[Methodological contribution to the controlled measurement of platelet aggregation]. Collagen-induced platelet aggregation was investigated in healthy volunteers under well defined experimental conditions. The Born aggregometer was used and the two parameters studied were the maximum amount and velocity of aggregation. Under these experimental conditions no significant differences in measurements on 3 consecutive days were found. In addition, identical results were obtained in the same volunteers 4 and 8 weeks following the first experimental period. This experimental procedure was therefore used to test a new nonsteroid anti-inflammatory agent, RU 43-715, for its effect on platelet aggregation. Furthermore, a controlled crossover study using 3 different substances was performed. In the light of the results in the present study, controlled studies on platelet aggregation can be performed even over on even longer period of time under the experimental conditions described.


Effects of anticoagulation on the interaction of human platelets with subendothelium in flowing blood. The subendothelial surface of rabbit aorta was exposed to a laminar stream of native human blood using a perfusion chamber. The blood was drawn at a constant flow rate and 37 degrees C from a cubital vein through the annular space of the chamber by means of a roller pump. Platelet interaction with subendothelium and fibrin deposition were measured morphometrically. Native blood and blood anticoagulated with 15 mM citrate obtained from the same donor was investigated at arterial blood flow conditions. Platelet adhesion was significantly increased by the anticoagulation. In contrast, platelet spreading and adhesion-induced aggregation were significantly inhibited by citrate. The extent of fibrin deposition varied greatly from one donor to another and did not correlate with platelet adhesion. It is concluded that initially, the two hemostatic systems platelet adhesion-aggregation and coagulation function independently.


[Granulocyte transfusions. Technical data, granulocyte function and results]. A new method called "repetitive filtration leukopheresis" is described for granulocyte transfusion therapy. 23 patients received a total of 91 transfusions. All patients presented neutropenia of less than 300/mm3 and various kinds of infection resistant to antibiotic therapy. A favorable result was observed in 18 cases following these transfusions, which did not produce the secondary effects noted by others (chills, rash, fever, dyspnea). It was felt that this remarkable tolerance was a result of the collection procedure (elution at pH 7.4 ommission of centrifugation, thus securing the functional integrity of the cells). This impression was confirmed by the results of a battery of tests performed on the collected granulocytes, which included evaluation of their phagocytic and bacteriolytic functions and of their ability to break down a phagocytized antigen, together with measurements of lysosomial enzymes released in the supernatant.


Erythrocyte-granulocyte rosette. An immune cellular interaction in some cases of autoimmune haemolytic anaemias. The erythrocyte-granulocyte rosette in some cases of autoimmune haemolytic anaemia is described. Its pathogenesis is ascribed to complement activation up to the C3b stage in vivo.


Ricin- and concanavalin A-binding sites on the surface of polymorphonuclear leukocytes have no receptor function in phagocytosis. Human and rabbit polymorphonuclear leukocytes (PMN) were incubated at 0 degrees C with ferritin conjugates of ricin or concanavalin A,and subsequently brought to 37 degrees C in order to induce the formation of lectin caps. The PMN were then alllowed to phagocytose yeast cells or staphylococci for 15 min and were subsequently processed for electron microscopy. The micrographs were evaluated by morphometry. It was found that lectin-treated PMN phagocytose as efficiently as untreated cells. Capped cells always engulfed the particles with a lectin-free portion of their plasma membrane. This indicates that ricin- and concanavalin A-binding sites on the PMN surface are not involved in particle recognition and uptake. The virtual absence of lectin on the membrane of the phagocytic vacuoles suggests that capped PMN is functionally polarized and only able to phagocytose at the pole opposite the cap.


[Structural model of factor VIII complex]. Gel filtration patterns on Sepharose CL-2B of functional subunits (procoagulant, ristocetin cofactor, antigen) derived from highly purified human factor VIII indicate that the native, intact complex is reproducibly eluted in the void volume. The complex is, however, degraded by proteolytic (and possibly other) enzymes contaminating the purified material during dialysis at room temperature. Resulting degradation products were fractionated by gel filtration and characterized by SDS-polyacrylamide electrophoresis. Our results suggest that factor VIII consists of identical subunits (mol. wt. about 500 000) which might be linked together by hydrophobic bonds. Only native high molecular weight aggregates posses ristocetin cofactor activity.


[Resolution of Bbeta and gamma chains from normal human fibrinogen Zürich II into 2 variants with each differing sialic acid content]. The gamma- and Bbeta-polypeptide chains of purified human fibrinogen (both pooled and single donor) have each been resolved into 2 major components: gammaL and gammaR, and BbetaL and BbetaR. They are similar in molecular weight (SDS-PAGE), but differ in sialic acid content, which approximates 2 and 1 residues per molecular of polypeptide in the L- and R-components respectively. Tryptic peptide maps of the L-and R- forms of the gamma chain showed differences within the small group of peptides containing the sialic acid residues. No differences between the peptide maps of BbetaL- and BbetaR-chains were found . A larger ratio of L:R in the gamma- and Bbeta-chains of dysfibrinogenemia fibrinogen "Zürich II" explains the higher content of sialic acid measured in the unmodified Zürich II fibrinogen molecule.


[Conformation of the fibrinogen molecule in solution: dynamic light scattering spectroscopy]. Human fibrinogen solutions were prepared either by filtration of ultracentrifugation. The sedimentation coefficient was S20,W = 7,9 S. The translational and the rotational diffusion coefficient DT and DR and the fraction of oligomers were determined using light beating spectroscopy. DT20,W was (2.03 +/- 1%) 10(-7)-cm2-sec-1, DR120,W = 40 000 +/- 10%-sec-1. The sedimentation coefficient and DT were strongly dependent on concentration. For pH values between 6.5 and 9.0, the diffusion coefficient DT at ionic strength greater than 0.2 was constant. The diffusion coefficient as measured by nanosecond fluorescence depolarization was DR//20,W = 1.6 x 10(6) sec-1. At a fibrinogen concentration of 2 mg/ml, these hydrodynamic data are compatible with an elongated molecule of 450 A length and an axial ratio of about 1:7.


[Rise in neutrophils after hydrocortisone seen as bone marrow reserve mass. Dependency on spleen size]. In 25 patients with a wide range of postmitotic marrow neutrophil mass a linear relationship was observed between the number of postmitotic marrow neutrophils and the rise of blood neutrophils after intravenous injection of 3 mg hydrocortisone/kg. Related to marrow neutrophil cellularity, the response curve was significantly higher in 10 splenectomized patients but greatly depressed in 10 patients with splenomegaly.


[Cell division, cytolysis and regeneration after cyclophosphamide]. Cytokinetic effects of 5 or 20 mg cyclophosphamide/kg body weight on thoracic duct lymph and blood cells of calves were analyzed. The larger dose caused a temporary cessation of lymphoid cell division, reduced the output of nondividing small lymphoid cells and impaired proliferation of neutrophil precursors. Feedback mechanisms acting on GO/G1 cells controlled the proliferation of lymphoid cells.


[Human monocyte function in normal subjects and in certain states of immunologic deficiency]. The functions of peripheral blood monocytes (phagocytosis, bacteriolysis, the metabolism, and catabolism of a protein antigen) have been studied in 12 normal subjects and in 23 patients suffering from either primary or secondary immune deficiency. Phagocytosis and bacteriolysis were altered in 1/3-2/3 of patients with either Hodgkin's disease, sarcoidosis or pulmonary tuberculosis, whereas catabolism of the protein antigen were found to be abnormal in practically all cases of agammaglobulinemia. These results show that monocytes may have intrinsic functional abnormalities in some conditions.


[Congenital liver cysts. Case report and review of the literature]. A study is presented of four female patients with congenital solitary liver cyst. The largest cyst had a volume of 4 liters. One of the patients studied had a neoplasm which was possibly the result of secondary malignant degeneration of the cyst. Congenital cystic degeneration may develop in the entire biliary tract. The clinical symptoms depend on the size, localization and number of cysts. Characteristic signs and symptoms caused by displacement of the intestinal organs begin to appear as a rule in late adulthood. The cysts rarely impair liver function. Hemorrhage into the cysts, rupture of the cystic wall, infection or secondary malignant degeneration of the cysts, torsion and strangulation are infrequent. Solitary cysts of the liver are not accompanied by cysts in other organs as is the case in polycystic liver disease. Diagnostic procedures, differential, diagnosis and therapeutic measures are discussed, and reference is made to non-congenital cystic formations in the liver.


