Studies of pathophysiology in primary amenorrhea. Patients with primary amenorrhea underwent stimulation with luteinizing hormone releasing hormone (LRH) before and after clomiphene administration to determine the maturational status of the hypothalamic-pituitary-gonadal axis, and to assess the development of feedback control mechanisms. Four patients with clinically recognizable conditions served as models. One patient had panhypopituitarism with undetectable baseline FSH and LH values, no response to LRH or clomiphene, and no detectable feedback control. One patient with a "specific" hypothalamic hypogonadotropism had low baseline gonadotropins with a normal response to LRH and no positive or negative feedback mechanisms reflected by no change in LRH response after clomiphene. A patient with delayed puberty due to low bodyweight had low FSH and LH baseline values and an "immature" response to clomiphene, characterized by lowered baseline gonadotropins and an increased peak LH following LRH stimulation. The fourth patient, with an adolescent polycystic ovarian syndrome, had a high baseline LH, normal FSH, hyperresponse to LRH, and a "mature feedback control" as evidenced by an increase in baseline FSH and LH, and a decrease in the LRH response while on clomiphene. The remaining patients showed inappropriate responses. They are regarded as having defects rather than dysfunctions, and the possible abnormalities are discussed in relation to the clinical findings.


Gonadotropic responsiveness to clomiphene, LRH, estradiol, and bromocriptine in galactorrheic women. Twenty hyperprolactinemic patients with galactorrhea were studied to determine their gonadotropic responses to various stimuli. Five women lacked response to gonadotropin following the administration of clomiphene citrate. Ten patients who had luteinizing hormone releasing hormone (LRH) tests before and during bromocriptine administration exhibited varied FSH and LH responses that apparently were unaffected by bromocriptine therapy. A loss of the normal positive feedback of estrogens at the level of the hypothalamus was demonstrated in most patients before and during bromocriptine therapy. Long-term treatment with bromocriptine in 11 women resulted in a decrease of serum prolactin, cessation of lactation in all, and pregnancy in 8. These results suggest that the failure of normal secretion of gonadotropins in hyperprolactinemic women may result from 1) inadequate release of endogenous LRH, and 2) loss of the positive feedback of estrogens, as a result of the same hypothalamic disturbance that provokes the hyperprolactinemia. In turn, the elevated prolactin levels may exert a short-loop negative feedback at the hypothalamic level, inhibiting cyclic gonadotropin release.


Antenatal glucocorticoid therapy for the prevention of respiratory distress syndrome in the premature infant. A double-blind study was designed to investigate the effects of antenatal glucocorticoids on the incidence of respiratory distress syndrome (RDS) in 128 premature human infants. There was a significant reduction (P less than 0.05) in the incidence of RDS in the betamethasone-treated infants to 8.7% compared to an incidence of 22.6% in the saline-treated controls and 25.0% in infants whose mothers received methylprednisolone. The effectiveness of betamethasone in reducing RDS was limited to premature infants delivered to mothers with intact fetal membranes and with an initial L/S ratio less than 2.0. The time between administration of the glucocorticoid and delivery did not significantly affect the incidence of RDS in this study. The failure of methylprednisolone to reduce the development of RDS in premature infants suggests its potential use in maternal therapy during pregnancy with minimal effects on fetal maturation.


Basal cell carcinoma recurrence: early diagnosis and surgical treatment. Twelve patients with twenty recurrent basal cell carcinomas of the lids and adnexa were studied. Observations on the behavior and treatment were discussed. Suggested management was also given. The radical aggressive approach towards these recurrent lesions is suggested, although initial excision of some basal cells need not be as radical. As in all malignancies the prompt recognition of lesion, combined with appropriate treatment and regular follow-up are emphasized to effect a cure with good functional and cosmetic results.


Histocompatibility matching in poor prognosis combined procedure keratoplasty. To determine the effect of histocompatibility matching and mismatching at the rabbit leukocyte-locus A (RL-A locus) on graft survival in rabbits, we created a model to enhance graft failure. Rabbit corneas received alkali burns with consequent vascularization of the graft bed. Each rabbit underwent large (10-mm) penetrating keratoplasty and simultaneous lens extraction. Grafts in four of six corneas from the matched group remained transparent for the extent of the experiment; none of the grafts in the mismatched group were transparent at the end of the experiment.


Keratoplasty and intraocular lenses: follow-up study. In an effort of explore new approaches with the possibility of improving on existing methods of managing problem cases with combined corneal disease and cataracts, 35 patients were treated by keratoplasty, cataract extraction, and intraocular lens implantation in various combinations or by cataract extraction and lens implantation without keratoplasty over the past two years. Twenty-four of twenty-six grafts have remained clear over a 3- to 21-month period of observation. The two failures have been successfully regrafted. Eleven patients received a penetrating keratoplasty, cataract extraction and intraocular lens with ten remaining clear. Eight patients with corneal disease and aphakia received a penetrating graft and intraocular lens with all grafts remaining clear. Seven patients with a clear graft received a subsequent cataract extraction and lens implantation with six remaining clear. Nine patients with endothelial dystrophy and cataracts were not affected by cataract extraction and lens implantation. The relatively high success rate, rapid visual rehabilitation, and reduction in the incidence of vitreous loss, vitrectomy, and delayed vitreous complications via the methods employed have, to date, proven encouraging. Caution is advised until data from a larger case series and long-term follow-up become available. Short-term success is directly related to technique. To achieve immediate success, the need for considerable experience in keratoplasty and lens implantation can not be overemphasized.


Staged excision and reconstruction of extensive facial-orbital tumors. Extensive facial-orbital tumors are basal cell carcinomas which are exceptionally difficult to treat by conventional therapy because of: (1) skin involvement of more than one square inch of the eyelids of face; (2) fixation to bone or periosteum at the orbital rim; and (3) extension onto the inner surface of the eyelid or through the orbital septum. Due to indistinct skin margins, visual impressions of the extent of these tumors are unreliable. Radiation is usually contraindicated because of possible bone involvement. Single stage excision of the entire tumor with frozen section evaluation of the margins is difficult because of the extent of the facial and orbital components of the lesion. A technique is described which involves staged excision and reconstruction of such extensive tumors. Stage one involves lamellar resection of the skin tumor. Lamellar resection is a modification of the Mohs technique, using permanent section evaluation of all margins, after which the surgical defect is allowed to heal by granulation or is grafted. Stage two involves en bloc resection of the remaining tumor, with frozen section evaluation of all margins. Stage three involves later cosmetic and functional reconstruction of the orbit and eyelids in a tumor-free location. The use of this technique is demonstrated by the description of a patient who would probably have required exenteration if conventional surgical methods had been used.


[Automatic analysis of gastrographies by means of optical digital equipment (author's transl)]. The present paper is concerned with problems of automatic analysis of radiograms, specially cinegastrographies. This study is connected with the utilisation of an interactive system including optical digitizer with its units of control and visualization. This system can explore the radiologic film in its current size of 30 X 40 cm. The particular interest of this application is extracting several parameters characterizing the size and the shape of the stomach. A middle axis can be extracted by computing, from this one a spatio-temporal diagram can be obtained. From this methodology of representation, several states of gastric motility could be characterized.


Catabolism of deoxythymidylate in some trypanosomatids. An initial observation concerning the failure of [3H]thymidine at high specific activity to be incorporated into the DNA of Crithidia fasciculata for more than a brief initial period has been correlated with the presence at high specific activity in the organism of a thymidine phosphorylase activity with an equilibrium in the direction of catabolism. This enzyme degrades thymidine to thymine which is not utilized by the organism. The enzyme has also been shown to be present in a number of other trypanosomatids, including the culture forms of Trypanosoma cruzi, where the specific activity was nearly as high as that in C. fasciculata. Evidence is presented that in C. fasciculata, the culture forms of T. cruzi and possibly other species of trypanosomatid, the thymidine phosphorylae, together with a thymidylate phosphatase, forms a catabolic pathway which degrades thymine nucleotides to thymine, which is then excreted. About 60% of the thymine nucleotides made by organisms appear to be metabolized through the pathway, suggesting that their synthesis is not subject to completely effective regulatory control.


[Demonstration and partial characterization of cardiotoxic and neutrotoxic substances in the serum of burnt patients (author's transl)]. Cardio-circulatory and neurological complications may appear between the second and seventh day of treatment of severely burnt (greater than 30% of body surface, 3rd degree) patients between the 2nd and 7th day, even if their lesions follow an apparently favorable course. The purpose of the present work was to isolate substances from the sera of such patients which would be responsible for the toxic effects. The sera of several patients were fractionated by Cohn's method n degree 6 and the fractions were tested in vivo in rabbits, rats and mice for their toxic effects. We could demonstrate in some of the fractions (II + III, IV and VI) toxic activity on the central nervous system, on the cardiocirculatory and respiratory systems. An acute toxic activity was also present as well as a substance increasing the permeability of the blood-brain barrier. All these factors together may be involved in the production of the above-mentioned clinical symptoms. Their appearance may depend on the concentration of toxic substances in the blood and on the resistance of the patients.


[Estrogen and progesterone receptors in non carcinomatous breast diseases (author's transl)]. Cytosolic receptors for estrogens and progesterone are studied using an exchange method in various types of benign breast diseases: fibroadenomas, fibrocystic mastosis, phylloid tumors and gynecomastias. The results show clearly that, contrary to breast carcinomas, receptors are generally not present in benign tumors. These results are statistically significant for all the women studied. Studying the pathological aspects of the tumors, it can be noted that the presence of receptors, is correlated with proliferation forms with large epithelial components. Furthermore, these results show that receptors are not found in gynecomastia. In conclusion, the physician should follow up very carefully the patients with a benign tumor, when hormono-receptors are present.


[HLA antigen and Willebrand's disease (author's transl)]. The frequency of HLA antigens was determined in 28 unrelated patients with Willebrand's disease and in 326 healthy controls. There was no significant difference between the two groups for any of the HLA antigens tested. Segregation analysis processed among the families of 26 of these patients didn't allow us to find any disorder of the HLA antigens distribution in the patient's group: transmission of the disease and transmission of the HLA haplotypes appear to be independant in 25 of 26 families studied. There is no linkage and no association between the Willebrand's disease genes and the HLA system genes.


