[Nuclear ribonucleoproteins containing pro-mRNA. XIV. Structural study using ethidium and fluorescamine]. Nuclear 30S RNP particles were studied by means of fluorescence techniques. It's shown that fluorescamin interacts with NH2-groups of protein molecule. As a result, covalent fluorescent label is formed. Quantum yield (rho), fluorescence spectra, lifetime of excited state (tau) and polarization of fluorescamin complexes with 30S particles were studied. Excitation spectra have their maximum at 395 nm, and fluorescence spectrum at 480 nm. These figures correspond to spectra of fluorescamin complexes with NH2-groups of lysine. Mean quantum yield (rho = 0.27) and lifetime of excited state of fluorescence (tau = 7.8 nsec) were measured. It's shown that fluorescamin forms two types of fluorescent complexes in 30S particles. These complexes differ only by their rho(rho1 = 0.11, rho2 = 0.30) and rho(rho1 = 3.6 nsec, rho2 = 10.0 nsec) by 2.7 times. Migration radius between fluorescamin bound to protein and ethydium bromide adsorbed on double-stranded regions of pre-mRNA in RNP-particles was measured. It's equal to 32 A. Adsorbtion isotherms of ethydium bromide were measured by fluorescence in 0.1 and 0.4 M NaCl. Data obtained showed that 6% of pre-mRNA in 30S particles bound the dye as a strong complex, i. e. this part of pre-mRNA is double-stranded. RNase treatment of RNP had no effect on this value. But the increase of NaCl concentration up to 0.4 M caused the dissociation of protein subunits to some extent followed by appearance of up to 40% free NH2-groups interacting with fluorescamin. Measuring of energy migration from fluorescamin to ethydium bromide showed that double-stranded pre-mRNA regions strictly bound to protein sticked out from RNP particle at a distance of about 27 A. The increase of NaCl concentration up to 0.4 M leads to disruption of this strict bond of double-stranded regions with protein. As a result, these regions of pre-mRNA become labile and move away from the RNP particle at more than 30 A. According to theoretical calculations, there is about 1--2 pre-mRNA hairpins (18--9 base pairs respectively) per one 30S particle.


[Study of the complex of myoglobin with nicotinic acid by the method magnetic circular dichroism. Nature of the double hemochromogen]. The complex formed by myoglobin and nicotinic acid exhibits unusual spectral properties. Instead of the usual two bands in the visible region the complex shows four bands assigned to the so called twin hemochromogen. Some attempts were previously made to clarify the nature of the twin hemochromogen, but the interpretation given was somewhat doubtful. We have shown that the combination of two spectral methods, namely magnetic circular dichroism and absorption spectra, give evidence that unusual absorption spectrum of the myoglobin complex with nicotinic acid is not attributed neither to the presence of the other hemochromogen nor to the soft vibrations but is due to the strong splitting of the pure electronic Q00 band into two Qox and Q0y bands. The splitting is caused by the distortion of heme structure by its asymmetrical environment.


The distribution of spontaneous chromosome aberrations in BHK21/C13 fibroblasts. Previous investigations of spontaneous aberrations in mammalian cells have been carried out on large heterogeneous samples of individuals, each of whom had had a different exposure to exogenous clastogens. In the present analysis using Syrian Hamster cells, a large number of metaphases were analysed from one sample of control cells. In this way all cells were exposed to the same doses of any unknown clastogens. The overall distribution of spontaneous breaks was found to be nonrandom. Breaks involved in different types of aberration had a nonrandom distribution, which was specific for each type. (e.g. terminal deletion and rearrangement).


[Reaction between the protein of gene 32 of phage T4 with DNA. Comparison of the properties of native protein and the product of its limited hydrolysis]. Interaction between DNA and limited hydrolysate of T4 gene 32 protein has been studied. This limited hydrolysate is obtained when 8000 dalton segment of native 32 protein is removed proteolitically, its molecular weight being 26,000 dalton. It is shown that the melting temperatures of DNA as well as that of the synthetic homopolymer poly[d(AT)] complexed with this modified protein are more than 60 degrees lower than that of pure DNA and poly[d(AT]. The secondary structure defects in DNA promote its unwinding by the modified 32 protein. As follows from the analysis of the melting curves of the modified 32 protein -- DNA complex, this protein cooperatively binds to denatured DNA. The binding constants and cooperativity parameters are found to be equal to 10(8)--10(10) M-1 AND 10(3) respectively. It is shown that the gene 32 protein in the same environmental conditions does not destabilized native DNA and poly[d(AT)].


Studies of X-ray-induced chromosome aberrations in cells of the black-tailed wallaby. I. Non-random exchange in peripheral blood cells irradiated in Go. The distribution of exchanges between individual chromosome arms in mitotic peripheral blood cells following X-irradiation in Go has been measured. It was found that, although all arms exchanged with each other, there were small but significant departures from the frequencies expected on the basis of random breakage and exchange. It is suggested that non-randomness may reflect the non-uniform state of condensation of chromatin in Go lymphocytes.


Procarbazine-induced specific-locus mutations in male mice. Procarbazine is used in drug-combination treatment of Hodgkin's disease. The specific locus method was used to test and confirm the ability of procarbazine to induce gene mutations in pre- and post-meiotic germ cells of male mice. The lowest dose of procarbazine that significantly increased the mutation frequency in As spermatogonia over the control frequency was 400 mg/kg (P = 0.003). The corresponding dose for the post-spermatogonial germ-cell stages was 600 mg/kg (P = 0.009). The dose--response was linear for the point estimates of the mutation frequencies after treatment of As spermatogonia with 0, 200, 400 and 600 mg/kg. The point estimate of the mutation frequency at the 800 mg/kg level was one-third of that expected from a linear extrapolation. Variation in mutation rates among the 7 loci between the lowest (a locus) and the highest (p locus) was 12-fold. Only 24% of procarbazine-induced specific locus mutations in As spermatogonia were lethal in the homozygous condition. From the mutation spectra and the viability tests, it is concluded that procarbazine-induced mutations may be mainly due to base-pair changes. Procarbazine-induced specific-locus mutations fulfilled the criteria for the estimation of the doubling dose, the dose necessary to induce as many mutations as occur spontaneously. The doubling dose of procarbazine in As spermatogonia of mice was 114 mg/kg. The therapeutic dose for procarbazine is about 215 mg/kg. If man and mouse were equally sensitive, this dose would induce 1.9 times as many mutations as arise spontaneously. From the incidence of patients with Hodgkin's disease (1 : 42 000) the calculated population dose of procarbazine is 5.12 micrograms/kg. Assuming equal sensitivity between the sexes we can calculate, for an estimated number of 30 000 genes, the induction of about 22 mutations per million children due to procarbazine treatment. The same number of induced mutations can be calculated if the risk of patients is used for the estimation of the genetic hazard.


Increased frequencies of aberrant sperm as indicators of mutagenic damage in mice. We have tested the effects of TEM in 3 strains of mice using the sperm morphology assay. In addition, we have made an attempt to evaluate this test system with respect to experimental design, statistical problems and possible interlaboratory differences. Treatment with TEM results in significant increases in the percent of abnormally shaped sperm. These increases are readily detectable in sperm treated as spermatocytes and spermatogonial stages. Our data indicate possible problems associated with inter-laboratory variation in slide analysis. We have found that despite the introduction of such sources of variation, our data were consistent with respect to the effects of TEM. Another area of concern in the sperm morphology test is the presence of "outlier" animals. In our study, such animals comprised 4% of the total number of animals considered. Statistical analysis of the slides from these animals have shown that this problem can be dealt with and that when recognized as such, "outliers" do not effect the outcome of the sperm morphology assay.


Cis-platinum(II) diamine dichloride causes mutation, transformation, and sister-chromatid exchanges in cultured mammalian cells. The anti-tumor agent cis-platinum(II) diamine dichloride caused dose-dependent toxicity in V79 Chinese hamster cells and in secondary Syrian hamster embryo cells. Chromosome aberrations were induced and positive dose--response relationships were observed for induction of sister-chromatid exchanges and 6-thioguanine-resistant mutations in V79 cells and morphologic transformation of secondary Syrian hamster embryo cells. The findings suggest that this chemical is a potential human carcinogen.


Private cost containment.

Private cost containment. Physicians should recognize that a more competitive health-care market would provide the best defense against government regulation. Aside from group-practice health-maintenance organizations, the cost-containment steps that might be taken in such a market are not well understood. In particular, little attention has been paid to how private health insurers might redefine their coverage to limit the cost-increasing effects of third-party payment. Insurer-provider agreements negotiated in a competitive environment would seem to be especially promising. Competing insurance plans would be variously organized and operated according to provider and consumer preferences. Traditional doctor-patient relations as well as fee-for-service payment could be preserved. The antitrust laws, while curbing concerted effort to prevent change, should assure that physicians are not exploited by dominant buyers. Lucrative opportunities already exist for enterprising and efficient providers.


Frequency and clinical description of high-cost patients in 17 acute-care hospitals. To assess the potential impact of national "catastrophic" health insurance on the medical-care system, the frequency and clinical characteristics of high-cost patients were surveyed at 17 acute-care hospitals in the San Francisco Bay Area. The percentage of patients whose yearly hospital charges exceeded $4000 in 1976 ranged from 4 at a community hospital to 24 at a referral hospital. Hospital costs charged to these patients ranged from 20 to 68 per cent of total billings, with the highest percentages generally occurring at large referral hospitals. Forty-seven per cent of adult high-cost patients had chronic medical conditions, and only one in six suffered from an acute medical "catastrophe." In addition, more than 13 per cent of high-cost patients died in the hospital. National catastrophic health insurance is likely to pay for much chronic illness and terminal care and divert resources toward acute-care hospitals.


Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. The diagnosis of coronary-artery disease has become increasingly complex. Many different results, obtained from tests with substantial imperfections, must be integrated into a diagnostic conclusion about the probability of disease in a given patient. To approach this problem in a practical manner, we reviewed the literature to estimate the pretest likelihood of disease (defined by age, sex and symptoms) and the sensitivity and specificity of four diagnostic tests: stress electrocardiography, cardiokymography, thallium scintigraphy and cardiac fluoroscopy. With this information, test results can be analyzed by use of Bayes' theorem of conditional probability. This approach has several advantages. It pools the diagnostic experience of many physicians ans integrates fundamental pretest clinical descriptors with many varying test results to summarize reproducibly and meaningfully the probability of angiographic coronary-artery disease. This approach also aids, but does not replace, the physician's judgment and may assit in decisions on cost effectiveness of tests.