[The effect of the collateral circulation on the total and regional myocardial function in coronary disease]. The cinecoronarograms, ventriculograms and electrocardiograms of 164 consecutive patients (32 patients without heart disease and 132 patients with coronary artery disease) have been analyzed. Total left ventricular function was assessed by the ejection fraction. Regional myocardial function was determined by a system of hemiaxes. 89 patients with complete obstruction of the right coronary artery (RC) and/or the anterior descending branch of the left coronary artery (LAD) were divided into subgroups with good, poor and no coronary collaterals. Total and regional left ventricular function was normal in patients with well collateralized coronary occlusions. Patients with poorly collateralized or non-collateralized occlusions had impaired left ventricular function. Patients with poorly collateralized coronary occlusions showed no difference in left ventricular function when compared to patients with coronary occlusions without collaterals. Combined occlusions of the RC + LAD without collaterals were not found. Good coronary collaterals have a protective effect on total and regional myocardial function, thus improving the prognosis in complete coronary artery obstruction.


[Normogram study: representative data on the state of health of male industrial workers in northern Switerland. III. Physiological and biochemical findings]. To obtain normative data on the health of men aged 20 to 65 years working in the industry of northern Switzerland, a representative study was conducted in 1260 men from 44 plants. The average pulse rate was 75/min and there was no age-related differences. The average blood pressure was 125/73 mm Hg in the 20-25 age group and 148/84 mmHg at age 60-65. An ergometric test (2 watt/kg/6 min) showed that forced vital capacity decreases significantly from 5561 +/- 782 ml in subjects aged 20-24 to 3809 +/- 757 ml in those aged 60-65. Cholesterol levels were 198 +/- 50 mg% (age 20-24), 240 +/- 42 mg% (age 50-54) and 235 +/- 47 mg% (age 60-65). Urine tests showed albumin in 15% and glucose in 4% of samples.


[Considerations on psychotherapy and sociotherapy in the aged]. Psychotherapy of the elderly has assumed increasing importance in recent years. W. Schulte, G. BENEDETTI, BEREZIN and others have expressed the view that the indication and methodology of such therapy must take into consideration the limitations imposed by age-related factors such as rigidity, concentration difficulties and a tendency to negate the proximity of death. Insight into the finiteness of life, brought about by the approach of death, is seen by the author as a basic problem in any psychotherapy of the elderly. However, the therapist should beware of unwarranted optimism. The practical procedure occasionally resembles that of "symbolic realization". Sociotherapy, however useful it may be, also involves the danger of camouflaging the problems surrounding the end of life. sabove all, the author sees a need to improve geriatric institutions and criticizes the lack of human warmth frequently observed in the treatment of the inmates of old people's homes.


[The dyspnea syndrome of the newborn in Switzerland. Results of a cooperative study within the framework of the Swiss Neonatology Group]. The Swiss Neonatology Group was founded in 1972 to strengthen cooperation between obstetricians and pediatricians in this country. To this end a collaborative study was made of the incidence of respiratory distress syndrom in Switzerland during 1974. Almost every neonatal unit of the country participated, and the study thus covered the problem cases taken from approximately 90% of all Swiss newborns. 30% of the newborns hospitalized in neonatal units (or 2% of all Swiss newborns) developed a respiratory distress syndrome. 16% of these died. One third of all the cases of respiratory distress and two thirds of the deaths were due to hyaline membrane disease, which mainly occurred in prematures. The other cases of respiratory distress were divided between aspiration, transient respiratory distress and other pulmonary disorders. 31% of the newborns with respiratory distress syndrome underwent mechanical ventilation, more than half of these having hyaline membrane disease. The success already achieved by modern perinatology looks hopeful for the future.


[Sinus node syndrome].

[Sinus node syndrome]. The sick sinus syndrome is caused by dysfunction of the sinus node and includes various forms of arrhythmia. In its chronic form the underlying disease may affect not only the sinus node but also the atrial, junctional and intraventricular conduction tissue. The most important clinical symptoms are, in decreasing order, dizziness, syncope, palpitations, cardiac failure, systemic embolism, and cerebrovascular insult. The main diseases causing dysfunction of the sinus node are coronary heart disease, myocarditis, and rheumatic fever. The diagnosis is based on history, clinical findings, ECG, specific provocative tests and, if necessary, long-term ECG monitoring. The sick sinus syndrome is most frequently seen in patients aged over 50 years. Treatment with drugs alone, such as atropin, catecholamines, digitalis or antiarrhythmic drugs is often difficult becuase of the frequent changes between bradycardic and tachycardic arrhythmia. In chronic and progressive cases, the best treatment is implantation of a cardiac pacemaker.


[Radiological, biochemical and clinical aspects of uremic osteopathy in patients with long term dialysis]. The clinical, biochemical and radiological signs of uremic osteopathy in 25 patients dialyzed at the dialyzing unit of the Medical Policlinic of the University of Berne are described. Comparison, mainly of radiologic signs, with the published experience of other centers shows a relatively high frequency of nonsymptomatic osteopenia and metastatic and vascular calcifications in our patients, even though their serum calcium and phosphorous concentrations were kept relatively normal. The frequencies of radiologic alterations in other dialyzing units reported in the literature differ widely from one center to another; this may be due to different technology, but even more to varying evaluation of the findings by different radiologists.


[Schistosomiasis. Apropos of 5 cases of Swiss citizens having traveled in endemic countries]. Among a series of 35 cases of schistosomiasis diagnosed in Geneva between 1961 and 1975 on biopsies (bladder, rectum and liver), the cases of 5 Swiss citizens who had lived in endemic countries are reported. Since the clinical manifestations are often misleading or hardly typical, the diagnosis rests above all on biopsy. After recall of the epidemiologic and pathologic features, the diagnostic steps are reviewed. The object of this study is to call the practiontitioner's attention to the increasing incidence of imported schistosomiasis among the inhabitants of temperate countries.


[Evaluation and significance of cholesterol containing abdominal fluid]. In 2 female patients with clinical suspicion of malignant abdominal tumor "ascitic" fluid obtained by abdominal paracentesis, was found to contain an abundant amount of cholesterol. Laparotomy revealed huge, benign ovarian mucinous cystadenomas. The cytological diagnosis of cholesterol-containing cystic fluid is discussed. Cholesterol-containing cystic fluid is discussed. Cholesterol-containing cystic fluids can be differentiated cytologocally from serous and chylous effusions, and also from cholesterol pleurisy and cholesterol peritonitis.


[Creatinine in erythrocytes. Possible effect on plasma creatinine]. Creatinine is present in red cells of healthy individuals in about the same concentration as in plasma. Therefore, hemolysis per se is not a major interference factor in the determination of plasma creatinine, unless the method used is influenced by hemoglobin. Some more important possible influences are discussed.


[Contribution to the effect of tri and tetracyclic antidepressive agents on the heart and blood circulation]. In 47 patients ECG tracings were recorded and cardiovascular values determined before therapy, during treatment with antidepressive agents after it had been in progress for at least 3 weeks, and 4 weeks after withdrawal of therapy. In a further 19 patients in whom antidepressive therapy could not be withdrawn, the same test battery was repeated after an average period of 13 months. No serious disturbances of cardiac rhythm were detected and certain changes in ECG criteria (prolongation of PR interval, widening of QRS complex, prolongation of QTc time and T-wave flattening) proved to be reversible. There was no difference between tricyclic and tetracyclic antidepressive agents. We are nevertheless of the opinion that ECG and cardiac function should be carefully monitored in elderly patients and in those on prolonged therapy with high doses of antidepressives. The results of this study are discussed and compared with previously published findings.


[Clinical indications for abdominal sonography]. The clinical indications for ultrasonography in diseases of the abdominal organs are systematically presented and discussed. The use of the gray-scale technique leads to an appreciable improvement in diagnostic potential, due in particular to the demonstration of small vascular structures. Consistency of tissue structures, the topographic-anatomical relationship between organs, and localization of space-occupying lesions are readily determined by sonography with a minimum of discomfort and stress for the patient.


HLA antigens and corticosteroid response. Compared with normal individuals, patients with primary open-angle glaucoma have increased prevalences of HLA-B12 and B7 antigens and are more responsive to glucocorticoids. Lymphocytes from both ocular normotensive and glaucomatous individuals with the HLA-B12 antigen require significantly (P less than .02) lower concentrations of prednisolone to inhibit phytohemagglutinin-induced transformation.


Field focusing nuclear magnetic resonance (FONAR): visualization of a tumor in a live animal. A nuclear magnetic resonance (NMR) image of a tumor in a live animal is reported. The field focusing NMR method or FONAR process that now achieves the tumor outline is described.


Infidelity of DNA synthesis in vitro: screening for potential metal mutagens or carcinogens. Thirty-one metal salts have been tested for their ability to affect the accuracy of DNA synthesis in vitro. All ten salts of metal carcinogens decreased the fidelity of DNA synthesis. Of the three metals which beforehand were considered to be possible mutagens or carcinogens, only one decreased fidelity. In contrast, 17 noncarcinogenic metal salts did not affect fidelity even when present at concentrations that were clearly inhibitory.