[Report of a case of subcutaneous abscess due to Eikenella corrodens in a splenectomized patient (author's transl)]. A case of subcutaneous abscess of the chest-wall due to Eikenella corrodens is reported in a patient recently splenectomized. This bacillus was grown in pure culture. Processing specimens and identification methods of this little Gram-negative bacillus are described. Eikenella corrodens is a commensal frequently encountered in mucous membrane surfaces. It is likely that this microorganism may be an "opportunist" pathogen.


[Oncornaviruses genome: properties of viral RNAs in virions and cells (author's transl)]. This review tentatively recaptitulates most of the known data concerning the genome of oncornaviruses (Retroviruses). The first part deals with the structural features of the 60-70S RNA and its constituting subunits and other cellular RNAs which are present inside the viruses. The second part describes the viral RNA species which have been found in various cell systems including infected producer cells, transformed and non producer cells, normal and inductible cells. A special part is devoted to viral RNAs isolated from human cancer cells.


[Liquid scintillation counting of 51chromium. Application to a micromethod of cell-mediated cytotoxic assay (author's transl)]. Detection of gamma emitting isotopes is achieved conventionally by using a gamma spectrometer, or in some cases by liquid scintillation counting. We applied these two methods to the detection of 51 Chromium released in a lymphocyte-mediated cytotoxic reaction. Detection in liquid scintillation appeared more efficient than conventional gamma detection: 16.74% vs 1,11%. It is therefore possible to reduce by a factor of 10 the number of target cells in the cytotoxic assay if liquid scintillation counting is used. Either method gave the same results when applied on the same samples. Liquid scintillation counting is to be preferred when high sensitivity is needed. In addition it offers the advantage of using the same apparatus for detection of gamma or beta emitting isotopes.


[Effects of hyperbaric environment on the course of experimental lymphocytic choriomeningitis (LCM) in the mouse (author's transl)]. During a week, adult Swiss mice inoculated with LCM virus were exposed to hyperbaric environment (51 ATA) in He-O2 mixture. This exposure delayed the mortality by virus infection for 5-6 days and/or lowered or abolished the specific cerebral pathology. However, at the moment of death, the infectious titer of virus in the brain of exposed mice was not significantly decreased. Some physico-chemical factors involved in hyperbaric environment were investigated in order to determine their possible role in inducing the delayed mortality. Temperature has no effect on the course of experimental LCM in the mouse while He-O2 mixture at atmospheric pressure aggravate the viral disease. Pure O2 applied at 2 ATA intermittently has some beneficial effect but only on specific cerebral alterations. Thus, it seems likely that "per se" hydrostatic pressure and/or an hyperabaric helium specific effect is responsible for the delay of mortality after hyperbaric exposure. Possible mechanisms leading to this delay, i.e. a transient abolition of immunologic response of mice to LCM virus, are briefly discussed.


[Gastro-intestinal electromyography: interest in the study of mechansims of regulation of intestinal motility (author's transl)]. Investigations we carried out in man and animals in order to study the relationships between the electrical and the mechanical activities of the intestine, and to precise the role of BER in the regulation of intestinal motility. In the dog, an intestinal movements transducer allowed to establish that spiking activities were concomitant with circular contractions, and that these two phenomena were rhythmed by the slow waves. Under basal conditions, the longitudinal movements occurred independently; under stimulation longitudinal movements occurred independently; under stimulation longitudinal relaxations were observed to correspond to circular contractions. In man, the post-laparotomy paralytic ileus provoked abnormalities in the BER which seemed to be related to a disturbance of the coordination of the motility, resulting in the absence of intraluminal propulsion. Administration of coherin, a postpituitary extract, was followed by a regularization of the BER and by a decrease of paralytic ileus duration. This confirms the important role of the BER in the myogenic regulation of the intestinal motility.


[Drug sensitivity of Haemophilus sp. and transfer of resistance into E. coli (author's transl)]. From June 1973 to July 1976, 742 strains of Haemophilus influenzae and parainfluenzae, isolated from clinical specimens, were routinely tested for in vitro sensitivity to twelve antibiotics: penicillin, ampicillin, cephalothin, streptomycin, kanamycin, gentamicin, chloramphenicol, tetracyclin, minocyclin, erythromycin, sulfamethoxazol, trimethoprim. 61 strains were found resistant to one or more of these antibiotics (ampicillin, kanamycin, chloramphenicol and tetracyclin). The MICs of 23 antibiotics were determined by the agar dilution method on most of the resistant strains and on 60 sensitive strains isolated during the same period and considered as control. 21 strains transferred their resistance determinants into E. coli K12; 23 plasmids were obtained isolated from these strains: 2 strains contained two different plasmids. 90% of the transconjugants were stable after repeated subcultures.


[Comparative study of three technics of inverse passive hemagglutination in the search for a surface antigen of the hepatitis b virus (Ag HBs) (author's transl)]. The following three different versions of reverse passive hemagglutination (RPHA) were evaluated for the detection of HBs antigen: Auscell I - Abbott, WH HBs - Wellcome and the hepanosticon - Organon technique and results obtained were compared with those obtained by the radio immuno assay (Ausria II of Abbott). In 493 sera studied, up to 16,8% were found positive by RPHA as compared to 17,2% positives by RIA. The percentage of false positives by the different methods varied from 4,9 to 7,3. Confirmatory tests, either absorption or neutralization, are necessary to ascertain accuracy of positive results in each of the 3 RPHA methods. The high quality of the Auscell and WH HBs confirmative test allows their sole use although they are slightly less sensitive than the RIA. We would recommand use of the Hepanosticon test whenever positive sera can be confirmed by RIA.


[Erysipelothrix rhusiopathiae infections. General review of 31 cases of septicemia with endocarditis reported in the literature (author's transl)]. Erysipelothrix rhusiopathiae is widely distributed in nature (animal, soil). It is commonly known as the causative agent of cutaneous lesions called "erysipeloid of Rosenbach". Only 31 cases of bacterial endocarditis have been reported in the literature. The etiologic diagnosis of Esysipelothrix infection was established by the presence of bacteria in blood cultures or heart-valve cultures. Immunological study is unusual owing to the rapid course of the infection. The histologic observation of heart lesions corroborates the diagnosis. The patient's receptivity depends on his occupation, general health (importance of rheumatic heart disease), sex (male), age (from 40 to 60 years old), but also on the season (from July to October) and climate (temperate). With the exception of the few cases where it is possible to recognize a portal of entry of infection or the appearance of typical cutaneous manifestations, bacterial endocarditis due to Erysipelothrix presents a clinical picture similar to that of most other bacterial endocarditis. The antibiotic treatment is an association of penicillin-streptomycin, administered in large doses over a period of at least four weeks. In spite of intensive therapy, many patients died.


[Simultaneous electrochemical determinations of total co2 and chlorides in biological fluids (author's transl)]. We thought it was interesting to study the results provided by an instrument intended for chlorides and total CO2 plasmatic determinations using specific electrodes. The main qualities observed are the following: -Chloride linearity 10 up to 300 mmol/I. -Total CO2 linearity 5 up to 50 mmol/I. The within run precision for chloride is 0,74% CV and for total CO2 is 1,56% CV. The between day precision is excellent: CI--0,95% CV. Total CO2 1,54% CV. --No contamination at all. --Throughput: 55 samples per hour. --Good correlation with the routine methods used in our laboratory CI--r = 0,90. Total CO2 r = 0,98. --No interferences at all by compounds such as hemoglobulin, bilirubin. --Possible measurement with urine, CSF, gastric fluid, ascites and pleural punctures and sweat. This instrument seems well adapted for pediatric, resuscitation and "stat" setting in a clinical laboratory.


Terbutaline and ephedrine in asthmatic children. The effects of terbutaline, ephedrine, and placebo on the cardiovascular and pulmonary systems have been compared in 24 asthmatic children. Ephedrine and terbutaline were both found to be effective bronchodilators, with onset of action within 30 minutes. The bronchodilator effect of ephedrine was maintained for three hours, while terbutaline was active for five hours. Terbutaline caused significantly greater improvement in pulmonary functions than did ephedrine. Both terbutaline and ephedrine were associated with clinically insignificant changes in blood pressure and pulse rate. The only significant side effect observed was hand tremor in children receiving terbutaline and this appeared only early in the course of drug treatment. There was no evidence of tolerance to the bronchodilator effect of ephedrine or terbutaline after eight weeks of therapy.


C-reactive protein in streptococcal pharyngitis. This study was designed to explore whether the test for C-reactive protein (CRP) is useful in differentiating bona fide streptococcal infection from the symptomatic carrier at the time of the acute visit to the physician. Serial blood samples from 157 children with symptomatic pharyngitis and a positive culture for group A streptococci were analyzed for the presence or absence of CRP. These data were compared with the patients' antibody responses to two streptococcal extracellular antigens (antistreptolysin O and antistreptococcal deoxyribonuclease B). Seventy-eight percent of patients with serologically confirmed streptococcal pharyngitis had a positive CRP test at the initial visit. Conversely, if the CRP test was negative at the acute visit, only about 25% later showed an antibody response. This latter finding held regardless of the degree of positivity of the initial culture, the presence of exudate or adenitis, or the presence of a temperature greater than 38.3 C (101 F) or coryza. These data suggest that the CRP test may be helpful to the clinician, especially if this abnormal protein is absent at the time of the acute visit.


Characteristics of the Inside-of-the Body Test drawings performed by normal school children. The Inside-of-the-Body test was administered to an unselected group of 150 elementary school children in Grades 1 to 6. The most frequently identified body part was the heart. Musculoskeletal and visible body parts were identified in younger children. Children in the higher grade levels drew more cavity organs and their drawings more frequently showed the organs in the correct anatomic arrangement. The Inside-of-the-Body test may be a useful adjunctive tool in the psychological assessment of children by identifying the development of internal body perception in normal children as well as those with physical and psychological disorders.


