[Clinical and hormonal evaluation of recurrence of goiter after thyroidectomy]. The incidence and features of goitre recurrences were investigated in a sample population of patients operated at the University of Turin Endocrine Surgery Centre. The following parameters were examined: sex, age, familial history of goitre, number of pregnancies, T3 and T4 levels, and TSH levels. Attention is drawn to the finding of significantly higher TSH values in the patients operated for recurrent goitre than in a series of persons free of recurrences after they had been operated on for goitre. Other workers have made the same observation, which is therefore regarded as a pointer to the correct interpretation of the recurrence of goitre.


[Prognosis of acute hepatitis B].

[Prognosis of acute hepatitis B]. The clinical course, persistance of HBs antigen, and the liver biopsy morphological picture were evaluated in 40 patients with acute viral hepatitis, type B. In 34 cases, the disease ran a satisfactory course and clinical cure was corroborated histologically. In 4 cases, onset was particularly severe and the disease ran a long course. Here the immunological test for HBs antigen was still positive 8 weeks after the disease began, while a biopsy at 4 months showed a morphological picture similar to that of acute hepatitis. Lastly, two cases with a protracted clinical course displayed persistent HBs antigen positivity one year after the acute episode, with a histological finding of persistent hepatitis and cirrhosis of the liver respectively.


[The clofibrate-dipyridamole combination in the treatment of athero-arteriosclerotic vasculopathy]. A group of patients with athero-arteriosclerotic vascular disease (coronary heart disease and atherosclerosis of the extremities) have been subjected to platelet antiaggregating-antidyslipidaemic treatment with a chlofibrate-dipyridamol association; a control series was treated with chlofibrate alone. Frequency of angina pectoris, pain intensity and trinitrine consumption ware evaluated in patients with coronary heart disease, claudicometry, oscillometry and thermometry in patients with atherosclerosis of the extremities. The following laboratory parameters were also analysed: cholesterolaemia, triglyceridaemia, prothrombin activity, fibrinogenaemia, uricaemia and tolerance of oral glucose loading. Analysis of the results has shown that the association improved the parameters considered in statistically significant fashion; chlofibrate alone led to significant modifications of coronaropathic group parameters (with the exception of pain intensity) whereas it did not lead to significant changes in parameters evaluated for atherosclerosis of the extremities. All laboratory parameters were modified favourably by the association to a statistically greater extent than by chlofibrate alone. Both the association and chlofibrate were well tolerated.


[Vascular myelopathies: anterior spinal artery syndrome. Considerations on 4 cases]. Four cases of acute onset myelopathy in which clinical and instrumental findings led to the diagnosis of anterior spinal artery syndrome are reported. The physiopathology, clinical medicine and treatment of vascular myelopathies are discussed on the basis of the series presented and reported data. It is also pointed out that vascular aetiology underlies a certain number of acute myelopathies, otherwise classified indiscriminately as myelitis.


Effects on reflex bladder activity of chemical stimulation of small diameter afferents from skeletal muscle in the cat. In anesthetized cats selective activation of fine muscle afferents of the hindlimb by KCl or bradykinin (Brad.) induced reflex changes in the urinary bladder. The nature of the reflex responses depended on the functional state of the bladder: they were excitatory when the bladder was quiescent and inhibitory during large, slow, rhythmic micturition contractions. Selective activation of large muscle primary afferents by succinylcholine was ineffective. All reflexes disappeared after cutting the sciatic or the pelvic nerves. Transection of the hypogastric nerves to the bladder had no effect.


Coding process in human stretch reflex analysed by phase-locked spikes. The Achilles tendon of man was tapped by triangular pulsatory waves with stimulus intervals from 10 to 100 Hz, while single motor unit spikes were recorded from the soleus muscle. The discharge probability of the motor unit spikes in relation to the triangular taps was analysed by means of cross-correlograms. A summation of the results of cross-correlograms of motor unit spikes with 10--100 Hz taps revealed one prominnet kernel, the primary correlation kernel. From the summated correlograms, it became clear that the mean width of the primary correlation kernel, the correlation time, was 8.3 +/- 2.5 msec. The correlation time is interpreted as representing the time-to-peak of the excitatory postsynaptic potential of an alpha-motoneuron.


Ascending projection from the respiratory centre to mesencephalon and diencephalon. The brainstem reticular formation, subthalamus and thalamus were explored in a search for units modulated by the respiratory centre. Experiments were performed on cats under local anesthesia, in which respiratory center oscillation was independent of movement of the lungs and thorax. A large proportion of units firing tonically showed an increasing frequency, phase related to phrenic nerve activity. Respiration related units (RRUs) rostral to the pneumotaxic centre were concentrated in definite areas of the brainstem reticular formation, subthalamus and thalamus. Respiratory modulation disappeared rostral to a section performed at the ponto-mesencephalic junction.


Direct projection of catecholamine (presumably dopamine)-containing neurons from hypothalamus to spinal cord. A procedure for combining catecholamine (CA) and horseradish peroxidase (HRP) histochemistry was used to demonstrate that some of the catecholamine-containing cells in the rabbit dorsal hypothalamus project directly to the thoracic spinal cord. These cells, which are probably dopaminergic, may be involved in the integration of pituitary hormonal secretion and peripheral autonomic nervous regulation.


Cerebellar afferents from the nucleus of the solitary tract. The cerebellar afferents from the nucleus of the solitary tract were studied in cat by means of retrograde axonal transport of horseradish peroxidase. Labelled cells occurred bilaterally in the nucleus of the solitary tract following injections in various folia of the cerebellar vermis and in the flocculus (the positive cases are shown in Fig. 1A). Injections in the anterior lobe vermis labelled cells in the caudal part of the nucleus, injections in the posterior vermis labelled cells in the rostral part (Fig. 2). The findings are discussed in relation to other efferent and afferent connections of the nucleus of the solitary tract.


Statistical analysis of the discharge patterns of medullary temperature-responsive neurones in rabbits. To characterize the medullary temperature-responsive neurones in rabbits, statistical analysis of interspike intervals was performed on 24 neurones recorded at various temperatures of the medulla. It was found that the medullary neurone fired at a relatively regular interval and 11 of 24 neurones displayed an invariable precision in thermoreception over a broad range of medullary temperatures; also, that the temporal distribution of interspike intervals of medullary neurones was markedly different from that of hypothalamic neurones.


Choline acetyltransferase induction in cultured neurons: dissociated spinal cord cells are dependent on muscle cells, organotypic explants are not. The dependence of the induction of choline acetyltransferase (CAT) on the type of tissue culture, monolayer or piece explants, of spinal cord (SC) and muscle (M) was studied. CAT activities of dissociated SC cells were low but were increased by M monolayers. In piece explants of SC, high CAT activities were achieved independently of muscle cells (chick, mouse). It is therefore likely that in tntact SC tissue factors other than the trophic influence of muscle are able to induce cholinergic maturation. M piece explants on SC monolayers did not induce CAT in, and their outgrowth was inhibited by, SC monolayers.


Metabolic and secretory processes in nerve-endings isolated from post-mortem brain. Isolated nerve ending particles (synaptosomes) prepared from rat and human cerebral cortex, after varying conditions of post-mortem storage were shown to possess good structural and morphological integrity and metabolic activity. Respiration, potassium retention, lactate dehydrogenase content, and stimulus-induced release of transmitter candidate amino acids, as well as the neuropeptide somatostatin, were measured. These preparations from post-mortem material showed properties which were closely comparable with similar preparations from fresh material. The relevance of these findings to studies on human post-mortem material is discussed.


Antidepressant drugs potentiate suppression by adenosine of neuronal firing in rat cerebral cortex. Adenosine and AMP (5'-adenosine monophosphate) applied by microiontophoresis produced depression of neuronal firing rates in cerebral cortex. A number of antidepressant drugs including examples which are known not to affect noradrenaline uptake systems, potentiated the depressant purine effects. Noradrenaline responses were unaffected or reduced. Purines may therefore be important in the mechanism of action of antidepressant drugs.


Effects of eye removal on receptors of alpha-bungarotoxin in the optic lobes of chick brain. The existence of receptors with high affinity for alpha-bungarotoxin and the pharmacologic properties of a nicotinic ACh receptor has been shown in the optic tectum of chick brain. In the present study eyes were removed from chicks at embryonic day 3 (E3), or at post-hatching day 3 (P3). In both cases, the total number of receptors for I125-alphaBT which developed in the deafferented optic lobe was about 50% of the number in normal lobes.


[Adjustment to retirement].

[Adjustment to retirement]. Rather frequently a person's commitment to his work is taken as one of the factors that thwart his adaptation to retirement. However, research has pointed out that people of different socio-economic classes do not in the same degree commit themselves to their work. Moreover a strong commitment to work does not necessarily lead to a negative attitude towards retirement, nor does a loose tie to one's work always lead to a positive attitude towards retirement. Factors that are more important to facilitate adaptation to retirement, are: to have sufficient means of subsistence, satisfying relationships, a good health, and the possibility to lead an active life. These requirements will be more frequently met with people of the higher and middle occupational level than with those of the lower level. Therefore, the former may be expected to show a better adaptation to retirement.


[Effect of sex and sex role in later life. Report of a seminar by Prof. Margaret Hellie Huyck, April 1978]. During a seminar at the University of Nijmegen in Holland, Prof. Margaret Hellie Huyck examined the influence of sex and gender on development in the second half of life. She began by presenting a framework for analyzing problems during the phase of the life cycle. She then proceeded to examine the consequences of one's sex and sex role for love, friendship and intimacy, as well as for sexuality later in life. She also presented research evidence on the quality of marriage during the second half of the life cycle. Her discussion on personality changes in men and women at mid-life was more extensive and included consequences of these changes for mental health. Since research on these areas is scarce, many questions for research became evident in the course of the seminar. Prof. Huyck ended the seminar by comparing different visions on the development of men and women over the life cycle, including the model which she sees as ideal.


