[Endometriosis in the episiotomy-cicatrix]. The endometriosis in the scar caused by episiotomy after delivery of twins has been shown, and the coalesced placentas have been peeled off. The first menstrual hemorrage began four weeks following the childbirth, and the first disorders in the scar appeared three months after child birth. A small number of such cases have been reported so far, probably because the endometrium in the second half of pregnancy has a slight ability of implantation, and the brisk fall in the sexual hormone production in the puerperium is not favourable for the growth of the probable implant.


[Oral contraceptives during pregnancy and fetal chromosome findings]. By means of direct chromosome preparation 7 foetuses are studied whose mothers had taken oral contraceptives during conception and early pregnancy. Two X0/XX-mosaics are found in whom it is questionable whether they are the result of taking ovulation inhibitors.


[Problems in the preoperative treatment of old patients]. Because of a higher duration of life the age surgical operations get higher importance also in the gynaecology. In elderly patients careful pre-operative treatment gives a reduction of lethality and morbidity. You must consider the shorted functional resources of the heart circulation system and the lungs and kindeys. Disturbances in electrolyte metabolism, water balance and acid-base regulation should optimally be compensated pre-operatively. At the same time the thrombosis prophylactic is a very important fact in the pre-operative treatment.


[Activity of lysozymes in blood serum of rabbits with experimental salmonellosis (Salmonella agona) (author's transl)]. The authors have analysed the influence of experimental infection of rabbits with Salmonella agona on lysozyme activity in the blood serum of examined animals. 37 rabbits were used in the experiments; experimental salmonellosis was developed in 22 out of this number, the remaining ones (15 rabbits) served as controls A statistically significant increase of lysozyme activity has been found in the serum of sick animals in the acute stage of the disease. A significantly high activity of this enzyme was observed in the diluted blood serum of experimental animals. No correlation was founds between the number of leucocytes and the percentage of granulocytes, and the lysozyme activity.


[Ten new serotypes of Salmonella subgenus I isolated from healthy carriers in Togo (West Africa)]. The Salmonella strains described in this paper were isolated from stool specimens of healthy persons in epidemiological studies in Togo (West Africa). All strains belong to the subgenus I of the genus Salmonella. [see text]


[Nine new Salmonella species belonging to sub-genera I, II, and III and a new serological variant of S. tornow (author's transl)]. Between October 1971 and March 1972, 168 samples were collected from tank-water and faeces of amphibious animals and reptiles living in the Aquarium of the Berlin Zoo. They were examined for Salmonella and Arizona. Nine unknown Salmonella species and one new serological variant of S. tornow were isolated. Two of the new species were found to belong to sub-genus I, three to sub-genus II, and for to sub-genus III (Arizona) (see article).


[Investigations on the structure of the sphingolipids of the genus Bacteroides (author's transl)]. In 1972 Fritsche and Thelen have described the difference between the structure of the komplex lipids of the genus Bacteroides and the genus Sphaerophorus. Further investigations of Fritsche demonstrated the possibility of grouping gramnegative anaerobes into the genus Bacteroides in spite of the fact, that one of the final products of metabolism of these strains is butyric acid. These strains are the so-called butyric acid producing Bacteroides. This paper describes the structure of the still unknown fatty acids of the komplex lipids of Bacteroides strains and confirms the heterogenity of the sphingosine bases of Bacteroides as a principle. Fife strains of Bacteroides - with and without production of butyric acid - were used for purification of their long chain bases, which were characterized by degradation. The unknown fatty acids were isolated from B. thetaiotaomicron and analyzed by Dr. Rosenfelder with the aid of mass spectrometry, O-methylation and dehydratisation. The experiments of Rosenfelder demonstrate, that the unknown fatty acids have the behaviour of 3-hydroxy fatty acids, the two main peaks are a hexadecanoic and a heptade-behaviour of 3-hydroxy fatty acids, the two main peaks are a hexadecanoic and a heptadecanoic acid. They have an identical behaviour with the 3-hydroxy-15-methyl-palmitic acid of Myxococcus fulvus. Therefore the genus Bacteroides differs from the genus Sphaerophorus by synthesis of 3-hydroxy fatty acids. The production of sphingolipids is a common characteristic of the genus Bacteroides, each of the five strains demonstrated a heterogeneous pattern of bases with sphingosines with 16 to 20, perhaps also 12 to 14 carbon atoms, sometimes predominantly the branched and n-heptadeca- and the octadeca-sphinganine can be identified. The possibility of the production of phyto-sphingosines is discussed.


The growth cycle of influenza viruses as studied in touch preparations of the allantoic layer of chick embryos. 4. The growth cycle of influenza B virus: presence of basophilic inclusions in cytoplasm of CAM epithelial cells. The infectious cycle of Influenza B virus occurring at the allantoic layer of embryonated eggs has been studied by means of cytological and immunofluorescence techniques utilizing touch preparations. The infectious cycle of the virus resembles closely that of Influenza A virus. Influenza B virus, regardless of the dose inoculated, affected the strata of the allantoic layer to a different extent. It totally destroyed the surface stratum (major growth cycle) in about 20 hours time when a 10(8) ID50 dose was inoculated and within 38 hours with a 10 ID50 dose. In the deep stratum, which remained denuded after the destruction of the surface one, most cells (90%) showed normal appearance and a small proportion (about 10%) appeared to be infected. This condition of a minor growth cycle of infection lasted till death of the embryos which occurred within 3--4 days as a maximum. At advanced stages of infection ulcerations (loss of epithelium) appeared which at no time were observed in a Influenza A virus infection.


Untraditional glucose fermenting actinomycetes as human pathogens. Part II: Rothia dentocariosa as a cause of abdominal actinomycosis and a pathogen for mice. Rothia dentocariosa was proved as a primary pathogen for man in the case of abdominal infection of a 19 year old woman. Clinical findings were typical for actinomycosis and the patient was cured with penicillin following surgery. Actinomycotic granules were proved by direct microscopy in the pus and R. dentocariosa was recovered as a single pathogen according to the microscopy. Two morphologically distinct isolates recovered from primocultures were described. They were studied separately and finally they were recognized as physiologically identical varieties of a single organism. In addition, the two morphological varieties of R. dentocariosa were considered to represent a particular kind of variability of the A-N type. The isolated germ was found to be pathogen for mice. Intraperitoneal infections provoked multiple nodules formation which were grown into the internal organs of experimental animals. The nodules were encapsulated and tended to spread without regard to the natural tissue plan. They contained pus involving microgranules of viable germs. This first report of the natural human infection caused by R. dentocariosa is the precedent for the definite establishing of this aerobic glucose fermenting actinomycete amidst the untraditional potential pathogens of human actinomycosis.


Immunizing effects of structural components of Leptospira icterohaemorrhagiae. The protective attributes of the structural components of Leptospira icterohaemorrhagiae strain Shibaura were examined. Guinea pigs were immunized with the outer envelope, the cell wall, the type-specific main antigen, and the protein constituent of the outer envelope respectively. Of the 4 preparations, the outer envelope, the cell wall and the type-specific main antigen showed a considerable protective effect in this order. The protein constituent of the outer envelope was less effective. Immunization with 200 mug of the outer envelope protected guinea pigs from lethal infection but no completely from the renal carrier state. The rate of protection from renal leptospirosis by the preparations of leptospiral components and lyophilized whole cells was always inferior to the survivor rate.


[Bone marrow eythroid series cellular reaction to antigenic stimulation]. The authors describe changes in the cells of the erythroid series of the bone marrow against the background of immunization with diphtheria toxoid. Physiological saline was injected to control animals. Changes in the blood system were in one direction and were expressed in the erythroblastic reaction; this reaction was less pronounced in control than in the experimental animals.


[Relation of intrahospital morbidity from staphylococcal infections to some properties of hospital strains]. Analysis of staphylococcus infection morbidity in a large obstetrical hospital for 5 years offered a possibility of establishing an association between the severity of the course of staphylococcus infections in patients, the bacteriophage type of the causative agent and its resistance to antibiotics. The qualitative changes in morbidity in the direction of the prevalence of minor forms and mild course ocurred in parallel with the changes of the leading bacteriophage type from the epidemic 75/77 and 80/81 to the nonepidemic bacteriophage types of the III bacteriophage group and the changes of the antibiograms of the causative agents in the direction of an increase in the number of strains sensitive to antibiotics. Since the severity of the course of staphylococcus infection characterized the pathogenicity of the strain of the causative agent a conclusion could be drawn on the association between the sign of virulence and determinants of the medicinal resistance and definite prophages in the hospital strains of staphylococcus.


[Patterns in the epidemic process of scarlet fever in various territories differing in respect of climate and geography]. Observations carried out in Ashkhabad and Petrozavodsk permitted to reveal specific features of the epidemic process in scarlet fever at the territories differing in climato-geographic respect. This was expressed in a different level of morbidity, differences in the character of periodicity, seasonality and age structure of morbidity. Along with this there were noted differences in the spread of the carrier state of hemolytic streptococcus and of their biological properties, and also in the process of immunity formation in the population. The data obtained suggest that one of the causes of epidemiological differences in scarlet fever detected in the southern and the northern districts were peculiarities of the immunological reactivity of the population and a difference in the carrier state of the highly toxigenic streptococci.


[Possibility of shortening an aerosol immunization session with dry live plague vaccine]. A comparative study of the 10- and 30-minute seances of the animal vaccination with the dry living plague aerozol EB vaccine demonstrated that the biological and the weight aspiration doses for a 10-minute vaccination seance constituted 96 and 89% of the dose, respectively, during a 30-minute exposure. According to the results of the passive hemagglutination test immunological shifts developing in guinea pigs after the 10- and 30-minute exposure proved to be equal. On this basis it is recommended to decrease the seance of the animal vaccination from 30 to 10 minutes.