Effect of birth order and perceived stress on social schemata. This experiment used the Felt Figure Technique developed by Kuethe in an attempt to investigate the relationship between birth order and the use of specific social schemata. Seven object sets were used, three two-figure sets and four three-figure sets. The results indicated that for the two-figure sets, firstborn individuals placed the figures closer together than laterborn individuals. For the three-figure sets, firstborn individuals under stress placed the figures closer together. The three-figure sets were also ordered in terms of the number of human figures in the object set. The results suggest that there is a measurable relationship between birth order and social schemata used by an individual.


Comparison of biofeedback pulse wave velocity and progressive relaxation on essential hypertensives. In a study undertaken to evaluate the clinical effectiveness of two behavioral treatments for essential hypertension (biofeedback on arterial pulse-wave velocity and progressive relaxation) 24 hypertensive subjects were randomly assigned to either a relaxation or biofeedback treatment group for 5 weekly sessions. In a second stage of the study 16 of the original subjects received both biofeedback and relaxation treatments during 5 additional weekly sessions. Results indicated that biofeedback and relaxation were equally effective in initial lowering of blood pressure in hypertensives. Although biofeedback training lead to superior reductions at the 3-mo. follow-up point, after 1 yr. the blood pressures of both groups were not only equal but well below those presented at the beginning of the study.


Adaptive training and individual differences in perception. Four types of training techniques were compared in the training of a perceptual concept-formation task. Adaptive training, a technique in which one parameter in the learning situation is varied so that the difficulty of a learning task remains constant for that individual, was compared to three intermediate approaches to training (self-adaptive, in which the trainees could control their own pace of learning by indicating when they felt they had mastered the problem, fixed sequence, and fixed task). The relationship between individual trainee's perceptual style and various stages of training was also investigated. Perceptual style was measured by the Hidden Figures Test, the Rod-and-frame Test, a Distracting Context Test, and a Cancellation Test. Results showed a definite (time to perform the task) advantage in favor of the adaptive training method. Fewer errors were committed under the self-adaptive approach, but the task completion time was significantly higher. Further analysis showed that for the adaptive-training group, measures of perceptual style could be used as predictors of future task success. No such relationship was found for other training techniques. In particular, field-independence appears to be important early in training but becomes increasingly less important, and for the final training criterion trials, is not predictive of performance. In contrast, the Distracting Contest Test-II, early in training, is not an important predictor but is an important predictor for the final criterion trials.


Contemporary dilemmas in personality assessment illustrated in a diagnostic case study. Hand Test and California Psychological Inventory data produced by two nonviolent sex offenders are presented in case study format. Marked similarities in personality of these subjects are noted and discussed in relation to difficulties which plague the field of measurement and evaluation. Social relevancy is noted and the need for systematic study of large samples is emphasized.


[The action of acupuncture on pain. Physiological basis]. A review of experimental studies concerning acupuncture gives a current indication as to the neurophysiological mechanisms of its hypoalgesic effects. In man, these effects are demonstrated by study of the nociceptive flexion reflex. Other methods for the study of pain threshold have revealed a hypoalgesic action in man and in the animal. The authors analyse the pathways and structures necessary to analgesia: peripheral afferent pathway, ascending pathways, suprasegmental controls. The inhibitory mechanisms activated by acupuncture appear to be identical to those involved in analgesia by morphine and by central stimulation.


Screening for bacteriuria: Microstix and dipslides. The Microstix system has been tested, in parallel with dipslides, for suitability as a screening technique for the detection of bacteriuria. Results obtained using each method on 228 urine specimens were assessed by comparison with the results of quantitative counts. Dipslides had a higher sensitivity (86-7%) than Microstix. The best specificity (100%) was obtained from those results (77-6%) where both components of the Microstix system were in agreement. Advantages of Microstix are its greater shelf-life and its compactness.


[Intermittent ventilatory assistance with a mouthpiece (volumetric type respirator): optical technic of rehabilitation]. The authors described an optical technique enabling patients with chronic respiratory insuffiency, at first to get used to assisted ventilation, then to control it, to obtain an active ventilation operated by machine corresponding to a particular shape of the pressure curve and to the lesser haemodynamic repercussion.


[Variations in gas exchange and hemodynamic effects of various means of oxygen administration (spontaneous ventilation, controlled ventilation and under I.P.P.B.) in 19 severely obstructed pulmonary hypertension patients]. In 19 cases of severe chronic respiratory insufficiency by obstruction, the authors studied the haemogasometry and haemodynamic incidence of inhaling a mixture with FiO2 by various ways and in respiratory reeducation. Controled ventilation with or without manual abdominal pressure, instrumental kinesitherapy under pressure relaxor and simple oxygen inhalation. The pressure relaxor seems particularly suited to patients suffering above all from hypercapnia and obstruction because of its limited haemodynamic repercussions.


[Rehabilitation of chronic pulmonary patients. Critical study of objectives and methods. Current state of the problem]. Having given a definition of chronic pulmonary patients and of readaptation by reference to the W.H.O. and to the results of an international survey and the study group of the special Unit of the European Society of respiratory Physiopathology, the authors report a critical study of the conception and the present aims of readaptation. They successively present the therapeutical, medico-social and psychological aspects of readaptation, the different techniques used today, and summarize the present functioning of Europeans centres of readaptation. Finally they draw the main lines of a program of readaptation with the public health scheme and envisage the problems of organization and functioning.


[Physiotherapy and aerosols with intermittent positive pressure in the rehabilitation of chronic obstructive lung diseases]. In patients with chronic obstructive bronchial disease, the maximal deposition of aerosol in the lung is obtained by intermittent positive pressure. In normal subjects the use of respirator hardly increases the aerosol deposition. On the contrary displacing the vaporizer in a lateral position reduces the bronchopulmonary deposition.


Electron and light microscopy examination of capsules around breast implants. An investigation, by scanning electron microscopy of the capsules formed around silicone breast implants revealed that they consist almost entirely of connective tissue. In contrast, the capsules around the Y-prostheses (with a polyurethane foam surface) showed a foreign body reaction. We believe that excessive capsule formation around silicone implants is, among other factors, most likely due to discrete or moderate bleeding with subsequent hematoma formation. Therefore, we favor a two-stage procedure for subcutaneous mastectomy with insertion of the implant at 4 to 6 months after the excision.


The illness of Ludwig II of Bavaria.

The illness of Ludwig II of Bavaria. It has been argued by many biographers of King Ludwig II that he was not mentally ill but simply labelled mad as part of a conspiracy to remove him from the throne. The evidence for his mental disorder is reviewed and the conclusion drawn that he was probably suffering from a schizophrenic illness of some twenty years duration prior to his suicide in 1886.


Microradiographic studies of renal lymphatics. Cortical and medullary lymphatics have been observed during micro-angiographic studies of canine renal allograft rejection and retrograde ureteral injection in normal pigs. Lymphatic filling results from microvascular damage in the canine model and forniceal rupture in the pig. Renal lymphatics function as an alternate route for drainage during altered physiological states.


New techniques for interruption of gastroesophageal venous blood flow. Enlarged gastroesophageal veins were successfully obliterated in 41 patients using embolization with modified autogenous clots and/or Gelfoam, balloon occlusion, iatrogenic perivenous hematoma, sclerosing agents (Sotradecol and Keflin), or a combination of these methods. Thirteen patients were actively bleeding when studied, and the site of bleeding was detected in 4. Surgical exploration of 16 patients and autopsy study of 5 showed persistent obliteration ranging between three weeks and seven months. No major complications requiring reparative surgery were encountered. Gelfoam soaked with Sotradecol is the preferred agent because it provides persistent obliteration of the embolized veins. Patients who are acutely bleeding or have done so previously are candidates for selective obliteration of the gastroesophageal veins.


Computed tomography of the kidney.

Computed tomography of the kidney. Computed tomography is an extremely accurate method of obtaining more definitive diagnostic information about a renal mass discovered on a urogram. Benign renal cysts are readily distinguished from solid renal neoplasms, and CT is often valuable in characterizing possible juxtarenal masses. The cause of a nonfunctioning kidney(s) on a urogram can often be discerned, and hydronephrosis is easily detected.


The serological relationship of a British Theileria with other Theileria species using the indirect fluorescent antibody test. Antisera and antigens of a Theileria species isolated from British cattle were compared with those of six strains of Theileria mutans from geographically separated areas in East and South Africa, using the indirect fluorescent antibody (IFA) test. It was found that the British Theileria species did not react in the IFA test with these strains of T mutans. The British Theileria species was also compared with a variety of other Theileria species using the IFA test and no reactions were detected. It was concluded that the British Theileria species, which has been designated T mutans Essex, could be distinct from African T mutans.


Antibody response of calves to a single infection of Fasciola gigantica determined by an indirect fluorescent antibody technique. The antibody response of six calves infected with 500 metacercariae of Fasciola gigantica each was monitored throughout 30 weeks of infection using an indirect fluorescent antibody technique (IFA). In vitro excysted F gigantica were employed as the test antigen. All animals showed high antibody titres from two to six weeks post-infection. Thereafter the antibody titres diminished gradually. Although all the experimentally infected animals harboured fluke burdens at autopsy, most gave negative IFA tests from 22 weeks post infection onwards. Specific immunofluorescent staining occurred on the surface glycocalyx of the newly excysted flukes. It is likely that this glycocalyx provides one of the earliest antigenic stimuli for the host's immune reactions to fascioliasis.


Observations on the possible invasiveness of Clostridium botulinum for waterfowl. Twenty-four ducklings given multiple doses of Clostridium botulinum type C spores and toxin per os and 27 affected waterfowl from four natural outbreaks of the disease were examined bacteriologically. No evidence of invasion of the blood or liver was found in any bird and it is suggested that invasiveness and toxigenesis in internal organs are probably of little, if any, importance in the causation of botulism in waterfowl.


Discrimination of B, T and null lymphocytes by esterase cytochemistry. A technique has been devised which optimally demonstrates non-specific esterase activity in human blood lymphocytes. The reaction is carried out on smears fixed with formalin vapour, using alpha-naphthol butyrate as substrate at pH 8 and at a low concentration for a short incubation period. The pattern of esterase activity revealed by this method provides a discriminating marker for mature T-lymphocytes, which show dense, localised, dot-like positivity, and a probable marker for 'null' cells in the form of scattered granular positivity. B cells appear to be negative. Monocytes show a clearly different pattern of granular positivity.


