[Significance of cytological studies for the diagnosis of thyroid malignomas]. The authors employed the needle aspiration biopsy for the morphological diagnosis of thyroid malignancies of 2000 goitres. Only 3 false negative diagnoses out of 120 proved malignant tumours were done. The cytological signs of malignant thyroid cells were in the majority of cases so clear that the malignancy could be recognized without difficulty. None of the changes typical for malignant cells were found in benign euthyroid or hyperthyroid goitres. It was possible not only to recognize a malignant thyroid tumour, but also to judge the grade of its differentiation and to identify certain histological tumour types (Hürthle cell adenoma, papillary carcinoma) according to some special cytological signs. The demonstration of the nucleolar apparatus by means of a simple cytochemical technic proved to be a very useful indicator for the appreciation of the function, growth activity and malignant transformation of thyroid cells.


Anovulation in adult female rats after neonatal intracerebral implantation of oestrogen. Four-day-old female rats were bilaterally implanted with paraffin micropellets containing 0.5% oestradiol benzoate (OB) into the mediobasal hypothalamus or the corticomedial amygdala. Controls received intracerebral paraffin pellets or two s.c. OB-paraffin implants. None of the treatments influenced the date of vaginal opening and vaginal cyclicity at 50 days of age. Permanent vaginal oestrus between 100 and 116 days of age and anovulatory ovaries at autopsy on day 116 were found in rats that had been implanted with OB into the mediobasal hypothalamus, but not in the remaining animals. The findings demonstrate that the delayed anovulatory syndrome can be induced in female rats by the neonatal intrahypothalamic implantation of a very low dose of OB, and that the corticomedial amygdala seems not to be a site of oestrogen action in this sterilizing effect.


Androgen dependent brain differentiation and life span. Intact females without neonatal hormone treatment served as control animals. A second group of female rats received 1.25 mg testosterone propionate subcutaneously on the first day of life causing in these genetic females a male-type brain differentiation. Male rats orchidectomized on the 75th day of life served as male "control" animals, since there was no lack of androgen during the neonatal phase of brain organization. A fourth treatment group consisted of males which had been orchidectomized on the first day of life representing males with female-type differentiated brains. The experimental animals belonging to the Sprague-Dawley-derived strain of our laboratory were kept under standard conditions for food, illumination and temperature.


A single-dose study of mexiletine (Kö 1173). Serum concentrations of mexiletine after a single dose were determined in 8 adult Caucasian males with complex partial seizures who were continuing to receive other antiepileptic drugs. Two patients each received a single dose of either 100, 200, 300, or 400 mg mexiletine. Serum concentrations were determined by two gas chromatographic methods. Serum concentrations ranged up to 795 ng/ml. Peak concentrations occurred 1 to 3 hr after administration of the drug and were significantly different between the 100- and 300-mg, 100- and 400-mg, 200- and 300-mg, and 200- and 400-mg doses. Differences between the other doses were not significant. Serum concentrations declined monoexponentially. Half-life ranged from 2.7 to 7.2 hr. Numerous papers have appeared in the European literature on the use of mexiletine to treat cardiac arrhythmias. Preliminary studies in the United States suggest the use of mexiletine as an adjunct for therapy of epilepsy.


A multiple-dose study of mexiletine (Kö 1173). In preparation for a prospective controlled study of mexiletine in the treatment of epilepsy, a preliminary study of serum concentrations after multiple doses was performed with 8 institutionalized Caucasian adult males with uncontrolled seizures and similar weight, medical regimen, and seizure classification. Two patients each received daily dosages of 200, 400, 600 or 800 mg mexiletine administered in capsules four times a day for 7 days, in addition to their usual medication. Serum concentrations of mexiletine were determined by the Kupferberg-Yonekawa method. After the first day, serum concentrations of mexiletine were significantly higher for the 600 and 800-mg dosages than for the 200- and 400-mg dosages. The differences in serum concentration between the 200- and 400-mg dosages and between the 600- and 800-mg dosages were not significant. Serum concentrations for the 200-mg and 400-mg dosages were generally below 400 ng/ml, whereas at dosages of 600- and 800-mg, serum concentrations ranged from 400 to over 1,100 ng/ml, after the  first day. Optimal dosage for this population appeared to be at least 800 mg/day. Half-life ranged from 3.5 to 7.8 hr.


A method for detecting epileptic seizures. A simple instrument for detecting seizures is described. Vibrations of the bed due to movements of the patient were converted to electrical oscillations by movement of a loudspeaker coil in reversed mode as transducer. To distinguish between normal movements and those caused by a seizure, three criteria were used--the amplitude of the oscillations, the time interval between them, and the duration of a burst of oscillations, each parameter compared with a reference value for each patient.


Effects of unilateral lesion in the midbrain reticular formation on kindled amygdaloid convulsion in cats. Daily stimulation of the amygdala in cats resulted in progressive development of electroclinical seizures culminating in a generalized convulsion (kindling). An electrolytic lesion in the midbrain reticular formation, ipsilateral to the stimulated amygdala, markedly elevated the generalized seizure-triggering threshold and reduced susceptibility to pentylentetrazol challenge. In contrast, globus pallidus lesions had no appreciable effect upon the generalized seizure-triggering threshold and appeared to enhance susceptibility to pentylentetrazol. The results support the hypotheses that (1) the midbrain reticular formation participates significantly in the kindled amygdaloid seizures and (2) the effects of lesions in the midbrain reticular formation do not depend upon the presence of forebrain bisection.


Immunogenetics of the Lennox-Gastaut syndrome: frequency of HL-A antigens and haplotypes in patients and first-degree relatives. Twenty-two patients with the Lennox-Gastaut syndrome and their families were examined for HL-A antigens by the microlymphocytotoxicity test. The antigen HL-A7 belonging to the HL-A locus showed a significantly increased frequency (p less than 0.0005) both in parents and in patients. The same antigen showed a significantly altered segregation in patients but a normal one in healthy siblings. Another antigen of the second HL-A locus, HL-A12, did not display a normal segregation in our patients, in whom it was nearly not represented.


Isolated seizures: an EEG and clinical assessment. A study has been made of 39 patients with isolated fits presenting to an EEG department. Patients were excluded when there was a doubtful history, alcoholism, or drug abuse. The 39 patients were compared with a control group of patients with epilepsy matched for age and sex. No basic difference was found between the two groups. In particular the EEG examination showed similar changes. In conclusion, patients with isolated fits should be assessed in the same way as those with established epilepsy, while recognizing that in the majority of instances no serious underlying cause will be found.


Diphenylhydantoin, phenobarbital, and primidone in saliva, plasma, and cerebrospinal fluid. Diphenylhydantoin, primidone, and phenobarbital were determined in saliva and plasma of 164 patients by gas-liquid chromatography. The saliva ratio was about one-tenth in patients on diphenylhydantoin, 0.32-0.38 on phenobarbital alone and with other drugs, 0.97 and 0.96 on primidone alone and with other drugs. The S/P ratio of phenobarbital was similar in patients treated with primidone alone or with co-medication. For diphenylhydantoin and primidone, the S/P and CSF/plasma ratio were similar; for phenobarbital the S/P ratio was lower due to the difference in pH of saliva and CSF. Thus the concentration in saliva serves as a measure of the nonprotein-bound or free concentration in plasma with the advantage that saliva is easy to obtain. Co-medication does not change the S/P ratio for the three drugs studied. The high correlation between levels in plasma and in saliva allows the plasma levels to be predicted from the concentration in saliva.


Is an application form useful to select patients with epilepsy who may drive? Of 1,268 persons who claimed to have epilepsy and were therefore disqualified for military service, 55% had a driving license 5 years later. Only 58% had applied for a driving license. Of those 14% who had answered truthfully the question "have you had fits, epilepsy etc." in the application form, 63% received a license. Fewer persons with epilepsy had a driving license after about 5 years (55%) than did age-matched controls (73%). The application form is of no use in preventing persons with epilepsy from obtaining a driving license. Adequate instruction of the patient and of his physician is to be preferred to the use of an application form.


Traffic accidents caused by epilepsy.

Traffic accidents caused by epilepsy. During a 10-year period, 203 traffic accidents were suspected of being caused by epilepsy; 155 of them definitely caused by seizures were selected for study. The seizures of 75% were psychomotor; in 12% the seizure was the first, and only 4% of the rest had reported that they had epilepsy when they applied for a license. Traffic accidents due to epilepsy were less serious than the "average accident". They involved another vehicle much less often, and they occurred more often outside rather than inside built-up areas. Accidents caused by epilepsy were rare--1/10,000 in the 10-year period. The characteristic features of the traffic accident due to epilepsy may be due to the "random" occurrence of seizures in traffic, and to the seizure-suppressing effect of increased vigilance in city traffic.


Paradoxical intoxication--a complication of anticonvulsant administration. A new syndrome, paradoxical intoxication, has been defined in which high levels of hydantoins, and in one instance carbamazepine,  produced an increase in seizures with little or no evidence of intoxication; a decrease in these levels produced an improvement in seizure control. This syndrome occurs often but not exclusively in those people who are less astute in assessing their neurologic status and therefore may experience unexpectedly higher blood levels of their anticonvulsants. Instances have been documented with serum levels above 40 mugm/ml for phenytoin or mephenytoin alone, or above 50 mugm/ml of combined hydantoins phenytoin and mephenytoin, and when the level is in the range of 20 mugm/ml and above for carbamazepine. Possible mechanisms underlying the syndrome are reviewed. Appropriate therapy is a reduction of the dose of the drug in question.


Bioavailability of two carbamazepine preparations during chronic administration to epileptic patients. Two preparations of carbamazepine, as tablets and in syrup, were given for 8 weeks to 20 patients with epilepsy in a randomized crossover study. Weekly plasma levels were 3-21 mg/1 on dosages of 5-24 mg/kg/day. There was no difference in absorption or steady-state level between the two preparations. Carbamazepine 10, 11-oxide was constantly present when the level of carbamazepine was over 5 mg/l, and tended to be lower with the syrup.