[Survival of patients admitted to a psychogeriatric nursing home]. The survival of 522 patients, admitted to a psychogeriatric nursing home between 1966 and 1976, was compared with that of the Dutch population, after matching for age and sex. Survival rates were lower in the investigated population; this was particularly influenced by the relatively high mortality of the psychogeriatric patients, who comprised 74% of the investigated population. In women survival rates were better than in men. The survival of married patients was shorter than the same in single patients, while it in the very old was relatively shorter than in the younger group of aged persons.


An exercise test to evaluate fitness for wheelchair activity. The purpose of this study was to develop a wheelchair ergometer (WERG) test to evaluate fitness for manual wheelchair activity. Thirty able-bodied females participated in a progressive intensity, discontinuous test where exercise bouts were 4 min in duration interspersed with 5-min rest periods.  Physiological responses of oxygen uptake (VO2), respiratory exchange ratio (R), net mechanical efficiency (ME), pulmonary ventilation (VO) and heart rate (HR) were determined during the final minute of exercise at power output (PO) levels of 30, 60, 90, 120 and 150 kpm/min. These responses were generally found to be linearly related to PO, however, net ME initially increased with PO and plateaued at approximately 11 per cent at 90 kpm/min. Criteria for fitness evaluation were based upon: (1) magnitude of physiological responses at each PO level; and (2) the maximal PO level completed.


Pentolinium for control of reflex hypertension in spinal cord injured patients. Ganglioplegia was produced by intravenous infusion of pentolinium tartrate 5 mg to control reflex hypertension in 29 patients with chronic spinal cord injuries undergoing 32 elective surgical procedures. The patient group with lesions above the first thoracic segment (T1) demonstrated significant but moderate intraoperative elevation of both systolic and diastolic pressure whether pentolinium was given prior to or during surgical stimulation. Patients with lesions below T1 had no significant pressure elevations with either mode of therapy. Pentolinium ganglioplegia can safely maintain blood pressure within reasonable limits in these patients; some increase in dosage may be required in patients with lesions above T1.


Urolithiasis in children with spinal cord injury. In the literature there is a paucity of references on urolithiasis in children with spinal cord injury. In this paper 28 cases of urolithiasis in 97 children with spinal cord injury are analysed. An attempt is made to evaluate the role of hypercalcemia, hypercalciuria and urinary tract infection in the genesis of these calculi.


Are spinal cord injury patients more prone to contrast reactions? A previous investigation has indicated that spinal cord injury patients are more prone to develop reactions to intravenous contrast media. An investigation into the incidence of contrast reaction in 100 spinal cord injury patients undergoing intravenous pylography together with the incidence in a control group of 100 non-paraplegic patients, has been made. This has shown that spinal cord injury patients do not have a higher incidence of reaction. The aetiology of contrast reaction is briefly discussed with particular reference to the paraplegic patient.


Ulnar compression neuropathy: an uncommon complication in surgical repair of pressure ulcers. Four patients with paraplegia at levels T3 or below were required to remain in the prone position for periods of 3 to 5 weeks following plastic surgical repair of their pressure ulcers. Serial nerve conduction studies permitted early identification of compromise of ulnar nerve function prior to onset of symptoms. These objective findings are helpful in encouraging patients to protect the nerve, thus preventing palsy.


Pes cavus and claw toes deformity in patients with spinal cord injury and multiple sclerosis. Patients with spinal cord injury or multiple sclerosis were surveyed for the presence of extreme foot deformities and spasticity. Pes cavus and claw toes were found in eight of 80 spastic spinal cord injury and two of 20 multiple sclerosis patients. Pes cavus and claw toes were not found in 29 flaccid spinal cord injury patients. Pes cavus and claw toes were associated with flexor reflexes which could be elicited by pin prick proximal to the knee, suggesting extreme spasticity--and by low excitatory thresholds for the anterior tibialis as indicated electromyographically. Complications of severe spasticity associated with spinal cord injury and multiple sclerosis include pes cavus and claw toes, mediated in part by spasms of the anterior tibialis.


Pressure redistribution in wheelchair cushion for paraplegics: its application and evaluation. A survey of the first 200 cases supplied with a "Paracare" pressure redistribution wheelchair cushion. The rationale of the design and material used is discussed. The method of application and follow-up studies are given and a total evaluation of the results achieved to date are presented.


Using warning devices to improve pressure-relief training. A training and monitoring system has been developed to train spinal cord injured patients to relieve pressure intermittently from ischium while sitting in wheelchairs. The system automates the training of wheelchair push-ups based on certain conditioning principles. The system reminds the patient to do a push-up of a specified duration and at specified intervals. The frequency and the duration of the push-ups are monitored providing information about performance of the patients, especially when the alarms to remind the patients are disconnected. A long-term study is in hand to assess the effectiveness of the system.


The polystyrene vacuum wheelchair cushion. A polystyrene bead vacuum wheelchair cushion has been tried with several patients with abnormal postural reflex activity. Excess spasticity can be reduced by this means and sitting comfort enhanced.


Cardiac fibroma (fibrous hamartoma) of infancy. Two case reports. Two cases of primary fibroma of infancy are described; one was a solitary tumour arising in the left ventricle and interventricular septum and the other consisted of multiple fibromatous tumours in the right ventricle and interventricular septum.


A micromethod prothrombin time for oral anticoagulant control. A capillary prothrombin time method was described using the Australasian Reference Thromboplastin (A.R.T.). The method was used for the control of oral anticoagulant therapy in 59 patients on 225 occasions and was found to be reliable and convenient. The capillary prothrombin ratio could be correlated with the conventional plasma prothrombin ratio.


The pathological assessment of ovarian neoplasms. I: Introduction to the common 'epithelial' tumours and analysis of benign 'epithelial' tumours. All neoplasms of the ovary encountered in a 25-year study period at the King George V Memorial Hospital were classified according to the World Health Organisation Histological Classification of Ovarian Tumours. Of these, one thousand fell into the category designated as 'common epithelial tumours'. In this report, the major clinical and pathological correlates and survival data of epithelial tumours as a whole are analysed and criteria are explained for the histological grading of the proliferating and malignant tumours. A detailed histological assessment of the 558 benign epithelial tumours is then presented.


Bilateral trephine bone marrow biopsies in Hodgkin's and non-Hodgkin's lymphoma. This study was undertaken to investigate the usefulness of bilateral rather than unilateral iliac trephine biopsies in demonstrating Hodgkin's disease and non-Hodgkin's lymphoma in the bone marrow. One hundred and seventy adequate bilateral biopsies were obtained from 145 patients. Among 76 bilateral trephine biopsies from 65 patients with Hodgkin's disease, tumour was found bilaterally in 3 cases and on only one side in 2 cases. Among 94 bilateral biopsies from 80 patients with non-Hodgkin's lymphoma, tumour was found bilaterally in 17 cases and on only one side in 12. Considering all of the cases in the series, the performance of bilateral biopsy increased the yield of positive marrows from an estimate of 27 to 34, an increase of 26%. We conclude that bilateral trephine biopsy is superior to unilateral biopsy for the demonstration of bone marrow involvement by Hodgkin's disease or non-Hodgkin's lymphoma and recommend that bilateral trephine biopsies be performed when a knowledge of the state of the bone marrow is important for clinical decision making.


Enterocolitis due to Yersinia enterocolitica in South Australia. From August 1976 to July 1977, all faecal specimens (3298) sent to the Enteric Department of the Institute of Medical and Veterinary Science, Adelaide were selectively cultured for Yersinia enterocolitica. Yersinia enterocolitica was isolated from three patients with diarrhoea, one of whom acquired her infection overseas. These organisms were not isolated from faecal or lymph node material collected from a limited number of sheep and pigs found to have enteritis at the time of slaughter. Enteric infection due to Yersinia enterocolitica does not appear to be common in Australia and selective culture methods using cold enrichment techniques do not appear to be justified especially in laboratories handling specimens derived mainly from adults.


Pulmonary responses to atmospheric pollutants. I: an ultrastructural study of fibrosing alveolitis evoked by petrol vapour. Rats exposed to an atmosphere contaminated with petrol vapour at a concentration of 100 parts per million for up to 12 weeks exhibit a high incidence of electron microscopic changes in the lung parenchyma characterized by interstitial fibrosis with associated alveolar collapse. Initial changes appearing after 6 weeks include degeneration of endothelium and interstitial fibroblasts followed by hypertrophy of Type 2 pneumocytes. Subsequent degeneration of surfactant organelles of the hypertrophied Type 2 pneumocytes correlates with the appearance of focal alveolar collapse and associated interstitial fibrosis. Because of the rapidity with which lesions are induced in the rat lung, this experimental technique provides an economical and reproducible model for an integrated study of the sequential morphological and biochemical events preceding pulmonary fibrosis which might well lead to a better understanding of the enigmatic human syndrome of fibrosing alveolitis.


Lantadene A toxicity in sheep. A model for cholestasis. Liver injury occurred after sheep were injected intravenously with the triperpene acid lantadene A, the toxic principle of the tropical plant Lantana camara. A single dose of 1--3 mg/kg of the compound caused mild hepatocellular injury characterized by transient rises in serum enzymes, with or without hyperbilirubinaemia. Higher doses resulted in hepatic necrosis. When low doses of the triterpene were given repeatedly over several days a cholestatic syndrome developed which appeared identical with that caused by consumption of the plant. This is a disease model which may be of value in experimental studies of intrahepatic cholestasis. This study provides evidence that lantadene A is hepatotoxic and does not require metabolism in the alimentray tract for toxicity in sheep.


Malignant intracranial chordoma and sarcoma of the clivus in infancy. Neuroradiological and clinical findings suggesting chordoma of the clivus are described in three children. They presented with torticollis as the primary and predominant symptom. Progressive deterioration with development of slurred speech, signs of intracranial pressure and further cranial nerve involvement led to more extensive neuroradiological investigation. The clinical and neuroradiological findings in these three children were similar; the prognosis was unfavourable for two of the children. The histological diagnosis in two cases was malignant chordoma; in the third case it was undifferentiated sarcoma of the clivus.


