic abscess. A sequela of first trimester abortion. First trimester therapeutic abortions were performed in 6790 patients from January 1, 1972, through December 31, 1973. The infectious morbidity during an 18-month concurrent time period which required readmission to the hospital was 0.52 per 100 women. Four of these women were ultimately diagnosed as having a pelvic abscess thought to be related to the procedure. The cause was probably related to undiagnosed or inadequately managed uterine perforation. Initial management should consist of systemic antibiotics and, if possible, surgical drainage via colpotomy. Two special precautions which should be taken are the use of antibiotics specific for Bacteroides fragilis and the investigation of the possibility of bowel injury. Laparotomy should be considered in unresponsive cases because of the possibility of bowel injury and the necessity of adequate surgical drainage even with appropriate antibiotic coverage.


Postabortal amenorrhea due to cervical stenosis. In the differential diagnosis of postabortal amenorrhea, the entity of cervical agglutination-stenosis without uterine synechiae should be included. Nine such cases are reported with discussion of its possible etiology, diagnosis, and management. Other clinics are urged to report this complication of first trimester abortion.


A reappraisal of the duration of labor.

A reappraisal of the duration of labor. The mean, median, and modal durations of labor have been established following a prospective study of 602 consecutive labors. The mean duration of labor for primiparae was 14.92 hours, while the median and modal durations were 13.20 and 9.66 hours, respectively. The corresponding figures for multiparae were 10.02, 9.28, and 7.80 hours, respectively. There was a statistically significant difference in the mean duration of labor in the 2 groups of patients (P less than 0.001). A significant positive correlation has been observed between the duration of the first stage of labor and the second stage of labor (P less than 0.001), and this might be of clinical importance. It has been suggested that the median and modal durations of labor may be more representative and informative than the mean or average.


[Endometriosis of the ileum].

[Endometriosis of the ileum]. The following is an account of a case of Endometriosis of the Ileum in an 11 year old girl. The patient's first menstruation was accompanied by pain localized in the lower right abdominal quadrant. Her second menstruation was again accompanied by pain. During an explorative laparotomy, a tumorous mass was found in the wall of the ileum 50--60 cm proximal to Valvula Ileocecalis. The tumor was seven mm in diameter, having a fibrous thickening in the surrounding wall. A resection of this segment of intensine was performed. Histological findings confirmed an endometriosis of the Ileum of a polypoidal infiltrative type. The patient encountered no difficulties postoperatively. Proceeding menstruations were painless, which is indicative of an isolated endometriosis of the ileum.


Prophylaxis of venous thrombosis and pulmonary embolism in patients with acute traumatic spinal cord lesions. Twenty-one patients with acute traumatic spinal cord lesions who were admitted to our Spinal Unit during 1974 have been treated with Calcium Heparin, using a dosage of 5000-7500 i.u. at 12-hourly intervals from the first days after the lesion until the use of a wheelchair, as a prophylactic measure in order to prevent venous thromboembolism. Of these 21 patients 18 received this treatment continuously, with a resulting 0 per cent of venous thrombosis and 0 per cent of pulmonary embolisms. In the three remaining cases, treatment had to be temporarily interrupted and in one case clinical thrombo-phlebitis was clearly evident. No case of pulmonary embolism was registered. We consider this technique to be very useful in the prophylaxis of thrombo-embolic complications in this type of patient. The use of this type of prophylactic therapy, results and conclusions are discussed.


Comparative analysis of the therapy of acute transverse myelitis. Three methods of treatment of acute transverse myelitis are presented. The first group of 16 patients were treated with antibiotics (average age 32.1). Three patients died, 11 remained unrecovered, while in two cases remarkable improvement was recorded. The second group of 15 patients, whose average age was 32.4, were treated with corticosteroid per os or instrumuscularly. Four of the patients died (three of them with ascendent course of disease), there was no change in five cases, while marked improvement ("cured" and "walking with assistance") was recorded in the remaining six cases. The third group of ten patients, eight women two men, ranging from 15 to 47 years of age (average age 26.9) was treated with methylprednisolone acetate intrathecally. Five patients were practically cured after 3 to 4 weeks. Two patients were cured to an extent that they could walk with assistance. In two cases no improvement was recorded, while one of the patients, who in addition suffered from serum myelitis, died of bilateral bronchopneumonia. In all these cases the drug was administered comparatively late, on the 6th or 7th day ofthe disease.


Dorsal longitudinal myelotomy.

Dorsal longitudinal myelotomy. An evaluation of dorsal longitudinal myelotomy in the management of spasticity of the lower limbs has been done in 17 patients. The follow-up has varied from 1 month to over 2 years. Most patients achieved satisfactory relief from spasticity. Eight patients have died after the operation in chronic care hospitals. In all except one, the spasticity had been relieved. Eight out of the nine living patients have benefited from myelotomy. Recurrence of spasticity following the first operation occurred in four patients, two of whom improved after a repeat myelotomy. In the presence of fixed contractures of the hip and knee joints, a satisfactory clinical result may not be obtained after the myelotomy.


