Adjuvant chemotherapy associated with surgery in the treatment of osteosarcoma. Preliminary results. The results are presented of thirty five cases of osteosarcoma in which radical surgery was associated with cyclic chemotherapy with vincrystin, adriamycin and methotrexate. Nine patients had pulmonary metastases at intervals of from three to twenty one months after operation; of these, seven died between six and twenty six months after operation. The remaining twenty six patients are in good health and show no signs of disease at follow up varying from twelve to forty eight months. The mortality rate and the percentage of patients with pulmonary metastase from six to forty eight months after operation are notably lower than in a previous series treated by surgery only.


A study of the development of fracture callus in the presence of an experimentally induced osteosarcoma. The results of two experiments are reported in which the formation of an osteosarcoma was induced in mice by the intraosseous injection of Moloney's virus. In the first group of fifty mice, a complete diaphyseal fracture was carried out nine days later at the site of the tumour. In the second group of 200 mice, a partial fracture was produced at the time of injection so that immobilisation was assured. The effects of cyclophosphamide and calcitonin administration were also studied in this group. The course of the repair processes of the bone was studied in both groups, and showed that, even in the presence of an osteosarcoma, these begin and can reach completion, though obstructed and delayed by the tumour.


Background to the therapeutic potential of essential amino acid analogues. Experimental investigation of the metabolic effects of essential amino acid analogues has to be critically assessed against a background of limited experimental techniques and very incomplete understanding of both protein metabolism and protein requirements. Although interest in the therapeutic use of these compounds initially centered on patients with chronic renal failure, their therapeutic potential is by no means confined to renal disease. The fact that metabolic effects of essential amino acid analogues cannot be explained simply in terms of their conversion to the essential amino acids raises the possibility that they may prove to be useful inducers of protein anabolism. Improvement in nitrogen balance may only be of the order of a few grams and measurable nitrogen balance is only a small proportion of total protein turnover, nevertheless, small changes may prove to be of considerable clinical significance.


Evidence for an anabolic action of essential amino acid analogues in uremia and starvation. Nitrogen-free analogues of essential amino acids, when administered with those essential amino acids for which analogues are ineffective or unavailable, exert three actions that may be beneficial in protein-deficient or protein-intolerant subjects. First, they bring about an increase in the concentrations of essential amino acids in the blood at the expense of the concentrations of certain non-essential amino acids, notably alanine and glutamine. This effect is most readily demonstrated in children with congenital defects of the urea cycle enzymes, but can also be seen during daily therapy of adults with portal-systemic encephalopathy. Second, these compounds promote nitrogen balance through their suppressive effect on urea synthesis (an effect not attributable to re-utilization of ammonia derived from urease action in the gut). This action is demonstrable in obese subjects who are already conserving nitrogen maximally at the end of a prolonged fast and can also be shown in the first week of fasting when the branched-chain keto acids alone are administered. In both situations, improved nitrogen conservation persists long after the analogues are metabolized, suggesting enzyme adaptations. In chronic uremics, nitrogen balance can be maintained in some (but not all) patients on very low nitrogen intakes. Third, these mixtures may delay or reverse the progressive decline in glomerular filtration rate characteristic of chronic renal failure in some cases: thus, for example, 5 of 6 patients taken off chronic dialysis have maintained lower serum urea concentrations without evidence of protein malnutrition for periods of 2-24 months.


Lead insult to the dentition in the leopard. Fracture of developing permanent canine teeth occurred in a black leopard hospitalized for lead poisoning. Spectrographic identification of lead in soft tissue at the site of injury suggests a relationship between lead insult and the developing dentition.


A chemical evaluation of collagen and hydroxyproline after treatment with GK-101 (N-Chloroglycine). The reactions of GK-101 (N-chloroglycine) with collagen and hydroxyproline, were studied with regard to caries removal. After reaction with N-chloroglycine, collagen was analyzed for bound available chlorine by iodiometric titration, and hydroxyproline conversion to pyrrole-2-carboxylic acid was measured by they production of a red chromogen after PAB treatment. The results indicated that collagen was chlorinated by N-chloroglycine and hydroxyproline was converted to pyrrole-2-carboxylic acid after N-chloroglycine reaction. These findings tend to indicate two possible pathways of N-chloroglycine protein interaction.


Longitudinal effects of an antibacterial oral rinse on gingivitis and dental plaque. The purpose of this study was to determine what effect oral rinse containing alexidine dihydrochloride (Calgon Consumer Products Company, a Subsidiary of Merck & Co.) would have on gingivitis and plaque. Following a dental prophylaxis, 167 male and female, 7-12-year-old students in Puerto Rican elementary school rinsed twice daily for 60 sec. with 10 ml of either a placebo oral rinse or one containing alexidine dihydrochloride. All students brushed their teeth daily in school. Gingivitis and plaque were scored on all buccal and lingual tooth surfaces prior to the prophylaxis and on days 30, 90, and 160. On these dates, blood and urine analysis were also made. A second prophylaxis was given at the end of the study. The adjusted mean gingivitis and plaque scores were compared between the treatment and placebo groups at 30, 90, and 160 days using analysis of covariance. The alexidine dihydrochloride oral rinse was found to reduce significantly gingivitis after 160 days (p less than 0.02) of treatment and plaque scores 30 days (p less than 0.01), 90 days (p less than 0.001), and 160 days (p less than 0.001) after treatment. No blood or urine changes were attributed to the active ingredient oral rinse.


The effect of local anesthetic solutions on the blood vessels of the rat molars. The effect of solutions of lidocaine, with and without adrenaline, on the blood vessels of the dental pulp and periodontal ligament in rat molars was examined. The vessels were visualized by intravascular injection of a supension of carbon particles. The results indicate that the anesthetic solution alone does have a local effect on the blood vessels. Local anesthetic solutions containing adrenaline had a more marked effect; in addition, a dose-dependent systemic effect of adrenaline was noted.


Enhanced fluoride uptake by teeth through use of iontophoretic techniques. The effects of electric currents on the uptake of fluoride ions by human teeth, in vitro were determined by measuring the change in fluoride ion concentration of the electrolyte in which teeth were subjected to the electrochemical treatment. There was an enhanced uptake when the gold electrode embedded in the tooth was polarized anodically. Evidence that the fluoride ions were taken upon by the teeth was shown by subsequent cathodic polarization of the gold electrode in a fluoride free electrolyte and by measurement of fluoride release into the solution.


The use of aneuploids in studies of genetics, breeding, and evolution in wheat. In wheat a unique series of aneuploids is available, ranging from all 21 possible monosomics to complex types which are simultaneously deficient for one chromosome and duplicate for another. Furthermore, lines with chromosomes from related, alien species either added to or substituted for wheat chromosomes are in common cytological use. This contribution considers the use of this range of material in studies designed to elucidate the evolutionary relationships of the species, investigations of the genetics of a polyploid with cytological diploidization, and in potential breeding manipulations.


Prospects and perspectives in mutation breeding. Induction of mutations, primarily a method of generating variation, can contribute to plant improvement when combined with selection, or recombination and selection, or with other methods of manipulating genetic variation. As a source of variability, induced mutations supplement naturally occurring variation. When specific mutants are selected following mutagenic treatments it is highly likely that a number of mutational changes will have occurred in the selected genotype. Hence, although most of the mutant varieties released so far have resulted from mutation and direct selection, the future trend will be for increasing use of mutants in association with recombination. Whereas induced mutations are generally regarded as random events, there are suggestions of some mutational specificity in response to different mutagenic agents and treatments. The best immediate prospects for increasing specificity lie in the manipulation of the selection environment. Biochemical selection applied to large number of plant cells in culture to locate mutations in specific biosynthetic pathways and the subsequent regeneration of whole plants offers great prospect for reducing the cost of breeding programs and altering the amount or composition of a desired end or intermediate product. Mutations in conbination with other techniques of genetic engineering will constitute the tools of the plant breeders of the future. Their present role in plant breeding has been established. They have advantages in certain situations, disadvantages in others. Greater understanding will lead to their more widespread use.


Artificial mutagenesis as an aid in overcoming genetic vulnerability of crop plants. Artificially induced genetic variation is being used effectively to supplement or complement sources of natural origin for practical plant breeding. Thus, creating genetic variation uill become increasingly important as crop genetic resources become more difficult to obtain via plant exploration. The aritificial induction of useful genetic variation offers important elements that can be used for overcoming genetic vulnerability: (1) new, previously unknown alleles can be induced in crop plant species to broaden the base of variation; (2) useful genetic variation can be induced in modern cultivars helping to shorten breeding time or to extend production "life"; (3) characteristics of existing genetic resource stocks can be improved to make them more useful in breeding; and (4) recombination in crosses may be enhanced. The performance of induced mutant crop cultivars and the successful uses of induced genetic variation in cross breeding indicate that artificial mutagenesis will play an increasingly greater role in plant breeding.


Prospects of breeding for salt tolerance in rice. Variations with regard to salt tolerance were observed in rice varieties, Blue bonnet, IR-8, Jhona-349, and Magnolia. Crosses (F1) between relatively salt-resistant (Jhona-349) and salt-sensitive (Magnolia) varieties were highly resistant to salinity. The F2 population resulted in some salt-resistant combinations. In the F3 and F4 populations, some desirable salt-resistant progenies were selected. Results obtained suggest that selection for salt tolerance may be possible within hybrid populations.


Useful genetic sources of economic importance and their utlization in wheat-breeding programs in Pakistan. Wheat breeders the world over have been utilizing genetic sources to tailor the varieties to meet ever-changing requirements. In the late 1940s Dr. Borlaug at CIMMYT recognized that further increase in yield would be possible only if lodging in the existing wheat varieties could be avoided, for which he began to look for a suitable source for dwarfness. The Japanese had developed semidwarf Norin strains through a series of crosses involving a local line, Daruma; American soft red winter variety, Fultz; and American hard red winter variety, Turkey Red. One of the Norin strains, Norin-10, was used in the breeding programs, first in Italy and then in the United States where Dr. Orville Vogel developed two to three semidwarf varieties. In 1953 Dr. Vogel supplied some F2 seeds of Norin-10 Brevor to the CIMMYT program in Mexico, where this source was employed extensively in the breeding rogram; a large number of varieties were developed, some of which worth mentioning are Pitic, Penjamo, Lerma, Sonora, Inia, Tobari, and Siete Cerros.


