[Attitudes towards alcohol in 2 groups of children 13 years of age]. Two groups of children, thirteen years of age, were given a questionnaire to study their attitudes towards alcohol consumption and alcoholism. The children belonged to two different socio-economical levels: low and high, and were selected at random, in the zone "Oriente" of the National Health Service, Chile. The analysis of answers was made along three directions: a) affective component; b) cognitive component; c) reactive component. The results show that children of low socio-economical level are more negative and rejective towards alcohol consumption than the others, and show more conflicts about it. Both groups reproduce adult patterns and opinions of their respective level. A future development of this type of research can be the criteria for prognosis in relation to early attitudes towards alcohol.


[Pharmacological and psychosocial aspects of drug dependence]. Use and abuse of psychotropic drugs start with history, but toxicomania starts much later, with the discovery of morphine, in early XIXth. Century; and increases sharply after the 2nd. World War. The author reviews the general classifications of drug abuse, stressing the many differences among them, as well as the differences in clinical approaches to each one of them, and in criteria for treatment. Abuse of drugs takes many different forms roughly reduced to three: a) "traditional" addicts, with permanent and heavy intake of barbiturates, amphetamines, alcohol and narcotics; b) regular mass consumers of medicines, legally prescripted by doctors on grounds of unwise criteria or sheer complicity; c) members of the "Drug Culture" making of drug abuse a symbol of doctrinary social claims. Addictive drugs are classified, according to Lehmann, into three groups: 1. Expansive drugs: producing intense feeling and elation, according to three classes: a) Thrill drugs, causing an immediate deep pleasure, a jolt in the stomach and warm waves towards the abdomen and genitalia, with orgasmic effects; b) Easiness drugs, increasing energy and self-reliance and decreasing fatigue or ill-feelings; c) self-realization drugs, leading to deep and rich self-awareness, and heighted aesthetic and intellectual potential. 2. Reductive drugs: lowering the intensity of sensations and emotions, in three kinds: a) Releaser drugs, causing removal of inhibitions and production of phantasies; b) Sedation drugs, easing tensions and anxieties; c) Stupefying drugs, blurring all contact with the outer world. The author analyzes the patterns of intake, which include generally two or more different types of drugs, and vary in the same individual according to circumstances. Finally, several factors leading to addiction are considered, among them: biological and genetical endowment or predisposition; psychological conflicts or flaws; and social factors.


A case report including EM and DNA repair investigations in a dermatosis associated with multiple skin cancers: epidermodysplasia verruciformis. This report describes the clinical, histological and electron microscopic observations in a 51-year-old male with epidermodysplasia veruciformis (EV). Cells with early signs of malignant transformation were found closely connected with virus infected epidermal regions. Skin cancers appeared initially on sun-exposed areas, such as the face and ear lobes. The UV-induced DNA repair synthesis was therefore studied, utilizing peripheral leukocytes. The patient had 40% lower UV-induced DNA repair synthesis than the mean of nine healthy subjects of the same age. These results suggest that a decrease in UV-induced DNA repair synthesis in combination with a possibly oncogenic viral infection may enhance the disposition for somatic mutations and malignant transformation in patients with EV.


The postinfarction clinic in Göteborg, Sweden. A controlled trial of a therapeutic organization. Since Jan. 1, 1968, a Postmyocardial Infarction Clinic has been operating in Göteborg, Sweden. The methods used have been presented previously in this journal. The present study compares 96 male postinfarction cases, 57-67-year-old, treated at the Postmyocardial Infarction Clinic and a random sample of 85 patients not treated at the clinic. The mortality did not differ between the groups but there was a significant difference with regard to non-fatal reinfarction. The reasons for this are only partially explained by better control of accepted cardiovascular risk factors in the group treated at the clinic. Cessation of smoking was vigorously recommended but lipid lowering, antiarrhythmic or anticoagulant drugs were never used in this group. The results indicate that formalized management of homogeneous patient groups may achieve a general reduction of recurrences.


Prognosis of patients with complete heart block or arrhythmic syncope who were not treated with artificial pacemakers. A long-term follow-up study of 101 patients. This paper reports the results of a retrospective study carried out with special reference to the survival rate in a series of 101 selected cases including patients with complete heart block (CHB) combined or not combined with Adams-Stokes attacks and patients with arrhythmic syncope without ECG evidence of CHB. All these patients were treated in our Department during 1958-68, none being artificially paced. Twenty-seven patients were alive at the end of the follow-up, i,e 6-15 years after admission to this Department on account of syncopal episodes or CHB. The survival rate--higher in females than males--was lower in the cases of CHB combined with Adams-Stokes attacks than in the cases of asymptomatic CHB. This applied also to the instances in which a complicating disease such as ischaemic heart disease (IHD), hypertension, diabetes, digitalis intoxication or cardiac enlargement coexisted. The survival rate in the 68 cases of CHB was higher at one year (68%) as well as at 5 years (37%) than that reported by other investigators. When assessing the survival rate in cases treated with artificial pacemakers, it is important to study the individual case histories with special reference to a previous or coexisting condition such as IHD, hypertension, diabetes or the presence of cardiac enlargement. The present results support the view that the indications for treatment with artificial pacing should be wide, albeit that the prognosis in this series was more favourable than might have been anticipated from observations by others.


Systolic time intervals in cardiac tamponade. Systolic time intervals (STI) have been measured in three patients with cardiac tamponade. The left ventricular ejection time (LVET), the preejection period (PEP) and the ratio PEP/LVET deviated significantly from the normal values. All three parameters improved immediately after pericardiocentesis and aspiration. The total electromechanical systole changed to only a minor degree. Measurement of STI may be a valuable tool in the diagnosis and treatment of cardiac tamponade.


Mortality pattern among initial survivors of acute myocardial infarction using a life-table technique. The 5-year pattern of mortality among 475 immediate survivors of acute myocardial infarction (AMI) (mean age 65 years on entry) is described by a life-table technique. The risk of death was highest during the early part of the follow-up. After 3-4 years, the prognostic influence of the AMI seemed to be overshadowed by the age effect. Special attention was paid to the incidence of sudden death, a fictive elimination of which was shown to reduce the risk of death by 9-22% during the different years of the investigation period. The absolute number of sudden deaths was highest during the early part of the follow-up period but the relative importance of this mode of death was approximately the same during the entire 5-year period after the AMI.


Removal of exogenous triglycerides in subjects with massive obesity before and after jejunoileal shunt operation. The fractional removal rate of exogenous triglycerides (TG) in 12 obese subjects with a mean body weight of 132+/-5 kg (S.E.M.) has been studied before a jejunoileal shunt operation. The study was repeated postoperatively at stable body weights 30-54 months later. The weight loss ranged from 13 to 65 kg (mean weight reduction 27%). In 8 patients, 0.3-6.0 kg of skin and subcutaneous tissue were removed surgically for cosmetic reasons during the weight reduction period. Serum cholesterol fell from 220+/-8 to 141+/-11 mg/100 ml (p less than 0.001). The serum TG reduction was not significant, 1.80+/-0.25 before and 1.50+/-0.19 mmol/l after operation. The fractional removal rate of exogenous TG, determined by the intravenous fat tolerance test (IVFTT) with the Intralipid fat emulsion, was not significantly changed. The IVFFT k2 value was 3.5+/-0.5%/min before and 4.3+/-0.6 after surgery (p greater than 0.05). Previous studies have shown that a major part of Intralipid is removed initially in skeletal muscle. The unchanged fractional removal rate of Intralipid, despite the marked reduction in the amount of adipose tissue, supports the concept that the adipose tissue may play a minor role in the initial elimination of exogenous TG from the bloodstream.


The intercorrelation of serum cholesterol, cigarette smoking and body weight. The Oslo Study. A screening for coronary risk factors in 18 000 Oslo men yielded 16 525 "healthy" men, aged 20-49. The intercorrelation of serum cholesterol, body weight and cigarette smoking was found to be more pronounced than described in other studies. Increasing daily exposure to cigarette smoke in the order: never-smoker, ex-smoker, non-inhaling smoker, inhaling smoker and present non-filter smoker, was parallelled by increasing cholesterol levels, but not by increasing body weight. Daily cigarette-smokers had lower body weight and higher serum cholesterol values than never-cigarette-smokers, with the exception of the 20+ cigarette-smokers who had higher serum cholesterol values and body weight than the never-cigarette-smokers. As regards ex-cigarette-smokers, both body weight and serum cholesterol tended to increase with the number of cigarettes smoked before quitting. Possible explanations of these findings are discussed.


Blood levels of 3,5,3'-triiodothyronine and thyroxine: differences between children, adults, and elderly subjects. The serum levels of 3,5,3'-triiodothyronine (T3) and thyroxine (T4) in children, adolescents, adults, and elderly subjects have been measured by radioimmunoassays. It was found that while the T4 levels were essentially equal in all age groups examined, the T3 levels were markedly different. In children and adolescents (1-15 years), high values were recorded; indeed, they exceeded the upper normal limit in adults (20-80 years). From the age of 20, the T3 levels remained unaltered until the age of 80, after which there was a further reduction, to values approaching the lower normal limit for T3 in middle-aged subjects. The findings emphasize that separate normal values must be established for different age groups, in order to avoid diagnostic misinterpretations and therapeutic failures.


On the influence of concomitant food intake on sulfonamide bioavailability. The influence of food intake on the bioavailability of a frequently used short-acting sulfonamide, sulfaisomidine (Elkosin), has been examined in eight healthy volunteers. The drug was administered as a single oral dose, both on an empty stomach and together with a standardized breakfast. Numerous venous blood samples were drawn for the first eight hours after ingestion of the drug, and the concentration of unmetabolized sulfonamide in serum was assessed by spectrophotometry. The observations indicate that concomitant food intake alters neither absorption rate, peak concentration, time to reach peak concentration, elimination rate, nor total amount of sulfonamide reaching the general circulation. Thus, the absorption of orally administered sulfaisodimidine is not at all affected by concomitant intake of food. This finding contrasts with previous observations on some other sulfonamides, and it may signify a therapeutic advantage of sulfaisodimidine. In addition, the amount absorbed showed only a little interindividual variation. This suggests that the use of standardized size and interval of sulfaisodimidine dosage can be recommended. The present findings emphasize that conclusions about the absorption of a certain drug should not be derived from studies with other, albeit chemically related, compounds.