Ultrasound diagnosis of ectopic ureterocele. Three children with ectopic ureteroceles were examined with ultrasound, intravenous urography and cystography. In all cases the ultrasound studies outlined the ectopic ureterocele within the fluid-filled bladder and in one case added additional information regarding the non-functional portion of the duplication and its ureter.


Cystourethrography: the effect of reservoir height upon intravesical pressure. The effect of infusion height upon intravesical pressure during cystography was studied in three dogs and three patients. Results indicate that during bladder filling the intravesical pressure is independent of the reservoir height.


The posteriorly tilted dens. A normal variation mimicking a fractured dens. The normal dens occasionally can be posteriorly tilted and in such cases, can mimic a fractured, posteriorly tilted, dens. Differentiation of the two conditions depends on: [1] knowledge that this normal variation of the dens occurs, and [2] demonstrating that no fracture exists. In many cases, this latter determination can be accomplished on plain films, but in other cases, laminography is required.


Phalangeal cone shaped epiphysis of the hands (PhCSEH) and chronic renal disease--the conorenal syndromes. The phalangeal cone shaped epiphysis of the hands (PhCSEH) observed in the extended Saldino-Mainzer syndrome (SMS), including nephronophthisis, are typed in accordance with standard tables. Of the more than 40 known types, type 28 and/or 28A were found in all eight cases available for analysis, frequently also associated with types 38, 38A, 37 and others. Similar PhCSEH are also observed in asphyxiating thoracic dysplasia (ATD), as well as in some cases of peripheral dysostosis combined with dwarfism. The striking similarity of the PhCSEH formula in our eight cases and of some cases of ATD, all suffering from chronic renal disease, suggests a common pathogenetic pathway of these conditions. The collective name of "conorenal syndromes" is suggested.


Intracranial calcification in a neonate with the Sturge Weber syndrome and additional problems. The neonate in this report had severe encephalotrigeminal angiomatosis with intracranial calcification, cranial hemiatrophy, microcephaly and generalised severe cerebral atrophy. Such findings are not common in the newborn with this syndrome.


Extensive sclerosis of the base of the skull due to primary nasal tuberculosis. An 8 year old black male is presented as a primary nasal tuberculous granuloma whose roentgenograms of the skull revealed extensive sclerosis of the periorbital region involving the frontal, sphenoid, and petrous bones. The tuberculous meningitis and the osseous sclerosis at the base of the skull were cured with anti-tuberculous therapy.


Radiographic studies of upper airway obstruction with cor pulmonale in a patient with pycnodysostosis. The purpose of this article is to present radiographic aspects of obstructive anatomical alterations of the upper airway before and during sleep in a 4 1/2-year-old boy affected with pycnodysostosis. The striking length of the uvula and the inspiration-exspiration changes in its position was an important factor in the obstruction of the upper airway. For better and earlier understanding of the actual mechanism of upper airway obstruction, the radiological data should be obtained during the same circumstances that the patient is experiencing his maximum discomfort.


Non-operative removal of an unusual foreign body from the duodenum after duodeno-jejunostomy. The authors report a case of peroral removal of an intraduodenal foreigh body in a 6 week old infant. The coaxial technique employed facilitates catheter manipulation and avoids traumatic lesions arising from manoeuvres during removal.


Congenital ureteral valve.

Congenital ureteral valve. A one year old boy with ureteral obstruction due to congenital ureteral valve is presented. This rare lesion is usually diagnosed pre-operatively as ureteral stricture or primary megaureter.


Pulmonary actinomycosis in children.

Pulmonary actinomycosis in children. The radiological features of three cases of pulmonary actinomycosis in children are presented. Two of the cases had the classical roentgen features of chronic consolidation with overlying rib periostitis. The third had non specific consolidation but demonstrated extension through the diaphragm. Two of our cases were mentally subnormal children in institutional care. Their pulmonary pathology is almost certainly attributal to poor dental hygiene, a constant problem in this group of children. Hence, although pulmonary actinomycosis is rare in the general populus, we suggest it might be suspected more often in the subnormal group when chronic consolidation is present.


Parathormone and perinatal calcium homeostasis. Plasma parathormone (PTH) and calcium concentrations were measured in 309 specimens collected from 190 newborns during the first 7 days of life. The patient material consisted of 51 preterm, 130 term, and 9 postterm infants, including 22 infants of diabetic mothers (IDM), 38 infants with hypocalcemia, and 25 asphyxiated infants. PTH was detectable, although in low concentrations, in cord blood samples despite the presence of elevated calcium concentrations. Postpartum, PTH concentrations in term, appropriate for gestational age (AGA) infants remained low during the first 2 days of life; a significant (P less than 0.05) and sustained increase in plasma hormone levels was noted starting on day 3. PTH concentrations in IDM and preterm infants remained low for 3 days and a significant hormone increase did not occur until day 4. Hypocalcemia was common in IDM and asphyxiated infants; these infants accounted for two-thirds of all hypocalcemic infants. The profile of plasma calcium in IDM during the first week of life was different than that of any other group of infants. Plasma calcium concentrations remained depressed over this period of time and exhibited a temporary drop on day 4 accompanied by an increase in plasma PTH levels. Asphyxiated infants exhibited low plasma calcium concentrations, despite PTH levels that were significantly (P less than 0.007) higher than those of age-matched term AGA newborns.


Development of an improved tracheal explant bioassay for the detection of the ciliary dyskinesia factor in cystic fibrosis serum. A tracheal ring explant system, when used with 25% cystic fibrosis (CF) serum, displayed obvious ciliostasis. Hamster, rabbit, and guinea pig explants all had measurable decreases in ciliary activity after 24 hr of incubation in the serum. The differential response to CF serum (relative to normal serum) was greatly increased by using explants which were maintained 24-72 hr in minimal essential medium (MEM) with 10% horse serum and which were selected on the basis of optimal ciliary activity and vigor. With such a bioassay system of guinea pig tracheal explants, incubation with 25% normal serum would produce essentially no change in relative ciliary activity (score of 242 of a possible 300), whereas CF serum resulted in an 86% decrease (score of 33). Scanning electron microscopic observation indicated that the explants displaying the CF-ciliostatic effect had significant accumulations of mucous over the ciliated epithelial surface. A biochemical viability assay (dehydrogenase activity) showed no cytonecrosis when CF serum-treated tissues were compared to standard explants (10% horse serum in MEM) or control explants (25% normal human serum).


Basal and pentagastrin-stimulated acid secretion in newborn human infants. Basal and pentagastrin-stimulated gastric acid secretion was measured in 26 healthy newborn infants on the 1st and 2nd days of life. Basal acid outputs (BAO) on day 1 (0.378 mEq/hr) and day 2 (0.388 mEq/hr) were similar and not significantly different from the maximal acid outputs (MAO) on day 1 (0.413 mEq/hr) and day 2 (0.452 mEq/hr). When calculated on a mEq/kg/hr basis, BAO on day 1 was 0.110 with an MAO of 0.122. The BAO on day 2 was 0.114 with an MAO of 0.133. Fasting serum gastrin levels obtained before the acid studies on each day were elevated (mean, day 1 = 100 pg/ml; mean, day 2 = 108 pg/ml). These findings suggest that either gastric acid secretion in the newborn is maximal under basal condition or that newborn parietal cells are unresponsive to pentagastrin on day 1 and 2 of life.


Salicylate intoxication and influenza in ferrets. A model of salicylate intoxication was developed in ferrets to permit the evaluation of the interaction with viruses isolated from patients with Reye's syndrome. Salicylate intoxication produced a mild elevation of the serum glutamic oxaloacetic transaminase and fatty changes in the liver, but these changes differed from those seen in Reye's syndrome on light and electron microscopy. Salicylates were associated with decreased activity of hepatic phosphorylase and a slight depression of activity or ornithine transcarbamylase, a mitochondrial urea cycle enzyme. Infection with influenza viruses produced mild fatty changes in the liver, but did not significantly potentiate the effects of salicylate intoxication on the over-all mortality, the degree of fatty changes, or the hepatic enzymes. Influenza infection alone was not associated with decreased hepatic phosphorylase activity, but was associated with decreased activity of ornithine transcarbamylase. Influenza A was isolated from the livers of two of four animals cultured in embryonated eggs.


Brain carbohydrate metabolism during experimental Haemophilus influenzae meningitis. Five-day-old infant rats which acquire Haemophilus influenzae b bacteremia and meningitis after intranasal inoculation have a transient depression in weight gain (2 days), but then continue to grow at the same rate as strain U--11 inoculated controls. Brain lactate, glucose, and glycogen concentrations increase during the first 5 days of disease in infected animals. The increase in brain glycogen can be accounted for by an influx of glycogen containing polymorphonuclear leukocytes. The increased concentrations of glucose and lactate were found not to be due to a change in brain weight to dry weight ratio or the volume of entrapped blood. The mean cerebrospinal fluid (CSF) glucose concentration was higher in animals with meningitis (2.7 mM) in comparison to U-11 inoculated controls (1.8 mM). This increase in brain and CSF glucose concentration appeared secondary to an increased brain uptake of hexoses as manifested by an increased [3H]mannitol uptake. Brain lactate accumulation was not explicable from the data available. There was no evidence of cerebral cortical cellular damage because in vitro oxygen uptake and lactate production were equivalent in control and meningitic animals. The ability of the infant rat brain to maintain cerebral adenosine triphosphate (ATP) content in menigitis and the failure of CSF glucose concentration to decrease might be a reflection of the importance of alternative oxidative substrate (e.g., beta-hydroxybutyrate) to the cerebral metabolism of the developing rat brain.


