Increased concentration of transcobalamin I in a patient with metastatic carcinoma of the breast. A patient with metastatic carcinoma of the breast and increased plasma cobalamin binding capacity (about 50 nmol/1) is described. The binding protein was identified as transcobalamin I (TCI) by DEAE cellulose ion-exchange chromatography, Sephadex G200 gel filtration and agar gel electrophoresis. Although the total plasma cobalamin concentration (about 20 nmol/1) was elevated, the patient complained of neurological symptoms in accordance with a functional vitamin B12 deficiency. Hence, an inactivation of the coenzyme is suggested by the demonstration of considerable amounts of 5'-deoxyadenosylcobalamin bound to the plasma TCI. Both urinary excretion of FIGLU and methylmalonic acid were within the reference ranges. Reported cases of increased cobalamin binding in patients with nonhaematological malignancy are reviewed. Further investigations to characterize the function of the cobalamin dependent metabolic pathways are necessary to determine the importance of the increased transcobalamin binding in these patients.


Pre-morbid factors in Hodgkin's disease. I. Birth weight and growth pattern from 8 to 14 years of age. The risk of Hodgkin's disease (HD) in young adults is correlated to height. This association indicates an etiologic factor acting during growth. Our aim was to evaluate the importance of growth pattern as a risk factor in HD. The register of records from the school health service of the Copenhagen Council was scrutinized in order to find Danes with HD born between 1930 and 1950. Whenever possible, three matched controls (comparable in respect to socio-economic status) were selected from the register for each case. The material consisted of 63 cases and 183 controls. Information regarding height, weight and birth weight was obtained from the school health records. The patients were taller than controls at 8, 10, 12 and 14 years of age. The birth weight was available in 33 cases and 99 controls, and was higher in the former (median 3.50 kg) than in the latter (median 3.30 kg) (P less than 0.01). Our findings suggest the existence of either a risk factor associated with rapid growth or a protective factor connected with slow growth, effective even before birth.


Bone marrow studies in myelomatosis.

Bone marrow studies in myelomatosis. The percentage of fat-cell areas in bone marrow particles from 22 patients with untreated myelomatosis was estimated. In only 1 patient was the mean fat cell area below 25% of the bone marrow area measured. A negative correlation was found between the area of fat cells and plasma cells, indicating a displacement of the fat cell area by the plasma cells. 28% of the patients had empty bone marrow deposits of iron. However, based on a normal iron saturation of S-transferrin and a normal sideroblast count in the bone marrow, the supply of iron to the erythropoiesis was considered sufficient. All patients but one had normoblastic bone marrows. Using a deoxyuridine suppression test in 10 patients, no biochemical defect could be demonstrated. To judge from the correlation coefficient a minor degree (9-14%) of the variation in Hb values could be predicted from the cellularity in the bone marrow while a major degree (70%) could be predicted from the renal glomerular filtration rate. The results do not support a displacement of blood-forming elements, iron deficiency, vitamin B12 or folic acid deficiency to be of general significance in the pathogenesis of anaemia, but agrees with a causal relationship between anaemia and renal failure.


DNA synthesis in subpopulations of blood mononuclear leucocytes in human subjects after vaccination against yellow fever. After vaccination of five volunteers with yellow fever live vaccine, blood mononuclear cells were isolated and labelled with 3H-thymidine at intervals. DNA synthesis was measured by scintillation counting and autoradiography of rosetted cells. Rosetting with sheep erythrocytes (E-RFC) identified T cells, and such erythrocytes coated with IgM antibodies and complement (EAC-RFC) identified B cells and monocytes. DNA synthesis in the total mononuclear cell fraction, as well as in subfractions enriched in or deprived of E-RFC, displayed a sharp increase on day 10--11 after vaccination, remained high on day 13--14, and then returned to the prevaccination level. There was a corresponding morphological transformation, measured by size distribution and number of nucleoli per cell. The major fraction of DNA-synthesizing cells before, during and after the peak of activity was found among non-rosette-forming cells. However, during the activity peak the numbers and proportion of DNA-synthesizing E-RFC were increased while the response with regard to EAC-RFC was not obvious. Thus within a complex cellular response a transient T-cell response was identified.


Sensitivity to glucocorticoids of lymph node cells stimulated in vivo by oxazolone. Sensitization of B10.A mice with oxazolone results in delayed-type hypersensitivity (DTH) and a two to three-fold increase in the weight of regional lymph nodes by the third day. Hydrocortisone treatment of the animals 3 days after sensitization suppresses the manifestation of DTH on the tenth day but not on the seventieth day and significantly decreases the weight of lymph nodes both in control and oxazolone-sensitized mice. The regional lymph node cells of oxazolone-stimulated mice were, like the controls, sensitive to dexamethasone in vitro, as judged by viability and thymidine incorporation. Dexamethasone binding capacity of the regional lymph node cells 72 h after oxazolone sensitization increased. However, the dissociation constant for dexamethasone, the binding specificity, and the nuclear transfer of the hormone were not altered. Since high doses of hydrocortisone given 3 days after sensitization were unable to erase permanently the DTH to oxazolone, it seems very likely that cells responsible for the immunological memory survive the high dose of hydrocortisone.


HBsAg positive adopted children as a cause of intrafamilial spread of hepatitis B. About 5% of the children adopted to Sweden from mostly India and Korea are chronic carriers of HBsAg. Most of them are also e-antigen positive. In this investigation 12 families with such children have been studied to evaluate the infectivity risk. Out of 36 family members 5 have had clinical hepatitis, another 2 were HBsAg positive without clinical symptoms and 15 had anti-HBs. It seems clear that these children are a source of infection and all children adopted from countries with high prevalence of hepatitis B should be screened to be able to define the risk group.


Disseminated intravascular coagulation in patients with meningococcal infection: laboratory diagnosis and prognostic factors. In 36 patients with meningococcal infection a close association between the laboratory evidence of disseminated intravascular coagulation (DIC) and unfavourable prognostic factors was established. Patients with platelet count lessthan 100000/microliter, Normotest lessthan 50% and plasma fibrinogen concentration less than 100 mg/dl had a serious prognosis. No significant differences could be extablished between patients with infection from serogroup A and B meningococci for either laboratory evidence of DIC or prognostic factors.


Bacterial endocarditis. I. A prospective study of etiology, underlying factors and foci of infection. In a prospective clinical and bacteriological study of 192 consecutive patients with septicemia admitted during the period 1967--1971 to a hospital for infectious diseases, 31 cases of proved (group I) and 10 with probably (group II) bacterial endocarditis were observed and analysed with regard to a variety of factors. The incidence of bacterial endocarditis was 3 per 1 000 admissions. The mean age of the patients was 52.6 years; there was no sex predominance. In about one third of the patients apparently normal valves were involved. Underlying non-cardiac factors were present in two thirds, even in younger age groups, in which chronic alcoholism and intravenous drug abuse were frequent. Secondary manifestations from various organs were noted in about three quarters of the patients, in one quarter already on admission. alpha-Hemolytic streptococci and staphylococci were most commonly isolated, followed by gram-negative enteric rods, beta-hemolytic streptococci, enterococci, and pneumococci. A probable portal of entry could be assumed in 80% of the patients and could often be related to the type of bacteria involved. In some cases, diagnostic or therapeutic procedures preceded the disease. A subacute course of the endocarditis was observed in one third of the patients and all these had alpha-hemolytic streptococci or enterococci. The aortic and mitral valves were equally often involved and equally often infected by alpha-hemolytic streptococci. In 4 patients, 3 of whom were drug addicts, the tricuspid valve was probably involved; all were infected by staphylococci. In one case autopsy revealed a mural endocarditis.


Antibiotic concentrations in saliva of purulent parotitis. In patients with unilateral acute purulent parotitis treated with penicillin and doxycycline the antibiotic concentration was determined in plasma and saliva from both the healthy and the affected parotid gland. The results show that the penicillin concentrations in purulent saliva of the diseased gland is considerably higher than in non-purulent saliva of the healthy parotid gland. There was no such marked difference in concentrations of doxycycline. The possible mechanisms behind these observations are discussed as are the conclusions that can be drawn concerning treatment of acute purulent and chronic recurrent parotitis.


Trichosporon cutaneum endocarditis.

Trichosporon cutaneum endocarditis. A 61-year-old man with Trichosporon cutaneum (T. cutaneum) prosthetic valve endocarditis is reported. He had had an aortic valve replacement for rheumatic heart disease 3 years earlier. Onset of the valve infection was subacute. A systolic murmur was noted on admission. Subsequently, he developed conjunctival hemorrhages, hematuria and transient episodes of confusion, aphasia and cranial nerve palsies. Three of 17 blood cultures taken over 3 weeks were positive for T. cutaneum. He was given amphotericin B (AmB) and 5-fluorocytosine (5FC); T. cutaneum infection of prosthetic aortic valve was identified. The aortic valve was replaced. Postoperatively he developed refractory ventricular fibrillation and died. Striking synergy to AmB-5FC and AmB-rifampin combinations was demonstrated in vitro.


Meningitis and bacteremia caused by Pasteurella ureae. Report of a case following intracranial surgery. An otherwise healthy 53-year-old woman underwent intracranial surgery for trigeminal neuralgia. One week later she developed meningitis and bacteremia caused by Pasteurella ureae and was treated successfully with antimicrobials. This organism is known to colonize the respiratory tract in certain individuals and is an extremely rare cause of meningitis or bacteremia. This is the first reported case of bacteremia in an adult.


Mechanics of shoulder locomotor system during exercises resisted by weight-and-pulley-circuit. The aim of the present study was to investigate how different ways of using a weight-and-pulley-circuit (wpc) influence the mechanics of a joint with adjacent muscles. A formula for the resisting moment with respect to a joint was developed and used in a computer model. The resistive effect of various modes of application of the wpc was calculated. It is shown how the resisting moment is influenced by changes of the following factors: 1) Angle between the horizontal plane and a line between joint and pulley (height of position of pulley); 2) Distance between joint and pulley; 3) Weight applied to the rope of the wpc; 4) Weight of the limb.