[Disorders of the cerebral function in patients in a dialysis-transplantation program]. 36 patients of a dialysis-transplantation program with well functioning cadaver kidneys were investigated psychometrically for organic losses in intellectual function. 50% of the patients showed organicity an average of 16 months after transplantation. These organic deficits were found significantly more often when dialysis treatment had been complicated by marked medical problems. It is concluded that early transplantation of well dialyzed, medically fit patients will contribute to preventing persistent organic brain syndromes.


[Extramembranous glomerulitis. Apropos of 92 cases]. 92 cases of extramembranous glomerulitis (EMG) documented by histology and immunofluorescence have been studied. At the time of renal biopsy the clinical and biologic picture was as follows: no proteinuria in 2%, isolated proteinuria in 18%, nephrotic syndrome without hypertension or azotemia in 41%, and hypertension and/or azotemia associated with proteinuria or nephrotic syndrome in 39%. A possible cause of the EMG was found in 27 cases: it was drug-induced or toxic in 10 instances, paraneoplastic in 7, lupus in 5 and parasitic (loasis) in 5.65 cases are regarded as idiopathic. The evolution is known in 66 cases and varies with the etiology: it is usually benign in secondary forms except the paraneoplastic cases. In the idiopathic forms it results in hypertension or more or less severe chronic renal failure in 62% of cases. The prognosis cannot be established on the basis of the initial histology. No treatment has proved effective.


Studies on a new antibiotic--Chuangxinmycin. A new antibiotic, designated Chuangxinmycin and produced by a new species of microorganism Actinoplanes tsinanensis n. sp., has been isolated in crystalline form. Assay methods, fermentation and isolation procedures for the antibiotic are described. UV-IR-, NMR- and mass spectra as well as specific rotation of the antibiotic are given. Its molecular formula is C12H11NO2S. Studies on its chemical structure and total synthesis have been completed. According to its chemical structure, Chuangxinmycin is a new type of compound of natural origin. It is active in vitro against a number of Gram-negative and Gram-positive bacteria, whereas in vivo it is active in mice against Escherichia coli and Shigella dysenteriae infections. It shows a low toxicity in mice, LD50 being 600 mg/kg (iv) and 1,770 mg/kg (p. o.) respectively. Preliminary clinical results show that Chuangxinmycin is effective in the treatment of septicaemia, urinary and biliary infections caused by Escherichia coli.


Extraordinary severe burn cases treated with integrated Chinese traditional and Western medicine. The treatment of two cases of extensive 3rd degree burn by means of integrated Chinese traditional and Western medicine is reported. The main factors of success are: the shock stage was tided over uneventfully; active measures were taken to build up the patients' vital energy; operative excision and spontaneous separation of eschar were combined; both auto- and homo-grafts were used to cover the wound surface to facilitate elimination of the wound; infections were tackled with the administration of Chinese herb drugs. In operations of severe burn cases, acupuncture anesthesia has also shown its superiority.


Experimental infarct sizing using computer processing and a three-dimensional model. A method for noninvasive sizing of myocardial infarction, in which data from technetium-99m stannous pyrophosphate scintigrams and a three-dimensional model were used, was tested on experimental, acute anterior infarcts in dogs. The results indicate that the method does size experimental anterior infarcts accurately, but further testing will be necessary to assess the capabilities of the technique for sizing other types of infarcts.


Mechanism of carbon isotope fractionation associated with lipid synthesis. The low carbon-13/carbon-12 ratio of lipids is shown to result from isotopic fractionation during the oxidation of pyruvate to acetyl coenzyme A. In vitro analysis of the kinetic isotope effects of this reaction indicates that there will be a large, temperature-dependent difference in the carbon-13/carbon-12 ratio between the methyl and carbonyl carbon atoms of acetyl coenzyme A and between those carbon atoms of lipid components which derive from them.


A bactericidal effect for human lactoferrin. Streptococcus mutans and Vibrio cholerae, but not Escherichia coli, were killed by incubation with purified human apolactoferrin. Concentrations of lactoferrin below that necessary for total inhibition resulted in a marked reduction in viable colony-forming units. This bactericidal effect was contingent upon the metal-chelating properties of the lactoferrin molecule.


Antiserums to neurons and to oligodendroglia from mammalian brain. Two specific antiserums were produced, one to rat neurons and one to lamb oligodendroglia isolated in bulk from brain. On the basis of immunofluorescence and absorption studies with bulk isolated cells, the antiserums were produced to specific surface components. The antiserums are useful as markers for cell identification and for studying proteins in plasma membranes.


Macrophage tumor killing: influence of the local environment. Tumor killing by activated macrophages is not a highly determined biologic event, but a relative capability influenced by the local environment. An intrinsic macrophage cytotoxic effector system is modulated by serum and other environmental factors that can either enhance or suppress tumor killing. Activated macrophages kill tumor cells only when a regulating threshold drops to a critically low level.


In vitro growth of Mycobacterium lepraemurium, an obligate intracellular microbe. By using an ultrasensitive technique to measure adenosine triphosphate in terms of functional biomass, we have confirmed that Mycobacterium lepraemurium (the agent of rat leprosy and a classical obligate intracellular microbe) grows in vitro in the Nakamura system. By using a sulfhydryl-containing medium that ocupies 65 to 75% of the culture tube volume, together with the five supplements recommended by Nakamura, we have obtained growth rates some eight times above the original. The new physicochemical environment and the use of adenosine triphosphate as an index of energy status in the presence and absence of growth provide a basis for investigating the physiology and growth of other noncultivated microbes.


Biochemical identification of homogentisic acid pigment in an ochronotic egyptian mummy. Roentgenograms of an Egyptian mummy, dating from 1500 B.C., showed extensive calcification of the intervertebral discs and articular narrowing in both hip and knee joints. Biopsy cores from the right hip showed parallel black zones in the region of the articular surfaces, leading to a clinical diagnosis of ochrinosis. The black pigment was extracted, analyzed, and compared to an air-oxidized homogentistic acid polymer. The two substances apparently were identical. The chemical evidence thus confirms the clinical finding of ochronosis, an autosomal recessive disorder. This is, so far as known, the earliest verified case of this disorder.


Mutagenic activity of quercetin and related compounds. The mutagenic activities of several flavonoids and flavonoid metabolites were examined by means of Salmonella typhimurium mutants that reveal base-pair substitution and frameshift mutagens. Of the compounds tested (naringin, rutin, neohesperetin, hesperetin, dihydroquercetin, quercetin, quercetin pentaacetate, permethylquercetin, m-hydroxyphenylacetic acid, and m,p-dihydroxyphenylacetic acid), only quercetin was mutagenic without microsomal activation. With activation, however, the mutagenic activity of quercetin was increased significantly and that of quercetin pentaacetate was revealed. The health implications of these findings and aspects of flavonoid structural requirements for mutagenic activity are discussed.


One strand equivalent of the Escherichia coli genome is transcribed: complexity and abundance classes of mRNA. DNA-RNA hybridization experiments show that essentially all of the genomic information is transcribed. High, intermediate, and rare abundance classes of messenger RNA (mRNA) are present, and their estimated complexities are equal to about 240, 1300, and 700 average-sized mRNA species, respectively. The high abundance mRNA species are present, an average, two to three copies per cell and constitute about 95 percent of the mRNA mass. Intermediate abundance mRNA species are present, on average, about once per 35 cells. The relative abundance and complexity of these mRNA classes correspond well with previous respective measurements on protein. Rare RNA species are thought to represent maximally repressed genes. Analysis of RNA synthesized in vitro by isolated nucleoids (chromosomes) suggests that sense and nonsense sequences are extensively interspersed on a given strand of the DNA.


Local tissue flaps in reconstructive facial plastic surgery. When a lesion is excised from the facial are and the defect cannot feasibly be closed primarily or by secondary healing, skin grafting or adjacent tissue transfer is usually used to close the defect. In the facial area, adjacent tissue transfer gives a better color and texture match and is preferred over skin grafting whenever possible. This paper presents some local flaps which are available for reconstruction of surgical defects in the facial area.


Paranasal aspergilloma caused by an albino variant of Aspergillus fumigatus. An unusual case of aspergilloma in the maxillary sinus caused by an albino variant of Aspergillus fumigatus var ellipticus is presented. Removal of the fungus ball by a left Caldwell-Luc procedure resulted in complete recovery for the patient. This case is the 17th culturally proven case of paranasal aspergilloma caused by A fumigatus, the third case reported from the United States, the first case due to aspergillosis caused by an albino strain of A fumigatus.


Clinical experience with amikacin, a new aminoglycoside antibiotic. Amikacin, a new semisynthetic aminoglycoside antibiotic, was administered parenterally to 20 patients suffering from severe Gram-negative bacterial infections. The antibiotic was found to be highly effective in controlling infection. It was well tolerated and no signs of nephro- or otoxicity were observed. The few side-effects which were seen appeared to be dose-related. The recommended 12-hourly dosage regimen has also proved useful in medium- to long-term management of refractory pulmonary infections.


A comparison of tolmetin with aspirin in the treatment of osteo-arthritis of the knee. A randomized, double-blind crossover study conducted on 55 patients showed tolmetin (Tolectin; Ethnor) (900 mg daily) to be as effective as aspirin (4 500 mg daily) in relieving the symptoms and signs of osteo-arthritis of the knee. Overall, aspirin produced significantly more side-effects, but the incidence of gastro-intestinal side-effects did not differ significantly. In almost every comparison tolmetin had the better score, but differences were not statistically significant; the only exception was the evaluation of the patients' well-being at mid-therapy, which significanlty favoured tolmetin.


Differentiation between mitochondrial antibodies and other auto-antibodies. A thin-section technique for demonstrating indirect immunofluorescence in tissue section is described. This technique makes it possible to differentiate a mitochondrial antibody from other cytoplasmic antibodies.


Sugar intake and diabetes mellitus.