Cost containment through risk-sharing by primary-care physicians. A new type of independent practice association has been organized to encourage primary-care physicians in private practice to become coordinators and financial managers for all medical care. Each patient chooses one internist, family or general physician or pediatrician and must be referred by that physician for all specialized care. The primary-care physician authorizes payment from his own account for all care provided to his patients. He shares any dificit or surplus remaining at the end of the year. After four years of operation, United Healthcare has 610 primary-care physicians treating 23,000 patients. Total hospital use during 1978 and 293 bed-days per 1000 patients, as compared with 479 for Blue Cross. The hospital-admission rate per 1000 was 88, as compared with 101 for Blue Cross. Average lengths of stay were 3.3 and 4.7 dyas, respectively. This plan represents another means to control costs in the private medical marketplace.


The contribution of specialists to the delivery of primary care. Despite increased numbers of medical-school graduates and opportunities for "primary-care" specialty training since the mid-1960's, many believe that the shortage of physicians delivering generalist care will continue through the 1980's. Missing, however, is solid information on the role of physician specialists in providing such care. Two national studies have shown that one of every five Americans now receives continuing general medical care from a specialist physician. Our study suggests that, despite the current shortage of generalist-physician services, continuing specialist participation in primary care will lead to sufficient generalist medical services by the mid-1980's. Whether specialist participation is the most appropriate or cost-effective way to improve access to such care is unclear. However, until this question is resolved, more governmental regulation of graduate medical education may be unwise. Offering all physicains, regardless of specialty, more primary-care experience during residency training might better deal with this aspect of American medical practice.


United States citizens in foreign medical schools and the future supply of physicians. Between 1973 and 1977, the number of United States citizens in foreign medical schools increased from 12,000 to 15,000, with Mexico and Italy responsible for training 55 per cent of these students. If all these students can successfully meet the requirements for entry into graduate training in the United States, their numbers, combined with the increasing size of entering classes in American medical schools, may exceed the number of positions presently available for first-year graduate training. Serious problems in the quality of education received in several new foreign medical schools must be addressed if these students are to enter the American medical system.


Isolation and partial characterization of immunologically reactive fractions from chitinase digested cell wall of Trichophyton mentagrophytes. Cell wall preparations of Trichophyton mentagrophytes were digested with chitinase following which various fractions were isolated by ultrafiltration and Sephadex gel filtration. All fractions isolated contained both polysaccharide and peptide material. A correlation was seen between those fractions capable of eliciting immediate and delayed skin reactions in sensitized guinea pigs and those capable of stimulating the in vitro proliferation of lymphocytes taken from sensitized guinea pigs. These immunologically active fractions also developed precipitin lines with antiserum taken from sensitized animals. A low molecular weight fraction was found to be completely reactive immunologically (UM2(a)), and appeared to have a molecular weight in the range of 2,000--4,000 as assessed by ultrafiltration and gel filtration studies.


Characterization of immunologically active peptides from the cell wall of T. mentagrophytes. A low molecular weight fraction from chitinase digested cell walls of T. mentagrophytes containing both polysaccharide and peptide moieties was found to have immunological reactivity at both the cellular and humoral level. This fraction (UM2(a)) was further degraded by treatment with either a combination of pronase and carboxypeptidase A or with trypsin. Peptides were separated from the carbohydrate-rich fraction by ultrafiltration. The carbohydrate-rich fraction retained the ability to induce both immediate and delayed skin reactions in sensitized guinea pigs and to stimulate the proliferation of sensitized lymphocytes in vitro. The peptide moieties retained reactivity in that they caused delayed reactions and lymphocyte proliferation but were unable to induce immediate or Arthus reactions in sensitized animals. Tryptic peptides from UM2(a) were purified by ion exchange chromatography. A high proportion of these peptides demonstrated immunological activity at both the cellular and humoral level since they were capable of inducing delayed reactions and/or lymphocyte transformation, as well as being capable of blocking the complement fixation reaction between UM2(a) and specific antiserum.


Studies on a species of Monosporascus isolated from Triticum. A species of Monosporascus isolated from darkened stem bases of Triticum in Libya is compared with the two known species of the genus: M. cannonballus and M. eutypoides. The isolate resembles M. cannonballus in the type of ostiole developed but M. eutypoides in having mainly two-spored asci. It differs from M. eutypoides in having a reduced ostiole but this may be a response to growth in culture as this species has only previously been reported from infected tissues. In addition to having mainly two-spored and not one-spored asci, the isolate differs from M. cannonballus in that the spores pass through a stage in which a reticulum is visible when viewed by SEM. SEM photographs of the spores of both M. cannonballus and M. eutypoides, to which species this fungus is tentatively referred, are included. On germination the ascospores of the Triticum isolate produce 5--10 germ tubes. A growth curve for cultures is provided showing that the optimum temperature for growth is in the range 25--35 degrees C. Subcultures held at 48 degrees and 55 degrees C for five days failed to grow when transferred to 30 degrees C but ones held at 45 degrees for the same period grew normally when the temperature was reduced to 30 degrees C. The appearance of the colonies at different temperatures is also described.


Conservation of reference strains of Fusarium in pure culture. More than 300 reference strains representing 60 species and varieties of Fusarium cultures named according to different taxonomic systems are currently maintained at the American Type Culture Collection (ATCC). They have been preserved by freeze-drying and by freezing and subsequent storage in liquid nitrogen (-196 degrees C) to insure their viability without contamination, variation, mutation, or deterioration. The materials and procedures used at the ATCC for the acquisition, accessioning, cataloguing, preservation and distribution are described. Longevity storage data for the strains available for distribution are presented and discussed.


Inhibitory effects of condiments and herbal drugs on the growth and toxin production of toxigenic fungi. The effects of thirteen kinds of powdered herbal drugs and seven kinds of commercial dry condiments on the growth and toxin production of Aspergillus parasiticus, A. flavus, A. ochraceus, and A. versicolor were observed by introducing these substances into culture media for mycotoxin production. Of the twenty samples tested, cinnamon bark completely inhibited the fungal growth, while the others only inhibited the toxin production. The inhibitors were easily extracted from the samples with solvents such as hot water, chloroform, or ethanol. The extracts from coptis, philodendron bark, mustard, green tea leaves, and zanthoxylum completely inhibited the aflatoxin production of A. parasiticus, however, they had little or no inhibitory effect against A. flavus.


Effect of peanut tannins on percent seed colonization and in vitro growth by Aspergillus parasiticus. The relationship between tannin content of mature, intact, cured peanut seed and percent seed colonization by Aspergillus parasiticus was examined. Tannin content in 9 cultivars, 7 of which were grown in both Tifton, Georgia and Puerto Rico, was significantly correlated with percent seed colonization. For data expressed as mg tannin/g intact seed and mg tannin/g seed coat, correlation coefficients with percent colonization were 0.74 and 0.76, respectively. Seed coat tannin, methanol-extracted, water-soluble material from peanut seed coats, was tested in vitro for effects on growth of A. parasiticus. As concentrations of tannins were increased to 7.5%, inhibition of fungal growth increased linearly to 88%; a concentration of 20% produced over 96% inhibition.


Toxigenic fungi isolated from Roquefort cheese. To evaluate the potential for mycotoxin production by fungi contaminating blue-veined cheese, as well as by the ripening fungus, Penicillium roqueforti, the fungal flora of six of local and imported brands was determined. A total of 19 fungi were isolated from the six brands tested. Fourteen of the isolates were toxic to chicken embryos. The toxigenic fungi produced the following mycotoxins: Aspergillus fumigatus, kojic acid; A. versicolor, sterigmatocystin; Penicillium roqueforti, penicillic acid and unidentified toxic metabolites.


Candida infected ascites caused by perforated ulcer. A case is presented of ascites infected with candida in a cirrhotic patient. Candida infection of the ascitic fluid and candidemia were found 24 hours after perforation of a gastric ulcer. Combined intravenous therapy with Amphotericin B and 5-Fluorocytosine eradicated the infection within two weeks. The need for comprehensive therapeutic approach in the debilitated patient prone to fungal and bacterial infection is emphasized.


The ovalbumin gene region: common features in the organisation of three genes expressed in chicken oviduct under hormonal control. Two large DNA fragments overlapping the chicken ovalbumin gene have been isolated by molecular cloning. Analysis of these fragments provided a map of a 46,000-base pair region of the chicken genome. This region contains the complete ovalbumin gene (including its mRNA leader-coding sequence) and at least two other genes of unknown function. All three genes are orientated in the same direction and their expression in chicken oviduct is under hormonal control. The three genes share some sequence homologies, suggesting that duplications have occurred in the ovalbumin gene region in the course of evolution.


Histone genes are clustered with a 15-kilobase repeat in the chicken genome. Histone mRNA isolated from 5-day-old chick embryos has been used as a template for complementary DNA (cDNA) synthesis. The resultant cDNA, after removal of sequences complementary to rRNA, was used to detect histone genes in adult chicken genomal DNA. Hybridisation data indicate that the histone genes are repeated about 10-fold in the chicken genome. Restriction endonuclease analysis reveals some sequence heterogeneity in these genes. However, the results show that chicken histone genes are clustered with a basic repeat unit of 15 kilobases.


A mutation altering the function of a carbohydrate binding protein blocks cell-cell cohesion in developing Dictyostelium discoideum. In Dictyostelium discoideum, carbohydrate binding proteins (CBPs) or lectins have been implicated in the molecular basis of cellular cohesion. To determine the role of these CBPs, we have attempted to isolate structural gene mutants in which the CBPs have a defective affinity for carbohydrate ligands. We now report the isolation of a spontaneous, cross-reacting material (CRM) mutant which is non-cohesive and fails to develop. The mutant seems to have a defect in the structural gene for one of the two developmentally regulated carbohydrate binding proteins (CBP-26), which renders it unable to bind to galactose-containing ligands. The fact that wild-type cells interact with the mutant and carry it through development strongly supports a model of cell-cell interaction in which cohesion is mediated by complementary molecules.