Melatonin: effects on the circadian locomotor rhythm of sparrows. The continuous administration of low levels of melatonin via intraperitoneally placed Silastic capsules either (i) shortened the free-running period of activity or (ii) induced continuous activity in house sparrows (Passer domesticus) maintained in constant darkness. After the melatonin-filled capsules were removed, the period of the circadian rhythm of activity lengthened in rhythmic birds and normal rhythmicity was restored in continuously active birds. The results suggest that melatonin is involved in the physiological control of circadian rhythmicity in sparrows.


Coombs--negative immune hemolytic anemia. An immune hemolytic anemia occurs in a few patients in whom the concentration of antibody on the red cell is below the level for detection by the usual antiglobulin test. Clinically, these patients are identical to patients with warm type Coombs-positive hemolytic anemia, except for the quantity of antibody on the cell. The course of the hemolytic disease is highly variable. It is postulated that the properties of the antibody in conjunction with the sensitivity of the reticuloendothelial system for antibody-coated cells account for hemolytic anemia occurring with such low concentrations of antibody. The response to steroid therapy and splenectomy, when indicated, is usually favorable.


Transfusion therapy for autoimmune hemolytic anemia. Transfusion therapy for patients with autoimmune hemolytic anemia poses major problems to both the blood bank that is charged with providing blood and the clinician who must manage the patient successfully. Profitable discussions between the clinician and the blood bank are necessary before the patient can receive the most beneficial form of treatment. These problems are summarized in Table 1. Although not all of these problems apply to all patients, there are quite enough problems that are generated by every patient. The blood bank and the clinician are usually confronted by different aspects of problems posed by the same patient, but all aspects are related, and a meaningful dialogue between the blood bank and the clinician is absolutely essential to achieve optimal patient management.


The role of the spleen and splenectomy in autoimmune hemolytic disease. The relationship of the spleen to the red cell in AHDW is determined by the characteristics of the surface protein coating of the red cell, rather than by a pathologic change in the reactivity of the spleen. The behavior of the spleen is essentially a passive response to red cells with abnormal properties. The critical properties are incompletely defined, but probably include cell shape, and perhaps more importantly, the intrinsic properties of the cell membrane. The effects produced by the spleen are mediated partly by the filtration mechanism of the splenic sinus walls, and partly by the more specific effects of cell-to-cell adhesion between the pulp macrophages and the red cells. The outcome is more complex than former concepts of red cell destruction encompassed: delay in cell passage produces cell pooling in the unfavorable environment of the splenic pulp, and there is microfragmentation, cell sphering, and partial phagocytosis, in addition to cell destruction with erythrophagocytosis in situ. Prediction of the degree of dependence of hemolysis on the spleen prior to splenectomy remains an area of uncertainty. Commonly, the decision for splenectomy is determined circumstantially, but current concepts would anticipate that the most relevant data would relate to the dimensions of splenic pooling, and the quantity and class of immunoglobulin present on the cells.


Animal models of autoimmune hemolytic disease. The dog is the principal known animal that develops spontaneous AIHA in the same confusing way as does man. All other occurrences of AIHA in animals are secondary to a variety of immune complex disorders. A recent review has more than adequately covered those conditions. The truly interesting point is that in all the animals studied except the dog, a viral etiology has been found in those conditions in which AIHA is expressed. Lastly, an area that has not been adequately exploited, and may well be an experimental direction to follow in the future, is the observation that graft-versus-host models could well provide significant new knowledge of the mechanisms involved in the recognition of self and subsequent cell destruction.


Management of urethral valve obstruction in male neonates. Over the past 6 years, 18 neonates with a posterior urethral valve obstruction have been treated. The mortality has been markedly reduced by meticulous investigation, better medical management of renal failure, greater use of catheter drainage and simpler methods of valve ablation and reduction in the use of nephrostomy and ureterostomy. Mortality was 33%, but ther has been no mortality in the last 7 patients.


Winter diarrhoea and rotaviruses in Rhodesia. In the winter fewer bacterial pathogens are isolated from patients with gastro-enteritis than in the summer. The incidence of rotavirus infection is, however, at its greatest during the winter months and the virus is rarely found in cases of gastro-enteritis which occur during the warm season. The clinical pattern in winter diarrhoea is characteristically severe and acute but there has been no mortality or cross-infection.


Paget's disease of bone in South African Blacks. Although Padget's disease of bone is considered to be an extremely rare condition in people on non-Caucasian extraction, we have encountered 9 cases among South African Blacks. The features of Paget's disease in our patients correspond in every way with the typical features seen in Whites with advanced Paget's disease. All 9 patients were considered to be racially pure South African Blacks by virtue of physical appearance, family history and gene marker studies. The striking racial distribution of this condition would tend to indicate a genetic predisposition rather than environmental factors as the cause of this condition.


Villous tumour of the duodenum.

Villous tumour of the duodenum. The occurrence of a villous tumour of the duodenum in an 18-year-old female patient is reported. This is the youngest patient who has been recorded as having this type of tumour. Fibre-optic endoscopy with biopsy of the tumour permitted a pre-operative diagnosis to be made.


Music, noise and hearing damage.

Music, noise and hearing damage. This article sets out the issues involved in the consideration of noise-induced hearing damage. Exposure to noise can lead to a shift in the hearing threshold, resulting in loss of hearing. This shift may be either temporary or permanent. When it is permanent it is usually irreversible and not all persons can be helped by hearing aids. Permanent shifting of the hearing threshold may be caused by exposure to high sound levels. Ratios between lengths of exposure and frequency levels are given. The measurement of sound levels and assessment of acoustic hazards are presently related to non-fluctuating sounds. Music fluctuates too much to be measured in these terms. Means have now been worked out to correlate the pressure of fluctuating sound (like music) with that of nonfluctuating sound (like industrial noise) and thus to equate statistics governing noise as an acoustic hazard with the hazard constituted by music. Table I shows the ambient sound levels which should be considered as unsafe per number of hours' exposure. I plead for better acoustic design in environmental planning and stress that people exposed to loud noise or music should undergo hearing tests regularly as the main preventive measure.


A simplified method of electrocardiogram interpretation. A modified step test is described, suitable for office use with the performance of the effort electrocardiogram. The results of haemodynamic changes are briefly presented and the results of measurement of 104 ECGs are tabulated and graphed. It is shown that by using ECGs taken 6 minutes after effort with lead V6 and by measuring the slope angle of the S-T segment, all abnormal subjects can be distinguished from at least 95% of normal subjects. The presence of a plane segment plus an S-T slope angle of less than 6,5 degrees will totally separate normal subjects from those with myocardial ischaemia. The patient's history will usually be found to accord with the above.


A study of the value of closed bone marrow biopsy. Percutaneous microtrephine bone marrow biopsy by the Jamshidi-Swaim method was employed in the investigation of selected patients during a 1-year period. Data obtained from the study confirm the importance of this procedure as a method of diagnosing bone marrow lesions characterised by altered architecture or malignant infiltration. Common examples of such lesions are aplastic anaemia, myelofibrosis, Hodgkin's and non-Hodgkin's lymphoma and carcinomatosis. Bone marrow aspiration is frequently not helpful in the diagnosis of these diseases, but it is important that both aspirated and biopsy material be examined together, since the two methods are often complementary.


A comparative study of ovarian tumours in black and Indian patients. An analysis of 426 primary ovarian tumours in Black and Indian patients in Natal shows a disparity in the incidence of cystomas and teratomas in the two groups. Cystomas comprise 29% of all ovarian tumours in Blacks compared with 67% in Indians. Germ cell tumours, however, predominate in Blacks, comprising 52%, as opposed to 19% in Indians. The Indian distribution is similar to that of American and European groups.


Ileal metastasis in cervical carcinoma: a case report. A patient with adenosquamous carcinoma of the uterine cervix, who presented with partial intestinal obstruction and a macroscopically normal cervix, is reported. The literature is reviewed.


[Successful control of the population increase in Paarl]. This article reports on the successful acceptance of voluntary sterilisation in Paarl. Emphasis has been put on postpartum sterilisation with increasing acceptance by women with 3 or 4 children. Average parity at time of sterilisation has diminished from 7,52 in 1971 to 5,70 in 1974. The grand multipara has virtually been eliminated--reduction of grand multiparas should be a top priority in any comprehensive family planning scheme.


Bone infarction complicated by sarcomatous change: a case report. A patient with a sarcoma of the tibia associated with multiple bone infarcts and a history of alcoholism, is presented. This is a rare association. The possible aetiological role of bone infarcts in relation to the development of a sarcoma is discussed.