Sugar intake and diabetes mellitus. Within the last century the prevalence and mortality rates of diabetes and other degenerative diseases have increased considerably. Simultaneously, there have been marked alterations in the types and amounts of food consumed. One of the most conspicuous dietary changes has been the very considerable rise in sugar intake. Some regard this change specifically as the factor most responsible for the increase in diabetes. In this review, the relationship between rises in sugar intake and prevalences of diabetes and the bearing of sugar intake on obesity are discussed. There is not enough evidence that a high intake of sugar specifically promotes the development of diabetes, but this does not imply that sugar intake is unimportant. Because of the high prevalence of obesity in some populations, restriction of sugar intake is as important as other dietary restrictions.


A simple method of posterior rectopexy for rectal procidentia. A simple method of posterior rectopexy as a treatment for rectal procidentia involved a series of horizontal nonabsorbable purse string sutures placed between the posterior one-third of the circumference of the rectum and the sacrum. The procedure seems to be effective.


Donor pretreatment in cadaver renal transplantation. Excellent cadaver allograft survival has been achieved with kidneys from cadaver donors pretreated with high intravenously given dosages of cyclophosphamide and intravenous injections of methylprednisolone. To test the efficacy of this method of pretreating the donor, allograft survival in 21 patients, group A, receiving kidneys from cadaver donors pretreated with 4 grams of cyclophosphamide and 4 to 6 grams of methylprednisolone given intravenously was compared with two other groups of cadaver allograft recipients, 39 patients, 23 group B patients receiving untreated kidneys harvested at the Mayo Clinic and 16 group C patients receiving untreated kidneys harvested elsewhere. Two year actuarial allograft survivors were 16 of 21 in group A, 13 of 23 in group B and seven of 16 in group C. We believe that cadaver donor pretreatment improves allograft survival significantly.


Hepatocellular transplantation in acute liver failure. Acute liver failure carries a high rate of mortality, but if metabolic support can be maintained for a critical period, liver healing and recovery are possible. Current techniques of temporary hepatic support are cumbersome and inconsistently effective. We studied the ability of dispersed hepatocytes to provide metabolic support when transplanted to rats with liver failure induced by dimethylnitrosamine (DMNA), a rapidly metabolized agent that is selectively toxic to liver cells. DMNA (20 mg/kg) was administered intravenously to 92 Lewis rats. Animals were divided into four groups receiving the following treatments 24 hours after DMNA administration: group I-intraperitoneal transplantation of hepatocytes prepared from 2.0 gm of normal isologous rat liver; group II-infusion into the portal vein of hepatocytes prepared from 1.5 gm of liver; group III-infusion of saline into the portal vein; group IV-no further treatment. The percentages surviving in each group 3 weeks after DMNA administration were 63%, 71%, 17%, and 6%, respectively. Mean serum glutamic oxaloacetic transaminase (SGOT) levels 3 days after DMNA administration were similar in the four groups, indicating that the degree of liver damage was equivalent. A significantly higher proportion of hepatocyte treated rats survived. Liver histology after DMNA administration showed hemorrhagic central lobular necrosis. A return to near-normal architecture occurred by 3 weeks in surviving animals. In group II hepatocytes were seen in portal venules, sinusoids, and central veins. We conclude that dispersed hepatocytes, transplanted either intraperitoneally or via the portal vein, can provide sufficient metabolic support to allow for recovery from drug-induced hepatic necrosis.


Quantitative bacteriology and pathology of the lung in experimental Pseudomonas pneumonia treated with positive end-expiratory pressure (PEEP). Mechanical ventilation with positive end-expiratory pre-sure (PEEP) is widely used to treat ventilatory failure complicating pulmonary infection. The present experiment was carried out to test the hypothesis that PEEP is beneficial in an experimental model of canine pneumonia studied for 24 hours. Sixteen mongrel dogs were assigned to ventilation with either zero end-expiratory pressure (ZEEP) or 10 cm H2O PEEP. Pneumonia was induced in half of each group by intratracheal inoculation with Pseudomonas. Tissues for quantitative bacteriology and pathology were obtained at the time of death at 24 hours. Three of four infected-ZEEP dogs died before 24 hours. The geometrical mean of quantitative bacterial counts from infected-ZEEP lobes was 2.0 X 10(6) (+/-3.9) (organisms/gm of tissue), while the mean of the infected-PEEP lobes was 1.7 X 10(4) (+/-3.6) (p less than 0.05). Semiquantitative pathology scores indicated greater injury to the ZEEP-infected than to the PEEP-infected lungs. Quantitative bacteriology and microscopic evidence of parenchymal injury were positively correlated. Thus PEEP-treated animals had lower quantitative bacterial counts, less microscopic pulmonary damage, and improved survival. The advantage conferred by PEEP may be due to facilitation of local mechanisms of pulmonary defense against infection, to increased systemic resistance to sepsis, or to both.


Aspiration pneumonia: beneficial and harmful effects of positive end-expiratory pressure. With an ex vivo, isolated, ventilated, perfused canine pulmonary lobe, the effects of various levels of positive end-expiratory pressure (PEEP) were evaluated following acid injury. Following intrabronchial instillation of hydrochloric acid, eight lobes were ventilated with 5 cm of H2O of PEEP, 12 lobes with 10 cm of PEEP, and eight lobes with 15 cm of PEEP during a 4 hour perfusion period. Blood flow was kept constant in all preparations. Lobes with 5 cm of PEEP developed a 39% intrapulmonary shunt and increased their weight by 220%. When PEEP was increased to 10 cm, weight gain was similar (184%), but shunting decreased markedly, to 7%. When PEEP was increased further to 15 cm, shunting remained low (13%), but weight gain increased markedly, to 411% of the initial lobe weight. This study demonstrates the beneficial effects of PEEP in aspiration pneumonia, but it also points out that increasing levels of PEEP can magnify acid-pulmonary injury by causing a further increase in interstitial and intralveolar edema.


Properties of washed human platelets.

Properties of washed human platelets. We have shown previously that washed human platelets resuspended in Tyrode solution containing albumin and apyrase maintain their disc shape and their ability to aggregate upon the addition of low concentration of ADP, providing fibrinogen is added to the suspending medium. We have now examined their responses to other aggregating and release-inducing agents. Collagen, arachidonate, thrombin, immune serum globulin, the ionophore A23, 187 and phytohaemagglutinin from Phaseolus vulgaris caused aggregation and release of granule contents. The response to adrenaline was variable. Serotonin caused the platelets to change shape but no aggregation or release occurred. Addition of a small amount of plasma was necessary for ristocetin-induced aggregation. Polylysine caused immediate platelet-to-platelet adherence with little or no release of granule contents. Responses to collagen or thrombin were greater in a modified medium containing magnesium but no calcium; in this medium, aggregation caused by ADP or polylysine was followed by the release of granule contents whereas these agents caused aggregation without release in a medium with both calcium and magnesium. When protein was omitted from the suspending medium, platelet aggregation in response to ADP was variable. In this medium, collagen and thrombin caused more extensive release than in the albumin-containing medium. Aggregation by polylysine was accompanied by release and extensive lysis in the protein-free medium. Thus, the composition of the final resuspending medium has a major effect on the responses of washed human platelets to aggregating agents.


A short-term culture method for the preparation of chromosome spreads from Rana pipiens. Chromosomes suitable for karyotyping were produced from short-term cultures of cells from embryonic northern leopard frogs, Rana pipiens, at various growth stages. Embryos were minced in a trypsin solution. The tissue fragments were subsequently cultured in an electrolytic solution containing fetal calf serum and Colcemid. We found this technique to be highly reproducible. In contrast to the conventional squash technique we were able to obtain a greater number of metaphase spreads suitable for identification and analysis of individual chromosomal aberrations.


[Total-body irradiation in non-Hodgkin's lymphomas as an alternative to chemotherapy]. On the bases of previous experiences and present results it can be stated that total-body irradiation is an effective therapeutical technique for treatment of lymphocytic non-Hodkin's lymphomas including chronic lymphatic leukemia; first results from prospectively randomized studies even revealed a slight superiority of this method as compared to the scheme of combined cytostatical therapy (CVP) mostly applied at present. Particular advantages of total-body irradiation are the easy applicability, the relatively short time needed for treatment, and the lack of subjective secondary effects. Thus, ambulatory therapy can be performed without any difficulty. The only complication which may occur arises from myelotoxicity reaching its maximum not earlier than after the end of treatment. Careful follow-up of the patients, therefore, is indispensable. The indication of total-body irradiation for the treatment of non-Hodgkin's lymphomas depends on the objective findings, the stage of disease, and mainly on the histological classification.


[O.E.R.T.C. study on the treatment of non-Hodgkin's lymphomas: origin-aims-means (author's transl)]. In 1975, the radiotherapy-chemotherapy group of the O.E.R.T.C. has proposed a therapeutic study upon non-Hodgkin's lymphomas. Patients are  included in the experiment but for the term of balance particularly considering medullar and hepatic involvement; exploratory laparotomy is performed only in patients aged less than sixty. The Ann Arbor classification is used for staging. Stage I cases undergo primary radiation therapy without randomization, followed or not by maintenance chemotherapy. Supradiaphragmatic stages II receive mantle field therapy followed if necessary by a prophylactic infradiaphragmatic irradiation. Infradiaphragmatic stages II are exposed to total abdominal irradiation, and after this, to supradiaphragmatic prophylaxis if needed. All stages II are randomized between two regimens of maintenance chemotherapy. Stages III and IV may be treated with two regimens of induction chemotherapy and following maintenance chemotherapy; in stage III cases an irradiation of the icebergs is performed. Finally, total irradiation of stages III or IV is possible for centers desiring it.


[Pathology of the malignant ovarian tumours (author's transl)]. A review of the principles of histological classification of the malignant ovarian tumours is given. In the center of the discussion figure the tumours originating from the surface epithelium, which make up the majority of ovarian tumours. In dependence on the tumour type they differ in tendency to spread and in prognosis. The clinico-pathological serial examinations existing so far stress the importance of the histopathologic differentiation between facultatively malignant ovarian tumours (borderline tumours) and indubitable carcinomas. Close relations between the type of a tumour and its tendency to spread manifest themselves, for instance, by the different frequency of an affection of both the ovaries, which relates to the different types of carcinomas. Apart from the lymphogenic dissemination, an early development of metastases to the diaphragm seems to have a particular bearing on the spreading of ovarian cancers.