Thyroid autonomy (Plummer's disease) with contralateral malignancy--mere coincidence? A patient with an autonomously functioning nodule in the left lobe and a papillary carcinoma in the right lobe of the thyroid gland is described. Some evidence suggests the association to be more than coincidental.


Variations in the relationship between the diaphysis and the epiphyses of the tibia. In all 56 tibiae from Lapps and 56 tibiae from Norwegians have been studied. These ethnic groups represent different weight bearing situations. Variables expressing adaptation to non-axial loading are dealt with. The bone is mainly studied in the AP and the ML planes, as well as in the three dimensional space. The material is analyzed statistically. The distribution form is examined and the deviations from normality are found to be moderate. Mainly positive skewness occurs. Platykurtosis is found as often as leptokurtosis. The deviations from a standard normal distribution are not supposed to affect the results significantly. There is a non-systematic pattern of distribution. The variability is generally lower in Lapps than in Norwegians. The standard deviation shows highest numerical values in indices, lowest in linear variables. Systematic group differences, especially in similar variables, are supposed to be of greater importance than isolated differences. The variables giving deviations from the reference planes or the diaphyseal axis, show the largest and the consistent left-right differences. In linear variables Lapps and females show lower mean values than males and Norwegians, respecitvely. In linear variables giving deviations from the reference planes, in angular variables and in indices, Lapps usually show the highest mean values. Lapps tend to show larger sex differences in variables giving deviations from the reference planes or the diaphyseal axis. However, the sex differences within the Lapps are small. The variations of the tibia are supposed to be the results of mechanical factors in bone remodelling. The epiphyseal-metaphyseal parts tend to have a constant shape, the adaptations to non-axial loading predominantly appearing in the diaphysis. The relation between the weight bearing line and the diaphyseal axis is discussed, particularly regarding the ML stability mechanism of the knee joint. The occurrence of torsion and its influence upon the AP and ML projected values regarding the relationship between the epiphyses and the diaphysis are discussed.


[Growth of eye and orbit in chick embryo. IX. Developement of eye and skull origin in 3-9 day old embryos with experimental bilateral microphthalmia]. Chick embryos in which on the third day of incubation the lens of both eye primordia was removed, were sacrificed at the ages of 5,7 and 9 days and fixed in a 70 per cent alcohol solution. An analysis was made of the consequences of the absence of normal large eyes upon the structure and growth of the skull. Immediately after the operation no changes in the head mesenchyme could be observed, but during the next days, as growth goes on, abnormal proportions and dimensions develop in the anterior part of the skull. Generally, this part of the skull is depressed and shorter than normal; cartilages around the eye have a different position and smaller dimensions. A perfect symmetry is only rarely maintained. There seems to be a very labile balance in the skull, as may be deduced from the presence of a buckled interorbital septum and the deviation of the upper beak.


Morphology of ovarian changes during the reproductive cycle of the house lizard, Hemidactylus flaviviridis. Ovarian changes during the reproductive cycle of the oviparous wall lizard (Hemidactylus flaviviridis Rüppel) are described and discussed. It ovulates from mid-March to mid-May with a peak in April. Two eggs, one from each ovary, are ovulated at a time. After the breeding season is over, the ovaries are reduced in size. From June to third week of February they contain small pre-vitellogenic fillicles which start increasing in size with the approach of March when yolk deposition occurs rapidly. The histological details of developing the pre-ovulatory follicles are described. Follicle cell nuclei are taken into the ooplasm of pre-vitellogenic follicles; they are finally absorbed before yolk deposition starts. Pre-ovulatory follicles show highly vascularized thecae and invaginations of the follicular epithelium. Follicular atresia generally occurs in follicles with polymorphic granulosae, in post-ovulatory ovaries. Their granulosa cells give rist to phagocytes which, after removing the ooplasmic contents, degenerate, while the theca interna cells are hypertrophied to form the interstitial gland cells in the walls of degenerated follicles. After ovulation, the granulosa cells hypertrophy to form luteal cell mass filling the follicular cavity. Fibroblasts which appear to arise from the thecal layer, invade the luteal cell mass and form septa. Blood vessels occur in the luteal cell mass. The possible physiological significance of corpora lutea in the wall lizard is discussed.


Statistical mechanics of protein folding, unfolding and fluctuation. Conformational fluctuations of globular proteins in the native state and the processes of folding and unfolding are studied from the statistical mechanical point of view. 1) It is pointed out that the formation of the native specific conformation of a globular protein is not a result of random sampling of minimum energy conformations. This fact provides a motivation for the study of the processes of folding, or the paths of folding, of proteins. The processes of folding and unfolding are shown to be statistical mechanical in nature. 2) The conformational (folding and unfolding) transitions in globular proteins are compared with the helix-coil transitions in polypeptides. The gradedness of the latter transition is shown to be due to the fact that the phenomenon is of an essentially one-dimensional system. The former transition is characterized ideally by the fact that it is of the all-or-none type. 3) A lattice model of proteins is introduced. "A protein molecule" is defined as a chain of noninteresting units of a given length on a two-dimensional square lattice. The copolymeric character of protein molecules is incorporated into the model by specificities of interunit interactions. 4) This model proved powerful for studying the statistical mechanical characterization of protein denaturation and fluctuations. The specificities of interunit interactions were shown to be the primary factors responsible for the all-or-none type transition from native to denatured states of globular proteins. 5) The model is studied by the Monte Carlo method of Metropolis et al., which simulates a kinetic process approximately. The method is shown to be a promising tool in finding the native conformation of proteins from their amino acid sequence. 6) A new theoretical method is developed to study phenomenologically the processes of protein folding and unfolding and the conformational fluctuations in the native state. An important role is played by a quantity S(H): the entropy of a protein molecule in solution in the conformational states with a given value of enthalpy H. Qualitative character of the S-H curve, such as whether it is convex or concave determines characteristics of the conformational  transition in a globular protein such as whether or not it is of the all-or-none type. 7) The concept of an ideal process of protein folding and unfolding is introduced and defined by three statements. The S-H curve is calculated for this ideal process. The curve is shown to be concave, indicating that the transition is of the all-or-none type. This conclusion is drawn essentially from the globularity and specificity of the native conformational of proteins. 8) Residual structures in the denatured state and conformational fluctuations in the native state are discussed. In order to discuss the latter, an independent fluctuating site model is introduced, in which it is assumed that there are several independent fluctuating sites, each localized in some part of the protein molecule...


Metabolic and electron microscopic studies post mortem in brain mitochondria. The RCR of malate+glutamate oxidation of isolated rat brain mitochondria decreased with increasing duration of anoxia and it ceased completely in the 12 hour ischemic group. After one hour of ischemic anoxia neither the respiration of mitochondria nor their morphology altered irreversibly. There is a strong correlation between the ultrastructural changes and RCR value of mitochondria, namely the RCR decreased proportionally with increasing number of light type of mitochondria. From our results we can conclude that the dense form seems to be the functional form, while the light mitochondrial structure is a transition to the non functioning homogenous type of brain mitochondria.


Diffusion of oxygen in plasma and blood. D in fresh human plasma has been found to decrease almost linearly with total protein content over a wide range of concentration and to vary only +/-4% in normals and +/-13% in abnormals. The average values for D in normal human plasma, at 25 and 37 degrees C, are 1.62 and 2.18 X 10(-5) cm2/sec respectively. For normal human blood at 42% hematocrit, the values of D, at 25 and 37 degrees C, are 1.20 and 1.62 X 10(-5) cm2/sec respectively.


Measurement of diffusivity and metabolic rate of O2 and CO2 in respiring tissue. The method described is apt to measure, at the same time, Krogh's diffusion constant and specific metabolic rates for O2 and CO2 in intact, respiring tissues. Due to metabolism tissue thickness for this method is limited to about 500 mum unless hyperbaric conditions are used. The results suggest that both KO2 and KCO2 are similar in alive and in dead tissue. Due to tissue inhomogeneity and to possible facilitation of O2 or CO2 transport our values of K have to be considered as effective mean values for the physiological range of PO2 and PCO2 in muscle at rest and at exercise.


A stochastic model for the transport of oxygen to brain tissue. Material balances around a small, but finite volume element have formed the basis for previous mathematical models describing the transport of oxygen in the brain microcirculation. Seeking a model which would be both simple and versatile, a stochastic model was proposed based on the assumption that oxygenation of the brain can be described quantitatively by simulating the activity of only one erythrocyte and the oxygen molecules surrounding it. Compared with existing deterministic models, the capillary space-average oxygen partial pressure profiles were in close agreement. Tissue tensions were decidedly different.


Autonomic and pharmacological control of oxygen autoregulation mechanisms in brain tissue. The effect of several agents active on autonomic nervous system functions was tested on brain oxygen autoregulation parameters. It was found that atropine, propranolol and isproterenol had no influence on the measured parameters. Phenoxybenzamine, tolazoline and dibenamine all suppress autoregulation. In an additional experimental series, a phenoxybenzamine infusion was given during O2 breathing. The infusion induced a marked rise in TpO2. It is concluded that an alpha-adrenergic mechanism is part of the autoregulation process, and its pharmacological blockade could be used to raise TpO2 levels in brain with O2 breathing at normal atmospheric pressure. Also, the increase in brain TpO2 induced by 95% O2 - 5% CO2 breathing seems to be blocked by alpha-adrenolytic drugs.


Renal tissue oxygenation during hypoxic hypoxia. No evidence was found to support the existence of changes in the intrarenal flow pattern among the different areas or of a compensatory redistribution of microcirculation in the renal cortex under hypoxia induced by breathing 10 % oxygen. It seems that under these conditions the kidney is able to preserve its basic metabolism by diminishing its oxygen consumption.


Effect of ionizing radiation on liver microcirculation and oxygenation. Platelet aggregation and adhesiveness, as well as TPO2 responses to hypoxia were measured as microcirculation parameters in beagle dogs subject to Co60 ionizing radiation to a dose of 4600 rads in 5 weeks. Simultaneously, changes in blood chemistry and coagulation were also determined. Marked changes in all studied parameters in the post radiation period lead to the conclusion that radiation liver damage is at least in part mediated through microcirculation disturbances.