Medical aid at the roadside.

Medical aid at the roadside. Aid given to patients at the roadside may be divided into three categories, namely first aid, ambulance aid and medical aid. The type of assistance actually rendered by the doctor will depend on how well he is equipped. The main situations with which a doctor may be faced, are dealt with under these three headings.


A human brain thromboplastin standard for distribution in South Africa. As part of an international co-operative study of the International Committee for Standardisation in Haematology, human brain thromboplastins prepared by the acetone-extracted and phenol-saline extraction techniques have been compared as to the yield, the proportion of reagent discarded and wasted, and the sensitivity related to an international standard, the British Comparative Thromboplastin standard (BCT). The phenol-saline extract showed greatly improved sensitivity with greatly reduced batch-to-batch variation as compared with the acetone-dried preparation. In addition, the sensitivity of this reagent conformed to that of the BCT. The implications of the use of such a standardised reagent to the therapeutic management of oral anticoagulant therapy are: (i) standardised, reproducible results; (ii) results comparable with those carried out by other laboratories using a similarly standardised reagent; and (iii) stable therapeutic range.


Vertebral osteomyelitis in insulin-dependent diabetics. Vertebral osteomyelitis continues to be a diagnostically and therapeutically challenging disease with a relatively high incidence in diabetics. The clinical features, investigations and treatment of 7 insulin-dependent diabetics with vertebral osteomyelitis are presented and possible aetiological factors in this group are discussed.


Acute arterial spasm of the lower extremities after methysergide therapy. A case of acute arterial spasm of the lower extremities, after the ingestion of methysergide, is presented. Arterial spasm was documented by arteriography, and return to normality followed discontinuation of the drug.


Henoch-Schönlein purpura: a case report. A case of Henoch-Schönlein purpura with the rare complications of facial and scalp oedema, followed by neurological complications manifesting as focal convulsions with transient conjugate eye deviation and cortical blindness, is described.


A clinical and radiological trial of meglumine loglycamate, a new intravenous cholangiographic contrast medium. The efficacy of meglumine ioglycamate was assessed in 100 unselected patients who underwent cholangiography for various reasons. Good to excellent opacification was achieved in 69% of all patients. A total of 17% of all patients showed side-effects, the majority of which were transient and of a minor nature. Blood pressure and liver function were apparently not affected, but SGOT levels increased transiently within 24 hours in 21% of patients. Renal excretion of the contrast medium occurred in 48% of patients, but in only 2 did it interfere with visualisation of the duct.


Histoplasmosis treated with a sulphonamide. A case report. Disseminated histoplasmosis involving the reticuloendothelial system in a Black boy, successfully treated with a sulphonamide, is reported. The importance of this rare disease in South Africa is discussed.


Trauma of the spinal cord in children.

Trauma of the spinal cord in children. The clinical and radiological features in 16 children with trauma of the spinal cord are presented. The extremely low incidence of traumatic paraplegia in children relative to the incidence in adults is noted. In 70% of the paraplegic children no abnormality of the vertebral column was detected by X-ray examination. The value of tomography and myelography in localisation of the site of injury in this group is considered. The pathogenesis of trauma to the spinal cord in children is briefly discussed.


Fat embolism in kwashiorkor.

Fat embolism in kwashiorkor. Fat embolism from the grossly fatty liver of an infant with kwashiorkor is described. Globules of fat were seen at necropsy in the hepatic veins, in the right atrium and ventricle of the heart and in the pulmonary artery. Sections of the lung showed fat emboli in numerous branches of the pulmonary artery. Examination of lung sections taken at necropsy from 40 patients who had severe kwashiorkor failed to show similar fat embolism.


An accelerated diagnostic approach to surgical jaundice. A clear distinction between obstructive and hepatocellular jaundice is difficult in many patients. Biochemical and clinical findings may cause confusion and result in long delays in diagnosis and treatment. Ultrasonography is a major advance in the positive identification of patients with dilated intrahepatic ducts, whether or not the gall bladder is dilated. Isotopic imaging also may be useful in identifying obstructive jaundice. If percutaneous transhepatic cholangiography (PTC) is performed soon after, the site and nature of the obstruction will become evident. Another advance is the introduction of a sheathless narrow needle for PTC. This reduces the possibility of complications and has the advantage of being able to puncture a normal, undilated biliary tree in as many as 60% of cases, ruling out an obstructive cause. The use of these newer radiological investigations will appreciably shorten the period between the onset of jaundice and the ascertainment of its cause.


Chronic proximal muscular weakness in alcoholics. In spite of the fact that peripheral neuropathy is very common in alcoholics, the chronic proximal muscular weakness and wasting found in alcoholics have been ascribed to myopathy. A clinical, biochemical, and histological study of 13 patients provided evidence for neuropathy. Enzymic histochemistry of muscle demonstrated selective type 2 neurogenic atrophy with evidence of reinnervation.


Incidence of renomedullary interstitial cell tumours and correlation with hypertension. In a study of 223 consecutive autopsies of subjects older tumours were found in 36 cases (16%) (25/130 males and 11/93 females). Only eight kidneys showed multiple lesions. Renomedullary interstitial cell tumours were correlated with the presence or absence of hypertension and no statistically significant correlation could be demonstrated. The incidence of renomedullary interstitial cell tumours increases with age.


Implementation of research in the homelands. The influence of urbanisation and a Western way of life is discussed in relation to the establishment of physiological norms and the epidemiology of disease in the homelands. The importance of continued research in these areas as a means of continuous assessment of the basic health state of the community is stressed. Once the basic health state has been established priority for health needs can be determined against the background of total appreciation of community resources. Attention is drawn to the 'implementation gap' which has thus far largely inhibited effective disease control and health promotion in the homelands, in spite of the wealth of research data available on the prevalence of illness in these communities.


Hereditary dysrhythmic congestive cardiomyopathy. A patient with hereditary congestive cardiomyopathy, who presented with recurrent episodes of life-threatening ventricular arrhythmias most often precipitated by exercise, is described. The condition is marked by either a progressive course, in which case congestive cardiac failure may set in towards the end, or by unexpected sudden death. The family tree could be traced for 10 generations. The information about the tenth generation firmly established that 4 members, 2 of whom had died, were affected. Other evidence suggests that the condition was the cause of death in 3 members of the eighth generation.


The frequency of uterine contractions in abruptio placentae. The frequency of uterine contractions was studied in 37 patients with severe abruptio placentae. They ranged from 3 to 16 per 10 minutes, with a mean of 7,86. When frequency of contraction was correlated with haematological and clinical data, a slight negative correlation was found between the frequency and haemoglobin and haematocrit values. In patients with intra-uterine fetal death, the mean frequency was 8,85 as opposed to 5,55 when the infant was born alive. This difference is statistically significant. The possible role of these abnormal contractions is causing intra-uterine death is discussed.


Cytology and mammography in the diagnosis of breast cancer. The results of an analysis of the accuracy of two diagnostic tests in a series of 714 patients with breast masses are presented. Fine needle aspiration cytology and mammography each had a false negative rate of 5,3%. Use of a combination of both techniques reduced the number of carcinomas missed to 2,3%. The need for histological examination of dominant discrete breast masses is emphasised.


A serological investigation of Mycoplasma pneumoniae infection on the Witwatersrand. Sera from patients with respiratory disease were examined for antibody to Mycoplasma pneumoniae by complement fixation test. During the study period of about 6 years, a 3-year cycle of infection was observed, which coincided with some epidemics in the UK and USA, suggesting the possibility of an approximately simultaneous world-wide spread. The epidemics lasted about 18 months each, during which the incidence of infection was over 10 times that of the interepidemic periods.


Saint's triad: confirmation and explanation. A quarter of a century ago Professor C. F. M. Saint of the University of Cape Town noted the occasional association of diverticular disease, hiatus hernia, and gallstones in a patient. The occurrences of these diseases, and the significance of their associations, are discussed. The suggestion is made that the diseases are casually related to the consumption of fibre-depleted diets.


Aneurysms of the petrous portion of the internal carotid artery. Aneurysms of the petrous portion of the internal carotid artery are rare lesions. One case is reported here and 18 others have been found in the literature. These lesions usually arise in young men who present with auditory dysfunction. The aneurysm is usually discovered as a pulsating purple mass in the middle ear and mistaken for a glomus jugulare tumor. A definitive diagnosis can be made by carotid angiography. Subtraction techniques are very helpful. Carotid ligation or trapping is the treatment of choice.