Insensible weight loss in patients with spinal cord transection. Insensible weightlosses (IWL) were determined in each of 24 patients with physiologically complete spinal cord transection. The patients were placed on a bed balance with an accuracy of +/- 5 g in an environmental chamber maintained at 24 degrees C. dry bulb and 17 degrees C. wet bulb temperature. Bihourly weight changes, corrected for food and fluid ingestion, were determined for a total of 24 hours. Tetraplegics have significantly lower (P less than 0.05) IWL than paraplegics. The IWL of paraplegics are in the range of IWL of normal persons reported in the literature. We conclude that a lower allowance for IWL should be for tetraplegics than for paraplegics or persons with intact spinal cords.


Investigation of the loss of bone mineral in patients with spinal cord injury. Thirty-six (36) spinal cord injury patients (22 tetraplegic and 14 paraplegic) had hand radiographs taken in association with bone density measurements. The cortical bone of the hand, the radius, and the ulna was found to be normal, but there was an obvious decrease in the amount of trabecular bone. There were three predominant radiographic patterns of osteopenia --generalised, juxta-articular, and cystic. The cause of this decrease in trabecular bone is not understood, although it may be related to alterations in blood flow.


The status of the urinary tract in a survey of 92 cases with neurogenic bladder. Since 1973 intermittent catheterisation was introduced in our centre and this practically eliminated pathology of the urethra. More than half of the patients had a high and complete lesion. It is our impression that 5 years following injury more than half of the patients preserved a normal upper urinary tract; however, only 39 of the 92 patients had a follow-up of over 5 years. Nephrolithiasis was rare in comparison to other reports in spite of belonging to the stone belt area. Complications of the lower urinary tract including a 10 per cent incidence of vesico-ureteric reflux were compatible with other series. Narrowing of the external sphincter on voiding cystogram should be substantiated by a profile pressure record. One female patient is a candidate for ileal conduit. Most of the patients have some form of erection but the data on ejaculation should be accepted with reserve. Two patients in this series died more than 10 years after injury, one due to a myocardial infarction and the other due to chronic renal failure following secondary amyloidosis.


Factors influencing readmission to hospital. I. Tetraplegia. Tetraplegia produces exceptionally severe physical impairment causing disability which demands almost total dependence on others for the activities of daily living but there is no impairment of mental function. The tetraplegic is, therefore, capable of influencing his environment and those features of it which may lead to the need for readmission to hospital. Of the factors studied relating to readmission to hospital, only age and occupational status of the patient at the time of his paralysis are of significance.


Warts: their diagnosis and treatment.

Warts: their diagnosis and treatment. Warts are common skin lesions caused by a papova virus. Their clinical appearance is variable. There is no definitive therapy. Therapy must be individually modified to get the best result with the least discomfort to the patient. Most warts will spontaneously resolve after an average of two years, so any therapy that has serious side effects or results in scarring should not be used. New modes of therapy, particularly immunotherapy, look promising but are still in the experimental stage.


Renal hypertension in children.

Renal hypertension in children. Preliminary results of this retrospective-prospective analysis of renal hypertension in 110 children indicate that hypertension may be secondary to a wide variety of acute progresive, and chronic renal diseases which may be either congenital or acquired. Affected children may be detected at any time from infancy through adolescence. Symptoms usually associated with acute glomerulonephritis (i.e., headache, swelling, nausea, vomiting, anorexia, fatigue, dizziness, and fever) occur in both acute and chronic renal diseases associated with hypertension. Headache and swelling are the most common symptoms in this series. Peripheral edema, rales, and increased heart size were found in between 10 and 25% of these children. Differential diagnosis may be approached by a consideration of causes of acute and chronic hypertension. The child with chronic renal disease usually presents with a long history of fatigability, poor growth, and pallor, and laboratory tests reveal elevation of the creatinine and BUN along with anemia, hypocalcemia, and hyperphosphatemia. In contrast, the child with acute renal disease and hypertension presents with a history of prior good health followed by the abrupt onset of signs and symptoms of renal disease; laboratory tests usually reveal modest elevations of creatinine and BUN, anemia is unusual, an abnormal urinalysis is common, and serum calcium and phosphorous levels are usually normal. Renovascular and asymmetric renal parenchymal disease represent uncommon but important conditions because surgery may be curative. Treatment may be surgical, medical, or combined. Surgical conditions include renal trauma, hydronephrosis, asymmetric renal disease, and renal arterial disease. Adequate blood pressure control without medication can be expected following surgery in instances of unilateral involvement with a normal contralateral kidney. Meticulous assessment of the contralateral kidney is needed to determine that it is normal. If surgery is unsuccessful or is not indicated, pharmacologic therapy is initiated with a stepwise regimen starting with the mildest agent (e.g., thiazides) and then adding additional antihypertensive drugs when adequate blood pressure control has not yet been achieved. The goal of therapy is the lowest, safest, tolerated blood pressure levels. Long-term, carefully designed studies of antihypertensive agents for children with renal hypertension are not available. The need for collection and critical analysis of data concerning the clinical course of children with renal hypertension is evident from a review of the literature and from the preliminary data presented in this series. The presentation of such information and a critique of outcome variables will provide a basis for program planning for affected children and improvement in patient care where indicated.