Shoulder muscle EMG and resisting moment during diagonal exercise movements resisted by weight-and-pulley-circuit. The aim of the study was to investigate which muscles contract (and to what extent) during diagonal shoulder movements resisted by a weight-and-pulley-circuit and the relationship between the calculated resisting moment of force and the maximum voluntary isometrical muscular moment. EMG, mechanical calculations and measurements of moments of force were used. With the resistance used in the study, flexion-abduction-external rotation (FLABER) highly activated all three parts of the deltoideus muscle and the infraspinatus. Flexion-adduction-external rotation (FLADER) highly activated the anterior and middle parts of the deltoideus, infraspinatus and moderately the sternocostal part of the pectoralis major. Extension-abduction-internal rotation (EXABIR) highly activated the posterior deltoideus and moderately the latissimus dorsi. Extension-adduction-internal rotation (EXADIR) highly activated the sternocostal part of the pectoralis major.


Overexertion injuries in keep-fit athletes. A study on overexertion injuries among non-competitive keep-fit athletes. During three years, 274 exertion injuries in middle-aged keep-fit athletes were collected. A keep-fit athlete was a person, who regularly took part in noncompetitive sports activities. Exertion injury was a nontraumatic pain syndrome in the musculo-skeletal system. In the material, there were 35 women and 239 men. Most of them were 30--39 years old. Most exertion injuries took place in July, August, and September. About 80% of the patients were joggers. 80% of them had been training regularly for more than one year. At the moment of occurence of the symptoms, 68% of the patients trained 3--5 times a week. Joggers ran approx. 40 km/week. About 30% of the injuries took place in the knee, 24% in the ankle, heel and foot, 17% in the leg, and 9% in the achilles tendon. Almost one fifth of the pain syndromes were chronic in nature. The majority responded well to rest and to conservative treatment. Fifteen cases were treated surgically. Most of the exertion injuries were typical exertion syndromes seen also in competitive athletes. Others were degenerative changes, organic anomalies etc., which revealed their first symptoms during regular keep-fit activities.


The influence of total hip replacement on selected activities of daily living and on the use of domestic aid. The effect of total hip replacement (McKee-Farrar and Brunswik prostheses) on selected activities of daily living and on the use of domestic aid in these activities was evaluated by interviewing 539 patients operated on. The mean age of the patients was 64.7 years and the mean follow-up time 4.2 years. After eliminating other diseases affecting mobility, a "proper" series of 294 patients was obtained. There was marked improvement in all activities. Walking ability was limited in 95% before and in 12% after the operation. The proportion of those unable to clean their homes decreased from 67% to 16%, to shop from 46% to 10%, to tie their shoes from 75% to 29%, to pull on stockings from 43% to 3% and to dress in other ways from 30% to 1%. The proportion of patients who were able to take care of themselves increased from 21% to 62%. The reliability of the interview was tested by comparing some objective observations with the information given by the patients. Thus a correlation was observed between the ability to walk and shop on the one hand, and pull on stockings and the flexion range of the hip, on the other.


The immediate effect of lumbar sympathectomy on arterial blood flow measured by electromagnetic flowmetry. The immediate effect of lumbar sympathectomy on arterial blood flow was studied in 51 patients with peripheral arterial disease by means of electromagnetic flowmetry. Concomitant arterial reconstruction was performed in 37 cases. The measurement was made on the reconstructed segment or on the bypass graft, and on the femoral artery when sympathectomy alone was performed. The flow increase varied considerably from case to case and was rather unpredictable. There was no significant correlation between the effect of sympathectomy and peripheral arterial disease or the condition of the outflow tract. Thus, on the basis of these measurements, it is difficult to determine the significance of lumbar sympathectomy as a method of increasing blood flow.


Raynaud's phenomenon in arterial obstructive disease of the hand demonstrated by locally provoked cooling. Finger systolic blood pressure (FSP) was measured by cuff technique before and after local cooling in three groups of patients (Raynaud's disease (7), subclavian stenoses, (5), thrombo-angiitis obliterans (15)), and in 15 normals. The response to finger cooling registered as a decrease in FSP indicates an increase of digital arterial tone. In all three groups, digital arterial tone increased more than in normals during finger cooling. Patients with Raynaud's disease showed a pathological increase in arterial tone at 23.5 degrees C with closure of the digital arteries at a mean temperature of 18.5 degrees C. The temperature eliciting these phenomena in patients with thrombo-angiitis obliterans was about 7 degrees C lower (16.5 and 11.0 degrees C, respectively). Accordingly, cold sensitivity and Raynaud's phenomena in the two groups may have a different pathophysiological mechanism, namely a pathological arterial tone in Raynaud's disease vs. a normal arterial tone in obliterative diseases acting on a narrow vessel.


Renal artery reconstruction in renovascular hypertension. Over a period of 8 years, 52 patients (31 females and 21 males) between 12 and 59 years of age (mean age 40 years) underwent renal artery reconstruction for correction of renovascular hypertension. Five patients were operated on bilaterally. A thoracoretroperitoneal approach was chosen at 48 of 57 renal artery reconstructions. The most used types of arterial reconstruction were thrombendarterectomy and vein patch, resection of the stenosis and end-to-end anastomosis, vein patch only or aortorenal vein bypass. No early or late nephrectomies were performed. These was no operative mortality, but 3 late deaths occurred. Twenty-two patients were normotensive postoperatively, 20 were improved and there were 10 failures. The follow-up time as 1--8 years. The blood pressures were measured after withdrawal of antihypertensive drugs for at least 10 days. The best predictable criterion for normotension was a positive renin test with a renin ratio of 1.5 or more. The normotensive patients were in the younger age group with a shorter duration of known hypertension and had mainly fibromuscular hyperplasia.


Congenital cystic adenomatoid malformation of the lung report of a case. The case history of male child is reported. At the ages of five and fifteen months he suffered attacks, of left upper lobar pneumonia. When ninteen months old, he underwent a lobectomy because of persistent air trapping in this lobe, accompanied by mediastinal displacement to the right side. He has since made a good recovery. From the pathological findings, congenital cystic adenomatoid malformation was diagnosed. Various aspects of this rare condition are discussed.


Platypnoea after pneumonectomy caused by a combination of intracardiac right-to-left shunt and hypovolaemia. Relief of symptoms on restitution of blood volume. A patient developed platypnoea about a month after pneumonectomy. The symptoms proved to be due to a combination of an atrial right-to-left shunt and hypovolaemia. Blood volume substitution did not change the direction of the shunt, but the symptoms were relieved. The physiological background to this may be a less pronounced venous desaturation and thereby a less marked influence of the shunt on the arterial oxygen saturation.


Lung split function test and pneumonectomy. A lower limit for operability. Regional 133Xe ventilation/perfusion studies were used to predict residual lung function after pulmonary resections. The accuracy of the method was good as checked by postoperative spirometry in 11 patients. In 25 patients with impaired lung function and pulmonary cancer, who were consecutively selected for surgery, the predicted postoperative maximal breathing capacities (MBC) ranged from 17 to 41 l/min-1 m-2. No patients became permanent pulmonary invalids. One patient died from myocardial infarction, 7 had transient pulmonary insufficiency and 17 patients survived operation without complications. Perfusion studies alone proved as reliable as perfusion/ventilation studies.


Oesophageal atresia and tracheo-oesophageal fistula. Early and late results in 86 patients. A series of 86 infants (54 boys and 32 girls) with congenital oesophageal atresia and tracheo-oesophageal fistula underwent operation during the years 1952--76. The operative technique is described. The average survival rate was 45%, increasing to 56% during the last 10 years. With correction for low birth weight and associated congenital anomalies, the survival rate is considerably increased, in our series to 73%. In most of the fatal cases, the causes of death were suture leakage, pulmonary complications and associated anomalies. Among the 36 survivors, 19 became free from symptoms and 19 had a radiographic stricture, but in the latter group dysphagia was present in only 13, including 10 who required repeated dilatation with a Fogarthy balloon catheter. It is emphasized that correct and early diagnosis and meticulous pre- and postoperative care are of the greatest importance if the cure rate is to be improved further.


The improved Björk-Shiley tilting disc valve prosthesis. The Björk-Shiley valve has been improved in three respects: (1) Increased strength by making the inlet strut an integral part of the orifice ring and doubling its cross-section area; (2) Improved hydrodynamics; (3) Elimination of the area of stagnant and low flow behind the disc. By utilizing a convexo-concave disc and by moving the pivot point downstream, the disc in open position is moved further out of the orifice ring. The flow through the smaller hole is thus increased by 40%. A significant clearance is obtained between the disc and the valve ring in open position. 234 of these valves have been inserted and followed-up for a maximum period of two years with excellent results.


Closed mitral valvulotomy after the age of fifty. This retrospective study is based upon a consecutive series of 90 patients with mitral stenosis who had their first closed mitral valvulotomy after the age of fifty. All patients were operated on during the period 1959--70 and were followed-up for at least 5 years until July 1, 1976. Calculated survival curves were compared with those of a group of 68 patients over fifty whose mitral stenosis was medically treated. The surgical mortality was 7.8%, largely due to the high mortality among patients in functional class IV. The late mortality rate after valvulotomy was significantly higher than in a matched population of the same age and sex, but significantly lower than in the medically treated patients. According to functional classification, the patients had improved markedly at the time of follow-up. High incidences of atrial fibrillation and late thromboembolic complications were noted. This study supports the view that closed mitral valvulotomy can be performed safely in patients over fifty with mitral stenosis without significant mitral regurgitation and heavy clacifications in functional classes II and III.


Long-term results of bypass grafts for atypical coarctation of the thoracic aorta. Long-term results of bypass grafts for atypical coarctation of the thoracic aorta are presented. Six of the 13 patients with atypical coarctation were treated with long bypass from the descending thoracic aorta to the abdominal aorta. One of them had correction of right renal stenosis with a saphenous vein graft. Late clinical results of surgery (average follow-up time 4 years, 5 months and the longest over 10 years) were excellent, except for one patient who died 3 1/2 years postoperatively of acute abdomen. This experience suggests that atypical coarctation of the aorta can be treated satisfactorily by the long thoraco-abdominal bypass graft technique. If unilateral or bilateral renal artery stenosis is found simultaneously, renal revascularization is also necessary to obtain normalization of the blood pressures.


[The dissecting of aortic aneurysm].