Post-meningitic hydrocephalus and syringomyelia treated with a ventriculoperitoneal shunt. Following cryptococcal meningitis, symptoms of cervical syringomyelia developed in a young heroin addict. Myelography confirmed syringomyelia and angiography demonstrated severe hydrocephalus. Ventriculoperitoneal shunting resulted in complete resolution of signs and symptoms of both hydrocephalus and syringomyelia.


Testing cerebrospinal fluid shunt capacity and adequacy by the lumbar route in adults. The pressure of the cerebrospinal fluid with the patient in a lateral position, the level of zero pressure in sitting position, and the infusion cisternography were evaluated as a test for determining shunt function. The lumbar infusion test gave information about shunt capacity, while the opening pressure in lateral and sitting position reflected shunt adequacy. A reduction in shunt capacity preceded the rise of the opening pressures when the shunt capacity preceded the rise of the opening pressures when the shunts became inadequate. Cisternography was relatively reliable in determining shunt adequacy when shunt capacity was near its high or low extreme, but unreliable in the middle ranges. In non-communicating hydrocephalus, the lumbar infusion test resulted in a correct conclusion as to shunt capacity provided the subarachnoid space was patent and the test was terminated before the ventricular system was empty.


Cavernous haemangioma in the pineal region. The authors report a case of a cavernous haemangioma in the pineal region which presented as a progressively enlarging mass lesion. Clinical, radiographic and pathologic features are briefly described. Total removal was achieved using the supracerebellar, infratentorial approach.


Papilledema associated with a sacral intraspinal cyst. A rare case of papilledema associated with a large sacral intraspinal cyst is described in a 34-year-old male. Symptoms were aggravated by heavy work and consisted of low back pain, headache, dizziness and episodic vomiting. Papilledema was observed on ophthalmological examination. A valvular mechanism was found to exist between the normal spinal sac and the huge sacral cyst. Division of the valvular fistula combined with a dural plastic operation brought complete relief of all symptoms.


Spinal cord injury in a fetus.

Spinal cord injury in a fetus. In her eighth month of pregnancy a woman was stabbed in the abdomen with a barbecue fork. Upon delivery one week later, the child was noted to have two scars in the thoracic region on the back. The legs were flaccid. Surgical exploration at the age of seven months revealed marked, dense scarring of spinal cord and arachnoid membrane. No similar case was found in the literature.


Combined steroid and hypothermia treatment of experimental spinal cord injury. Canine spinal cords were compressed at T-13 by an epidural balloon maintained at 160 mm Hg for one hour. After seven weeks, mean motor ratings of dogs treated with either parenteral dexamenthasone or non-irrigative local hypothermia (on the dorsal dura mater at 6 degrees C for four hours) indicated ability to walk well, whereas untreated dogs could not walk. A third treatment group received both dexamethasone and delayed local hypothermia; this group performed poorly in early weeks, but eventually surpassed the other groups and became the only group to attain a final mean motor rating which was superior to that of controls at a significance level of p less than .01. Hypothermia was induced by means of a miniature epidural heat exchanger which eliminated tissue irrigation as a possible experimental variable. The possible mechanisms of action of hypothermia are reviewed.


Transatrial repair of tetralogy of Fallot. In 12 months since March, 1975, 25 of 27 patients with tetralogy of Fallot have had corrective operations without ventriculotomy. Infundibular obstructions were excised and ventricular septal defects were closed through a right artiotomy with retraction of the anterior leaflet of the tricuspid valve. Pulmonary valve stenosis was relieved through a pulmonary arteriotomy. In five patients the pulmonary annulus was patched 0.5 to 1.5 cm. into the right ventricle. Immediately after repair peak right ventricular-pulmonary arterial systolic pressure difference averaged 17 mm. Hg and ranged between zero and 40 mm. Hg. Cardiac indices averaged 2.85 L. per square meter per minute 4 hours after operation. All but two patients developed right bundle branch block. One patient with severe pulmonary hypertension died. Fourteen patients have been recatheterized. Right ventricular-pulmonary peak systolic pressure differences ranged between zero and 45 mm. Hg (mean, 22). Cineangiograms show contraction of the free right ventricular wall during systole. Transatrial repair of tetralogy of Fallot is feasible technically in many patients, avoids muscle necrosis and coronary arterial injury, and improves cardiac output in the immediate postoperative period.


The indications for pericardiectomy in the uremic pericardial effusion. Uremic pericarditis developed in 37 of 295 patients (8 percent) admitted to the chronic hemodialysis program at our institution. Sixteen patients (43%) underwent limited pericardiectomy through a left anterior thoracotomy approach with no operative deaths and minimal morbidity (19%). Twenty-one patients (57%) were treated successfully with intensive hemodialysis. The use of pericardiocentesis did not avert cardiac tamponade in any patient in our series. The procedure was associated with two life-threatening complications and its use, therefore, has been limited in the therapy of uremic pericarditis. We recommend surgical intervention in all patients with hemodynamic instability and echocardiographic evidence of enlarging effusions or an effusion unchanged in size following 10 days of intensive hemodialysis.


Unoperated, asymptomatic significant internal carotid artery stenosis: a review of 182 instances. One hundred and sixty-eight asymptomatic patients with a carotid artery stenosis of more than 50% were observed over a period of up to 12 years. During this time, 136 patients remained asymptomatic, two patients developed atypical neurologic symptoms that spontaneously disappeared, 26 patients developed transient ischemic attacks and successfully underwent carotid endarterectomy, three patients developed transient ischemic attacks that were ignored and they subsequently suffered a completed stroke, and one patient suffered a completed stroke without a warning transient attack. These data suggest that surgery is not required in the patient with an asymptomatic carotid stenosis until a transient ischemic attack occurs.


The improvement of cognition and personality after carotid endarterectomy. Seventeen patients with at least 50% carotid artery stenosis were given intelligence and personality tests just prior to and 6 weeks after carotid endarterectomy. When compared with nine control patients, the endarterectomy patients showed increases in verbal-comprehension I.Q., perceptual-organization I.Q., decreases in time to complete perceptual motor tasks, decrease in asphasic signs, and significant reductions in anxiety, suspicion, confusion, disorientation, and other personality symptoms generally associated with senility. Statistical evaluation showed these results to be valid.


Recurrent carotid stenosis.

Recurrent carotid stenosis. Twenty-nine patients developed recurrent stenosis of the carotid artery 5 months to 13 years following carotid endarterectomy. Thirty-two recurrent lesions were repaired. Recurrent atherosclerosis was present in 19 patients, intimal fibrosis occcurred in nine patients, and one patient had external stricture. All recurrent atheromas developed more than 2 years following original operation (mean, 5 years) and intinal fibrosis was seen in the first postoperative year in all but one patient (mean, 9 months). Reconstructive techniques included endarterectomy for atherosclerosis and patch angioplasty and resection and anastomosis for intimal fibrosis.


Further experiences with bovine arterial grafts. Following favorable laboratory experience with the chemically modified bovine arterial graft (reported previously), we have used it for arterial reconstruction of the lower extremity in 84 operations upon 79 patients. The over-all patency rate was 42%. There were 7% infections, which usually occurred in secondary and tertiary procedures. Five percent of the grafts became aneurysmal. These results, published reports, and the results of a questionnaire mailed to vascular surgeons indicates similarity of experience. The disadvantages of frequent early thrombosis of undetermined cause, aneurysmal degeneration in approximately 4%, the considerable cost, and the nonavailability of the graft in different dimensions have resulted in our discontinuation of use for arterial reconstructions.


Multiple sequential femoral tibial grafting for severe ischemia. For the past decade a common procedure used to salvage severely ischemic limbs has been autogenous vein bypass grafting to the distal popliteal artery or, if the popliteal trifurcation is occluded, to one of the tibial-peroneal branches. Reported limb salvage rate and long-term graft function varies considerably but in most series is low. To increase graft flow and to decrease resistance in femoral-poplitical-tibial grafts and thereby to perfuse the ischemic foot more effectively, we have employed multiple sequential anastomoses of a single vein graft to distal branches--a technique similar to that used occasionally in aortocoronary bypass grafting. The autogenous vein graft alone, or in combination with bovine heterograft, has been used in six patients with gangrenous toes or far advanced ischemia and in one patient with severe claudication. Multiple anastomoses below the knee were carried out in each patient. Anastomosis has been to a blind popliteal segment, then to a tibial or peroneal in four patients, to both tibials in another two patients, and to both tibials and the peroneal in one patient. Flow rates measured on the operating table clearly demonstrated a significant increase in flow through the graft with each additional anastomosis. There has been a greater response to surgery with return of pulses, warmth of the foot, and rapid healing as compared with previous patients having single femoral-tibial anastomoses. One failure occurred acutely from a technical problem early in the series; one failed at 3 months in a patient with pancreatic cancer and another patient died 2 weeks after operation of a myocardial infarct.