Levels of free amino acids in serum and cerebrospinal fluid after administration of taurine to epileptic and normal subjects. The modifications associated with taurine treatment of the free amino acid content of serum and cerebrospinal fluid were investigated in epileptic and control subjects. In patients with epilepsy the main findings were, in the serum, the correction toward normal of the amino acid levels that were low prior to therapy, and in the cerebrospinal fluid, the increase up to above-normal levels of glutamic acid, greatly diminished before treatment. Thus taurine, which has an anticonvulsant action appears to partially correct the amino acid imbalance in epileptics. The monitoring of taurine-induced glutamate changes in the cerebrospinal fluid could help to establish the correct therapeutic dose.


Duration and lateralization of febrile convulsions. Etiological factors. The relationships of certain etiological factors (sex, age, family history of febrile convulsions or epilepsy, term, birth weight, prenatal or perinatal anomalies, temperature, cause of fever) to the duration and localization of the first febrile convulsion (FC) were studied in 402 patients. In patients with prolonged seizures (over 30 min), the mean age was younger, the proportion of girls, common infectious diseases of childhood, and immunization was higher and that of respiratory infections lower than in patients with brief convulsions. In patients with unilateral seizures, the proportion of positive family histories and respiratory infections was lower and that of common infectious diseases of childhood and of immunization was higher than in patients with bilateral convulsions. The association of each of these etiological factors with the duration or lateralization of the first FC was independent of the others.


Food for all.

Food for all. Ensuring food for all requires an interdisciplinary approach, an evaluation of all sectors of the economy and the formulation of objectives which include proper nutrition in overall development plans. It is my contention that the introduction of nutrition priorities at this level, complemented with the traditional immediate and short-term measures of food aid, nutrition programmes, health campaigns and nutrition education will do much to alleviate the world's food problems. Priorities must be defined, planning structures strengthened, and politicians convinced that objectives can be reached. Otherwise, meagre resources will continue to give low priority to agriculture and social reform and we will have accomplished little toward our objective of food for all.


A histological survey of pre-excitation syndrome and related arrhythmias. The scanty available data in histology of accessory AV pathways, namely James', Mahaim's and Kent's fibres, together with Paladino's bundle, defects in the fibrous annuli and "Ring tissue", were considered for their bearing on old and new pathophysiological questions about ventricular pre-excitation and complicating tachy-arrhythmias. The histological findings in nine hearts allowed for a realistic and synthetic schematization of all the main types of anomalous AV bypasses, which have been emphasized in discussing the subject. The inadequacy of basic knowledge concerning the anatomoclinical significance of James and Mahaim fibres and "Ring tissue" in ventricular pre-excitation is pointed out, and the importance of Kent bundles in pathogenesis of WPW is confirmed. In a case of supraventricular paroxysmal tachycardia, without pre-excitation, a Kent bundle was demonstrated, which suggests the possible existence of latent forma of WPW with antegrade-blocked AV bypass, underlying reciprocating tachycardias of this kind. New trends in morphological investigation on the AV junction and anatomophysiological bypasses in the area are outlined.


[The prediction of coronary heart disease. A mathimatical model applied to Italian field studies (author's transl)]. The multiple logistic function (MLF) was applied for the estimation of coronary heart disease (CHD) - "hard criteria" in 5 years as a function of several risk factors in two rural Italian areas belonging to the "Seven Countries Study". CHD was estimated with solutions including 4, 5 and 11 factors respectively. Only serum cholesterol showed a statistically significant contribution; but other factors, like age and physical activity, very likely contributed to a better discrimination between "cases" and "non-cases". By increasing the number of factors the discrimination tends to improve anyway. In the solution with 11 factors, 46% of the observed cases was found in the upper 10% of the estimated risk probabilities; 57% in the upper 20%; while no cases were found in the lowest 20% of the same rank probability list. For practical purposes of selecting high risk individuals for preventive action, a simple 5 factor solution, including age, systolic blood pressure, serum cholesterol, consumption of cigarettes and physical activity is suggested.


[Ultrasonic angiocardiography and ultrasonic cineangiography: comparison between two techniques (author's transl)]. In a comparison of the performances of ultrasonic tomography (UT) versus ultrasonic cineangiography (UC), a new technique of cross sectional imaging of the heart using a low resolution (40 lines per frame) real time multiscanner apparatus, was performed. Technical problems related to both techiques are reviewed and discussed. UT seems to deserve consideration when precise anatomical details are required while UC is particularly recommended when function studies are indicated, but mainly if computer facilities are available. Both systems represent a real technical advance on conventional echography.


[Ecographic measurements of some cardiac sarcomere parameters (author's transl)]. The authors report on some measurements of cardiac sarcomere length and rate of contraction with ecocardiographic techniques carried out in man. The mean cardiac fibers' velocity of shortening, also measured ecographically, is connected with sarcomere contraction velocity.


Left heart diastolic extra-sounds. An intracardiac phonocardiographic and hemodynamic study. In 53 patients with either normal hearts or with rheumatic valve disease (predominantly mitral disease), third and fourth heart sounds (S3, S4), were recorded by intracardiac phonocardiography inthe left ventricle, left atrium and/or ascending aorta. The corresponding sounds were recorded externally in less than one half of the cases only. The S3 was mostly present in the ventricle and in cases of volume overload. The S4 was found with about the same incidence in the left atrium and left ventricle, and more often in cases of pressure overload. The incidence of these sounds showed only a minimal correlation with the left ventricular diastolic pressures, while no correlation at all was found between such pressures and the time intervals P-S4 and A2-S3.


[Evolutive study of the VCG in the first week of the normal newborn infant (author's transl)]. The vectorial and morphological variations of the VCG (Frank method) during the first seven days of life of sixteen normal newborn infants were analyzed. A byphasic distribution of the QRS vectors in the horizontal plane was found at birth. Successive observations showed a rising of initial forces of left septal activation and a slight increase of left parietal forces. The T loop variations were more remarkable, being probably correlated with rapid postnatal hemodynamic modifications. After a few days the T loop was oriented posteriorly and to the left, not changing this direction for many year. The P loop did not differ from the adult's in the majority of cases. Sometimes it showed a figure-or-eight rotation in the horizontal plane, probably due, according to the authors, to a different pathway of atrial activation.


[Results of surgical therapy of the partial form of persistent common atrioventricular canal (author's transl)]. 20 patients with partial form of persistent common atrioventricular canal underwent surgery at the Centro di Cardiochirurgia "A. Blalock", University of Turin, between 1969 and 1974. In each case the treatment of lesions took place in the following order: the repair or replacement (one case) of the mitral valve; the closing with a patch of the atrial septal defect; the repair, in one case, of the tricuspid. The most frequent post-operative complications were arrhythmias, which in two cases consisted of a total atrioventricular block. Only one patient died postoperatively for an acute pulmonary oedema following an imperfect mitral valve correction. Six months after surgery, another patient died from bacterial endocarditis. Thirteen of the eighteen surviving patients showed excellent results at the clinical and/or hemodynamic check; two had fair results and three had poor results. In two cases, mitral insufficiency was hemodynamically aggravated, whilst in another five it disappeared. In eight, a slight apex systolic murmor 1-2/6 persisted, which was not correlated with any radiological or electrocardiographical sign of mitral insufficiency (and for three of these, not even a hemodynamic one). The authors consider that the most difficult problem in surgical therapy for these malformations is still the treatment of mitral lesions.


A multicenter double blind clinical trial on 3.4.5-trimethoxybenzoiyl-epsilon-aminocaproic acid (C-3) in acute myocardial infarction. 186 out of 391 patients with acute myocardial infarction were treated with C-3 and 205 with placebo in a multicenter, double-blind clinical trial. Ensuing complications were treated in the same way in both groups. C-3 was injected i.v. slowly at the dose of 2 g statim plus 6 g by continuous drip infusion over 24 hrs for 5 days. During treatment, clinical progress was influenced only in regard to cardiac failure since in the C-3 group the improvement was more significant than in the placebo one (P less than 0.0025). Mortality rates were 8.1% and 11.2% for the C-3 and placebo groups, respectively. The difference in mortality was significant (P less than 0.05) for patients treated with C-3 for more than 24 hours. Mortality in male patients treated with C-3 for more than 12 hours was significantly lower (P less than 0.025). In patients less than 60 years old mortality rate was significantly lower (P less than 0.05) and was more so in patients receiving C-3 for more than 12 hours (P less than 0.025). Mortality due to complications was lower in the C-3 group, with arrhythmias (9.8% vs 14.2%), cardiogenic shock (69.2% vs 75%), and cardiac failure (9% vs 19.4%). Results agree with the hypothesis that C-3 may be effective in acute myocardial infarction by improving the action of traditional antiarrhythmic drugs, and augmenting myocardial contraction energy.


[The influence of pre-load on myocardial contractility indices. Experimental research (author's transl)]. The behaviour by increasing the ventricular volume of several parameters and indices proposed for measuring the cardiac contractility has been determined in isolated guinea pig hearts beating under isometric conditions. Particularly, V max calculated on the total pressure has been compared with the Vmax calculated on the developed pressure. Whilst the later showed to be independent of preload changes, Vmax was calculated on the total pressure, decreased by changing the ventricular volume. Moreover, it showed itself to be independent of pre-load changes. An index proposed recently obtained from the plot (P, P'), as ratio between the positive portion of the area and the developed sistolic pressure wals also demonstrated.


[His electrogram recordings in disturbances of atrio-ventricular conduction in acute ryocardial infarction (author's transl)]. 48 His bundle recordings were performed on 30 patients with acute mycardial infarction and various degrees of atrioventricular block. Studies were undertaken at the time of transvenous pacemaker insertion and/or removal from the right ventricle, without pharmacological or electrical stimulation tests. The connections between site of the infarcted area and localization of the a-v block were investigated, to identify uncommon relations. Several atypical cases were observed: among 12 cases of patients with anterior infarction, 6 had prolonged P-H interval, with prolonged H-V interval in 4 cases, and normal H-V interval in the remaining 2 cases. Among the 18 cases of inferior infarction, 5 had prolonged H-V interval, 2 of which had a normal P-H interval and 3 with prolonged P-H interval. In the latter cases, the identification of a two-step a-v block by His bundle recordings was shown to be important from the clinical and prognostic viewpoint. Nevertheless, it is evident that the His bundle recording is insufficient by itself to provide any evidence of the inner pathogenetical mechanism of these phenomena, and only various hypotheses can be advanced.