[Studies in biotechnology at the Federal Technical College, Zurich]. A new Curriculum, termed Technical Biology (or Biotechnology) has been instituted at the Swiss Federal Institute of Technology in Zurich, Switzerland. Biotechnology is regarded not as a Natural Science, but as an Engineering Science. On a solid basis of two years of mathematics, physics, chemistry, physical chemistry, and biology, courses are offered in technical microbiology and process and control engineering.


[Concepts for the synthesis of new biologically active substances]. Three concepts for the synthesis of biologically active compounds are discussed and illustrated by examples. In addition to the accidental finding of biologically active compounds, synthesized purely for chemical reasons, analogy models can serve as guidelines for synthesis. In the latter, naturally occurring or synthetic biologically active molecules are modified to optimize or alter the biological properties. A third approach for the synthesis of active substances is oriented according to the side of action. Models from biochemistry and molecular biology serve as a basis for synthesis planning.


[Computer and chemical synthesis].

[Computer and chemical synthesis]. Numerous computer programs have gained entry into drug research; some of them are already used as a matter of routine, whereas others are still being tested. The special advantages of the use of computer programs are shown for the two fields "computer-assisted synthesis planning" and "quantitative structure-activity relationships". Several aspects of cooperation between man and computer are briefly discussed.


[Cochleotopic organization of the primary auditory region of the cerebral cortex in cats]. The cochleotopic organization of the primary auditory cortex (AI) was investigated by means of focal potentials evoked by direct electrical stimulation of the cochlea in cats under nembutal anesthesia. Two foci of maximal activity (dorsal and ventral) which were more prominent in the rostral and medial parts of AI appeared in 85% of animals in response to local stimulation of different cochlear regions. The analysis of the projectional maps shows that different cochlear regions are represented in AI nonproportionally. The basal region is projected to a larger cortical area than both the middle and apical ones. Significant variability was found for cochlear representation in the auditory cortex of different cats.


[Heterogeneity of a neuron population with complex receptive fields in the visual cortex of costs]. Visual responses of the striate complex cells to stimuli orientation, direction and velocity of movement were studied in awakening, unanesthetized cats. "Complex" cells were divided into four groups according to the response characteristics which were obtained using a stationary slit, moving light spot and moving oriented stimulus. The first group units response characteristics suggest the presence of the orientation selectivity mechanism in their receptive field organization, the fourth group--the direction selectivity mechanisms, the second and third groups--the presence of both mechanisms. It is supposed that there are two separate mechanisms for coding the orientation and direction of the stimulus movement in the neuronal structures of the visual cortex.


[Horseradish peroxidase labeled neurons of the ventrobasal complex of the thalamus projecting to the somatosensory zone I of the cat cerebral cortex]. The morphology and topography of the neurons in the ventro-basal complex (VB) projecting to the somatic sensory cortex (SI) were studied by the method of the retrograde axonic transport of horseradish peroxidase (HRP). Different types of HRP-labelled cells were found in this structure. The concentration of labelled cells was the greatest in the central part of the VB. The most peculiar feature in the distribution of HRP-positive neurons was their organization in two large populations in the dorsal and ventral portions of the VB. A comparison with the somatotopic map of the VB revealed that the central region of this complex is the area of the representation of the forelimb and the head. Our morphological results confirm the neurophysiological conception about the organization of the thalamo-cortical input on the "point-to-point" projection principles.


[Late prolonged discharges in the motor nerves of the hindlimbs and their relationship to locomotor rhythmicity in thalamically immobilized cats]. Effects of flexor reflex afferents stimulation were investigated on high decerebrated curarized cats. Stimulation of ipsilateral flexor reflex afferents evoked late long-lasting discharges in flexor nerves. Contralateral flexor reflex afferents stimulation evoked late discharges both in extensor and flexor nerves. Transition from late discharges to rhythmic discharges was observed. Early segmental reflexes were tonically depressed in thalamic in comparison with acute spinal cats. A similar tonic depression of segmental reflexes took place in acute spinal cats after DOPA injection. Segmental reflexes were distinctly modulated during late and rhythmic discharges. On the basis of the data available possible central mechanisms of the observed changes of segmental reflexes are discussed.


[Structure of the theoretical distributions of postsynaptic potential amplitudes upon quantum analysis]. It is suggested that formulas commonly used to calculate theoretical amplitude distributions of postsynaptic potentials (PSPs) for their further quantum analysis lead to the overestimation of the quantum value variations (sigma nu) and neglect the variations of a noise level (sigma 2n). A proper formula taking into account both parameters in proposed. The necessity to consider sigma 2n is shown by statistical analysis of "individual" and "minimal" PSPs recorded in the neurons of the central ganglion of the snail and hippocampal neurons of the rabbit. Taking into account sigma 2n resulted in a better agreement between theoretical and experimental distributions and provided an indirect method for sigma nu estimation.


[Electrical responses recorded from the round window of the cat cochlea]. The parameters of the cochlear round window responses to stimulation by acoustic clicks of different intensity, polarity and frequency were studied in experiments on anesthetized cats. The intensity function reflecting the dependence of the amplitude of potential change upon the level of stimulating click included two parts differing in slope. The dependence of the electric responses on the stimulus intensity and frequency was also studied. A specific form of the reaction was found in some cases. The study of all these parameters gives us some reasons to make a conclusion on the function of the auditory nerve.


[Responses of ampullae of Lorenzini in a uniform electric field]. Analysis of discharges of a single electroreceptor in a uniform electric field resulted in the conclusion that there is a linear relationship between the potential difference on a single ampulla and relative changes in the spike frequency. The topography of the ampullar groups can be described as a system composed by electric gratings. It is supposed that the maximum of the directional diagram of a grating corresponds to the area of a maximum sensitivity of an ampular group.


[Cooperative effect of calcium ions in freeing a mediator from the neuromuscular synapses of large and small muscle fibers of frog sartorius muscle]. The dependence of a amplitude and quantum content (m) of the end plate potentials on the external calcium concentration was studied in experiments on the frog sartorius amplitude of the miniature end plate potentials were found. The data obtained suggest that the number of calcium ions taking part in the release of each transmitter quantum may be different.


[Synapses with myelinated and unmyelinated preterminal portions of axons in cat cerebral cortex]. The electron microscopic study of the cat cerebral cortex revealed two kinds of preterminal axonal regions with synaptic boutons at the end: nonmyelinated and myelinated. In the first case their diameter was about 90 nm; in the second case it was considerably greater; the myelin could reach the bouton. The possible physiological meaning of these structural features is discussed.


[Feedback inhibition in microsegments of the visual cortex]. Interaction between 3-4 neighbouring neurons in the visual cortex of awakening cats was examined using a cross-correlation analysis. In some microsystems neurons revealed a tendency towards synchronized activity indicating a shared excitatory input. In other microsystems asymmetrical interaction was observed: neurons with larger spike amplitudes exhibited excitatory effect on neurons with smaller spike amplitudes (latent period about 5 ms) and neurons with small spike amplitudes inhibited neurons with large spike amplitudes (latent period 1-8 ms, duration of inhibition 30-200 ms). Suggestions were made about the existence of recurrent inhibition and inhibitory interneurons in microsystems of the visual cortex.


[Interaction between auditory and trigeminal afferent volleys in the dorsal cochlear nucleus of rats]. In chloralose anaesthetized rats preliminary electrical stimulation of the second branch of the trigeminal nerve diminished the amplitude of all component of the evoked potential produced by click, when the interval between conditioning and testing stimuli was up to 40 ms. Only late negative-positive component of the evoked potential was depressed when the interval between the stimuli was increased. The conclusion is made that the afferent inflow to the dorsal cochlear nucleus is controlled by peripheral mechanisms changing the sensory input and by central descending inhibitory influences on the nucleus.


[Change in the feedback inhibition of monosynaptic spinal cord reflexes following removal of the anterior lobe of the cerebellum in cats]. In acute experiments on cats monosynaptic extensor and flexor reflexes and their recurrent inhibition were recorded from a L7 ventral root filament before and after removal of the anterior lobe of the cerebellum. Removal of the anterior lobe reduced the amplitude of monosynaptic extensor and flexor responses and at the same time decreased the level of recurrent inhibition of extensor reflexes and increased that of flexor reflexes. On the basis of these data it is suggested that the background control form the anterior lobe of the level of recurrent inhibition is one of the possible mechanisms participating in the cerebellar control of spinal motoneurons.


[Dynamics of neuronal responses of the auditory zone of the cortex of wakeful cats during the process of elaboration of a defensive conditioned reflex to acoustic stimulation]. In chronic experiments on cats the neuronal responses (recording by means of glass microelectrodes) of auditory cortex I were studied during elaboration of a defensive conditioned reflex to a sound stimulus. During conditioning the biphasic reactions with a rather short-latent (50-100 ms) and more long-latent (400-500 and 800-900 ms) activation were predominant. The neighbouring neurons whose responses were recorded by the same microelectrode were involved into the activity more intensively. A differentiating stimulus in 70% of applications caused distinct changes in neuronal activity (predominantly of activation type). Analysis of the dynamics of responses of the same neuron during a great deal of combinations and its comparison with the formation of a motor reaction showed no direct correlation between the two events.


Hypertension in children: endocrine aspects. Hypertension in children is a rare disorder with reliable estimates of annual incidence that do not exceed 0.1%. At least one third of these cases have no definable etiology when all of the presently available diagnostic studies are used. Major invasive or expensive evaluations are indicated when hypertension is sustained or severe, and should be directed toward the renal and renovascular areas. Serum potassium and calcium estimates are essential in every case, but the more extensive evaluations of thyroid, parathyroid, adrenal cortical and adrenal medullary hormones should be reserved for patients with specific indications of malfunction in those systems.