Oxygen fields induced by recessed and needle oxygen microelectrodes in homogeneous media. Computer simulations of the operation of both the recessed and conically-shaped needle type microelectrodes were developed. The accurate portrayal of their geometries was greatly facilitated by the use of specialized three dimensional orthogonal coordinate systems with coordinate surfaces coincident with the geometry of the problem. From the simulations, calculations were made of the induced PO2 fields, oxygen sensitivities, stirring artifacts, measurement errors, and time constants.


Chemotherapy of helminthiasis among wild mammals. II. Baylisascaris transfuga (Rudolphi, 1819) Sprent, 1968 infection of polar bear. Effective chemotherapy by Mebendazole of Baylisascaris transfuga infection of five polar bears is reported and a control measure programme directed towards limiting the infection under the prevailing condition is discussed.


[Myobiiae parasites of rodents, Insectivora and Chiroptera (Acarina: Prostigmata)]. The author studies a collection of myobiid mites parasitic on rodents, insectivores and bats. This material contains 15 species, amongst them 7 species and 2 subspecies are new and are described for the first time.


Further observations relating to Trixacarus (Caviacoptes) Caviae Fain, Hovell and Hyatt, 1972 in guinea-pigs (Acarina: Sarcoptidae). Three cases of sarcoptic mange in guinea-pigs were found to be due to Trixacarus (Caviacopties) caviae FAIN et al. The history and lesions of each case are described together with a method of treatment.


[Pericentric inversion of chromosome 3, homozygote and heterozygote, and centromeric translation of chromosome 12 in a family of orangutangs. Evolutionary implications]. An orangutang family is reported in which the father (Piku) is homozygous for a pericentric inversion of chromosome 3 and heterozygous for a structural rearrangement of chromosome 12 (author's nomenclature for this species). The latter is interpreted as transposition of the centromere by insertion into band q213 [in cen (12)(q213)]. Piku's mate has a normal female chromosome complement. His daughters by this mate (Agnès and Ursula) are heterozygous for both his rearrangements.


Yersiniosis in the Bristol Zoo (1955-1974). Ninety one cases of Yersiniosis occurred betwen 1955 and 1974 at Bristol Zoo. Species affected included a range of primates and birds, a rodent (Capybara) and a carnivore (Caracal Lynx). The incidence of the disease was highest in the winter months. There were variations in the annual incidence of Yersiniosis, with peaks occurring at intervals of 4-6 years. Common pathological findings included miliary focal necrosis and abscess formation.


Hemoccult detection of fecal occult blood quantitated by radioassay. Results from the quaiac slide or Hemoccult (HO) test for fecal occult blood were compared with quantitative determinations of gastrointestinal loss after intravenous administration of 51Cr-labeled red cells. Subjects were 80 consecutive patients, without dietary restriction, who were referred because of clinical suspicion of gastrointestinal blood loss or complex anemia. A total of 555 stool specimens analyzed for 51Cr loss were graded negative, trace, or positive by the HO method. Of 338 specimens containing 0-2 ml/day by isotope assay, 7.4% were positive to the HO qualitative test. Loss of at least 10 ml/day in 51Cr equivalent was necessary to assure that the majority of HO reactions would be positive. Of specimens containing more than 30 ml/day, 93% were positive. The ratio of 51Cr-labeled red cell equivalents to stool volume and the percentage of positive HO reactions increased together. When this ratio exceeded 10%, two thirds of the HO responses were positive.


Influence of pregnancy on the development of various gastric lesions in rats. The influence of pregnancy, and to some extent lactation, on various gastric lesions in rats were studied. Shay ulceration and gastric lesions induced by cold-restraint stress and ulcerogenic agents, such as acetylsalicylic acid (ASA), reserpine, or epinephrine, in rats were significantly aggravated by pregnancy (day 20 of pregnancy). Gastric hypersecretion, which was observed during pregnancy in pylorus ligation preparation, appears to contribute to the mechanism of aggravation of gastric lesions. ASA induced a marked back-diffusion of acid in pregnant rats which might resulted in the aggravation of ASA-induced gastric lesions. In contrast, histamine-induced gastric lesions were markedly inhibited according according to the progress of pregnancy but after 10 days' lactation returned to the level seen in nonpregnant rats. The histaminase inhibitor aminoguanidine strongly aggravated the histamine-induced gastric lesions in pregnant rats as compared with the non-pregnant ones.


Inhibition of water absorption by ricinoleic acid. Evidence against hormonal mediation of the effect. In three dogs, each with a jejunal and an ileal Thiry-Vella loop, the isolated segments were perfused with isotonic electrolyte solutions (control) for 90 min. One loop was then perfused with 5mM ricinoleic acid for an additional 90 min, while the other loop was perfused with the control solution. Loops perfused with ricinoleic acid all showed reduced fluid absorption. Perfusion of one loop with ricinoleic acid produced no changes in fluid absorption from the loop perfused with the control solution. In other experiments, 4 Ivy dog units (IDU) per kg per hr of cholecystokinin (CCK) produced no change in water movement in loopd perfused with control solution or recinoleic acid. These experiments suggest that the effect of ricinoleic acid on intestinal water transport is not mediated through the release of a circulating humoral substance.


Effect of chronic antacid ingestion on serum gastrin and gastric secretion. Basal gastrin and acid secretion, and histamine- and food-stimulated acid secretion were examined before and after 6 weeks of regular antacid consumption by 20 normal volunteers, in order to test the hypothesis that regular use of antacids produces gastrin cell hyperplasia, altered gastrin inhibition by acid, and gastric hypersecretion. We found no differences in fasting serum gastrin, basal or maximal histamine-stimulated acid, or acid output in response to a protein meal after consumption of commercial antacids with or without calcium carbonate. The results suggest that normal subjects do not acquire functional hyperactivity of the gastrin mechanism after a period of regular antacid use.


Leukoplakia of the anal canal.

Leukoplakia of the anal canal. Two cases of leukoplakia of the anal canal are presented, with illustrations of the typical gross and microscopic appearance. The lesions were asymptomatic, and were discovered by routine rectal examination. Histological findings included hyperkeratosis and acanthosis extending cephalad from the anal verge to the dentate line. Followup after 3 and 15 years revealed no evidence of dysplastic changes, and a review of the literature did not uncover any reported cases with dysplasia or with documented evolution to malignancy. There is little evidence that leukoplakia of the anal canal is premalignant but patients should be followed carefully, since the natural history of this rare lesion is unknown.


The role of metoclopramide in peroral jejunal biopsy: a controlled randomized trial. Metoclopramide is known to enhance gastric emptying and stimulate duodenal and small-intestinal peristaltic activity. The effect of the drug on peroral jejunal biopsy was examined in a controlled, double-blind, randomized trial. Forty-nine patients (24 females and 25 males) who required jejunal biopsy for diagnostic purposes were admitted to the study. All the biopsies were performed by the same operator using the Quinton multipurpose suction biopsy tube and applying the same technique. Twenty-four patients ranging in age from 18 to 67 years (mean 44.5) received placebo intravenously (sodium metabisulfite), and 25 patients from 16 to 73 years old (mean 39.9) received 10 mg of metoclopramide intravenously prior to the jejunal intubation. Objective parameters of the study were (1) time in minutes required for the intubation at the biopsy site, ie, the area at the ligament of Treitz, and (2) fluoroscopy time. Intubation time in the placebo group was 22.3 +/- 1.9 min (mean +/- SEM) vs 11.3 +/- 1.4 min in the metoclopramide group (P less than 0.001). Fluoroscopy exposure time was 2.47 +/- 0.25 in the placebo group vs 1.40 +/- 0.12 min in the metoclopramide group (P less than 0.001). Subjective clinical evaluation of the operator's assessment of the procedure was based on a 0-4 scale (much easier = 0, easier = 1, average = 2, harder = 3, and much harder = 4). Metoclopramide administration resulted in a significantly easier performance of the procedure (P less than 0.001) but did not influence patient tolerance. Three patients who received metoclopramide and one receiving placebo developed mild to moderate drowsiness of short duration. The results of this controlled trial indicate that metoclopramide significantly shortens the time required for jejunal biopsy and reduces fluoroscopy exposure. Its regulatory action on gastrointestinal motility contributes to the easier performance of a valuable diagnostic procedure.


Fulminant hepatic failure secondary to congestive heart failure. An elderly female with an acute episode of congestive heart failure, unaccompanied by any periods of hypotension, developed fulminant hepatic failure with an accompanying coagulopathy. Attempts to establish an etiology for her acute hepatic insufficiency, other than cardiac failure, proved negative. Fulminant hepatic failure as a consequence of congestive heart failure, without prolonged periods of hypotension preceding alteration in hepatic function, has not heretofore been described. Liver function is adversely effected in congestive heart failure. Hepatic ammonia clearance is impaired in cardiac failure and may be diminished to the point of resulting in hepatic encephalopathy. Coagulopathy is a frequent concomitant of fulminant hepatic failure. Establishing a clear etiology for a coagulopathy in the face of concomitant liver disease is difficult, thus making any therapeutic intervention fraught with peril.


Sororal occurrence of diffuse esophageal spasm. In this report, we have described two sisters with classical symptoms, radiological appearances, and manometric features of diffuse esophageal spasm. To the best of our knowledge, familial occurrence of this disorder has not been documented previously.


Colonic cancer--hypotheses of causation, dietary prophylaxis, and future research. Colonic cancer is rare in primitive populations. In western populations it was uncommon in the past, but now accounts for about 3% of all deaths. The cause almost certainly lies with dietary changes. Probably, alterations in bowel milieu interieur, from interaction between metabolites and microbacteria, promote carcinogenesis. Changes in intakes of protein, fat, sugar, refined cereal products, and crude fiber have been advanced as predisposing or causative factors. Evidence suggests that (i) fall in fiber intake, but (ii) rise in fat intake, in their ability to increase fecal concentrations of bile acids and sterols (possible precursors of carcinogens) are most likely to be culpable. As preventive measures, a significant rise in fiber intake is practicable only from regular bran ingestion. A major reduction in fat intake is grossly unlikely. Even were rigorous dietary changes implemented, an early fall in colonic cancer incidence is highly improbable due to the long-term character of the disease. Future research must include characterization of the diet, metabolism, and disease pattern of segments of western populations who have low colonic cancer mortality rates; also, elucidation of the bearing of various intakes of different food components on the biochemistry and microbiology of the feces.