[Etiology of acute suppurative destructive pneumonias in children]. Clinical, immunological and bacteriological studies were carried out in 63 children with the so-called staphylococcus destruction of the lungs. It was shown that in some of the cases destructive process in the lungs, along with the pathogenic staphylococcus, could be caused by the Gram negative bacteria (Proteus, Bac. pyocyaneus, etc.). It was found that in children of different age groups the titre of antistaphylococcus antibodies up to 0.5 AU/ml was normal and pointed to the absence of any inflammatory disease of staphylococcus etiology; a titre of 2 AU/ml - and overcould be considered as diagnostic. In connection with bacterial poly-etiology of acute destruction of the lungs in children it is suggested that it should be designated as "acute purulent destructive pneumonia". The importance of immuno-bacteriological studies in children with diseases with the mentioned pathology is emphasized; these examinations permit to choose proper complex therapy.


[Isolation and identification of Neisseria in bronchial asthma]. A study was made of 29 strains of neisseria isolated from the mucosa of the pharynx and the bronchi of patients suffering from infectious-allergic bronchial asthma of different severity. Comparison of the strains by 22 tests (including the assessment of the morphological, biochemical and other signs) permitted to establish the species of neisseria with some probability. The species reference was determined in 23 cultures. N. perflava was isolated in 10 cases, N. subflava--in 6, N. flava--in 3 cases and N. sicca--in 4 cases, 2 strains corresponded to apigmentary N. cinerea. The species was not established in 4 cultures. There was found no connection between a definite microbial association and the species of neisseria and the severity of the disease. Pigment species of neisseria should be tested as diagnostic allergens.


[Quantitative indices of lysozyme activity in staphylococci]. The lysozyme activity of 354 lysozyme-positive and 100 lysozyme-negative (by the results of qualitative test) staphylococcus strains were studied quantitatively. The method was based on titration of the lysozyme in the culture fluid of 48-hour broth cultures of the strains under study. The quantitative method proved to be more sensitive than the qualitative one, and permitted to reveal the lysozyme production in 71% of the strains which were formerly considered to be lysozyme-negative. There were distinct species differences between the lysozyme-positive staphylococci: the mean lysozyme level in the S. aureus was significantly greater then in the S. epidermis. There was no regular association between the lysozyme activity, staphylococcus origin, bacteriophage reference and the antibiotic resistance.


[Comparison of the physiological and biochemical indices of the phagocytosis of ram erythrocytes by macro- and microphages]. Morita and Perkins' method was applied to the study of the stage of ingestion and destruction of an antigen (sheep erythrocytes) in the macrophages of peritoneal exudate of rabbits and rats and in the microphages of rabbit pleural exudate. Ingestion and intracellular destruction of the antigen were accompanied by intensified respiration and glycolysis of phagocytes. Respiration of the three types of phagocytes at two stages of phagocytosis and also the digestive capacity of microphages proved to be sensitive to cyanide and colchicine. The latter failed to influence the ingestion of the antigen by the three types of phagocytes and its digestion by macrophages. The differences in the metabolism routes of macro- and microphages in intracellular destruction of the antigen was postulated. An intensification of the phagocytic activity after the immunization was characteristic of rabbit and rat macrophages.


[Use of regression analysis in the quantitative evaluation of the activity of biological preparations]. Use of regression analysis in the assessment of the activity of biological preparations under experimental conditions permitted not only to assess the quantitative effect (ED50) more strictly, but also to find other parameters of importance for the results of comparison, for example with the standard, i.e. in standardization. To these belong regression coefficient, parallelism of regressions, and the relative potency. By the presence of a parallelism one can judge the similarity between the activity mechanism of the active principle of the preparations being compared. Relative potency characterizes the activity of the preparation in the relative values in comparison with the standard, with a statistical evaluation of this value with the aid of the confidence interval. The authors suggest a program for Mir-2 computer facilitating the calculations in using the analystical method which is more objective than the graphic method of assessment of the linear dosage-response curve.


A study of DNA from chloroplasts separated by counter-current distribution. Three types of chloroplasts (Peak I, Peak II, and Peak III chloroplasts) isolated by counter-current distribution in aqueous polymer two-phase systems have been studied with respect to DNA content. (The characterization was performed by studying the buoyant density, the melting profile and the amount of DNA of each type). The DNA was found to differ between the three types of chloroplasts.


Structural studies of metabolic products of dopamine. IV. Crystal and molecular structure of (-)-noradrenaline. The crystal structure of (-)-noradrenaline has been determined by X-ray methods, using 1000 observed reflections collected by counter diffractometer techniques. The crystals are orthorhombic, space group P212121, with a=8.611(2), B=6.138(2), And c=14.912(4) A. Least-squares refinements yielded a conventional R-factor of 0.036. Standard deviations in bond lengths are 0.003 A and in bond angles 0.2 degrees. The crystal structure of (-)-noradrenaline corresponds closely to that of (-)-adrenaline in molecular geometry, conformation, and arrangement in the crystals. The results of the structure investigations are discussed in relation to the biological activity of these biogenic amines.


[Contribution to the clinical study of the Parsonage and Turner syndrome. 15 personal observations (author's transl)]. The seimological aspects of 15 observations of amyotrophic neuralgia of the shoulder are described. This group includes 12 men and 3 women. The signs were bilateral in 4 patients. A recurrence was observed in 3 cases, suggesting a constitutional predisposition. One patient also demonstrated neuropathic signs in the lower limbs. Special emphasis is put on the mode of onset and the prodromal symptoms. A functional overloading of the scapulo-humeral articulation is evident in 5 cases. In 12 patients a complete functional recovery was observed in less than one year.


Segmental fibre breakdown and defects of the plasmalemma in diseased human muscles. Thick round fibres common in cross sections of muscle biopsies from patients with muscular dystrophy are due to contracted and swollen segments of otherwise normal muscle fibres. This contracture leads to segmental fibre breakdown, which is identical with Zenker's waxy degeneration. In biopsies from 90 patients suspected of neuromuscular disease, segmental contracture was seen in all or nearly all patients with infantile muscular dystrophy, necrotic myopathy or acute alcoholic myopathy. It was present in half of the patients with polymyositis or myotonic dystrophy. In resticted forms of muscular dystrophy it was rare as it was in neurogenic atrophy. In 9 clinically normal patients it was absent. In electron micrographs of the initial stage sarcomeres were moderately shortened, the sarcoplasmic reticulum was distended and the mitochondria were normal. In the plasmalemma holes were found, through which glycogen granules were lost into the interstitial tissue. In later stages myofibrils were overcontracted and homogenized; in large areas the plasmalemma was absent. Based on these findings a hypothesis for the development of waxy degeneration is proposed: locally defects of the plasmamembrane cause segmental contracture, glycogen granules and water soluble enzymes are lost through holes in the plasma membrane, and finally the affected fibre segment becomes necrotic.


Epileptic activity and anatomical characteristics of different lesions in cat cortex. Ultrastructural study. Three different types of lesions have been studied in the cortex of the cat, by means of electroencephalography and electron microscopy. These three types of lesions can be listed in order of increasing magnitude according to their capacity to induce abnormal electrical activity: 1.  incision of the cortex gives paroxymal activity, 2. intracortical insertion of a resin pellet generates weak epileptic activity, 3. intracortical insertion of a colbalt resin pellet  produces epileptic activity. A parallel can be drawn between electrophysiological and anatomical data: there seems to  be a quantitative relationship between the degree of epileptic activity and the extent of perilesional tissue. Furthermore, in this perilesional tissue, oedema is observed, the intensity of which varies according to the type of lesion. Thus, the epileptic activity of a lesion seems to be proportional not only to the volume of the perilesional tissue but also to the development of the oedema.


[Histochemical study of choroid plexuses, ependymal epithelium and subcommissural organ in experimental conditions (author's transl)]. Activities of some dehydrogenases (DH) belonging to the metabolism of glucose, glutamic acid and gamma-aminobutyric acid, and to Kreb's cycle are investigated in choroid plexuses, ependymal epithelium and subcommissural organ of the rat. The observations are completed by detection of acid phosphatase activity. Metabolic modifications are demonstrated following carbonic anhydrase inhibition and plasmatic sodium hypertonicity. After treatment with Diamox, an increase of the activity of the various DH considered is observed in choroid plexuses. The effect seems to be only transient. Plasmatic hypertonicity induces some changes in DH activity in the different tissues. Acid phosphatase activity remains unchanged in these conditions.


Experimental cerebral ischemia in Mongolian gerbils. II. Changes in carbohydrates. A cerebral ischemia was produced by unilateral ligation of the common carotid artery in the neck of Mongolian gerbils (Meriones unguiculatus), which are frequently characterized by deficiencies in the circulus of Willis. Concentrations of glucose, lactate, pyruvate and glycogen were measured in the hemisphere on the side of occlusion and in the contralateral control hemisphere of animals sacrificed after 5, 15 and 30 min, as well as after 1,3,5 and 9 hrs of carotid clamping. Significant decrease of glucose, and increase in lactate and pyruvate concentration were found in the hemisphere ipsilateral to occlusion; the extent of the changes was proportional to the duration of the ischemia. After an initial fall, an increase in the glycogen content occurred in the later stages of ischemia. Glycogen, glucose, lactate and pyruvate were determined also at 1, 5, 20 hrs and 1 week intervals following release of an occlusion lasting for 1 hr. Return to normal values of glucose and pyruvate was seen at 1 hr after release. The lactate and glycogen levels were significantly raised on the occluded side after 20 hrs release. An increased level of glycogen was observed as long as 1 week after a 1-hr carotid occlusion.


L-dopa plus dopa-decarboxylase inhibitor. Sleep organization in Parkinson's syndrome before and after treatment. Sixty-four all-night sleep polygraphic recordings have been carried out in patients affected by Parkinson's syndrome, before and after treatment with an association of l-dopa plus a peripheral dopa-decarboxylase inhibitor. Without any drug, parkinsonian patients showed sleep disruption with frequent awakenings, reduction of total sleeping time and lessening of REM stage rather than slow sleep. Treatment with l-dopa plus inhibitor appeared to be able to restore good night sleep organization with a noteworthy increase in the REM stage.