Hypercalcemic and hypocalcemic disorders: diagnosis and treatment. Current concepts concerning the mechanisms, diagnosis and means of treatment of a number of the major causes of hypercalcemia and hypocalcemia are reviewed. In particular, the role of abnormalities in metabolism of vitamin D including (1) excessive hepatic production of 25-hydroxyvitamin D (vitamin D intoxication), (2) increased production of 1 alpha, 25-dihydroxyvitamin D (hyperparathyroidism and sarcoidosis), (3) impaired production of 1 alpha, 25-dihydroxyvitamin D (hypoparathyroidism, renal failure, vitamin-D-dependent rickets type I, pseudohypoparathyroidism) and (4) resistance to 1 alpha, 25-dihydroxyvitamin D; the use of vitamin D and its metabolites therapeutically is discussed.


Relationship of sympathetic nervous system tone and blood pressure. Plasma concentrations of norepinephrine (NE) appear to reflect sympathetic nervous system (SNS) tone. Plasma NE increases substantially when the SNS is stressed by acute postural change or physical exercise. Standing up from the recumbent position elevates NE by about 90% in healthy normotensive and hypertensive subjects. Although a primary role of the SNS is the maintenance and stabilization of blood pressure, there does not seem to be a direct relationship between plasma levels of NE and blood pressure. Patients with essential hypertension cannot be differentiated from normotensive subjects of the same mean age on the basis of either basal plasma levels of NE nor increments in NE after a standard postural stress. Patients with syndromes affecting the autonomic nervous system who suffer from orthostatic hypotension may have striking abnormalities in SNS response to stress, and some subgroups may be distinguished on the basis of the plasma concentrations of NE and the changes in NE elicited by stress.


Chronobiology of blood pressure.

Chronobiology of blood pressure. Blood pressure in normal and hypertensive subjects shows circadian variability with the minima during the hours of sleep. The factors influencing blood pressure show circadian variability, in particular, plasma and urinary aldosterone, plasma deoxycorticosterone and urinary sodium (factors implicated in cardiac output), angiotensin II as measured by plasma renin activity, plasma and urinary epinephrine and norepinephrine, and plasma and urinary prostaglandins of the E series (factors implicated in peripheral resistance). Direct causal relationships have not been established. The treatment of hypertensive subjects in relation to the circadian variability is reviewed.


Hydrochlorothiazide diuresis in healthy man: review of the circadian mediation. This is a review of evidence for a circadian-mediated pharmacology of a single dose of hydrochlorothiazide in normal man. The normal circadian rhythms of urine volume and electrolytes are discussed in detail. Information is documented that hydrochlorothiazide diuresis, in normal subjects on a normal schedule of diurnal activity/nocturnal rest, progressively increases for 4 h after a.m. administration and for 8 h after p.m. administration. This suggests that the therapeutic efficiency of a single dose may be enhanced (nearly 50%) by the simple expedient of prescribing in the afternoon. No information is provided as to whether the circadian-mediated response appertains in disease or with continued drug administration. The word 'circadian' is not found in classical pharmacological texts although many examples of circadian-mediated drug action have now been described. A circadian reappraisal of drug effects in general is overdue.


[A study on the problem of thoracic discprolapse (author's transl)]. The article reports on twenty patients with thoracic prolapsed discs treated by surgery within a period of ten years. The incidence in relation to prolapses at all levels was 1.2%. The average age was 50.3 years and there was no definite sex predominance. The segments Th 10-11 and Th 11-12 were the preferred sites. The period of the disease varied from a few hours to nine years. Among the most frequent subjective complaints were radiating pain, paraparesis of the legs and disturbed micturition. A definitely traumatic cause of the disease was present in one case only. Besides exact neurological diagnosis it is imperative to effect myelography with positive contrast medium, revealing the typical circular or oval-shaped filling defects. In our patients, laminectomy was performed 17 times, and hemilaminectomy three times. Besides removal of the prolapse, the dentate ligament was always divided. In some cases we also performed rhizotomy. Operation improved 15 patients, whereas in two patients the condition got worse and three patients showed neither improvement nor deterioration.


The recurrence of intracranial meningiomas. A series of 126 patients with meningioma, operated upon 7-17 years ago, is reviewed as to the recurrence of the tumour. The overall rate of recurrence of the histologically benign lesions was 29 per cent. The most important factors influencing the prognosis were the site of the tumour and the degree of radicality of excision. Both factors were illustrated best in the parasagittal meningiomas, which carry the highest rate of recurrence. Infiltration of tumour into adjacent bone does not necessarily carry a higher risk of a clinically relevant recurrence. There seems to be a great variation in the rate of growth of different meningiomas.


Angiographic diagnosis of cerebral oedema. Cerebral oedema is usually associated with brain vascular lesions, such as infarction, neoplasms, angiitis, thrombophlebitis, etc. and we consider that angiographic examination is essential for the diagnosis. In this paper we analyse the angiographic signs of cerebral oedema and the differential diagnosis between oedema and any associated lesions. We also consider that it is very important to establish a diagnosis between primary oedema and hydrocephalus with a view to establishing the correct treatment in each case.


[Secondary blood coagulation disturbances after severe head injuries (author's transl)]. The release of tissue thromboplastin after a severe brain injury can lead to a consumption coagulopathy. In a group of 83 patients with severe brain injury, platelet count, fibrinogen, prothrombin, partial thromboplastin time and thrombin time were investigated. The pathological laboratory findings in 14 were compatible with a consumption coagulopathy. These alterations were demonstrated during the first hours following trauma and represented an extra handicap for the patients who had to be treated surgically.


[Pineal teratoma--case report (author's transl)]. A 3-year-old boy had a history of nausea and vomiting for 1 month. After two episodes of tonic cramp, he became drowsy and then semicomatous. Physical examination on admission revealed a dehydrated semicomatous boy with fixed, dilated pupils of equal size, horizontal nystagmus, and left hemiparesis with bilateral Babinski signs. Plain skull films showed a separation of coronal and sagittal sutures. A high density area surrounded by cyst was found in the pineal region in CT scan. Angiography demonstrated stretching of the posterior choroidal arteries, backward displacement of the Galen, the posterior mesencephalic and the precentral vein. The right occipital transtentorial approach was selected to remove the tumor totally. Histology revealed epidermis, hair follicle, sebaceus and sweat glands, columar gland, bone, cartilage, muscle, fatty tissue, nervous tissue, and connective tissue, indicating a pineal teratoma. There was no evidence of germinoma.


[Aneurysm surgery in the older patients (author's transl)]. A series of 9 patients over 70 years of age with saccular aneurysms, operated on by a direct surgery is reviewed in order to discuss the aneurysm surgery in the older patients. The median age of the patients was 74 years, and median interval from the hemorrhage to surgery was 18 days. Operative mortality was 11% and morbidity was 33%. Result of intracranial aneurysm surgery in the older patients depends on the surgical technique for the arteriosclerosis. 1. Treatment of the aneurysm neck must be abandoned when a severe arteriosclerosis exists around it. Subsequent to exposure of the whole aneurysm, a complete reinforcement of the aneurysm wall should be undertaken. 2. Especially gentle manipulation of the brain is necessary since small arteries are easily pulled out from the sclerotic artery. 3. The cerebral veins must be preserved as well as possible to avoid the venous congestion, which easily causes an intracerebral hematoma following brain retraction. 4. The frequency of pre and postoperative complications is high, but through vigorous care, they are kept under control. 5. It is best not to judge the surgical indication simply by the chronological age, but rather to consider the physical age including the laboratory findings. Therefore, other than cases of severe arteriosclerosis, the same principles for surgical indication in younger patients should be used for older patients.


[Surgical treatment of the carotid-ophthalmic aneurysms (author's transl)]. Six cases of carotid-ophthalmic aneurysm submitted to direct operation were studied. 1. One out of six cases died postoperatively (mortality rate 16.7%). 2. Exposure of the internal carotid artery at the neck is absolutely necessary for its temporary occlusion. Temporary occlusion of the internal carotid artery at the neck makes the dissection of the aneurysmal neck easier and prevents the aneurysmal rupture during operation. 3. To cope with various complicated handlings, bifrontal carniotomy is recommended. 4. In order to make easy the dissection of the aneurysmal neck, the unroofing of the optic canal as well as the extensive removal of the tip of the anterior clinoid should be performed. 5. From our experience as well as review of the literature, the surgical result of the giant aneurysms is bad. Some new therapy is expected to be developed for the giant aneurysm of this site.


[Cervical internal carotid artery occlusion after recovery from suicidal hanging--a case report (author's transl)]. A case of internal carotid artery occlusion due to attempted hanging was reported. This 51-year-old man, who failed in suicidal hanging, remained in right hemiplegia and total aphasia. Left carotid arteriogram revealed complete occlusion of the internal carotid artery approximately 1 cm distal to its origin. Surgical exposure of the internal carotid artery was performed 4 weeks after the attempted hanging. The occlusive portion was percutaneously injured by ligature, whereby there was a horizontal breach of intima, media and adventitia at the level of the ligature. The damaged arterial wall was resected, and a reconstructive vascular surgery in the neck was performed. But postoperative arteriogram showed an unsatisfactory result. Pathogenesis of traumatic involvements of the internal carotid artery was discussed with literature. Also it was discussed that internal carotid artery occlusion was a very important factor causing death in suicidal hanging.


[An operated case of clivus chondroma (author's transl)]. A case of clivus chondroma was presented in detail with a review of twenty-four cases reported in Japan. A twenty-eight-year-old house wife was admitted to hospital with complaints of muscle weakness and numbness on the right side of the body. Neurological examination revealed the right hemiparesis and hemihypesthesia. Cranial nerve palsies were also disclosed on the right Vth and the left IXth, Xth and XIth nerves. Craniograms showed a ring-like calcified shadow localized in the clival region without definite bone destruction. Roentgenograms disclosed many well-demarcated radioluscent areas in the phalanges of both hands and feet. The marked separation between the basilar artery and the clivus was demonstrated on vertebal angiograms and pneumoventriculograms. CT scan showed an irregularly shaped low density area localized on the clivus, which turned out to be enhanced following contrast infusion. The tumor was partially removed by the subtemporal approach, and was histologically chondroma. The patient was discharged, gaining adequate muscle strength after operations.