Lysine-vasopressin: hemodynamic effects in the anesthetized dog. Vasopressin (ADH) is known to reduce secretin-stimulated pancreatic exocrine secretion. The present study attempts to relate this inhibitory effect to the vasoconstrictive potency of ADH. Regional blood flow in most of the vascular areas. The greatest reduction in blood flow was seen in the gastrointestinal area especially in the left gastric artery, cranial and caudal pancreaticoduodenal arteries, as well as the cranial and caudal mesenteric arteries. Renal blood flow was not altered by those concentrations of ADH that reduced gastrointestinal blood flow. ADH reduced pancreaticoduodenal blood flow in concentrations comparable to those concentrations that reduced pancreatic secretory flow. The reduction of gastrointestinal blood flow was due to increased impedance and not to diminished cardiac inotropy.


Effect of carbenoxolone on electrolyte output of salivary glands during nasogastric intubation. The effect of carbenoxolone on the output of salivary electrolytes stimulated by a nasogastric tube was studied in healthy volunteers. Mean +/- SE values for volume and electrolyte concentrations in control studies were volume 121 +/- 19 ml/hr, pH7.39, Na+19 +/-5, K+20 +/- U, Cl-20 +/- 3, HCO3-18 MEq/liter and osmolality 71 +/- 8 mOsm/kg. Mean +/- electrolyte outputs were quite large, Na+ 2.4, k+2.4, Cl-26, and bicarbonate 2.2 mEq/hr. Our control data indicate that in the course of gastric secretory testing the indwelling gastric tube stimulates salivary electrolyte output sufficient to interfere with accurate assessment of gastric ionic fluxes and gastric acid analysis. Therapeutic doses of carbenoxolone (100 mg three times daily) given orally for 3 weeks had no effect on salivary volume, electrolyte output, or concentration. We conclude that carbenoxolone has no minerallocorticoid effect on mixed salivary secretion. Attention to salivary secretion is recommended in all gastric secretory studies and is mandatory where low acid output is suspected.


The effects of acute and chronic ethanol administration on canine bile secretion. In 9 conscious dogs (4 of whom were alcohol-fed for 24 months with 50% intragastric ethanol), provided with gastric and duodenal fistulae (Thomas cannula), the effects were studied of an acute iv ethanol infusion (1.3 g/kg) on hepatic bile secretory plateau levels after emptying of the gallbladder was induced by a continuous perfusion of secretin (0.5 CU/kg/hr) plus CCK-PZ (8 Crick-Harper-Raper U/kg/hr) and sodium taurocholate (0.62 mumol/kg/min). Acute iv ethanol infusion in nonalcoholic dogs reduced hepatic bile flow rate (29%), bile salt concentration (55%) and output (67%). In alcohol-fed dogs, acute iv ethanol reduced only the rate of flow (25%). Hepatic bile salt concentration and output plateau values were significantly higher in the alcohol-fed than in the nonalcoholic dogs. There were no significant differences between the two groups of dogs in the rate of evacuation, bile salt output, or lipid composition of gall bladder bile following a single iv injection of CCK-PZ.


Gastric secretory function in patients with chronic renal failure undergoing maintenance hemodialysis. Gastric secretion was evaluated in 9 male patients with chronic renal failure on maintenance hemodialysis. Five secreted low or normal quantities of acid and 4 exhibited hypersecretion, 2 of whom had associated peptic ulcer disease. Serum gastrin responses to a protein meal were comparable to control subjects. Calcium infusion in two basal hypersecretors depressed acid secretion. The only statistically significant correlation observed was between basal acid output ans serum levels of parathormone. These studies suggest that while acid secretory abnormalities vary in patients with chronic renal failure on hemodialysis, there is no apparent sensitivity of the gastrin-secreting cells to protein or calcium ion which might account for acid hypersecretion. Secondary hyperparathyroidism may influence the occurrence of acid secretory abnormalities.


Fibropolycystic disease of the hepatobiliary system and kidneys. This complicated case of fibropolycystic disease of the hepatobiliary system and kidneys was ably and incisively analyzed by Professor Sheila Sherlock. Her clinical acumen was revealed by her ability to differentiate congenital hepatic fibrosis, Caroli's disease, and adult polycystic disease of the liver and kidney. Interesting histologic features of this case included hepatic fibrosis with intact limiting plates anc central veins and the presence of bile plugs in the ducts, but the absence of bile statsis in the parenchyma. A percutaneous transhepatic cholangiogram demonstrated the dilated intrahepatic and extrahepatic ducts. Washing out the "gunk" from the biliary tract by T-tube drainage has great limitations in this type of case. Therefore, Dr. Adson suggested irrigation of the biliary ductal system using tubed placed transhepatically, plus a wide choledojejunostomy. Dr. Sherlock questioned this surgical approach. The use of chenodeoxycholic acid for this "gunk" was suggested. In spite of the dilated ducts and pathologic changes in the liver, the patient was not jandiced and did not have stones in her biliary tract. The genetics of this patient's problems was discussed.


Giardiasis: an overview for the clinician. Since the clinician confronting a case of giardiasis may find the current literature confusing and weighted towards rare immunoglobulin deficiency syndromes, a classification is proposed to answer questions pertinent to understanding and managing this infection. Current thinking of giardiasis must involve the realization that (1) asymptomatic carriers exist; (2) that the majority of symptomatic patients have no structural disease explaining their symptoms; and (3) that those patients with anatomic lesions and giardiasis probably have an underlying predisposing condition. A short review of the association of giardiasis and immunodeficiency will then be presented, along with current concepts of diagnosis and therapy.


The natural history of liver disease in former drug users. Three hundred and twenty drug-free former narcotic addicts were studied with regard to persistence of abnormalities of liver function and morphology, and their relation to hepatitis B infection. Hepatitis B antibody was present in 52.4 per cent, while HBs antigen was detected in only 6 per cent. Transaminase abnormalities, initially present in 39 per cent, were found in 22 per cent six months after cessation of drug abuse. Abnormalities tended to persist thereafter, although there was some continued return to normal levels. Liver biopsy findings of chronic persistent and aggressive hepatitis correlated with persistence of HBs antigenemia and transaminase elevation. Follow-up liver biopsies in seven subjects showed decreased inflammatory reaction in five. None showed progressive liver disease. We conclude that: (1) 15 to 20 per cent of former narcotics addicts have chronic persistent hepatitis or chronic aggressive hepatitis after cessation of drug absuse for six months or more; (2) serologic evidence of exposure to HBs antigen is frequent, and rapidly develops after the start of needle use; (3) although histologic ad chemical abnormalities usually persist, progression did not occur, and some individuals demonstrated spontaneous improvement.


An increase in urinary catecholamines of renal origin in patients with "borderline" hypertension. Plasma and urinary catecholamines (norepinephrine and epinephrine) and urinary dopamine excretion were studied in 45 essential hypertensive patients subdivided into borderline (labile) and stable hypertension. Borderline hypertensive patients had a higher mean fractional renal clearance of catecholamines (the clearance of catecholamines relative to creatinine clearance) than both control subjects and stable hypertensive patients. A significantly positive correlation between the renal clearance of catecholamines and urinary dopamine excretion was also found in those with borderline hypertension, but not in control subjects or those with stable hypertension. These data indicate that patients with borderline hypertension have a relatively exaggerated renal catecholamine release. They probably reflect an increased sympathetic discharge to the kidney in "borderline" hypertension, occuring to a lesser degree in stable hypertension and control subjects. Thus, urinary catecholamine measurements do not specifically reflect the level of circulating catecholamines, particularly in borderline hypertension.


Meningioma associated with parathyroid adenoma. A woman hospitalized because of attempted suicide with diazepam tablets was found to have hypercalcemia and other signs of hyperparathyroidism. Electroencephalogram indicated a brain lesion which was confirmed by a brain scan and angiogram. The hypercalcemia persisted after removal of the meningioma and serum levels of calcium returned to normal only after a parathyroid adenoma was removed during an additional intervention. This association of meningioma with hyperparathyroidism is unique in the literature. The difficulties of diagnosis resulting from the neuropsychiatric symptoms common to the two disorders are discussed.


Vibrio fetus endocarditis in a patient with systemic lupus erythematosus. Vibrio fetus endocarditis occurred in a patient with systemic lupus erythematosus receiving azathoprin and prednisone. Blood cultures required 14 days to become positive. The fastidious growth requirement of this organism is reviewed because lack of appreciation of these may result in failure to make the diagnosis. This is the first reported case of Vibrio fetus endocarditis occurring in the setting of a connective tissue disorder and immunosuppressive therapy.


Strabismus measurements in the Siamese cat. Anatomical and neurophysiological studies suggest a relationship between "abnormal" visual pathways and strabismus found in the Siamese cat. A telephotographic method for measuring eye positions in these cats reveals that newborn Siamese cats have a conspicuous exotropia appearance. Adult animals appear to have esotropia, orthophoria, or exotropia, which can be intermittent.


Instrument myopia--microscopy.

Instrument myopia--microscopy. Looking through optical instruments stimulates the eye to accommodate more than would be necessary for naked eye viewing; this increased near power is called instrument myopia. The amount (up to -5 diopters) varies with the observer and the conditions of viewing. Using microscopes produces -1.5 to -2 diopters of instrument myopia. More instrument myopia is found with low-power magnification, inexperienced users, and when focusing form minus blur to sharp image. Physiologically, the instrument myopia appears to be associated with an accommodative equilibrium position and, psychologically, with a sensing of proximity.


Does stereopsis change with age?

Does stereopsis change with age? Stereopsis thresholds were measured on 242 subjects with normal visual acuity and ranging in age from 8 to 46 years. The results showed no trend with age and no significant sex difference. The log-second threshold mean was 0.74+/-0.21 with a test-retest reliability coefficient of 0.70+/-0.05.


Purtscher's retinopathy in acute pancreatitis. A patient who became blind following an episode of alcohol-induced pancreatitis is described. The clinical appearance of this patient's retinal changes corresponds most closely to post-traumatic (Purtscher's) retinopathy. The etiology of the retinopathy is best explained by retinal vascular occlusion due either to fat embolism or thrombosis.