Ontogeny of amino acid reabsorption in human kidney. Evidence from the homozygous infant with familial renal iminoglycinuria for multiple proline and glycine systems. Seven infants (two French Canadian, four Ashkenazi Jewish, and one Greek) with massive selective hyperiminoglycinuria (proline, hydroxyproline, and glycine) were detected by urine screening in the second week of life. Follow-up investigations and family studies revealed that each subject had a benign condition, familial renal iminoglycinuria, an autosomal recessive condition. The family studies (Table 1 and Fig. 1) indicate the presence of at least two different mutant alleles segregating in this small group of probands. Hmozygotes of two forms and one genetic compound were identified. Quantitative studies revealed normal concentrations of proline and glycine in plasma (Fig. 2), normal maturation of creatinine clearance (as an index of glomerular filtration rate) (Fig. 3), and elevated renal clearance of proline and glycine (Table 2). Fractional excretion (CAA/CCR) of both proline and glycine in the probands was far in excess of that expected for the normal postnatal infant; FFPro and FEGly approached 100% of the filtered load on occasion (Fig. 4). A schedule of maturing tubular reabsorptive activity was apparent in the proband group. Proline reabsorption matured earlier than glycine reabsorption in the homozygotes (and the genetic compound) as it does in the normal infants (Fig. 5). Our findings suggest that three gene products serve net tubular reabsorption of imino acids and glycine in human kidney. One, affected by mutation in our patients, is responsible for a shared transport activity; a second with preference for proline, and not affected by the mutation, has an "early" schedule of postnatal maturation; and a third with preference for glycine, also not affected by the mutation, has a "late" schedule of maturation.


Placental transfer of analogs of glucose and amino acids in experimental intrauterine growth retardation. We have employed the model in which one uterine artery is ligated to study maternofetal transport and tissue uptake of glucose and amino acids in the intrauterine growth-retarded rat. On the 18th day of gestation, the artery supplying one uterine horn was ligated. Two days later the rats received [3H]2-deoxyglucose and [14C]alpha-aminoisobutyric acid iv. One hour later the growth-retarded and control fetuses were delivered by Cesarean section and appropriate blood samples were obtained. The growth-retarded fetuses had an average weight reduction of 27%, significantly increased placental to fetal weight ratio and brain to body ratio, and a significantly reduced liver to body body ratio. Total radioactivity derived from tritiated deoxyglucose in whole fetal tissues, placenta, liver, and brain were significantly decreased in the intrauterine growth-retarded (IUGR) fetuses; this was also true per gram of tissue except for liver. Liver to plasma, brain to plasma, and whole fetal tissue to plasma 3H ratios were significantly increased in the IUGR group. The radioactivity derived from [14C]alpha-aminoisobutyric acid was significantly reduced in whole fetal tissues, placenta, liver, and brain in the IUGR fetuses whether expressed per whole organ or per gram of tissue. Significant differences in liver to plasma, brain to plasma, and whole tissue to plasma 14C ratios were not observed.


Glucose metabolism, lactate, and ammonia production by the human placenta in vitro. Fifteen human placentas were obtained at term. Placental fragments were incubated in a bicarbonate-buffered Earle's solution. Additions of glutamate (1 mM) or glutamine (1 or 2 mM) were made. All incubations showed a net utilization of glucose. There was a striking variability among placentas in the net glucose utilization rate (1.27 mumoles/g/hr-11.44 mumoles/g/hr, coefficient of variation = 62%). The intraplacental coefficient of variation in glucose utilization was only 14%. All placental incubations showed a net production of both lactate (mean = 7.5 mumoles/g placental wet weight/hr) and ammonia (mean = 3.5 mumoles/g placental wet weight/hr). There was no correlation between lactate of ammonia production and glucose utilization. The addition of sodium glutamate (1 mumole/ml) produced no change in glucose utilization or ammonia production. The addition of glutamine (1 and 2 mumoles/ml) produced a significant increase in ammonia production over that found in the controls, but no change in glucose utilization. Incubation with 2 mumoles glutamine/ml demonstrated an increase in lactate production. All incubations showed a striking increase in ammonia concentration after 45 min of incubation. Individual placentas may differ markedly in their ability to utilize glucose in an in vitro system. Ammonia production may be a normal metabolic endproduct in a tissue lacking an active urea cycle or a byproduct of the purine nucleotide cycle.


Glycine transport by human diploid fibroblasts--absence of a defect in cells from patients with nonketotic hyperglycinemia. Glycine transport in human diploid fibroblasts was shown to be by a single sodium-dependent system. Glycine transport does not appear to exhibit transstimulation or transinhibition. Transport appears to be similar to the A transport system of other mammalian cell lines, as defined by competition patterns. Normal and nonketotic hyperglycinemia (NKH) fibroblasts could not be distinguished on the basis of accumulation or initial rates. A distribution ratio of 15 to 30 was reached by both types of cells. The normal lines have slightly lower apparent Kms (1.1-1.3 mM) than the NKH lines (1.8 to 2.4 mM). The values for the Vmax of the normal cells (11.4-12.9 nmole/mg/min) and the NKH cells (7.0-16.7 nmole/mg/min) overlapped. There were no measurable differences in either the long-term incorporation into protein of leucine and glycine or the oxidation of glycine in normal and NKH fibroblasts.


Laser light-scattering spectroscopy: preliminary results on bioassay of cystic fibrosis factor(s). The effect of 7 cystic fibrosis sera and 4 normal sera was investigated in 37 cultures of ciliated epithelium of the rabbit trachea. Serum was introduced in the Rose culture chambers in a concentration of 10% by volume. The frequency of ciliary beat was monitored by laser light-scattering spectroscopy. The results show that the response of cilia to sera can be well characterized by laser light scattering. Our preliminary evidence suggests that an early increase in the frequency of ciliary beat, followed by rapid arrest of ciliary activity, is a sensitive and characteristic response produced by cystic fibrosis serum, and not by normal serum.


Chromatic induction effects in the Hermann grid illusion. The chromatic Hermann grid illusion was investigated in sixteen subjects, with variation of the lightness contrast between the chromatic inducing squares and the background, and the saturation and hue of the inducing squares. Subjects made magnitude estimates of the sharpness and clarity of perceived dots at the intersections of the grid, and matched the appearances of the dots with Munsell chips. A chromatic induction effect was found to occur in the absence of lightness contrast, but the sharpness of the illusory dots increased with increasing lightness contrast (p less than 0.001). The saturation of the perceived dots increased with increases in the saturation of the inducing squares (p less than 0.05), and was higher for the longer wavelengths than for the shorter wavelengths (p less than 0.005). Neural units with center-surround arrangements responding differentially to light of the same color in the center and the surround, e.g. red off-centers and red on-surrounds, could account for the chromatic induction effect.


The utilization of external and movement cues in simple spatial tasks by blind and sighted children. The role of visual experience in coding spatial position by movements or by external cues was examined in simple (nonrotational) shift tasks with blind and sighted children. Age and the salience of external cues were also of interest. Results showed that the congenitally totally blind used movement cues significantly more even when external cues were present and prominent. The blind with minimal visual experience coded by external cues, but made errors beyond the age by which blindfolded sighted children performed correctly. It was argued that visual experience affects coding by drawing attention to external cues, and by providing more adequate spatial information than other sources usually available to the blind. In its absence, movement coding and self-reference can become preferred strategies.


Eye guidance in reading: fixation locations within words. Three broad categories of models of eye movement guidance in reading are described. According to one category, eye movements in reading are not under stimulus or cognitive control; the other two categories indicate that cognitive activities or stimulus characteristics are involved in eye guidance. In this study a number of descriptive analyses of eye movements in reading were carried out. These analyses dealt with fixation locations on letters within words of various lengths, conditional probabilities that a word will be fixed given that a prior word was or was not fixated, and average saccade length as a function of the length of the word to the right of the fixated word. The results of these analyses were supportive of models which suggest that determining where to look next while reading is made on a nonrandom basis.


The relationship between brightness contrast and illusory contours. One group of subjects rated differences in brightness and another the clarity of illusory contours for eight figure-ground combinations of the Kanizsa and Ehrenstein patterns made from Munsell papers. For four combinations there was a difference in Munsell value (brightness) between figure and ground and for another four no difference. For the latter the pattern was derived from differences in hue or colour quality. For the combinations with a Munsell value difference the ratings of both brightness difference and contour clarity were high and for those of uniform value both were low. The results are interpreted as supporting the argument that illusory contours derive primarily from contrast-induced differences in brightness and possibly in colour between contiguous, physically uniform regions.


Hans Gertz revisited: the different effects of invisibility and darkness on pursuit eye movements. Subjects were required to track their self-moved hands with smooth eye movements in total darkness. The effect of holding transparent and opaque screens between the eyes and the hand upon pursuit eye movements was examined. Opaque screens produced a significant decrement in pursuit when the eye was moving in a direction in which it was generally less efficient at making smooth eye movements.


Recalibration of the convergence system. Adaptation to convergence-altering prism spectacles was studied. The subjects were trained for 8 min with either convergence-increasing or convergence-decreasing prisms. Before and after training they estimated the distance to a binocular dot varying in the stimulus it provided to convergence. Both the preadaptation and postadaptation estimates showed that the reciprocal of estimated target distance is linearly related to convergence. Further there was a consistent change in the direction of adaptation expected from the preadaptation to the postadaptation test. This change was accounted for in terms of a recalibration of the effective absolute convergence level.


A perceptual phenomenon and its neurophysiological correlate. A square-wave grating from which the fundamental harmonic has been subtracted (missing fundamental grating) when viewed from a suitable distance appears similar to another grating of periodicity three times higher. The neurons of the visual cortex of the cat, in a given range of spatial frequencies characteristic of each cell, give similar responses to the two gratings.


A comparison of visual tilt illusions measured by the techniques of verticle setting, parallel matching, and dot alignment. The tilt illusion (TI) was investigated by using both short (19 min) and long (2 deg 6 min) test lines, at three angles of test line-inducing line separation (15 degrees, 45 degrees, and 75 degrees). Three groups of ten observers each provided data under one of three task conditions: vertical judgment, parallel matching, and dot alignment on a common visual display. The main result was that both the vertical judgment and the parallel matching task provided similar, classic TI angular functions with the means ordered 15 degrees greater than 45 degrees greater than 75 degrees and with small attraction effects at 75 degrees in three of the four relevant functions. The third task, dot alignment, yielded results different from the average of the other two: no attraction effects occurred and, with the short test line, the obtained mean illusion at 45 degrees exceeded those at the other intersect angles. These results are consistent with alignment data reported by others. One explanation is that the inducing line produces an apparent bowing of the test line which would be reflected in dot alignments but not in vertical setting or in parallel matching. However, direct evidence does not support this hypothesis. An alternate hypothesis, for which independent evidence exists, is that alignment errors reflect perceptual mistracking but that the origin of these errors is not the tip of the test line but within it. Although this does not explain dot alignment errors, it highlights their complexity and the need to interpret them with caution.