[Correlations of the coronary arteriography with clinical data and electrocardigraphy]. The correlation between coronary arteriograms, E.C.G. and clinical data of two thousand patients was studied. In those suffering from angina on effort there was a significant correlation between the intensity and frequency of the anginal pain and the extension of the lesion in one, two or in all three main coronary arteries. In those suffering from angina at rest only one of the coronaires was usually affected. The greatest degree of lesions was found in patients with prolonged and spontaneous crises of anginal pain. In those patients suffering from progressive angina and intermediate coronary syndrome the lesions were spread totwo or all three coronaries. E.C.G. abnormalities were always correlated with significant lesions of the coronary vessels while normal or "atypical" E.C.G. were usually correlated with only slight lesions in these vessels or with normal vessels. In a few cases however angina and myocardial infarction were present in spite of apparently normal coronaries. The reason for this discrepancy is still under investigation: myocardial metabolism and coronary flow abnormalities could in part explain these finding.


[Subaortic membranous stenosis associated with infundibular pulmonary stenosis. Case report (author's transl)]. A case of combined congenital discrete subaortic stenosis and infundibular pulmonic stenosis is described. Clinical, haemodynamic data and surgical results are reported. Only one similar case has been previously described.


The triad secondary R waves, RS-T segment elevation and T waves inversion in right precordial leads: a normal electrocardiographic variant. A bizarre electrocardiogram characterized, in right precordial leads, by the triad, high secondary R waves, marked RS-T segment elevation and deep T waves inversion, was observed in an otherwise normal individual. Its persistence for forteen years and its absence at lower levels than in routine right precordial leads demonstrate its nonpathological origin. The few similar cases reported in the literature are reviewed and theie mechanism is discussed.


[Polygraphical observations on patient carriers of Lillehei-Kaster disc prosthesis (author's transl)]. Polygraphical tracings of 34 carriers with mitral prosthesis and 11 with aortic prosthesis were studied. The most significant observations were: 1) that it is not possible to record the mitralic click of the opening constantly, and that the correlation between the width of mitralic clicks is inferior to that which can be observed in the other types of artificial valve; the time of isovolumetric contraction was likewise inferior; 2) that the correlation between the width of the two aortic clicks is inferior to that observed in the other types of aortic valve; the time of expulsion from the left ventricle is longer, probably in connection with the fact that the moment of recording, the patients had not yet achieved a normal functional capacity.


Nitrogen balance studies on protein-rich food mixtures for preschool children in Egypt. Nitrogen balance measurements were carried out on children aged 5 to 30 months. They were fed diets supplemented by PRFMs or by SMA milk powder as the sole source of dietary protein. Sesamena (or SLW-II) was fed to a group of 8 children, Arabeana to another group of 9 and Supramine to a third group of 8 children. The measurements were reported on the same children when they were given SMA milk powder as a reference protein. Therefore, each subject acted as his own control. The technique used was that of Fomon et al(23) with certain modifications. All three mixtures could maintain the children in positive nitrogen balance. Sesamena gave the best mean NPU value (69 +/- 5.9) which is 96% of reference. Supramine gave the highest mean digestibility (87 +/- 6.8) which is 102% of reference. Sesamena proved to be a suitable weaning food satisfying all the standards of PRFMs recommended by the PAG(14,15). It contains a good quality protein, cheap and can be easily prepared at the family level after appropriate education of mothers. This mixture can be also manufactured at the national level.


Clinically diagnosed poliomyelitis in a presumably vaccinated population. Vaccination against poliomyelitis has been compulsory all over Egypt since 1968. Therefore, it is presumed that all infants and children below six years have already been vaccinated. This study is planned to estimate the magnitude of paralytic poliomyelitis in Egypt after six years compulsory vaccination. The cases studied were investigated with regard to socioeconomic status and history and place of vaccination, association of vomiting and diarrhoea or breast feeding within two hours of vaccination, and blood grouping. These results were compared with those of a control group of non-paralytic cases chosen at random from patients who visited the same hospital. Samples of the vaccine were collected from different centres in which children received vaccination and were titrated to estimate their potency at Agouza Laboratories for Vaccines and Sera. The results revealed that still we have a high incidence of poliomyelitis viz : 985/100,000 out-patients, also males are more affected than females with sex ratio 3:2. Of the paralytic cases 22% had proper vaccination while improper vaccination was found in 78%. There was predominance of blood group O among the paralytic cases. The detailed results and discussion of paralytic cases compared to the control has been also fulfilled. Tiltration of the vaccine revealed a lower than the accepted standard indicating altered potency.


Study of the pattern of Widal test in infants and children. III. Effect of T.A.B., diphtheria tetanus, pertussis and measles vaccinations on the level of enteric fever agglutinins. Widal test was done before and 15 days after the last dose of T.A.B. (33 Children) Diphtheria (13) Tetanus (16), Pertussis (7) and Measles (7) vaccinations. The tremendous rise of Widal agglutinin titers after T.A.B. vaccination could not foul up the results of the Widal test if we follow closely the suggested diagnostic Widal criterion combining a titer of 1/80 or more for "O" and 1/60 or more for one"H" agglutinin with the other "H" agglutinins at a lower titer.


Improved feeding patterns in the prevention of childhood malnutrition. In this study simple assessment of the nutritional status and evaluation of the dietary economic and social conditions were done for a sample of urban and rural infants and young children. Home-made diets, supplying the recommended dietary allowances for proteins and calories were suggested. These diets cost the same amount of money, originally spent on foods for the baby. A follow-up study for three months showed that babies reached growth standards better than the original for the same group at similar ages.


The cat as a possible source of Toxoplasma infection for man. The authors examined 1,027 persons divided into two groups by means of the toxoplasmin skin test. Group I contained 472 persons who owned domestic cats. Of these 255, i.e. 54.0% gave a positive reaction. Group II consisted of 555 persons who did not own cats. Of these 237, i.e. 42.7% reacted positively. A statistically significant difference at the 1% level of significance was assessed between the two groups. A difference of highest diagnostic importance was found in persons of unexposed occupations in the lowest age group, 14-19 years: 39.5% positive reactions among cat owners and 16.1% among those who did not own cats. The results support the assumption on the role played by domestic cats in the epidemiology of toxoplasmosis. An analysis of the ethology of the cat as regards its importance in the spread of Toxoplasma infection is the subject of the present study.


Histochemistry of the parenchyma of Cysticercus bovis. The contents of mucosubstances, proteins and lipids, and the activity of several enzymes were studied in the parenchyma of the bladder wall and the invaginated portion of Cysticercus bovis aged 108 days. The parenchyma of both parts contained a large amount of glycogen and minute bodies with a high activity of acid phosphatase and non-specific esterase. By contrast to older larvae, the young larvae contained a minute amount of hydrophobic lipids. The rostellum was developed and similar to the suckers contained glycogen.


The effect of immunosuppressants on experimental infection with Fasciola hepatica. Results are presented on the effect of immunosuppressive substances such as chlorambucil, cyclophosphamide, azathioprine, amethopterine and a cortizone derivate of betamethasone, on the development of Fasciola hepatica in the rat. The suppression of the immune response of the host to immunosuppressants was reflected in an earlier start of migration of the flukes to the common bile duct, and in an earlier onset of egg production as compared with that in the controls. Of the substances employed, cyclophosphamide and betamethasone were the most effective ones within the period from week 2--6 p.i., which is the time during which the migration of the flukes in the liver parenchyma is highest. Pathological changes in the liver of the animals were less marked than those of the infected controls. Evidence was obtained on an increased pathogenicity of infective larval flukes causing a higher mortality of the hosts in comparison with that of the control animals. On the other hand, the administration of immunosuppressants did neither influence the total number of developed flukes nor the appearance of eosinophilia in the peripheral blood of the treated animals.


Redescription of two species of the genus Gyrodactylus Nordmann, 1832 (Monogenoidea) from Misgurnus anguillicaudatus. A redescription is given of Gyrodactylus macracanthus Hukuda, 1940 and G. micracanthus Hukuda, 1940. G. paralatus Gussev, 1955 was placed in synonymy with the species G. macracanthus. Specimens determined by Ergens and Dulmaa (1968) to be G. paralatus are considered to be identical to G. micracanthus.


Two myobiid mites (Myobiidae: Trombidiformes) from the Great Himalaya Mountains). In the region of the Barun Glacier, in the vicinity of the Makalu Mountain in the Great Himalaya (Nepal) two mite species of the family Myobiidae, Protomyobia kounickyi sp. n. and Radfordia lemnina (C. L. Koch, 1841) were found on Soriculus caudatus soluensis (Gruber) and Alticola roylei (Gray) respectively at high altitudes (3450--4900 m). A single specimen of the latter species slightly differs from specimens from the typical host, Clethrionomys glareolus (Schreber), in a greater length of l4 and d5 and in the form of coxal setae I, but it is not regarded as a different taxon.


Rhadinopsylla (Actenophthalmus) mesoides Smit, 1957 (Siphonaptera, Hystrichopsyllidae) in Czechoslovak western Carpathians. A series of 50 specimens of Rhadinopsylla mesoides was found among fleas of small rodents in the western Carpathians. According to variability of some characters in Rh. mesoides from the High Tatras the authors consider the subspecies Rhadinopsylla mesoides skuratowiczi Bartkowska, 1972 to be a synonym of Rhadinopsylla mesoides Smit, 1957.


[Children of foreign workers form the viewpoint of medical practice]. Medical practitioners in Duisberg, Velbert, Wuppertal and Düsseldorf were requested to give information on special health problems in children of foreign laborers. The majority of the medical practitioners reported no differences between the health problems in children of foreign laborers and those of German children. However, many reported that malnutritional and catarrhal diseases occur more often and neurotic disturbances less often in the foreign children. The higher incidence of illness in the foreign children can probably be reduced to some extent by informing the foreign parents about the suitable nutrition of small children and of appropriate clothing in Germany.