[The dissecting of aortic aneurysm]. In the light of the literature and a critical analysis of the author's own results, guidelines for therapy of aortic dissection from the surgical viewpoint are recommended. In cases of dissection of the ascending aorta, surgery should be performed as soon as possible. Only in special cases without complications can surgery be delayed with pump team standby. In uncomplicated cases of dissection of the descending thoracic aorta, medical therapy appears to be the method of choice. Some life-threatening situations render surgery inevitable. Surgical treatment of dissection of the aortic arch is indicated only on an ultima ratio basis.


[Conservative and surgical treatment of thoracic aortic aneurysm]. 34 patients with aneurysms of the ascending and descending thoracic aorta are analyzed with regard to treatment (surgical, n = 23, or conservative, n = 11) and survival. In 17 patients the aneurysm was true and in 17 dissecting (acute in 3, chronic in 14). Mean age, sex, symptoms, main clinical data and the relation between true and dissecting aneurysm were comparable in both groups. Conservative treatment was commenced either due to contraindications (4 patients) or in the absence of an immediate life-threatening situation ( n = 7). At the end of 1977 (mean survival time 27 months), 5 of 11 patients were still alive, 3 unable to work and 2 suffering from severe cardiac failure (class IV NYHA). In 23 patients resection of the aneurysm with graft interposition or angioplasty (n = 19), aortic valve replacement (n = 18) and coronary reconstruction (n = 10) was performed. Intrahospital mortality was 50% (12 of 23), but survival was favorable, 8 patients being alive 37 months after surgery, 7 of them at work. The problem of the diagnosis and treatment of both dissecting and non-dissecting thoracic aneurysms is discussed.


[Long-term minoxidil therapy: renin, aldosterone, noradrenaline and the need for beta blockers]. Minoxidil-induced sequential changes in plasma renin activity, urinary aldosterone and norepinephrine excretion were assessed in 11 patients with severe hypertension receiving propranolol or oxprenolol, chlorthalidone and spironolactone. Blood pressure with this treatment alone averaged 175 +/- 7/114+/-4 mm Hg (mean +/- SEM). Addition of minoxidil in a dose of 5 to 35 mg/day (mean 16 mg/day) reduced blood pressure within one week to 125+/-5/87+/-3 mm Hg. Plasma renin, urinary aldosterone and norepinephrine increased two- to threefold initially, but returned to baseline within two weeks and remained unchanged during a mean follow-up of 6.8 months. In 6 patients beta-blocking drugs were then progressively reduced and withdrawn without adverse effects, though blood pressure and heart rate increased slightly in 5 patients who required readministration of minimal doses of beta-blockers. Neither renin nor urinary aldosterone or norepinephrine excretion changed significantly after discontinuation of beta-blockade. Thus, the stimulating effect of minoxidil on renin, aldosterone and norepinephrine secretion lasts less than 3 weeks. With long-term minoxidil treatment the need for beta-blockade is markedly reduced, and these drugs may even become unnecessary in some patients.


[Nuclear medical determination of the ejection fraction and the regional wall movements of the left ventricle]. Left ventricular ejection fraction was determined in 114 patients by radionuclide and contrast angiocardiography. The correlation coefficient (r) amounted to 0.66. Exclusion of patients with arrhythmias and with a difference in heart rate exceeding 15 beats per minute between the two determinations of the ejection fraction increased r to 0.80 (61 patients). In patients with coronary artery disease and cardiomyopathies (n = 35), r was higher (0.88) than in patients (n = 26) with acquired valve disease or congenital heart disease (0.60). Comparison of first pass radionuclide angiocardiography and gated blood pool scanning with contrast angiocardiography in 19 patients elicited an r-value of 0.82 for the first pass method and of 0.31 for gated blood pool scanning. Visual assessment of local wall motion by gated blood pool scanning in 15 patients showed agreement with cineangiographically quantitated segmental motion (normo-, hypo- or a-kinesis) in 50 of 60 (= 83%) evaluated segments.


[Percutaneous transluminal dilatation of chronic coronary stenoses. First experiences]. The technique of percutaneous transluminal dilatation of coronary artery stenosis consists of a catheter system introduced via the femoral artery under local anesthesia. A preshaped guiding catheter is positioned in the orifice of the coronary artery and through this a dilatation catheter is inserted into the branches if the artery. This dilatation catheter (outer diameter 0.5--1.25 mm) is equipped with a sausage-shaped distensible segment (balloon) at the tip. The balloon is inflated to a pressure of 5 atm. This pressure compresses the atherosclerotic material in a direction perpendicular to the wall of the vessel, therby dilating the lumen. Up to now 29 patients have been treated with primary success in 23 (79%) and long-lasting success in 21 (72%). Three patients underwent emergency coronary surgery to avoid infarction. Dilatation is indicated in patients with disabling angina which jeopardizes their quality of life and with coronary lesions which are proximal, subtotal, concentric and non-calcified.


[Experimental coronary ligation in swine: reduction of myocardial infarct and hemodynamic and metabolic changes by means of the calcium antagonist RO 11-1781]. In a comparative study the effect of the new calcium antagonist Ro 11-1781 on experimental infarct size and left ventricular function in the pig has been investigated. The calcium antagonist was administered 30 min prior to ligation of the left anterior descending coronary artery and twice daily on the following 4 days. For morphometric assessment of infarct size the ventricular myocardium was cut into slices and stained with nitro-benztoluene. There was a significant reduction in infarct size of about 25% in the calcium antagonist-treated group in comparison with the control group. After coronary occlusion left ventricular function is equally depressed in both groups, as is myocardial lactate extraction, which becomes negative.


[Immediate and long-term prognosis of sub-endocardial infarct]. A comparison is conducted of two groups of patients with myocardial infarction: one group of 77 patients with subendocardial myocardial infarction (SEMI) and another of 166 patients with transmural myocardial infarction (TMI). In-hospital mortality, ventricular arrhythmias and a-v blocks are higher in TMI. Late follow-up (mean: 43 months) shows, however, that after discharge SEMI shows a higher mortality and more angina and recurrences of myocardial infarction that TMI. These results, and the ECG localization of the MI recurrences, suggest that SEMI usually reflects severe coronary artery disease.


[Ventricular arrhythmias in the acute stage of experimental swine myocardial infarct; effect of the beta blocker pindolol and the calcium antagonist Ro 11-1781]. A study was designed to examine ventricular arrhythmias in the acute phase of experimental myocardial infarction in the pig and to evaluate possible antiarrhythmogenic influence of the beta-adrenergic blocking drug pindolol (Visken) and the calcium antagonist Ro 11-1781. Ventricular fibrillation (VF) occurred in 17 of 18 animals, in 4 almost immediately after coronary occlusion and in 12 with a delay of about 17 min. VF was almost always induced by episodes of ventricular tachycardia (VT) which were started by single ventricular premature beats (VPBs). VPBs occurred in 3 phases, whereas VT and VF coincided only with phase 1 and phase 3. The prematurity index QR/QT of single VPBs decreased significantly with time after coronary occlusion. The beta-adrenergic blocking drug pindolol and the calcium antagonist Ro 11-1781 did not prevent VT or VF.


[Short and long-term prognosis of intraventricular conduction disorders in the acute stage of myocardial infarct]. The short- and long-term prognosis of acute intraventricular (iv) conduction defects is analyzed in 59 patients admitted to the coronary care unit with acute myocardial infarction. In-hosptial mortality of patients with iv conduction disturbances was more than twice (30%) the mortality of patients without iv conduction defects (13%; p less than 0.001). Mortality was very high among patients with all forms of incomplete trifascicular block or complete right bundle branch block. Among survivors of the group with conduction defects, the late death rate was significantly higher than in survivors of the group without conduction disturbances (25% and 8% respectively: p less than 0.001). The short- and long-term prognosis of acute conduction defects in myocardial infarction depends on the extent of necrosis. Permanent endocardial pacing is therefore indicated only among patients whose death risk is related to conduction disturbances.


[Long-term prognosis of pacemaker therapy in acute myocardial infarct with arrhythmias]. The short- and long-term results of provisional pacemaker therapy in fresh myocardial infarction have been investigated. In this cardiac unit in the period 1975--1977 provisional pacemakers were implanted in 48 patients due to severe conduction disturbance or sinus node syndrome with non-tolerated heart failure. 16 patients had bifascicular block (11 anterior, 3 diaphragmatic, and 2 non-localizable infarctions): in 9 (56%) of them, progression to complete AV block occurred. 27 patients exhibited AV block of 2nd to 3rd degree without evidence of fascicular blockades (21 diaphragmatic, 3 anterior, and 3 non-localizable infarctions). In 5 patients, sinus node dysfunction was the reason for pacemaker implantation. Hospital mortality in the group was 31.2% and thus was twice as high as the hospital mortality in all patients hospitalized in this unit with myocardial infarction during the same period (16.5%). The hospital mortality in patients with anterior infarction was 57.2% compared with a mortality of 16.7% in patients with diaphragmatic infarction. Late mortality (18 months after myocardial infarction) in the group was 46.8%. None of the patients with diaphragmatic infarction died during this observation period. In the patient group with anterior infarction, the mortality rose to 85.8%. Of the 14 patients who died in hospital, death in 12 was due to severe heart failure: neither bradycardic nor tachycardic arrhythmias were immediate factors in death. At autopsy, all patients exhibited severe coronary sclerosis with extensive myocardial infarction. Only 2 patients died from arrhythmia (atrial fibrillation/asystole). In 6 of the 34 survivors, a definitive pacemaker was implanted. 3 of these patients died in the first year after the myocardial infarction. Death was sudden in all three.


[Adjustment of unstable diabetics with a simple insulin infusion program]. In view of the importance of knowing exactly how much insulin is required by diabetics who are difficult to control with subcutaneous insulin, an insulin infusion program has been tried in such patients. The apparatus, which was produced by Siemens as a prototype, works according to the following simple and flexible principle: During the day a basal rate of insulin is continuously infused. During the three main meals an additional rectangular insulin infusion is initiated by turning a knob. After an hour the apparatus switches automatically back to the basal ratio. We have used this machine in 13 patients who are fully mobile. 11 of them showed an almost ideal blood sugar profile after 4 days. After switching back to subcutaneous insulin 8 of these 11 patients did better than before but not as well as on the insulin infusion program.