Frequency, phase, and colour coding in apparent motion. We present some results which indicate that the known spatiotemporal limits for apparent motion are consistent with the motion being sinusoidal or a result of filtering. Given this we investigated how two such motions interact as a function of their relative temporal phase differences. This was accomplished by inducing two independent motions from complementary coloured event pairs. Results indicated critical phase limits for perceiving the two motions (red and green) which were consistent with the frequency specificity of the effect. The results are discussed within the framework of a filtering process for the perception of apparent motion.


On the limits of Fourier decompostitions in visual texture perception. Recent discoveries of nonlinear perceptual analyzers in effortless texture discrimination cast serious doubt on the usefulness of Fourier image decompositions to describe suprathreshold visual-texture perception. We now explain the meaning of these results.


Texture discrimination and the analysis of proximity. A major theory of early visual processing has recently been proposed by Marr, which considers a number of aspects of visual perception in great detail, including grouping and texture discrimination. New phenomena associated with texture discrimination are described and experiments reported which allow a preliminary comparison of Marr's theory, as it applies to texture discrimination, with more established theories such as that due to Julesz. One experiment produced results which are clearly consistent with Marr's account, but the ability of his theory to deal with additional data on region suppression is not established. The theory of the analysis of proximity relations proposed by Fox offers a broadly satisfactory account of many texture perception results, while relying on the more fundamental parts of Marr's theory of primitive visual processes to deal with the remainder. A further attraction of proximity analysis is that it may shed new light on the classical paradox of symmetry perception. Some ways in which the preliminary proximity analysis model is incomplete are discussed, and it is concluded that development of the model may be profitable for theories of early visual processing.


Auditory texture perception.

Auditory texture perception. A set of three studies was designed to investigate the role of touch-produced sounds in the perception of surface texture. Subjects were capable of judging roughness on the basis of sounds alone. Auditory judgments were similar, but not identical to corresponding haptic touch judgments. When both sources of information were available, subjects tended to use the tactile cues. The nature of the auditory stimulus for roughness is considered.


[Factors affecting cell counts in milk from individual cows (author's transl)]. The number of somatic cells was determined in samples from approx. 700 cows in 70 herds, altogether 2570 samples. The average cell count was 250 thousands per ml with range from 7 thousands to 5 mill. The data were analysed with respect to effect of age of the cow, stage of lactation, and test day yield. The analyses showed that the cell count was strongly affected by age and yield. The effect of yield is removed by multiplying the recorded cell count by milk yield (cell count in thousands per ml times milk yield in kg congruent to total cell count in mill.). The cell count increases approximately linearly by increasing age of the cow up to 9--10 years, when it is about five times as large as for two-year-old cows. This increase is partly caused by a higher frequency of infection in older cows, but there was a distinct trend in the same direction even for cows which were noninfected when the sample was collected. After elimination of the effect of yield there was a slight drop in the cell count by advancing lactation.


Spectrofluorometric assay of chlorpromazine, half-life and pharmacokinetics of chlorpromazine in goats of different ages. The pharmacokinetics studies in 48 experiments on the animals of different ages showed that the half-life of CPZ in kids (new born, 1 week and 3 weeks old) and goats (3 months old and adult animals) ranged from 1.47 to 1.86 hour while distribution half-life was only 0.11 to 0.17 hour. Volume of distribution of CPZ in kids and goats was much higher than 1 which indicated that the drug was extensively localized in the tissues. The elimination of CPZ was more rapid in the adult goats than in the kids. The half-life of CPZ was short and elimination was rapid in the goats as compared to the literature values for man, rat and dog. The differences are attributed primarily to the more rapid metabolism of CPZ in the goats than in the kids or man, rat and dog.


A field survey of fat mobilization and liver function of dairy cows during early lactation. Relationship to energy balance, appetite and ketosis. NEFA, total lipids, bilirubin, GOT, acetoacetate and glucose in blood plasma of cows were measured during early lactation. Feeding and yield were also recorded. NEFA and bilirubin values showed a gradual decrease with advancing lactation, while total lipids rose gradually during the first months of lactation. GOT showed no definite trend during early lactation. Acetoacetate values were at maximum 21--30 days post partum and glucose values were high at partus and low during the first weeks of lactation. NEFA were negatively correlated to energy balance during the first month of lactation. Total lipids, bilirubin and GOT seemed not to be dependent on energy balance in cows with normal appetite. NEFA, bilirubin and GOT were significantly elevated in cows with reduced appetite. NEFA were positively correlated to bilirubin, GOT and acetoacetate and negatively correlated to glucose. The correlation coefficients were higher during the first month of lactation than during the second and third month. Cows contracting clinical ketosis showed high values of NEFA a long time before any clinical symptoms appeared. Significantly increased values of acetoacetate occurred only the last days before treatment when plasma glucose had reached low values.


[An information system for a department of nuclear medicine (author's transl)]. A computer system is connected on-line to each working place of a department for nuclear medicine. It is assisting the daily work such as the measuring and processing of the measured data, the medical interpretation of the results and the finding of the diagnosis, and finally the composing and writing of medical reports. Additionally this system supports the organization of the department in many ways. The organisation and functions of the system are described.


[Correction of unilateral 131I-hippuran clearance by sonographic evaluation of kidney depth (author's transl)]. In 47 patients the value of kidney depth measurements for the correction of unilateral 131-I-hippuran clearances was studied using ultrasonography. The accuracy of this method was found to be superior to that of the lateral scintigram. In cases with normal cranio-caudal position or slight unilateral caudal dystopia the maximum difference in kidney depth was 1.25 cm and a maximum correction of the unilateral clearance in 2.8% was necessary. Kidneys with unilateral caudal dystopia differed up to 6 cm in depth, leading to a correction by 12%. Our findings indicate that a correction for kidney depth is necessary if one kidney shows significant caudal dystopia and slight dystopia in the supine position. In patients with nephroptosis position-dependent alterations of unilateral perfusion can only be evaluated by correcting for kidney depth.


[Evaluation of isotope nephrograms by the deconvolution method (author's transl)]. By means of deconvolution, which can be preformed simply with a minicomputer, a new function is derived from the circulation activity time function and the renal activity time function. This function describes the impulse response of the system "Kidney". The activity time functions are determined with a four-probe counter. The impulse response allows statements about the time during which the activity remains in the kidney, the relative blood flow of both kidneys and a so-called passage time distribution. It was also attempted to substitute the circulation activity time function by a derivative of the bladder activity time function.


[Kinetics of whole-body water and bromide space in patients with liver cirrhosis (author's transl)]. The kinetics of extracellular water (82Br) and total body water (THO) in controls and patients with liver cirrhosis are studied. Analysis of the plasma activity of the radionuclides as a function of time shows that distribution volumes and kinetics can be described by a linear open three-compartment model and that the volumes are of about equal size. Measuring is carried out in the central compartment in which the radionuclides are injected as a bolus. In cirrhotic patients equilibration into a third compartment is attained about four times slower than in controls. Elimination is reduced by about the same factor. Reduced diffusion and effective blood flow in the cirrhotic patients are discussed as possible reasons for the differences.


Identification and management of juvenile hypertension. Juvenile hypertension is a new field of study, and a definitive approach to diagnosis and treatment has not yet been developed. This article outlines the approach at the hypertension clinic of Children's Hospital Medical Center, Cincinnati, where experience has confirmed the value of routine blood pressure measurement from an early age. Early identification and treatment may reverse target organ damage in youngsters with moderately severe or severe hypertension and may prevent sustained hypertension in those with borderline pressure elevations.


Hypertension in the elderly: special considerations in treatment. The goal of antihypertensive therapy in the elderly should be to reduce systolic blood pressure to 140 mm Hg and diastolic pressure to 100 mm Hg without disturbing cerebral or coronary blood flow or depressing cerebral function. This goal can usually be accomplished by using half doses of thiazide diuretics alone or in combination with half doses of hydralazine. Drugs which produce postural hypotension or depress cardiac output and cerebral function should not be used.


Primary care of ocular emergencies. 1. Traumatic injuries. The primary care physician often must shoulder the heavy medical (and often legal) responsibility for diagnosis of ocular emergencies and for definitive or interim therapy. Proper and timely simple diagnostic procedures followed by appropriate therapy may mean the difference between permanent loss of sight or recovery of useful vision. Lacerations, contusions, and foreign-body injuries are discussed here.


Primary care of ocular emergencies. 2. Thermal, chemical, and nontraumatic eye injuries. First- and second-degree flash burns can be treated by the primary care physician, but third-degree burns will require a specialist for extensive debridement and skin grafting. Actinic keratitis, often associated with welding and snow skiing, is painful but can be treated with drugs in the office. There is no treatment for eclipse burn. Alkali is more toxic to the eye than is acid and can dill corneal epithelium and endothelium. All chemical burns require copious irrigation, but a patient with an alkali burn must be sent immediately thereafter to an ophthalmic surgeion. Acute glaucoma and acute occlusion of the central retinal artery are the two major nontraumatic eye emergencies. Patients with either of these injuries should be referred to a specialist after emergency measures have been taken.


Temporomandibular joint disease: results of a ten-year study. Ninety patients with clinically documented temporomandibular joint disease were followed for ten years. Sixty-four of these patients were treated by conservative means alone, and over 90% responded with complete relief of symptoms. Conservative therapy consisted primarily of jaw rest, with adjunctive use of heat, analgesics, and antiinflammatory agents.