Activation of masculine sexual behavior by intracranial estradiol benzoate implants in male rats. Intracranial implants of estradiol benzoate (EB) were used to explore sites of action for the activation of masculine copulatory behavior in castrated male rats. In experiment 1, 27 or 30 gauge implants were placed unilaterally throughout the hypothalamus and preoptic area. Dihydrotestosterone (DHT) was administered subcutaneously (s.c.) to each male. 25 of 42 males with EB implants located in the medial anterior hypothalamic-preoptic area (AHPOA) exhibited ejaculatory patterns on at least 40% of the post-implantation tests. In contrast, only 4 of 18 of the males with implants located posterior to the anterior hypothalamic area displayed this level of response. This difference in the proportion of animals responding for each implant group was statistically significant. Seminal vesicle weights were not correlated with the occurrence of copulation. In experiment 2, either EB-filled or empty cannulae were placed unilaterally in the AHPOA. Half of the males of each group also received DHT s.c. Intracranial EB in conjunction with DHT s.c. resulted in a significantly greater frequency of ejaculatory response than any other treatment. Despite significant differences among the groups in seminal vesicle weights, there was no correlation with occurrence of ejaculatory behavior. These results are consistent with the hypothesis that testosterone (T) exerts its effects upon masculine sexual behavior via conversion to estradiol (E2); and that the principal neural site of action is the AHPOA.


Observations on the secretions of the subcommissural organ and the pineal in the adult brush-talled possum (Trichosurus vulpecula). Secretory functions of the subcommissural organ (SCO) were investigated using mainly transmission and scanning electron microscopes, in 40 adult (19 males, 21 females) Trichosurus vulpecula which were caught in different seasons over several years. There is clear evidence of apical secretion, Reissner's fiber (RF), a presumptive basal secretory material with associated perivascular space and labyrinthine basal lamina. Secretory function does not appear to be related to the sex of the animal or to the season when they were investigated. Radioimmunoassay of blood, SCO and pineal gland (PIN) for melatonin (MEL) was carried out in 18 adult animals in summer and winter. Gonads were also histologically examined. The SCO showed very little MEL. Findings suggest that the PIN of this animal has a low capacity to store and secrete MEL. Further, there is no evidence for the increased storage or secretion of MEL during darkness, and more specifically at midnight. The present investigators support the view that other indoles such as methoxytryptophol or pineal peptides may elicit the physiological effects of PIN.


Central effects of angiotensin II in water and saline loaded rats. In unanesthetized water-loaded rats, intracerebroventricular (IVT) angiotensin II (AII) injections produce centrally mediated pressor effects and antidiuresis. Experiments were performed to evaluate the role of antidiuretic hormone (ADH) release versus neurogenic mechanisms in the antidiuretic responses to central AII median eminence lesions used to block ADH release abolish antidiuretic effects but only attenuated pressor responses to IVT AII infusions. Pretreatment with an intravenous infusion of ADH antibody had a similar effect. Central administration of AII in water and saline-loaded rats produced no change in effective renal plasma flow or glomerular filtration rate, Natriuretic and kaliuretic responses to IVT AII injections were similar to those observed to intravenous ADH infusions. These data are consistent with the suggestion that antidiuresis and osmotic excretion observed after IVT AII injections in the rats are the result of ADH release, and that neurogenic mechanisms play a major role in the blood pressure but not in the antidiuretic responses.


The effect of L-3,4-dihydroxyphenylalanine (L-dopa) on the prolactin response to sexual behavior in the male rat. L-3,4-dihydroxyphenylalanine (L-dopa) was administered intraperitoneally (i.p.) to sexually experienced male rats, and blood was collected both by decapitation without anesthesia and by cardiac puncture with ether anesthesia. Samples were taken before and during mating with a receptive female. Both the prolactin (Prl) response to ether and the Prl response to mating were suppressed by L-dopa. Basal Prl levels were depressed, but not significantly. However, sexual behavior was not altered by L-dopa. It was concluded that the previously reported loss of the Prl response to an estrous female in male rats lesioned in the medial preoptic area (MPOA) could not account for their loss of sexual behavior. Further, elevation of Prl levels during mating is not necessary to normal sexual behavior in the intact male rat.


The effect of hypothalamic lesions on estradiol-induced changes in LH release in the ewe. The effect of hypothalamic lesions on estradiol-induced changes in plasma luteinizing hormone (LH) concentration was studied in ovariectomized ewes. The ewes had stainless steel electrodes chronically implanted in the hypothalamus (HYP), and electrolytic lesions were made within 1 h after the injection of 50 microgram estradial benzoate (EB) i.m. Blood samples were collected at 2--6 h intervals for 30 h after EB, and the plasma was subsequently assayed for LH. None of the lesions produced had any effect on the normal immediate (within 12 h after injection) inhibitory effect of estrogen on LH release. However basal hyothalamic lesions, ranging from the suprachiamatic region back over the optic chiasma down to include the anterior tuberal region, effectively inhibited the normal stimulatory effect of estrogen (12--30 h after injection) on LH release. The results are consistent with the interpretation that, in the normal biphasic LH response to injected estrogen in the ewe, the early inhibition of LH release results from direct inhibition of pituitary sensitivity to endogenous LH-releasing factor (LRF). On the other hand the estrogen-induced LH release which occurs subsequent to this inhibitory phase is principally the result of increased LRF secretion by the HYP.


Cystic lesions associated with intracranial meningiomas. Three unusual cases of large, peritumoral cystic lesions associated with intracranial meningiomas are reported. In each case, the cyst caused difficulty in the interpretation of the computed tomogram when the latter was considered as a diagnostic test by itself, but the composite information obtained from the clinical history, cerebral angiography, and a radionuclide brain scan led to the correct preoperative diagnosis. The cyst was extrinsic to the tumor and contained xanthochromic fluid with a high protein content. The cyst wall consisted of brain parenchyma that showed glial cell proliferation (confirmed by the presence of glial fibrillary acidic protein by immunoperoxidase staining).


Total morbidity and mortality rates of patients with surgically treated intracranial aneurysms. The authors report their recent experience in treating 80 patients with intracranial aneurysms. A total of 83 surgical procedures were performed with a surgical mortality of 4.8%. Fifty-six patients had suffered a subarachnoid hemorrhage. Total mortality for this group was 14.2% regardless of clinical grade. Early surgical intervention, meticulous preoperative monitoring, and control of circulatory dynamics were used to improve the perioperative morbidity and mortality rates. We believe that any major improvements in the outcome of patients with aneurysms will come from advances in perioperative management.


Microsurgical lumbar discectomy: preliminary report of 83 consecutive cases. The application of microsurgical technique to lumbar discectomy may be of dual value: minimal disruption of the integrity of normal anatomy and meticulous hemostasis may help to speed the process of convalescence, and the retention of epidural fat around the nerve root may help to prevent adhesions, a common cause of the late, "failed disc" syndrome. The authors report their experience with 83 consecutive microdiscectomies for lumbar disc protrusions. The results must be considered as tentative because the follow-up period has been short and the authors found it difficult to quantify the quality of health during the convalescent phase, although this seemed to be excellent. Their short term results are similar to those of the larger series reported by Williams, whose experience with microsurgical lumbar discectomies began 6 years ago. No other series have been reported. The authors describe their technique and compare it to that of Williams.


Personality factors and results of lumbar disc surgery. Patients undergoing surgery for herniated lumbar discs were evaluated prospectively with a battery of psychological tests. Personality factors in patients having a good outcome were compared to those in patients having a bad outcome. Both groups had similar surgical findings. Patients with a good outcome were more stable, cautious, efficiently defensive, self-confident, realistically concerned with their illness, mildly depressed, generally optimistic regarding outcome, and able to withstand setbacks without resorting to emergency reactions. Patients with a bad outcome were less stable, were unpredictable, had inefficient defenses, were more obviously depressed, and were less able to withstand stress and breakdown. However, even the degree of psychological testing used in this study does not definitely predict outcome.


Effects of glycine administration on canine experimental spinal spasticity and the levels of glycine, glutamate, and aspartate in the lumbar spinal cord. Twelve female mongrel dogs were made paraplegic by midthoracic spinal cord transection. Beginning at 9 weeks posttransection, either glycine (50 mg/kg) or saline was injected intramuscularly each day and the signs of spinal spasticity were assessed clinically. After treating the dogs for 3 weeks, we removed the lumbar enlargement of each dog and microdissected it into gray and white areas which we assayed for glycine, glutamate, and aspartate content. Some of the clinical signs of spasticity improved in the animals injected with glycine compared to the saline-injected controls. The content of glycine was significantly elevated in the central gray matter and ventral medial white matter of the glycine-treated dogs. The levels of glutamate were also significantly elevated in the central, lateral ventral, and medial ventral gray matter and in the dorsal lateral and ventral medial white matter of the glycine-treated dogs. The possible role of these segmental putative neurotransmitters in spinal spasticity is discussed.


Effect of total body temperature on toxicity of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU). One hundred eighty-two rats were divided into groups to test the effect of three different total body temperature levels on the toxic effect of three different dose levels of 1,3-bis(2-chlorethyl)-1-nitrosourea (BCNU) and to assess the effect of delayed total body temperature elevation on BCNU breakdown products. Results were tabulated on the basis of life survival figures. At depressed total body temperatures (28 degrees C), normally expected toxicity was avoided. Elevated body temperatures, on the other hand, enhanced the toxic effect of BCNU. Delayed total body temperature elevation (3 and 6 days after BCNU administration) created similar toxicity. This finding was not observed when total body temperature elevation was delayed 10 days. The results point toward an interesting interaction between BCNU and heat (immediate and delayed) on the basis of an elevated metabolic rate of tissue, a synergistic effect of two therapeutic modalities, interference with normal reparative processes by the combination, or an enhancement of retained serum protein-bound breakdown products of BCNU.


Successful management of bilateral carotid-cavernous fistulae with a trans-sphenoidal approach. A patient with traumatic bilateral carotid-cavernous fistulae was successfully treated by an entirely extracranial approach. The larger fistula on the left was exposed via a transethmoidal, trans-sphenoidal route and was directly opened and packed while the cavernous carotid artery was stented open by an intraluminal balloon catheter. The balloon catheter provided temporary hemostasis and was removed after the fistula had been packed. The left carotid artery remained patent, and the smaller fistula on the right was subsequently obliterated by a balloon catheter. The fistulae have remained cured, and the left internal carotid artery supplies the cerebral circulation.