Conditioning in human opiate addicts.

Conditioning in human opiate addicts. Eight volunteers maintained on daily methadone participated in a classical conditioning procedure to determine which if any of the elements of narcotic withdrawal could be conditioned; The unconditioned stimulus was the injection of a small dose of naloxone. The unconditioned response was a brief precipitated withdrawal syndrome. The conditioning stimulus was a tone, odor, and injection of saline. Conditioning was successful in the pilot study in 5 of 8 subjects. The conditioned response consisted of tearing, yawning, lacrimation, systolic blood pressure increase, respiratory irregularities and subjective feelings of narcotic withdrawal sickness (nausea, muscle aches, chills). A second group of 8 subjects showed, in addition to the above, evidence of conditioning of heart rate, respiratory rate, respiratory, rate and skin temperature decrease. These laboratory findings support the clinical reports of a conditioned withdrawal syndrome and suggest ways to improve treatment results by detecting and extinguishing or modifying conditioned responses.


Severe combined immunodeficiency with cartilage-hair hypoplasa: in vitro response to thymosin and attempted reconstitution. The present report describes an infant with severe combined immunodeficiency and cartilage-hair hypoplasia whose lymphocytes responded to thymosin in vitro. Immunologic evaluation was undertaken at 4 1/2 months of age following a history of recurrent severe infection. Family history included three cousins who died in early infancy, one from streptococcal meningitis and pneumonia, one from generalized varicella, and another from reticuloendotheliosis. Quantitative immunoglobulins were markedly depressed: IgG 141, IgA 0, and IgM 24 mg/100 ml. There was an absolute lymphopenia, multiple skin tests were negative, and in vitro lymphocyte responses to mitogens and antigens were depressed. Spontaneous E rosette determinations were 21% compared with control values of 65.7%. Erythrocyte adenosine deaminase (ADA) activity was normal. The patient's E rosette formation increased in the presence of thymosin, fraction 5, reaching a maximum of 56% with a concentration of 500 mug thymosin. Blastogenic responses to phytohemagglutinin also increased in the presence of thymosin. Transplantation of 24-week fetal thymus in Millipore diffusion chambers and subsequently transplantation of 18-week fetal thymus by intraperitoneal injection was accomplished. E rosettes increased to 35-40% and blastogenic responses to mitogens increased. Eight days after the second transplant the patient underwent a mild graft vs. host reaction which subsided after 1 week and mitogen blastogenic responses again increased to 5-8 times previous values, but still well below control ranges. Repeated episodes of pulmonary infection ensued, cor pulmonale resulted, and the clinical course was relentlessly downhill with the patient expiring from respiratory failure 5 months after transplantation.


Glutamate dehydrogenase, alanine aminotransferase, thymidine kinase, and arginase in fetal and adult human and rat liver. In fetal livers of both man and rat thymidine kinase activity was 12 times higher than in the adult, glutamate dehydrogenase and arginase were present at 20-50% of their adult values, whereas alanine aminotransferase activity was only an insignificant fraction of that in the adult. Although the developmental changes for the four enzymes were quantitatively similar in both species, qualitatively there were some significant differences. In adult human liver, glutamate dehydrogenase activity was distributed almost equally between the cytosol and particles; the concentration of only the soluble enzyme increased after birth. In rat liver, glutamate dehydrogenase remained exclusively a particulate enzyme. The soluble hepatic alanine aminotransferase activity rose in both species after birth (from less than 2 U/g to 41-57 U/g, respectively). Thymidine kinase was wholly soluble in the fetal livers; only in adult human liver was additional activity (at least 50% of the total) found in the particles. Arginase isozymes, identical and apparently the same single isozyme in fetal and adult rat liver, show an ontogenetic change in man. A shift from a single form, common to human fetal liver and fetal kidney, to at least two variants in adult human liver, indicates another complexity of the fully differentiated liver in man.