Forefoot perfusion pressure and minor amputation for gangrene. In many cases of digital gangrene, limited amputation to preserve the majority of the foot is possible. In the absence of invasive infection, forefoot perfusion pressure is the single most important factor in determining outcome of minor amputation. At ankle pressures of less than 35 mm. Hg, salvage of the foot appears to be futile. The presence or absence of diabetes mellitus has no noticeable effect on the result of amputation. Ankle systolic pressure measurement cannot supplant but should supplement clinical judgement in selecting surgical treatment for gangrene.


Importance of calf vein thrombophlebitis. Fifty-four patients with phlebogram-proven deep vein thrombophlebitis limited to the tibial and popliteal veins were studied for evidence of pulmonary embolism, both symptomatic and silent. All but two patients were symptomatic of either phlebitis or embolism. Pulmonary embolism, as judged by lung scan defects with V-Q imbalance, changing serial scans, or positive pulmonary angiograms were found in 50%. Popliteal thrombi had an embolism incidence of 66%, whereas tibial thrombi had a 33% incidence. Emboli from the popliteal veins were more extensive than were tibial emboli. Forty-five percent of all emboli were silent. Bilateral phlebitis was accompanied by a 75% incidence of pulmonary embolism. Emboli from tibial veins were minor in five of nine instances, but three instances involved 20% or more of total lung volume and one involved over 40% of total lung volume. These results support the belief that popliteal thrombophlebitis merits anticoagulant therapy. They also suggest caution in the management of tibial vein phlebitis. Objective tests are recommended to monitor for pulmonary embolism and for propagation of the thrombus before deciding to withhold anticoagulants in tibial thrombophlebitis.


Simplified technique for the management of refractory varicose ulcers. A technique of accurately visualizing incompetent perforating veins with the use of intraosseous venography following muscle stimulation is described. The procedure was employed in 55 patients with recurrent stasis ulcers who had had previous operations. Surgical management incorporating our venographic technique yielded extremely satisfactory results in this selected group.


Lymphangioplasty: a ten year evaluation. Sixteen patients with refractory primary and secondary lymphedema have had multifilament Teflon wick lymphangioplasties during the past 10 years. There were no operative deaths or operative complications. All patients experienced an early reduction of their edema, with objective improvement lasting 6 months to 5 years. The average duration of benefit was 13 months. Subjective improvement has lasted to 7 years. Lymphangioplasty is simple, virtually free of complications, and offers periods of control of edema and cellulitis that compare favorably with those obtained by other operative procedures. It should be considered for the management of patients with incapacitating lymphedema, especially those patients with a limited life expectancy.


The clinical significance of Raynaud's syndrome. This study was performed to determine the frequency of occurrence of associated autoimmune disease in a group of patients presenting with Raynaud's symptoms. A consecutive group of 100 patients presenting with Raynaud's syndrome underwent detailed prospective clinical and immunologic evaluation. Magnificantion hand arteriography was performed in certain patients. Based on current diagnostic criteria, the following autoimmune diseases were diagnosed or were suspected strongly: Raynaud's syndrome with scleroderma or CRST--28 patients; Raynaud's syndrome with lupus erythematosus--ten patients; Raynaud's syndrome with miscellaneous autoimmune disease--43 patients: Raynaud's syndrome without diagnosable autoimmune disease--19 patients. Fourteen of the 19 patients in the latter group had isolated serologic abnormalities. Arteriography showed combined organic arterial obstruction and vasospasm of the palmar and digital arteries in all patients. Patients with severe Raynaud's symptoms had more extensive arterial obstruction than did patients with mild or moderate Raynaud's symptoms. These results suggest that all patients with Raynaud's syndrome should be regarded as at high risk for having an associated autoimmune disease.


Growth rates of small abdominal aortic aneurysms. A policy of utilizing B-mode ultrasound scan measurements of abdominal aortic aneurysms to help determine operability in poor-risk patients with small asymptomatic aneurysms has been pursued for the past 6 years. Indications for surgery in such patients have included enlargement to 6 cm. in any transverse diameter, the development of symptoms, or evidence of leak or rupture. In addition, patients treated nonoperatively have been followed by serial B-mode echo scans, permitting the accumulation of aneurysm growth rate data. Such data indicate that small aneurysms grow an average of 0.4 cm. per year, but that dramatic increases in aneurysm size may occur unexpectedly in asymptomatic patients. These data appear to have value in both individual decision making and as a baseline for weighting the various risk factors in the poor-risk patient with a small asymptomatic abdominal aortic aneurysm.


The value of Doppler blood velocity tracings in the detection of aortoiliac disease in patients with intermittent claudication. Velocity tracings obtained with a Doppler ultrasound probe located over the common femoral artery have been evaluated as to their ability to predict the state of the proximal aortoiliac segment. Aortography was used as the assessor of the extent of aortoiliac disease. Five parameters of the tracings sensitive only to aortoiliac disease were submitted to miltivariate analysis. The probability of the aortoiliac segment having greater or less than 10% stenosis was calculated. In 86% of limbs, a high probability of diagnostic value and practical use resulted.


[The Laboratory Animal Act (author's transl)]. The Laboratory Animal Act which was passed by the Second Chamber of Partiament in the Netherlands on June 1, 1976, is regarded as a Landmark in the care and management of laboratory animals, in previous years achieved on a voluntary basis. In addition to direct regulations for the protection of laboratory animals, the act includes standards to expert knowledge and skill, which have to be complied with by those taking part in experimental studies on animals, such as animal technicians, scientists who use the results of these experiments and specialists in laboratory animal science.


[Pig health programmes and zootechnics (author's transl)]. The task of the veterinarian in modern pig keeping developments is stressed. The relationship between zootechnics and pig health programmes is illustrated in eight examples in the fields of breeding. nutrition, housing and management. By comparing data on herds at regular intervals, "probleem-herds" may be traced and special attention can be paid to these herds. This approach was practised by several years in the province of North-Brabant.


[Some aspects of hereditary perceptive deafness and leukism (author's transl)]. A discussion of certain aspects of leukism and deafness as well as the possible relationship between the two, based on a study of the literature on cats, dogs, mink, mice and man. This is followed by some preliminary communications on personal studies in Dalmatians, Bull Terriers and Rottweilers. The paper concludes with some notions on genetic aspects.


A blade guide for hand trimming resin blocks for ultramicrotomy. A simple razor blade guide is described for trimming resin blocks for ultramicrotomy. Slices of unwanted resin (with or without tissues) may be removed at controlled thickness from the sides or tops of blocks leaving smaller blocks with smooth, flat surfaces. Either flat-embedded or dowel-mounted specimens may be trimmed.


[Therapy planning and prognosis evaluation in malignant kidney neoplasms. A lymphographic study of 50 malignant kidney neoplasms]. Of fifty patients with malignant renal tumors who underwent lymphographic examination, 15 (30%) had lymph node metastases. Two years from the beginning of therapy, 13 of these patients were deceased in spite of surgical and radiological treatment. The enhancement of the five-year survival rate following radiation therapy for malignant renal tumors is quoted between 7 and 26%. This success is probably due to the destruction of micrometastases, not being representable lymphographically. Radiation therapy of malignant renal tumors, therefore, can only be effective including the para-aortic lymphatic chains.


[Therapy simulator for radiotherapy planning]. The ideas prevailing so far with regard to therapy simulators are represented and the type of the simulator used is described; after that, the range of problems a simulator is applied to, is being analysed more detailedly. The use of the simulator is necessary within two phases of irradiation planning: Firstly, to trace that cross-sectional view of the body which is best adapted to dosage planning along with a preliminary adjustment informing upon the beam directions and the field sizes needed. Secondly, to accomplish the final fixation of the needed beam directions and field sizes inclusively the marking of cutaneous fields, a definitive schedule of doses having been laid down before. The requirements, therapy simulators have to meet according to these considerations, are discussed.


[Calculation of dose distribution of fast electrons within and behind tissue inhomogeneities of any width]. A new algorithm allowing for the effects of tissue inhomogeneities on dose distributions of high-energy electrons is presented for the purposes of treatment planning computations. Starting from the electron dose distribution for homogeneous tissue the doses contributed by the partial beam hitting the tissue inhomogeneity are substituted by those arising from a partial beam which was alterated by stopping, scattering and changed distances in the inhomogeneity. Since actual data for partial beams of limited cross-section are used and the scatter contributions from the rest of the total beam into and behind the inhomogeneity remain unchanged, good approximation compared to measured values is achieved.