Serum and Placental lactic dehydrogenase and alkaline phosphatase isoenzymes in normal pregnancy and in pre-eclampsia. LDH isoenzymes and heat-stable alkaline phosphatase were studied in the serum and placental extract of 20 cases of pre-eclampsia and 10 normal pregnancies as a control. The starch-gel electrophoretic serum and placental isoenzymogram showed that LDH4 and LDH5 were the main isoenzymes in the placenta while LDH1 and LDH2 were the main isoenzymes in the serum in pre-eclampsia. The electrophoretic serum protein pattern in pre-eclamlobulins with decreased albumin fraction, while in the placenta, the albumin fraction was increased together with a decrease in the alpha-globulins. The electrophoretic pattern of serum alkaline phosphatase showed a main band of activity at the B-globulin zone in all cases of normal pregnancy and pre-eclampsia. In the placenta, two additional bands were detected.


Continuous epidural anaesthesia with a low frequency of instrumental deliveries. The results of 204 cases of regional analgesia by means of continuous epidural block during labour and delivery are reported. The frequency of instrummental intervention using forceps or the vacuum extractor is low, less than 15% for primi- and multi-gravidas combined, although pathological conditions were recognized prior to blockade in almost one-third of the parturients. Moreover, the frequency of emergency Caesarean section has dropped significantly since epidural anaesthesia was introduced into the clinic. The 1 min Apgar scores of babies born to mothers given epidural anaesthesia are similar to those of babies born to mothers receiving conventional analgesic agents. The amount of blood lost by mothers given epidural anaesthesia was, on average, 15% less than in a control group. It is concluded that the essential feature of our technique of administering continuous regional analgesia is a selective block of small pain fibres with the deep tactile sensations largely intact, and the motor pathways virtually unaffected. This has been achieved using small doses of bupivacaine 0.25% concentration and meticulous observation of the individual patient.


Presence of antisperm antibodies in fertile and infertile persons. The sera of 70 infertile and 30 fertile couples were tested for the presence of sperm agglutinins with Kibrick's macroagglutination technique and Boyden's haemagglutination test. 15.7% of the couples studied showed the presence of sperm agglutinins (by Kibrick's method) of which 5.7% were from males and 10.0% were from females. By the haemagglutination test, 13% of the couples studied were found to possess sperm agglutinins, of which 3% were from males and 10% were from females. 30 fertile men and women studied for sperm agglutinins were found to be negative by both methods. It was also observed that these two tests detected different types of sperm agglutinins. The cervical mucus samples from 45 females (15 fertile and 30 infertile) were tested for sperm agglutinins with a mucus penetration test. 23.1, 16.5, and 57.4% of the samples from infertile females, showed 0-degree, 1-degree and 2-degree penetration respectively. In case of samples from fertile females, 6.6, 13.2 and 79.2% showed 0-degree, 1-degree and 2-degree penetration respectively. Addition of serum from infertile females to cervical mucus from the infertile female increased the 0-degree penetration percent cases to 50%, as compared with 23.1 when only cervical mucus was used. Addition of serum from fertile females, or horse serum or pure albumin or globulins did not increase the 0-degree penetration cases.


Studies in cholestasis of pregnancy. V. Gallbladder disease, liver function tests, serum lipids and fatty acid composition of serum lecithin in the non-pregnant state. Women from an earlier series of cholestasis of pregnancy (CP) were called for a retrospective study to consider presence of gallstones in the gallbladder (evaluated by cholecystography), liver function tests, serum lipids and lipoproteins and the relative fatty acid composition of serum lecithin (as determined by GLC). The attendance in the retrospective study was 60%. Estimated on the total series (assuming that none of the non-responders would have a positive X-ray), the incidence of gallbladder disease was 23.7%. Among women with previous cholestasis of pregnancy and with a positive X-ray finding no characteristic changes in liver function tests or serum lipids were revealed. The women with positive X-ray had, however, a lower alpha-lipoprotein cholesterol than women with negative X-ray. A characteristic finding among women with positive X-ray was furthermore the low relative content of palmitic acid (16:0) in serum lecithin. Also women with negative X-ray had a lower relative content of palmitic acid than controls. It is suggested that the low palmitic acid content is expressive of an influence on liver lecithin synthesis pathways and that the serum lecithin fatty acid composition reflects similar changes in bile lecithin. The "basic defect" in CP influencing liver lecithin synthesis might be the primary cause for disturbed cholesterol solubility in bile and of the frequent occurrence of gallstones in CP.


Phospholipids and creatinine in amniotic fluid in relation to gestational age. 185 samples of amniotic fluid were obtained from 174 healthy women with uncomplicated pregnancies in the 15th-43rd week of pregnancy by abdominal amniocentesis or by puncture of the amniotic sac via an amnioscope. The concentrations of creatinine (183 cases), phospholipid phosphorus and the ratio of lecithin/sphingomyelin (L/S-ratio, 130 cases) were determined. The treatment of the amniotic fluid samples (centrifugation, filtration and lipid extraction) and the methods for the determination of L/S-ratio were examined and the accuracy and limitations of the latter method were defined and discussed. The relative amounts of lecithin and sphingomyelin as well as the L/S-ratio and creatinine concentration were closely correlated to gestational age. A L/S-ratio of greater than or equal to 2.25 indicated all women to be greater than or equal to 34th week of pregnancy; 64% of them had reached the 38th week. A creatinine concentration of greater than or equal to 1.8 mg% corresponded to X greater than or equal to 35th week or pregnancy, while 75% of the women had reached at least the 38th week. With a L/S-ratio greater than or equal to 2.25 and a creatinine concentration greater or equal to 1.8 mg% of all women were greater than or equal the 36th week. 71% of the women greater or equal the 38th week fulfilled these critiera. A combination of the two parameters seems to be of a great value in discrimination between gestational ages less than the 36th week and greater than or equal to the 38th week.


Serum alkaline phosphatase in pregnancy. I. A comparative study of total, L-phenylanine-sensitive and heat-stable alkaline phosphatase at 56 degrees C and 65 degrees C in normal pregnancy. 312 paired, serial estimations of total, L-phenylalanine-sensitive and heat-stable alkaline phosphatase (at two temperatures, 56 degrees C and 65 degrees C) were performed on sera from 31 pregnant healthy women from 18 weeks to term. Heat-stable alkaline phosphatase, determined at 65 degrees C, enriched the serum in a smooth exponential course throughout the second and third trimester, whereas the other enzymic activities investigated showed more irregular increments. There was a slight, but significant correlation between total alkaline phosphatase activity of the placenta and serum heat-stable alkaline phosphatase at term, whereas there was no correlation between the weight of the child at birth and heat-stable alkaline phosphatase in the serum of the mother. It is concluded that to test the feto-maternal unit, determination of serum alkaline phosphatase should be performed at 65 degrees C with due regard to appropriate sampling and experimental design.


On some late effects of bilateral oophorectomy in the age range 15-30 years. Between 1910 and 1940, 146 young females, aged 15-30 years, underwent bilateral salpingo-oophorectomy as part of a radical operation for salpingo-oophoritis. These women or their records were reviewed in 1971. 42 women had died in the meantime. More than half (22) of them had died from cardiovascular diseases, 5 from carcinoma of the uterus and 4 had committed suicide. None had died from carcinoma of the breast. Of 68 who were still alive, information by questionnaire was obtained and 32 were admitted to hospital for extensive examination. 32 age-matched women to be operated on for prolapse but with no other known disease of the reproductive tract served as controls. A further control group was added as 11 of the 68 were found to have menstruated again after the operation which had evidently not completely removed the gonads. Complete oophorectomy was found to have been followed by: (a) an increased incidence of cardiac symptoms and nervous diseases as well as an increased use of drugs; (b) a significant increase in the frequency of coronary vascular diseases in ages up to 70 years; (c) an increase in the serum cholesterol and triglycerides, most significantly in the ages below 60-65 years. Women with symptomatic coronary disease had a higher serum cholesterol level than women without and women with signs of peripheral vascular diseases had a significantly higher concentration of serum triglycerides; (d) an increased frequency of fractures (radius and femoral neck), increased osteoporosis and thinner cortical bone. The brittleness of the skeleton was correlated with low excretion of oestrogens in the urine. No vertebral compression or abnormal decrease in height was observed. (e) an increased adrenocortical activity with significantly increased excretion of 17-ketosteroids, 17-OH-ketosteroids and low polar total oestrogens. This activity abated in women above 65 years. (f) a traumatic psychological experience of the accompanying sterility while sexuality seemed to be largely unaffected in many of them. Almost half of the women examined by the psychiatrist were unusually mentally active and agile and they had a lower excretion of estriol than the rest.


Tubal surgery. Report of 101 cases with special reference to the experience of the surgeon. A report is given of the results of tubal surgery in 101 cases selected from 851 sterility patients. The follow-up time was 3-10 years. Ordinary surgical technique was applied with the use of prednisolone and antibiotics but largely without the use of polyethylene tubing or other splints. Fourteen surgeons were involved. Since the most experienced surgeon operated on about 30% of the cases, an assessment of the effect of the surgeon's skill was possible. The patients are divided into groups with regard to type of operation, and the result is judged with regard to conception, live birth, ectopic pregnancy and abortion as well as with regard to patency. After salpingolysis the conception rate was 52%, and after salpingostomy 32%. There was, however, a gap between the conception rate and the live birth rate, especially for the salpingostomy cases. The live birth rate was more than twice as high after salpingolysis than after salpingostomy. The small lasting effect of cut adhesions is also demonstrated by the observation that combined unilateral or bilateral lysis did not interfere with the result after salpingostomy. Contrary to this, the patients conceived faster after salpingostomy than after salpingolysis. There was no difference between the results in the patients operated on by the most experienced surgeon and in those treated by the thirteen less skilled gynecologists.