Alexia without agraphia in a musician after transcallosal removal of a left intraventricular meningioma. After a meningioma situated in the trigone of the left lateral ventricle was excised by the transcallosal approach of Kempe and Blaylock, a right-handed musician with a right hemianopsia developed alexia without agraphia. In contrast to previously reported cases of this syndrome arising from other etiologies, he was unable to read single letters or numbers. Neuropsychological studies at 42 and 126 days after operation also disclosed an inability to associate auditory or tactile stimuli with visually perceived material, whereas speech and verbal comprehension were intact. Although the alexia extended to musical notes, he could interpret other musical symbols (e.g., treble clef). Appreciation of rhythm and expressive musical ability were relatively preserved, although judgment of other musical features (including discrimination of pitch, duration, and loudness) was compromised. The findings suggest that alexia may occur as a consequence of the transcallosal procedure when a right hemianopsia is present. However, other linguistic abilities may be better preserved by the transcallosal approach to the ventricle than by a transcortical operation.


Calvarial hemangioendothelioma with intracranial hemorrhage: case report. A case of a hemangioendothelioma of the occipital bone that presented clinically as an acute epidural hematoma is reported. The literature regarding this rare bone tumor is reviewed. The treatment of choice seems to be wide surgical excision, but life-threatening hemorrhage may occur due to extreme tumor vascularity. The role of radiotherapy remains uncertain.


Chondroma of the spine in a newborn infant: case report. We report a newborn infant with a chondroma of the spine covered by a large lipoma. The child had no neurological deficit. Presenting as a tumor of the back, the chondroma was successfully excised. A review of the pertinent literature emphasizes the rarity of this lesion.


Response to amitriptyline and urinary MHPG in bipolar depressive patients. This investigation was done in order to test the hypothesis that urinary MHPG levels provide a predictor of response to therapy in depressed patients. 15 elderly biopolar depressives were included in this study. Their depressive state was estimated by the Hamilton Depressive Scale and their urinary MHPG levels were simultaneously measured before and after 5 weeks of amitriptyline therapy. When comparing amitriptyline responders to nonresponders by parametric techniques, the responders excreted significantly higher mean MHPG levels before the treatment than the nonresponders. During treatment MHPG levels rose significantly in both groups.


Interaction between intermittent photic stimulation and auditory stimulation on the human EEG. Preliminary investigation through power spectral analysis. The effects of flicker photic stimulation (6, 8, 9, 10, 11, 12, 14, 16 flashes/sec) and of white noise (80 dB SPL) on the EEG of man were investigated with the aid of power spectral analysis. In order to evaluate both the alpha attenuation response (AAR) and the 'driving' reaction induced by flicker as well as the effect of noise, the analysis was carried out on broad (delta, theta, alpha, beta) and on narrow (bandwidth: 1 Hz) spectral bands. A significant correlation between the amount of AAR induced by noise and a measure of the tendency to exhibit photic driving was found, though there was no clear-cut interaction between the photic stimuli and noise when delivered stimultaneously.


[Purpose, organization and structure of the coronary unit]. The purposes of the coronary unit are: 1) monitoring of fatal arrhythmias; 2) monitoring of shock and decompensation; 3) protection of the ischaemic myocardium. The structure and organization that a coronary unit should have to fulfil its purposes are described.


[Occupational toxic hepatopathies. Current etiopathogenetic and diagnostic trends]. The large number of xenobiotic agents, associated with work or otherwise, that can attack the body, and the fundamental part played by the liver in the control of metabolic homeostasis offered the occasion for an examination of the present position with regard to the aetiopathogenesis and diagnosis of occupational toxic diseases of the liver. Attention is particularly directed to recent biochemical knowledge (molecular and cellular), to the main aetiopathogenetic features, and to the most modern criteria for the evaluation of liver damage, especially that of a chronic kind.


[Ileo-cecal malignant carcinoid tumor with orbital metastases as initial symptoms. Anatomo-clinical study]. A case of carcinoid tumor of the last ileal loop is presented; the first clinical sign was exophthalmos due to bilateral orbital metastases. The case is believed to be the third recorded one of carcinoid with metastases to the orbit; other metastatic lesions were located in myocardium, liver, spleen, kidney, ovary and trachea. Porgressive hirsutism was present in association with the somewhat atypical clinical picture.


[The electrocardiogram and arterial hypertension in primary hyperparathyroidism]. Cardiovascular conditions of 27 patients with primary hyperparathyroidism have been examinated. Hypertension has been found to be the only alteration significantly present (33,33% of patients), while heart disease are uncommon. Hypertension is often present without concomitant disease of the kidney. Blood pressure became normal in only one case over nine (11,11%) after parathyroidectomy.


[Antibacterial effects of 70 percent denatured ethyl alcohol on hospital bacteria strains]. Data relating to a study of the activity of 70 percent methylated spirits on some bacterial strains isolated in a hospital environment are reported. It was found that the spirit had very little effect over times of 30'' or less, a good bactericidal power for time of 1', and an excellent bactericidal power for times of more than 1'.


[The Pelger-Huet granulocytic anomaly].

[The Pelger-Huet granulocytic anomaly]. Pelger-Huet's granulocyte abnormality is discussed. This abnormality is characterized by the presence of granuloyctes with a non-segmented nucleus and thick nuclear chromatin gathered in large lumps, in contrast with the "youthful" appearance of the nuclei. In humans, a real Pelger-Huet abnormality with familial character and dominant autosomic transmission is distinguished together with a pseudo-Pelger in which the granulocytes assume cytological features similar to those typical of the constitutional abnormality but whose genesis is closely correlated to the disease of which these are an epiphenomenon.


[Value and limitations of exfoliative cytological study of the pancreatico-duodenal juice collected during the secretin and pancreozymin test in the diagnosis of pancreatic carcinoma]. Studies on exfoliative cytology of the pancreatic-duodenal juice in the diagnosis of pancreas neoplasia are not numerous and the data reported are not uniform. The present study examines 176 patients, 18 of them suffering from carcinoma of the pancreas. In these latter patients there were no advanced signs of the disease. Cytology gave a correctly negative result in 46.8% of the normal subjects and in those with non-neoplastic pancreatic or digestive conditions, correctly positive in 66.6% of the pancreas neoplasias, falsely negative in 2,2% of the total series and in 33.3% of the pancreatic cancers, and falsely positive in 1,1% of the series. In 47.7% of cases, the study proved useless owing to the absence of material in the collected juice.


[2 cases of Apud cell tumors of the rectum and colon]. Two cases of Apud cell tumour of the rectosigmoid are presented. The question of gross diagnosis and the therapeutic efficacy of polypectomy are discussed. Lastly, an account is given of the morphological, functional and embryogenetic features of these tumours.


[Value of allergic intradermal reactions to antibiotics in preparation for surgery (in patients with a history of drug allergy)]. An allergological examination technique for application in patients with a history of hypersensitivity to antibiotics is described with reference to a personal series of 250 subjects admitted to the Bologna University obstetric and gynaecological pathology department for small pelvis surgery. The method of investigation is described and the results obtained are reviewed. It is felt that the investigation is of value in preoperative screening insofar as it eliminates or reduces the risk of allergic shock, and enables more precisely directed antibiotic management to be employed.


[The behavior of lecithin cholesterol acyltransferase (LCAT) in acute viral hepatitis and post-hepatitis cirrhosis]. The behaviour of LCAT was examined in acute viral hepatitis and post-hepatic cirrhosis. In the former case, the enzyme was also investigated during remissions. The influence of cholestasis on LCAT activity was evaluated. Depression was noted in cirrhosis and the acute stage of hepatitis, whereas enhanced values were observed during remissions. Depression of the enzyme by cholestasis is explained in a variety of ways.


[Behavior of post-ischemic reactive hyperemia in increasing periods of circulatory arrest in healthy subjects and in patients with peripheral obliterating arteriopathy]. Reactive hyperemia was studied by plethysmographic measurement of the blood flow in the calf in normal subjects and in patients with peripheral arterial disease following circulatory arrest for periods ranging between 1 and 20 minutes. The duration of occlusion is an important factor in determining the behaviour of reactive hyperemia. Peak flow increases significantly when there is up to 10 minutes of circulatory arrest. Following release of an occlusion of 15 or 20 minutes, the further rise of peak flow is very moderate. The duration of subsequent hyperemia is greater in patients than in normal subjects, when the length of the occlusion is of 1 to 10 minutes. When circulatory arrest is prolonged for more than 10 minutes, the recovery time of basal flow is significantly greater in normal subjects. Several mechanisms are involved in reactive hyperemia; their relative importance may vary with the duration of occlusion. Circulatory arrest of 3--5 minutes is a useful clinical test to screen patients with arterial occlusive disease. It is not the best for a full evaluation of the blood flow in the lower limbs either in normal subjects or in partients.


[Histological and clinical correlations in thyroid pathology]. The cases of 138 patients who underwent, during the last six years, an operation for thyroid affections, have been reviewed in order to compare the definitive histological response with the clinical diagnosis. On the basis of this analysis it was pointed out that, even with the aid of the commonly used diagnostic investigations, it is difficult to get a certain and sure knowledge of the anatomo-pathological picture, before beginning the operation. Furthermore, the definitive histological diagnosis itself may be wrong if it is not based upon the examination of the whole removed tissue, using as many sections as possible.


[Oxolinic acid treatment of urinary sepsis in patients with renal insufficiency]. The effect of oxolinic acid, administered at the rate of 750 mg twice/day, has been studied on 31 patients with urinary tract infections. Many of them had a marked impairment of renal function due to nephropathies of various origin. Favourable results, with sterile urine and complete remission of symptoms, were obtained in 73.3%. Patients who were resistant to previous different therapies, were successfully treated. Oxolinic acid was on the whole well tolerated and proved to be effective also in patients with impaired renal function. In some of the latter an improvement in renal function occurred as a result of the effective urinary infection care. The tolerability of oxolinic acid was good: only one patient interrupted the treatment because of insomnia; other 4 had transient and mild side-effects.