[Vesicorenal reflux. Morphological diagnosis and indications for anti-reflux plasty]. The importance of reflux-pyelonephritis in children and adults is discussed. Important leading-symptoms are the incontinence after the age of four besides the cystoureteritis, which is resistant to all kinds of therapy. Following the discussion of the etiopathogenesis of the reflux and its consequences, the symptomatic of the reflux is described in detail and a diagnostic program is given. Extended urological diagnosis includes intravenous urography with preceeding x-ray-examination, reflux cystogram and cystourethrogram during urination. An essential emprovement of these diagnostic measures for the recording of the vesicoureteral reflux is the recording by the 100-mm-cutfilm-camera. Indications for surgical measures and the operative proceeding are discussed.


[Maternal mortality in cesarean section as compared to vaginal delivery]. Caesarean section-rates of more than 10% in our days are not seldom; the reasons are the changed and enlarged indications for Caesarean section. The increase of the Caesarean section-frequency is parallel to the decrease of maternal mortality. The authors' investigations came to the same results. From 1963-1974 they examined 29534 deliveries (28184 spontaneous deliveries and 1350 Caesarean sections). In the examined years the Caesarean section-frequency increased from 3.6% to 5.7%. The maternal mortality of all deliveries was 5.47% (14 from 29534);the maternal mortality of the spontaneous vaginal deliveries was 0.14% (4 from 28184), in the Caesarean sections the maternal mortality was 7.41% (10 from 1350). The different causes of exitus in Caesarean section are discussed. Even "adjusted statistics" show that maternal mortality in Caesarean section is until today 10 to 15 times as high as in vaginal deliveries. Therefore Caesarean section means a ten times higher risk than a spontaneous delivery. For these reasons Caesarean section should not develop to the delivery's "method of choice" and we should keep our intentions also in future to the vaginal methods of delivery.


[Eclampsia. Incidence and therapy, results of the University Gynecological Clinic Göttingen]. The occurrence of eclampsia in the last two decades in the women's hospital of the University of Goettingen was evaluated. In a total of 32,578 birth  there was an incidence of 0.11%. Maternal mortality was 16.2%, perinatal mortality 19.5%. 73% of the patients were primiparae, 24.3% unmarried pregnant women. A regression of the frequency of eclampsia is seen within the last 20 years and certainly due to the intensive antenatal care.


[Fulminant hepatitis. Complications and therapeutic possibilities]. Clinic and histologic characteristics in fulminant hepatitis are pointed out, participation of other organs is reported. Coma, bleeding and renal failure are complications and often are followed by death. Conservative treatment prophylacting complications is described. Newer methods in treatment of coma are exchange-transfusion, liver-perfusion and -grafting. They showed success in some cases. Success, however is less due to the method than to ability of regeneration of the remaining liver tissue. Despite the newer methods of treatment the rate of mortality is yet 80 to 90%.


[Surgical manegement of breast cancer].

[Surgical manegement of breast cancer]. A survey of common operative methods in carcinoma of the breast is given. The own procedure in localized and generalized stages of the disease is presented. Simple mastectomy plus axillary dissection has according to our experience proven to be the method of choice.


[Total reform of the Food Act. Health-related aspects]. Consumer-protection will be made stronger through reform of the laws concerning sale of such commodities as food, cosmetics and tobacco, which can be damaging to health. Important new developments have already been introduced in the areas of residue-control, additives, declared contents and advertisements, including those concerning the claimed benefits of healthfoods. There have been alterations in penalties for contraventions of these laws. If this reform is to make a positive contribution to the field of health protection then a more direct co-ordination with legislation concerning the environment is necessary.


[Effects of water with a low mineral content on serum electrolytes and blood pressure]. The effects of low-mineral content water (Adelholzener Primus-Quelle) in 62 patients were studied of which 14 were hypertonic. Changes of blood sodium, potassium, chloride and bicarbonate were not observed in either group. In the hypertonic patients, blood pressure decreased from a mean systolic value of 168 to 140 mmHg and mean distolic pressure from 105 to 88 mmHg. Observations to date suggest the following indications for a low-mineral content water diet: 1. hypertension, 2. renal insufficiency in stages of compensated and decompensated retention, especially in cases with high serum potassium levels, 3. in the initial therapy of diabetes, gout and obesity; patients with a high water demand should be treated with low-mineral content water until the optimal intake of electrolytes is established.


Blood group, serum protein and red cell enzyme polymorphisms in a population from the Seychelle Islands. 161 inhabitants of the Seychelle Islands have been examined for blood group, serum protein, and red cell enzyme polymorphisms. The gene frequency data obtained from this survey supports the anthropological view that the present-day Creole-speaking inhabitants of the Seychelle Islands result from a admixture of African and European stock.


Genetic variation in Nigeria. I. The genetics of phenylthiourea tasting ability. Phenylthiourea (PTC) taste sensitivity thresholds have been measured for 2,013 Nigerians using a modified sorting technique. The frequency of non-tasters was observed to be 12.5% and the t gene frequency was 0.354. There was a significant difference between the sexes at the 0.01 level for the overall population. However, when the data are analyzed according to the geographical origin of the subject, the sex difference is found only in one of three geographical regions. Also, there may be geographical influences on PTC taste sensitivity, although this was not statistically significant. The estimates reported in this population differ considerably from some of the previously published estimates for black populations.


Immunoglobulin Allotypes of European Populations. I. Gm and Km(Inv) allotypic markers in Hungarians. The distribution of G1m(f, z, a, and x), G3m(b0, b1, b3, c3, c5, g, s, and t) and Km(1) (formerly Inv[1]) allotypic markers have been examined in 184 Hungarians. The results indicate that the frequency of the immunoglobulin haplotypes Gmza;g, Gmzax;g, Gmf;b and Km1 is similar to the frequencies observed in surrounding populations. In addition, Hungarians were found to be polymorphic for the Oriental haplotype Gmza;bst, and had low frequencies of other uncommon haplotypes. Our data indicate that about 5% of the Hungarian genome is of Oriental origin.


Polymorphism of esterase D in some population groups in Japan. Electrophoretic types of red cell esterase D (Es D) have been determined in more than 1,000 blood samples from Tokyo. The allele frequency for Es D2 was found to be 0.342. Typing was also carried out in samples of the Ainu of Hokkaido and of the Ryukyuans of the Okinawa Island: the Es D2 frequencies were found to be 0.273 and 0.369, respectively. These values are considerably higher than those described in Europeans, Negroes and even in Asiatic Indians. The results indicate that Es D with a marked degree of heterogeneity is a valuable marker for genetic, anthropological and forensic application in Mongoloid groups.


Immunoglobulin allotypes of European populations. II.Gm, Am and Km(Inv) allotypic markers in Czechoslovakians. The distribution of G1m(f,z,a, and x), G2m(n), G3m(b0, b1, b3, b5, c3, c5, g, s, t, and v), A2m(1 and 2) and Km(1) (formerly Inv[1]) allotypic determinants has been examined in a series of Czechoslovakian blood donors. The results indicate that Gmza;-;gvA2m1, Gmzax;-;gvA2m1, Gmf;n;bvA2m1 and Gmf;-;bvA2m1 are present in polymorphic frequencies. Further, 9 idiomorphic phenotypes were observed; however, without family data it was not possible to exactly define the majority of these. The observed frequencies of Gmza;g, Gmzax;g and Gmf;b and Km1 are similar to those observed previously in Czechoslovakians and similar to those observed in adjacent populations, though different from those observed in Western Europeans, primarily due to a higher frequency of Gmf;b in Czechoslovakians.


C'3 polymorphism of human complement in North-East England. The C'3 polymorphism of human complement was investigated in a sample of 268 unrelated individuals in North-East England. The two common genes were comparable in frequency with other European populations investigated so far. Two individuals were found to have rare variant C'3 types.


Red cell glutamate-pyruvate transaminase gene frequencies in Gambia, West Africa. The red cell GPT phenotypes have been determined in two village populations in Gambia, West Africa. A total of 887 people have been investigated. The results confirm the previous observations that the frequency of the GPT gene is far higher in African populations than Caucasian populations.


Anterior chamber of the eye. A genetic and anthropological study in Greenland Eskimos. During a population survey in Eskimos family resemblance with respect to anterior chamber depth (ACD) was studied. Heritability estimates of about 0.7 against a marital correlation of zero were obtained. No correlation between ACD and parity, but a significant correlation with stature was found which possibly accounts for the sex difference in ACD. Significant associations between ACD, iris colour, facial appearance, and corneal diameter were observed. West Greenlanders with a predominantly Eskimoan physiognomy showed smaller anterior chambers than unmixed East Greenland Eskimos and Eskimo-Caucasian hybrids.


Inhibitory effect of progesterone on the phytohaemagglutinin- induced transformation of human peripheral lymphocytes. Effect of sex steroids, progesterone and estradiol-17beta, on transformation of human lymphocytes induced by PHA was investigated. Responses of peripheral lymphocytes from non-pregnant women to PHA was markedly reduced in the presence of progesterone at a concentration of 10(3) or 10(4) ng/ml. Estradiol-17beta, on the other hand, had no effects on the PHA-induced transformation under the present experimental conditions. The immunosuppressive property of progesterone may contribute to depression of maternal cell-mediated immunity against fetus during pregnancy.


Central component of the cario-accelerator action of angiotensin II in dogs. Injection of angiotensin II into a lateral cerebral ventricle (I.C.V.) or into a peripheral vein of anaesthetized dog elicited a rise in blood pressure and transient bradycardia followed by sustained tachycardia. Spinal transection at C2 and bilateral vagotomy abolished the central cardiovascular effect of I.C.V. angiotensin. However, in spinal transected dogs the usual pressor response to intravenous angiotensin was observed. Since the transient bradycardia was absent in bilaterally vagotomized dogs or in dogs with their blood pressure stabilized by means of a mechanical buffer devise it must be reflex in origin. The tachycardia was more marked in vagotomized dogs. Prior administration of a beta adrenergic receptor blocking agent propranolol, blocked the tachycardia, but the pressor response was unaffected. The cardiovascular responses to centrally administered angiotensin were practically abolished by prior treatment of dogs with reserpine or by extirpation of both adrenal glands. Thus it may be concluded that ICV angiotensin induces a centrogenic release of catecholamines from the adrenal medulla which is responsible for the cardiovascular responses.