[A parallel-plate small volume chamber for dosimetry of fast electrons and its use]. The ionization chamber described is designed for dosimetry of electron radiation above ca. 100 keV. It is used for the measurement of the cavity ion dose and of the absorbed dose within solid or water phantoms. Its construction corresponds to a flat chamber in accordance with DIN 6800. The cylindric main body is made of plexiglass (diameter 30 mm, height 14 mm) and encompasses the measuring volume being flush with the surface (diameter 5 mm, height 2 mm; chamber window 2.3 mg/cm2; build up cap for measurements in water 236 mg/cm2). The chamber is constructed with regard to its independency on energy and direction of the incidence as well as to the minimization of the remaining influence quantities, thus answering for the accuracy class "reference-class instrument" (+/- 0.5%). The polarity effect and field perturbation effect are to be neglected, the displacement comes to 0.1 mm, the statistical inaccuracy of measurement to 0.1%. The calibration for the chamber was obtained with a 15 MeV electron beam. The calibration factor for the cavity ion dose is constant, not being related to energy, at least in the range of performance from 2 to 15 MeV according to the primary standard used for calibration (graphic double extrapolation chamber). The overall uncertainty of the calibration factor amounts to +/- 1.5% for the cavity ion dose and to +/- 1.8% for the energy dose. Numerical values of all characteristic quantities and influence quantities which correspond to DIN 6817 and also measurement results for the determination of dose and energy are reported.


Xeroradiography of the breast with an improved technique. Xeromammograms taken by the technique described by Wolfe and Lutterbeck are time consuming as compared to filmmammography. As there is no automatic exposure setting, about 20% of our xeroradiographs had to be repeated on account of wrong exposures. That's why we developed a new attachment ensuring a good compression of the breast and equipped with an automatic exposure timing. We use this since October 1974. All xeromammograms are taken with the patients within a short time. Usually there is no need to repeat a xeromammogram because of wrong exposure.


[Tumor hyperthermia using high frequency for increase of oncolysis by clostridium butyricum (M 55)]. In solid experimental tumors hypoxic cells preferably are inactivated by means of a short-termed radio-frequency treatment with eddy-current fields. Hence follows an increase of the necro-biotic areas. The presence of anoxic-necrobiotic areas is indispensable for the termination of certain anaerobic spores such as Clostridium butyricum s. oncolyticum (M 55). Local tumor hyperthermy is tested as a technique in altogether 861 mice bearing neck tumors, in order to enhance the germination of oncolytic Clostridia in tumors differing by their mode of formation and rate of growth. In all the three test systems used (Ehrlich solid carcinoma, Harding-Pasey-melanoma, fibrosarcoma induced by methylcholanthrene), the oncolysis being brought about by Clostridia can be intensified significantly by means of a short-termed warming of the tumor up to temperatures of 42 to 44 degress C using radio-frequency.


Growth retardation in normal and malignant tissues. A similiarity is found in the regression and regrowth curves of normal and malignant tissues after radiation treatments. The similarity implies that even in malignant tissues there is the practical, at least, limitation of tumor growth as in a normal organ, which is due to growth rate retardation. The retardation is considered to be the result from homologous inhibition of tumor cells. A tumor has its own growth rate which varies according to its total cell number and its environment. Approximately six months old skin metastases from breast carcinoma are still growing but are very close to the asymptote size which appears to be about 1000 cubic millimeters.


[Periodic compensation reactions in the course of postnatal growth of mouse liver following fractionated roentgen radiation during embryogenesis. 1]. Following daily fractionated X-irradiation in utero, a postnatal study of the mouse liver was made with regard to compensatory growth responses depending on the radiation dose and on the age of the germ while irradiated. Exposure to doses between 10 R/d and 60 R/d was performed during blastogenesis (1st to 5th day p.c.), organogenesis (6th to 13th day p.c.), fetogenesis (14th to 18th day p.c.), as well as during the early (6th to 10th day p.c.) and the late embryogenesis (11th to 15th day p.c.). Besides deviations of the increase in weight and of the nucleic acid content, the incorporation of 3H-thymidine into DNA was measured by means of scintilation counts and radioautographs. As compared with controls, all irradiated experimental groups exhibit a periodical increase of the proliferative hepatic growth especially towards the end of the first and of the second post-natal week. The possibility of inducing compensatory responses decreases, however, with increasing age of the germs, a gradation thus appearing from overcompensation effects after exposures during blastogenesis down to poor proliferation responses after irradiations in the course of fetogenesis. The dose dependence of proliferation responses after irradiations during organogenesis is characterized by an overstrain of the capacity for recovery following 60 R/d, by maximum compensatory growth after 40 R/d, and by a slight stimulation of growth following 10 R/d, in the otherwise apparently normal animals. Late proliferative responses of the developing liver are regarded as a self-stabilisation towards the predetermined norm of growth. Essential differences in comparison with a stress - or a strain - stimulated growth (as in the adult regenerating liver) are suggested by the observation that (a) cytogenesis in the functionally independent populations of blood cells and of parenchymal cells is stimulated partly at the same time and to a similar extent, (b), that stimulation effects reach a peak always within equal stages of development independent of the X-ray doses and the age at irradiation and (c) that an acceleration of growth is possible with a normal or even augmented ratio of organ-weight to body-weight.


Synthesis of fluorinated 3beta-hydroxypregn-5-en-20-one derivatives. Treatment of the unstable 3beta-hydroxy-20, 20-dimethoxypregn-5-ene 3-acetate with acetic anhydride at reflux temperature gave a mixture of 3beta-hydroxy-20-methoxypregna-5, 17(20)-diene and 3beta-hydroxy-20-methoxypregna-5, 20-diene 3-acetates. Fluorination of this mixture with perchloryl fluoride afforded after fractionated crystallization 3beta-hydroxy-17-fluoro-20-methoxypregna-5, 20-diene 3-acetate. Acid hydrolysis of the reaction mixture and subsequent chromatographic separation led to 3beta-hydroxy-17-fluoropregn-5-en-20-one 3-acetate and 3beta-hydroxy-21-fluoropregn-5-en-20-one 3-acetate. 3beta-Hydroxy-17-fluoro-20-methoxy-pregna-5, 20-diene 3-acetate did not react further with perchloryl fluoride even under forcing conditions. Fluorination of 3beta-hydroxy-20-(N-ethyl benzylamino)-pregna-5, 17(20)-diene gave 3beta-hydroxy-17, 21-difluoro-pregn-5-en-20-one, exclusively.


Isolation and identification of a sulfur-containing metabolite of spironolactone from human urine. In the urine of normal subjects who were given an oral dose of 500 mg spironolactone (3-(3-oxo-7alpha-acetylthio-17beta-hydroxy-4-androsten-17alpha-yl)-propionic acid gamma-lactone; Aldactone) together with 100uCi H-20, 21 spironolactone, a so far unknown major metabolite has been detected by thin layer chromatography. The metabolite then could be isolated by means of counter-current-distribution. According to masspectral and magnetic resonance data, the metabolite has been assigned the structure of 3-(3-oxo-7alpha-methyl sulfonyl-6beta, 17beta-dihydroxy-4-androsten-17alpha-yl)-propionic acid gamma-lactone. By oxidation of the corresponding methylsulfinyl compound - another already known metabolite of spironolactone - with m-chloroperbenzoic acid, a compound has been isolated which proved to be identical with the new metabolite according to TLC, MS and NMR.


Evidence that the maintenance of early pregnancy in the rabbit requires ""blastocyst estrogen''. It has been shown by others that treatment with only progesterone is sufficient to induce implantation and maintain pregnancy in ovariectomized-adrenalectomized rabbits. Based on these results, it was deduced that induction of implantation in the rabbit does not require estrogen. In making this deduction, ""blastocyst estrogen'' was not taken into account. In the present study, blastocyst development and implantation were prevented by instilling the anti-estrogen CI-628 into the uterine lumina of pregnant, ovariectomized, progesterone-treated rabbits. Our interpretation of these results is that the CI-628 PREVENTED THE ACTION OF ""BLASTOCYST ESTROGEN''. However, on the basis of the present results, we cannot determine whether the specific target of ""blastocyst estrogen'' is the blastocyst, the uterus, or both.


Partial purification of rat liver glucocorticoid binding proteins by affinity chromatography. Dexamethasone (9-fluoro-16alpha-methyl-11beta,17,21-trihydroxy-1,4-pregnadiene-3,20-dione) binding proteins from rat liver cytosol were purified approximately 6470 fold by the use of an affinity column in which deoxycorticosterone was linked to CH-Sepharose 4B through a disulfide linkage. The receptor proteins were eluted from the column by washing with beta-mercaptoethanol. A preliminary Sephadex G-200 filtration step of the cytosol was necessary in order to separate the dexamethasone binding proteins from other glucocorticoid receptors.