Natural and induced genetic variability in wheat. An account is given of the genetic variability in primitive wheats collected from the northwest Pakistan. Apart from genetic sources for disease resistance, drought tolerance, and other plant characters, new sources of possible height reduction in wheat were identified and described. The taller-growing primitive wheats have better emergence, perhaps largely because of their longer coleoptiles. A detailed account is given of comparative genetic studies of height-reducing genes, through both conventional genetic analysis techniques and induced mutation breeding procedures. Both approaches demonstrated the effect of height genes on grain size. At the present time there is a linear relationship between plant height and 1000-kernel weight. Possibilities of achieving a break-through in wheat yields through increased kernel size in short wheats are discussed.


Tissue culture studies on Amaranthus viridis. Amaranthus viridis is a plant that is very widely distributed in our country, grows easily, and is eaten by low-income groups. It has been found that the proteins of this plant, like most other plants, are deficient in some essential amino acids. We were able to develop cultures from the cut-end parts of this plant tissue. The commonly used media were modified to achieve good and fast growth. Results have been obtained on the techniques, histology, chromosomal, and biochemical studies which indicate that the plant could be useful as a research tool to study problems in crop improvement at the cellular level.


Synthetic amphiploids in breeding--genetic and evolutionary studies in wheat. Synthetic amphiploids play an important role in breeding programs of wheat and in the genetic and evolutionary studies of the wheat group. One of the most obvious uses of amphiploidy has been the development of hexaploid and octaploid Triticale. The utilization of synthetic amphiploids as a means of introducing commercially important features of related species into cultivated wheat is now well documented. The projects to produce hybrid wheat are based on the manipulation of cytoplasms and restorers by means of artificially obtained amphiploids. The amphiploidization of interspecific hybrids by treatment with colchicine results in homozygosity. Therefore, a direct use of synthetic amphiploids for genetic studies has been limited to some extent. More often they were used indirectly, viz. as the initial step in the production of single chromosome addition and substitution lines. Such lines were used for detailed and highly informative genetic analyses and also as sources of alien variation for wheat breeding. Crosses between some of the synthetic amphiploids resembling natural species and the cultivated wheats have been successfully used in the evolutionary studies of wheats.


[Pathohistological study on the effect of various methods of osteosynthesis on the osteogenesis in experimental fracture of the lower jaw]. The lower jaw of 60 dogs was fractured and effects of wire and three variants of chemical osteosynthesis have been followed up concerning validity, course and rapidity of osteogenesis. A wire of 0.4 mm in the diameter was applied in wire osteosynthesis and autopolymerizing acryalte ("Simplex" Galenica) in chemical osteosynthesis with briding of the fracture line interfragmentarily or mixed with bone scrapings. The pathohistological examinations performed 7, 14, 21, 60 and 90 days after the intervention and osteosynthesis employment have shown that there is no difference in validity, course and rapidity of osteogenesis in fractures of the lower jaw under conditions of wire and pure chemical osteosynthesis. Since there is no histochemical obstacles and taking into account advantages of chemical over wire osteosynthesis it should be recommended in fractures of the lower jaw.


[Proximal gastric vagotomy without drainage in the treatment of duodenal ulcer]. Observations in the treatment of 107 patients with duodenal ulcer by proximal gastric vagotomy without drainage are reported. Operative technique has been described. There were no operative mortality and immediate postoperative complications rarely occured. Incomplete vagotomy was proved in 2,8 of the operated patients. It has been concluded that the best results could be expected insimple duodenal ulcer, some forms of duodenal ulcer bleeding, perforation of acute ulcer and erosive gastritis. Additional stenosis was observed in some penetrating duodenal ulcers. Optimism is justified in a long-term prognosis. Recurrent ulcer was proved in 2 patients.


[Obstructing lesions of the trachea following tracheotomy]. Within the last four years 8 patients with tracheal stenosis were treated at the ORL Clinic of the M.M.A. The sites of stenosis were at the site of tracheostome, anterior and lateral tracheal walls and circular stenosis of the whole tracheal lumen. Two patients had combined stenosis of trachea and tracheostome. The authors have applied combined palliative surgical interventions without radical approaches but with the employment of longer passive dilatation. Six patients were cured, the complete decannilman was performed, one patient quitted the treatment while one is still under treatment.


[Stomatologic preparation of patients with malignancies of the maxillofacial region for radiation therapy]. A series of 3456 patients with malignant tumours of the maxillofacial region have been treated at the Clinic for Maxillofacial and Oral Surgery of the Military Medical Academy, Stomatological Clinic of the M.M.A. and Radiological Institute of Medical Faculty in Belgrade. The most frequent localization was lips and mucosa of the oral cavity, 77,9%. The irradiation therapy was applied in 42,3% of the patients and combined surgery and irradiation therapy in 28,6% Postirradiation changes of the oral cavity mucosa were found in 25% of the patients, teeth changes in 50% and Candida albicans was found in 56% of the patients. In order to prevent irradiation and postirradiation complications, all the patients with malignant tumours foressen for irradiation therapy should undergo a detailed stomatological examination and sanation of the oral cavity and teeth. The authors advocate team work in establishing the diagnosis and treating in which an important place should have stomatologist.


Acquired erythroenzymopathies in blood disorders: study of 200 cases. Enzyme abnormalities are frequently found in the red cells of patients with various acquired blood disorders. In leukaemias, preleukaemic states and bone marrow insufficiencies with or without sideroblastosis, changes in enzyme activity are usually characterized by the coexistence of deficiency of some enzymes and an increased activity of others. The most frequently decreased activities are those of pyruvate kinase, phosphofructokinase,2,3-diphosphoglycerate mutase and adenylate kinase; the most frequently increased activities are those of hexokinase, aldolase, enolase, 6-phosphogluconate dehydrogenase and glucose-6-phosphate dehydrogenase. In primary myelofibrosis and in polycythaemia rubra vera, enzyme deficiencies are infrequent and differ from those observed in leukaemias and related disorders. Phosphohexose isomerase and phosphoglucomutase deficiencies seem relatively specific for polycythaemia rubra vera. Explanations for the acquired enzymopathies are still at the stage of hypothesis. The theory of multiple genetic damage may explain some findings but has not yet been proved right. The possibility of post-translational molecular modification is suggested as a working hypothesis.


Percutaneous cervical cordotomy.

Percutaneous cervical cordotomy. Percutaneous cervical cordotomy provides a nonoperative opportunity to interrupt the lateral spinothalamic pathways in patients with pain who are not good operative risks for an open cordotomy. The technique is relatively simple, but requires some practice. Indications should be the same as for open cordotomy, with critical patient selection. Results are comparable to those of surgical cordotomy.


[Retention status of crown/bridge constructions]. An apparatus consisting of an acid resistant steel cone and a cap of the same maternal, was used for retention and rotation experiments after cementation of the cap on the cone. The upper diameter of the cone was 6 mm, the lower diameter 7 mm and the height 6 mm. The force of retention, the force necessary for removing the cap from the cone in the direction of removal, was 89,7 +/- 8,3 kp. Forces of rotation, 30 kp applied 100 times continuously, did not reduce the force of retention. Increasing the forces of rotation to 50 kp damage was cuased on the cement, resulting in removal of the cap from the cone after some applications. The possible clinical value of the investigation was discussed.


Single-breath pulmonary diffusing capacity. Reference values and application in connective tissue diseases and in various lung diseases. 1.1. Diffusing capacity of the lungs was measured by using a Mark 4 Resparameter. The single-breath diffusing capacity (D) for carbon monoxide was found to be dependent on the lung volume (VA) during the breath-hold. The same applied to D/VA and to the time constant (tau) for carbon monoxide uptake. This confirms the theoretical considerations and the results of other investigators. This effect should be taken into account especially when making serial determinations of D on the same subject. 1.2. The repeatability of the method was found to be reasonably good; the coefficient of variation was about 4% in normal subjects, as well as in a series of patients with rheumatoid arthritis. 1.3. The effect of the correction for haemoglobin concentration was calculated and tabulated for a set of possible values of DM/Vc and haemoglobin. This correction did not reduce the scatter of D values in normal subjects, but it was adopted for clinical use for theoretical reasons. Caution in its use and interpretation of the correction is emphasized. 2.1. Healthy males and females, 20-69 years of age, were examined to establish reference values for the D measurement. Multiple linear regression equations were calculated stepwise, and equations based on age and height were then used in the clinical prediction equations. Similarly, prediction equations were calculated for clinical spirometry. 2.2. The prediction equations were compared with some published reference values. The equations provide a basis for the evaluation of the effect of various factors, such as age and smoking, in different populations. 3.1. Respiratory function, clinical symptoms and chest x-ray findings were examined in patients with connective tissue diseases. Three different investigations were thus formed: a) consecutive patients (free of lung disease other than that possibly due to a connective tissue disease) with definite rheumatoid arthritis (RA, 21 cases), systemic lupus erythematosus (SLE, 18 cases) or scleroderma (SCL, 6 cases) were subjected to detailed tests. b) 129 patients from the Rheumatism Foundation Hospital, Heinola, Finland, were subjected to measurement of diffusing capacity and vital capacity in addition to chest radiography and routine clinical assessment c) the histological findings on 12 patients subjected to a needle biopsy of the lung in order to exclude other conditions were compared with the results of diffusing capacity and x-ray examinations. 3.2. Restrictive impairment of the respiratory function was the general finding in all of these groups. The reduction in diffusing capacity was out of proportion to the reduction in lung volume, however, in most cases with abnormally low values. Low D values were encountered in about half of the RA and SLE and in all of the SCL patients in group a, and in 13% of the "average" RA patients studied in Heinola. The typical histological finding in patients with reduced D was a thickening of the alveolar wall...