Cardiac acceleration by angiotensin II in dogs. The effect of angiotensin II on heart rate of dogs were studied by intravenous and intracerebroventricular routes. Following differences were noticeable when the results obtained with intracerebroventricular were compared with those obtained after intravenous administration. The onset of tachycardia was less as compared to the intravenously administered angiotensin. The dogs required to produce tachycardia was less and the magnitude of tachycardia was also greater with intracerebroventricular administration. The initial bradycardia observed with intracerebroventricular or intravenous administration of angiotensin, could be prevented by using the mechanical buffering device. The spinal cord transection at C2 level and bilateral vagotomy abolished the tachycardia. It is speculated that angiotensin acts centrally either  on the hypothalamic or medullary accelerator neurones (central sympathetic structures) and produces some degree of increased adrenegic neuron discharge which is responsible for cardiac acceleratin in dogs.


Effects of Co60 gamma radiations on the conduction properties of frog sciatic nerves. The effect of Co60 gamma radiations on the amplitude, detection period and duration of the action potential of sciatic nerves of Rana Tigrina frogs have been studied. Dose levels of up to 120 KR were employed. Irradiation of the nerves with dose levels upto 30 KR does not seem to affect the action potential profiles. The amplitude falls rapidly therafter, registering less than 5% of the orginal value after irradiation by a dose of 120 KR. Qualitatively similar behaviour is seen in the case of detection period and duration of action potential. These results are examined in the light of the authors' data (11) on the effect of Co60 gamma rays on the enzyme acethlcholinesterase (AchE). Portions of this paper have already been communicated (12).


Study of urinary volume and creatinine excretion in women medical students. The urine volume per 24 hours is much lower than that reported in literature and therefore, it is necessary to establish Indian base lines. The experiments have been done under three different weather conditions, the results suggest an extent of allowance to be made for interpreting the results of concentration of substances in urine. The daily creatinine excretion was much lower than that reported in Western literature. This may be of value when creatinine excretion is being used as a check for completeness of 24 hours urine volume in Indians.


Thrombccytopenia related to the severity of alcoholism. Platelet counts of 42 alcoholics studied showed that 88% of them had thrombocytopenia. This hematological response to ethanol was dose related. Liver function assessed by biochemical tests showed no liver parenchymal damage and hence could not explain the thrombocytopenia. It has been suggested that this effect may result from a direct effect of ethanol on bone marrow from shortened platelet survival or their sequestration.


A simple method for continuous recording of perfusion rate of blood vessels of frog. A method for continuous registration of perfusion rate of frog blood vessels has been developed utilizing a modified Marey's tambour with lever system, connected to the perfusion bottle. The responses of frong blood vessels to some autonomic drugs have  been studied using this method.


Acid inhibiton in insulin test- a preliminary report. The initial suppression of acid secretion in Insulin Test has been a subject of various interpretaitons. A study of hypothalamic recordings in a patient undergoing sedative neurosurgery for behaviour disorders revealed marked suppression of electrical activity in the lateral hypothalamic nucleus within three minutes after the injection of insulin, followed later by spike formation corresponding to parasympathetic stimulation, when hypoglycaemia is established. It appears that the initial suppression of acid secretion is due to a direct action of insulin, suppressing electrical activities of lateral nucleus, the spike formation occurring later, corresponding to onset of hypoglycaemia with stimulation of the nucleus and consequently gastric secretion.


Hypoglycaemic effects of onion, Allium cepa Linn. on diabetes mellitus - a preliminary report. Hypoglycaemic fractions of A. cepa Linn (onion) have been separated. After 7 days treatment, the more active hypoglycaemic fraction was about half as active as Phenformin in lowering the fasting blood sugar of alloxan-diabetic rabbits. Oral administration of the hypoglycaemic fraction to alloxan-diabetic rabbits improved their glucose tolerance also. Juice expressed residue of onion, when fed to diabetic patients along with their food, controlled the hyperglycaemia effectively.


Treatment with sisomicin of complicated urinary tract infections in patients with varying degrees of renal function impairment, pharmacokinetics and dosage adjustment. The efficacy, tolerance and pharmacokinetics of the new aminoglycoside antibiotic sisomicin, have been studied in 29 elderly male patients with varying degrees of renal function impairment and suffering from complicated urinary tract infections. The antibiotic was equally effective in patients with normal and impaired renal function and a cure (negative urine culture at one week follow-up) of 56% was obtained. There was little apparent toxicity with the dosage regimens used, although serum creatinine values were statistically but not clinically significantly increased in some patients following treatment. Serum half-lives of sisomicin were prolonged in cases of impaired renal function but accumulation of antibiotic could be prevented by varying dosing intervals between 8 and 24 hours based on serum creatinine values. There was good correlation between serum creatinine and sisomicin serum half-life values and a practical method is described for dose adjustment based on the relationship between serum half-lives and serum creatinine concentrations.


[Electrocardiogram changes in purulent pericarditis. Report on 21 cases]. The electrocardiograms of 18 out of 21 patients hospitalized between 1964 and 1972 with purulent pericarditis presented significant changes. With the exception of three cases of primary isolated pericarditis, most of the patients presented with septicemia. Staphylococcus aureus was the predominant pathogen in 16 cases. Classical electrocardiographic evolution in four phases was recorded in six cases. Draining of the pericardial effusion in the patients without pleurisy was followed by low-voltage amelioration in half of the cases. The duration of the electrocardiographic changes was shorter in patients who underwent intrapericardial treatment. One quarter of the patients suffering from myopericarditis with conduction disturbances--Block AV 1, 2 and Wenckebach's periods--had a worse prognosis.


Hypoglycaemic action of bengalenoside, a glucoside isolated from Ficus bengalensis Linn, in normal and alloxan diabetic rabbits. A comparative study of the hypoglycaemic action of the ethabolic extract of the bark of Ficus bengalensis and a glucoside isolated from it has been made with tolbutamide, both in normal and alloxan diabetic rabbits. The glucoside is more active than the crude extract and it is half as potent as tolbutamide.


Experimental and clinical studies of 5-fluorocytosine activity in candida ocular infections, II. The effect of 5-fluorocytosine in treating experimental candida infection in rabbits' eyes. Mild and severe experimental ocular infections in rabbits' eyes were induced by inoculation of Candida albicans with or without addition of dexamycin drops. These rabbits were treated with 5-Fluorocytosine, topically, orally and in a combined topical and oral manner. The topical treatment was effective only in mild infections. Severe infections responded to oral and especially to combined oral-tropical treatment.


Pyonephrosis due to salmonella cholerae-suis variant kunzendorf. A patient with unilateral infection of the kidney due to Salm. cholerase-suis is presented. Long-term treatment with ampicillin was of no avail. Nephrectomy terminated the infection. The extirpated kidney showed severe obstruction, stones and tissue damage.


Diagnosis and importance of asymptomatic bacteriuria in adults. There are now laboratory means of screening and identifying people who, although they are free from the signs of urinary tract infection, fit into abnormal groups owing to the high numbers of bacteria and leukocytes in their urine. Chronic bacteriuria and pathologic pyuria, with or without symptoms, have important physiologic and pathologic consequences. It is the physicians opportunity to recognize and treat these asymptomatic as well as symtomatic urinary tract infections. If untreated and uncorrected the result, with progressive frequency over a period of 10-15 years, is increased morbidity, especially with pregnancies, structural damage to the kidneys, kidney stones, uremia, hypertension, and premature death.


Studies with trimipramine on isolated kitten atria. The effect of different doses of trimipramine has been studied on the force of contraction of isolated kitten atria. Trimipramine produced dose dependent increase in the force of contraction of the atria. Pretreatment of kitten with reserpine or of the isolated atria with propranolol inhibited the positive inotropic effect of trimpramine. The positive inotropic action of trimipramine is probably due to the release and /or due to blocking the uptake of spontaneously released noradrenaline. Trimipramine was also found to potentiate the positive inotropic action of noradrenaline. This potentiation not only decreased in relation to the time of exposure of the isolated atria to trimipramine but also the action of noradrenaline was antagonised.


Determination of the inner surface of macroporous ion exchange resins. Study on macroporours IX resins and the pore structure. In addition to ion exchange reactions, macroporous ion exchange resins also show adsorptive properties which are due to the large pores of the resin beads and to the inner surface inside the beads. To measure this surface and the pore radii requires very precise fixation of the condition existing prior to the drying of the water-moist resin beads. Such stabilizing fixation can be achieved by displacing the regain water by isopropyl alcohol and subsequent drying for measuring the pore data.


Pore flow models and their applicability. Pore flow models are classified and concisely reviewed, and it is shown that despite their apparent differences, they are equivalent. It is proven that the difference between the classic formula of Guerout-Elford-Ferry and the most recent ones developed by Pappenheimer-Ussing and Kedem-Katchalsky, is due to the introduction of a more proper viscosity coefficient for the water inside the membranes in the newer formulae. Fundamental assumptions involved in the models are restated and criteria for their applicability are mentioned. Arguments regarding the fundamental validity of the pore size formulae when applied to tight membranes, where continum hydrodynamics become questionable, are reviewed. Recent theoretical analysis of the situtation by Mikulecky, where he shows the calculated pore size merely reflects the extent of the membrane-water interaction is briefly presented. It is argued that since his analysis neglects the influence of the membrane-water interaction on the viscosity coefficient, his treatment is far from conclusive. In support of this argument, the results of the Kinetic studies of Levitt based on direct simulation through molecular dynamics is presented where water molecules (considered as non-interacting hard spheres of 1A radius) are observed in a rigid cylindrical pores of 3.2A in radius and 11A long. The pore size, calculated following the procedures of pore flow models, is in good agreement with the physical size of the simulated pore. It is then concluded that the fundamental validity of the pore flow models in the case of tight membranes is yet unsettled, theoretically, but empirically its validity seems confirmed in some instances.