Effect of sodium restriction and angiotensin II infusion in Bartter's syndrome. Five patients with Bartter's syndrome were investigated. Sodium restriction (less than 10 mEq/day for at least 5 days) showed a renal sodium wastage in only two patients (I and II) in spite of increased aldosterone secretion rate (from 151-427 to 680-842 mug/day). The effect of angiotensin II (A II) 80ng/kg/min for 30-180 min, on plasma renin activity (PRA), plasma aldosterone, and urinary sodium excretion was compared with the effect of a previous infusion of 5% dextrose given at the same rate, 0.5 ml/min for 1 hr. A II infusion resulted in increased plasma aldosterone levels: from 236-330 pg/ml to 800-881 pg/ml in 30 min. This increase was also observed in patient II (from 139 to 600 pg/ml). PRA was decreased by A II infusion (from 1,142-2,462 to 121-1,625 ng/liter/min). In patient IV, this decrease in PRA was also observed when he was on a salt-restricted diet (from 1,934 to 370 ng/liter/min); but the minimal PRA was still higher (370 ng/liter/min) than with a normal diet (121 ng/liter/min). In no case could normal PRA level be obtained. A II infusion induced an increase in urinary sodium excretion only in the two patients with renal sodium wastage (from 80-90 to 265-230 muEq/min in 30 min). Urinary sodium excretion decreased in the other patients from (37.5-213 to 4.30-46 muEq/min) and fractional sodium excretion was reduced in patient V (from 0.56% to 0.45% at 30 min and to 0.29% at 120 min). No significant change with A II infusion was observed in patient IV when he was on a sodium-restricted diet (from 1 to 2.5 muEq/min in 30 min). Urinary potassium excretion was similar to sodium excretion. No change was observed in plasma potassium and sodium.


Dietary lipid and postnatal development. I. A model for neonatal studies requiring high and low fat diets from birth. As a prerequisite to a biochemical investigation into the role of dietary lipids in regulating perinatal fatty acid metabolism, we developed and evaluated a model in which the amount of lipid in the diet can be easily controlled from birth to at least 10 days of age. Neonatal rabbits were fed purified equicaloric diets in which lipid supplied either 14.2% or 77.6% of the total calories. Mortality due to all causes was about 40% in both groups. Some differences in physical development between the two groups were noted. Animals receiving the smaller amount of lipid (LF group) gained weight to 150% birth weight day 10, whereas the group receiving the larger amoung of lipid (HF group) did not gain. In addition, the HF group had lower body temperatures, smaller liver and kidney weights, and greater brain weights relative to body weight. These differences are discussed in relation to the composition of the HF and LF diets. The model promises to provide a direct approach to a more precise evaluation of varied dietary regimens in the neonatal period. In particular, the model lends itself to studies relating diet to developing biochemical functions. In an accompanying paper, we report the results of an investigation comparing fatty acid oxidation in heart and liver of neonates fed the HF and LF diets described here.


Mannosidosis: clinical, morphologic, immunologic, and biochemical studies. The primary metabolic defect in mannosidosis is the deficiency of the acidic alpha-mannosidase A and B activites which results in the lysosomal accumulation of mannose-rich substrates. Out studies demonstrate that the enzymatic diagnosis of suspect homozygotes can be made reliably using plasma, isolated leukocytes, or cultured skin fibroblasts assayed carefully at the appropriate acidic pH. Immunologic studies of a mannosidosis homozygote revealed significant abnormalities of neutrophil function; these included a depressed chemotactic responsiveness and impaired phagocytosis of bacteria. Lymphocyte transformation studies showed a 20% of normal response to purified phytohemagglutinin and a 25% of normal response to concanavalin A. Three major components of alpha-mannosidase activity in normal human liver were resolved by ion exchange chromatography on DEAE-cellulose and electrophoresis on cellulose acetate gels. Electrophoresis of the liver extract from homozygote I with mannosidosis revealed only one band of activity which coelectrophoresed with the alpha-mannosidase C isozyme partially purified from normal liver. However, ion exchange chromatography revealed the presence of residual hepatic acidic activities; the residual A isozyme was eluted in a position corresponding to that of normal alpha-mannosidase A whereas the residual B activity was eluted at a slightly more electronegative position than that of normal B isozyme. The apparent Km values for alpha-mannosidase activity as determined from Linweaver-burk plots were 1.1 mM for normal liver and 0.9 mM for normal leukocytes. In contrast, the residual activity in these sources from homozygote 1 could not be saturated within the solubility range of the substrate; the apparent Km value was estimated at 15.4 mM in liver extracts. Zinc significantly lowered the apparent Km value of the acidic activity in normal liver (from 1.2 to 0.24 mM), whereas this metallic ion had little effect on the values for mannosidosis hepatic activity (from 15.4 to 12.3 mM). Unlike zinc, cobalt had its major effect on the acidic activity in the mannosidosis liver extract, lowering the apparent Km from 15.4 to 3.9 mM, whereas the apparent Km for the normal activity was increased from 1.2 to 1.9 mM. The residual acidic activities were markedly stimulated by zinc in both leukocytes (approximately 300%) and plasma ( approximately 400%) from the homozygotes and to a lesser extent in those sources from normal individuals. In contrast, cobalt enhanced the residual acidic activities in leukocytes (approximately 500%) and plasma (approximately 200%) from the homozygotes while inhibiting these acidic activities (78.9% and 47.7%, respectively) in normal individuals.