Tumefactive extramedullary hematopoiesis of the stomach. A 3 X 4 cm submucosal gastric mass of extramedullary hematopoeitic tissue occurred in a patient with chronic myelogenous leukemia. Such stomach masses have been misinterpreted as malignant tumor. Tumefactive extramedullary hematopoiesis of the stomach is an infrequent occurrence in patients with extramedullary hematopoiesis but should be considered in the differential diagnosis of patients known to have this condition.


beta-blocking drugs and renin secretion in the anaesthetized dog. 1. The effect of propranolol and sotalol on renin secretion was studied in the anaesthetized dog. 2. beta-adrenergic blockade did not modify basal renin secretion and did not affect the rise of renin secretion induced by haemorrhage or aortic constriction. 3. beta-adrenergic blockade diminished the rise in renin secretion induced by stimulation of the renal nerves.


Plasma renin, urinary sodium excretion and vascular disease. 1. Urinary sodium excretion and plasma renin activity have been measured in a group of persons with untreated mild hypertension and in a control normotensive group. 2. Preliminary analyses of the data indicate that the daily sodium excretion was significantly higher in the hypertensive group but the plasma renin activity did not correlate significantly with the urinary excretion of sodium. 3. These findings suggest that sodium intake was significantly greater in a population with mild hypertension than in a comparable normotensive group.


Plasma renin activity and cardiovascular disease. 1. A group of patients with essential hypertension was divided into three categories on the basis of the plasma renin activity. 2. There was no correlation between the plasma renin activity categorized as high, normal or low and the duration of hypertension, the incidence of left ventricular enlargement, the blood urea nitrogen, serum creatinine, cholesterol or uric acid respectively. 3. Analysis of data showed that the incidence of cardiovascular events in the hypertensive population correlated with the plasma renin activity only in combination with known risk factors.


Inhibition of the pressor and aldosterone-releasing effects of angiotensin II. 1. Competitive or non-competitive inhibition of the myotropic and pressor response of angiotensin II is dependent on the nature of the substituent in position 8 of the antagonist peptide analogue. Substituents in other positions of the molecule, particularly position 1, contribute greatly to the potency of these antagonists. 2. As is evidenced after adrenalectomy or after blockade with phentolamine and phenoxybenzamine, the initial pressor activity observed with all the antagonistic peptides is partially due to the release of catecholamines and partially to a direct myotropic effect. 3. [Sar1, Thr8]angiotensin II has been found to possess the lowest agonist to antagonist ratio of all antagonists tested. 4. [Des-Asp1, Ile8]angiotensin II selectively and specifically inhibits the release of aldosterone from adrenal cortex. Thus, unlike angiotensin II, this heptapeptide has pronounced organ specificity, suggesting that the heptapeptide (angiotensin III) is the aldosterone-releasing hormone.


Pathogenesis and prevention of stroke in spontaneously hypertensive rats. 1. A colony of stroke-prone spontaneously hypertensive rats has been developed by selective breeding. 2. These animals developed severe hypertension early in life, the magnitude of the hypertension being closely related to the incidence of stroke. 3. No evidence was obtained of any humoral factor responsible for strokes. 4. Local factors predisposing to stroke were a scanty arterial supply with characteristic recurrent branching of long and large arteries, together with increased vascular permeability, angio-necrosis, and formation of microaneurysms. 5. Strokes could be prevented by adequate antihypertensive therapy from an early age.


A pilot trial of treatment for mild hypertension; interim report of the Medical Research Council's trial in Britain. Progress in the pilot phase of the British multicentre randomized controlled trial of treatment for patients with mild hypertension is described.


Yoga and biofeedback in the management of 'stress' in hypertensive patients. 1. Psychophysical relaxation exercises based on yogic principles and reinforced by biofeedback instruments were used for behaviour modification in sixteen hypertensive subjects. 2. Preliminary studies indicated that their pressor response to emotional and physical stimuli became less exaggerated and less protracted compared with controls.


Comparative pharmacology of new specific angiotensin antagonists. 1. The angiotensin II antagonism by newly synthesized 8-C-phenylglycine analogues of [5-isoleucine]angiotensin II in different preparations was investigated in vitro and in vivo. 2. All analogues competitively inhibited the myotropic effect of angiotensin II on the isolated colon ascendens of the guinea-pig and the stomach of the rat. 3. In normotensive dogs, cats, rabbits, guinea-pigs and rats the blood pressure response to infused angiotensin II was inhibited by the antagonists. The angiotensin II-induced fall in renal blood flow in the dog was blocked during infusion of the analogues. Acute renal hypertension in rats was significantly decreased. Of conscious rats variously with normal blood pressures, spontaneous hypertension and chronic renal hypertension, only in the last group could a marked uniform fall in blood pressure be demonstrated. The central pressor effect of angiotensin II was also inhibited in conscious rats. 4. 8-C-Phenylglycine analogues of [5-isoleucine]-angiotensin II exhibit a specific antagonistic activity to endogenous and exogenous angiotensin II.


Adrenergic mechanisms in human hypertension and in spontaneously hypertensive rats. 1. The role of adrenergic neuronal mechanisms in the development of early hypertension in man and the spontaneously hypertensive rat has been explored. 2. In both, a hyperkinetic circulatory state is associated with reduced parasympathetic and increased adrenergic cardiac influences. 3. Spontaneously hypertensive and normotensive control rats were treated with propranolol from conception until 12 weeks. Although heart rate and output remained reduced, there was no difference in growth or elaboration of pressure with respect to their untreated controls. 4. After another series of spontaneously hypertensive and control rats received cardiac autonomic blockade (atropine and timolol), they sequentially received alpha-adrenergic blockade (phenoxybenzamine), ganglionic blockade (trimethaphan) and smooth-muscle vasodilatation (hydralazine). These studies revealed only a small pressure differential between the two groups before hydralazine and still less thereafter; unlike the control rats, pressure in spontaneously hypertensive rats fell markedly after ganglionic blockade as a result of reduced output, indicating greater adrenergic control mediated through venoconstriction. 5. These findings indicate: increased cardiovascular adrenergic control in young spontaneously hypertensive rats, the hyperkinetic circulation merely reflecting one aspect of increased total cardiovascular input. Structural alterations seem to participate minimally. 6. These experimental observations closely, resemble findings in early hypertensive man, and it is suggested that altered total cardiovascular adrenergic input is responsible for the elaboration, development, and maintenance of essential hypertension in man.


The vasomotor centre and its afferent pathways. 1. Experiments were carried out on two groups of anaesthetized greyhounds. The response of the first group to infusions of angiotensin II into a vertebral artery for 5 min and to bilateral occlusion of the common carotid arteries for 2 min was studied before and after bilateral ablation of the areas postrema. The response of the second group to infusions of angiotensin and to carotid occlusion was studied before and after mid-collicular transection of the midbrain. 2. Bilateral ablation of the areas postrema abolished the response to angiotensin infused into a vertebral artery at the dose used but did not significantly alter the response to carotid occlusion. Transection of the midbrain did not abolish the response to either procedure. 3. It is concluded that the structures involved in the cardiovascular response to carotid occlusion are anatomically distinct from the area postrema and that neither response requires the integrity of connections above the pons. 4. An attempt has been made to construct a schematic diagram of the vasomotor centre.


Control of high and low blood pressure in the dog by aortic and sinus nerves. 1. Changes in afferent activity in the aortic and sinus nerves with alterations of blood pressure were studied in anesthetized dogs. Mean aortic blood pressure was changed from 220 to 50 mmHg by using a pressurized reservoir connected to the abdominal aorta. 2. The stimulus--response curve (defined by measuring the mean impulse frequency at various pressures) from both nerves was S-shaped; the curve for the aortic nerve was shifted to the right of the sinus nerve curve. 3. In the dog, the aortic arch baroreceptors act predominantly as an anti-hypertensive mechanism; at lower pressures, the major control occurs through the sinus baroreflex.


Spinal sympathetic reflexes in the cat and the pathogenesis of arterial hypertension. 1. In vagotomized anaesthetized cats with both common carotid arteries occluded, stretch of the thoracic aorta induced reflex increases in arterial blood pressure, heart rate and left ventricular dP/dtmax. Similar responses were obtained in cats with spinal transection at the level of the first cervical nerve roots. 2. The hypothesis is advanced that sympathetic excitatory reflexes may contribute to the maintenance of hypertension through positive feedback.


Carotid baroceptor re-setting in the hypertensive dog. 1. The behaviour of forty-four single carotid baroreceptor fibres from nine dogs with normal blood pressure was contrasted with that of forty-seven single fibres from nine dogs with renal (nephrectomy--clip) hypertension. 2. It was found that in response to a square-wave pressure step, the mean steady-state threshold pressure was 99.23 mmHg for the normotensive dogs and 129.13 mmHg for the hypertensive dogs. 3. The degree of re-setting appeared to correlate with the duration of the hypertension but was not seen until an animal had been hypertensive for more than 4 days. 4. In one animal, hypertensive for 7 weeks but whose blood pressure returned towards normal after removal of the clip, the receptor characteristics was normal. 5. No change in the gain of the receptor sensitivity was seen. 6. Light-microscopy and electron miscroscopy of the opposite (non-perfused) carotid sinus revealed no differences in the fibre morphology or density between the hypertensive and normotensive animals (a random sampling, four normal and six hypertensive).


The intrinsic brain iso-renin--angiotensin system in the rat: its possible role in central mechanisms of blood pressure regulation. 1. Angiotensin is produced by the intrinsic isorenin--angiotensin system. 2. Angiotensin is secreted into the cerebrospinal fluid of nephrectomized rats. 3. Angiotensin in cerebrospinal fluid elevates systemic blood pressure. 4. Rats with hereditary diabetes insipidus are virtually non-responsive to intraventricular angiotensin. 5. Angiotensin II is elevated in the cerebrospinal fluid of spontaneously hypertensive rats. 6. An intraventricular perfusion of the angiotensin II receptor-blocking agent P 113 decreases blood pressure in spontaneously hypertensive rats.


The response of the renin--angiotensin systems in rats to the injection of angiotensin II antibodies. 1. Antibodies against angiotensin II were purified by affinity chromatography. 2. When injected intravenously into rats, the antibody distributed in the extracellular space with a half-time of 11 h and a distribution volume of about 10 ml/100 g body weight. The antibody was eliminated with a half-time of 7 days. 3. Plasma angiotensin II concentrations increased about 100-fold the control values 7 min after antibody injection and declined in parallel with the antibody concentration. It was calculated that only about 1--4% of the binding capacity of the antibody was occupied by angiotensin throughout the experiment. 4. Since the plasma renin concentration was normal, except during the short initial phase of stimulation, it is concluded that upon antibody injection the renin-angiotensin system rapidly reached an equilibrium, with concentrations of free angiotensin close to or identical with normal concentrations.