Poisoning in children: an approach for the primary physician. Poisoning continues to be one of the major causes of mortality and morbidity in young children. The Product Safety Packaging Act needs to be expanded to cover toxic agents and drugs known to be involved in the majority of ingestions. Those agents that are particularly toxic will require more stringent measures than safety packaging. The primary physician is in the position to institute rapid and appropriate therapy for most poisoning. Consideration of poisoning in making a presumptive diagnosis and early institution of general supportive measures are critical. Familiarity with techniques of gastric emptying and with use of activated charcoal and naloxone as antidotes is essential, as is s knowledge of when to refer patients for specialized care. By educating parents about poison proofing the home and about appropriate first aid measures, the primary physician can play an important role in poison prevention.


Aneurysm of the sinus of Valsalva: its natural history. This case demonstrates that complications develop with aneurysm of the sinus of Valsalva. The aneurysm is diagnosed almost exclusively only after rupture. We feel that echocardiography provides a convenient means to follow cases of suspected aneurysms. A change in aortic root size may indicate imminent rupture. Fluttering of the anterior leaflet of the mitral valve would suggest aortic insufficiency, while an increase in right ventricular size coupled with paradoxical septal motion would strongly suggest a left-to-right shunt. Change in a murmur or in the aortic silhouette probably warrants cardiac catheterization. If rupture is suggested by clinical findings and corroborated by catheterization, surgery is indicated to prevent progressive cardiac failure.


Sexuality during the climacteric.

Sexuality during the climacteric. Menopause is a time of psychologic adjustment as well as of physical change. Its effects are closely related to sexuality, a neglected aspect. Sexual desire may increase, decrease, or remain the same, but the general pattern is one of declining sexual interest and activity with increasing age. The male climacteric is considered a time of decreasing sexual activity and capability, lowered self-esteem, and declining energy. Physical symptoms are milder than in women, and the process if more gradual. Health care professionals involved with menopausal patients should provide factual information and give supportive guidance which will permit women to continue to develop their full sexual potential.


Counseling the menopausal patient.

Counseling the menopausal patient. The menopausal patient needs someone in whom she has confidence--preferably her family physician or obstetrician-gynecologist--to take the time to explain the changes of menopause, answer questions, and allay fears. Misconceptions concerning physical, emotional, and sexual effects should be corrected, and the advantages and disadvantages of hormone therapy should be discussed. Sympathetic counseling and proper medical supervision can guide women comfortably through the troubled waters of the menopause and into the safe harbor of the postmenopausal years.


A behavioral approach to patient compliance. A behavioral program for increasing a patient's compliance with a drug regimen can be administered by a physician or by trained health care personnel. The program focuses first on the development of a strong external cue to the timing of medication and then on helping the patient to have realistic expectations and to establish an appropriate self-reward for compliance. Monitoring of degree of compliance is essential to the success of the program, as is development of a cooperative, rather than authoritatian, relationship between physician and patient.


Childhood nephrotic syndrome: clinical associations and response to therapy. The concept of nephrotic syndrome has changed from that of a single disease entity in children to that of a complex association of distinct types of glomerular histopathology and clinical courses. Nephrotic syndrome is steroid-responsive in the majority of children. The prognosis for steroid-responsive children is good, even for those who have frequent relapses requiring maintenance therapy or for those who become steroid-dependent. The disease rarely progresses to renal insufficiency or death in these patients. Cyclophosphamide and chlorambucil have proved effective only in steroid-responsive patients with minimal-lesion disease. Because of their toxicity, these agents should be limited to use in patients with severe steroid side effects. The effectiveness of these drugs in steroid-resistant diseases is unclear and still under investigation.


Genetic causes and workup of male and female infertility. 1. Prenatal reproductive loss. Studies show that the greatest check on human reproduction occurs prenatally in apparently fertile couples. Most chromosomally abnormal embryos are aborted spontaneously. This paper, to be published in three parts, reviews the major known anatomic, functional, genetic, and environmental causes of infertility and reproductive wastage. The second and third parts, to appear in succeeding issues, are concerned with chromosome abnormalities and congenital malformations in the period from birth to adult life and with the diagnostic workup of infertile men and women.


Generalized decline in psychologic functioning. In late middle age, many patients consult physicians with nonspecific complaints involving a decline in mental functioning. Distinguishing between psychologic and organic causes of mental impairment, particularly between depression and dementia, is essential.


Possible association between peliosis hepatis and diethylstilbestrol: Report of two cases. In the two cases presented here, peliosis hepatis occurred after prolonged administration of diethylstilbestrol for treatment of prostatic carcinoma. Hepatic dysfunction has not been reported in previous trials of this drug, and further study is needed to confirm an association between diethylstilbestrol and peliosis.


Fertility and cancer therapy.

Fertility and cancer therapy. With increased survival of increasing numbers of cancer patients as a result of therapy, the consequences, early and late, of the therapies must be realized. It is the treating physician's duty to preserve as much reproductive potential as possible for patients, consistent with adequate care. With radiotherapy this means shielding the gonads as much as possible, optimal but not excessive doses and fields, oophoropexy, or sperm collection and storage prior to irradiation. With chemotherapy it means the shortest exposure to drugs consistent with best treatment and prior to therapy the collection and storage of sperm where facilities are available. At present this is still an experimental procedure. Artificial insemination for a couple when the male has received cancer therapy is another alternative. Finally, it is the responsibility of physicians caring for patients with neoplasms to be knowledgeable about these and all other effects of therapy so that patients may be counseled appropriately and understand the implications of therapy for their life.


Practical approach to hypertension. 1. Diagnostic evaluation. The comprehensive diagnostic evaluation once recommended for hypertension is no longer practical or necessary. In the majority of cases, a thorough history, physical examination, and basic laboratory workup are sufficient to determine the severity of the hypertension and to detect target organ damage. Secondary hypertension is truly rare in clinical practice and should not be pursued with complex, costly, and possibly risky tests unless specific indications are present.


Practical approach to hypertension. 2. Treatment. With information obtained from the hypertensive workup (described in part 1 of this article), the physician devises a treatment plan. A stepped-care approach is generally favored, with a diuretic, an adrenergic blocker, and a vasodilator being added in turn until blood pressure is brought under control. The indications and contraindications, dosages, and side effects of the most commonly used antihypertensive agents are discussed here, with suggestions for increasing compliance.


The cause of the raised plasma urea of acute heart failure. The concentrations of urea, urate, phosphate and creatinine were measured in the plasma of 30 consecutive patients admitted acutely with heart failure. On admission, 20 had a raised plasma urea, 21 had a raised plasma urate, but only 6 had a raised plasma phosphate and only 6 had a raised plasma creatinine. A further 9 of the patients developed a raised plasma urea after admission. The increase in plasma urea present on admission was greater than expected for the fall in GFR (as indicated by the increase in plasma creatinine). The results for plasma and urine taken together suggest that a major cause of the raised plasma urea was an increased urea production rather than a reduced glomerular filtration rate. There was no obvious relationship between plasma urea and clinical features, or diuretic therapy.


Limb salvage by femoral profundaplasty.

Limb salvage by femoral profundaplasty. One hundred and seven profundaplasties have been performed for rest pain or gangrene due to advanced arterial degeneration below the inguinal ligament. Local anaesthesia was used for 78 operations. There were 19 early failures (2 deaths and 17 amputations) and 16 later amputations. During 4-5 years of follow-up, 25 other patients have died. The results for diabetic gangrene were worse than for other indications.


Fatal retroperitoneal haemorrhage complicating anticoagulant therapy. Eight cases are reported of extensive retroperitoneal haemorrhage in patients receiving anticoagulant therapy who subsequently died and underwent postmortem examination. No patient had an obvious source of bleeding, and in 5 cases no other cause for death was apparent. Three patients had had vascular surgical procedures: the other 5 were given anticoagulants for suspected venous thrombo-embolism. Six cases presented as unexpected circulatory collapse with rapid demise. Four patients had in addition gastro-intestinal bleeding of varying degree, with no obvious source. This acute massive type of retroperitoneal bleeding contrasts with the commoner presentations of pain, swelling, bruising and compression neuropathy: a high index of suspicion and urgent treatment are required if mortality is to be reduced.


Teething complications, a persisting misconception. Fifty children were admitted to hospital with symptoms of illness that were attributed, by the parent or general practitioner, to the process of teething in the course of one year. In all but 2 cases an organic cause, other than teething, could be found and the most serious conditions were meningitis in one patient and febrile convulsion in 11.


Scurvy and vitamin C deficiency in Crohn's disease. A case of scurvy presenting in a patient with Crohn's disease is reported. A normal response to replacement therapy is seen. Vitamin C (ascorbic acid) deficiency was found in 7 out of 10 patients with clinically quiescent Crohn's disease, 4 of whom had an adequate oral intake of vitamin C. There was no significant difference in oral intake between patients with Crohn's disease and matched controls but there was a significant difference (P less than 0.001) in leucocyte ascorbic acid levels. It is recommended that patients with Crohn's disease be screened for vitamin C deficiency and receive prophylactic vitamin C supplements daily.


Extra-cranial aneurysm of the internal carotid artery treated by proximal ligation. A case of aneurysm of the extra-cranial section of the internal carotid artery extending to the base of the skull is described. Treatment comprised proximal vessel ligation, the tolerance of the patient's cerebral circulation to this procedure first being assessed by measuring the back pressure across the circle of Willis after temporary carotid artery occlusion. The value of this technique is discussed.


Myocardial infiltration with immature cells in hypereosinophilic syndrome. A case of hypereosinophilic syndrome is reported. Investigation failed to reveal any precipitating cause or evidence of leukaemia. Death was due to intractable cardiac failure, and post-mortem examination showed infiltration of the myocardium with sheets of immature cells. The relevance of these cells is discussed and further investigation such as cardiac biopsy is suggested for similar cases.


Primary malignant lymphoma of lung.

Primary malignant lymphoma of lung. Primary malignant lymphoma of the lung is a rare variety of lymphosarcoma, to be distinguished from secondary lung involvement in disseminated malignant lymphoma. The condition tends to remain localized to the lung, and lymph nodes are not involved. The prognosis is better than in disseminated malignant lymphoma, and in the case described here a 35-year-old woman was treated by radiotherapy and chemotherapy and survived 20 years.