Cardiac tamponade in primary myxedema and review of the literature. A case of cardiac tamponade secondary to primary myxedema is described. The nature of the patient's pericardial fluid and clinical course compared with other cases in the literature is reviewed. The patient had no recurrence of cardiac tamponade. Complete resolution of the pericardial effusion occurred 10 months followint initial pericardiocentesis and L-thyroxine therapy.


Polycythemia vera in an anephric man.

Polycythemia vera in an anephric man. The effect of renal failure and bilateral nephrectomy on erythropoiesis and plasma erythropoietic activity was observed in a patient with polycythemia vera. For eight years the patient's hematocrit was maintained between 45 and 50 per cent by phlebotomy and in spite of the development of renal failure the hematocrit did not decline. Following rejection of a renal transplant, the hematocrit fell to 18 per cent but rose to 40 per cent with oral iron therapy. Following bilateral nephrectomy, the hematocrit fell to 29 per cent but subsequently increased to 37 per cent. After an episode of gastrointestinal bleeding the hematocrit was 21 per cent but subsequently rose to 32 per cent. Erythropoietin could not be detected in the plasma either before or after nephrectomy. In addition, erythropoietin failed to stimulate 59Fe incorporation into heme in vitro in the patient's marrow cells. The data incidate that, in polycythemia vera, erythropoiesis does not require erythropoietin.


A new electrode for electroretinography. Clinical electroretinography is an uncomfortable, disquieting experience for a patient because of the contact lens electrodes used. Such electrodes are either expensive to buy or difficult to make. An aluminized Mylar electrode performs satisfactorily, elicits minimal patient apprehension or discomfort without topical anesthesia, is simple to make, and is disposable.


Biofeedback reinforcement in the training of limitation of gaze: a case report. A 22-year-old patient having a history of congenital strabismus with surgery at age 6 and again at age 14 suffered from a limitation of dextroversion following 2 surgical procedures with diplopia initially experienced beyond 18 degrees. Ten sessions of treatment by traditional visual training methods and biofeedback reinforcement were compared in extending the deficient range of dextroversion. Biofeedback was found to be significantly better than conventional approaches in this treatment.


Hageman factor deficiency in ataxia telangiectasia. Ataxia-telangiectasia is clinically characterized by the presence of cerebellar ataxia, choreoathetosis, and oculocutaneous telangiectasia. Humorocellular immune deficiency may be associated with the disease. So far, no coagulation abnormalities have been reported in patients with ataxia-telangiectasia. Presence of Hageman factor deficiency in our patient could merely be a coincidental occurrence of two rare independent disease states. Since this coagulation abnormality in Hageman factor deficiency is rather subtle and not usually associated with clinically significant bleeding, this defect can be easily overlooked.


"Pseudo-giant P-waves" and pericardial friction rub following chlorpromazine therapy. A patient is presented who manifested two previously undescribed complications of chlorpromazine therapy: a transient pericardial friction rub and "pseudo-giant P waves". After slowing of the heart rate, the "giant P-waves" proved to be superimposed U and P-waves. His history demonstrates the protean and at times unusual complications of chlorpromazine therapy and illustrates the dramatic therapeutic effects diphenhydramine may have in reversing some of this toxicity.


Epidemiological considerations in predicting regional vision health care needs. The use of crude practitioner to population ratios when age-specific ratios are more appropriate can lead to significant errors in estimates of the need for health care manpower. A comparison of these 2 methods is made using age-specific data for Florida as an example. A brief survey of other epidemiological factors affecting clinical manpower projections is given.


Effects of non-contact tonometry on refraction. The spherical component of refractive error was measured subjectively before and after noncontact tonometry in 19 eyes and also on the fellow (control) eyes without tonometry. No significant change in this measure of refractive error was found after tonometry. The tested group could not be distinguished from the control group.


Effective degree of mydriasis with phenylephrine and tropicamide. The mydriatic effects of several concentrations of phenylephrine and of tropicamide were studied in 84 young adults for 90 min following topical instillation. Pupillary diameter was estimated (a) under ambient photopic illumination and (b) when illumination was increased to that associated with direct ophthalmoscopy. Evaluation was made of the "degree of mydriasis," i.e., the difference in pupillary diameter between the eye receiving the mydriatic agent and the contralateral control eye when the pupillary light reflex was stimulated. In subjects with light or hazel irides, phenylephrine caused maximal dilatation in 60 to 75 min, mean values being 5.6 mm with 1 drop of 2%, 6.0 mm with 2 drops of 2.5%, and 7.1 mm with 1 drop of 10%. Maxiumum degrees of mydriasis were 3.0 mm with 2 drops of 2.5% and 3.1 mm with 1 drop of 10%. With 0.5% tropicamide, maximum diameter was 8.0 mm in 30 min in subjects with light, hazel, or brown irides, and the maximum degree of mydriasis was 5.0 mm. It is concluded that when a mydriatic agent is used to facilitate intraocular visualization, neither specification in terms of (a) maximum diameter under ambient illumination nor (b) degree of mydriasis provides optimal characterization. It is suggested that the "clinically effective diameter," i.e., pupillary diameter under illumination corresponding to that to be used during examination, would be the most useful specification.


Dynamic and static violations of Hering's law of equal innervation. Hering's Law of Equal Innervation treats the double eye as a single organ. Normal humans often execute saccadic eye movements that are dynamic violations of Hering's Law. These infractions are produced by differences in the neural controller signals sent to each eye and are exemplified by monocular movements, such as dynamic overshoot, glissades, and double saccades; these dynamic violations occur more frequently in fatigued subjects. In contrast to dynamic violations, static violations of Hering's Law are usually indicative of pathological conditions.


Survey of student research in behavioral and developmental optometry. Behavioral and developmental optometry are in need of research. Studies conducted by optometric students can provide a major contribution. The present paper reviews selected student research studies conducted at the Illinois College of Optometry. The topics include: trends in developmental vision, phenomena in binocular vision, and techniques in diagnosis and treatment.


The relationship between eye dominance and monocular acuity: an additional consideration. Multivariate techniques  were used to explore the relationship between ocular dominance and asymmetries in visual acuity or acuity dominance. The convergence distance under which the acuity testing takes place was found to affect the relationship between these two variables.


Reconstruction after pharyngolaryngectomy-esophagectomy. Seventeen patients with carcinoma of the hypopharynx and/or cervical esophagus who require total pharyngolaryngectomy-esophagectomy are presented; Twenty-one different reconstructive methods were applied in the seventeen patients. An overall two year survival rate of 35 per cent was attained with effective palliation in 65 per cent of the patients. The Wookey and free jejunal transplantation procedures were unsuccessful as primary means of pharyngoesophageal reconstruction, although the Wookey principle was occasionally useful in salvaging failures of other procedures. The reversed deltopectoral flap was successfully employed in a small number of patients with only minimal extension below the cricopharyngeus but was found to be unfeasible in several other instances because of the extent of esophageal resection required. Transposition of the entire stomach was successfully employed in a number of suitable patients and is an excellent method of esophageal replacement in relatively healthy patients. The reversed gastric tube esophagoplasty was useful in more debilitated patients, with resection and reconstruction performed in separate stages.


Squamous cell carcinoma of the oropharynx: why we fail. The squamous cancers of the oropharynx in 384 patients were staged according to a T and N system. Three hundred seventy-one of them were treated for cure at a time when modern surgical and radiotherapeutic technics were available. The patient records were analyzed in regard to five year survival, factors influencing treatment failure, and the effect of new primary cancers. Failure to eradicate the cancer at the primary site remains the largest reason for the patients' demise, but as aggressive local and regional treatment becomes more successful, greater numbers of patients survive only to become victims of distant metastases and second primary cancers.


Carcinoma of the hypopharynx.

Carcinoma of the hypopharynx. The data in this study suggest that radical surgical treatment offers the best chance for control of disease in patients with cancer of the hypopharynx. The cervical lymph nodes are at a very high risk for early involvement by metastatic disease. Elective treatment of cervical lymph nodes must be considered in initial treatment planning to obtain better control of regional disease.


Surgical exploration in asymptomatic hypercalcemia. The use of the serum auto-analyzer (SMA-12) has resulted in a marked increase in the diagnosis of hyperparathyroidism. Seventy-five patients with asymptomatic hypercalcemia were explored: sixty-eight with solitary adenomas, six with multiple adenomas, and one with diffuse hyperplasia. Postoperatively, all patients reverted to normocalcemia. Surgical exploration of asymptomatic hypercalcemia is advocated to reduce surgical morbidity and mortality and to prevent the development of renal and osseous complications of hyperparathyroidism.


Management of recurrent salivary gland tumors. The management of 129 patients with recurrent tumors of the salivary glands is analyzed, Principles of approaching recurrent tumors and guidelines for their management are outlined in detail. Age distribution, symptoms, time to recurrence, cases that showed possible malignant degeneration, and complications are reviewed. The surgical procedures, recurrence rate, and survival rates are recorded.


The malignant "cold" nodule of the thyroid. From 1958 to 1976, 910 patients with cold nodules of the thyroid underwent thyroid surgery (714 females, 196 males). Thyroid carcinoma was present in 202 patients (22.2 per cent) (149 females, 20.9 per cent; 53 males, 27 per cent). Rate of malignancy in an age group was greatest in patients older than seventy years (19 of 47 patients, 40.4 per cent) followed by patients twenty-one to thirty years of age (37 of 125 patients, 29.6 per cent); 90 per cent of all patients were from twenty-one to seventy years of age. Blacks had a lower rate of thyroid carcinoma than Caucasians. Data from the Cancer Surveillance Group also showed age-adjusted incidence rates in blacks in Los Angeles County to be lower than that of Caucasians.


The undelayed Mütter flap in head and neck reconstruction. Twenty-one mastoid-occiput-based shoulder flaps have been used to reconstruct patients with head and neck cancer. When the tip of the flap does not extend beyond the midclavicle, this flap can safely be elevated and transferred into its final position without delay procedures. Not requiring secondary sectioning and implantation, the Mütter flap can successfully be used to reconstruct multiple defects within its arch. Its utility thus rivals the more commonly used medially based deltopectoral flap and forehead flap.