[The antigenicity of various new chromatographically purified depot insulin preparations]. Four groups of adult diabetics who had never received insulin before were treated for 10--12 months with the following insulin preparations: 1. Insulin Lente, purified by conventional methods; 2. Insulin Lente, purified by gel-filtration; 3. Insulin Lente Monocomponent (MC); 4. Insulin Monotard. Insulin antibodies were measured in these four groups at regular intervals and compared. MC Lente is significantly less antigenic than conventional Lente insulin, but Monotard, a pure pork insulin preparation, is even less antigenic than MC Lente (all 3 Lente preparations contain 70% ox insulin). The average insulin requirement in the Monotard group is significantly lower than in the conventional Lente group.


[Selective neurectomies in hemifacial spasm: an anatomo-pathologic discovery]. Today the treatment of choice in hemifacial palsy is selective neurectomy of the branches of the facial nerve. Palliative surgery has improved experience in the treatment of facial palsy. An anatomical finding is reported which could contribute to a better understanding of the etiology of facial spasm.


[Agranulocytosis and intravenous cloxacillin]. Two patients receiving parenteral cloxacillin treatment developed agranulocytosis. Upon discontinuation of the drug, the number of leukocytes rapidly returned to normal. It is likely that an immunologic mechanism may be implicated in this drug-induced blood dyscrasia.


[Lactacidosis in biguanide therapy: diagnosis and therapy. 4 cases compared to 179 cases in the world literature]. In 4 out of 9711 (= 1:2400) patients, lactice acidosis due to biguanides was diagnosed. Serum lactate concentration averaged 18.2 mmol/l and the pH value 6.87. All patients showed signs of renal insufficiency and three had congestive heart disease. In addition to treatment with biguanides, other factors might have contributed to the lactice acidosis in these patients: prolonged fasting, severe dehydration due to persistent vomiting, acute bronchopneumonia, and acute pyelonephritis. On addmission, two patients were in shock and all patients were semi-conscious or comatose. All patients were treated with bicarbonate and glucose/insulin. One patient was hemodialysed. Two of our four patients died. Oour four patients are compared with 179 patients in the literature with respect to mortality and prognosis of lactic acidosis due to biguanides.


[Renovascular hypertension: therapy by means of percutaneous transluminal dilatation of renal artery stenoses]. Percutaneous transluminal dilatation was performed in 5 patients with unilateral atherosclerotic renovascular disease and one patient with occlusion of a renal artery. Hemodynamic activity of the stenosis was documented by determination of pre- and poststenotic blood pressure values and by measurement of renal plasma flow. Flowing transluminal dilatation all patients showed a significant drop in blood pressure and antihypertensive treatment could be reduced or even discontinued. Only one patient became hypertensive again 3 months after the dilatation procedure. In this patient both the reduction of renal plasma flow and the delayed nephrographic effect on the stenotic side in the intravenous urogram were interpreted as symptoms of a recurrence of significant renal artery stenosis. In 2 of the six patients with impaired kidney function glomerula filtration are increased, as documented by a decrease in serum creatinine values. The results show that percutaneous transluminal dilatation may be a valuable method in the management of renovascular hypertension.


[Total proteins and electrophoretic protein fractions in the juvenile cerebrospinal fluid]. In the CSF of 933 children and  young people, total protein (T.P.) and the protein fractions (separated by electrophoresis were found to be definitely dependent on the age of the child, both in patients and normal controls. The highest values of T.P. are found in the first weeks of life. A steep decrease to the lowest values in the second to third year is followed by a slow increase over the next decade until the adult range is reached at the age of about 15 years. Because of the immature blood-CSF barrier and/or blood-brain barrier, the protein fractions of the newborn show a transsudative electrophoresis pattern with high albumin and gamma-globulin, but low prealbumin. Some weeks later, the pattern has completely changed: a transient elevation of beta 1-globulin, followed by elevation of the prealbumin and the alpha 2-fractions, is correlated with a decrease in the albumin, tau- and gamma-globulin fractions. At the age of 12--16 years, adult conditions are nearly reached. When children with various neurological diseases are compared with normal controls of identical age, the pattern of deviations is generally very similar to that observed in adults with the same diseases.


[Auricular fibrillation and acute aortic insufficienncy in Reiter's syndrome]. The case is presented of a 27-year old male with typical Reiter's sundrome (RS) and cardiac lesions. Eight months after the initial onset of the joint and mucosal symptoms, atrial fibrillation and signs of cardiac failure suddenly supervened. Rheumatic fever, hyperthyroidism and myocardial infarction were ruled out. Digitalization and Valsalva maneuvers produced a return to normal sinus rhythm. At the same time a diastolic murmur was heard and the diastolic pressure fell to 40 mm Hg, suggesting acute aortic insufficiency. This carditis was attributed to RS. The evolution was favourable, although a mild degree of aortic insufficiency persisted.


[Salivary electrolytes, digitalis glycosides and cardiac insufficiency]. In a group of 29 patients treated with digoxin for cardiac failure, only 16 showed increased calcium and potassium concentrations in saliva. There was no correlation in the 29 patients between serum digoxin levels and concentrations of salivary electrolytes. On the other hand, in 4 normal subjects treated with digoxin no change in salivary electrolytes was noted. It is concluded that modifications in salivary electrolytes seen in patients with cardiac failure treated with digitalis are not due to this drug. However, a retrospective clinical study showed a good correlation between clinical signs of cardiac failure and increased levels of salivary calcium, potassium and CaX Kproduct. It is suggested that this phenomenon is due to the well-known adrenergic stimulation in patients with cardiac failure.


[Hepatobiliary scintigraphy: a functional test]. 99mTc-diethyl-HIDA selective captation by hepatocytes and rapid excretion into bile provides a scintigraphic imaging of liver, biliary system and gall bladder. Substance blood clearance and liver half-life measurements add quantitative information on liver function. Normal, cirrhotic and jaundiced patients with extrahepatic obstruction were studied and each group showed significant characteristics. Through non-invasive biliary system visualization and liver function evaluation, hepatobiliary scintigraphy has its place as a complementary investigation in hepatology.


[Liver tumors and oral contraceptives].

[Liver tumors and oral contraceptives]. Benign liver cell tumors in young women are reported with increasing frequency. An association between benign tumors and oral contraceptive use was first suggested in 1973 by Janet Baum. During the past ten years we have observed 15 benign liver cell tumors, all of the focal nodular hyperplasia type. Ten of the 15 women were taking or had taken oral contraceptives. This association was found not to be statistically significant (0.06 greater than p greater than 0.05). We also diagnosed 2 liver cell carcinomas in women who had taken contraceptives.


[Occult blood in feces--a prospective study for the comparison of Hemoccult and Fecatest]. Stool samples of 150 unselected patients were tested for occult blood by the Haemoccult test and the Fecatest. The results show that the Haemoccult test is more suitable for screening for cancerous and precancerous colonic lesions than the Fecatest. Less than 10% of the patients had positive stool samples with the Haemoccult test, while bleedings lesions were subsequently found in about 2/3 of the cases. In contrast, the Fecatest was positive in 50% and in 70% after storage. These findings show clearly that the Fecatest cannot be recommended for the screening of colonic tumors.


[How effective are simple laboratory tests (Hb, BSG) in the early diagnosis of stomach neoplasms]. Up to now only early resection has proven of value in healing gastric carcinoma. It is therefore mandatory that the pathologic lesion be diagnosed as early as possible. Thus, patients with persistent epigastric complaints under symptomatic treatment should undergo endoscopy even if blood parameters are still within normal limits. The fact that, among all our gastric cancers diagnosed in 1977 by endoscopy, 23% were classified as early cancers indicates that the method is well suited to establishing true early diagnosis.


[Autoimmune polyendocrinopathy with IGA deficiency]. Case report of a 35-year-old female patient who was admitted in Addisonian crisis and in whom primary adrenal, ovarian and thyroid failure was detected. Antibodies against the adrenals and the thyroid were found, together with dinished serum IgA levels. The patient had been treated for 20 years with diphenylhydantoin, a drug known to induce immunological disturbances, e.g. depression of serum IgA levels. The IgA deficiency and pluriglandular failure may be due to prolonged therapy with diphenylhydantoin. The coincidence of IgA deficiency and autoimmune diseases is well known. As far as is known this is the first case of IgA deficiency associated with autoimmune polyendocrinopathy.


[Measurement of human body fat by means of gravimetry. Application of Archimedes' principle]. The weighing of the human body under water is an application of Archimedes' law. Fat being lighter than water or than the structures of lean body mass, body fat can be measured by determining the specific gravity of the human body; that is, by underwater weighing. Body fat has been determined in an "ideal" sample of 14 men and 23 women, all aged 20 years. Testing against a reference measure of body fat makes it possible to test the validity of some anthropometric measurements and of some indices of obesity. These indices offer no advantages over anthropometric measurements.


[Folic acid and vitamin B 12 in chronic alcoholics]. In 64 chronic alcoholics folic acid and vitamin B12 in plasma and folic acid in erythrocytes were determined. The mean values of folic acid in plasma and in erythrocytes were significantly below normal. The determination of vitamin B12 showed normal results in a group of 20 cases treated with vitamin B12 containing drugs, whereas in the group of untreated alcoholics significantly reduced values were found. Comparison of folic acid and vitamin B12 concentrations in plasma revealed a more frequent deficiency of folic acid than of vitamin B12, which was combined with anemia in half the alcoholics investigated. The need to treat chronic alcoholics with folic acid and vitamin B12 is pointed out.


Gene dosage compensation and the evolution of sex chromosomes. Dosage compensation is a mechanism by means of which the activity of X-linked or Z-linked genes is made equal in the two sexes of organisms with an XX compared to XY or ZZ compared to ZW basis of sex determination. In mammals, compensation  is achieved by the inactivation of one X chromosome in somatic cells of females. In Drosophila, compensation does not involve inactivation. The two X chromosomes in females as well as the single X in males are regulated, and individual genes are thought to respond independently to the regulatory mechanism. It is proposed that in both groups of organisms the evolution of heteromorphic sex chromosomes was gradual and occurred as the direct result of the evolution of dosage compensation rather than the reverse.