Central serotonergic neurons and experimental neurogenic and renal hypertension in the rabbit. 1. Rabbits received intracisternal injections of 5,6-dihydroxytryptamine (5,6-DHT) in order to ablate central serotonergic nerves and deplete central serotonin stores. Depletion was most marked in the spinal cord where serotonin concentration was reduced to less than 50% of that in rabbits given control injections. 2. In normal rabbits, intracisternal 5,6-DHT caused a transient reduction in arterial pressure, which was maximal 1 week after injection. 3. Intracisternal 5,6-DHT completely prevented the neurogenic hypertension produced by sinoaortic denervation in control animals and reversed it when given after sustained neurogenic hypertension had developed in denervated animals. These studies suggest that central serotonergic neurons participate in the baroreceptor reflex arc. 4. Intracisternal 5,6-DHT did not modify the renal hypertension that follows bilateral renal wrapping.


Dopa, catecholamines and their metabolites in essential hypertension. 1. Urinary excretion of dopa, catecholamines and their metabolites (vanillylmandelic acid, methoxycatecholamines, 3-methoxy-4-hydroxyphenylglycol and homovanillic acid) were studied in eighty patients with essential hypertension and in twenty-five healthy control subjects. 2. Increased urinary excretion of catecholamines, dopa and catecholamine metabolites was found in a proportion of cases. 3. The relationship between urinary excretion of catecholamine metabolites and the excretion of dopa and noradrenaline was studied. 4. In view of the suggested significance of 3-methoxy-4-hydroxyphenylglycol as an index of brain catecholamine metabolism, particular attention was paid to urinary excretion of this metabolite in the subjects under study.


Effect of a competitive angiotensin antagonist on the renal haemodynamic changes induced by inhibition of prostaglandin synthesis in rats. 1. Inhibition of prostaglandin synthesis by indomethacin induced an increase in blood pressure which did not occur when rats were bilaterally nephrectomized. 2. The blood pressure effect was related to the state of sodium balance and thus to the activity of the renin--angiotensin system. 3. Indomethacin induced a decrease in renal blood flow. 4. Angiotensin receptor blockade with Sar1-Ala8-angiotensin II blunted the blood pressure effect and prevented the renal haemodynamic changes induced by indomethacin.


Renal prostaglandin synthesis in experimental renal-clip hypertension in the rat. 1. The hypothesis that suppression of prostaglandin E synthesis by indomethacin exacerbates renal-clip hypertension in the rat was investigated in four groups of rats. 2. Indomethacin was shown to exacerbate hypertension in renal-clip animals. 3. Synthesis of prostaglandin E, determined by gas--liquid chromatography, was suppressed in medullary tissue from the hypertensive animals irrespective of indomethacin treatment. 4. The findings support the concept that prostaglandins participate in the blood pressure regulatory function of the kidney but pose a number of unsolved questions.


Effect of prostaglandins (E2 and A2) on the enzymatic reaction of human renin in isolated homologous system and with added normal and hypertensive plasma. 1. Prostaglandin E2 significantly inhibits the renin reaction in whole plasma as well as in the isolated system of semi-purified human renin and human renin substrate. The inhibitory effect of prostaglandin A2 was less marked in whole plasma and absent in the isolated system. 2. The inhibitory effect of prostaglandin E2 was more marked in normal than hypertensive plasma and was maximal at the lowest concentration used. In hypertensive plasma the maximal inhibitory effect was achieved at tenfold higher concentrations. 3. In normal plasma prostaglandin E2 does not affect the rate of product formation (k5 = k6), but inhibits the overall renin reaction by decreasing the total amount of available enzyme-substrate and enzyme--substrate modifier complex (K2 less than K3). 4. In hypertensive plasma prostaglandin E2 acts as a potential accelerator of the rate of product formation (k6 greater than k5). In the range of substrate concentration employed, the apparent inhibitory effect is explained by an even greater lack of available complex (K less than K3). This behaviour in hypertensive plasma is consistent with the presence of an additional modifier (? activator).


Blockade of renin release by lanthanum.

Blockade of renin release by lanthanum. 1. The effects of lanthanum on renin release and renal vasoconstriction were studied in the isolated perfused rat kidney. 2. Lanthanum reduced noradrenaline-induced renal vasoconstriction. 3. Lanthanum prevented isoprenaline-induced and glucagon-induced stimulation of renin secretion.


Angiotensin blockade in studies of the feedback control of renin release in rats and rabbits. 1. In rabbits actively immunized against angiotensin II (AII), the appearance of anti-AII antibodies was associated with a rise in plasma renin activity (PRA), which did not occur in mock-immunized controls. 2. In conscious rabbits, infusion of the angiotensin inhibitor, Sar1-Ala8-angiotensin II (P-113), at rates of 0.055, 0.22 or 1.1 nmol min-1 kg-1 into the renal artery, caused dose-related increases in arterial PRA and renal arteriovenous PRA difference. Renal blood flow fell with the high dose, but not with the low or medium doses. A fall in arterial pressure, asynchronous with peak renin secretion, accompanied the medium- and high-dose infusions. 3. Intravenous infusion of inhibitor P-113, 5.5 nmol min-1 kg-1, into anaesthetized rats produced highly significant increases in PRA and plasma renin concentration without reduction in arterial pressure. There were no changes in PRA or plasma renin concentration in saline-infused control rats. 4. These findings suggest that AII blockade interrupts a negative feedback loop controlling renin secretion.


Effect of angiotensin II and of an angiotensin II analogue (Sar1-Ile8-angiotensin II) on blood pressure, plasma aldosterone and plasma renin activity in the dog. 1. The effect of infusions of equimolar doses of angiotensin II (AII) and of the angiotensin analogue Sar1-Ile8-angiotensin II on arterial blood pressure, plasma aldosterone and plasma renin activity were compared in normal anaesthetized dexamethasone suppressed dogs. 2. Angiotensin II induced a significant increase of blood pressure and of plasma aldosterone whereas plasma renin activity decreased. The blood pressure was only slightly affected by large doses of the analogue. Plasma aldosterone, however, increased and plasma renin activity decreased. These changes were significant but less pronounced than after the infusions of angiotensin II. Plasma aldosterone remained high and renin activity low for 40 min after the infusions of the analogue. 3. The results suggest a strong agonistic potency of Sar1-Ile8-angiotensin II at the adrenal and renal angiotensin receptors, and that it is almost ineffective at the vascular receptors. The inhibition of renin secretion by angiotensin seems not be related to its vasoconstrictive activity.


The role of the renin--angiotensin--aldosterone system in cardiovascular homeostasis in normal man. 1. To examine the role of angiotensin II in the maintenance of blood pressure and control of aldosterone secretion, eight normal human subjects were studied on a tilt table in sodium-replete and sodium-depleted states, before and after the administration of an angiotensin converting-enzyme inhibitor (CEI). 2. Administration of CEI was followed by a marked fall in blood pressure on tilting in sodium-depleted, but not in sodium-replete, subjects. CEI administration also resulted in a rise in plasma renin activity in the supine position, in the absence of haemodynamic change. The rise in plasma aldosterone observed both in response to tilting and sodium depletion did not occur after CEI, even though plasma renin activities were higher. 3. These results indicate that: (a) angiotensin II is essential for blood pressure control in the sodium-depleted individual; (b) angiotensin II exerts direct feedback control on renin secretion; (c) angiotensin II is the primary stimulus to aldosterone secretion in response to both sodium depletion and posture.


Treatment of patients with severe hypertension by inhibition of angiotensin-converting enzyme. 1. The results of the administration of the nona-peptide inhibitor (SQ 20,881) of the enzymatic conversion of angiotensin I into angiotensin II in twelve severe hypertensive patients are presented. 2. Administration of the compound was associated with a fall in blood pressure in ten of twelve patients. 3. Four patients had a normal plasma renin activity (PRA) with a range of 1.6-3.7 ng h-1 ml-1 and eight patients had a high PRA with a range of 5.0-74 ng h-1 ml-1. Two of the patients with normal PRA had no fall in blood pressure despite receiving 2 mg/kg of the compound. Two patients with normal PRA, however, did respond, thus indicating that a high PRA is not necessary for a response to the inhibitor compound. 4. It was found that haemodialysis or diuresis with frusemide enhanced the blood pressure response to the compound. 5. The presence of a measured low total blood volume was found to be associated with an exaggerated fall in blood pressure to a small dose of compound (0.125 mg/kg) in one patient.


The use of angiotensin-converting enzyme inhibitor in the diagnosis and treatment of hypertension. 1. The anti-hypertensive effect of converting enzyme inhibition was evaluated in twenty-three hypertensive patients (seven renovascular, four essential, four malignant, one scleroderma, three chronic renal failure, four primary or idiopathic aldosteronism). 2. In sixteen patients a single injection (1--4 mg/kg) of the inhibitor produced an immediate anti-hypertensive effect, which lasted up to 16 h. In six patients the anti-hypertensive effect of the inhibitor was significantly improved after sodium depletion. 3. Plasma renin activities increased and plasma aldosterone concentrations decreased consistently except in idiopathic aldosteronism. 4. Converting enzyme inhibition provides a direct way of defining the degree of renin-dependency of the hypertension. Accordingly, it can be used diagnostically and for planning appropriate therapy. Therapeutically, it could be advantageous in hypertensive emergencies because of its safety, specificity and capacity to reduce aldosterone secretion.


Routine abscess tonsillectomy: late results. The late results of abscess tonsillectomy as a routine treatment of peritonsillar abscess were investigated. The material comprises 113 patients. Follow-up was performed two to five years after the operation (bilateral dissection tonsillectomy under general anesthesia). Symptoms of pharyngitis, recurrent or chronic, were present in 17 percent of the patients, in most cases without major objective changes in the throat. The incidence of these symptoms was highest--70 percent--in patients past middle age without any history of trouble from the throat before the peritonsillar abscess. Tonsil remnants were seen in 28 percent, but only 6 percent of the patients had new episodes of febrile throat infections. The results are discussed. A reserved attitude to abscess tonsillectomy (and to interval tonsillectomy) is recommended for peritonsillar abscess in elderly patients without previous trouble from the throat.