[Radiation therapy of oropharyngeal tumors (author's transl)]. The clinical data as well as a statistical evaluation of the treatment of patients with oropharyngeal tumors, who had undergone a combined treatment by interstitial radium therapy, megavoltage irradiation, and operation, lead to the conclusion that better final results and palliation effects may be obtained by a megavoltage irradiation of the tonsillar region and soft palate than by means of ultraradical surgery. Good results have been observed after interstitial radium therapy or electrosurgical operations of keratoid squamous cell carcinomas. The radical operation with preceding telecobalt irradiation, however, is to be preferred in the case of basioglossal squamous cell carcinomas.


The immunological diagnosis of human hydatid disease. There is evidence that the yearly incidence rate of hydatid disease may be increasing in endemic areas and in regions of the world hitherto free of the infection. The availability of an accurate method of detection in both man and other animals would facilitate understanding of the global epidemiology. The diagnostic procedures in use in human hydatidosis have often given inconclusive results in animal infections. The following tests are discussed and their usefulness appraised: intradermal, complement fixation, haemagglutination, latex agglutination, indirect fluorescent antibody, immunoelectrophoresis, counter immunoelectrophoresis, enzyme linked immunosorbent assay, radio-immuno assay and lymphocyte transformation.


Host antigens and parasite antigens of murine Schistosoma mansoni. An indirect fluorescent antibody technique was used to detect mouse host antigens and parasite antigens on the surface of Schistosoma mansoni. A rabbit anti-mouse rbc antiserum to detect host antigens, and serum from mice immune to S. mansoni was used to detect parasite antigens. Schistosomula prepared after penetration of isolated mouse skin did not possess host antigens but bound antibody from immune serum (immune antibody); schistosomula recovered from the lungs of mice five days after infection possessed host antigens and failed to bind immune antibody. In contrast, schistosomula recovered from the skin of normal or immune mice three and 20 hours after cercarial penetration, adult worms, and cryostat sections of adult worms, were positive for host antigens but also bound immune antibody. Strong binding of immune antibody only occurred with the cryostat sections. Anti-schistosome antibody can therefore bind to schistosomes in the presence of host antigen. The lung forms of schistosomula however, may have different surface properties as there is no evidence that immune antibody binds to these forms.


Immunofluorescence and counter immunoelectrophoresis in the diagnosis of kala-azar. Techniques of indirect immunofluorescence (IF) and counter current immunoelectrophoresis (CIEP) were employed and compared for the diagnosis of kala-azar among children in Fars Province of Iran. It is suggested that the diagnostic titre for kala-azar by immuno fluorescence is over 1 in 64. In fact a majority of the cases had a titre of more than 1 in 256. CIEP using soluble antigens prepared form the promastigote form of Leishmania donovani, was also applied to sera from patients with systemic leishmaniasis and other diseases. The CIEP test correlated well with the indirect immunofluorescent test. It is therefore suggested that CIEP, which is a rapid and less sophisticated test, can be applied for the diagnosis of kala-azar cases and epidemiological surveys.


The survival in nature of Wuchereia-infected Anopheles funestus Giles in North-eastern Tanzania. Hungry Anopheles funestus females were caught in CDC light traps positioned overnight in village houses in which the occupants were protected by bed nets. The sampling was performed in six huts near Muheza, in North-eastern Tanzania, September to November 1972. Parous, unfed mosquitoes were carefully examined, usually under phase-contrast optics, for the presence of developing Wuchereria bancrofti larvae. Because A. funestus seek blood meals at three-day intervals, most filariae were three, six, nine, 12 and 15 days old, and could with confidence be assigned to one of these five easily recognized age groups. Of 3,289 unfed A. funestus examined, 1,723 (52%) were parous. Developing and mature infections amongst the parous were 272 in number. Simultaneous infections of two age groups numbered 21, one mosquito was triply infected, thus there were 249 infected mosquitoes (7-57% of the total). The regression of loge number of infections (y) on estimated age in days (X), agreed with the hypothesis of linearity (r=-0-9967); the equation loge y=5-52-0-1646X suggested an average daily mortality rate of 16-46% in good agreement with the mean 15-6% observed in A. funestus by Gillies & Wilkes. The equation above affords an estimate of the probability of an A. funestus becoming infected at a single random feeding. The expected number of day 0 infections, given by the antilog of the first term of the equation and taken as a fraction of the biting population, gives the estimate. The values obtained were 0-058-0-087. Use of Macdonald's (1952) formula for the sporozoite rate provided estimates of 0-071-081. Age-specific worm densities in A. funestus did not vary significantly between day three and day 15 infections, and no evidence was obtained to suggest that the higher worm burdens influenced the survival of their hosts. The frequency of superinfections did not support the  contention that a previously established infection inhibits the chance of a second, younger infection from becoming established.


Strain differences in Echinococcus granulosus, with special reference to the status of equine hydatidosis in the United Kingdom. The genetics of speciation in the genus Echinococcus are briefly discussed. As the organism is a hermaphrodite and multiplies asexually in the larval stage, the genetic mechanism for the ready production of new strains is inherent in the life-cycle. Some biological, biochemical and nutritional differences between the horse and sheep strains are examined. The sheep strain may be grown to sexual maturity, in vitro, in a diphasic system; the horse strain fails to grow in such a system. Differences have also been demonstrated between the soluble proteins of the two strains. The sheep strain is infective to man but, probably, non-infective to horses. The horse strain (which is now the major strain in the U.K and Ireland) appears to be poorly infective to sheep and may prove to be non-infective to man. The importance of determining the basic characteristics of other strains of E. granulosus are also stressed.


Fetal and neonatal fatality in rat hybrids from mothers stimulated with parental skin. A breeding experiment was conducted in which MAXX female rats were mated with BN male rats. These two strains of inbred rats are identical for AgB antigens and differ only in antigens governed by minor histocompatibility loci. MAXX females, which were exposed before pregnancies to four BN skin grafts, delivered 117 offspring of which 28 (23.9%) were stillborn and 10 (8.5%) dead within 24 hr of birth. In contrast, of 126 offspring in control groups, only one was stillborn and one dead within 24 hr. In BN-grafted MAXX females, placentas were partially necrotic with marked polymorphonuclear reaction, which could account for stillbirths or the newborn deaths shortly after birth. The stillborn fetuses had grossly noticeable wrinkled skin. Histologically, the architecture of the epidermis was disturbed. The dermis was edematous and contained occasional mononuclear cells.


[Extravesical antirefluxplasty (author's transl)]. The indications and the detailed technique of extravesical antirefluxplasty are presented. Realized on 409 ureters (247 cases), extravesical antirefluxplasty has been successful in 95% of these cases. The failures, i.e., obstructions (1,5%) and persistent reflux (3%), are analized.


[Intraluminal balloon occlusion of the renal artery: clinical applications and observations (author's transl)]. A method permitting percutaneous catheterization and temporary balloon occlusion of the human renal artery with a 5-F-Swan-Ganz-Catheter is presented. When properly performed, the arterial occlusion is reliable, low in complications, and less traumatizing to the vessel than external clamp occlusion. The technique was employed in 112 patients for occlusion of the renal artery prior to tumor nephrectomy, for attaining stop-flow conditions for improved nephrophlebography, for preventing the reflux of emboli at transarterial embolisation of inoperable kidney tumors, or, combined with simultaneous hypothermic perfusion via the second lumen of the catheter, in extensive kidney surgery necessitating ischemia. Particularly this last range of application offers new possibilities for in-situ surgery of the kidney, as it renders dissection of the renal pedicle and cumbersome surface cooling of the kidney unnecessary.


Occult neuropathic bladder.

Occult neuropathic bladder. The occult neuropathic bladder is a condition of uncertain etiology about which confusion has arisen with regard to diagnosis and management. Incontinence and upper urinary tract deterioration are secondary to high intravesical pressure associated with urinary retention and functional outflow resistance. Diagnosis is a matter of exclusion, and the various methods of investigation are discussed. Development of continence and preservation of renal function may be achieved by improving bladder evacuation and preventing reflux. Diversion may be unavoidable but should be considered only when conservative methods have failed.


Action of oral and parenteral bethanechol on decompensated bladder. A double blind balanced Latin-square study was conducted on 20 adult patients with decompensated bladders to determine the relative effectiveness of oral and parenteral bethanechol chloride (Urecholine) on the stretch response of bladder muscle. Detrusor reaction was measured by modified cystometry. Five mg. of subcutaneous bethanechol chloride produced a significant increase in intravesical pressure which was more rapid in onset, of larger magnitude, and of shorter duration than oral doses of 100 and 200 mg.


Bilateral chronic ureteritis associated with Serratia marcescens. To our knowledge this is the first case of bilateral obstructive uropathy caused by nonspecific chronic ureteritis to be reported. Prior to operation the bilateral involvement was throught to be due to a tuberculous infection or retroperitoneal fibrosis. The diagnostic difficulties were similar to those previously reported in the unilateral involvement. The focus of the infective organism found was Serratia marcescens which originated in the right kindey.


The use and preliminary results of the Troutman surgical keratometer in cataract and corneal surgery. The Troutman microsurgical keratometer has been shown to be useful in monitoring intraoperative procedures, and it has been demonstrated in the case of cataract and keratoplasty to have a significant influence on the control of operatively induced astigmatism. It is applicable to any surgical procedure which has the potential of altering permanently and unpredictably the corneal curvatures. Intraoperative keratometry has clearly demonstrated some inadequacies of our current cataract and keratoplasty techniques. It is now being used to guide our efforts toward a more rational control of the vexing problem of astigmatism.


Radical anterior segment surgery for epithelial invasion of the anterior chamber: report of three cases. Three patients who developed epithelial invasion of the anterior chamber were treated by radical anterior segment surgery. Two adults had typical epithelial downgrowth of the anterior chamber, while the third patient, an 8-year-old child, developed large serous cysts following evacuation of a traumatic hyphema. In all three patients, the invading epithelium involved the iris, cornea, and angle, while the two adults had epithelium on the vitreous face as well. The operation consisted of an en bloc excision of cornea and sclera with contiguous iris, ciliary body, and vitreous when necessary. A free-hand corneoscleral graft was fashioned and sewn into the bed using interrupted 9-0 nylon sutures on the scleral side and continuous 10-0 nylon sutures on the corneal side. The patients all developed transitory glaucoma in the early post-operative period. The glaucoma was controlled with acetazolamide. A mild anterior uveitis usually was present for several months and was suppressed with topical applications of corticosteroids. Histopathologic study of the excised tissue showed complete removal of the epithelium.