Results of BCG adjuvant immunotherapy for melanoma of the head and neck. The present study was performed to determine if postoperative systemic BCG adjuvant immunotherapy would improve survival in patients with pathologic stage II melanoma of the head and neck. Seventeen of twenty-five (68 per cent) patients treated with BCG are free of disease, whereas only seven of seventeen (40 per cent) patients treated by radical neck dissection alone are free of disease. Clark's technic for determining the level of invasion of the primary lesion was used to predict the presence of metastatic tumor in regional lymph nodes. Results indicate that patients with pathologically confirmed lymph node metastases from melanoma of the head and neck benefit from postoperative BCG adjuvant immunotherapy.


Analysis of survival and disease control in stage I melanoma of the head and neck. From 1958 through 1969, 357 patients were treated for melanoma of the head and neck. Of these, 166 had invasive, clinical stage I disease. All patients had wide local excision of the primary. Elective regional node dissection was performed in sixty-nine patients and in the remaining ninety-seven observation only was elected. Retrospective analysis of these 166 patients considered (1) survival and disease control, (2) sites and timing of failures, and (3) the effect of sex, site, type of biopsy, skin grafting, and regional node dissection on disease control and survival. More than 80 per cent of the local recurrences developed within the first twenty-four months. Similarly, in the patients not undergoing initial neck dissection, 80 per cent of those who subsequently had clinically positive regional nodes did so within twenty-four months. In the sixty-nine patients undergoing elective regional node dissection, the survival rate was 33.5 per cent at five and ten years in those with histologically positive nodes. Those patients with elective neck dissections having histologically negative nodes had a survival rate of 75.8 and 67.1 per cent at five and ten years, respectively.


Advanced and recurrent squamous carcinoma of the lower lip. The results of aggressive surgical treatment of primary lip cancer and advanced and recurrent carcinoma of the lip are illustrated and discussed. Early detection of involved lymph nodes before capsular penetration occurs and careful and complete dissection of the submental and submandibular regions are advocated as possible ways to prevent persistent upper neck disease, the main killer of these patients.


Carcinoma of the palatine arch.

Carcinoma of the palatine arch. 1. Carcinoma of the palatine arch is part of a regional diathesis of carcinoma of the mucosa of the upper aerodigestive tract and this concept has a definite influence on the choice of treatment. 2. Surgery has an important role in the management of both the primary tumors and the regional metastatic nodes. 3. Radiation therapy is indispensible in the management of carcinoma of the tonsillar crypts, stage IV tumors of the palatine arch, and primary tumors of the palatine arch with certain specific extensions. 4. Comprehensive management of carcinoma of the palatine arch requires careful evaluation of each patient and his disease, vigorous application of the chosen method of treatment by either the surgeon or the radiotherapist, and continuous follow-up study and supportive treatment for the rest of the patient's life.


Carcinoma of the oral cavity. factors affecting treatment failure at the primary site and neck. A retrospective review of the clinical records of patients with carcinoma of the oral cavity was undertaken, and several parameters were studied in terms of comparing two groups of patients: those who were controlled at the primary site and neck and others who failed locally or regionally following initial treatment. A comparative statistical analysis of the factors studied revealed that female patients who had a higher T status, a higher N status, and thus a higher stage of disease did poorly in terms of local and regional control of disease. Those patients whose primary tumors manifested deep invasion and those who had positive margins after surgical resection at the primary site had also a significantly high incidence of local/regional failure. Presence of extracapsular extension of disease in cervical lymph nodes and involvement of soft tissues in the neck as well as involvement of multiple lymph nodes at multiple levels also put the patients in a high risk category. We urge that these factors be considered as prognostic criteria and be used to select patients for treatment by additional modalities on an elective basis in hope of achieving better local and regional control of disease and perhaps better cure rates.


Treatment of carcinoma of the oral tongue by radium needle implantation. Forty-nine patients had a radium implant for carcinoma of the oral tongue. In thirty-four of the forty-nine (70 per cent), local three year control of the cancer was achieved. Three patients in whom the radiation failed were rescued by subsequent surgery. The five year absolute survival in this series was 63.8 per cent. In conclusion, we believe that improved survival rates without functional and cosmetic defect can be obtained by closer cooperation between surgeons and radiotherapists.


Clinical staging of cancer of the head and neck: a new "new" system. A revised clinical staging system for cancers arising in head and neck sites has been prepared. It utilizes a uniform N classification for cervical node metastases. The T classifications describing the extent of the primary tumor are generally similar but differ in specific details for each site. Although the present system makes use of past field trials and more recent clinical studies, it cannot be considered final. Clinicians managing cancer in head and neck sites are encouraged to test the system with their own patient data to elicit further areas for improvement.


Applications of the Karapandzic principle of lip reconstruction after excision of lip cancer. The number and variety of technics available for lip reconstruction has suggested to some authors that no method is ideal. In fact, excellent results can be obtained under proper circumstances by any one of several procedures. The principle of innervated myocutaneous flaps adds yet another tool to the surgeon's armamentarium, but it does not relieve him of the responsibility to select the most appropriate procedure in each case. As Karapandzic has stated (or understated), "This obviously is not a technique suitable for all lip defects, but in selected cases it gives a very satisfactory result."


Immediate repair of the Commando defect by cervical and pectoral flaps. A ten year experience with immediate cervical flap repair of the Commando defect is reported in a selected series of more than seventy patients with clinically negative neck-nodes. Preoperative radiotherapy of 2"000 and 3,000 r to the neck and primary tumor has not interfered with wound healing. The cosmetic and functional result is highly commendable.


Combined radiation-methotrexate therapy in preoperative management of carcinoma of the head and neck. Fifty patients with primary carcinoma of the head and neck were treated preoperatively with 2,000 r and 500 mg/m2 of methotrexate. This combination reduces the tumor size in more than 90 per cent of patients, converts many of the tumors to a more manageable state, and appears to indicate that improved survival will occur.


Electrocardiographic studies during hypotensive anaesthesia using sodium nitroprusside. Multiple lead electrocardiographic recordings from 20 patients were studied before, during and after a period of induced hypotension with sodium nitroprusside. Although small changes in ST segment and T wave were observed in 9 patients, none of these persisted into the postoperative period. Other significant changes were confined to a temporary disturbances of cardiac rhythm in 2 patients, both of whom spontaneously reverted to sinus rhythm during the anaesthetic. Our findings indicate that there are no permanent ischaemic myocardial changes associated with induced hypotension using sodium nitroprusside.


Cardio-respiratory changes during pneumoencephalography. Carbon-respiratory changes associated with changes in posture and injection of intrathecal oxygen were studied in fifeen patients undergoing pneumoencephalography in a Phillips isocentric chair, while breathing spontaneously and anaesthetised with halothane in oxygen. Haemodynamic changes associated with changes in posture were of a minor nature. A rise in PaCO2 occurred in the prone position in two obese patients. There were significant rises in blood pressure following injection of more than 5 ml of oxygen as a bolus into the subarachnoid space.


The administration of metoclopramide with atropine. A drug interaction effect on the gastro-oesophageal sphincter in man. The effects of intravenous atropine 0-6 mg alone, metoclopramide (Maxolon) 10mg alone and atropine 0-6 mg and metoclopramide 10 mg in combination, on the lower oesophageal sphincter (LOS) were studied in three groups of normal human volunteers. Atropine decreased the LOS pressure by an average of 8 cm H2O (P less than 0-001), whereas metoclopramide increased the LOS pressure by a mean of 29 cmH2O compared to basal values (P less than 0-001). In contrast, no change in sphincter tone was noted following injection of atropine-metaclopramide mixture. These findings are relevant to the pre-operative preparation of patients presenting for emergency anaesthesia, since gasgro-oesophageal reflux and pulmonary aspiration of acid gastric content continues to be a significant cause of morbidity and mortality.


The reliability of a linear analogue for evaluating pain. A linear analogue for rating pain with 10, 15 and 20 cm lines is significantly less variable than a 5 cm line (mean error of 15 cm line is 0-19%, 95% confidence limits for the group +/- 2% and an inood correlation between repeated ratins of a recalled pain distant in time. The variance of the rating is significantly less than the repeated rating of a random mark. The linear analogue rating of a constant pain stimulus is reproducible and changes in rating are likely to be real changes of opinion. Pethidine 150 mg intramuscularly had no significant effect, tested 30 minutes after the administration, on the accuracy or reproducibility of the analogue rating. A linear analogue seems a suitable method of recording the patient's opion of a severe pain such as that of labour.


Anaesthetic records in Great Britain and Ireland. A survey of anaesthetists and their use of anaesthetic records was carried out in Great Britain and Ireland. An analysis of 206 different record sheets from 175 hospitals or groups showed that, although many features were similar, important aspects were omitted in some, while others had too many options which were not necessarily relevant to the administration of an anaesthetic. No attempt has been made to offer an ideal design for an anaesthetic record, but the information may assist those anaesthetists wishing to change the current practice in their hospital or group.


Multiple sclerosis and surgery.

Multiple sclerosis and surgery. Five patients with multiple sclerosis showed deterioration following operation and anaesthesia. In every case the change was associated with pyrexis due to infection. No correlation was found between aggravation and any anaesthetic agent used.


Hyperbaric oxygen in acute ischaemia due to allergic vasculitis. A case of a child with allergic vasculitis to penicillin is presented. The patient received successful treatment with hyperbaric oxygen (HBO) therapy. The pathophysiological mechanism of acute peripheral anoxia and the infleunce of HBO treatment on it is described.


Removal of catecholamine-secreting chemodectoma. The use of neuroleptanaesthesia, adrenergic blockade and sodium nitroprusside. A case of catecholamine-secreting chemodectoma of the neck in a 47-year-old male who also had temporal lobe epilepsy is described. Details of presentation, diagnosis and successful treatment are given. He was fully alpha blocked with phenoxybenzamine and given neuroleptic drugs but his blood  pressure rose to dangerous levels when the tumour was handled and did not respond to intravenous phentolamine. Sodium nitroprusside was successfully used to achieve blood pressure control.


Air embolism during anaesthesia for arthography in a child. An infant aged 5 months, weighing 6 kg and suffering from congenital dislocation of the hip joint, was subjected to air arthrography of the right hip joint under general anaesthesia. Air embolism occurred following injection of air into the joint. The clinical management is described. Resuscitation was successfully accomplished and the patient was discharged from hospital without untoward sequelae.