[Cerebrovascular disorders in the fascicular block picture on the electrocardiogram]. 3894 ECG of neuropsychiatric patients were investigated for mono- and bifascicular blocks and the charts taken out for closer examination. Within this group of patients, the percentage of cerebral circulatory disturbances proved to be significantly increased. Among 97 patients there were 15 suffering from syncopal attacks. These attacks seem to be caused by intermittent occurrence of a trifascicular block. In a randomized control group of 50 patients not a single syncopal attack was found. The risk for a patient to develop syncopal attacks is correlated to the advancing degree of blockage in the ECG. When an intermittent trifascicular block is detected in a patient suffering from syncopal attacks, an electric pacemaker should be implanted.


[Ventricular arrhythmias in reduced glycoside tolerance and digitalis poisoning together with myocardial infarct]. Electrophysiological fundamental principles of the heart muscle cell and the conduction system are discussed in detail. Basic differences are described. Pathophysiology of ventricular arrhythmias is emphasized, especially the ectopic conduction development and conduction defect of the reentry mechanism. Decreased digitalis tolerance of different causes and overdosage of digitalis may lead to ventricular premature heart beats and tachycardias. Myocardial infarction is discussed in detail because lethality within the first hours of infarction is mostly caused by ventricular fibrillation.


[ECG changes and peripheral blood pressure during endoscopic study of the stomach]. It is reported on alterations of ECG and blood pressure appearing in 51 patients during endoscopic examination of the stomach. Above all, these alterations consisted of repolarisation disturbances with a partial preterminal negative T and isolated supraventricular extrasystoles. Atrioventricular blocks or spreading of the QRS-complex were not observed. In all patients a distinct increase in frequency was present while the endoscope was introduced. Since regression of all these alterations would occur after examination, a vegetative-functional stimulus might be the inducing factor. In endoscopic examinations the risk of any incidents appearing in connection with the system of coronary circulation is minimal. In patients with considerable previous damage of the heart caution is advised.


[Endoscopic biopsy using the electrocautery snare (macro particle biopsy)]. The biopsy snare has greatly improved the diagnostic and therapeutic possibilities in gastro-intestinal endoscopy. Experience with endoscopic polypectomy in the digestive tract has stimulated the use of the biopsy snare for the excision of larger particles. Thus, besides that larger particles can be obtained, also deeper excisions are possible. Usually muscularis mucosae and parts of the submucosal layers are included. Mucosal hyperplasia and submucosal processes can be recognized and analysed preoperatively. Even the resection of inoperable stenosing neoplasms is now possible. The results of 93 gastro-intestinal big particle biopsies are reported. The risk of big particle biopsy proved to be minimal; once bleeding occurred and was managed conservatively.


[Pathophysiologic significance of small intestine flora in the stagnant loop syndrome]. A report is given about a 53 years old man with a "stagnant loop syndrome" associated with a diverticulosis of the whole small intestine and colon. Steatorrhoea was the main clinical symptom. The classification, distribution and frequency of intestinal diverticulosis is based on radiological results. The pathological values of the absorption tests prompted for a discussion of new examinations in the "stagnant loop syndrome". The property of the intestinal bacteria to influence the absorption of fat, xylose and vitamin B12 is stressed. Finally the possible methods of treating the diverticulosis with "stagnant loop syndrome" are discussed.


[Joint occurrence of spinal anomalies and colonic diverticula]. We investigated the radiographs of 125 patients with respect to variations of intestines (diverticula, polyps, carcinomas) and simultaneous anomalies in vertebral column (fissure of vertebral arches, asymmetric growth of vertebral arches, deterioration of ribs, fusing of vertebrae). There is a significant correlation between diverticula of colon and anomalies in vertebral column, whereas we found no correlation between other variations of intestines (polyps, carcinomas) and anomalies in vertebral columns. It is according to the theory of syndrome anomalies if there is an embryogenesis relation between anomalies of intestines and vertebral column.


[Cholestatic jaundice after taking the laxative Normolaxol]. Report on two cases of jaundice developing shortly after ingestion of a new laxative, Normolaxol (quinolylmethylenediphenol). Clinical and morphological aspects of the acute cholestasis are described and discussed regarding differential diagnosis and pathogenesis.


[Radiological study of the neoplastic bladder]. Radiological methods useful in the examination of bladder tumours are reviewed, with particular reference to preoperative evaluation in accordance with the system. Examples are drawn from a personal series.


[Traumatic lesions of the urinary tract. Radiographic aspects]. Techniques of radiology of use in the study of traumatic lesions of the urinary apparatus are discussed and 14 cases are reported in detail.


[The radiological picture of chronic pyelonephritis]. The urographical and angiographical signs that aid the radiological diagnosis of the different stages of chronic pyelonephritis are discussed. A number of cases are presented by way of illustration.


[Results of therapy of carcinoma of the cervix uteri in cases followed from 1962 to 1968 at the Alberti Radio Institute of the Civil Hospitals of Brescia]. The 5-years follow-up results and late complications in 607 cases of tumour of the uterine cervix, observed at the "O. Alberti" Radiotherapy Institute of the Brescia Civil Hospitals between 1962 and 1968 are examined. Treatment used was radiological, surgical or an association of the two.


[Complications of pelvic radiotherapy of cervico-uterine carcinoma. Observations on case records from 1954 to 1968]. Complications observed in 146/674 patients subjected to radiological therapy or radiosurgery at the Modena University Radiology Department between 1954 and 1968 are discussed.


[Association of cervico-uterine carcinoma and other extra-uterine primary neoplasms. Observations on 31 cases]. Out of 874 patients undergoing radiotherapy for carcinoma of the uterine cervix, 31 cases (3.5%) of second primary malignant tumour in another site were encountered. Half the cases preceded and half followed uterine cancer. The data are analysed and discussed.


[Clinical and statistical evaluation of radiotherapy of cervico-uterine carcinoma]. Statistical appraisal of the results of radiotherapy, with or without surgery, in the light of various clinical and technical factors is illustrated with reference to 1466 cases of carcinoma of the cervix treated at the Modena University Radiology Department between 1950 and 1973.


[Nonvisualized gallbladder in cholecystography per os: radiotomographic study after a second dose]. Tomography after a second dose of contrast medium gave useful information in 46/57 (81%) cases where the gallbladder was not visualized after a first dose per os. Eight cases are presented in detail.


[Congenital osteochondrodysplasias. Personal cases]. The different forms of congenital osteochondrodysplasias are reviewed and personal cases (achondrogenesis; thanatophoric dwarfism; thanatophoric dwarfism associated with cloverleaf skull; asphyxiating thoracic dystrophy etc.) are presented.


[Angiographic and bronchographic aspects of idiopathic and secondary vanishing lung in childhood]. Three cases of primary vanishing lung and one case secondary to endobronchial foreign body in children were studied by bronchography and angiography. Results are discussed.


[2 cases of bronchiectasis caused by an undiagnosed endobronchial foreign body]. Two cases in which an unknown foreign body gave rise to bronchiectasia are culled from a series of 54 cases of endobronchial foreign bodies in children and discussed.


[Cockayne syndrome. 3 cases].

[Cockayne syndrome. 3 cases]. Three cases of Cockayne's syndrome, observed in patients aged 10, 5 and 1 years are reported and discussed; skeletal X-ray findings are illustrated and analysed.


[A rare case of external blind accessory urethral canal]. A case of external, blind accessory urethra in a boy is described. The abnormality was examined radiologically and confirmed surgically.


[Bone localizations of Hodgkin's disease]. Bone lesions have been observed in 43 out of 415 Hodgkin's disease patients (9.6%): the radiographic findings are discussed with reference to clinical problems.


[Radiotherapy of Hodgkin's disease: indications, methodology and clinical observations]. Staging and general management in Hodgkin's disease are reviewed and the radiotherapy technique described. Short-term results with a personal series of 33 cases are reported and early side-effects discussed.


[Endocavitary radiotherapy of carcinoma of the cervix uteri using a modeled device and Ir-192. Computerized dosimetry]. A computerised dosimetry programme for use in intracavitary radiotherapy of cervical carcinoma using a shaped after-loading apparatus and 192Ir wires is described. The technique for its use is explained and the results observed are discussed.


[Transillumination of the breast].

[Transillumination of the breast]. The physical basis of the method, the procedure, the normal and pathological findings are described. On a series of 125 pathology cases observed, transillumination proved useful as a diagnostic aid in breast diseases.


[Diagnostic and prognostic value of chest radiography in bed in the acute phases of myocardial infarct]. The existence of a correlation between Peel's index, pulmonary radiological findings (X-ray carried out in bed immediately after admittance) and clinical condition at discharge has been verified statistically in 92 patients admitted to coronary units for acute myocardial infarction.


[A simple injector for direct lymphography]. A gas pressure injector for easy lymphography is described; skilled personnel are not required, cost is very low and operation reliable. The injector has been used without problems in 300 abdominal lymphographies.


[Combined anesthesia with propionylpromazine (Combelen) and methadone (Polamivet). A sure simple method of anesthesia in gastrointestinal surgery in dogs]. In more than 400 cases of gastrointestinal surgery on mongrel dogs, a combination anesthesia of a neuroplegic agent--propionyl promazine (Combelen) and methadone (Polamivet), an analgesic--was administered without additional intubation or ventilation. This type of anesthesia is simple to apply and practically without risk; the conditions for the operation are therefore excellent. No monitoring personnel is required, no intra- or post-operative incidents have occurred. Thus this method may be recommended as safe and simple for experimental abdominal surgery in dogs.


Internal bile diversion--a new model for the study of cholesterol metabolism. Biliary diversion in different ways has been studied as a prevention against induced hypercholesterolemia in experimental animals. A new model for the study of cholesterol metabolism is described in dogs in this paper. The technique consists in ligation and division of the common bile duct and interposition of an isoperistaltic loop of jejunum between the gallbladder and urinary bladder. This technique is free of complications such as diarrhea, infection, and peptic ulceration that are seen in other biliary diversion models, and it is tolerated well by the animals. This requires further study for its effectiveness in the prevention of experimental hypercholesterolemia and subsequent development of arteriosclerosis.