A simplified approach to the measurement of specific airway resistance. A simple algebraic manipulation of known formulas leads to a direct expression for the specific airway resistance (SRaw) which precludes separate measurements of the airway resistance (Raw) and the thoracic gas volume (TGV). The equation is: SRaw = tg beta (PBar - PH2O) e2, in which tg beta stands for the relation between the plethysmographic box volume and pneumotachograph flow fluctuations; PBar - PH2O is the barometric por graphical units. Thanks to this new formula SRaw can now be easily measured with great precision and quickly calculated, even in the case of those children (Table 1) with whom this was not previously possible. No further cooperation is needed than breathing at a normal rate through mouthpiece into a whole-body plethysmograph. The intraindividual coefficient of variation (CV) for SRaw is about 8% and never exceeds 15% (Table 1).


Annual summary of vital statistics-1975. Data for this article, as in previous reports, are drawn principally from the Monthly Vital Statistics Report, published by the National Center for Health Statistics. The international data come from the Demographic Yearbook and the quarterly Population and Vital Statistics, both published by the Statistical Office of the United Nations, and the World Health Statistics Report, published by the World Health Organization. All the United States data for 1975 are estimates based upon a 10% sample of material received in state offices between two dates, one month apart, regardless of when the event occurred. Experience has shown that for the country as a whole the estimate is very close to the subsequent final figures. There are, however, considerable variations in a few of the states; state information should be interpreted cautiously.


Endotracheal intubation and its relationship to bacterial colonization and systemic infection of newborn infants. The role of antibiotics in preventing respiratory tract bacterial colonization and systemic infection after orotracheal intubation was prospectively studied in 54 newborn infants. Respiratory tract colonization was assessed from nasopharyngeal and tracheal aspirate cultures obtained at intubation and daily thereafter, while systemic infection was monitored by blood, cerebrospinal fluid, and suprapubic urine cultures performed initially and every three days thereafter while intubated. Colonization and systemic cultures were also obtained at extubation or death. The study group, provided with antibiotics at intubation, and the control group were similar in birthweight and gestational age, as well as race, sex, hospital or origin, and indication for intubation. Colonization at intubation was five times more common in infants intubated 12 or more hours after birth than in infants intubated earlier. Subsequent colonization was twice as frequent in infants intubated longer than 72 hours as well as in those requiring two or more reintubations. Systemic infection occurred only in those infants who were initially or subsequently colonized and was three times more frequent in the control group than in the study group.


Neonatal circumcision: a ten-year overview: with comparison of the Gomco clamp and the Plastibell device. The records of 5,882 live male births were reviewed to ascertain the incidence and nature of complications following neonatal circumcision. Approximately one half of the patients were circumcised with the Gomco and half with the Plastibell. The incidence of complications was 0.2%; most frequent were hemmorrhage, infection, and trauma, there were no deaths; and no transfusions were given.


Computerized axial tomography in chronic seizure disorders of childhood. Ninety-eight children with chronic seizure disorders were studied by computerized axial tomography (CAT). Structural abnormalities were identified in 30% of these children. The greatest incidence of abnormalities was in children with focal motor seizures (43%) and in those whose EEG demonstrated focal slowing together with focal spikes (38%). The most common abnormality was either focal or generalized atrophy (13%). Only about 2% of the abnormalities discovered by CAT were potentially of therapeutic significance. However, the demonstration of a static process, or the finding of a normal CAT, may be quite helpful to the family and physician in certain children with chronic seizure disorders.


Early intrauterine development: II. The rate of growth in Black and Central American populations between 10 and 20 weeks' gestation. The application of the growth-rate standards, extablished for Caucasian embryos and fetuses in a previous report, to Black and Central American racial groups has been investigated. Comparison between menstrual age and crown-to-rump length indicated differences in the 10 to 15 weeks' gestation range. However, growth rates for the same groups were practically identical between the 15th and 20th weeks of pregnancy. This finding suggests that the actual rate of growth is closely similar in the respective ethnic groups and that apparent discrepancies reflect erroneous, or purposefully false, menstrual histories rather than dissimilar growth patterns. Largely identical rates of development were suggested by the crown-rump length to foot length to body weight interrelations among the various racial groups. A moderate, but rather predictable, deviation from the earlier established standards was noted in the crown-rump length versus foot length ratios of Black American fetuses, providing the only exception to what appears to be a practically identical rate of growth for the investigated ethnic groups in the first half of gestation. The evaluation of the results was extended to involve the effect of educational and social factors on currently available data of embryonic and fetal growth. It is suggested that heretofore unconsidered factors may affect the validity of widely quoted standards of intrauterine growth.