Methods of calculating uterine blood flow from the wash-out curves of intra-arterial and local injections of 133Xenon. The wash-out curve from the human non-pregnant uterus of intra-arterially and locally injected 133Xenon can be broken down into two, sometimes three components. It has not been shown that these components are physiologically meaningful. However, if it is assumed that the uterus is composed of two or three compartments perfused in parallel, it is possible to calculate total blood flow per unit weight using relative weights of the compartments and compartment blood flows. Relative weights may be determined from the amount of isotope present in each compartment at the start of the washout. The possibly false assumption of a certain number of compartments has in this study been avoided by evaluating curves after intra-arterial injections according to the stochastic method of Zierler analysis, disregarding any elimination of isotope left after 20 minutes. After local injections initial slope analysis has been used. The equation for values according to Zierler as a function of compartment values is y=0.9772x-0.5921, for modified Zierler analysis values y=1.2582x-2.3993 and for initial slope values y=0.8679x-1.3412. The conclusion is that compartment analysis may be a good alternative for calculation of mean blood flow, even if it has not been shown that individual compartment values are physiologically meaningful.


Intravascular coagulation in pregnancy--treatment with heparin. Two pregnant women with a history of miscarriages or premature labour are described. In the 25-27th week of pregnancy routine examinations showed high levels of FDP in serum. Subsequent extensive coaggulation studies revealed a positive ethanol gelation test, low levels of firbrinogen, plasminogen, alpha2-macroglobulin and P&P and high level of AHF related protein for the stage of pregnancy, i.e. finding indicating abnormal proteolysis with activation of the coagulation and fibrinolytic system. Continuous intravenous heparin treatment caused the coagulation system to return to normal throughout the rest of pregnancy. Both women gave birth to healthy babies without any complications. But the placenta showed numerous infarcts. The heparin treatment may have prevented later developing of placental dysfunction.


Prevention of premature delivery in a unicornuate uterus by cervical cerclage. A 26-year-old woman had two premature deliveries when 6 months pregnant. Neither produced a living child. A hysterosalpingogram was done, confirming a diagnosis of unicornuate uterus. When the patient became pregnant again, a third and fourth time, cervical cerclage was done in both cases. Pregnancies were terminated by cesarean section because of breech presentation and malformation of the uterus and in each case a healthy living child was delivered. In our view, in order to prevent premature deliveries, when a diagnosis of uterus malformations has been confirmed, a cerclage should be performed.


Inner ear damage and hearing loss after exposure to tones of high intensity. Experimental animals (cats) were exposed to tones of 125, 1000, 2000, and 4000 Hz at sound pressure levels in the range 120 to 157.5 dB, and for durations of one hour (1000, 2000, 4000 Hz) or four hours (125 Hz). Pure tone audiograms were obtained for each animal before and after exposure. Post-exposure tests were continued until complete recovery of hearing had occurred or until a stable permanent threshold shift had been measured. Cochleas of animals were examined by phase-contrast microscopy; condition of all hair cells was recorded. Extent of inner-ear damage and range of frequencies for which hearing loss occurred increased as exposure tone was decreased in frequency. For example, exposure to 4000 Hz produced damage in a restricted region of the cochlea and hearing loss for a relatively narrow range of frequencies; exposure to 125 Hz produced wide-spread inner ear damage and hearing loss throughout the frequency range 125 to 6000 Hz.


Audiological findings in 125 cases of acoustic neuromas. The audiological findings in 125 patients with surgically confirmed acoustic neuromas are presented. Following the classification by Pulec et al. (1971) we found 20 medium-size and 105 large tumours; small tumours were not represented. A clear connection between the degree of hearing loss and tumour size was noted, while there was no correlation between duration of history and tumour size. An attempted evaluation of the different audiological tests (ABLB and Metz recruitment test, speech discrimination scores, tone decay, reflex decay, and Békésy tracings) that were applied to the patients, has been made. Attention is called to some audiological findings which, to our knowledge, have not been described previously. No patient in the entire material had normal hearing; 73 had anacusis, and 52 hearing losses of varying degree. In the presence of a normal contralateral ear, the evaluation of audiological tests at PTA thresholds poorer than 80 dB is rather questionable. Attention was therefore concentrated on 32 patients with a hearing loss of 80 dB or less. The pathophysiological basis for the typical hearing loss in patients with retrocochlear disease is a reduction in the number of active fibers in the acoustic nerve and it was to be expected that abnormal findings would be present especially in those tests that exert the greatest demand on the total transmission capacity of the nerve, in other words with the application of intense and/or prolonged sounds. The Metz test is just such a procedure and it is not surprising that it shows the highest degree of validity between all the tests. No single test suffices to distinguish cochlear from retrocochlear disease and it is necessary to use a battery of tests. Any unexpected variability in the outcome of ordinary routine test results has gradually become one main indication to pursue the diagnosis with more elaborate procedures, ant it has been a great help always to apply the Metz test as a part of our routine clinical examination.


Speech discrimination in quiet and in white noise by patients with peripheral and central lesions. Speech-discrimination scores in quiet and in white noise (O dB S/N ratio) were obtained from six groups of subjects. Differences of 40% or more between scores in quiet and in white noise were observed for less than 1% of the normal ears tested but were found for 8.0% of ears with noise trauma, 48% of ears with Meniere's disease, 62% of ears with subsequently surgically confirmed 8th-nerve tumors, 14% of ears of patients with multiple sclerosis, and 42% of ears contralateral to the lesion in patients with temporal-lobe damage.


Undistorted and filtered speech audiometry in children with normal hearing. Undistorted and filtered speech tests were carried out in 140 test subjects with normal hearing acuity ranging in age from 4 to 19 years. Routine adult word lists were used in all tests. The intelligibility of undistorted speech rose markedly in the age groups from 4 to 9 years and correspondingly in the filtered speech test up to 11 years, taking the group 16-19 years as basis of reference. According to these results a speech discrimination test can be made in childhood with the same methods as in adults, if the norms are taken into account. In the filtered speech test the binaural test result and the monaural discrimination ability of the left ear were significantly better than the monaural test results for the right ear up to the age of 12-13 years.


Ototoxicity of topically applied gentamicin using a statistical analysis of electrophysiological measurement. Ototoxicity of topically applied gentamicin was studied in guinea pigs. 0.3% gentamicin was instilled in one side of the middle ear cavity and Ringer's solution was instilled in the other side, and the difference in the cochlear microphonics measured with the round window electrode was analysed statistically. Instillation of Ringer's solution in the middle ear cavity for 1 day did not cause any significant sensorineural hearing loss, but on the 3rd day of instillation significantly reduced responses were observed, compared with the responses from non-treated ears, followed by a partial recovery starting on the 4th day. When gentamicin 0.3% was instilled into the middle ear cavity, significant deafness occurred 24 hours later, and highly significant deafness on the 2nd and 3rd day. The usage of gentamicin ear drops of the current formula should be discouraged until a better formula is provided.


Firing mechanisms in the single vestibular neurons in the cat. Spontaneous unitary discharges in nucleus vestibularis lateralis (NVL) neurons were studied in locally anesthetized cats. The mean +/-S.E. firing rate of spontaneous unitary discharges of NVL neurons was 19.8 +/- 0.9 Hz. About 12% of NVL neurons showed a random firing. The spontaneous unitary discharge rate of the gamma distribution at lambda=2 was relativley low. However, the others were high. Patterns of peak interval time of the distribution with one peak and the interpeak interval time of those with two and three peaks were almost the same.


The relationship between the nuclear DNA content in smears of aspirates and the prognosis of mucoepidermoid carcinoma. Cytophometric analysis of nuclear DNA content was performed in a series of mucoepidermoid carcinomas with an extreme difference in the clinical course, which was observed during a follow-up period of 6-13 years. The prerequisite for such a study was the development of a method, which made it possible to study the nuclear DNA content in tumour cells obtained at the time of diagnosis, i.e. 6-13 years ago in the present material. A special cytochemical procedure with destaining of the original Giemsa stain, refixation and subsequent Feulgen staining of the smears of aspirates in the original cytological material was developed. The cytophotometric nuclear DNA analysis of tumour cells in smears of aspirate from mucoepidermoid carcinomas showed that higher ploidy tumours (near-triploid) had a worse prognosis when compared with near-diploid tumours. These data are supported by our previous findings that a shift from a near-diploid to a near-triploid DNA content of the tumour cell nuclei was associated with the prognostic important property of invasive growth. Thus, the cytophotometric nuclear DNA analysis of aspirated tumour cells seems to give valuable information about the malignancy degree of the individual tumour, which is not possible to obtain only from the cytomorphological features.


The patency of the maxillary ostium in relation to body posture. Eleven subjects were investigated concerning the effect of postural changes on the functional size of the maxillary ostium. The ostial size expressed as the percentage of the initial value decreased only slightly when the body position was altered from 90 degrees (sitting) to 30 degrees, while the decrease between 30 degrees and 0 degrees (lying) was more pronounced. A cuff around the neck inflated to 25 mmHg gave a decrease corresponding to a value of 20 degrees body position. Insufficient ventilation of the paranasal sinuses when lying down may result, especially in cases already having small ostia in the sitting position.


Laser therapy of human benign and malignant neoplasms of the skin. Radiation of a powerful neodymium-doped glass pulsed laser, Pulsar-1000 type, has been used for therapy of 235 patients with a total of 257 precancerous lesions and benign tumours, 76 basal and squamous cell carcinomas, 13 melanoblastomas and 59 metastatic melanoblastomas in the skin. Energy density used in the treatment of precancerous lesions and benign tumours was 200-450 J/cm2, in basal and squamous cell carcinomas 400-500 J/cm2, in melanoblastomas and their skin metastases 800-1 000 J/cm2. The results have been satisfactory.


Olfactory neuroblastoma.

Olfactory neuroblastoma. A case of olfactory neuroblastoma, type 1 (olfactory neurocytoma), in a 44-year-old man is described. The tumour grew extensively in the right nasal cavity with involvement of the maxillary sinus and ethmoidal region, but was radically removed at operation. The prognosis and treatment are discussed in the light of earlier literature.