S-adenosylhomocysteine hydrolase is an adenosine-binding protein: a target for adenosine toxicity. When adenosine deaminase activity is inhibited, low concentrations of adenosine are toxic to human lymphoblast mutants that are unable to convert adenosine to intracellular nucleotides. In order to identify the mediator of this cytotoxicity, we searched for a cytoplasmic protein capable of binding adenosine with high affinity. Such a protein was identified in extracts of human lymphoblasts and placenta as the enzyme S-adenosylhomocysteine hydrolase.


Entry of insulin into human cultured lymphocytes: electron microscope autoradiographic analysis. Electron microscope autoradiographs were prepared of IM-9 human cultured lymphocytes incubated with iodine-125-labeled insulin. With the use of [125I]insulin and Ilford L-4 emulsion, the technique had a resolution half-distance of approximately 0.085 micrometer. Autoradiographs revealed a time-dependent entry of insulin into the cell interior that was maximal after 30 minutes of incubation. At this time point nearly 40 percent of the [125I]insulin was in the interior of the cell at a distance 1 micrometer or greater from the plasma membrane. Grain distribution and volume density analyses revealed that the intracellular insulin was concentrated in the endoplasmic reticulum and nuclear membrane.


Inhibition of nociceptive discharges of parafascicular neurons by direct electrical stimulation of nucleus centrum medianum. Pain evoked unit discharges in the parafascicular nucleus could be inhibited by direct electrical stimulation of the centromedian nucleus of thalamus, with residual inhibitory effect lasting for several minutes after cessation of stimulation. The optimal frequency of stimulation for production of the inhibitory effect was found to be 4--8 pulses per second. The duration of inhibition following each stimulating pulse lasted for 100--170 msec. Analysis of oscillographic records shows that there exists before the onset of the inhibition of parafascicular discharges a latent period of 10--20 msec which far exceeds the time required for impulse conduction between the two closely related structures, suggesting that a long tortuous neuronal circuit is involved in elaboration and transmission of the inhibitory effect.


Growth of infective forms of Trypanosoma rhodesiense in vitro, the causative agent of African trypanosomiasis. A new approach to the culture of African trypanosomes led to the growth of the infective forms of the causative agent of human African trypanosomiasis. Infective cultures of Trypanosoma rhodesiense were initiated and maintained in vitro on Chinese hamster lung cells. By changing daily one-third of the Hepes-buffered RPMI 1640 medium containing 20 percent fetal bovine serum, the trypanosome numbers increased to 3 X 10(6) to 5 X 10(6) cells per milliliter. After 80 days in vitro at 37 degrees C, the cultured trypomastigotes are infective for mice and rats and morphologically similar to bloodstream trypomastigotes in having a subterminal kinetoplast and a surface coat. In addition, they possess L-alpha-glycerophosphate oxidase, the predominant steady-state terminal oxidase of bloodstream trypomastigotes.


Prolonged inhibition in burst firing neurons: synaptic inactivation of the slow regenerative inward current. By using voltage clamping and microiontophoretic techniques, it has been found that the prolonged cholinergic and dopaminergic inhibition seen in Aplysia burst firing neurons occludes the inward current on which slow oscillations depend. It also mimics the temperature and ionic sensitivity of that inward current. This prolonged inhibition, which cannot be inverted and is insensitive to extracellular potassium changes, thus appears to result from a synaptically produced inactivation of the regenerative slow inward current underlying bursting.


Decrease in adrenergic axon sprouting in the senescent rat. When the septal area in young adult rats is denervated by a lesion of the fimbria-fornix, adrenergic fibers proliferate within the denervated area. The same operation performed on aged animals gives rise to a qualitatively similar but quantitatively less pronounced response. This reduction in reactive growth may reflect a decreased capacity of the aged brain to remodel its circuitry and restore lost function.


Center-surround organization of auditory receptive fields in the owl. The spinal receptive fields of specialized auditory units in the midbrain of the barn owl (Tyto abla) contain two functionally antagonistic areas: an excitatory center and an inhibitory surround. The response of these units represents the balance of acoustic activation of the two areas, which in turn depends upon the location, intensity, and spectral content of the sound stimulus.


Rapid changes in brain benzodiazepine receptors after experimental seizures. Seizures induced in the rat by electroshock or by injections of pentylenetetrazol increase the specific binding of diazepam to putative receptor sites in cerebral cortical membranes. The enhancement of diazepam binding results from a rapid increase in the number of available binding sites rather than a change in receptor affinity. The postictal increase in cortical benzodiazepine receptors suggests that the cerebral cortex might be more sensitive to the anticonvulsant effects of the benzodiazepines after seizures. This observation may be related to the mechanism of action of these drugs in the treatment of recurrent seizures such as status epilepticus.


The red cell as a fluid droplet: tank tread-like motion of the human erythrocyte membrane in shear flow. When whole human blood is subjected to viscometric flow, individual red cells are seen to be elongated and oriented in the shear field. In addition, a tank tread-like motion of the membrane around the cell content occurs. In dilute suspensions of erythrocytes in viscous media, the same behavior is better observed and can also be measured quantitatively.


Human flicker sensitivity: two stages of retinal diffusion. A well-known solution of the diffusion equation gives an exponential square-root function as the frequency response for a one-dimensional diffusion or transmission process. When two or more such processes are cascaded, the result is still an exponential square-root characteristic, but with a longer time constant. This seems to explain why flicker thresholds obey the Kelly-Veringa diffusion model at high frequencies, even though the psychophysically inferred diffusion process is much slower than the first stage of visual transduction measured by, for example, late receptor potentials. Two such stages in tandem are sufficient to account for the psychophysical data, because the psychophysical time constant is proportional to the square of the number of stages involved. In addition, the nonlinear behavior of flicker thresholds under intense light adaptation can be explained if the loss factor in the first stage is proportional to the amount of the photopigment bleached. Apparently the flicker thresholds are governed by first- and second-order retinal neurons.


Memory impairment in Korsakoff's psychosis: a correlation with brain noradrenergic activity. The concentration of the primary brain metabolite of norepinephrine is diminished in the lumbar spinal fluid of patients with Korsakoff's syndrome. The extent of its reduction is significantly correlated with measures of memory impairment for individual patients. These data suggest that the memory disorder of Korsakoff's syndrome may result from damage to ascending noradrenergic pathways by the diencephalic and brainstem lesions associated with this disease.


Fractional factorial analysis of growth and weaning success in Peromyscus maniculatus. Fractional factorial designs were used to explore simultaneously the effects of eight variables on survival and growth of neonatal deer mice, Peromyscus maniculatus. Two of the variables had significant effects on weaning success. The magnitudes of their effects are illustrated.


Medical technology and cost containment: two applications of operations research. The government proposes "common sense" regulations to help contain rising health costs due to the increasing use of high-technology procedures, such as computerized tomography scanning. Two illustrations are given showing that such ad hoc regulations may have the effect of increasing costs and are certainly far from the optimum obtained by known methods of operations research.


Long ascending projections from substantia gelatinosa Rolandi and the subjacent dorsal horn in the rat. Small neurons of the substantia gelatinosa Rolandi and the subjacent dorsal horn of the spinal cord have been thought to exert a direct modulatory effect only on neurons located within a distance of a few spinal segemnts. By using the technique of retorograde transport of horseradish peroxidase, however, it has been found that in the rat a significant number of these cells, particularly those of the subjacent dorsal horn, ascend many spinal segments to the lateral cervical nucleus and to the lower brainstem. These data provide an anatomic basis for a role of substantia gelatinosa Rolandi and subjacent dorsal horn cells in madulating or contributing to sensory information transmission not only in nearby segments but in far distant structures.


beta-Endorphin is associated with overeating in genetically obese mice (ob/ob) and rats (fa/fa). Small doses of the opiate antagonist naloxone selectively abolished overeating in genetically obese mice (ob/ob) and rats (fa/fa). Elevated concentrations of the naturally occurring opiate beta-endorphin were found in the pituitaries of both obese species and in the blood plasma of the obese rats. Brain levels of beta-endorphin and Leu-enkephalin were unchanged. These data suggest that excess pituitary beta-endorphin may play a role in the development of the overeating and obesity syndrome.


Long-latency "subthreshold" collicular responses to the constant-frequency components emitted by a bat. A previously undescribed response pattern has been observed in certain single units in the posterior colliculus of Pteronotus suapurensis. These units, constituting about one-third of those tuned to the region of the dominant constant-frequency (CF) components of the orientation sounds, respond to a tone pip with a burst of spikes at a latency of 3 to 6 milliseconds, within the frequency-intensity domain of a normal V-shaped response area. In these units, however, as intensity is dropped below threshold for this response, a response of 5-to 10-milliseconds longer latency appears and persists throughout another 10 to 30 decibels of attenuation. These late responses can be very vigorous, are sharply tuned to frequencies at or just above the CF components of the signal, and are often strongest and of lowest threshold at stimulus durations of 1.5 to 3 milliseconds--approximately the duration of the CF component. These properties imply that the late responses are concerned with analysis of the CF components of echoes, apparently in ways not as prominent in other bats.


Gene amplification and drug resistance in cultured murine cells. Resistance of mouse cells to the folate analog, methotrexate, results from selection of increasingly resistant cells on progressive increases of methotrexate in the culture medium. High-level resistance is associated with high rates of synthesis of dihydrofolate reductase and correspondingly high numbers of reductase genes. In some variants high resistance and gene copy number are stable in the absence of selection pressure, whereas in others they are unstable. Analogies are made to antibiotic and insecticide resistance wherein selection of organisms with increased capacity to counteract the drug effect results in emergence of resistance. Gene amplification may underlie many such resistance phenomena.


Subsynaptic plate perforations: changes with age and experience in the rat. The relative frequency of appearance of discontinuities in the postsynaptic thickening, or perforations in the subsynaptic plate, increased with age and experience. Rats reared from weaning in complex or social environments had a significantly higher proportion of occipital cortical synapses with perforations than did rats reared in isolation. In addition, the relative frequency of these perforations more than tripled between 10 and 60 days of age. Shifts in the frequency of perforations can occur independently of changes in the size of synpases. This result suggests a new potential mechanism of synaptic plasticity.


Hippocampal aging and adrenocorticoids: quantitative correlations. Altered neural-endocrine relations have been proposed as factors in mammalian aging. In the same rats from three age groups we quantified astrocyte reactivity in hippocampus, performed radioimmunoassays for plasma adrenocorticoids, and measured adrenal weight. These variables were correlated in individual animals and generally increased with age. The findings are consistent with recent hypotheses that endocrine levels are related to brain aging, either as cause or effect.