[2 methods of phalangization of the 1st metacarpal bone]. The author has elaborated two technics of phalangization of the first metacarpal bone based on transposition of four triangle skin grafts. The technic concerned was employed in 21 patients on 23 stumps with good functional results.


[Osteosynthesis with a rod in crushing injuries of the knee joint and periarthric fractures of the femur and crural bones]. The authors describe the treatment of 14 patients having crushing injuries of the knee joint of periarthric fragmentation fractures of femoral and crural bones with a wide zone of soft tissues damage. Economic resection of the joint with subsequent formation  of a juncture between the femoral and tibial bones with a long rod (65--75 cm) seems to be mostly rational.


An outbreak of type C botulism in broiler chickens. An outbreak of type C botulism involving three-week-old broiler chickens on deep litter is described. No direct source of toxin was found. Cl botulinum type C was distributed widely in the litter, and several thousand per gram were demonstrated both in the litter and in the intestinal contents of chicken.


Yersinia pseudotuberculosis in the cat.

Yersinia pseudotuberculosis in the cat. Yersinia pseudotuberculosis infection in the cat is described. Clinical findings included inappetence, lethargy, rapid emaciation, jaundice and an enlarged left kidney. Chronic pseudotubercular lesions were found in the kidneys and lungs and Yersinia pseudotuberculosis Type IIB was recovered from both sites.


Corynebacterium pyogenes mastitis among heifer calves. In August 1975 an outbreak of C pyogenes mastitis occurred involving 18 heifer calves at the National Institute for Research in Dairying. This paper describes the outbreak which affected animals varying in age from five to 22 months. Fourteen of the cases (77%) were among calves less than 10 months old. The advisability of using fly control measures among young stock in the summer months is discussed.


Control of ovulation and fixed time insemination in heifers following cloprostenol. The time of ovulation was determined in heifers following two injections 11 days apart of 500 microgram of cloprostenol by recovery of reproductive tracts at slaughter. Ovulation had not begun by 72 hours while 31%, 61% and 95% had ovulated by 78, 92 and 96 hours respectively after the second injection of cloprostenol. Injection of synthetic LH-releasing factor (GnRH) given 48 hours after cloprostenol significantly hastened the time of ovulation in animals slaughtered at 78 hours after the second cloprostenol injection. Insemination of heifers at 48, 60 or 72 hours resulted in lower fertility than two inseminations at 60 and 72 hours or at 48 and 72 hours after treatment. Controlling the time of ovulation with GnRH did not increase the fertility following a single insemination 71 hours after the treatment with cloprostenol.


Evaluation of the indirect fluorescent antibody test for Babesia major and Theileria mutans in Britain. Use of the indirect fluorescent antibody (IFA) tests is described to detect antibodies to Theileria mutans and Babesia major in the sera of infected cattle. When antisera against T mutans and B major were tested against homologous antigens high antibody titres were recorded: when they were tested against each other or against Babesia divergens antigen insignificant titres (1/40 or less) were recorded. Thus the test was found to be species specific. Animals recovered from T mutans and B major infections retained significant levels of IFA titres for 22 and 11 months respectively. It is suggested that the IFA test could be used for field survey of the piroplasms of cattle in Britain.


[Serum siderophilin (transferrin) and ekkrinosiderophilin (lactoferrin) as non-specific microbiostatic agents in human health and disease: clinical implications (author's transl)]. A short historical review of the antimicrobial effects of siderophilin, the iron chelator in human plasma and serum, is followed by a presentation of the rational basis for assigning it a role in the overall defence mechanisms of the host against infectious disease. Details are given of the qualitative and quantitative activities of normal and pathological sera on the growth and nutrition of several pathogenic bacteria and the fungus Candida albicans as governed by the percentage iron saturation of their contained siderophilin. Staphylococcus aureus is differentiated from Staphylococcus albus by its ability to grow in normal serum whose percentage iron saturation affects not only the metabolism of Staphylococcus aureus but also its production of diffusible factors and sensitivity to antibiotics. The protein iron chelator of bodily secretions, ekkrinosiderophilin, found in relatively high concentrations in human milk is likewise evaluated for its antimicrobial properties and their relevance to the health of the newborn.


[Long-time survival after experimental lung homotransplantation (author's transl)]. Haemodynamic and respiratory function tests were carried out in a dog submitted to left-sided lung homotransplantation. It was observed that successful immunosuppressive therapy enabled the graft to maintain adequate function for the entire 28-month period of observation.


[Colon transplant for oesophageal carcinoma (author's transl)]. The most suitable procedure for oesophageal replacement is colon interposition. The extent and staging of the tumour and the patient's general condition must be considered more than hitherto in the assessment of the indication for surgical intervention. Colon interposition only for the purpose of restoring the act of swallowing is not indicated because of the poor life expectation and the high operative mortality. Alternative modern methods are megavoltage irradiation and tubular prosthetics in the case of disturbance in swallowing. In accordance with the literature we elect to use one layer of interrupted sutures. With anisoperistaltic interposition the incidence of cervical fistula development seems to be higher.


[Pancreatic fistulae (author's transl)]. The incidence of postoperative persistent external fistulae following inflammatory or traumatic lesions of the pancreas has increased over the past years. The choice of the optimum time for surgical rectification of this condition, as well as the operative technique is discussed in this review of the literature and 11 cases treated under our care over the past 15 years. It appears advisable 1) not to wait longer than about 6 weeks to carry out operative closure of the fistula (this period of time being necessary for the fistula to develop by granulation), 2) to undertake fistulo-jejunostomy with long section of the canal of the fistula, if possible, especially when applying the "pull through" method and 3) to place, if possible, the drainage tubing along the gastrocolic ligament, during the initial operation thereby selecting the most advantageous site for the development of any subsequent fistula.


[A rare complication during insertion of a vena cava catheter according to the Seldinger method: fragmentation of the guide-spiral (author's transl)]. This paper reports the occurrence (10 occasions) of fragmentation of the guide-spiral during catheterization of the superior vena cava in 9 patients according to the Seldinger method. Reasons for this severe complication are faults in the material, technical inadequacy or lack of supervision. Such complications are dangerous for the patient and have a high mortality. Better results can only be achieved by early diagnosis and--if possible--removal of the foreign body.


[Sociological, legal and theological aspects of selection for treatment in myelomeningocele (author's transl)]. The arbitrary and arrogant presumption to be entitled to select cases for treatment amongst severely handicapped children cannot be justified at all, either from the legal or the theological point of view. The idea of selection can only be explained on the basis of the discrepancy in modern medicine between being forced, on the one hand, to continue in the tradition of the great biological and technical discoveries of the past decodes and, on the other hand, not being able to solve important current problems such as the determination of the time of death, the beginning of life or the inability to influence or prevent congenital malformations. The doctor, however, is charged against all exhortations of social Darwinism by society to help his patient to the best of his knowledge and skill.


[Dependence of the specific growth rate of Escherichia coli MI 30 on the ammonia concentration]. The transient behaviour of ammonium limited continuous cultures of E. coli ML 30 led to the hypothesis that the bistability of pyruvate formation primarily is caused by a bistability of the ammonia metabolism. Therefore, a function of mu([NH+4]) should be expected different from that of Monod type. Measurements of the specific growth rate during washout of continuous cultures at different ammonium concentrations and at such low cell concentrations that the changes in the ammonium concentration of the medium could be neglected, showed a complex function with a relative minimum near 2 mg/1NH+4. This function allows bistability of the ammonium concentration in an ammonium limited continuous culture. The results are discussed on the basis of the two systems of ammonia assimilation found in prokaryotic cells.


Anaerobic growth of Escherichia coli on formate by reduction of nitrate, fumarate, and trimethylamine N-oxide. Anaerobic growth of E. coli, strain K-10, depending on formate oxidation by nitrate, fumarate, and trimethylamine N-oxide was followed in a medium containing peptone. The presence of formate and peptone was indispensable for growth with fumarate and trimethylamine N-oxide reduction. While there was no growth in the absence of acceptor, growth was observed in the absence of formate by nitrate reduction though not as much as under aerobic conditions. Per mole consumed formate equimolar succinate or trimethylamine was formed, but 1.2 mole of nitrate was produced, probably depending partly on peptone oxidation. The molar growth yield on formate was found to be 6.5, 7.6, and 7.0 g cells/mole depending on the reduction of nitrate, fumarate, and trimethylamine N-oxide, respectively, suggesting the formation of one mole ATP coupled to the anaerobic electron transfers from formate.


[Early symptoms of hyperparathyroidism in nephropathies]. The development of an autonomous (tertiary) hyperparathyroidism in patients with renal diseases must clinically be taken into consideration, when by therapeutic measures the causes of a compensatory overfunction of the parathyroid glands were excluded, but the symptoms of a hyperparathyroidism continue or even increase. This is of special importance in the control of patients with renal grafts. The increase of the serum calcium on more than the normal value in simultaneously increased serum phosphate level and increased activity of the alkaline bone phosphatase in connection with demineralisation of the skeleton, osteoclastic changes of the bones and estraossary calcifications may be regarded as early symptoms of a hyperparathyroidism. It is to be discussed the hypothesis, whether in every autonomous hyperparathyroidism a regulative reaction precedes. In patients with renal diseases in a limited number a prevention of the regulative overfunction of the parathyroid glands is possible by an early compensation of a calcium deficit (acquired vitamin D resistance), a hyperphosphataemia and a renal acidosis.


Properties of insoluble collagen from three different types of muscles. 1. Lyotropic solubilization of insoluble collagen from heart, M. longissimus dorsi and M. semimembranosus offers differently polymerized structures. In M. semimembranosus and in heart muscle the degree of polymerization is the highest, whilst in the solubilized portion of M. longissimus dorsi considerable proportions of alpha-and beta-chains can be observed. 2. All the polymeric structures can be broken down by pepsin and dithiothreitol treatment. 3. The proportion of collagen type I to III varies in different muscles. Collagen type I constitutes a considerable portion of the collagenous core in M. longissimus dorsi and in heart muscle, whilst in M. semimembranosus the predominating type is collagen type III.