The Lack anaesthetic system. An assessment during spontaneous ventilation. The Lack anaesthetic system is a coaxial modification of the Magill circuit. The resistance of the system was found to be unacceptably high. When air was administered through the system to spontaneously breathing trained volunteers, marked evidence of rebreathing was present when fresh gas flow equalled minute volume. It is suggested that a fresh gas glow equal to one and a half-times minute volume would be required to prevent rebreathing of alveolar gas.


A safety block for scavenging systems.

A safety block for scavenging systems. A safety block is described which protects the patient from expiratory obstruction when using scavenging systems, and provides the anaesthetist with a visual and auditory check on the functioning of the system.


A light for anaesthetists.

A light for anaesthetists. A new type of lighting device is incorporated into the ether screen cross-bar, enabling better illumination of the patient's face. A 12-V, DC power supply is used. The temperature, with vacuum-assisted cooling, should not cause burns to an unconscious patient. Assessment of patient colour was evaluated and found to be reliable. The lamp must not be used with flammable anaesthetic agents.


The immediate use of antimicrobial agents. The use of antimicrobial agents in the surgical period is discussed with reference to the role of the anaesthetist in prophylaxis against the spread of infection in the patient, the treatment of established infection, the protection of the anaesthetist against infection from the patient and of the patient against the side-effects of the antimicrobial agents themselves.


The effects of deliberate hypotension and foot down tilt on the incidence of deep vein thrombosis during plastic surgical operations: a pilot survey. The incidence of postoperative deep  vein thrombosis (DVT) has been investigated in a group of 88 patients undergoing plastic surgical operations on the head and neck, and upper limb. Fifty-two cases were operated upon in the foot-down tilt position and 36 were horizontal. With the effects of blood pressure ignored as a possible contributory factor, the incidence of thrombosis in the latter group was 8-3% and was slightly higher in the tilted group (11-5%). Of those who were hypotensive, 3 developed DVT out of 41 (7-3%) who were tilted; whilst in the 11 who were normotensive and tilted 3 developed DVT, an incidence of 27-3%. Of those who were normotensive and operated flat the incidence of deep vein thrombosis was 8-0%, while in those subjected to a foot-down tilt it was 27-3%. The hypothesis has been advanced that frequent inflation and deflation of the cuff used for monitoring blood pressure in the hypotensive patients may release fibrinolytic activity and explain these differences. Age, sex and operative duration were not found to have an effect. It is concluded that the incidence of postoperative deep vein thrombosis in patients undergoing plastic surgical operations is lower than that found in general surgery, and is not worsened by deliberate hypotension.


The epidural sieve and MBC (minimal blocking concentration): an hypothesis. Certain painful stimuli-of which those associated with placental abruptio and impending rupture of a uterine scar are examples-can penetrate an apparently well-established lumbar epidural block. As a possible explantation of this anomaly, it is suggested that, when used in the concentrations currently employed, the local anaesthetic reaches nerve axons only slightly above the minimal blocking concentration (MBC) of the drug, and that a more powerful stimulus can provoke an impulse which may be conducted through the "blocked" segment of axon. The beneficial aspects of the "epidural sieve" should be welcomed and no attempt made to eliminate the phenomenon.


A method of anaesthesia for fractional coagulation of the Gasserian ganglion. Intermittent anaesthesia with propanidid. A method of anaesthesia is described for fractional coagulation of the Gasserian ganglion. The surgical procedure demands short periods of anaesthesia alternating with periods of full consciousness, during which sensory testing is carried out. In spite of the rare possibility of a hypotensive reaction, propanidid is considered to be the drug of choice for this technique. 31 patients wih typical trigeminal neuralgia have been treated with immediate relief of symptoms, whilst 3 (10%) have been successfully re-treated after recurrence of pain paroxysms. Two patients developed lung emboli, from which they recovered, in the post-operative period, and a third patient had a non-fatal myocardial infarct a week after treatment. Alternative approaches to the problem of intermittent anaesthesia, with and without intubation, are discussed.


Assessment of methods of anaesthesia used for total alloplasty of hip joint with application of bone cement. The authors analyse 151 cases of anaesthesia for total hip joint alloplasty. Fifty-three patients had general anaesthesia and in 98 cases epidural analgesia was performed. Although the statistical analysis of correlations between the fall of the arterial blood pressure and the age of patients failed to demonstrate significant differences between both types of anaesthesia the authors regard local analgesia as superior.


The effect of bone cement used for endoprosthesis stabilization on the activity of lysosomal enzymes in peripheral blood granulocytes. The effect of bone cement used for stabilization of hip joint endoprosthesis on the activity of lysosomal enzymes in peripheral blood granulocytes was studied. The operations were carried out under balanced, non-toxic, endotracheal anaesthesia using muscle relaxants. The blood for tests was obtained from an antecubital vein before and during anaesthesia, before application of bone cement, and 10 min., 1 hour and 24, 48 and 72 hours after endoprosthesis implantation using bone cement. The activity of acid phosphatase, acid protease and neutral protease was determined by calculating it in relation to protein level in the studied fractions. During anaesthesia as well as during the operation when bone cement was applied no statistically significant differences were found in the activity of lysosomal enzymes. On the other hand, after the operation statistically significant changes were found in the activity of lysosomal marker enzymes. Lability of lysosomal membranes appeared with permeation of hydrolases into supernatant. These results confirmed the importance of lysosomal proteins in the processes of wound healing and general postoperative course.


Iontophoretic blockade in treatment of carotid sinus syndrome. The author describes the results of treatment by his own modification of carotid sinus blockade with lidocaine electrophoresis in 17 patients. The results confirmed the effectiveness of the method and demonstrates its simplicity and safety.


The development of the intramural nerve plexus of the gastro-intestinal tract. The chicken intestinal tract from the 6th day of breeding until the 20th day after hatching was examined histochemically for acetylcholinesterase activity. The enzyme was detected first in the perikarya and subsequently also in the ganglion-cells processes. The appearance of the acetylcholinesterase reaction deposit was observed first in the stomach and duodenum and later in the rectum. The histogenetic development of the intramural plexus in the small gut proceeds caudad, but in the colon in the opposite way, i.e., craniad. In the duodenum and colon the nervous development is complete in chicken embryos of 11-12 days and in the rest of the small intestine in embryos of 13-14 days of breeding. In the human embryo of 60 mm CRL the development of the intramural plexus is already completed.


In vitro elastic fiber formation by aggregated arotic cells of newborn rabbits. Cells isolated enzymatically from the aortas of newborn rabbits were aggregated and grown in organ culture. Bundles of microfibrils, some of them with an amouphous core (elastin), were evident in 3-day-old aggregates. Furthermore, droplets of elastin surrounded by darker dots and short filaments, corresponding to the elastic units were observed. In 6-day-old aggregates the number of elastic fibers composed of bundles of microfibrils with deposited elastin increased. Elastic elements which probably resulted from a coalescence of elastic units were also present. These two ways of elastic fiber formation in aggregates are compared with those described in papers on aortic development.


The onset of ossification in the human calcaneus. A (silver) radiographic and microscopic study of the onset of ossification in the calcaneus of 177 human fetuses between 49 and 150 mm C.-R. length has revealed the presence of two independent and developmentally different ossific sites. A lateral locus, intramembranous (parachondral) in origin and precocious in appearance, was observed in slightly over 16% of the fetuses examined between 93 mm (the first appearance of this bone) and 150 mm C.-R. It occupied the vascular connective tissue within the anterior portion of a distinct groove on the inferolateral wall of the cartilaginous calcaneus between the retrotrochlear eminence anterosuperiorly, and the lateral process of the tuber posteroinferiorly. A centrally situated, primary ossific centre, endochondral in origin, was detected in only 11% of the fetuses between 118 mm (the initial appearance of this centre) and 150 mm C.-R. It was situated in the centre of the anterior third of the cartilaginous calcaneus in relation to the sustenaculum tali medially and to a distinct cartilaginous prominence on its lateral surface. Only four fetuses possessed both ossific sites (lateral and central): at 122, 143, 145, and 150 mm C.-R., and in only one of these was continuity established between them. One fetus (122 mm) possessed two independent endochondral centres (superior and inferior).


The costo-uterine muscle of the guinea-pig: a smooth muscle attaching the uterus to the last rib. A conspicuous smooth muscle (of transverse sectional area comparable to that of the taenia coli) situated in the suspensorium ovarii and in the ligamentum ovarii proprium of the guinea-pig is described. The muscle is attached to the last rib, it reaches the medial side of the ovary, to which it is loosely attached; it passes beyond the caudal pole of the ovary (from which it receives additional muscle bundles), it approaches the oviduct, passing ventral to it, then it spreads around it and eventually reaches the distal end of the uterus; this muscle (which is here indicated as costo-uterine muscle) is in direct continuation with, or transforms itself into, the longitudinal outer coat of the uterus.


Distribution of retinal ganglion cells in five mammalian species (pig, sheep, ox, horse, dog). In order to ascertain shape and location of the central area, the distribution of ganglion cells was measured in whole mounts of the retina from pig, sheep, ox, horse, and dog. Although exact comparison of corresponding points of measurement in different animals was not possible, the measurements allowed the mapping of retinal ganglion cell density, typical for the particular species. In all ungulates a streak of high cell density extends along a straight horizontal line, dorsal to the optic disc. As a rule a maximum of ganglion cell density is found close to the temporal end of the visual streak. In the dog a well demarcated oval portion of the streak continues into a short temporal (variable) and a long nasal linear arm. The functional significance of these findings is discussed.


A human embryo of 28 mm crown-rump length with cerebral, esophagotracheal and cardiovascular malformations. The following malformations were observed in a human embryo of 28 mm crown-rump length obtained at operation for tubal rupture in a case of extrauterine pregnancy: 1. Secondary anophthalmia with dysplasia and in part aplasia of the diencephalon. Rudiments of both eyes and eyestalklike proliferations within the diencephalon. No lenses and on the left side only a palpebral fissure. Hypoplasia of the right telencephalic hemisphere and of the right side of diencephalon, mesencephalon and proximal parts of the medulla oblongata. Pseudotumorous proliferations in the diencephalon, in the alar plate of the medulla oblongata (protruding into the fourth ventricle) and in the arachnoid. Hypoplasia of the right internal, middle, and external ear. Dysplasia and in part aplasia of facial osseous elements (cebocephalia). 2. Proximal esophageal atresia with distal tracheoesophageal fistula. 3. A Fallot's tetralogy with right-sided aortic arch and regressive right-sided ductus arteriosus, tricuspid atresia, hypoplasia of the right ventricle with excessive hypertrophy of its wall, and hypoplasia of the pulmonary trunk. Single left superior vena cava and abnormal, semicircular course of the stems of both coronary arteries.