Mass-screening of a female population for detection of early carcinoma of the breast. In 1969-1970 a breast mass-screening was undertaken in Gävle, with thermography and questionnaire. Mammary radiography and clinical examination of subjects with abnormal screening reports and of a group of normal subjects were performed. In spite of having achieved early detection of malignant tumours in many cases with a preponderance of carcinoma cases in the abnormal group, thermography was found to have considerable drawbacks as a screening method.


Mucosal malignant melanomas of the head and neck with special reference to cases having a prolonged clinical course. A histological re-examination and re-classification of primary mucosal tumours of the head and neck region, treated at Radiumhemmet and Karolinska Sjukhuset during the period 1927-1970, revealed that 41 tumours were malignant melanomas. All these 41 tumours were located in the nasal cavity, paranasal sinuses and oral cavity and not a single case of primary mucosal malignant melanoma was found in other locations of the head and neck region. In the present study, the long-term prognosis has been analysed. The follow-up period was at least 5 years and ranged up to 48 years. It was found that mucosal malignant melanomas had a very poor prognosis with a five year survival rate of 17% (7 of the total 41 cases) and a ten year survival rate of 7% (3 of the total of 41 cases). The unpredictability of the clinical behaviour of this tumour type is elucidated by cases with a prolonged clinical course despite a primary relatively limited surgery, repeated local recurrences and regional lymph node metastases in an early stage of the disease. Thus, there is always a never-ceasing risk of death in the tumour disease when once a malignant melanoma has occurred. For this reason a meticulous and lifelong follow-up of tumour patients is stressed, and also the value of repeated surgery of local recurrences and regional lymph node metastases.


Hormonal treatment of mammary carcinoma with Progynon-Depot and Depostat. The results of combined treatment with 90 mg estradiol valerianate and 300 mg 17-alpha-hydroxy-19-norprogesterone-capronate (SH 834) (3 ml once a week i.m.) in 117 cases with disseminated or inoperable mammary carcinoma are reported. Objective remissions of 3 to 36 months were obtained in 48 patients. Soft tissue, lung and pleura metastases responded more favourably than bone metastases. Liver and brain metastases were unaffected.


Thyroplasty type I (lateral compression) for dysphonia due to vocal cord paralysis or atrophy. Based on the experimental results of thyroplasty, thyroplasty type I which aims at medical shifting the vocal cord was performed on 8 patients with dysphonia, 6 with vocal cord paralysis and 2 with vocal cord atrophy. The surgery was conducted on either in- or out-patient basis and local anesthesia was used. Usually, a rectangular incision was made on the thyroid cartilage at the level of the vocal cord, and the fragmemt was depressed inward. A cartilage piece taken from the opposite side was used as a wedge, if necessary, to enhance the effect of lateral compression of the vocal cord. The voice after surgery was generally satisfactory, except in one case of traumatic vocal cord paralysis. Complications such as stridor or dyspnea were nil. As surgical intervention inside the thyroid cartilage is minimal, fine and reliable adjustment of depression is possible during the surgery.


Epidermoid carcinoma of the lip. Histologic grading in the clinical evaluation. A retrospective microscopic evaluation of primary biopsies was carried out in a material of 438 patients with carcinoma of the lip. A multifactorial grading system consisting of 8 parameters, each sub-divided into 4 grades, was used. The degree of malignancy showed a statistically significant correlation to the frequency of metastases, frequency of recurrence or residual tumour, mortality and T classification. This grading system may allow a separation of risk groups in which special treatment and follow-up should be applied.


Skin reactions after different fractionation schedules giving the same cumulative radiation effect. The CRE formula was used for calculation of biologically equivalent radiation doses with different fractionation schedules. The early radiation effects, skin erythema and pigmentation were measured with a reflectance spectrophotometer at wavelengths 578 and 660 nm. The course and maximum for both erythema and pigmentation agreed well with the two types of fractionation. The results seem to justify further use of this simple formula.


Influence of oestrogen on the excretion of strontium-90 and -85 in mice. Groups of male CBA-mice were treated with oestrogenic hormones alone or in combination with 85Sr and 90Sr. The strontium retention was measured in special skeleton parts and also by means of whole body counting. After a period of increasing bone weight in mice treated with oestrogen and 90Sr, there were signs of a serious breakdown of that newly formed 'oestrogenic' bone tissue. The strontium retention was in no case found higher in animals treated with both the hormones and 90Sr when compared to those treated with 90Sr alone. The life span was shortened in mice given the combined treatment. The results support the theories that at the same time irradiated and stimulated cell populations are exposed to a larger risk for induction of tumours and that the irradiation injury cannot be referred entirely to the irradiation dose in a physical sense.


[Development of the gonads and gonaducts in the polypterids (Pisces)]. No study of the development of the gonads and gonoducts in Polypterus has ever been made in a more or less complete way. The present study does not fill up this gap, but repairs several lacks of knowledge, by putting clear a few items that may contribute to a better understanding of this development. In larvae between 5,5 mm and 9,6 mm the primary gonocytes appear under the pronephric ducts in the anterior region of the opisthonephros. A genital crest is foreshadowed there; one of its characteristics is a cubial epithelium. The latter does not have any relation with peritoneal channels and it does not contribute to the formation of gonocytes. In the following stages the gonocytes get very numerous because of cellular multiplication. They cause a local transformation of the genital crest into a genital fold; when the number of gonocytes has increased very much, a part of the fold gets transformated into a gonad. At no stage is there any intrusion of medullary tissue into this gonad anlage.


Initiating contractions of the gravid uterus through electro-acupuncture. This is a report on 35 patients on whom electro-acupuncture was tested as a method of initiating contractions. In all cases the membranes remained intact up to the end of the electro-acupuncture. Before the electro-acupuncture none of the patients had experienced any labor pains. The subjective reports were checked by planimetric evaluation of the tocogram curves. A statistical comparison of the values before and after electro-acupuncture was undertaken. Thirty-one cases evidenced certain increase in the intensity of labor contraction frequency (p less than 0.01). Amniotomy was performed immediately after the electro-acupuncture on 31 cases. In a control group likewise consisting of 35 gravidae with intact membranes, no electro-acupuncture was performed. In this control group no significant increase in labor activity could be observed. If amniotomy was performed on gravidae with contractions induced by electro-acupuncture, there was no latent period to be observed. Through avoidance of a lengthened latent period after amniotomy, fetal jeopardy during labor induction can be reduced.


The correspondence between some motor points and acupuncture loci. A double blind study was conducted to establish the possible correspondence between some motor points and acupuncture loci. The protocol calls for the acupuncturist marking the first group of volunteers with invisible ink at the acupuncture loci. Then the motor points in the same volunteer are found by electrodiagnosis. The error is made visible by UV illumination. In the second group, the procedure is reversed. A statistical analysis of the error yields the following classes of correspondences: (a) Excellent: 1st Dorsal Interosseus (hand) = LI-4; Abductor Pollicis Brevis = Lu-10; Abductor Minimi Digiti = SI-4; 1st Dorsal Interosseus (foot) = LI-3; Tibialis Anterior = Curious Locus; Orbicularis Oculi = GB-1; Frontalis = GB-14; Splenius Capitis = GB-20; Sternocleidomastoid = LI-18; Semi Spinalis Capitis = BI-10. (b) Good: Opponens Pollicis = Curious Locus; Peroneus Longus = Curious Locus; Flexor Digitorum Longus = Ki-3 (Ki-6); Trapezius (upper) = GB-21; Rectus Abdominis = Ki-15; Vastus Medialis = Sp-10.


Acupuncture analgesia in China.

Acupuncture analgesia in China. A delegation of ten Canadian anaesthetists visited the People's Republic of China in April and May 1974 and observed 87 surgical and 19 dental operations under acupuncture analgesia. In 80% of the cases observed the analgesia appeared adequate for the conduct of the planned surgery. The utilization of acupuncture analgesia varied from hospital to hospital; surgeons and anaesthetists appeared to have confidence in using it in a limited number of planned surgical operations. The technique of induction varied from hospital to hospital, but a certain pattern became apparent; body needling was related to the site of operation and also based on ancient theories; using loci unrelated to the operative site, para-incisional needles were used to produce skin analgesia; ear needling alone was used in 19 cases and nose needling in one. No premedication  was given for short cases and dental extractions. Most hospitals used electrical stimulation; in one institution needles were left in place during induction and throughout surgery without stimulation with equal results. A considerable degree of analgesia appeared to be present immediately post-operative and patients moved without concern for the operative site. It was felt that acupuncture analgesia represents n China an alternative to regional anaesthesia and that surgeons adapt their technique to the conscious patient in the operating room. It is essential that the patient cooperate and is prepared and motivated to withstand the emotional stress and unpleasant sensations associated with the surgery. Problems include inadequate suppression of visceral pain, lack of muscle relaxation and inadequate analgesia. In the author's opinion acupuncture analgesia has a very limited scope in our practice; it is time consuming and imposes considerable restrictions on the surgeon. However, the phenomenon is real and its investigation should contribute to a better understanding of the function of the nervous system.


The effect of acupuncture on essential hypertension. Twenty-eight patients with essential hypertension were treated with acupuncture therapy. Sixteen showed excellent improvement in terms of the lowering of blood pressure to normal and the disappearance of original symptoms. Eight had moderate improvement and 4 showed no response. The results of treatment seem to indicate that improvement is closely related to the duration of disease and the history of drug treatment. The selection of acupuncture loci and the techniques of needle insertion and manipulation are discussed in detail.


Cellular composition of the nipple aspirate specimen of breast fluid. I. The benign cells. A nipple aspirator device was used to obtain breast secretions for cytologic examination, as well as for viral and biochemical analysis. Examination of the first 1,456 specimens from 796 women revealed ductal epithelium in 54%. Ductal epithelial cells were often absent in specimens from normal women; however, 78.5% of women with benign breast disease on tissue biopsy had specimens containing ductal epithelium. Apocrine metaplastic cells were a further indication of the presence of breast disease, and were rarely found in specimens from asymptomatic women. Foam cells were often abundant in specimens from normal breasts, but were found in decreased numbers in specimens from women benign breast disease. Differences in the occurrence of ductal epithelial cells, apocrine metaplastic cells, and foam cells suggest an alteration in the rate of maturation of ductal epithelium in women with both benign and malignant breast disease. The finding of a relative abundance of cells in nipple aspirate specimens from women with breast disease and few or no cells in specimens from women with normal breasts is believed to be of great importance in the cytologic evaluation of nipple aspirate specimens.