Determination of IgG antibodies produced by the kinetoplast fraction antigens of Trypanosoma rhodesiense, T. vivax and T. brucei by enzyme linked immunosorbent assay. Antibodies to trypanosome homegenate and subcellular particles of different trypanosome species, with emphasis on the kinetoplast fraction, were measured by the ELISA method. The antibodies formed to these homogenates and subcellular particles could be titrated; the kinetoplast fraction, particularly, not only gave titration against a heterologous strain, but also showed activity against this strain after two to three antigenic variations.


[The action of selected herbicides on bacteriophages and Escherichia coli (author's transl)]. The effect of eight herbicides on the multiplication of bacteria and bacteriophages was tested with Escherichia coli, strains W1665F+ and C600, and with the RNA-phage M12 and the DNA-phage lambda in turbidimetric investigations and one-step growth experiments. E. coli is inhibited by seven of the herbicides investigated in concentrations of 10(-3)M, partly of 10(-4)M, too, and is promoted by some compounds in weaker concentrations. Naphthylacetic acid, (NES) largely independent of its concentration, causes increased density of bacteria in fluid culture. The multiplication of the M12 phage is inhibited in sometimes wide ranges of concentration by 2,4-D, MCPA, 2,4-DP, and CMPP but it is stimulated by NES and amitrole. The lambda-phage multiplication is inhibited only by CMPP, MCPA, MCPB, and phenylacetic acid interfere with the lysogenization of the bacteria and increase the lytic activity of the lambda-phages as 2,4-DP and NES do. 2,4-D strongly inhibits the plaque-forming ability of M12 phages already prior to their contact with the host cells, whereas MCPA and CMPP are inhibitory in the first phases and 2,4-DP in all phases of the phage replication. In the lambda-phage replication, too, CMPP is effective only in the first phases. Aspects of the mode of action of the herbicides in the procaryoute virus system are discussed.


Gentamicins.

Gentamicins. Gentamicin is a new broad-spectrum antibiotic, basic and water-soluble, produced and developed by Schering Corporation-Bloomfield, New Jersey (1967 and 1968). It is produced by Micromonospora purpurea, a member of a genus of microorganisms from which no other antibiotics have been derived. Paper chromatographic techniques showed the components of gentamicin complex designated as C', C'a, and C2. Gentamicins are bactericidal antibiotics, active in vivo in low concentrations against a wide spectrum of both Gram-positive and Gram-negative organisms. Among the responsive Gram-positive groups of microorganisms are Staphylococcus aureus including many resistant penicillinase producing strains and group A betahemolytic Streptococci. Among the clinically more important species of Gram-positive organisms responsive to gentamicin are both indole-positive and indole-negative Proteus, Pseudomonas, Escherichia coli, Aerobacter, Klebsiella, Salmonella, and Shigella. The production of gentamicins was improved by adding cobalt to the growth medium.


[Possibilities of drug-induced prevention of thrombosis with special reference to pre-, per- and postoperative time of treatment]. According to the postoperative prophylaxis of thromboembolia a review of actual publications is given. The therapeutical problems of Coumarin, Dextran, Acetylsalicylic acid and low dosis Heparin were discussed. A final answer to the various questions can not be given. Concerning the prophylaxis low dosis Heparin seems to become the anticoagulant of choice.


Transcription of rat DNA fractions reassociated to various cOt values. Two fractions of rat liver DNA: "intermediate" (reassociated to COt = 1 - 10(2), moleXsecX1(-1)) and "slow" (COt = 10(2) - 10(5) showed differences in template activity on transcription with E. coli RNA-polymerase. The "intermediate" fraction both in double- and single-stranded form was a better template than the "slow" one. The efficiency of transcription dropped progressively for the template obtained at COt values increasing from 10(2) to 10(6). No differences in the template activity of the "intermediate" and "slow" fractions were observed when rifampicin-resistant transcription was studied.


[Experimental models for the pharmacologic study of anti-arrhythmia drugs]. In order to assess the value and therapeutic safety of an antiarrhythmic drug, it must be submitted to multiple tests, which reproduce as faithfully as possible the conditions observed in human pathology. The main experimental approaches are presented here: screening and control tests. For each test, the authors emphasize the various experimental factors limiting their interpretation and allowing the extrapolation to men.


[Transplantation of the kidney in children and young adolescents. Report of 8 cases]. In this article we reviewed our experience in transplantation of children and young adolescents. Basic data of patients, immunosuppression and transplant function are reported. Favouralbe and unfavourable effects of transplantation have been discussed. A small number of patients cannot permit to make statistical conclusions. The only possible conclusion is the increasing number of such patients in our country require a more rapid development of regular dialysis and transplant program in Yugoslavia.


[Experience with 38 deltopectoral flaps in reconstructive surgery of the head and neck (author's transl)]. The deltopectoral flap was described by Bakamjian in 1965 for pharyngo-oesophageal reconstruction. Since then, the indications of this excellent flap have been extended and the versatility of the flap has allowed extensive skin and mucous membrane resections in cancerology. The authors have used 38 deltopectoral flaps in 36 patients with difficult reconstructive problems. The results have been good in 31 cases. There were 7 failures.


Soft tissue defects of the lower extremities. Based upon our experience with 459 skin and soft tissue defects of the lower extremities, of which 326 were covered surgically, the different etiologies of these defects are listed and the factors influencing the choice of a method of coverage are discussed. The advantages and disadvantages of the different reconstructive methods are reviewed and illustrated with representative cases.


[Flat crossleg flaps in the repair of large skin, muscle and bone defect of the leg. Present indications, new techniques (author's transl)]. This is a report on a patient who suffered a large skin, muscle and bone defect of the leg following a Volkmann's ischemia. The author's indications for a flat crossleg flap are explained : extended skin defect at the anterior and inner aspect of the broken tibia or a skin defect associated to a tibial defect making a secondary bone graft necessary. Finally the authors describe an original technique of crossleg flap : this consists in a trapezoidal flap with the large side being the implantation basis.


Effect of different respirator adjustments on central haemodynamics in open-heart surgery patients. Changes in cardiac index (CI) mean pulmonary artery pressure (PAP), mean pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), and pulmonary artery vascular resistance (PVR), associated with spontaneous respiration (SR) and two different types of intermittent positive pressure ventilation (IPPPV and IPNPV) were studied in a total of 17 patients undergoing aortic valve replacement or myocardial revascularization. Swan-Ganz thermodilution pulmonary artery cardiac output catheters were used and the aim was to determine: whether postoperative cardiac output may paradoxically be greater during IPPPV than during IPNPV or SR; whether the use of "negative" pressure in the expiratory phase during controlled ventilation may be responsible for bringing about the central haemodynamic conditions prevailing during spontaneous respiration; and whether, in weaning from postoperative IPPPV to SR, there is a risk of pulmonary congestion as a consequence of possible autotransfusion. IPPPV connected with anaesthesia induction caused a highly significant deterioration central haemodynamics. The use of positive end-expiratory pressure (PEEP) is not to be recommended for such patients at this stage. On the first postoperative day, the mean CI was lower during IPPPV than during IPNPV (P less than 0.1) or during SR (P less than 0.05). The changes observed in CI, were, however, so slight that the authors consider the routine use of PEEP to be beneficial during controlled ventilation following major open-heart surgery. In some patients, the CI was paradoxically higher during IPPPV than during IPNPV or SR. The mean CI was nearly the same during IPNPV (3.32) as during SR (3.38). However, PAP, PCWP and PVR values were significantly higher during SR than during IPNPV. Thus, according to this study, the use of "negative" end-expiratory pressure during controlled ventilation did not in these patients produce central pressure conditions corresponding to spontaneous respiration. The present study supports the finding that in weaning from controlled ventilation with PEEP to SR there is a danger of pulmonary congestion. This could be predicted by measurement of pulmonary wedge pressure, but not by measurement of central venous pressure.


Weaning from mechanical ventilation by means of intermittent assisted ventilation I.A.V. Case reports. A new ventilator is described which is capable of interposing controlled breaths synchronized with the patient's own breathing rhythm. This ventilation pattern is called "intermittent assisted ventilation" (IAV). It differs from intermittent mandatory ventilation (IMV) in that each ventilator cycle is triggered by the patient. IAV constitutes a new approach to the problems during the critical period of weaning from mechanical ventilation. Further, this new ventilator provides means for continuous display and recording of airway gas flow and pressures and expired minute volume (EMV) during different types of ventilation, e.g. controlled ventilation, intermittent assisted, and spontaneous ventilation.


A comparison between placebo, pizotifen and 1-isopropyl-3-hydroxy-5-semicarbazono-6-oxo-2.3.5.6-tetrahydroindol (Divascan) in migraine prophylaxis. The effects and side-effects in migraine prophylaxis of placebo, Divascan (1-isopropylnoradrenochrome--5--monosemicarbazone) and pizotifen were compared in a double-blind cross-over study. The dosage was for Divascan 15 mg a day and for pizotifen 3 mg a day. Data from the last 6 weeks of each test period of 8 weeks were used to assess the effect of the treatment. Thirty patients entered the trial. Data from 28 patients treated with placebo and Divascan and 27 patients treated with pizotifen were used for final evaluation. Pizotifen significantly reduced the number of migraine attacks, headache index and the consumption of ergotamine. Divascan also seemed to have effect. The consumption of ergotamine was reduced compared with placebo and there was a reduction, although not significant, of headache frequency and headache index. Pizotifen gave significantly larger reduction in headache frequency and headache index than Divascan and signficantly more patients stated a preference for pizotifen compared with Divascan. A good or very good effect was reported by 11 per cent of the patients on placebo, 39 per cent on Divascan and 70 per cent on pizotifen. Pizotifen had frequent side-effects, mainly drowsiness and weight gain, whereas Divascan in this respect did not differ from placebo. Physical examinations and laboratory investigations did not show any significant changes, apart from weight gain.