Memory impairment in epileptic patients: selective effects of phenobarbital concentration. Nineteen epileptic patients were tested first under medium (week 1) and then under high (week 2) therapeutic levels of phenobarbital. Relative to response times of 20 controls with equivalent practice but without medication, response times of patients in a short-term memory scanning task were strikingly slowed during week 2. However, increased phenobarbital did not slow responses in a task requiring access to information in long-term memory.


Gallium-67 imaging in the management of Hodgkin's disease and other malignant lymphomas. Gallium-67 imaging is useful in the management of patients with malignant lymphoma, despite its obvious limitations. Data currently in the literature regarding the detectability of sites of lymphoma by 67Ga imaging should be regarded as representing the minimum that can be expected from the method, since all reported series are based on outmoded imaging techniques. The detectability of disease sites appears to vary with tumor histology and anatomic location. Gallium-67 imaging is most useful in following patients after treatment. However, it may justifiably play an important role in the initial staging of lymphoma if the prior probability of disease in the abdomen is low. Lymphoma in abdominal lymph node sites is at least as detectable by 67Ga imaging as by lymphangiography.


Role of gallium 67 in inflammatory disease. Gallium 67 has been found to be extremely useful for detection of inflammatory disease. In the skeletal system it complements the 99m Tc-phosphate compounds in differentiating periatricular osteomyelitis, septic arthritis, and cellulitis. Gallium is particularly useful in documenting successful treatment of bone infection because the phosphate scan remains positive for much longer periods of time. In a variety of chest disorders gallium uptake has been found to correlate well with the active inflammatory state. One  of the most frequent uses of gallium imaging has been for localization of inflammatory foci in postoperative patients as well as in patients who present with fever of undetermined origin. Neutrophilic labeling followed by migration to the inflammatory area appears to be the major mechanism of localization of radiogallium. For this reason leukopenic patients constitute a group in which false negative results may be encountered.


The use of gallium-67 in pulmonary disorders. Imaging of the chest cage with gallium-67 (67Ga) citrate is relatively easier to perform and interpret than imaging of the abdomen, because normally pulmonary concentration is low after 48 hr and physiologic accumulation in bones and breast can be recognized by its distribution. Modern scintillation detectors, particularly large field cameras with multiple pulse-height analyzers, give substantially better gallium images than those available in the past. Because of the nonspecific affinity of gallium through neoplastic and inflammatory processes, its value in the differential diagnosis of pulmonary diseases is limited. However, based on the literature and our own observations in over 1100 patients with established diagnosis of a variety of pulmonary diseases, we feel that the judicious use of 67Ga in selected patients is helpful in answering specific questions. These include preoperative evaluation of hilar and mediastinal involvement in pulmonary neoplasms, differential diagnosis of pulmonary infarctions and bacterial pneumonias, evaluation of pulmonary infiltrates regarding infectious etiology, follow-up of sarcoidosis on corticosteroid treatment, assessment of inflammatory activity in interstitial fibrosis and, in selected cases, early detection of neoplastic and inflammatory diseases before radiography becomes abnormal, such as diffuse carcinomatosis and Pneumocystis carinii infection. Potential large-scale application of pulmonary gallium imaging could be found in the screening of subjects exposed occupationally to noxious dust and in long-term serial follow-up of pulmonary tuberculosis patients for treatment response and reactivation. However, it remains to be seen whether gallium imaging statistically provides essential additional information in these indications when compared to cheaper conventional techniques.


A method for localization of sources of human cerebral potentials evoked by sensory stimuli. A method based on potential field theory is described for assessing the location and orientation of dipole generators of the human scalp-recorded sensory evoked potential (EP). The method assumes that the EP at a given moment is due to a single dipole source and that the head can be modeled by a homogeneous conductive sphere (brain) surrounded by inner (skull) and outer (scalp) shells of differing conductivity (three-sphere model).  Solution for source location and orientation from the surface potential field is given for the case of a single homogeneous sphere (one-sphere model). It is then shown that a unique solution for the three-sphere model can be derived from the one-sphere solution. Solutions are obtained by application of an iterative procedure which minimizes the error between calculated and empirical potential fields. A test of the method is described in which the calculated location and orientation of a dipole was in good agreement with the known source of an early component of the human somatosensory EP.


Photoreceptors and visual pigments in a cichlid fish, Nannacara anomala. Correlation of visual pigment content and photoreceptor cell structure is studied in the cichlid fish Nannacara anomala the retina of which is characterized by simple organization of the outer plexiform layer. The visual cell types consist of long and bulky rods and only two types of cones: equal double cones and short single cones. Both types of cones differ form other known teleost cones in that their outer segments are very slender yet twice as long as the inner segments. The double cones form a square mosaic with four doubles along the sides an a single cone in the center. Four rods usually surround the single cone and a few others lie in the corners of the square. The population densities of photoreceptor cells in the central part of the retina is 45,600 cones and 52,600 rods per mm2. The cone to rod ratio is 1:1.15; the double cone to single cone ratio is 4.07:1. The outer segments of photoreceptors contain four spectroscopic types of pigment: one type in rods with lambda max = 498 +/- 5 nm, one type in single cones with lambda max = 460 +/- 5nm, and one in each member of the double cones with lambda max of 555 +/- 5 and 600 +/- 10 nm. Single cones are found to contain only the blue-absorbing pigment. The double cones, whenever both members are successfully recorded from, appear to use two spectrally different pigments. Based on spectral bandwidth determination, the four pigments are probably of the prophyropsin class, although some admixture (10--20%) of rhodopsin-class pigments is also indicated, especially in double cones.


Tuning curves and masking functions of auditory-nerve fibers in cat. Single units of the auditory nerve are maximally sensitive to a given frequency, the so-called characteristic frequency (CF). Tuning curves (functions relating the "threshold" for such units to the frequency of a sinusoidal stimulus) have inspired psychophysical measurements of masked thresholds in humans. At low levels, the results bear a striking resemblance to neural tuning curves, suggesting that a small, homogeneous group of units determine the so-called psychophysical tuning curves. This paper describes physiological measurements modeled after the psychophysical forward-masking paradigm. A masking tone was used to reduce the response in auditory-nerve fibers elicited by a probe tone that followed the masker. The level of the masking tone was varied to maintain a criterion level of responding to the probe. Plotting level of the masker as a function of its frequency yields a fiber-masking function. For low probe-tone levels, fiber-masking functions of low CF fibers and the tips of functions from high CF fibers were similar in shape to tuning curves obtained with single tone bursts. The fiber-masking function depends upon the response criterion and upon the level, duration, and frequency of the probe. Varying the level of the probe can also alter the shape of the fiber-masking function. These results have implications for interpreting psychophysical masking functions.


Factors influencing cutaneous directional sensitivity. The influence of stimulus velocity and traverse length on the ability of human subjects to indicate in which of two opposite directions a brush moved along the skin was determined using a forced choice procedure. Stimulus velocities ranged from 0.75 to 250 cm/sec, and traverse lengths ranged from 0.5 to 6 cm; measurements were made on both the  thenar eminence and the preaxial upper arm. Performance was expressed in terms of "critical traverse length" i.e., that traverse length at which, for a given velocity, the subject would correctly identify the direction of brush motion on 75% of the trials. The data indicate that the capacity to identify direction of tactile stimulus motion increases with traverse length and is optimal for velocities between 3 and 25 cm/sec. The overall level of performance was better on the thenar than on the upper arm.


Frequency selectivity in the parakeet (Melopsittacus undulatus) studied with narrow-band noise masking. Narrow-band noise masking was studied in the parakeet (Melopsittacus undulatus) using a modified method of limits and an instrumental avoidance-conditioning procedure. Masked thresholds were obtained from five subjects at 10 frequencies between 0.5 and 5.0 kHz for each of four sensation levels (26, 46, 66, and 86 db) of a 1/3-octave band noise masker centered at 1.6 kHz. The amount of masking was found to be linearly related to noise level, and the shape of the masking curve was symmetrical on both sides of the center frequency of the masker. In all cases, the greatest threshold shift occurred at the center frequency of the masker. The relative symmetry of the parakeet narrow-band masking curves contrasts with masking results reported in mammals.


Olfactory sensitivity during the menstrual cycle. Women were tested for sensitivity to several odorants at ovulation and menstruation. Three involatile esters (pentadecalactone, coumarin, and cinnamyl butyrate) predicted by gas chromatographic data to be strongly retarded by the olfactory mucus showed similar significant changes in sensitivity. By contrast, a more volatile ester (amyl acetate) predicted to diffuse more readily though the mucus showed no such changes. This suggests that variations in olfactory sensitivity observed between ovulation and menstruation depend on odorant volatility and thus may result from peripheral mechanisms limiting the access of odorant molecules to the olfactory receptors.


The effects of a surround on vibrotactile thresholds. Psychophysical thresholds for the detection of vibration on the thenar eminence were measured as a function of stimulus frequency. As has been found in earlier studies, the threshold functions had two separate branches: one relatively flat branch at low frequencies and a U-shaped branch at higher frequencies. When the rigid surround which is used to confine the stimulus to the region of the vibrator contactor was removed and vibration was allowed to spread freely over the surface of the skin, thresholds along the relatively flat segment of the curve increased while thresholds along the U-shaped segment decreased. The results were interpreted in terms of the duplex model of mechanoreception.


Metamorphosis of breast cancer.

Metamorphosis of breast cancer. In two decades there has been a sweeping metamorphosis of the antiquated conception of breast cancer as a solitary mass of questionable operability, accompanied by numerous axillary lymph nodes and probably distant metastasis. An undreamed-of recognizable preclinical stage of breast cancer has drastically changed attitudes and reactions in physicians and patients. These changes have paralleled the applications of clinical mammography. The smallest of premammography breast cancers are now advanced cancers. The average size of operable breast cancers at Emory University is now less than 1 cm in diameter, and ten-year cure rates with minimal cancers exceed 95%. The treatment of these minimal breast cancers, often in a two-stage surgical procedure with the patient participating in decisions, may include psychotherapy and reconstructive surgery. Pathologists have assumed new roles in coping with disturbing epithelial cellular changes in premalignant and borderline malignant breast lesions. Today predictive clinical signs and symptoms are associated with advanced cancer, with limited specific clinical changes relating to early breast cancer. Over one third of breast cancers are being discovered in women under 50 years of age, and mammography is the primary means of detecting these cancers.