[Distribution of dosage and estimation of dosage absorbed by critical organs in the fields of irradiation of lymphomas]. Dose distribution in blanket irradiation was determined using the photodensitometer in a life-size dummy; doses in critical tissues (especially heart, spinal cord, bone marrow) are discussed with reference to likely biological risks.


Prerenal hypertension caused by a postoperative A-V fistula. The A-V fistula in the renal pedicle with functioning renal parenchyma leads to a prerenal hypertension by the blood-steal effect from the renal artery through the fistula into the vein, according the pressure gradient over the fistula. The etiology of these A-V fistulas is pointed out. A case corrected by surgical removal of the fistula is reported.


Lymphangiographic findings in Behçet's disease with lymphangiectasia of the small intestine. Bipedal lymphography was performed in 5 cases of Behçet's disease. In 4 of 5 cases, histologic examination of intestinal biopsy specimens showed lymphatic dilatation of the small intestine which were considered to be a characteristic finding of intestinal lymphangiectasia, a protein-losing enteropathy, but no patient with Behçet's disease showed reduced concentration of serum total protein as well as abnormal value of 131I-PVP test. Lymphograms showed an increase in number of iliopelvic and lumbar lymphatic vessels as a major finding, but they failed to demonstrate a hypoplasia or aplasia of lymphatic system or obstruction of thoracic duct. It is conceivable that the lymphatic dilatation of the small intestine in Behçet's disease may be related to increased flow of lymph due to excessive vascular hyperpermeability and may not be related to a block of lymphatic system which has been considered to be a cause of enteric protein loss in intestinal lymphangiectasia. The authors wish to emphasize that the dilatation of lymphatic vessel of the small intestine is not a sufficient finding to indicate the presence of protein-losing enteropathy.


Ventricular activity during atrial fibrillation. Studies with His bundle electrography. His bundle electrograms were recorded in 12 patients with atrial fibrillation. In all cases but one, the dominant rhythm was atrial fibrillation. In 1 case the dominant rhythm was fascicular tachycardia due probably to digitalis overdosage. However ventricular, fascicular and junctional beats could be often recognized on His bundle tracings, even when QRS configuration was similar to supraventricular conducted beats due to atrial fibrillation. In the patients in whom sinus rhythm occurred, the H-V interval was unchanged. Although it is admitted that during atrial fibrillation the zone of concealment of A-V conduction is in the A-V nodal area, concealed penetration of atrial impulses in the fascicular system may be encountered in patients not treated with digitalis.


Serum iron, glutamic oxalacetic transaminase and creatine phosphokinase in acute myocardial infarction. A comparative study. The serum iron was subnormal on the first three days, following acute myocardial infarction in thirty patients. This is significantly less than the incidence of abnormalities demonstrated by assays of creatine phosphokinase (CPK) and glutamic oxalacetic transaminase (SGOT) in serum. Occasional patients had abnormal serum iron concentrations in association with normal CPK activities. For this reason serum iron determination may usefully supplement CPK activity measurements and possibly those of SGOT activity as an aid to the detection of acute myocardial infarction.


Surgical treatment of the congenital fistulae of coronary arteries. Six cases of coronary artery fistulae surgically treated are presented. All patient but one was male; the ages varied from 4 to 44 years. The fistulae originated from the left coronary artery in three cases from the right in two cases and from both arteries in one case. The draining heart chambers were the right atrium in three, the right ventricle in two and the pulmonary artery in one case. Associated lesions were present in three cases. One patient died on the early postoperative period and the evolution was satisfactory in five cases.


Venous pressure and compliance of the peripheral capacitance vessels. Compliances of the peripheral capacitance vessels decreased gradually in accordance with the increase in pressure of the brachial vein. The relationship between them formed a number of hyperbolic-like curves, the same results as those found in many cases of both normal subjects and patients with congestive heart failure. The decrease of compliance of the peripheral capacitance vessels was not the result of an organic change, but of a functional change of the vessels caused by distention.


Traumatic lateral sinus thrombosis. Report of two cases. Two cases with thrombosis of the transverse sinus caused by a fracture crossing the sinus are reported, and the roentgenological changes seen in cerebral angiography are discussed. In 1 case, a filling defect was seen which at subsequent autopsy was found to correspond with an intraluminal thrombosis. In the other case, not verified at autopsy, the angiographic changes were consistent with a thrombosis of a transverse sinus.


Compliance of the peripheral capacitance vessels in patients with congestive heart failure. A method for measuring compliance of the peripheral capacitance vessels is reported, and the values of compliance in patients with congestive heart failure are compared with those in normal subjects. Peripheral venous compliance and right brachial venous pressure in both patients with congestive heart failure and in normal subjects, when plotted graphically, showed a relationship described by many hyperbolic curves. The mean value of compliance of the peripheral capacitance vessels in patients with congestive heart failure was only half that in normal subjects. This difference was statistically significant (P less than 0.001). After the congestion in the patients with congestive heart failure disappeared following treatment with digitalis and other drugs, the values of compliance became nearly the same as in normal subjects. It seems that the increase of compliance of the peripheral capacitance vessels is not due to an organic change but to a functional change of the vessels caused by distention.


Effects of diuretics on lipid metabolism in patients with essential hypertension. Available clinical evidence indicates a high prevalence of hyperuricemia in patients with essential hypertension; this becomes accentuated with diuretic therapy. Since there is an association of hyperlipidemia with hyperuricuria and hypertension and since hyperuricemia is a feature of diuretic therapy, we explored whether these relationships might be provoked by prolonged diuretic therapy. Eighteen male patients with uncomplicated essential hypertension of mild severity were treated for 9 months with hydrochlorothiazide and supplemental potassium chloride, 100 mg and 45 mEq/day, respectively. Arterial pressure, renal function, and serum electrolyte, uric acid, blood glucose, and lipid concentrations were measured several times before and during therapy. Arterial pressure remained significantly reduced during therapy (P less than 0.001); this was associated with reduced serum potassium (P less than 0.01) and increased blood glucose and serum uric acid concentrations (P less than 0.005, P less than .025, respectively). Blood urea nitrogen, serum creatinine, sodium, cholesterol and triglyceride levels did not significantly change with treatment. Thus, although diuretics increase serum uric acid and blood glucose, their effect on serum lipid concentration is negligible.


Venous thrombosis in childhood. A case report and review of the literature. Venous thrombosis in childhood is an extremely rare condition. The etiologic factors in childhood are different than in the adult. Generalized infection seems to play the main etiologic role, and for this reason antibiotic treatment is usually necessary. Anticoagulant treatment is mandatory; however its application presents many difficulties. The administration of calcium-heparin subcutaneously for a long time is feasible, well-controlled, without side effects and highly effective. The authors therefore strongly recommended this anticoagulant treatment in childhood.


Sudden death and the floppy mitral valve syndrome. A 38-year-old female with a history of palpitations, premature ventricular contractions, and a systolic murmur collapsed suddenly and died. Post-mortem studies showed shortened chordae tendinae and myxomatous transformation of both mitral leaflets. As this syndrome becomes more clinically recognizable it appears that its benignancy is diminishing. Thus, it is felt that patients with findings of ventricular extrasystoles and a systolic murmur should have a careful cardiac evaluation to determine the presence of the floppy mitral valve or ballooning mitral leaflet syndrome and that appropriate measures for treatment be taken when necessary.


Multiple lead ECG submaximal treadmill exercise tests in angiographically documented coronary heart disease. One hundred patients underwent submaximal exercise tolerance testing and coronary cineangiography. Sixty-six percent of the exercise tests were diagnostic including 48 positive and 18 negative tests; 34 patients had indeterminate test results. The occurrence of exercise induced ventricular premature beats was not related to significant coronary artery disease. Ventricular asynergy was significantly more frequent in patients with positive exercise tests (p less than .0001). Application of the age-adjusted target heart rate criterion recommended from Scandinavia and Myrtle Beach to patients with indeterminate results due to failure to reach target heart rate resulted in six false negative tests and lowered sensitivity. The number of positive diagnostic responses achieved using a multiple electrocardiographic lead system was compared with positive diagnostic responses detected in a single lead (V5) and the number of positive tests identified by the additional leads was highly significant (p less than .0001). A high incidence of indeterminate test results due to failure to achieve target heart rate is noted.


Traumatic arteriovenous fistulas. A follow-up study. Over the period 1958 to 1972 14 patients with traumatic arteriovenous fistulas were treated. The mean period from trauma to surgical closure of the fistula was 13.3 years. No form of reconstructive vascular surgery had been performed initially. The dominating symptom of arteriovenous fistula was a pulsating tumor with a marked thrill. Excision of the fistula and reconstruction of the artery and vein was performed in 11 patients. In 3 patients the fistula was first ligated resulting in early recurrence of the shunt. At follow-up 3-15 years postoperatively all fistulas were closed, but 5 patients had moderate symptoms.


Pattern of occlusive peripheral vascular disease in India. (clinicopathological study of 79 cases). The pattern of peripheral vascular disease in India was studied in 89 patients undergoing amputation for vascular insufficiency. A control group of 26 limbs was studied for aging changes. Clinically, cases were classified into TAO (25), ASO (54) and thrombo-embolic disease (10). Angiographic, macroscopic and microscopic study of dissected vascular tree was done in view of clinical diagnosis. No significant difference was noted in the frequency and extent of involvement of limb arteries in TAO and ASO. Histologically angiitis was noted in 4 cases of TAO and one of ASO but these did not form a distinct clinical group. Primary thrombotic occlusion was seen in 21 cases of TAO and 23 cases of ASO. Atheroma with and without thrombosis was found in 26 cases. In 4 cases the arterial tree was normal. Atheromatous lesions were not seen in control group. In the groups under study they were thought to represent old thrombi rather than degenerative lesions predisposing to thrombosis. In view of these findings it was felt that Buerger's disease was primarily a thrombotic disorder. Angiitis was rare and was probably secondary. The two clinical groups TAO and ASO are not pathologically distinct as very high percentage of the latter showed primary thrombosis. The genesis of thrombosis in two groups however may be different.