Urinary fructose excretion in health after fructose test. Urinary excretion of fructose during three hours following the ingestion of 100 g of hydrolysed sucrose (in 200 ml) was studied in 85 normal men. This solution was better tolerated than a solution of 50 g of pure fructose and gave higher urinary excretion of fructose than with 100 g of unhydrolysed sucrose. The mean fructose excretion was 54.0 mg (S.D. 40.6 MG). The majority of subjects (63) excreted between 1 and 75 mg and the highest value was 187mg. This suggests a relatively inexpensive method for assessing the existence of porta-systemic shunts beyond normal.


On the properties of solid and liquid ion exchangers. II. Infrared and NMR studies of lithium and cesium salts of dinonylnaphtalene sulfonic acid in heptane. Infrared and NMR measurements on solutions of lithium and cesium dinonylnaphtalene sulfonates (DNNS-salts) in heptane show that the state of water in these systems is in several respects similar to its state in solid ion exchange resins and in some respects also similar to that in ordinary water. The two cations differ in their interaction with the sulfonic acid group at low water contents, the interaction being stronger for Li+. Spin-lattice relaxation measurements on LiDNNS show that the state of lithium both in DNNS and in solid resins is quite different from that of lithium salts in aqueous solutions of the corresponding concentration.


Pattern recognition in severe displacement of the thalamostriate and internal cerebral veins: the W and infinity signs. Severe displacement of the thalamostriate and internal cerebral veins from the midline results in an unfamiliar distortion of these vessels arteriographically. Depending on the side of the mass effect, the thalamostriate-internal cerebral vein complex will have either an infinity (infinity) or a W configuration. Because these configurations appear frequently, recognition and understanding of them aid in the interpretation of cerebral arteriograms.


The hypertelorism-hypospadias syndrome.

The hypertelorism-hypospadias syndrome. Recently, an association between telecanthus and/or hypertelorism and hypospadias has been reported in several families. We describe six more families in whom we have found this association. Seven of the eight affected individuals were males. The other was a girl with hypertelorism and a minor urethral abnormality. The mothers in all six families had hypertelorism and/or telecanthus. Mental retardation and cleft palate were also common in our families and those reported previously. The radiologic findings in our first family, which was reported elsewhere as the "branchio-skeletal-genital syndrome," are considered in detail and include skull abnormalities, maxillary hypoplasia, dentigerous cysts and vertebral abnormalities.


Skeletal metastases from retinoblastoma. Four patients with skeletal metastases from retinoblastomas are presented. Radiologically, the metastases showed periosteal new bone formation and permeative-type bone destruction, particularly involving the long bones of the extremities, and they tended to be bilateral. The metastases resembled those of neuroblastoma and, to a lesser extent, medulloblastoma. The relationship between these three tumors is discussed.


The interphalangeal joint of the great toe in rheumatoid arthritis. The radiographic abnormalities of the interphalangeal joint of the great toe in 50 patients with rheumatoid arthritis were compared with those in 14 patients with psoriatic arthritis. Alterations were seen in 50% of the rheumatoid joints. Characteristic superficial erosions along the medial aspect of the proximal and distal phalanges, with little change in the joint space, differed from more widespread and extensive destruction of this joint in psoriasis. In addition, periosteal proliferation, bony ankylosis and tuft resorption, frequently noted in psoriatic arthritis, were unusual in rheumatoid disease. An anatomic investigation of the interphalangeal joint of the great toe explains the sites of marginal erosions in rheumatoid arthritis. Although selective involvement of this articulation occurs in psoriatic arthritis and Reiter's syndrome, it is the radiographic pattern of articular abnormality which allows their differentiation from rheumatoid arthritis.


Blunt trauma to the main hepatic artery. Two patients are presented who sustained common hepatic artery injuries secondary to blunt trauma. One patient had a laceration and thrombosis of the proximal hepatic artery while the second patient developed a false aneurysm with dissection which necessitated ligation of the hepatic artery.


Radiographic appearances following the Thal procedure. The Thal procedure for repair of distal esophageal stricture is described briefly and the radiographic appearance is ilustrated. The radiologist should be aware of the procedure to avoid confusing the post-operative appearance with a para-esophageal hiatus hernia or diaphragmatic eventration.


Polyphosphate bone scanning of non-malignant bone disease in children. The advent of 99mTechnetium phosphate bone scanning radiopharmaceuticals has opened new methods of investigation of pediatric bone diseases. In axial skeleton pain, suspected osteomyelitis, evaluation of vascular integrity and suspected but undetected fractures, the bone scan has proved to be a highly complementary study to the radiologic examination.


Prepyloric mucosal diaphragm.

Prepyloric mucosal diaphragm. The present case of PPMD is reported as an example of gastric outlet obstruction which did not produce overt symptoms until a lifespan of more than eight decades had elapsed; yet this lesion is considered to be congenital in origin. The clinical, radiologic and pathologic features of this entity were discussed, based on the present and other reported cases. Under clinical conditions in which the more usual causes of gastric outlet obstruction are not apparent, awareness of this anomaly may be of great significance in the management since simple excision of the membrane is curative.


[Venous bypass on the opposite side (Palma's operation). Preoperative evaluation. Technical variants. Indications and results]. Permanent obstruction of an iliac vein may produce serious consequences. Palma's operation of inter-femoral transposition of the internal saphenous vein on the opposite side, has permitted numerous improvements, but may lead to 30 p. 100 failures. Temporary arterial blood supply to the area increases the operative risk and requires a second stage operation for suppression of the fistula, but it maintains permeability of the by-pass, if correctly performed. The indications should thus be drawn up with circumspection and one may regret that such extensive venous lesions had not been prevented or treated actively as soon as they started to develop.


[Total pancreatectomy in acute necrotizing hemorrhagic pancreatitis. Indications and technic]. The place of total pancreatectomy in the treatment of pancreatitis is still ill- defined. The author makes a plea for this operation and notes the indications, the surgical technique and its results and possible complications. The operation is indicated in cases of total or 2/3 rds necrosis of the gland, in cases involving the head of the pancreas and part of the body. The gland should be dissected out and continuity should be restored by choledoco-jejunal and gastro-jejunal anastomoses. The important thing is to carry out this operation early, between the 3rd and 6th day, treating the areas of necrosis before the lesions become the site of uncontrolled infection. 7 patients out of 9 operated on in this way, are alive with easily controlled diabetes, a low fat diet and pancreatic extract.


[Use of the Doppler effect in pathology and vascular surgery of the lower extremities]. A clinical, arteriographic and hemodynamic comparative study, using the Doppler effect in 100 cases, suggests: -- that a study of the Doppler effect is a very useful method of diagnosis to determine the site of obstruction and the state of the blood vessels beyond the obstruction, even in the absence of adequate radiological images; -- following operation, it permits one to assess a case of thrombosis, even when the latter is not obvious clinically. It makes unnecessary post-operative arteriographic controls in tired or high-risk patients.


[Post-traumatic pancreatitis with left pyelo-pancreatic fistula]. The authors report a case of special anatomical interest and emphasize the frequency of post-traumatic pancreatitis, the importance of cutaneous and joint manifestations revealing certain pancreatic diseases.


[Development of treatment of severe thoracic injuries]. About 25 p. 100 of cases of closed trauma of the thorax may be classified as severe, for they rapidly endanger life. Their treatment has made considerable progress since the report of J. Dor and H. Le Brigand in 1960. However, when severe trauma is treated, the mortality has remained unchanged over the last ten years. The treatment of fractures of the sternum includes respiratory assistance and internal fixation of the fractured bones, these two methods together, when correctly applied, give good results. Endothoracic lesions are now better recognised. Hemothorax and pneumothorax are now treated by a well recognised method. Visceral lesions, such as bronchial rupture, or major vascular ruptures, e.g. aorta, and heart lesions may be diagnosed at an early stage and be operated on more often. On the other hand, it is now better recognised that diffuse pulmonary lesions, e.g. pulmonary contusions or "shock lung", which is usually treated by artificial respiration alone, still may have a poor prognosis in some cases. From this it results that many surgical teams have enlarged the indications for early thoracotomy in the same way as laparotomy is more often carried out in abdominal trauma. In fact, these indications require circumspection and thoracotomy should only be carried out in specialised thoracic surgery units. If this is not available, aspiration, drainage, tracheotomy, continuous extension, are still applicable, but it is also necessary for them to be carried out correctly; if not, failures and complications of these minor measures are frequent. The use of these methods has shown the existence of therapeutic failures, including major bilateral bony lesions, diffuse severe lung injuries with resistant anoxia, complex multiple injuries with thoracic involvement and, finally, combined thoracic and cranial lesions, the mortality of which is about 50 p. 100. These facts explain why treatment of severe thoracic trauma gives variable results. The mortality varies from 12 to 15 p. 100, in some series up to 50 or 60 p. 100 These discrepancies may be explained by different modes of recruitment of the services, some of which receive a large number of very severe cases of multiple injury with a high mortality. However, over the last 15 years, one may consider that the general prognosis of severe thoracic trauma has improved considerably.


[Chronic familial pancreatitis (6 cases, 3 families)]. The authors report 6 cases of chronic familial pancreatitis. They review the literature on this disease which is still little recognised and seek the specific characteristics, early onset, transmission as an autosomic dominant with incomplete penetrance, relatively favourable prognosis, together with the suggestive signs, pancreatic lithiasis and certain complications. Apart from these signs, chronic familial pancreatitis differs very little from common chronic pancreatitis. The only cause is apparently genetic. Etiopathogenesis is thus still obscure. Treatment should be started early, but surgical methods are the same as in primary chronic pancreatitis.


[Paraplegia caused by closed injury of the dorso-lumbar joint without apparent primary vertebral lesion]. Paraplegia due to closed trauma of the lumbo-dorsal junction, without bony lesions are exceptional. The author reports a case due to rupture of the posterior ligements, without vertebral displacement on the first films, but which became complicated secondarily by dislocation, which it was necessary to reduce by open operation. It thus seems that there occurred during this accident a marked vertebral displacement reponsible for paraplegia which became spontaneously reduced thanks to muscle contraction, but which recurred secondarily following muscular relaxation. This case illustrates the necessity for repeated X Rays in cases of marked lumbar trauma even if the initial films appear normal.