Asymptomatic Bartter's syndrome.

Asymptomatic Bartter's syndrome. A 63-year-old man had asymptomatic Bartter's syndrome, discovered during evaluation for hypokalemia. Elevated plasma renin and aldosterone levels, angiotension resistance, and elevated urinary prostaglandin excretion were noted. Tubular function studies implicated the proximal tubule as the site of a mild sodium reabsorption defect, and renal wasting of potassium and magnesium were also noted. Indomethacin therapy lowered the urinary prostaglandin excretion and the renin and aldosterone levels but did not correct the hypokalemia. Spironolactone therapy resulted in normalization of serum potassium but not serum magnesium levels. Bartter's syndrome may result from various causes but renal wasting of sodium, potassium and/or magnesium probably exist in all cases. Unexplained, asymptomatic hypokalemia in any age group may be due to Bartter's syndrome.


Nafcillin-associated granulocytopenia.

Nafcillin-associated granulocytopenia. Three patients treated with nafcillin developed granulocytopenia. Only three other such cases have been reported. This complication is most likely due to a direct toxic effect on the bone marrow; markers for an immunologically mediated mechanism have not been found. Nafcillin-associated granulocytopenia usually occurs during the third week of therapy and remits spontaneously with prompt cessation of nafcillin administration.


Acetaminophen overdoses at a county hospital: a year's experience. During a recent one-year period nine cases of hepatotoxicity caused by overdoses of acetaminophen were recognized at Parkland Memorial Hospital. This contrasted with the previous year in which no cases were seen. These cases and an additional case seen after the one-year period are presented and discussed. Hepatic injury ranged from mild, with only SGOT elevations in several patients, to severe, with marked prolongation of prothrombin times in four and stage IV hepatic encephalopathy in two. One patient died of fulminant hepatic failure. Other manifestations of acetaminophen overdoses included renal dysfunction in three patients, lactic acidosis in three, shock in two, and hyperamylasemia in two. These findings indicate that extrahepatic complications of acetaminophen overdose may be more common than indicated in previous reports. Because of the delayed nature of the clinical manifestations of acetaminophen overdose, as clearly demonstrated in these patients, decisions on hopsitalization and treatment must be made early based on the history and on acetaminophen levels.


Vincristine-induced dysphagia.

Vincristine-induced dysphagia. Dysphagia was observed in two patients receiving combination chemotherapy for metastatic carcinoma of the breast. Results of esophagogram and esophagoscopy were unremarkable. Vincristine, an anticancer drug, was incriminated as the causative agent. Cessation of vincristine therapy resulted in definite improvement. In one patient, inadvertent administration of vincristine caused prompt recurrence of dysphagia, which again disappeared upon discontinuation of the drug. The major toxicity of vincristine is neurologic. The exact mechanism for vincristine-induced dysphagia is unknown, but it does appear to be reversible.


Clinical trial of surgery for morbid obesity. A clinical trial of jejunoileal and gastric bypass in 38 morbidly obese patients is described. The results which led to the decision to discontinue the clinical trial are discussed. Gastric bypass is recommended as the surgical procedure of choice in properly selected patients with morbid obesity.


Subtrochanteric fractures of the femur: treatment with ASIF blade plate fixation. Management of the severely comminuted subtrochanteric fracture of the femur has been extremely difficult due to problems in stabilization, failure of fixation, and/or failure of the device, as well as associated high morbidity and mortality. Twenty-three such fractures treated with the Association for the Study of Internal Fixation (ASIF) blade plate fixation are reviewed. There were 17 primary unions (0 to 6 months), two delayed unions (6 to 12 months), and two nonunions with device failure, requiring reoperation and bone grafting before healing. There were two deaths, but only one was due to postoperative complications. This review indicates that ASIF blade plates provide adequate stabilization and fixation with a high rate of union in these fractures.


Pott's paraplegia.

Pott's paraplegia. Tuberculosis of the spine associated with neurologic deficit has fortunately become an uncommon disease. Of 48 patients with Pott's paraplegia seen over a 20-year period, 28 were adequately followed up. Ten patients in this series died, most of causes not directly related to the tuberculosis, and ten patients were lost to follow-up. Most of the patients in this study were in the older age group which, in part, accounts for the mortality. Of those who did survive, the outlook for recovery from the paraplegia was very good with or without surgical intervention.


Echocardiographic findings in amyloid cardiomyopathy. Echocardiographic manifestations of two patients with cardiac amyloidosis are presented. The findings consisted of increased thickness of the left ventricular posterior wall and interventricular septal wall, a normal to small left ventricular cavity, and pericardial effusion. The echocardiograph is useful in the evaluation of patients with cardiomyopathy and congestive heart failure.


Distal renal tubular acidosis in selective hypoaldosteronism. Renal mechanisms for metabolic acidosis in selective hypoaldosteronism were investigated in a patient with marked renal insufficiency. Studies demonstrated a distal hydrogen ion secretory defect. Control of elevated serum potassium levels did not normalize urinary acid excretion, but systemic acidosis was improved. Mineralocorticoid therapy normalized serum potassium without increasing urinary potassium. Hyperkalemia did not directly affect renal acid handling, and extrarenal mechanisms for potassium excretion are suggested. Measurement of rectal mucosal potential difference suggests this test may be of value in detecting a wide range of abnormalities in aldosterone metabolism.


Endometriosis after "pelvic cleanout".

Endometriosis after "pelvic cleanout". In many patients endometriosis is ultimately treated by total abdominal hysterectomy and bilateral salpingo-oophorectomy. Endometriosis in a 31-year-old, white, multiparous woman demonstrates the unusual nature of this disease. Five years after a total abdominal hysterectomy and four years after a bilateral salpingo-oophorectomy for a pelvic abscess, she had an endometrioma above the apex of the vagina. Her previous surgery had revealed no evidence of endometriosis. This patient's age, parity, and previous pelvic cleanout made her an unusual candidate for this disease.


Herpes simplex virus encephalitis: an atypical presentation. Herpes simplex virus (HSV) encephalitis is an acute febrile encephalopathy usually characterized by disordered mentation, fever, headache, and focal seizures. We have described a patient with HSV encephalitis whose initial illness was manifested solely as a seizure disorder. Consequently, the diagnosis was not made until late in the hospital course. This atypical presentation of HSV encephalitis is emphasized to facilitate recognition of this disorder and to prompt early diagnostic brain biopsy so that appropriate antiviral therapy can be instituted.


Hepatic hemangioendotheliomas and hyperbilirubinemia. A 3-week-old infant with hyperbilirubinemia and hepatomegaly secondary to hemangioendotheliomas of the liver was presented. Review of the literature produced 18 cases of associated jaundice in 182 infants with hepatic vascular tumors, an incidence of 10%. This disorder should be considered in the differential diagnosis of the infant with hepatomegaly and jaundice, particularly in the presence of gastrointestinal complaints, cutaneous hemangiomas, congestive heart failure, or abdominal bruit. Liver scan should be done in such infants to rule out vascular tumors. Although mortality appears to be high in jaundiced infants with such tumors, currently available therapeutic modalities may be of value in treating these infants.


Polymyositis leading to diagnosis and resection of occult localized carcinoma of the cecum. Polymyositis in an elderly but alert man led to an intensive search for an occult malignancy, which was found and removed. A five-year follow-up without evidence of metastasis supports the concept that polymyositis may antedate metastasis of underlying carcinoma and provide an opportunity for diagnosis and excision of the tumor before it has spread.


Thioridazine-associated immune hemolytic anemia. An association between the ingestion of 72 gm of thioridazine over a 31-month period and immune hemolytic anemia is reported, with a schematic presentation of drug treatment and hematopoietic response during hospitalization.


Spontaneous rupture of a uterine vein during labor. Spontaneous rupture of a utero-ovarian vein during pregnancy is a serious complication that is likely to be misdiagnosed because of its rarity. In this report, a 23-year-old multiparous woman, 39 weeks pregnant, with a history of a previous salpingo-oophorectomy, had symptoms suggestive of a massive intraperitoneal hemorrhage. At exploratory laparotomy she was found to have a torn uterine varix. A 5 lb boy was delivered by cesarean section. Mother and son survived.


Asplenia associated with a congenital diaphragmatic defect and neurologic anomalies. A case of asplenia with the assoicated congential defects of a diaphragmatic hernia, hydrocephalus, anophthalmia, and dysostosis of the frontal skull bones is reported. A small ventricular septal defect was also present. The case is discussed with particular emphasis on the embryologic malformations.


Lap-sash three point seat belt fractures of the cervical spine. Cervical spine injuries associated with three-point fixation lap-sash seat belts result from impact against the sash. While such injuries are infrequent and often without serious neurologic sequelae, they may produce serious deficits with grave injuries. Flexion-extension fractures of the lower cervical vertebrae, fractures of the transverse and spinous processes of the lower cervical and uppermost thoracic vertebrae, discal disruptions, and brachial plexus avulsions may occur. Of the 3 patients reported here, 2 escaped serious damage.


Metastatic disc infection and osteomyelitis of the cervical spine. Surgical treatment. Two cases of vertebral osteomyelitis and discitis in the cervical spine are presented, both having arisen from hematogenous spread to the spine. Bacteriologic diagnosis was established in 1 patient, but the infection had subsided in the other. Both patients were treated with anterior debridement and fusion, and a supplemental posterior wiring and fusion was performed in the second case to reduce kyphotic angulation. In the second case, both the anterior and posterior surgery were performed while the patient was under the same anesthetic. Satisfactory results were achieved in both cases.


Chondrosarcoma of the spine.

Chondrosarcoma of the spine. Involvement of the spine by chondrosarcoma is rare. Three recent cases involving the cervical with or without extension to the thoracic spine are reported. Detailed radiologic investigations to evaluate the extent of the disease are essential to management. Computerized axial tomography and angiography were performed in 1 case and were extremely helpful. Surgical resection of the lesion is the only currently effective method of treatment, but long-term survival figures are not good.