Leiomyoma of the duodenum presenting as a pyogenic liver abscess. Leiomyoma of the duodenum is a rare condition which is most often diagnosed only as an incidental finding at post-mortem. It may present clinically with pain or haemorrhage. A case is described of degeneration of a leiomyoma of the fourth part of the duodenum giving rise to pyogenic liver abscess. There is no previous report of this association in the literature.


Adult pre-sacral teratoma.

Adult pre-sacral teratoma. The clinical details and management of an adult female patient with a pre-sacral teratoma causing obstructed labour are described.


Volvulus of the transverse colon.

Volvulus of the transverse colon. Volvulus of the transverse colon is a rare condition requiring early diagnosis and treatment. In the absence of ischaemic changes within the redundant bowel, success can be anticipated with conservative fixation procedures. A case is reported which was treated by reduction, decompression and parallel colopexy. Although this disease has been infrequently reported in the past there may well be an increasing incidence with the introduction of high fibre diets and the use of the colonoscope.


Anorexia nervosa presenting as foot drop. A patient with anorexia nervosa is reported whose presentation with foot drop was to a neurological department. Bilateral peroneal nerve palsies were subsequently demonstrated. The aetiology of these transient palsies is discussed.


Pregnancy rate of a progestogen oral contraceptive. The results of this survey show that 0.5 mg of ethynodiol diacetate (Femulen) is a reliable oral contraceptive with a pregnancy rate calculated by the Pearl Index of 0.52 per 100 women years. This is superior to the failure rates for both 0.075 mg dl norgestrel and 0.35mg norethisterone and approximates more closely with the claimed failure rates for combined oestrogen/progestogen preparations. There is no evidence which suggests that side effects occur with prolonged use of Femulen therapy.


Synthesis and pharmacological screening of certain N-substituted amides structurally related to some local anesthetics. Diphenylacetyl chloride and pivaloyl chloride have been condensed with a wide variety of amines. Some of the resulting amides showed local anesthetic properties higher than those of procaine hydrochloride.


Synthesis of some newer piperazinoquinazolones as cardiovascular agents. Twenty nine new substituted 2-methyl-3-(gamma-piperazino-propiophenyl)-4-quinazolone hydrochlorides were synthesised by the Mannich reaction of substituted quinazolones with substituted piperazines and evaluated for their cardiovascular activity. Several compounds of the series exhibited marked and sustained hypotensive activity.


[Azoles. Part 5: On halogen-nitroindazole derivatives and their antibacterial properties (author's transl)]. The authors describe a modified procedure for the synthesis of the 3-halogenindazole derivatives 1--7 and of the 1-hydroxymethylindazole derivatives 8--14. The compounds 8--13 yield the corresponding 1-chloromethyl derivatives 15--20, and 23 is obtained from 3. The compounds 7--23 exert slight antibacterial effects.


Physico-chemical analysis of systems with a main component acetylsalicylic acid in ethanol-water mixtures. Part 3: Systems containing calcium acetylsalicylate. The systems C9H8O4-(C9H7O4)2Ca-25% ethanol-water mixture (I), C9H8O4-(C9H7O4)2Ca-50% ethanol-water mixture (II), C9H8O4-(C9H7O4)2Ca-95% ethanol-water mixture (III) have been investigated at 15 degrees C by physico-chemical analytical methods. It was established that under the conditions of the no experiments no double or triple compounds of acetylsalicylic acid and calcium acetylsalicylate have been formed. The fields of the crystallization of the pure components are outlined. In systems I and II there exist crystallization fields of (C9H7O4)2Ca - 2H2O and in system III field of (C9H7O4)2Ca. The anhydrous salt and the crystalline hydrate were isolated and were investigated by chemical analysis and X-ray diffraction analysis.


[Ultra-violet spectrophotometry in drug control. Part 23: Conclusions from the spectrophotometric behaviour of drugs with pyridine, naphthalene, quinoline and isoquinoline chromophores (author's transl)]. The results from a systematic study of drugs with pyridine, naphthalene, quinoline and isoquinoline chromophores are evaluated and condensed into conclusions. In addition to previously reported findings, the ultra-violet and visible spectra of a further nine drugs containing the mentioned chromophores are presented.


Stability of acetylsalicylic acid in divided powders in the presence of aminophenazone. The combination of acetylsalicylic acid with aminophenazone, often prescribed in divided powders, is considered to be incompatible. High performance liquid chromatography was applied to determine the content of salicylic acid which is the main known product from the decomposition of acetylsalicylic acid. The analysis of model samples containing a 1:1 (by weight) mixture of acetylsalicylic acid and aminophenazone, after having been stored under usual conditions in starch capsules, showed that the decomposition of acetylsalicylic acid into salicylic acid did not exceed 0.8% even after ten weeks.


[Interactions between macromolecular adjuvants and drugs. Part 16: Effects of human serum albumin and Mg2+ on oxytetracycline-polyvinylpyrrolidone interactions (author's transl)]. Equilibrium dialyses and fluorescent spectroscopic measurements demonstrated that human serum albumin (HSA) affects the oxytetracycline (OTC)--polyvinyl-pyrrolidone K 90 (PVP) interactions. The preferential binding of OTC with HSA, as compared to PVP, was evidenced by means of a three-compartment model. The binding values increased with the increase of the portion of PVP in the PVP-HSA mixture. Superadditive OTC bindings occurred at a ratio of 1:1 (by weight). The addition of Mg2+ to PVP-containing solutions, at a molar ratio of 1:1, also produced an increase of the interactions of this antibiotic with PVP, whereby maximal OTC-PVP bindings of 50--60% were reached.


Availability of norethisterone acetate from combined oral contraceptive tablets. The availability of norethisterone acetate in HCl (0.1 mol/l) from combined oral contraceptive tablets in the presence of certain proprietary preparations and adsorbent drugs which are used as antacids, intestinal adsorbents and for peptic ulcer was investigated. The percent dissolution of the hormone in the presence of these drugs was greatly reduced depending mainly on the nature of the adsorbent drugs.


[Study of the texture of furosemid tablets. Part 2 (author's transl)]. The authors studied the alterations of the texture and of the physical properties of Furosemid tablets, which are prepared with the aid of hydroxypropylcellulose mucilage, that occur during storage. Klucel MF mucilage proved to be a very good binding agent. Though the film bursted on drying during storage, by which the pore volume of the tablets increased, the mechanical strength remained almost unchanged. The cause of this is the formation of solid bridges.


Sources of Atomic and Nuclear Data for Biomedical Purposes. Users of nuclear and atomic data for biomedical purposes often have difficulty in identifying the most up-to-date and appropriate sources of such data. The biomedical Subcommittee of the UK Nuclear Data Committee have prepared a list of recommended data sources available at the beginning of 1978 on radioactive decay schemes; neutron cross-sections and data for neutron activation analysis; excitation functions for the production of radionuclides by charged particles; W-values for neutron and electron dosimetry; X- and gamma-ray cross-sections; stopping powers and ranges for charged particles; and dose deposition by electrons and beta particles.


A system for measuring total body calcium in man using the 40Ca(n, alpha)37 Ar reaction. A technique to measure total body calcium using the 40Ca(n, alpha)37 Ar reaction has been developed. The technique is based on collecting 37Ar exhaled in the breath following a 10 mrad uniform total body irradiation by 14 MeV neutrons. The 37Ar in the exhaled breath is extracted by selective absorption and its radioactivity is measured inside a low-background proportional detector. The facilities developed include an activation facility providing a +/-2.7% activation uniformity, a closed circuit rebreathing and gas collection system, and a gas purification and counting system. The technique provides a precision of +/-2.4% as determined by repetitive measurements of human volunteers and has an accuracy for determination of total body calcium in grams of +/-5%.


An X-ray fluorescence technique for in vivo determination of lead concentration in a bone matrix. We have previously reported the in vivo detection of lead in the skeleton of man by means of X-ray fluorescence analysis using a 740 MBq 57Co source for excitation and a 1 cm(3) Ge(Li) detector for registration of the Pb Kalpha and Kbeta radiation. The varying geometry, density and atomic composition of the tissues of interest (mainly fingers) introduce several problems in estimation of the true concentration of a given element. A two-component cylindrical finger phantom was therefore constructed from silica paraffin wax and animal bone ash. The diameter of the finger bone was estimated from X-ray examinations in two orthogonal projections. The bone mineral concentration was then estimated from the quotient of the number of coherent and Compton scattered primary photons. The lead concentration in the finger bones was then derived from a measurement on a finger phantom made of silica paraffin wax and bone ash with the same size and bone mineral concentration as the real bone. The minimum detectable lead concentration in a finger bone was 14 microgram g(-1) for 15 min measuring time. The lead concentration measured in workers from a metal industry was found to be in the range of 40-100 microgram g(-1).


Transfer functions for describing ultrasound system performance. A practical method of assessing ultrasonic A-scan pulse-echo scanner performance is described, which relies upon the identification and quantitation of an overall system transfer function. The mapping of reflecting elements into an image is then described by this transfer function, and indices of system performance, and particularly resolution and range accuracy, are developed in terms of the shape of the transfer function. Some advantages of this method compared to more conventional methods of assessing scanner performance are discussed.


Calculations of charged-particle recoils, slowing-down spectra, LET and event-size distributions for fast neutrons and comparisons with measurements. A rapid system has been developed for computing charged-particle distributions generated in tissue by any neutron spectra less than 4 MeV. Oxygen and carbon recoils are derived form R-matrix theory, and hydrogen recoils are obtained from cross-section evaluation. Application to two quite different fission-neutron spectra demonstrates the flexibility of this method for providing spectral details of the different types of charged-particle recoils. Comparisons are made between calculations and measurements of event-size distributions for a sphere of tissue 1 micrometer in diameter irradiated by these two neutron spectra. LET distributions have been calculated from computed charged-particle recoils and also derived from measurements using the conventional approximation that all charged particles traverse the chamber. The limitations of the approximation for these neutron spectra are discussed.