[Energy and protein needs of surgical patients]. Energy and protein requirements following operation, are those levels which permit the best possible use of fatty and protein body reserves, without the resistance to trauma becoming diminished. The fatty reserves in a 70 kg man, correspond to 72 000 calories and require, to be used without danger of acidosis, 100 or, preferably, 200 g of glucose daily. Energy expenditure may be about 1 200 calories, thus much less than one would think. Fat does not have the antiketosis effects, nor the nitrogen sparing effects of glucose and their interest in raising calory intake has not been demonstrated. There is a level of nitrogen intake of about 20 to 30 g of protein, below which, nitrogen balance becomes rapidly negative and one then has to increase considerably the protein intake to 80 or 90 g to restore nitrogen balance. 200 g of carbohydrate, then 20 to 30 g of amino-acid, provide a calory intake of 900, easily administrable by the parenteral route, without the danger of bacteremia with more hypertonic solutions in infected operated patients. Higher calory intakes are only indicated in multiple trauma and burns.


[Technical modification in colpohysterectomies for prolapsus: reinforcement of perineorrhaphy by paravaginal suture]. After colpohysterectomy and myorrhaphy of the levator ani muscles for prolapse, there persists a weak point between the utero-sacral ligaments attached behind the pubic symphysis and the levator ani muscles. The author describes a technical device permitting one to fill this gap by suturing the two fascia on each side of the vagina.


Stimulation of the cell-free adenylate cyclase from guinea pig cerebral cortex by acidic amino acids and veratridine. Vesicles from guinea pig cerebral cortex prepared by homogenization in Krebs-Ringer buffer contained adenylate cyclase activity which was stimulated by the acidic amino acids, cysteine sulfinic and glutamic acids, and by norepinephrine as well as by an alkaloid, veratridine. With these vesicular preparations the concentrations of amino acids required for half-maximal stimulation were about 30 muM, only about 1/30 those necessary with intact-cell preparations. Nearly additive effects were observed when either of the active amino acids was combined with norepinephrine at their optimal concentrations.


Involvement of adenylate cyclase in mechanisms of denervation supersensitivity following surgical denervation of the dog heart. Following surgical disruption (4-16 weeks) of the nerves supplying the dog heart, catecholamine (norepinephrine and epinephrine) levels in the atria and ventricles were markedly reduced. Using the 10,000 g particulate fraction as an enzyme source, the activation of adenylate cyclase by norepinephrine was considerably greater in the denervated myocardial preparations (atria and ventricles) than in control hearts. Moreover, in the denervated ventricular preparation fluoride (5 and 10mM) elicited a significantly greater stimulation of the enzyme than that observed in the controls.


Squamous-cell carcinoma of the finger and nail bed: a review of the literature and treatment by the Mohs' surgical technique. Squamous-cell carcinomas of the finger and the nail bed are uncommon lesions. Etiologic factors, clinical and histological morphology and treatment modalities of squamous-cell carcinomas, specifically of the hand digits, are discussed. Six new cases of squamous-cell carcinomas of the finger and nail bed treated by the Mohs' surgical technique are presented. The advantages of this modality are outlined. A review of the relevant literature with detailed references is included.


Alternate cryogens for cryosurgery.

Alternate cryogens for cryosurgery. There is need for a storable cryogen suitable for use in dermatological cryosurgery as an alternate for the standard nonstorable cryogen now used (liquid nitrogen). Argon gas was tested and found satisfactory, but has not proved to be commercially feasible. Nitrous oxide apparatus is now available but is of limited usefulness. Various freons (fluorinated hydrocarbons) present possibilities for our use. Although they are incapable of producing the degree of cold and depth of penetration attainable with liquid nitrogen apparatus, they can be used to treat the vast majority of lesions now treated by cryosurgery in an office-based dermatological practice. Freons 12, 22 and 13, alone or mixed with other gases, have been tested. Freon 22 seems the most practical for general dermatologic cryosurgery. Although these gases are considered relatively non-toxic, at this time we really do not know their total noxious capabilities.


A new simplified cryosurgical instrument: the Foster Froster. The authors report in detail the development of a simplified, yet highly efficient cryosurgical instrument. It is lightweight, portable, inexpensive, and easy to use. Studies show it to be comparable in most instances to a popular contemporary unit. Its chief drawback appears to be that it cannot serve as a liquid nitrogen reservoir for extended periods, although it can be used for multiple procedures without re-filling.


Histographic surgery: accuracy of visual assessment of the margins of basal-cell epithelioma. In 72 basal-cell epitheliomas, the clinical extension and the actual extension of the defect measured by complete tumor removal by Mohs' chemosurgery were compared. Subclinical extension depends on the type of basal-cell epithelioma (primary, recurrent), on case history, location, clinical diameter, number of previous treatments and histological type. It is remarkably great in large (diameter more than 20 mm), in morphea-like basal-cell epitheliomas on the forehead, temple and scalp, especially following several previous treatments. In such cases the excision should include at least a 5-10 mm margin of "normal tissue." Present results again show that "histographic," that is, Mohs' chemosurgery is the method of choice for the treatment for these tumors.


The practical use of Z-plasty.

The practical use of Z-plasty. Properly employed, Z-plasty is a valuable way of avoiding complications of tension and contracture that may result in hypertrophic scars, and for repairing such scars if they occur. Careful preoperative planning to place the limbs of the Z in the lines of least tension and to make limbs of equal length at 60 degree angles to the central limb are essential to success. Cautious handling of the flaps and attention to hemostasis helps to ensure that success. Occasionally, Z-plasty has to be resorted to unplanned when it is found that an excision will result in tension exceeding expectations if primary closure were to be done.


Excisions in the area of the chin--a clinical note. Elective excisions on the face below the mouth and on the sides of the chin appear to yield better results when the wrinkle lines radiating out from the lips are utilized. Smile wrinkle lines appear to be less useful as demonstrated in the two cases presented.


Control of echolalic speech in psychotic children. Immediate echolalia, a common language disorder in psychotic children, was studied in a series of replicated single-subject designs across six schizophrenic and five normal children. In Experiment 1, each child was presented with several questions and commands, some of which set the occasion for specific, appropriate responses and some of which did not. The former were referred to as discriminative stimuli and the latter, as neutral stimuli. The psychotic children tended to echo the neutral stimuli while responding appropriately to the discriminative stimuli; the normal children, in contrast, typically echoed neither type of stimulus. In Experiment 2, three psychotic children were taught appropriate responses to each of several neutral stimuli. Following this training, the children generally responded appropriately to these stimuli without echoing. A plausible interpretation of these results is that the neutral stimuli were initially incomprehensible or meaningless to the children (whereas the discriminative stimuli were comprehensible or meaningful) and that verbal incomprehensibility may be one important determinant of immediate echolalia. Finally, the results are noteworthy in that they isolate a sufficient treatment variable (i.e., the reinforcement of alternative, nonecholalic responses) for eliminating instances of this language anomaly.


Normal versus deviant children. A multimethod comparison. The present study investigated differences between referred and nonreferred children and their families on the basis of home and clinic observations and parent questionnaires. Subjects were 28 families with children between 4 and 8 years of age who had been referred to a clinic for acting-out behavior and 28 nonreferred controls matched on several variables. Home observation results indicated that referred children showed significantly more deviant behavior and less prosocial behavior than nonreferred children and that their parents emitted more negative and commanding behavior in contrast to the control group. Systematic observation in the clinic revealed significant differences only in parent negativeness and number of commands. Finally, all five factors of the parent attitude questionnaire yielded large and significant differences between groups. There was considerable overlap between groups on all behavior variables but less overlap on the parent attitude measure. Results from a stepwise discriminant analysis classified 90% of referred children and 90% of nonreferred children correctly on the basis of the parent attitude variable alone. Taken together, these results suggest that child behavior is not always the critical variable in referral and stress the importance of multiple assessment procedures for child-family problems when children are referred for treatment.


Aerobic work capacity of mentally retarded boys and girls in junior high schools. The maximal oxygen uptake (Vo2 max) and ergometer load at a heart rate of 170 beats/min (PWC170) were determined in mentally retarded children (74 boys and 53 girls) of ages 12-15, whose IQ ranged from 36 to 91, and the results were compared with those for normal children. Mentally retarded boys and girls showed significantly inferior body height and weight, but no significant difference was found in skinfold thickness. The mean value of PWC170 for boys and girls was 14.34 kpm/kg/min and 11.31 kpm/kg/min, respectively, significantly less than that of the normal group. The mentally retarded boys had mean VO2 max per unit body weight of 42.4 ml/kg/min, which was significantly less than the 51.2 ml/kg/min of normal boys. The mentally retarded girls had a mean of 33.1 ml/kg/min which was also less than the 41.3 ml/kg/min of normal girls. The correlation coefficient between body weight and PWC170 (kpm/min) was 0.711 and 0.720 for boys and girls, respectively, while that between body weight and VO2 max (liter/min) was 0.641 for boys and 0.656 for girls. No significant correlation was found between IQ and PWC170 (kpm/kg/min) nor between IQ and VO2 max (ml/kg/min) both for boys and for girls. Similarly, no significant correlation was found between mental age and the VO2 max value (ml/kg/min).


Physiological parameters related to running performance in college trackmen. Submaximal and maximal oxygen consumption (VO2) and heart rate (HR) were correlated with running performance in events ranging from 100 yards to 2 miles, using as subjects 20 members of a college track team. In the first of two studies (n=11) a multi-stage walking test was used to determine VO2 and HR. Max VO2 expressed in ml/kg/min, was significantly related to 1 mile run performance but not to any of the other runs. Submaximal HR was significantly related to performance in both the 1 mile and 2 mile runs. Correlations between these physiological parameters and performance in the 220, 440, and 880 yard runs were nonsignificant. Multiple R's using max VO2 (ml/kg/min) and submaximal H were .758 and 9671, respectively, for the 1 and 2 mile runs. In study two (n=9) a running test for VO2 and HR was used, which resulted in a mean max VO2 about 7 ml higher than than elicited in the walking test, implying that for trained runners a running test was a more valid test of aerobic power. Marked relationships were found between body weight and performance, positive for the 100 yard dash and negative for the 2 mile run. Submaximal HR was again significantly related to performance in the 1 and 2 mile runs. Max VO2 was positively related to 2 mile performance and negatively related to 100 yard dash performance. Multiple R's using max VO2 and submaximal HR were .799 and .925 for the 1 and 2 mile runs, respectively. Using submaximal HR and weight the multiple R's were .777 and .945, showing that these two can account for a large amount of the variance in distance running performance. In neither study was submaximal VO2 significantly related to running performance.