Artifactual midline cervical defect seen during myelography. A case of ventral extradural cervical defect produced by extension during myelography is reported. The defect simulated a herniated cervical disc. This phenomenon has been reported in the lumbar area, but not in the cervical region. The etiology is discussed.


Congenital kyphosis in myelomeningocele. Vertebral body resection and posterior spine fusion. The deforming mechanisms in the congenital lumbar kyphosis of myelomeningocele are situated anteriorly. Posterior wedge resection with local fusion therefore will not prevent progression of the deformity. Nonetheless, this procedure may be the only method of affording sac closure, or providing continuity of the ulcerated integument. Definitive corrective surgery will be required later and must combat the anterior deforming forces. Resection of the apical vertebral body followed by posterior fusion with Harrington instrumentation provides a solid straight spine.


Scoliosis, spondylolysis, and spondylolisthesis. Their relationship as reviewed in 539 patients. Five hundred consecutive idiopathic scoliosis patients in whom routine oblique roentgenograms of the lumbosacral area were obtained, plus 39 patients with a presenting problem of spondylolisthesis, were reviewed in an attempt to answer questions concerning the best therapeutic approaches in patients having coincident scoliosis and pars defects. The incidence of pars defects in patients with idiopathic scoliosis was found to be 6.2%, slightly higher than in the white female population at large. The indications for a surgical approach to the pars defect and/or the spinal curvature parallel the indications for each problem arising independently.


Developmental lumbar spinal stenosis. Pathology and surgical treatment. The purpose of this presentation is to outline the extent of surgical resection necessary for complete decompression of the neural elements in spinal stenosis and to introduce a system for the evaluation of disability in patients with spinal stenosis. Sixteen patients with the confirmed diagnosis of lumbar spinal stenosis were evaluated by the system. Ten cases were treated surgically. Indications for operative treatment were 1) intolerable pain in average daily living, 2) progressively worsening or significant degree of motor weakness, and 3) sphincter dysfunction. Satisfactory results from operative treatment were expected only after adequate and thorough decompression. The extent of surgical decompression was determined by clinical evaluation, myelographic examination, and by the type of disease process exhibited. The most common cause of unsatisfactory results was inadequate decompression of spinal contents. The extent of adequate decompression is described according to three different variations of pathologic anatomy of spinal stenosis: a) concentric contraction of the spinal canal, b) sagittal flattening of the spinal canal, and c) stenosis caused by anomalous articular process(es). No excellent results were obtained even after thorough and adequate decompression of spinal contents.


Lytic spondylolisthesis above the lumbosacral level. The syndrome produced by lytic spondylolisthesis depends on the level at which it occurs. Above the lumbosacral level the incidence of neurologic signs and spinal stenosis increases, and further forward slip in adult life is not uncommon. Twenty-seven patients with lesions above the fifth lumbar vertebra and symptoms severe enough to warrant surgery were studied. Some radiologic observations are made. The patients were divided into two groups for assessment of the results of surgery. Patients with no neurologic signs obtained satisfactory results after a fusion procedure alole. Patients with a neurologic deficit fared less well after surgery, and the importance of decompression in this group is stressed.


Community versus hospital Staphylococcus aureus. Antimicrobial susceptibilities and some features of nasal carriage and acquisition. Susceptibility of community and hospital isolates of Staphylococcus aureus to 15 drugs has been tested. The organisms were isolated from the noses of White adults admitted to two general surgical units. Approximately half of each group were resistant to beta-lactamase-labile penicillins. Hospital staphylococci displayed a greater degree of multiple drug resistance and resistance to methicillin and erythromycin than did community strains. A nasal carriage rate of 28.6% was found among White patients admitted. A comparative survey of 54 Black adults from a rural community revealed a significantly lower rate (14.8%). On non-carriers admitted to hospital, 21.9% acquired S. aureus nasally.


Organophosphate poisoning in Rhodesia. A study of the clinical features and management of 105 patients. A series of 105 patients with organophosphate poisoning admitted to Harari Hospital during the past 4 years is described. Poisoning with organophosphate compounds is being seen more frequently in hospital practice in Rhodesia. Many of the cases are attempted suicides, but frequently there is no positive history of contact with the poison. The majority of patients exhibit the classic clinical features of parasympathetic overactivity, but diagnosis may be obscured by atypical presentation. Rapid diagnosis and utilization of the treatment regimen outlined in this article should reduce the mortality to less than 15%.


[Ferrokinetic studies and the prognosis of aplastic anaemia]. The value of ferrokinetic studies for determining the prognosis of patients with aplastic anaemia was assessed 17 patients. Plasma 59Fe clearance, red cell 59Fe incorporation (at 10 days), sacral and hepatic 59Fe uptake (at 6,0 h, measured by surface counting), and 59Fe bone marrow scanning were compared with peripheral blood pancytopenia and marrow cellularity on aspiration and biopsy. In this limited study no statistically significant correlation could be found between ferrokinetic determinations and other criteria of bone marrow failure, although there was a tendency for plasma 59Fe clearance and sacral 59Fe uptake to show some correlation with marrow cellularity on biopsy and with degrees of reticulocytopenia, thrombocytopenia and neutropenia. Ferrokinetic measurements did not differentiate between patients with favourable and those with poor prognoses.


Caecal bascule--a potential clinical and radiological pitfall. Case reports. Caecal volvulus is usually associated with a twisted caecum, seen to occupy the umbilical area or left hypochondrium on radiography. Caecal bascule refers to the form of volvulus in which the distended caecum is situated within the pelvis. The caecal bascule type of obstruction is uncommon, and clinical and radiological appearances may be confusing. Two cases are presented and the incidence, pathogenesis and radiological features are discussed.


Haemophilus endocarditis. A report of two cases. Two cases of infective endocarditis caused by Haemophilus species are presented. Salient features were the following: occurrence in young adults, presence of underlying valvular disease, and presumptive diagnosis of renal artery embolism in one patient and petechial haemorrhages in the other. Recent reports of an increasing number of cases of infective endocarditis caused by Haemophilus species prompted us to report these 2 cases.


Patterns of disease in Black and Indian children in Natal. A statistical study of all admissions to the paediatric unit at King Edward VIII Hospital, Durban, during a 16-year period indicates the disease pattern encountered, and emphasizes the prevalence of preventable diseases, largely the result of malnutrition and infection, which leads to a high mortality, especially in the very young.


Bronchography in children aged 3 years and under. Anaesthetic techniques and results. Bilateral bronchography was performed on 89 children aged between 3 months and 3 years. The bronchographic technique involves instillation of oily propyliodone into the tracheobronchial tree by positive pressure ventilation, and the procedure is carried out under general anaesthesia. Technically adequate bronchograms were obtained in 84 of the children, and with a solitary exception the complications of bronchography were few and trivial. In bronchiectatic children bronchography is a valuable and accurate investigation, which should in general be restricted to those patients who on clinical grounds are thought to have surgically manageable bronchiectasis.


Mesothelioma in relation to asbestos fibre exposure. A review of 70 serial cases. Seventy consecutive patients suffering form mesothelioma of the pleura were referred to the National Research Institute for Occupational Diseases. In only 1 case was it not possible to elicit a history of significant exposure to asbestos dust. An occupational and environmental history must be taken by a knowledgeable person before it is possible to conclude that there has been no asbestos exposure.


XYY karyotype, female phenotype and gonadal dysgenesis. A case report. A rare association of female phenotype with the 47,XYY karyotype in a 14-year-old White girl is described. She was studied because of her short stature and proved to have gonadal dysgenesis. She showed no masculinization and there were no Turner stigmata. Her intelligence was normal, she was sociable and her outlook was feminine.


Curiosa paediatrica.

Curiosa paediatrica. Curious clinical conditions occasionally seen nowadays are most likely to be genetic aberrations. To find something which is curious but not abnormal nor, indeed, uncommon, but left unrecorded in our medical literature, is worth a notice. This is one of a small collection of curiosities, which I have called for academic reasons 'scalae abdominis infantis' (vel infantum) but the Editor has aptly dubbed the 'inbuilt football jersey'.


Blood pressure of Indian and Coloured Schoolchildren aged 10--12 years. In South Africa, hypertension is common among Indian and Cape Coloured adults. To throw light on this adverse situation, blood pressures are being determined in these ethnic groups. In the first instance, pupils aged 10--12 years were studied. Mean data are among the lowest on record for children. They are similar to values found for rural and urban Black pupils but significantly lower than most corresponding values published for White children. Neither salt nor sugar intakes appear influential. It would seem that factors which promote hypertension in adults in the two ethnic groups are not yet evident in the prepubertal Indian and Coloured children.


The deaf doctor.

The deaf doctor. Cardiopulmonary auscultation and considerable difficulty in hearing lecturers are major problems which face prospective deaf medical students. As a result, their opportunities for obtaining a medical degree have been, until recently, severely limited. However, rapid advance in electronics research have now made available to them a suitably amplified electronic stethoscope and a free-field radio transmission system.


Articular cartilage degradation and the pathology of haemophilic arthropathy. Synovial membrane and specimens of articular cartilage, obtained from the affected knee joints of 5 haemophilic patients at the time of surgical synovectomy, were studied. All the synovial specimens showed villous proliferation and multiplication of synovial cells. Haemosiderin granules were present within synovial cells and in macrophages. There was congestion and capillary proliferation. An inflammatory infiltrate of plasma cells and lymphocytes was seen in some instances. Articular cartilage changes were classified into the following 4 grades according to severity: 1--an increase in the number of surface chondrocytes with fibrous metaplasia, and the appearance of superficial fissures; 2--a fibrous vascularized overgrowth, resembling rheumatoid pannus; 3--deep fissuring and necrosis of cartilage; 4--erosion and disappearance of articular cartilage with exposure of subchondral bone. In the first 3 grades, deep nests of chondrocytes containing haemosiderin were present. These cell aggregates became larger and more degenerate as cartilage degradation progressed. Damaged articular cartilage was deficient in glycosaminoglycan (acid mucopolysaccharide). No excess enzyme activity could be demonstrated within the cartilage matrix. Immunofluorescent studies were not helpful. Electron microscopical examination revealed siderosomes within degenerate chondrocytes and synovial cells. Granules resembling haemosiderin were also present in the cartilage matrix. It is considered that iron products affect both chondrocytes and matrix adversely and play a part in articular cartilage destruction in haemophilia.