Birthweight of children with phenylketonuria. The assumption that children with phenylketonuria (PKU) develop normally until birth was brought into question by the recent report that PKU children weigh several hundred grams less at birth than their unaffected siblings. We have examined intrafamily differences in birthweight in 40 sibships with at least one affected and one unaffected child. The difference in mean birthweights computed by taking a weighted average of the intrafamily differences was 69 gm, and the adjusted estimate of the birthweight difference between children with PKU and their siblings, obtained from a fitted multiple regression function, is -51 gm. The findings are not consistent with the large difference in birthweight reported previously and are compatible with the assumption that the intrauterine physical growth of children with classical PKU is not adversely affected.


Children with encopresis: a study of treatment outcome. A pediatric treatment program for encopresis was established in a large medical center. This consisted of counseling and education, initial bowel catharsis, a supportive maintenance program to potentiate optimum evacuation, retraining, and careful monitoring and follow-up. A group of 127 children received care for this problem. At the end of one year, outcome data were obtained on 110 patients. Of these, 51% had not had "accidents" for more than six months. Another 27% showed marked improvement and were having only rare episodes of incontinence. 14% of these children showed some improvement, but continued to have incontinence, while 8% showed no improvement whatsoever during the treatment year. These four outcome groups were compared with respect to a large number of demographic, developmental, psychosocial, and clinical variables.


Home management of bronchopulmonary dysplasia. Home oxygen was utilized in six infants with BPD with no complications.  This program allowed for early discharge of the infants, resulting in a mean financial savings of $18,000 per infant and a more normal family environment for the babies.


Tularemia: an unappreciated cause of exudative pharyngitis. A boy with a persistent febrile illness accompanied by exudative pharyngitis found to be due to tularemia is described. The role of tularemia as a cause of exudative pharyngitis is discussed.


Atrioventricular block complicating meningitis: treatment with emergency cardiac pacing. Percutaneous insertion of a transthoracic pacing wire is described in a child who developed complete A-V block during hospitalization for treatment of meningitis. This is a simple method and the necessary material can be easily included on emergency carts.


Amikacin pharmacokinetics in the therapy of childhood urinary tract infection. Amikacin, a new aminoglycoside antibiotic with a spectrum similar to that of gentamicin, has been used mainly in adults. This report summarizes the first use of this drug in children with urinary tract infection. Organisms were eradicated in all cases and recurrent infection occurred in one half after one week. No evidence of ototoxicity or nephrotoxicity was found. Four children developed transient elevation of serum glutamic oxaloacetic transaminase. Serum level (17 mug/ml) of the drug at one hour and its urinary excretion in six hours (60% of the dose) was comparable to those of adults. This antibiotic is potentially valuable and has thus far not shown major toxicity when given for up to 11 days in patients with normal renal and liver functions.


Lymphagiomas of the alveolar ridges in neonates. Blue-domed, fluid-filled lesions on the alveolar ridges of neonates were noted in 3.7% of all normal black newborns examined. None were found in whites. On microscopic examination of eight such lesions, the diagnosis of lymphangioma was made. These lymphangiomas should not be confused with Epstein's pearls, Bohn's nodules, eruption cysts, or mucous retention phenomena. The natural history of such lymphagiomas is unknown. However, spontaneous regression was noted in several cases.


Phosphaturia in thalassemia.

Phosphaturia in thalassemia. Thirteen phosphorus balances were performed in four thalassemic children aged 6 to 10 years. No correlation was found between phosphorus intake and serum level or between phosphorus intake and net absorption. There was a positive correlation among daily phosphorus intake, net absorption, and 24-hour urinary excretion. The 24-hour urinary excretion level was higher than net absorption, indicating that these children have normal phosphorus absorption but abnormally high renal phosphaturia, which leads to a deficiency of phosphorus. A strongly positive correlation was found between values for hemoglobin and serum alkaline phosphatase. In the thalassemic patients with hemoglobin levels larger than or equal to 7.5 gm/100 ml, the serum alkaline phosphatase values were larger than or equal to 15 King-Armstrong units, suggesting normal osteoblast function.


Energy dose for ventricular defibrillation of children. Transthoracic direct current shock is the recommended treatment for ventricular fibrillation in children as in adults. To determine the appropriate energy dose, data were collected from 71 defibrillation attempts in 27 children. Sixty-three of the 71 shocks (89%) were successful in terminating fibrillation. Fifty-seven shocks were within 10 watt-seconds (w-sec) above or below an energy dose of 2 w-sec/kg of body weight. Fifty-two (91%) of these were effective and five (9%) were ineffective. In every case, fibrillation was ultimately terminated by a shock of 4 w-sec/kg or less. The results of these studies suggest that an energy dose of 2 w-sec/kg (or approximately 1 w-sec/lb) is adequate to defibrillate most children weighing under 50 kg. We currently use 2 w-sec/kg and double the energy dose if the first defibrillation attempt is unsuccessful.