[Changes in zinc retention in pregnancy]. Enhanced retention of nutrients in the gravid organism, which exceeds the normal deposition in the reproductive organs and in fetuses, is called 'pregnancy anabolism'. For zinc this superretention could be established only in the liver which was enlarged in gravid rats, too. In all other tissues of gravid animals, zinc contents were lower compared with nongravid rats. After lactation, these changes in zinc status were equalized, and gravid and nongravid animals showed the same values.


[Enhanced retention of zinc in the gravid organism]. Enhanced retention of nutrients in the gravid organism, which exceeds the normal deposition in the reproductive organs and in fetuses, is called 'pregnancy anabolism'. For zinc this superretention could be established only in the liver which was enlarged in gravid rats, too. In all other tissues of gravid animals, zinc contents were lower compared with nongravid rats. After lactation, these changes in zinc status were equalized, and gravid and nongravid animals showed the same values.


Influence of norepinephrine and fasting on the oxygen consumption of genetically-obese mice. Oxygen consumption was monitored in fed and fasted, lean and obese mice of the ob/ob strain before and after subcutaneous injections of norepinephrine (NE). The increase in oxygen consumption after NE was of a similar magnitude in both lean and obese fed mice, but of a longer duration in the obese. Prior fasting caused a diminution of the response in the lean but was associated with an enhanced response in the obese mice. Fasting also resulted in a significant depression of the resting oxygen consumption of the obese mice but not of the lean. The relevance of these findings to the inability of the obese mouse to withstand cold exposure and to the maintenance of the obese state is discussed.


Effects of exercise on plasma and liver lipids of rats. IV. Effects of exercise on hepatic cholesterogenesis and fecal steroid excretion in rats. The effects of treadmill exercise on hepatic cholesterogenesis and fecal steroid excretion were studied using male Wistar rats fed a commercial pellet ration. Exercise, in comparison with ad libitum or pair-feeding sedentary groups, caused the following significant changes: (i) a reduction in the concentration of plasma triglyceride, phospholipid and cholesterol; (ii) a reduction in liver weight; (iii) increases in hepatic 3-hydroxy-3-methylglutaryl-CoA reductase activity and incorporation of mevalonate into digitonin precipitable sterol; (iv) increases in excretion of neutral and acidic steroids into the feces; (v) the increase in lipoprotein lipase activity in the cardiac muscle, and (vi) the decrease in the concentration of carcass triglyceride but not of cholesterol. These data suggest that the mechanism responsible for the plasma cholesterol-lowering effect of exercise is attributable to an increase in exretion of fecal neutral and acidic steroids accompanied by an acceleration of cholesterol turnover in the body.


Beneficial effect of zinc supplementation on reproduction in rats fed rapeseed protein concentrate. Three groups of 33 90-day-old female Sprague-Dawley rats were fed, ad libitum, the following diets for 2 weeks before breeding. Diet 1 (D1) contained 20% protein from casein, diet 2 (D2) had the same level of protein from Tower rapeseed (Brassica napus) protein concontrate (RPC) and diet 3 (D3) was the same as D2 with a zinc supplement (70 mg/l) in the drinking water. From each group 6 animals were killed before breeding and 5-9 animals were killed at 1 and 2 weeks of gestation and post-partum. From each rat, blood, thyroids, liver and femur were collected for the determination of zinc, copper, iron, manganese, calcium and magnesium. As a measure of the reproductive performance, body weight, number of pups in the uterus or delivered live or dead, and gestations days before parturition were recorded. The pups were examined for obvious deformities and also analysed for the above mineral elements by atomic absorption spectroscopy. In group D2, levels of zinc in maternal serum, liver, femur and in the pups were significantly lower than the comparable levels in the other two groups. The zinc supplemented RPC-fed group did not show the anorexia experienced by the unsupplemented group and there was neither a significant difference between reproductive performances of groups D1 and D3 nor was there any significant difference between the zinc levels determined. It was concluded that the toxic symptoms caused by RPC feeding was attributable to zinc deficiency probably caused by the high phytate level in the RPC.


Beneficial effect of zinc supplementation on reproduction in rats red rapeseed protein concentrate. Three groups of 33 90-day-old female Sprague-Dawley rats were fed, ad libitum, the following diets for 2 weeks before breeding. Diet 1 (D1) contained 20% protein from casein, diet 2 (D2) had the same level of protein from Tower rapeseed (Brassica napus) protein concontrate (RPC) and diet 3 (D3) was the same as D2 with a zinc supplement (70 mg/l) in the drinking water. From each group 6 animals were killed before breeding and 5--9 animals were killed at 1 and 2 weeks of gestation and post-partum. From each rat, blood, thyroids, liver and femur were collected for the determination of zinc, copper, iron, manganese, calcium and magnesium. As a measure of the reproductive performance, body weight, number of pups in the uterus or delivered live or dead, and gestation days before parturition were recorded. The pups were examined for obvious deformities and also analyzed for the above mineral elements by atomic absorption spectroscopy. In group D2, levels of zinc in maternal serum, liver, femur and in the pups were significantly lower than the comparable levels in the other two groups. The zinc supplemented RPC-fed group did not show the anorexia experienced by the unsupplemented group and there was neither a significant difference between reproductive performances of groups D1 and D3 nor was there any significant difference between the zinc levels determined. It was concluded that the toxic symptoms caused by RPC feeding were attributable to zinc deficiency probably caused by the high phytate level in the RPC.


Bioavailability of zinc in infant cereals. The bioabailability of zinc in three cereals was determined by a rat assay, using total femur zinc as the indicator. The basal diet contained 25% egg white solids and 0.6 microgram zinc per gram. The infant cereals were included in the diets at three graded levels to supply 3--12 microgram zinc per gram. Zinc sulphate was used as a standard source, with and without supplemental iron (185, 370, 555 microgram/g, respectively) at 3, 6 and 9 microgram zinc per gram with a view to determine the effect of excess iron on zinc availability. Added iron from sodium iron pyrophosphate was not found to have any effect on the bioavailability of zinc from zinc sulphate. The responses for the three cereals were linear but the regression lines representing them and the standard source did not have a common intercept. However, the ratio of the slope of the regression line for the test source to that of the standard indicated that the cereal containing soy protein was a better source of zinc (ratio = 0.49) than the barley cereal (9.10) or the rice cereal (0.32). These ratios did not show any correlation with the actual iron-precipitable phytate phosphorus content or the reported crude fibre content.


Effect of zinc on some biochemical indices of metabolism. The role of zinc in some metabolic functions in man was investigated in 14 healthy male volunteers with primarily high or low serum zinc. In all the subjects, results of laboratory tests reflecting blood picture, metabolism of carbohydrates, fats and proteins and thyroid function as well as serum calcium and phosphate levels varied within the normal range. Significant differences between the subjects classified by serum zinc were found in alpha1-globulins. Serm thyroxins, effective thyroxine ratio and the immunoglobulins IgA showed  a tendency to lower levels in subjects with low serum zinc. Substitution with zinc sulphate resulted in an increase of alpha 1-globulins, serum thyroxine and effective thyroxine ratio, and a decrease of albumin. Other tests remained by the therapy. The results suggest that there is a relationship between zinc and some metabolic functions in healthy subjects without symptoms of zinc deficiency.


Influence of different dietary carbohydrates on liver and plasma constituents in rats adapted to meal feeding. Male Sprague-Dawley rats were given in one experiment diets with starch or sucrose and in a second experiment diets with glucose or fructose. In each experiment, one group of 5 rats was fed ad libitum and five other groups fed a 3-hour meal each day. After 36 days, one group of the meal-fed rats was killed when the meal was due, and the other groups at intervals after the beginning of the meal. The group fed ad libitum was killed the next day after 21 h fasting. Meal feeding led to a smaller food intake and a smaller gain in weight, and a lower blood concentration of triacylglycerol. The diets with sucrose or fructose produced heavier livers and kidneys than did those with starch or glucose. The consumption of the meal led also to a temporary increase in the weight of the liver. The weight of the kidney, however, did not change in rats given starch or gluocse, but fell in rats given sucrose or fructose. Meal consumption was also followed by an increase in the concentration of liver glycogen, irrespective of the nature of the dietary carbohydrate. The concentration of plasma fatty acids was affected differently by meals containing the different carbohydrates, the extremes being a continuing fall with starch and no change with fructose. The concentration of triacyglycerol was increased by sucrose or fructose after the presentation of the meal. The concentration of blood glucose rose and then fell when the meal contained starch or glucose, but fell and then rose when it contained sucrose, and especially when it contained fructose. The concentration of insulin in meal-fed rats receiving sucrose was higher than that of rats receiving starch, both before and after the meal. This difference was not seen in rats fed ad libitum. The results indicate that the effects of meal feeding, or of sucrose or fructose, are not additive.


The effects of dietary sucrose and streptozotocin-diabetes on blood and liver constituents. The levels of ATP, ADP, AMP, inorganic phosphate and 2,3-DPG have been determined in blood and liver of normal and streptozotocin-diabetic rats maintained for up to 11 months on a diet in which the sole carbohydrate source was either starch or sucrose. The feeding of sucrose to normal rats did not significantly alter the adenine nucleotide or phosphate content of the liver and blood. The diabetic state caused a reduction in the ATP, and an increase in AMP and phosphate content of the liver. The feeding of sucrose to the diabetic animals increased the blood phosphate level. The erythrocyte 2,3-DPG content was unaffected by the alterations of ATP and phosphate levels or by the diabetes.


Nutritional properties of poppyseed oil relative to some other oils. Male Wistar rats were fed a purified basal diet with 20% lard and corn oil (3:1), sunflower oil, poppyseed oil, low-erucic rapeseed oil from Brassica napus, cultivar Tower, or mixtures of these oils, for 1 or 26 weeks. None of the hearts exhibited lipidosis at 1 week. At 26 weeks, the level of serum triglycerides was higher in rats fed the mixture of lard and corn oil than in those fed only vegetable oil, and the incidence of cardiac necrosis and fibrosis was higher in rats fed the rapeseed oil than in the other animals. Cardiac phospholipids in rats fed the rapeseed oil contained an elevated level of omega 3 docosahexaenoic acid, particularly in phosphatidylethanolamine. Poppyseed oil exhibited properties similar to those of sunflower oil, was absorbed as well as olive oil, and appeared to be a promising oil for human consumption.