Fibrinolytic activity in aneurysmal bone cysts. Euglobulin fibrinolytic activity of cyst fluid from six patients with aneurysmal bone cysys was considerably higher than that of arterial and venous blood of the corresponding patients. The high fibrinolytic activity was associated with a very low concentration of fibrinogen and a low concentration of plasminogen. Correspondingly, a high plasminogen activator activity was found in cyst tissue related to endothelial lining. It is suggested that fibrinolysis is an important factor in the maintenance and expansion of the aneurysmal bone cyst.


Quantitative one-stage assays for factors V and X. The relative sensitivities of the prothrombin time, Russell's viper venom time and activated partial thromboplastin time were determined in one-stage quantitative assays for factor V and factor X. Sensitivity was defined as the slope of the reference curve. The prothrombin time was the most sensitive test for factor X and the least sensitive for factor V. The Russell's viper venom time was the most sensitive test for factor V and least sensitive for factor X. The activated partial thromboplastin time approximated the sensitivity of Russell's viper venom for factor V and had intermediate sensitivity for factor X. The data indicate that factor V is best quantitated by the Russell's viper venom time and factor X by the prothrombin time, exactly the opposite of what is customarily done.


Normative and parametric analyses of school maladjustment. Format and instructional revisions were made in the TRF, a previously reported school adjustment measure, to extend its diagnostic, prescriptive, and empirical utility. Factor analyses of school adjustment ratings on the revised CARS with a normative sample of "healthy" primary graders demonstrated that while the revisions maintained the scale's original three-factor structure, they increased specific item factor loadings and accounted scale variance. To extend the screening utility of the proposed measure, normative and parametric comparisons are reported describing adjustment ratings for sex, age, and city/country subgroups. Comparisons of children who are or are not referred to a secondary prevention program provide evidence of the CARS discriminative validity and screening potential.


Job design variables as change measures in a correctional facility. The importance of working conditions is stressed as a neglected area of concern in human service organizations. The present investigation attempts to demonstrate the utility of the concept of job design dimensions as evaluative measures of change in a correctional facility for delinquent youth. Staff were administered a modified version of the Hackman/Lawler Job Design Inventory at two time periods separated by an interval of 14 months. Staff who were participants in an innovative institutional change program at both times were compared with staff who were not participants at Time I but were at Time II. The results provide support for the notion that examination of the perceptions of working conditions by employees may be an important method for assessing institutional change.


The community psychologist as social planner. Designing optimal environments. The environmental movement may provide a vehicle by which community psychologists can contribute to large-scale ecological change. This paper uses one outgrowth of the environmental movement--the environmental impact assessment process--to illustrate the procedures for input by community psychologists can participate in the environmental impact assessment process to (1) predict the effects of any new project on the demand for treatment services and (2) suggest ways in which a project may be designed to prevent psychological problems and enhance community well-being.


The prediction of "shows" and "no-shows" to a crisis center: a replication. The relationship between measures of worker effectiveness in a therapeutic telephone intervention and whether a caller shows for a scheduled appointment can be used to assess the variables that contribute to "successful" telephone counseling. This study replicated the findings of a previous investigation in showing that the motivation of a caller in response to the question of a referral was positively correlated with "showing" for the appointment. Futher, the identification of a specific problem related negatively to the caller's response to the referral. However, the concreteness of the phone worker was not correlated with whither the scheduled appointment was kept by the caller.


Selecting nonprofessional counselor trainees with the Group Assessment of Interpersonal Traits (GAIT). The GAIT is a procedure for sampling and measuring communication behavior. Candidates for a counselor-training program (136 Ss; 86% women; average age 44 yr.) took the GAIT in 18 groups and completed written forms for staff screening. Data included pre-GAIT first impression peer ratings and GAIT Empathy. Acceptance, and Openness ratings by peers and by trained audiotape judges. After nine months of training, 26 remaining Ss were judged on a counseling readiness criterion. First impression and peer GAIT ratings were positively intercorrelated, but none predicted counseling readiness. The criterion was correlated with both trained GAIT Empathy (Kendall tau = .40) and staff ratings (.41. both ps less than .01). Suggestions were made for using the GAIT as a counselor selection instrument.


A competency-based curriculum for training middle-level community--clinical psychologists. The focus of this paper is to delineate the basic skills that might be appropriate for a community--clinical psychologist.. The need for competent professionals to deliver mental health services has exceeded the capacity of existing training programs. Current training emphasis is aimed at providing a community--clinical psychologist on the middle level who would have a set of skills or competencies that would easily identify him as a psychologist


Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: introduction. It has been observed that among men of Japanese ancestry, there is a gradient in CHD mortality increasing from Japan to Hawaii to California. A study of 11,900 Japanese men in Hiroshima and Nagasaki, Japan, Honolulu, Hawaii, and the San Francisco Bay Area of California has been conducted to investigate this disease difference. This paper describes the selection of the study populations and their age distributions, and outlines the study methods. This paper also introduces and briefly summarizes four papers that give the results for mortality comparisons, biochemical and blood pressure distributions and results for heart disease prevalence among the three cohorts.


Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: mortality. Stroke, coronary heart disease (CHD) and total mortality are evaluated from death certificates in enumerated cohorts of 45-64-year old Japanese men in Hiroshima and Nagasaki (1965-1970), in Homolulu (1966-1970), and in the San Francisco area (1968-1972). Total mortality is highest in Japan with no consistent differences between Japanese Americans in Homolulu and San Francisco. Age-specific CHD death rates are markedly lower in all three Japanese groups than in American whites. The CHD rates are consistently and significantly lower in Japan that in American Japanese. Stroke death rates for American Japanese men appear equivalent to figures for US white men of the same age, but are significantly lower than in the Japan cohort for the 60-64-year-old group. The number of stroke deaths below that age are too few as yet for analysis. Validation of mortality ascertainment and of the accuracy of death certification has been carried out in Japan and in Hawaii. The international differences in mortaltiy do not appear to be due to certification or other methodologic artifact.


Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: distribution of biochemical risk factors. Distributions of serum cholesterol, glucose, uric acid and triglycerides are examined among Japanese men living in Japan, Hawaii and California. Laboratory methods are described in detail and efforts to assure comparability of these methods. In every age group studied, the mean, median and percentile for each of the biochemical variables are lower for men in Japan than in Hawaii and California.


Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: blood pressure distributions. Blood pressure measurements were made on three Japanese populations residing in Japan, Honolulu, and Northern California. A common protocol was utilized in an effort to standardize inter-observer variability. Zero terminal digit preference varied among the three areas and there was differential clustering of diastolic values at 80 mm Hg and 90 mm Hg in Hawaii and California, respectively. Diastolic blood pressure did not rise with age in any of the three populations while systolic blood pressure rose in each. Blood pressure levels in Japanese in Japan were intermediate to those in Hawaiian and Northern California Japanese, California having the higher blood pressure levels. Since the relative weights of the Japanese migrants to Hawaii and California were substantially higher than the relative weights of the non-migrant populations in Japan, the blood pressures were adjusted for these differences. When this was done, most of the differences among the various study subgroups were explained. The findings indicate that the blood pressure distributions of the Japanese populations residing in Japan, Hawaii, and Northern California cannot of themselves account for the observed differences in coronary heart disease and stroke occurrence among these populations in which there is a gradient from high stroke rates in Japan to low rates in California and a reverse trend for coronary heart disease.


Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: prevalence of coronary and hypertensive heart disease and associated risk factors. A study of coronary heart disease (CHD) among Japanese migrants compared with Japanese living in Japan provided the opportunity to study factors possibly responsible for the high rates of CHD in America as compared with Japan. Comparable methods were employed in examining 11,900 men of Japanese ancestry aged 45--69 living in Japan, Hawaii and California. The age-adjusted prevalence rates for definite CHD as determined by ECG were: Japan 5.3, Hawaii 5.2 and California 10.8/1000. For definite plus possible CHD the rates were 25.4, 34.7 and 44.6. The prevalence of angina pectoris and pain of possible myocardial infarction, determined by questionnaire, showed a similar gradient. Elevated serum cholesterol showed a Japan-Hawaii-California gradient, but the prevalence of hypertension in Japan was intermediate between the prevalence in Hawaii and the higher prevalence in California. The three geographic locations were compared as to prevalence of CHD at comparable levels of blood pressure and cholesterol. At each blood pressure level and at each cholesterol level, the greater prevalence of CHD in California persisted. These facts, plus the near universality of smoking in Japan, suggest that conventional risk factors only partly explain the observed gradient in CHD.


Prevalence of intestinal parasites in Latino residents of Chicago. In 1970, 250,000 Spanish-speaking persons resided in Chicago, 80,000 of whom were Puerto Rican. Because migration to Chicago is constantly occurring from areas where intestinal parasites are endemic, a survey was conducted in a predominantly Puerto Rican neighborhood to determine the prevalence of these parasites and to provide impetus for further case finding and treatment programs. The survey was part of an epidemiologic and cutreach workers going door-to-door obtained histories, hematocrits, and single stool specimens from 358 individuals. An overall intestinal parasite prevalence rate of 18.6% (67 persons) was found. Specific rates were Trichuris trichiura 13.9% (50 cases), hookworm 6.6% (24 cases), Giardia lamblia (3.9% (14 cases), and Strongyloides stercoralis 1.7% (6 cases). There were no cases of Ascaris lumbricoides or ENTAMOEBA HISTOLYTICA, Although several nonpathogenic protozoa were found. The most affected age groups were 15--24 years followed by 5--14. Two of the Giardia cases were individuals never out of the continental United States. An incidental finding was a high rate of low hematocrit readings not correlated with the parasite findings.