Improvement of the flow properties of blood: a new therapeutical approach in occlusive arterial disease. The general pathophysiological basis in occlusive arterial disease is the reduced flow rate of blood in the microcirculation. Blood flow in the ischemic tissue can be increased by improving the flow properties of blood. The fibrinogen concentration of blood and the deformability of red cells are two main factors determining the flow properties of blood. Ancrod, a fibrinogen-lowering substance, improves the flow properties of blood by decreasing the viscosity of blood and plasma and by desaggregation of erythrocyte aggregates. Treatment of patients suffering from severe occlusive arterial diseases with Ancrod exhibits surprisingly good results. Disappearance of rest pains and reduction in the use of analgetic drugs has been proved statistically. In the exercising muscles a local hyperosmolarity exists, which is able to decrease the deformability of red cells thereby impairing the flow in narrow capillaries. The addition of Pentoxifyllin to blood in-vitro reduces the rigidity of red cells in hyperosmolar blood samples by increasing their cellular ATP-content. Thus the reduced flow rate of hyperosmolar blood through 8 mu-capillaries could be increased twice (p less than 0.0005) by the addition of Pentoxifyllin. These in-vitro results could be the starting point of a new idea for the treatment of patients with intermittent claudication.


Phonocephalography extra-cephalic.

Phonocephalography extra-cephalic. Phonocephalography is the amplification and recording of sounds from the surface and cavities of the head aiming for the introduction of a non-invasive pre-angiographic technique. Nasopharyngeal Phonocephalography was found successful for recording of normal tracing. The effect of the extra-cephalic sounds and factors on the tracing were discussed. Phonomyelography is the application of the idea on the vertebral column. The tracing recorded was demonstrated. Modern technology has undergone considerable progress for the introduction of non-invasive techniques in medical diagnosis. Since Laennec introduced his stethoscope auscultation, amplification and recording of sounds in cardiology had reached a respectable diagnostic procedure. This article represents a trial for the introduction of a simple non-invasive pre-angiographic diagnostic technique by amplification and recording of sounds from the surface and cavities of the body.


A clinical approach to hypertension.

A clinical approach to hypertension. 1. A new approach to hypertension is introduced by taking into consideration not only casual blood pressure but also baseline blood pressure, blood pressure lability and cold pressor response. 2. In addition to blood pressure measurements the vascular damage in terms of atherosclerosis and/or retinal arteriosclerosis was also taken into consideration by grouping the patients into four groups: Normal; Arteriosclerosis; Hypertension; Hypertension & superimposed arteriosclerosis. 3. Prior to initiating treatment, at least six casual blood pressures were taken by the technical assistant and the physician, during three different visits. 4. The step method, by starting with thiazides and adding other antihypertensive agents during the subsequent office visits according to response was followed. 5. The patients were followed for a four to seven year period so that a meaningful prognostic and therapeutic evaluation was possible. 6. All patients with pure hypertension and without arteriosclerosis and those with pure arteriosclerosis and without hypertension survived during the period of observation. 7. Twenty-three per cent (12 of 51) of males having hypertension with super-imposed arteriosclerosis died, as compared to only 4% (2 of 54) of females; thus a male to female mortality ratio of about 6:1 was observed. 8. A comparison of the living and deceased males of the mixed group having hypertension and superimposed arteriosclerosis showed that the most significant difference between the two subgroups was a marked exaggeration of diastolic cold pressor response in the deceased as compared to the still living patients. 9. It remains to be seen whether or not in these patients with a marked exaggeration of the diastolic cold pressor response, by using a more vigorous treatment with drugs such as methyldopa, propranolol or guanethidine in relatively high doses, we might be able to reduce mortality and increase survival.


Stabilized venous distensibility of normotensive and hypertensive humans on high and low sodium intake. Venous responses to stabilized orthostasis (45 degrees head-up tilt) were studied in seven normotensive subjects and eight hypertensive patients, when on high and low dietary sodium intake. Exchangeable sodium and blood volumes were determined to permit correlation with any significant changes in venous behavior. The intent of this study was to detect and analyze any diet-induced changes in responses of forearm veins to prolonged orthostasis. The pharmacological effects of sodium depletion by medication and diet on arteries and veins of hypertensives are discussed. The results of this study indicate that dietary sodium depletion did not have adverse effects on the ability to maintain stabilized venous tone during orthostasis. These results support recommendations that moderate dietary sodium restriction be included as part of antihypertensive regimens.


Systolic time intervals and heart sounds in left bundle branch block. Systolic time intervals and heart sounds were studied in twenty patients with left bundle branch block. A definite cause for the organic heart disease was not ascertained. Abnormal duration of the electromechanical systole (Q-A2), due to a prolongation both of the preejection period (PEP) and of the Q-M1 intervals, was found to exist in all. Prolongation of Q-M1 was due to lengthening either of the electromechanical interval (EMI) or of the pre-isovolumetric contraction time (PICT). Isovolumetric contraction time (ICT) was prolonged in thirteen patients only. There was a good correlation between LVET/ICT ratio and the duration of ICT intervals. Six patients showed a first heart sound of normal intensity and duration. There was no correlation between the duration of the systolic time intervals and the characteristics of the first and second heart sounds.


Prolonged atrial standstill.

Prolonged atrial standstill. A 55 year old man with hypertensive cardiovascular disease and uremia was studied. Atrial standstill was confirmed by intracardiac electrocardiography and by inability to stimulate the atria using intraatrial cardiac electrical pacing. Atrial standstill was observed to persist for at least three months in duration. This rare cardiac mechanism disorder of atrial standstill, its characteristics and possible mechanisms are reviewed.


Retrograde catheterization of the pulmonary veins following surgical correction of transposition of the great vessels. Prior to a Mustard repair for transposition of the great vessels, complete physiologic data of the pulmonary bed can be obtained by catheterization of the pulmonary artery with a "J" formed wire, and direct catheterization of the pulmonary veins via an atrial septal defect. Following "physiologic" repair ready access to the pulmonary veins is denied. Evaluation of the pulmonary venous pressure is of great importance, however, in differentiating pulmonary vascular disease from pulmonary hypertension secondary to patch obstruction of pulmonary venous return. This paper describes a technique of catheterization of the pulmonary veins following a Mustard repair for TGV.


Studies of hemorrhage on the optic disc. The general medical and laboratory findings in 60 patients having a sector hemorrhage on the optic disc were compared with the findings in 102 patients with intraocular pressure elevation but without a disc hemorrhage. Of 22 parameters studied, systemic hypertension was the only abnormality which occurred significantly more frequently in the hemorrhage group. A study of the intraocular pressures suggests that hemorrhage may not be related to the level of intraocular pressure. Examinations of 50 patients with systemic hypertension and of 50 patients with cardiac abnormalities revealed no hemorrhage on the optic disc. These factors by themselves may not be responsible for the occurrence of hemorrhages.


The influence of cycle length on the effective and functional refractory period of the human AV node. The influence of atrial cycle length on the effective and functional refractory period of the human AV node and atrium is presented. In general, decrements in atrial cycle lengths resulted in a shortening of the refractory period of the atrium and the functional refractory period of the AV node. The effective refractory period of the AV node was not significantly prolonged. The physiologic significance of the effective and functional refractory periods of the AV node are discussed.


Invasion of the optic nerve by retinoblastoma: a clinicopathological study. We have studied all cases of optic nerve invasion in retinoblastoma seen at the Edward S. Harkness Eye Institute in New York since 1925. Since 1959 optic nerve invasion has been less extensive--suggesting earlier diagnosis and management. Since 1959 there has also been an increase in the number surviving. Survival correlates with the extent of spread to optic nerve, choroid and extrabulbar tissues. Current and future therapy are discussed. The importance of subpial extension of retinoblastoma is noted and its relationship to the mode of therapy is emphasized.


Complications of corticosteroid therapy in presumptive temporal arteritis. Two elderly patients presented with symptoms suggestive of occult temporal arteritis. Both were treated with high doses of corticosteroids although subsequent biopsies of the arteries did not show evidence of arteritis. After 5 months of corticosteroid therapy, the first patient died of Gram-negative bacterial pneumonia and cystitis and disseminated intravascular coagulation. The second patient, six days after the biopsy, died of pneumococcal meningitis which had presumably spread from a focus about the left optic nerve. In the first patient, necropsy studies showed that the loss of vision appeared to be due to arteriosclerosis of the nutrient vessels of the optic nerve while in the second patient, the visual symptoms appeared to be due to a localized optic perineuritis. Corticosteroid therapy in elderly patients carries a high morbidity, as is illustrated by the first case and may mask unsuspected underlying disease processes, as presumably occurred in the second. We discuss the importance of obtaining a biopsy diagnostic of temporal arteritis in order to justify the continuation of corticosteroid therapy and the significance of a negative biopsy.


Sympathetic ophthalmitis. Successful treatment of late cases. Three severe cases of sympathetic ophthalmitis, which presented late for treatment, are described. The response to prolonged treatment with systemic prednisolone was unexpectedly good, occurring as long as 70 days after starting treatment and continuing up to 16 months.


Bacteriology of the socket in patients with prostheses. Fifty-two unilaterally enucleated patients were studied for symptoms, signs, and actual presence of bacteria in the socket and fellow eye. The majority (85%) of asymptomatic sockets were found to have a mixed culture of pathogenic organisms. Sockets had a significantly (P = .001) greater frequency of pathogenic organisms than the fellow eye. Cross contamination does not appear frequently but is a definite possibility. We recommend culture and treatment of the asymptomatic socket before surgery on the remaining eye.


Results after vitrectomy in diabetes.

Results after vitrectomy in diabetes. Eighteen eyes in seventeen patients with diabetic retinopathy were operated on using the vitreous infusion-suction cutter. All had severe loss of vision due to retinal detachment or vitreous hemorrhage, or both. Thirteen eyes had a significant improvement in vision. The surgical management and postoperative problems are described. The results suggest that this technique is useful in selected cases of blindness caused by diabetes.


Optic disc observations in glaucoma.