On Ce, Clambda, and the effective wall material of a Baldwin-Farmer chamber. An expression relating the constant A to the characteristics of an ionisation chamber is developed. This constant, used to obtain the mass ionisation from the instrument reading, appears in expressions for Ce and Clambda, and is a function of the chamber wall material. Measurements with a Baldwin-Farmer chamber are described, and indicate that the effective wall material is more nearly equivalent to Lucite than to air in 60Co gamma radiation. The resulting value of A is nearly 1.5% lower than the figure commonly used.


Cavity ionisation theory applied to the design of a maximum permissible fluence instrument. The maximun permissible fluence is proposed as a practical concept in radiological monitoring of photon fields. It is virtually this concept that is used for monitoring neutron fields. The practicability of designing instruments with a required response function over a large energy range is examined. Cavity isonisation theory is employed to examine the effect of gas filling, wall material, chamber size and wall thickness on response function and the optimum parameters for the design of an ionisation chamber are thus identified. An experimental chamber of parameters close to the optimum has been constructed and its response compared with the response calculated from cavity ionisation theory. It is concluded that it is possible to design an instrument, the energy response of which follows the maximum permissible fluence. The approach and data in this paper will facilitate any necessary design changes which would arise in the event of national regulation being modified.


Neutron sensitivity of a carbon-walled CO2-filled ionisation chamber. In an earlier publication, an expression was derived for the sensitivity of carbon walled, carbon dioxide-filled ionisation chamber, for low-energy neutrons. This expression has been extended to allow its use for high-energy neutrons, and has been used to make detailed calculations for a particular ionisation chamber irradiated with either 15 MeV or 5.5 MeV neutrons. These results of these calculations are compared with experimental values and, within the stated limits, reasonable agreement is obtained.


Increased lyoluminescence response of mannose on storage. The effect of storage on the lyoluminescence response of mannose was investigated and the dependence of the change in response on absorbed dose determined. It was found that for doses greater than the saturation value, there was an enhancement of response on storage. The hypothesis that the local concentration of oxygen near the free radical sites in the irradiated mannose is a determining factor in lyoluminescence response is postulated and discussed.


The low- and high-temperature response of lithium fluoride dosemeters to X-rays. The energy response of lithium fluoride (LiF) thermoluminescent dosemeters has been determined at two temperatures. Glow peaks 3,4, and 5 are measured at 240 degrees C and peaks 6 and 7 at 300 degrees C. In studying the response to X-radiation it was observed that the response of LiF chips to photons below 150 keV is greater, relative to cobalt-60, than that expected from the energy absorbed in the material. There is an enhancement of 10% at 240 degrees C and of about 100% at 300 degrees c for the same energy absorption. This effect is particularly important where precise measurement of X-ray dose is required and corrections of from 10 to 15% above the correction from rads in LiF to rads in water will be necessary depending upon the maximum read-out temperature. Qualitatively the enhancement may be explained in terms of the higher mean rate of linear energy transfer at low photon energies relative to cobalt-60 gamma rays.


Correction for beam hardening in computed tomography. We investigate how one can estimate from the total attenuation, p, of a polyenergetic X-ray beam what the total attenuation, m, of a monoenergetic beam would have been along the same ray. We find that for beams with typical diagnostic X-ray spectra passing through the human body one can find a simple function f such that f(p) is a sufficiently close estimate of m to allow good reconstructions. We also find that m cannot be accurately estimated from p based on the assumption that the human body consists of water alone. Our results are demonstrated by reconstructions of a mathematical model of a cross-section of the human thorax. This article is self-contained and includes in its Appendices a detailed discussion of the mathematical nature of the problem of bean hardening in computed tomography.


Physical therapists' knowledge of sexuality of adults with spinal cord injury. Helping the adult with spinal cord injury to adjust to sexual limitations is an important and neglected part of his rehabilitation. Health professionals of all fields have been perceived to be deficient in their knowledge of the sexuality of the adult with spinal cord injury. A test with 40 statements reflecting myths, misconceptions, and truths about the effect of spinal cord injury on sexual function was administered to 30 physical therapists responsible for rehabilitating these adults. At least 28 of the 40 items were missed by 10 percent or more of the therapists. Experience and participation in educational programs appeared to contribute to the respondents' knowledge, as reflected by the test, but only experience was a statistically significant variable.


Continuing education: an attitudinal survey of physical therapists. A descriptive study of 903 physical therapists located primarily in southeastern United States was undertaken to determine their attitudes toward continuing education and the types of course offerings they desired. A majority of physical therapists kept themselves up-to-date in professional practice, mainly through discussion with colleagues, study groups, and inservice training sessions. The continuing education courses they preferred were comparatively recent topics in physical therapy education--such as musculoskeletal assessment and mobilization--specific neurophysiological approaches to treatment of adults and children, and administration. The study also revealed the preferred schedule, length, type, and cost of continuing education courses, as well as the amount of advance notice preferred and willingness to complete preassigned readings. The main problem that respondents had in participating in continuing education was that courses did not fit into their schedules. A majority of respondents favored mandatory continuing education for relicensure.


Systematic curricular development in physical therapy. A three-year, federally funded competency-based education project has been completed at The Ohio State University, School of Allied Medical Professions. Six allied health divisions cooperated in the project: Physical Therapy, Medical Communications, Medical Dietetics, Medical Record Administration, Medical Technology, and Radiologic Technology. The purpose of the project was to have the six ongoing programs adapt an established, systematic process to plan for and develop curricular revisions. Professional roles and competencies were delineated as a basis for establishing performance criteria and instructional strategies. The materials that the Division of Physical Therapy developed and the processes that were used in conjunction with this project are described.


Foot-pounds of torque of the normal knee and the rehabilitated postmeniscectomy knee. Foot-pounds of torque of the knee flexors and knee extensors of eight rehabilitated patients who had had meniscectomies were obtained isometrically and at 60 and 210 degrees per second by use of an isokinetic apparatus. Our purpose was to test the null hypothesis that no significant difference in torque would be manifested between the rehabilitated postmeniscectomy knee and the normal knee. Mean torque developed by the rehabilitated postoperative knee was 10 to 12 percent less than the mean torque developed by the normal knee. We found a significant difference between means of torque of the normal knee and the rehabilitated knee for isometric flexion, rapid dynamic flexion, and rapid dynamic extension. Means of torque of knee extension for the three types of contraction for both knees of the subjects demonstrated similar patterns in which torque developed isometrically was greater than torque developed by slow dynamic tension, which in turn was greater than torque developed by rapid dynamic contraction. Means of torque of knee flexion for the three types of contraction for both knees of the subjects created patterns in which torque developed isometrically was essentially equal to torque developed by slow dynamic tension, and both these measurements exceeded torque developed by rapid dynamic contractions. Overall, the results suggest that physical therapists need to use rehabilitative techniques that promote muscular power and muscular endurance in addition to muscular strength and that more attention needs to be directed to the rehabilitation of knee flexors.


[Intra-femoral artery injections in a hospital angiology clinic]. Intra-arterial injections of vasodilators are due to Henri Reboul. After a recent disfavor, the modern equipment together with a simple and detailed technique make it possible to easily do repeated injections. The only accidents are hematomas due to insufficient compression. Use of anticoagulants is the main counter-indication. Lidocain hydrochloride or pure scylocain 1% are the safest drugs. The antispasmodic papaverine, various vasodilators, antibiotics and heparin can be added. In out patient clinics, the rate of injections is one to three per week for a series of 10 injections at the most. Stage II arteritis is the ideal situation and successes are also found in stages III and IV. During the first visit for a acute phlebitis intra-arterial injection of scylocain with 100 mg. heparin makes it possible to start the necessary therapy with anticoagulants. The simple post-phlebitis venous edema seems a case in which the technique should be used.


[Do indications still exist for intra-arterial infiltrations in vascular pathology?]. Intra-arterial infiltrations are a useful therapeutic measure in various vascular diseases where it is important to obtain a lasting and rapid peripheral vasodilatation. In arteritis of the lower limbs, it is paradoxical to match infiltration against surgery. None of these two therapeutic measures can cure completely. Depending on the circumstances, infiltrations can be used at all the stages of arteritis, but the difficulties of applying them limit their use. In certain phlebitis mainly with arterial manifestations, infiltrations can relieve immediately the spasm. In trophic disorders of arterial or venous origin the help the formation of scars. Infiltrations should be used, however, only under maximal technical conditions, which render them harmless.


[Use of the Doppler for intrafemoral injection in arteritis]. The discovery of a femoral artery that is clinically non palpable can be made using the Doppler. It is thus possible to use a direct intra-arterial treatment. This is what was done by the authors, who thereby divided the patients into two groups: the first, 22, with non palpable femoral arteries; the second, 20, with palpable femoral arteries. They obtained good results with intermittent claudications, with increase of the walking perimeter, and among the trophic problems they noted, an increase of the walking perimeter, and among the trophic problems they noted, an increase in arterial pressure on the limbs in question, a phenomenon of which they discuss the pathogenic causes.


[Long-term results of the treatment of arteritis with intra-arterial injections using Reboul's technique]. We have made a non-selective search for patients undergoing treatment for more than five years for an arterial deficiency of the lower limbs. Most of the patients studied suffered from intermittent claudications for which surgical treatment was impossible (distal lesions, diabetes, coronaritis) or had failed (sympathectomy, recurrences). Faced with the inefficiency of vasodilators, and in addition to strict medical treatment of the risks factors of arterio-sclerosis disease (tobacco, obesity, hypercholesterol, sedentary habits), we treated these patients using intra-arterial injections according to the method of Reboul. Our patients generally received one injection per week of xylocaine-priscol-pronestyl. Once an improvement appeared, these injections were spaced out so as to become semi-annual. We grouped 67 patients suffering from intermittent claudications and 5 patients suffering from arteritis ulcers. We studied the results obtained from this so-called palliative treatment (the claudication going from an average 201 meters to 3,395 meters after five years and cure of the ulcers).