Unsuspected pulmonary vascular abnormalities associated with diaphragmatic hernia. The pulmonary vasculature of 12 newborn infants who died with unilateral diaphragmatic hernias was studied. Four developed severe ventilatory insufficiency after birth and promptly died. Their lungs were both hypoplastic and airless dur to compression by displaced abdominal viscera and mediastinal shift. Corrective surgery permitted lung expansion and adequate ventilation for one to two hours in five infants. Subsequently, ventilatory insufficiency supervened and they died. Postoperative blood gases revealed a right-to-left ductus arteriosus shunt in one infant. Ten of the infants with hernias had a significantly greater mass of muscle in pulmonary arteries than did matched controls. This may partially explain the fetal-type circulatory infants.


Blood magnesium and the renal magnesium threshold in lichen-fed and fasted reindeer. In the blood plasma of lichen-fed reindeer the magnesium level was rather low (1.44 +/- 0.17 mg/100 ml) while the levels of calcium, phosphorus and glucose were normal. Fasting for 2--3 days provided no evidence of magnesium deficiency, leading to increments in blood and urinary magnesium. Simultaneous increments in urinary calcium indicated mobilization of bone minerals. The renal magnesium threshold appeared to be at about 1.8 mg of Mg/100 ml of plasma as in other species.


Mycobacteriosis in a roe-deer caused by wood-pigeon mycobacteria. A mycobacterium, hitherto found only in wood-pigeons, was isolated from a roe-deer with generalized tuberculosis-like lesions. It is of great epidemiological interest that a mammal, under certain conditions, can attract this pathogen.


[The etiology of "alveld" elucidated by the BSP-test]. The lamb disease called alveld is caused by Narthesium ossifragum. It is observed clinically in white lambs as a photosensitization, which may become very severe. At a more advanced stage, icterus often occurs as well, the latter affecting both black and white lambs. Adult sheep are rarely affected by alveld. Presence of phylloerythrin in the blood is a prerequisite for the photosensitization. Phylloerythrin is formed by microbial action from chlorophyll and is normally excreted in the faeces and the bile. Sufficient excretion fails in lambs getting alveld. The function of the liver has been examined in 40 lambs which had grazed for 10 days on Narthecium ossifragum, using the BSP-test of Rosenthal & White (1925). Fourteen out of 40 lambs showed a pathological liver dysfunction, while no clinical symptoms could be observed. Five to seven days thereafter 9 out of the 14 lambs with liver dysfunction became subject to photosensitization. (Table I). The ability of the BSP-test to indicate alveld at an early stage was statistically significant. It is concluded that liver dysfunction precedes photosensitization.


Mercury in various tissues of fish caught downstream of a wood pulp factory in the kammerfoss river, South Norway. The mercury content of perch (Perca fluviatilis) and brown trout (Salmo trutta) from a river in South Norway, previously shown to be contaminated with mercury from a wood pulp factory, was studied during a 5-years period after the use of mercury in the factory had been discontinued in 1970. In addition to muscular tissue, samples of liver, kidney, brain, heart, and gonads were also analyzed in some cases. The mercury level in the musculature remained nearly constant at about 1 mug/g during the years 1971-1975. The organ distribution studies indicate a relatively even concentration level in different organs of moderately exposed individuals, while mercury contents exceeding 100 mug/g have been observed in the liver of fish exposed to high mercury pollution.


[Hyperthyroidism induced by iodine in an apparently normal thyroid gland. A new iatrogenic disease]. Iodine-induced thyrotoxicosis was reported to occur in patients with previously altered thyroid gland. Evidence is presented here from 23 cases that iodine-induced thyrotoxicosis may also occur in patients with no prior thyroid desorder and is characterized by: a) an almost undetectable 131I uptake, wich can be activated by TSH; b) a spontaneous improvement within a few weeks or months after withdrawing the high intake of iodine; c) the absence of any detectable thyroid abnormality after recovery.


[New plasmid resistance of Staphylococcus aureus to aminosides (gentamicin, tobramycin, amikacin]. Recently, strains of Staphylococcus aureus resistant to gentamicin, tobramycin and amikacin have been discovered in several hospitals in France. These new resistances, of two different types, are of plasmid origin and of enzyme mechanism. This study describes their current incidence.


[Erythema nodosum in sarcoidosis. 37 cases]. Erythema nodosum was seen in 37 out of 564 cases of sarcoidosis, i.e. 6.4. per cent. The female preponderance of the association was 56.8 per cent. It was accompanied by fever in 84 per cent of cases and with an increased sedimentation rate, greater than 50 mm in the first hour, in 44 per cent of cases. Articular manifestations (arthralgia or arthritis) were seen in 73 per cent of cases, with a predilection for the ankles. Progression by acute excerbations of the erythema nodosum and/or articular manifestations was rare. Mediastino-pulmonary involvement accompanying the erythema nodosum included mediastinal lymphadenopathy in all cases. Infiltration of the pulmonary parenchyma was seen in 27 per cent. Spontaneous resolution of the mediastino-pulmonary lesions occurred in 82 per cent of cases, regardless of the initial radiological appearance.