Optic disc observations in glaucoma. In glaucomatous eyes, contrary to normal eyes, the blind spot size is not correlated with the disc or cup size, and the size of the optic disc, cup and optic rim also varies. The variation in area of the glaucomatous optic disc correlates with variation in area of the optic cup. The rim width and total rim area in glaucomatous eyes are decreased. In glaucoma the upper, lower and nasal rim widths are about the same, whereas the smallest rim width occurs temporally. Thus, clinically cupping in glaucoma eyes need not be vertically oval.


Malignant melanoma arising in a choroidal magnacellular nevus (melanocytoma). A case is presented of a 55-year-old Caucasian male whose right eye was enucleated for a mixed spindle-A and spindle-B malignant melanoma in 1967. The ophthalmoscopic picture, fluorescein angiography, and overlying peculiar orange pigmentation were suggestive of a malignant lesion. Study of serial sections of the entire lesion made possible the histologic reconstruction of the lesion, clinicopathologic correlation of the yellow-orange pigment, and the location of the nevus and mixed spindle-cell melanoma components.


Tumor-associated antibodies in the serum of patients with uveal melanoma. Antibodies reacting with autologous and allogeneic cytoplasmic antigens and with autologous surface membrane antigens of uveal melanoma cells were demonstrated in the serum of three patients with relatively small, histologically-proven malignant melanomas of the choroid. The significance of these findings and planned applications of these investigations with regard to diagnosis, prognosis, and therapy of patients with suspected or proven ocular melanomas are discussed.


Clinical electroretinography by the skin electrode and signal averaged method. Conventional electroretinography requires the application of a ring or contact electrode to the anaesthetized cornea. A simplified method for routine clinical electroretinography is described. Skin electrodes are used, signals are appropriately filtered, amplified, passed to a signal averager and displayed on an oscilloscope. Sixteen sweeps are employed and a wave form similar in appearance and frequency content to that obtained by the corneal electrode method, is obtained. Values for the light and dark adapted eye in normal subjects (pupils undilated), are provided and the findings in the stages of retinitis pigmentosa and in other disease states, are noted.


Adaptation of Jena 5000 photocoagulator to continuous wave laser power source. We describe the modifications made in adapting a Jena 5,000 photocoagulator to a tunable dye laser power source and discuss the principles of the tunable dye laser.


Primary localized conjunctival amyloidosis following strabismus surgery. A 13-year-old white boy developed bilateral polypoid conjunctival masses overlying the lateral rectus muscles six months after surgery for divergent strabismus. Histologic examination confirmed the presence of amyloid in these lesions.


Strabismus fixus divergens and associated craniofacial anomalies. A case of congenital strabismus fixus divergens is described. Other anomalies were vertically oval corneas, high mixed astigmatism, amblyopia, horizontal nystagmus, microcephaly, maxillary hypoplasia, micrognathia, low set large ears, and hyperostosis frontalis interna.


The 21 point vision analysis without a phoropter. This paper offers a sequence of valid tests, objective in nature, to measure the vision performance and provide an appropriate prescription for an individual who is unable to undergo the demands of a 21 point analytical refraction, through a phoropter, due to age, intelligence or communication difficulty.


Analyzing infants vision: evaluating progress. This paper is a further report outlining and analyzing the data from the first 271 infants and toddlers seen at the Infants' Vision Clinic of the Optometric Center of New York during its first two years of operation. The data investigated this paper concerns the evaluation of the progress made by those children who returned to the clinic for continuing visual care.


Clinical application of bell retinoscopy. The procedure of bell retinoscopy is described in detail, including changes in motion, color, and brightness of reflex. The responses are divided into eight categories. Suggestions are included to guide and direct the optometrist in prescribing lenses on the basis of bell retinoscopy.


Children's vision--a 20/20 outlook.

Children's vision--a 20/20 outlook. Twenty years ago, A. M. Skeffington, O.D., talked about the "uniqueness" of optometry which included prevention, remediation and enhancement. Fifteen years ago, Arnold Gesell, M.D., urged optometry to pay attention to the preschool years and to examine and supervise (with optometric expertise) the vision of these children and to learn to identify those children who would present difficulties in learning. At the same time, Darell Boyd Harmon, Ph.D., suggested that optometry "gear up" for an expected avalanche of visually-related learning problems. Optometry did listen and learn, the avalanche is here and developmental optometry has prospered. This paper briefly explores some of the long and short-range benefits of vision therapy.


A multidisciplinary evaluation of the child with a visually related learning disability. It is conceded that not all learning disabilities result from vision or visual perceptual problems. Optometrists are advised to familiarize themselves with techniques employed by other disciplines dealing with learning disabled children. It is suggested that they direct themselves to the myriad of variables involved in the care of the under achieving or non-achieving child so that their own specific techniques will become of greater value to the patient.


Optometric intraprofessional referral of visual dysfunctions. Every optometrist has the professional responsibility to detect visual dysfunctions. If optometrists do not wish to provide vision therapy in their offices they have an obligation to refer. Simple screening tests and guidelines for referral are described.


A training program for elementary school teachers. Optometrist-teacher communications. Communication between optometrists and teachers is critical to optometric involvement in interdisciplinary team approaches to learning disabilities. The classroom teacher may be a prime source of referrals to the general optometrist as well as the vision development specialist. Optometry's contribution to classroom learning cannot be fully realized without sound optometrist-teacher communication. The basic design of a training program to enhance optometrist-teacher communications is presented in this paper. The individual optometrist may modify and supplement the program to suit the special needs of the teachers involved.


Optometric care for a child manifesting qualities of autism. S.G. still manifests many of the behavior characteristics of an autistic child. Optometric vision care was significant in that it did allow S.G. to develop better visual contact, longer periods of meaningful attentiveness, and to establish some rudimentary relationships with situations and people. His visual contact is still quite limited to things and space at relatively close distances. Binocular functioning has markedly improved.


Optometric intervention in the control of juvenile delinquents. We are losing the battle against crime and delinquency and we have to continue to lose so long as we keep developing juvenile delinquents. In order to prevent crime, we have to prevent juvenile delinquency for criminals are not born, they develop from juvenile delinquents. Research studies in Chattanooga, Tennessee, show that the youngsters brought before the juvenile court have many different kinds of problems, but one problem that almost all have, other than the drug scene kid, is that they cannot read adequately. Many high school students are reading at first, second and third grade level; 91 percent to 94 percent of our juvenile delinquents are having reading and learning difficulties in the classroom. Consequently, they are all socially promoted and are facing the sting of failure which leads to truancy and conflict with school authorities. These children go from frustration to frustration and become behavior problems in the classroom. The teachers of the first, second, and third grades know which children are having difficulty with reading and will have possible behavioral problems, possibly becoming juvenile delinquents. This writer believes there are five essential preconditions which contribute to one's becoming a juvenile delinquent. Robert had them all: 1. Lack of proper supervision by the parents is the first precondition which contributes to juvenile delinquency. The family is the first and basic institution for the development of the child's emotional intellectual, moral, spiritual, physical and social behavior. 2. Improper discipline is the second factor. Experience teaches us that permissiveness should be controlled at an early age, and too much discipline is just as bad as too little discipline.(ABSTRACT TRUNCATED AT 250 WORDS)


Optometric manpower resources--1973. Part II. The Optometric Manpower Resources Project, funded under government contract since June of 1971, has completed its 1973 national census of licensed optometric manpower in the United States. The first article in this series of three reported on the distribution of optometrists by census region and the current ratio of practicing optometrists to civilian population. This second article reports on the principal forms of employment of active optometrists, the distribution of number of years in practice and practice size. The data indicate that there has been a shift away from self-employment (88% in 1968, 77% in 1973) into more varied forms of salaried employment, especially among those in practice fewer than ten years. Practice size is shown to peak at between fifteen and twenty-four years in practice with a median of approximately 5,400 patients.


Rotational characteristics of the Warner-Lambert Softcon hydrophilic contact lenses. The rotational characteristics of seven Warner-Lambert Softcon soft hydrophilic contact lenses were monitored on the subject's eye by direct observation and photographically for approximately 30 minutes. Lens parameters which altered the rate and direction of rotation were recorded and evaluated.


Mydriatic effects using low concentrations of phenylephrine hydrochloride. The dose response relationship of different concentrations of phenylephrine with and without prior application of topical anesthetic was measured to determine the minimum concentration which produced maximum mydriasis. As little as 0.125% phenylephrine caused mydriasis in some subjects and maximum mydriasis was achieved with 2%. Concentrations greater than 2% produced very little additional mydriasis. A therapeutically effective dose could be as low as 1% with prior installation of a topical anesthetic.


Waxed windshields are hazardous in the rain. Seven automobiles were washed and waxed at four car washes. Photographic determinations were made of the glare produced by the wet or dry waxed windshield in a headlight beam. When wet, the waxed windshields scattered three times more light than in the normal human eye. The wet wax scattering was 24.8 times higher than when dry. No wax residues should be permitted on windshields and the National Highway Traffic Safety Administration should issue a mandatory windshield cleaning requirement after waxing.


A vision care module within a prototype HMO. The Health Maintenance Organization (HMO) concept is dedicated to the prevention of disease and disability. Organizations incorporating this concept must include vision care if complete service is to be offered. Described in this paper is one such HMO, Group Health Cooperative of Puget Sound, with details of the successful integration of optometric vision care into this medically oriented, multidisciplinary setting.


Paraprofessional utilization in optometry. Issues that surround the use of paraprofessionals in optometry are examined. The experiences and findings from paraprofessional programs in other health disciplines are reviewed as they relate to optometry. Paraprofessional utilization is a significant yet neglected alternative that has the potential of relieving the increasing manpower shortage in optometry. This concept is reviewed in terms of its effects on productivity and quality of care. The viability of this concept has been found to be dependent upon the subjective acceptance of paraprofessionals by the health professional as well as the consumer. Patient attitudes and acceptance are largely determined by the professional's acceptance. Values and beliefs held by the optometrist or some other discipline may manifest themselves as significant barriers to increased utilization of paraoptometric personnel. The socialization process must begin during the years of professional education and early years of clinical experience.


Osmotic edema associated with contact lens adaptation. When associated with the new contact lens patient, corneal edema may stem from quite different physiological bases, e.g. relative anoxia or osmotic imbalance. A quantitative overview of the osmotic origins of epithelial edema is given here.