Exercise management.

Exercise management. Aerobic exercise is receiving increasing emphasis as an important health promoting behavior. This paper provides a model for assessment and management of the healthy exercising adult. A data base is presented that enables the practitioner to determine the presence of risk factors and/or disease, to identify health problems which might modify exercise prescription and to collect information to individualize the prescription. The remainder of the paper details the elements of exercise prescription with a specific focus on patient education.


The pathology of female genital tuberculosis. A 31-year study of 1436 cases. The pathology of 1436 cases of female genital tuberculosis (FGTB) observed from 1946 to 1977 is reviewed. The frequency of FGTB was highest in 1956, when it represented 5.5% of all gynecologic pathology specimens. The incidence declined in 1964 as a result of a nationwide antituberculosis campaign, falling to 0.27% in 1977. Sixty-six percent of the patients were 25-35 years of age, and 11% were postmenopausal. All patients presented with either primary (94%) or secondary (6%) infertility. The percentages of involvement of the different parts of the genital tract were: fallopian tubes 100%, endometrium 79%, cervix 24%, vulva and vagina 0.07%, and ovaries 11%. The clinicopathologic and diagnostic criteria of FGTB in the different regions are described, and special attention is paid to the effects of specific treatment on the tuberculous lesion.


The occasional need for myomectomy.

The occasional need for myomectomy. Only occasionally is there a good indication for either abdominal myomectomy or vaginal myomectomy. Among 3205 patients who had major gynecologic operations, 1022 had leiomyofibromas; 718 needed abdominal hysterectomy, 253 needed vaginal hysterectomy, and only 51 were treated by myomectomy. Vaginal myomas and a few submucous uterine myomas were excised vaginally. Parasitic myomas and a few intramural myomas were excised abdominally. Indications, symptoms, number, size, tissue characteristics, methods, subsequent fertility, and subsequent pelvic operations are all discussed. In 26 of these patients, myomas were discovered during other conservative gynecologic operations, requiring decision-making during operations; criteria are discussed.


The role of ultrasonography in the management of endometritis/salpingitis/peritonitis. Ultrasonography has been used as an adjunct in managing pelvic infections when culdocentesis is contraindicated. Twenty-three of 42 women presenting with endometritis/salpingitis/peritonitis (ESP) had ultrasonographic masses. The erythrocyte sedimentation rate (ESR), white blood cell count (WBC), and the highest temperature in the first 24 hours failed to distinguish those with sonographic masses from 19 patients without pelvic masses. The clinical parameter that tended to distinguish patients with masses versus no masses occurred in individuals who had an IUD at the time of admission. If a patient had an ESR greater than 65 mm/hr and an IUD, sonography demonstrated a mass in 71.4% of the cases. The clinical response to multidrug therapy (bactericidal-bacteriostatic, bactericidal-bactericidal, and triple-drug therapy) were comparable in the patient populations with or without a sonographic mass. Sonography is of little use in the acute phase of ESP. It is best reserved for those patients who do not respond to adequate antibiotic therapy and for the serial evaluation of a large tubo-ovarian complex when conservative management is indicated.


Neurological assessment of the hemiplegic patient. There are more and more situations where nursing is responsible for ongoing assessment of the functioning of the hemiplegic patient who has been discharged from an acute care setting. The goal of the neurological assessment in the primary care setting is to determine the ability of the hemiplegic patient to perform activities of daily living. The objectives of this paper are to: 1) suggest a guideline for neurological examination of the hemiplegic patient in seven functional areas. The purpose is not to describe the total neurological examination, but rather to focus on the examination of pertinent neurological areas that provide data about the functioning of the patient; 2) outline potential problems derived from pertinent neurological findings in these seven areas; 3) discuss general implications these problems have for the nurse to assist the hemiplegic patient and his family, optimizing his potential. No attempt will be made to discuss details of nursing intervention.


Surgical complications and results of modified Marshall-Marchetti-Krantz procedure for urinary incontinence. At the Mayo Clinic from January 1960 through December 1975, 673 patients underwent a modification of the Marshall-Marchetti-Krantz operation as a primary or secondary procedure for recurrent stress incontinence. There were 96 patients (14%) lost to follow-up, and 28 patients have died; 549 patients have been followed for 2-16 years. Of the 549 patients, 227 underwent the procedure as a primary operative effort; 91% of these were cured or much improved from socially disabling stress urinary incontinence, 7% were unchanged, and 2% became worse. There were 322 patients who underwent surgery for persistent or recurrent stress incontinence. This group had had a total of 740 previous unsuccessful operations (an average of 2.3 per patient) specifically for stress incontinence; 90% of these patients were cured or much improved, 5.3% were unchanged, and 4.7% became worse. The Marshall-Marchetti-Krantz operation is an effective and safe procedure associated with minimal morbidity and no mortality.


Skeletal muscle adaptations to growth and exercise. Because of the structure of the body, humans are able to carry out a wide variety of different physical activities. This versatility is due primarily to the efficiency and design of the muscular, skeletal, and nervous systems. The skeletal muscles are the focal point of movement, and are designed to adapt during growth to fit the changing skeletal size, to hypertrophy as a result of overload to more easily handle a task, and to increase oxidative capacity as a result of endurance work so that a person can resist fatigue for increasing periods of time. The purpose of this article is to review these processes of adaptation.


Smooth muscle within ovarian decidual nodules: a link to leiomyomatosis peritonealis disseminata? Evidence is presented for the coexistence of smooth muscle and decidual cells in nodules on and within the ovarian tunica albuginea at term. Routine histologic techniques and electron microscopy have been employed in characterizing the morphology of the nodules. Recent literature concerning the frequency of ovarian decidualization during pregnancy is discussed with respect to the possible relationship of such decidualization to the histogenesis of leiomyomatosis peritonealis disseminata (LPD). The hypothesis that LPD may represent "disseminated fibrosing decidua" is discussed in light of finding collagen fibrils, secretory decidual cells, and smooth muscle cells in these nodules. It is concluded that the present case does not represent "fibrosing decidua." The authors agree with others who have proposed that the smooth muscle in ovarian decidua and LPD result from proliferation of stem cells which may reside in the subperitoneal stroma in association with ectopic endometrial stroma and which may respond to the hormones of pregnancy.


Ovarian hilus cell heterotopia.

Ovarian hilus cell heterotopia. A systematic pathologic study was done of the paratubal and parametrial tissues, submitted along with distal tubal segments excised for sterilization and with uteri (with or without attached adnexa) removed for common gynecologic conditions. Heterotopic ovarian hilus cell rests were noted in 12 cases, giving an overall incidence of 0.52% (12/2299). These cell rests, confined exclusively to the endosalpinx and perisalpinx, were easily differentiated from pregnancy-related decidual nodules, Walthard rests, foci of paratubal endometriosis, and ectopic adrenal rests.


Invasive cancer of the cervix after cryosurgery. Pitfalls of conservative management. Eight cases of invasive cervical carcinoma detected after cryotherapy for presumably noninvasive cervical lesions are reported. Three of these patients died from their disease less than 2 years following definitive therapy. The potential dangers of a less-than-optimal work-up of patients prior to freezing are analyzed and discussed in detail. Possible explanations for failures of cryotherapy are discussed, and guidelines for prevention of failures are presented.


Mesonephroid carcinoma of the ovary. A clinicopathologic, histochemical, and electron microscopic study. Eighteen patients with mesonephroid ovarian carcinoma were investigated. Typical findings for the mesonephroid tumors were abundant extracellular an some intracellular neutral mucin mixed with sulfate and carboxyl groups, and large amounts of glycogen, especially in clear cells. The latter observation is considered to be an important aid in distinguishing them from other epithelial ovarian carcinomas. Some cells contained intracellular cysts that were covered with stubby microvilli similar to those found on the lumenal surfaces of the larger cysts in the tumors. Simultaneous estrogenic endometrial activity in the post-menopausal patients was frequently observed. The significance of this observation is discussed.


The prognostic value of serum immunosuppressive effect in patients with ovarian cancer. Sixteen patients who underwent surgery and postoperative chemotherapy for carcinoma of the ovary were studied. Eleven survived more than 18 months without evidence of recurrence, and 5 died more than 5 months after surgery. Serial determinations were made preoperatively and postoperatively of the immunosuppressive effect of the serums of these patients on the response of normal lymphocytes to phytohemagglutinin stimulation. These determinations were plotted for each patient; the shapes of the curves for patients who survived are markedly different from those of patients who died. The prognostic value of these findings is discussed.


Management of abnormal Papanicolaou smears in pregnancy. All pregnant patients with abnormal cervical cytologic smears were evaluated as outpatients in the colposcopy clinic. Of the 131 patients, 84% had colposcopically directed biosies. Initial biopsy diagnosis of severe dysplasia/carcinoma in situ was noted in 16% of patients with class II smears and 43% of patients with class III smears. Two patients underwent conization and 2 had modified conizations because they failed to meet our criteria for adequate colposcopic evaluation. Of the 110 patients available for postpartum follow-up, all had either the same or a lesser degree of cervical intraepithelial neoplasia. Invasive carcinoma was not detected in any patient who underwent subsequent hysterectomy or conization. No abortions or premature labors could be directly attributed to the procedure.


Glucose intolerance during pregnancy. II. A comparative study of diagnostic screening methods. The present study was designed to compare the relative validity of the 2-hour postprandial glucose test (2hpp) and the rapid intravenous glucose tolerance test (IVGTT) as predictors of the outcome of pregnancy. Both tests were performed at the onset of the third trimester of pregnancy in each of 77 women who constituted a selected group of patients considered to be at high risk of developing gestational diabetes. Data concerning newborns were recorded in each case. The IVGTT was found to give a significantly larger yield of positive results (44.15%) as compared to the 2hpp test (35.06%). Furthermore, significantly heavier babies and higher rates of perinatal morbidity were noted in those cases with abnormal IVGTT results as compared to those with normal values. No such association was seen in those cases with abnormal values of 2hpp. These results suggest that the rapid IVGTT is a more dependable test than a single postprandial blood glucose estimation in screening pregnant women for gestational diabetes.