Free physical movements during waiting while standing and sitting. Man's habitual physical movements in a daily life situation while waiting for someone in front of a railway station in either a standing or sitting posture were studied. The free movements of 113 male and 171 female standing subjects and 236 male and 67 female sitting subjects were recorded for a period of three minutes by commentary using a tape recorder. The mean frequency of spontaneous movements was 13.8/min during standing and 14.3/min during sitting, the neck and lower limb movements being frequent in the former and the neck and upper limb movements in the latter. Males smoked, yawned, and crossed their legs more often than females. Any physical movement was most frequently followed by cessation of movements. Kinds of movements following a preceding motion proved almost independent from the type of the preceding one. Most of such movements ended within 2.5 sec, scarcely lasting for longer than 30 sec, while about 90% of the periods of being still were shorter than 15 sec. It is suggested that most of spontaneous physical movements in waiting occurred independently and were intercalated between short pure rest periods.


Serial determination of cardiac output during prolonged work by a CO2-rebreathing technique. Cardiac outputs were calculated on eight male college students while walking on a treadmill at controlled heart rate levels. The heart rate levels were maintained through the use of a heart rate controller (Quinton Model AI-607), standard deviations for heart rate in beats/min ranged from +/-2.1 at the heart rate level 110 to +/-3.2 at 170. Test-retest correlations of the cardiac output values at the various heart rate levels were: at heart rate 110, 0.66 after 7 min and 0.85 at 30 min; at heart rate 150, 0.92 after 7 min and 0.68 at 30 min; at heart rate 130, 0.97 after 7 min, and at heart rate 170, 0.85 after 7 min. The calculated cardiac output values when plotted against oxygen uptake compare favorably with published reports. The data collected demonstrate that the CO2-rebreathing method used in the present investigation provides a reliable bloodless technique for determining multiple cardiac output during prolonged work of varied intensities.


The mechanism of generation and transmission of forces in leg extension. This paper deals with the mechanical and electromyographic evaluation of the mechanism generating and transmitting the resultant leg extension force by maximal isometric contraction in two directions, the knee and hip joint being kept at 90 degrees. The two directions were a) from the center of gravity of the body to the ankle joint and b) from a point near the knee to the ankle. Six male subjects in a supine position exerted a maximal leg extension force of 47-112 kg for a) and 51-73 kg for b). These values were close to the smaller values of two forces estimated at the knee and at the hip from maximal isometric forces at the corresponding joint of the same joint angle. It was thus suggested that the joint limiting the resultant leg extension force was the knee for a) and the hip for b). The single joint muscles exhibited almost maximal activities when they concerned the joint which limited the resultant leg extension force. The double joint muscles were often contracted only moderately during the maximal isometric leg extension, indicating a different role of double joint muscles even at the maximal force production at a particular joint.


The geneis and mechanism of human error in accidents resulting latent danger. Six accidental cases caused by overlooking latent environmental danger were analyzed and the geneses and mechanism of the human error involved were discussed. In all cases detection of the danger was easy or indications by some warning were distinct. In a typical case, a lineman, after cleaning the insulators of a suspended line, proceeded toward the danger zone of another line charged with current on reaching the ground. He disregarded the warning flag, and received a shock and fell to the ground. It was also common in all the other cases that victims were conducting relatively easy or habitual activities and responded, being almost unaware of the unusual physical characteristics of the environment, to its more apparent aspects. These errors were relevant to experimental results by the author that subjects had great difficulty in identifying the rule of presentation of signal figures if the key item and the rule, either serial or positional, were different from foregoing trials. It is suggested that an individual fails to see an external object that has little function  value in regard to the content of the current behavior under influence of personal habitual experiences and the theories of human error need to be reconstruct as the basis of ecological knowledge about them.


Incidence of near accidental drowsing in locomotive driving during a period of rotation. The incidence of drowsings as a cause of near traffic accidents was studied on the basis of daily recordings or near accidental events by 288 locomotive drivers during a rotation period of 2-3 weeks. Of 198 near accidents reported during 2,290 trips, 34 cases, or 1,5 cases per 100 trips, were operation missess involving drowsing or strong drowsiness. Improper operation due to drowsing occurred at a certain rate for any group of drivers, irrespective of the type of train, running sections, weather, and other operative conditions such as train delays, whereas 117 cases of danger caused by unforeseen obstacles on the track were related to site characteristics, and 47 cases of other disorders were frequent in unusual operative conditions such as arrival-departure, poor signal display, wrong instructions, or equipment failure. Thus continued driving under ordinary track conditions at a more or less constant speed was likely to induce drowsiness under the dominant influences of fatigue and time of the day; 79% of such cases occurred between midnight and 6 a.m. Most drowsings on the second night appeared during the first 2-4 hr of duty. Effects of monotony and insufficient rest were discussed in relation to recurrent fluctuation in vigilance.


A proposal for the clinical classification of acute coma due to organic cerebral lesions. The purpose of this paper is to propose a preliminary scheme which standardizes the terminology and the manner of classifying comatose states due to organic cerebral lesions. This attempt is based on recognition of the need to use a common language in order to facilitate the transmission of information in this field.


Severe traumatic coma in infancy and childhood: results after surgery and resuscitation. This study deals with 390 cases of severe traumatic coma in infancy, childhood and youth, aged between 4 months and 19 years. Cases in which unconsciousness lasted less than 24-48 hours have not been considered here. 161 patients were operated upon for intracranial space-occupying lesions or for open head injury: extradural haematomas 60; extradural haematomas + brain lacerations and/or subdural haematomas 16; acute subdural haematomas 18; brain laceration 36; open head injuries 17; decompressive operations, hydromas and contusions 14. 102 patients recovered and 59 died. 229 subjects were given only to resuscitation treatment. 164 recovered and 65 died. Recovery and mortality rate are discussed in relation to the pathologicial lesions and to the clinical picture (severity, evolution and duration of coma). Overall mortality rate was 31%. Mortality was higher in operated patients (36.6%) and lower in patients in whom space-occupying lesions were not demonstrated by angiography and who underwent only resuscitation treatment (28%). The lowest rate was observed in cases of extradural haematoma (25.4%) and open head injury (23%). Highest mortality rate have been observed in cases of decerebrated coma (with or without signs of low brain stem impairment). Complete recovery can be achieved even after prolonged decerebration. 31 patients showed the typical picture of the "apallic syndrome": in 28 cases after prolonged decerebrated coma, in 3 cases after coma without decerebration. Of our 31 cases, 4 died, 4 are still in a chronic apallic state and 23 recovered. Of these, 10 patients had a remarkable recovery and 13 remained severely disabled.


The Doppler ophthalmic test: report of a study on its value in diagnosis of internal carotid artery insufficiency. The Authors have investigated the significance and the limits of the directional Doppler method in a group of subjects affected by internal carotid obstruction in various sites and degree. On the basis of the obtained results the Authors point out how this method represents a concrete progress in the field of non invasive diagnosis of the insufficiency of this artery.


Cranial and orbital epidermoid tumours.

Cranial and orbital epidermoid tumours. This paper reports on 14 cases of cranial and orbital epidermoid tumours, of which 2 epicranial, 4 extradural intracranial, 4 fronto-orbital-sinusal, 2 orbital and 2 orbito-nasal cases. Referring to these cases and data published in the specialised literature, the authors show that this type of tumour is more frequent in males, and is generally of embryologic but very rarely of mechanical origin. The main symptom is tumefaction in cranial tumours and exophthalmos in orbital tumours. There is very rarely association with a space-occupying process (tumour, cerebral abscess). Evolution is slow and progressive; the only treatment is surgical. After total ablation there were no recurrences and the postoperative course was very satisfactory.


Considerations on the results of surgical treatment of cerebral abscesses. The results of surgery in 96 patients affected with cerebral abscess are reported. The lesion was completely removed in 65 patients, 33 underwent drainage (in many cases by Adso-Craig's technique) and only in one case was a combined operation performed. Overall mortality was 15.1%. More or less serious neurological and/or psychic deficits were present in 40% of patients, whereas epilepsy occurred in 26.6%. Furthermore, it was noted that excision of the abscess originates fewer epileptic complications type (20.9%) than drainage of the abscess cavity (37.5%). As regards the type of operation, the Authors suggest complete excision of the abscess as more advisable limiting drainage to cases of localization in "noble" areas or when complete removal can jeopardize patients in very serious conditions.


Tetraplegia from trauma of the cervical spine in the absence of fractures and luxations. Spinal cord lesions are not infrequent in cervical traumas in absence of fractures and/or luxations. In hyperextension traumas conservative treatment is normally sufficient. In hyperflexion and unknowm mechanism traumas neurosurgical treatment is often necessary due to the frequency of a discal herniation. Myelography is indispensable for correct and complete diagnosis and for this reason its use is strongly recommended.


On the radical treatment of a large carotid-ophthalmic aneurysm: case report. General remarks on carotid-ophthalmic aneurysms are followed by the description of a personal case in which direct closure of an "inoperable" aneurysm was successful. The surgical treatment of these malformations is discussed.


Repair of traumatic cerebrospinal fluid leaks using tissue adhesives. 14 cases of post-traumatic cerebrospinal fluid leaks, sealed with tissue adhesives and fascia, or galea, are reported. None of the patients had recurrence in a follow-up ranging from five months to three years. Tissue adhesives provided a tough adhesion of the patch and, as a consequence, an immediate and stable repair of the leak.