The cancellous structure in the calcaneus and its relation to mechanical stressing. The structure of the cancellous bone in the calcaneus is comparable to a three-dimensional trajectorial system, best adapted to resisting bending stresses. This can be seen from the curve trend of the tensile fascicles. Since stressing takes place mainly in the sagittal plane, the adaptation of the structure must be examined in this plane. The photoelastic experiments prove that similar trajectorial patterns result from different types of loading (e.g., standing with and without muscular contraction, the transmission of forces before and after the fusion of the tuber apophysis); and therefore the stresses remain the same. The trajectorial patterns, already established from the experiments, correspond with those of the cancellous structure, which indicates that a state of adaptation exists. Using the definition given in Roux's "maximum-minimum" law, this means that the bone achieves maximum resistance with a minimum of material. The photoelastic experiments can also be successfully applied to a short, skeletal element, which has been stressed in a complex manner. Furthermore, the theory of causal histogenesis in the supporting tissues can be proved, since the position of the epiphyseal center coincides with that of a singular poing (hydrostatic pressure) in the trajectorial pattern. A division of the trajectorial pattern, into lateral and medial fascicles (as described by T. von Lanz and W. Wachsmuth) cannot be seen in the bone sections and consequently cannot be regarded as being factual.


The embryological development and cytodifferentiation of the pars distalis of the golden hamster (Mesocricetus auratus). A light and electron microscopic study. The embryological development of cytodifferentiation of the hamster pars distalis was investigated using light and electron microscope techniques in order to obtain basic information for comparison with pituitary development in other mammalian species. The normal chronological events in the development of the hamster pars distalis closely paralleled the pituitary organogenesis of other laboratory rodents. Rathke's pouch formed and touched the infundibulum at 8 1/2 days of gestation and separated from the stomodeum 3 days later. Penetration of vascular elements from the developing hypophysial portal system into the pars distalis occurred at 12 1/2 days gestation. This was also the first day that small secretory granules were seen in any of the parenchymal cells. Further cytodifferentiation during the following prenatal, and first few postnatal days of life revealed granulated cells which, in most cases, could not be identified using morphological criteria or granule size as may be done in the adult. An orderly sequence of inductive and morphological events appears to take place in the developing hamster adenohypophysis paralleling similar events observed in other animals.


The distribution of intercellular gap junctions in the developing retina and pigment epithelium of Xenopus laevis. The distribution of gap junctions in the developing retina and pigment epithelium of Xenopus has been examined from optic vesicle to photoreceptor outer segment stages. In the retina and pigment epithelium walls of the optic vesicle gap junctions are found between ventricular cells in the apical contact zone and close to the outside wall; a neural tube type of distribution. Optic cup formation brings the retina and pigment epithelium into contact and gap junctions form between them. After the stage of retinal specification gap junctions, previously more numerous dorsally, are more often found in the ventral retina and pigment epithelium. They continue to be found in the retinal centre between ventricular cell processes in the apical contact zone and near the vitreal basement lamella above the ganglion cell layer until stage 35. Gap junctions are occasionally made by ganglion cells and their axons, providing possible pathways initiating cell differentiation. After stage 35 gap junctions seem to be confined to the peripheral rim of the eye cup where new cells are formed throughout larval life. The observed distribution suggests that gap junctions may provide intercytoplasmic pathways for retinal specification intrinsic to the retina and pigment epithelium.


[A comparative study of the cardiovascular effect of dobutamine. Preliminary results obtained in a surgical resuscitation unit]. Dobutamine (dobutamin hydrochloride, Lilly) is a new inotropic catecholamine; it is presented in lyophilized ampoules for I.V. use, each containing 250 mg of dobutamine to be reconstituted with 5 per cent glucose or sterile water for injection. In the first part of this study, animal pharmacology is reported as described in medical literature: inotropic activity with minimal chronotropic effects, direct action, no vasconstriction, minimal arrhythmogenic activity and minimal diversion of blood flow to skeletal muscles are the main experimental features. The authors report afterwards their own experience with dobutamine in 8 patients (cranial traumas) without cardiac failure, and in 9 patients presenting with a cardio-circulatory failure in a toxi-infectious condition. In all patients tested, hemodynamics parameters (heart rate, mean A.P., central venous pressure) and cardiac output measurement (dye dilution method) were performed. Cardiac index and systolic index, total systemic resistances, left ventricular performance were also calculated. Dobutamine dosage ranged from 2.5 to 10 mcg/kg/mn except in patients with low output syndrom (2.5 and 5 mcg/kg/mn). Dobutamine offers new possibilities by its constant and indisputable inotropic activity contrasting with its minimal chronotropic effect.


[Semi-micromethod for the assay of vitamin E. Use in neonatal pharmacology]. A micromethod using 250 mul of plasma was described for assaying vitamin E. The complete extraction of the plasmatic vitamin E was made possible. The sensitivity and occurency of this method are particularly suitable in pediatric determinations. The vitamin E plasmatic levels were measured in the low birth-weight newborn given or not a 10 mg vitamin E supply in the feeding.


[Proposal of a new procedure for the exploration of hepatocellular function. The trimethoxybenzene test (TMB)]. The authors propose a new method of exploration of liver cell function based on the study of demethylation of a rapidly assimilated atoxic compound, trimethoxybenzene (TMB) in dimethoxy-hydroxybenzene (DMHB). Whereas in normal subjects, the urinary excretion of the metabolites was rapid and marked, 180 mg within 3 hours after taking a 400 mg dose, in patients with liver cell failure, the excretion of DMHB was considerably reduced, 80 to 95% in cirrhosis.


[Use of dopamine in the treatment of shock states]. The utilisation od dopamine at an average dose of 6 mug/kg/mn, for the treatment of 19 shock states, is proved to be of particular interest. The lapic action, the special amelioration of the left ventricular function suggest that dopamine is an useful drug in the treatment of circulatory failure and myocardial inefficiency. The renal and mesenteric vasodilatation produced, prevent or treat the acute renal failure of shock. The actions of dopamine are different from those of other vasopressive amines (norepinephrine, isoproterenol, glucagon) and make dopamine on the first drug to treat shock states.


[The diagnosis of a group of Streptococci. 1 - Comparative study of various techniques for the extraction of the polyoside antigen from Streptococci]. The present importance of streptococcal pathology implicates the identification of the streptococcal groups. The authors have carried out a comparative study of the various methods of extraction of the group specific antigen. They demonstrated the advantages and disadvantages of each method and consider the pronase extraction method to be the simplest, the most rapid and the most specific.


[Comparison of values, obtained on heparinised serum or plasma, for common biochemical examinations]. The biologist may prefer to use plasma rather than serum to facilitate sampling procedures in his laboratory. It is important to know whether or not the patients' results will be affected by this change. In daily practice, there is no difference to speak of between plasma and serum for bilirubin, calcium, potassium, creatinin, urea, cholesterol, sodium, uric acid, triglycerid and iron. There are, however, differences for total proteins, phosphates and glucose.


[Steroid receptors and hormonal receptivity. New pharmacological and therapeutic approaches applicable to the control of fertility]. The definition and main characteristics of the steroid hormone receptors are given. One may note a relationship between hormonal receptivity and the physiological changes in the concentration of the receptors in the target organs. The distribution of the various receptors is given in detail showing the existence of (a) different receptors for the same hormone in different target cells; (b) different receptors for different hormones in the same cells; (c) different receptors for the same hormone in the same cell. A new pharmacological approach is proposed based on differentiation of receptivities from which there results a dissociation of the therapeutic effects.


[Androgen receptors. Their value in physiopathological investigations in man]. There is less knowledge of androgen receptors than of oestrogen receptors but, in recent years, important progress has been made. The author thus describes the physico-chemical properties of the androgen receptors. He discusses also the problems raised by their estimation. The exchange techniques are practically unusable as the androgen receptors are easily destroyed even at 15 degrees C. The author proposes and describes another method which isolates the hormone-receptor complex with protamine sulphate. He also considers the prospects of these receptor estimations in prostatic disease, e.g. androgen-dependent adenoma. The absence of androgen receptors in testicular feminisation syndrome finally permits excellent illustration of the importance of the study of receptors in the understanding of cellular insensivity to a hormone.


[Insulin receptors: physiopathological implications and applications]. The study of insulin receptors has permitted important progress in the knowledge of various pathological conditions, such as, diabetes, obesity. Studies in recent years of the changes in the link between insulin and receptors has proved that the receptor may present interesting variations in affinity with regard to insulin. The notion of negative cooperativity is thus discussed by the lecturer. The number of receptors may also vary. A study of insulin receptors in the experimental, genetic or acquired obesity and in human obesity, is very instructive. Another point emphasized concerns the use of the receptor for the study of structure activity relationships, but also the possibility of estimation of insulin according to the principle of radiocompetition by the receptor. This method of analysis permits one to study the various forms of hormone in patients.


[The role of surgery in the treatment of lymphoma (author's transl)]. 18 cases of abdominal lymphoma in children are reported. Six survived longer than two years after surgery, chemotherapy and radiotherapy. Surgery in lymphoma can be useful for diagnosis, staging and when the tumor arises within intestinal lumen, for cure.


[Rhabdomyosarcoma in children (author's transl)]. 48 cases of embryonal sarcoma are reported. 41.6% of them are currently surviving, three for longer than five years, two longer than four, five longer than three, five longer than two, and five longer than twelve months. Treatment is based on surgery, chemotherapy and radiotherapy.


[Aniridia associated with gonadoblastoma in Smith-Lemli-Opitz syndrome (author's transl)]. One case of bilateral "in situ" gonadoblastoma associated with aniridia and Smith-Lemli-Opitz syndrom is reported. This observation confirms the incidence of gonadoblastoma in intersex patients. Coincidence of this tumor and aniridia is considered by the authors as previously unreported.