Serosurvey for "acute hemorrhagic conjunctivitis" virus (Enterovirus 70) antibodies in the Southeastern United States, with review of the literature and some epidemiologic implications. Acute hemorrhagic conjunctivitis (AHC) has been epidemic throughout much of the Eastern Hemisphere since its emergence in central West Africa in 1969. The disease had a distinctive clinical picture and an unusual geographic epidemiology. Between 1969 and 1975 AHC has occurred almost exclusively in crowded coastal areas of tropical countries during hot, rainy seasons. Only a few documented outbreaks have occurred in inland cities and in subtropical or temperate climate zones. Of 1014 residents of the eastern or southeastern United States who were screende for neutralizing antibodies to three or four strains of AHC virus (enterovirus type 70), three (0.3%) had titers ranging from 1:10 to 1:40. However, no clinical evidence of prior experience with AHC disease could be ascertained for these persons, so that the antigenic specificity of the detected antibodies is unknown. We conclude that populations of coastal tropical areas of northern South America and all of Central America are vulnerable to AHC epidemics.


Epidemic hepatitis B: a sustained outbreak in a large military population. A sustained outbreak of viral hepatitis occurred at an Army base in Texas between January 1971 and June 1973. Seven hundred ninety-two admissions but no deaths were recorded in a military population of 35,000. Cases were sporadic, with highest attack rates in low-ranking soldiers with disciplinary problems. Twenty-nine per cent of patients had histories of intravenous drug use within six months prior to  hospitalization; most of the rest had close personal contact with jaundiced persons. Of 505 patients tested, 31% were seropositive for hepatitis B antigen (HBSAg) by counterelectrophoresis. Comparison of 38 hepatitis patients (cases) to 34 orthopedic patients (controls) revealed marked differences in rates of exposure to jaundiced persons are shared needles. Sixteen (94%) of 17 antigenemic cases tested were of subtype ayw. Seven (78%) of nine NBSAg-negative cases tested were antibody (anti-HBS) positive three months later.


The Tecumseh Study of Respiratory Illness. IX. Occurence of influenza in the community, 1966--1971. The occurrence of types A and B influenza infections was determined by isolation and serology over six years among residents of Tecumseh, Michigan. By isolation, there was evidence of type A infection for a limited period during each year of the study; most rises in titer were detected during the periods of viral isolation, but some also occurred out of season. Outbreaks of type B infection were encountered three times during the six-year period and out of season infections were less frequently seen than with type A. Infection rates with type A were relatively flat over the age range, with high rates seen in infants and small children; in contrast, highest infection rates with type B were observed in the 5--14-year-olds. On examination of illness rates, it was found that some of the outbreaks wound have gone undetected if surveillance techniques for infection had not been in operation. Frequency of respiratory illness with activity restriction was taken as a guide to influenza virus activity during outbreaks; it was found that highest rates of such illnesses occurred among the 1--4-year-olds for type A outbreaks, and among the 5--9-year-olds during mixed or type B outbreaks.


The tethered conus.

The tethered conus. The tethered conus is a real and treatable entity. It presents with a variable though fairly constant symptom complex. The diagnosis is probably not even considered in many patients with this condition. Recognition of the possibility of this condition by both the clinician and radiologist is needed. Properly performed oil or air myelography is the only method of preoperative confirmation of a tethered conus and should be done in all cases where it is suspected.


Roentgen recognition of acute plastic bowing of the forearm in children. Traumatic bowing of one or both forearm bones in children represents an acute plastic deformation of bone. Plastic curvatures have been produced in the dog ulna, but have been recognized only recently in man. The biomechanics and histologic changes of the experimental model explain the roentgenological features found in children with traumatically bowed bones: (1) broad fixed curvatures which hold fractures in angulation and resist orthopedic reduction; (2) absence of periosteal new bone formation following the injury; and (3) partial correction of the plastic corvature by cortical remodeling in young children. In a series of 17 patients, eight children had bowing of the ulna with an angulated fracture of the radius, five had bowing of the radius with an angulated ulna fracture, and four children had both the radius and ulna bowed without fracture. Manipulative reduction in the majority of children with fractures failed to reduce the plastic curvature, causing partial loss of pronation and supination.


Drowning: another plunge.

Drowning: another plunge. Hypoxia, pulmonary edema, acidosis, and aspiration compose the syndrome of near drowning. A review of 20 cases of near drowning indicated that the initial chest roentgenogram bears little weight in assessing the present or future clinical status. In some cases a 24 to 48 hour delay occurred before roentgenographic evidence for pulmonary edema was noted. The composition of fluid aspirated does not affect the outcome. The results of this report suggest that patients with a history of near drowning should be followed closely for at least 48 hours despite an initial normal chest roentgenogram.


Arteriomegaly.

Arteriomegaly. Arteriomegaly describes tortuous, ectatic, irregular vessels with prolonged blood flow. Seven cases of this entity are outlined with representative case reports. The increased incidence of aneurysms, thrombosis and embolization is noted in this and other series. The possibility that tortuous vessels may be confused with aneurysms on examination is also discussed. Due to the prolongation of blood flow, adequate arteriographic evaluation may be quite difficult.


Dissecting aneurysm of thoracic aorta: reappraisal of radiologic diagnosis. In a series of 24 cases of acute dissecting aneurysm of the aorta (not including Marfan's disease) the diagnosis was usually suspected on the basis of the clinical picture and plain chest roentgenograms. The most consistent clinical sign was severe pain. Absent pulses and a neurological deficit were each noted in only five patients. In many cases there was no correlation between the clinical picture and the type or the extent of the dissection. Widening of the aortic arch and obliteration of the aortic knob with displacement of the trachea to the right are the most common signs in plain chest roentgenograms. A barium swallow examination in these cases reveals an elongated compression and displacement of the esophagus by the aortic arch. Calcification in the area of the aortic arch is the exception rather than the rule in dissecting aneurysms. Angiography is essential for the definitive diagnosis of dissecting aneurysms. The diagnosis is based on the demonstration of two channels, either by the presence of a linear radiolucency separating the two lumens, or by differences in flow that present as delayed opacification or delayed washout. If only the true lumen is opacified, widening of the outer extraluminal border of the aorta or narrowing of the lumen indicates the presence of a dissection. Abnormal catheter recoil and position were helpful in only two cases, and are not informative when the false lumen is catheterized. Failure to visualize main aortic branches was not always due to involvement by the dissection. It can also be caused by reduced flow due to severe proximal compression of the main lumen. The exact location of the intimal tears is usually not demonstrated unless additional injections are made in the area assumed to contain the tear. If only the false lumen is opacified in the ascending aorta, this can be recognized by the demonstration of a blind end, by failure to visualize the sinuses of Valsalva, from flattening of the medial border of the opacified channel, and from delayed washout in the blind end.


Roentgenology of sinus of Valsalva aneurysms. Aneurysms of the sinuses of Valsava are neither rare nor always fatal. They are of three types: congenital, acquired, and associated with cystic medial necrosis. Each can be recognized by its characteristic appearance on plain roentgenograms and arteriography. With surgical repair, the congenital type and that which is the result of cystic medial necrosis carry a good prognosis for the patient. With the acquired type, usually syphilitic, the prognosis with conservative management is good.


Angiographic features of Cimono-Brescia fistulas. Forty-four patients with operatively created arteriovenous fistulas have been examined angiographically. Widening of the main arteries of the forearm was evident, the most pronounced widening occurring in the artery feeding the fistula. Stenosis of the arteries or veins seldom influenced the flow significantly. Blood from the fistula was often partly or totally directed into the hand. In nine patients filling of deep veins was evident, and in most of these cases big fistulas were present. A rough estimate of the blood supply to the hand indicated poor supply in eight patients of which only one had symptoms of ischemia. Brachial angiography is of value in estimation of the blood flow in fistulas, when cannulation of veins is difficult, when thrombosis is suspected, or when a new fistula is planned after decreased function of an old one.


The cervical aortic arch.

The cervical aortic arch. Cervical aortic arch anomaly is a rare congenital entity. The aortic arch extends into the soft tissues of the neck before turning downward on itself to become the descending aorta. Nineteen cases have been previously reported in the world literature with one more presently in publication. We have collected six additional cases, in four of which the cervical arch was located on the left. Formerly the left cervical aortic arch was felt to be much less common than the right. It now appears that they have equal incidence. Four of our cases were also associated with cardiac anomalies, and this coincidence has not been previously reported.


The role of lymphangiography in chylothorax. A report of six nontraumatic cases. Six cases of nontraumatic chylothorax secondary to filariasis, postinflammatory thoracic duct obstruction, idiopathic lymphangiectasis with lymph node hypoplasia, lymphangioma and lymphoma (2 cases) are reported. All cases were studied by lymphangiography, which provided considerable diagnostic information. In those cases which are undiagnosed at the time the chylothorax is discovered, a lymphangiogram should be carried out prior to any therapeutic measures.


Peripheral vascular perfusion scanning. Correlation with the arteriogram and clinical assessment in the patient with peripheral vascular disease. Peripheral vascular perfusion scan during rest and reactive hyperemia does not necessarily offer the same information as the arteriogram or the clinical assessment of the peripheral pulses. The information obtained from the peripheral vascular perfusion scan offers potentially clinically useful information regarding the physiologic significance of various arterial lesions to the surgeon in selection of his therapeutic approach. The peripheral vascular perfusion scan uniquely and under varied physiologic conditions permits assessment of the effect of arterial disease on the distribution of perfusion within the extremity. The peripheral vascular perfusion scan is not in competition with, but is complementary to, arteriography and clinical assessment of the patient with peripheral vascular disease.


Experience in parathyroid scanning.

Experience in parathyroid scanning. In our experience, the low success rate of 75Se parathyroid studies does not justify continuance of the test as a routine diagnostic procedure. The initial results using the 99mTc O4--131I subtraction technique are encouraging but further experience is required in order to ascertain whether this procedure will justify a place as a routine test in the localization of parathyroid adenoma.


Roentgenology of sporotrichosis.