[Acute consumption coagulopathies. 120 cases]. Consumption coagulopathy is frequently observed in a resuscitation department. 120 cases of various etiologies are reviewed: complications of pregnancy (61 cases), infections (23 cases) or various stresses: acute hemolysis, shock, severe hepatic failure, intoxications, acidosis, heat-stroke... Consumption coagulopathy is intricated with the general stress which induces it, and with the visceral lesions induced by the stress and which can be aggravated by the consumption coagulopathy. The state of shock is observed in 76% of the cases, the haemorrhagic syndrome in 73%. Acute hemolysis and the clinical signs evocative of disseminated intravascular coagulation (cutaneous signs) are more rare. Following the initial manifestations, visceral complications may develop: renal, hepatic, respiratory, neurological, digestive. The evolution of the biology must be carefully studied. The diagnosis is made on both clinical and biological data. Etiological and pathophysiological treatment should be carried out. In our series, controlled and adapted heparin therapy was given systematically.


[Effusions rich in amylase without pancreatitis. 14 cases]. This study involved 14 cases or pleural effusions or ascites rich in amylase and unrelated to chronic pancreatitis, a pseudo-cyst of the pancreas or acute pancreatitis. A pleural effusion rich in amylase may be secondary to a pancreatic neoplasm but this possibility seems rare. Amylase-containing effusions related to a nonpancreatic neoplasm are more common. The lesion is in general an advanced pleuro-pulmonary carcinoma, frequently an adenocarcinoma. The amylase activity of neoplastic effusion fluid is significantly increased but although levels similar to those of certain pancreatic effusions may be seen, very high figures would appear to be rare. Finally, two cases of amylase-rich pleural effusions were related to a pleuro-digestive fistula and one left-sided effusion was secondary to abdominal trauma.


[Gastric mucosa in patients with rheumatoid polyarthritis treated by anti-inflammatory agents. Clinical, radiological, endoscopic, anatomopathological and ultrastructural study]. One hundred patients (50 male, 50 female) suffering from rheumatoid arthritis, treated for more than 6 months with steroid and/or non-steroid anti-inflammatory agents were studied using barium X-rays and gastro-fibroscopy. In 69, one or more gastric biopsies were taken during the endoscopy. The study showed a marked preponderance of ulcerous lesions in males, 9 of the 13 iatrogenic ulcers being found in this sex. It also confirmed the frequency of gastritis and the absence of any correlation between clinical signs and radio-endoscopic findings as well as between the latter and histopathological data. An ultra structural study carried out in 20 cases revealed focal lesions of the clear cells of the neck of the fundus and antral glands and, in 4 cases, marked changes in the gastric endocrine cells.


[Profile of surgical tumors of the mediatinum. Apropos of a series of 742 operated patients]. The authors seek to draw statistical conclusions on the basis of 742 surgically treated mediastinal tumours. Tumours of the thymus were the most common (20%). They were followed by tumours of the thyroid, neurogenic tumours, haematosarcomas and mediastinal cysts - all with an occurrence rate of around 12 to 15%. From a histological standpoint, 34.5% of the tumours were malignant or "potentially malignant". After a topographical study of these tumours, the authors discuss the possibilities of surgical treatment, the latter being great even in the case of malignant lesions.


[Adrenal scintigraphy using 131 I-19-iodocholesterol. Value in the exploration of Cushing's syndrome]. On the basis of 7 cases representing the essential types of aetiology of Cushing's syndrome, it is possible to define the value, limitations and role of adrenal scintigraphy using 131I-19-iodocholesterol in the diagnostic investigation of hypercortisolism. The essential value of the investigation is morphological rather than functional drome. Thus adrenal scintigraphy has the same role in diagnostic investigation as various radiological procedures such as pneumoperitoneum and angiography. The latter, however, are technically difficult and fraught with risk, in contrast to the isotopic examination. The principle limitations of the method are not dosimetric but lie in the relative difficulty of interpretation of the documents obtained.


Interaction of ethidium bromide with DNA: effect of LiCl and ethylene glycol. The interaction of the intercalating dye ethidium bromide with several native and synthetic polydeoxyribonucleic acids has been studied by means of circular dichroic spectra. The CD of DNA-ethidium bromide complexes in the 290-360 nm region is characterized, especially at high salt and at high ethylene glycol content, by positive and negative bands near 308 nm and 295 nm, respectively. These dye associated CD bands are unaffected by the addition of LiCl or ethylene glycol, suggesting that the relative conformation of dye and neighboring base pairs does not change when the conformation of the rest of the DNA changes.