Roentgenology of sporotrichosis. Localized cutaneous as well as unifocal and multifocal systemic sporotrichosis may all produce roentgenographic findings. Localized cutaneous nodules may occasionally extend to the bone below producing a locally erosive lesion similar to those more commonly found in blastomycosis. More frequently, sporotrichosis involves the joints, either alone or with accompanying skin nodules. The joint changes are those of a pyogenic arthritis of the knees, elbows, hands, or feet which is difficult to distinguish from pyarthrosis produced by other organisms. The pulmonary findings depend upon whether or not the lung is the only site of infection. If there are no other areas of involvement, the pulmonary findings may be indistinguishable from those of secondary tuberculosis. However, if the skin on joints are also involved, small nodules appear and apparently do not proceed to cavitation.


Xerographic manifestations of male breast disease. Male breast disease, although overshadowed by its female counterpart, is still a problem which often comes to the attention of the radiologist. The major importance of mammography is differentiating unilateral gynecomastia from cancer. We now recognize four xeroradiographic patterns of gynecomastia: (1) increased ducts only; (2) ductal hyperplasia mimicking adenosis; (3) small ducts with stromal proliferation; and (4) fatty replacement only. These reflect the duration of the process. Gynecomastic masses are central, smooth, and most important, extend from the nipple outward, usually bisecting the midplane. Ducts may be visible. Carcinoma is usually central, dense, with irregular spiculated margins and, unlike gynecomastia is rarely in the midplane of the nipple, although it can be retroareolar in location. There may be concomitant skin changes or lymphadenopathy seen on the xerogram and these never occur in gynecomastia. There are numerous etiologies for gynecomastia, and these have been discussed in detail. It is thought that the radiologist should be aware of the pathophysiology of male breast disease and understand its significance.


The use of xeroradiography in the investigation of diseases occurring in the central nervous system. A total of 88 cases of normal and pathological conditions of the skull, brain and spinal cord was studied by skull series, pneumoencephalography, and air myelography. The roentgenographic images of these structures were recorded by conventional roentgenograms, xeroradiograms, and tomogrrams and compared with each other. In general the high resolution and wide recording latitude of xeroradiography produced a more pleasing, sharper image than that obtained by conventional roentgenography. However, the individual tomographic image was superior to xeroradiography.


Thorium induced hepatic hemangioendothelioma. Roentgen-angiographic findings in two additional cases with clinical "inform and  consent" problems. 1. Two additional cases of presumed, thorium-induced hemangioendothelioma of the liver are reported. 2. The angiographic pattern of large venous lakes conforms closely to the pathologic descriitions of this malignancy. 3. To our knowledge, angiography of the thorotrast (and vinyl chloride) liver, before the clinical evolution of malignancy, has not been recorded and may provide information of prognostic and therapeutic value. 4. Incidental identification of thorium deposits in the tissues of clinically healthy patients creates perplexing "inform and consent" problems. Presumably, these must be solved on an individual basis. 5. Because the use of thorotrast has been discontinued since the early 1950s, all physicians reviewing chest and abdominal roentgenograms should be aware of the characteristic appearance of human thorotrast deposits, especially in the liver, spleen and celiac lymph nodes. 6. The number of living thorotrast "carriers" and previous deaths from thorotrast related malignancy seems highly uncertain at this time.


Intrathoracic kidney.

Intrathoracic kidney. Two cases of ectopic, partly intrathoracic kidneys are discussed. One case represents bilateral ectopy, an extremely rare condition. This anomaly deserves consideration because a correct diagnosis can save the patient extensive examinations and possibly thoracic surgery.


Cavernous hemangioma of the kidney.

Cavernous hemangioma of the kidney. Three patients with cavernous hemangiomas of the kidney all presented with hematuria. In each there was found a poorly defined renal medullary mass with displacement of the calyces and renal vessels and paradoxical hypovascularity of the mass. This rare, benign tumor of the kidney should be considered in the presence of this characteristic clinical picture.


Radiologic features of the interureteric ridge. Careful attention to the dimensions and symmetry of the interureteric ridge, when it is visible, aids in interpretation of abnormalities in the bladder and ureters. It is important in evaluating renal agenesis, low ureteral calculi, trauma, and neoplasm.


Schwannomas of the central nervous system. Isolated schwannomas may occur in many different situations within the central nervous system. Most neurilemmomas are benign, and enucleation after longitudinal dissection of the nerve will usually affect a cure. It is for this reason that the roentgenological appearances should be appreciated and this diagnosis considered so as to attempt total surgical removal.


The neuroradiologic evaluation of "optic neuritis". Optic neuritis, even when clinically typical, cannot be diagnosed with certainty because mass lesions compressing the anterior visual pathways may mimic it. The radiologist is in a position to assist in identifying such lesions or in ruling them out and thus preventing surgical exploration. While every patient in whom the diagnosis of optic neuritis is entertained should have plain roentgenograms of skull, orbits and optic canals, we have developed a schema for detailed neuroradiologic investigation based on clinical and plain roentgenographic findings. A classification of such lesions by location is illustrated.


Barium findings in retrograde intussusception. Four instances of antiperistaltic intussusception are presented. These serve to depict the varied roentgen appearances in both types of intussusception on barium study and emphasize two simple interpretational principles: (1) when contrast material is administered orad to an antegrade or caudad to a retrograde intussusception, it must first enter the intussusceptum; and (2) when barium is administered orad to a retrograde or caudad to an antegrade intussusception, it must first enter the intussuscipiens. Attention is also directed to tube related intussusceptions and to potential difficulty in their identification.


The timing and sequence of events in the development of the limbs in the human embryo. A documented scheme of the early development of the human limbs is presented. It is based on (1) published and unpublished personal observations, and (2) reports of other workers who personally studied staged human embryos. The necessity of studying staged embryos in determining the precise sequence of developmental events is stressed.


Internal structure of cat extraocular muscle. Teasing preparations of cat extraocular muscles (EOM) were used to study the arrangement of muscle fibers and the distribution of the different cholinesterase-positive sites, i.e. (1) large motor endplates, (2) small motor endings of the 'en grappe' type, (3) myotendinous junctions and (4) myomyous junctions. The distribution of these cholinesterase-positive structures gives clear evidence of a complex muscle architecture of cat EOM. In the global layer of cat EOM, only multiply innervated muscle fibers run the whole length of the muscle. The focally innervated muscle fibers are generally shorter; they are usually arranged in series of two to three fibers being interconnected by myomyous junctions. Moreover, muscle fiber splitting is frequently present resulting in a netlike arrangement of muscle fibers. Most of the myomyous junctions occur between focally innervated muscle fibers, but also end-to-side connections of focally to multiply innervated muscle fibers are observed; multiply innervated muscle fi0ers have not been found connected to each other. In this layer, large motor endplates are distributed in several bands between origin and insertion. In the orbital layer all muscle fibers run from tendon to tendon, focally as well as multiply innervated ones. Here, large motor endplates are confined to a band in the middle of the muscle, and myomyous junctions are generally absent. Some functional implications of this complex architecture of cat EOM are discussed.


The postnatal development of the ovary in the "nude" mouse. The postnatal development of the ovary of the heterozygous nude (nu/+) mouse with the genetic background BALB/c is very similar--if not identical-- to that of other mouse strains. As other BALB/c mice, the nu/+ females become sexually mature during the 5th week post partum (p.p.). At this age the ovaries corpora lutea at various stages of differentiation. In the ovaries of newborn and 1 week-old homozygous (nu/nu) mice, the differentiation of oocytes into primary and secondary follicles is delayed. In the third postnatal week, the ovaries of homozygous females contain more atretic follicles than those of their heterozygous littermates. This increased degeneration of follicles may account for the greater mass of secondary interstitial tissue, which is observed in the ovaries of adult nu/nu females. In nine out of the 5 to 7 week-old nu/nu mice studied, the ovaries contained no-/or only very few corpora lutea. Thus in homozygous nude females, the onset of sexual maturity is delayed. This ovarial immaturity may persist throughout life. In other animals development may become normal. In addition to the impaired postnatal development of the ovary, unspecific inflammation of the uterine wall (endo- and/or myometritis) was detected in 47% of nu/nu animals older than five weeks. No direct correlation was, however, found between the delay of sexual maturation and the inflammatory changes in the uterus as many of the animals with an endo- or myometritis possessed mature ovaries. The low fertility of the female homozygous "nude" mouse seems, therefore, to be caused not only by an impaired differentiation of the ovary but also by inflammatory processes in the uterus.


Quantitative studies of the effect of progesterone on endometrial morphology of the spayed rat. The effects of various dosages and of various time periods of treatment with progesterone have been studied in the spayed, mature rat. Test objects were the cells of the luminal epithelium and of the endometrial stroma which were examined by qualitative and quantitative electron microscopy. No significant response was observed in epithelial or stromal cells until after 12 hrs of progesterone treatment. The nuclei of both cell types were then more circular than earlier with reduced long diameters. The functional significance of this change in configuration is unclear since only in the stromal cells was it followed by nuclear growth. Further, after 12 hrs of treatment the relative amounts of mitochondria and granular endoplasmic reticulum of stromal cells were reduced while the volume of the stromal cell cytoplasm appeared enlarged. This is taken as evidence that progesterone causes an intracellular oedema probably by decreasing cell membrane permeability. This response is probably not specific for the stroma but also includes the luminal epithelium, although the volume of the epithelial cell cytoplasm could not be determined here. Nucleolar enlargement did occur in stromal cells and was observed after 12 hrs of treatment but was not significant until after 24 hrs. At this point of time the net amount of granular endoplasmic reticulum in stromal and epithelial cells was increased indicating an increased protein synthesis in both cell types. However, only in the stromal cells was this associated with nucleolar enlargement, which supports the idea that progesterone stimulates protein synthesis through different mechanisms in the two cell types. Testing various dosages of progesterone showed that 0.5 mg had an effect similar to 5 mg of progesterone. When 0.05 mg progesterone was injected the only effect observed was an increase in the amount of apical vesicles of the luminal epithelium, showing that the epithelium is more sensitive to progesterone than the stroma.