The in vivo metabolism of androgens by muscle and adipose tissue of normal men. Androstenedione and testosterone labeled with 3H and 14C were fused simultaneously at constant rates into the brachial arm vein of 10 normal men. During the infusions blood samples were obtained from the brachial artery, a deep vein draining primarily muscle and a superficial vein draining primarily adipose tissue of the arm contra-lateral to the infusion. In the 10 men the mean +/- SE value for the fractional metabolism of adrostenedione by muscle is 0.20 +/- 0.30 which is not different from the mean value for the fractional metabolism by androstenedione by adipose tissue, 0.29 +/- 0.04. The mean value for the metabolism of testosterone by muscle, 0.04 +/- *.01, is significantly less than the metabolism by adipose tissue, *.11 +/- 0.01. Interconversion between adrostenedione and testosterone occurs in both tissues. The mean value for pA,T A,M is 0.024 + 0.005 and for pA,T A,AT is 0.024 +/- 0.005. The mean value for pT,A A,M is 0.005 +/- 0.003 and for pT,A A,AT is 0.008 +/- 0.003. The fractional metabolism of these androgens by these tissues is similar to the fractional metabolism of estrone and estradiol by these same tissues. Muscle appears to contribute about 5-12% of the overall metabolism of androstenedione and testosterone and 10-15% to theoverall conversion of androstenedione to testosterone. Adipose tissue contributes about 2-7% of the overall metabolism of these androgens and 5-10% of the overall conversion of androstenedione to testosterone, but less than 2% to the overall conversion of testosterone to androstenedione. In normal men, muscle appears to be more important to the metabolism of androstenedione and testosterone than is adipose tissue.


15-Azasteroid blockage of cell permeability and mitochondrial respiration. The 15-azasteroid, 1,10,11,11a-tetrahydro-11a-methyl-2H naphth (1,2-g)indol-7-o1, inhibits the growth of the cell culture lines KB and L-M as well as several strains of bacteria. The inhibition of growth is reversed following removal of the steroid from the growth medium. Using in vitro grown L-M cells, the compound inhibited the transport of amino acids and uracil. The action was non-detergent like and at least 100 times more effective in terminating metabolite transport than sodium azide. The azasteroid inhibited the oxidation of glutamate in isolated rat liver mitochondria. The oxidation of succinate was not effected by the azasteroid alone but in the presence of glutamate, the azasteroid uncoupled the oxidation of succinate from the ADP-ATP control. It is suggested that the azasteroid may be acting directly on the electron transport system and/or acting indirectly through membrane perturbations which disrupts the electron transport process.


Androgen on the estrogen receptor. I - Binding and in vivo nuclear translocation. In the immature rat uterus, high concentrations of androgens competed specifically with estradiol on the estrogen receptor (RE). This competition was stereospecific for C19 steroids bearing a 17beta and/or 3 hydroxyl group. Very low affinity ligands, such as testosterone, could not compete with estradiol at equilibrium but decreased the association rate of estradiol on its receptor. High doses (greater than 0.4mg) of 5dihydrotestosterone provoked in vivo as in vitro the nuclear translocation of RE. The nuclear receptor thus formed displayed the same 5.2 S sedimentation constant as that induced by estradiol. We conclude that the weak affinity binding of androgens to the estrogen receptor is sufficient to induce its nuclear translocation in vivo provided androgen concentration is high enough in uterus to occupy the estradiol binding site. Conversely, progesterone which does not bind RE could not provoke its nuclear translocation.


Bruits, ophthalmodynamometry and rectilinear scanning on transient ischemic attacks. One hundred seventeen patients with clinical signs and symptoms of transient ischemic attacks (TIAs) were evaluated. All underwent clinical evaluation for bruit, ophthalmodynamometry, rapid sequence scintiphotography with rectilinear scanning and four-vessel cerebral angiography. The results of these tests were compared for reliability in predicting location of lesions causing transient ischemic attacks. Angiography remains the most accurate procedure in evaluating extracranial vascular lesions. When determination of bruits, ophthalmodynamometry and brain scanning are done together, accuracy is greater than when any one of the procedures is done alone.


EEG surveillance as a means of extending operability in high risk carotid endarterectomy. Some patients who have transient ischemic attacks are denied operation because severe occlusive lesions in other extra-cranial arteries may be inappropriately interpreted as constituting an unacceptable surgical risk, or because the lesion is so distal as to make its removal hazardous. Failure of endarterectomy is usually due to incomplete removal of the lesion or to thrombosis upon the frayed intima. Such lesions require excellent visualization and meticulous surgical technique -- not always possible with a shunt. Among 130 consecutive carotid endarterectomies performed under general anesthesia, EEG changes consistent with cerebral ischemia appeared in only nine (7%). These patients required a shunt. In 11 patients normal EEG tracings were obtained during endarterectomy despite contralateral carotid occlusion. None of these patients had a neurological deficit. Continuous EEG monitoring is a reliable method of detecting changes in cerebral perfusion, permits a more meticulous endarterectomy in high-lying lesions without a shunt, and extends operability in high risk patients. Angiographical findings may be an unreliable predictor concerning risk of endarterectomy.


Comparison of vascular reactivity in spinal cord and brain. The local tissue PO2 in the brain cortex and in the spinal cord of rats was examined with ultramicroelectrodes. In the spinal cord the PO2 was highest in white matter, intermediate in dorsal horn gray matter, and lowest in the ventral horn gray matter. In the gray matter of the cord, as well as in the brain, the PO2 at a fixed locus was found normally to oscillate. CO2 responses were more brisk in the cord than in the brain while the responses to hypoxia were similar. Therefore, it appears that the physiological regulation of blood flow in the spinal cord is qualitatively similar to that of the brain.


Ophthalmodynamometry in internal carotid artery occlusion. Retinal artery pressure was measured by ophthalmodynamometry in 15 patients with occlusion of the internal carotid artery in its extracranial part. Nine of the patients had severe neurological deficit whereas the remaining six had slight or intermittent symptoms. Retinal artery pressure was reduced on the side of the internal carotid artery occlusion in all patients studied. Near-zero low diastolic retinal artery pressure on the affected side was a common finding among patients with severe deficit and was also seen in some patients with slight deficit. Its presence strongly suggests occlusion of the ipsilateral internal carotid artery.


Paradoxical dilation of the large cerebral arteries in hypocapnia in man. By grouping patients who had carotid angiograms under unusually carefully monitored conditions it has been shown that hypocapnia is associated with vasodilation at low blood pressure but not at high blood pressure. The mechanism is discussed in general terms and it is suggested that the hypocapnic vasodilation may be a response to cerebral hypoxia and may be transmitted via an intracerebral autonomic pathway. Clinical and angiographical diagnoses are given for 50 patients.


A new sign of occlusion of the origin of the internal carotid artery. When the origin of the internal carotid artery is occluded, the transmission of cardiac sounds along the carotid stops at the site of the occlusion. This is a new neurovascular sign which is being reported.


Effect of intracarotid prostaglandin E1 on regional cerebral blood flow in man. The effect of prostaglandin E1 on regional cerebral blood flow (rCBF) was studied with the intra-arterial 133Xe method in ten awake patients under local anesthesia. Measurements were taken from 16 areas of a hemisphere in seven patients, from 35 areas of a hemisphere in two patients and from 256 areas of a hemisphere in one patient. The prostaglandin was dissolved from the crystalline state without the aid of alcohol. It was given intracarotidly as a constant infusion at a rate of 5 ng per kilogram per minute for five minutes before the measurement and continued during the measurement. In every patient a mild increase in blood flow during the prostaglandin infusion was seen. The flow increase took place in all parts of the hemisphere. It averaged 11.2% (p less than 0.01). During the infusion, the skin supplied by the internal carotid artery and the conjunctiva on the infused side became red and sometimes swollen. A slight pressure was noted by most patients, but none had pain. No side effects of the infusion were noted.


Intensive care management of stroke patients. Two hundred eighty patients were admitted to an intensive care stroke unit over a one-year period. Subsequent investigation indicated that only 199 of these patients actually had cerebral ischemic or hemorrhagic lesions, 10 had other cerebrovascular lesions, and the remaining 71 patients had unrelated diseases, predominantly seizures. Detailed analysis of 103 stroke patients revealed an overall incidence of 59% hypertension, and 72% had hypertensive, ischemic or valvular heart disease. Fifty percent of the patients had various cardiac arrhythmias, some of which were responsible for the acute cerebrovascular lesion. Fourteen patients died during the acute phase, 11 from apparently irreversible cerebral selling, mainly due to cerebral hemorrhage. Secondary complications such as pneumonia, pulmonary embolism, pressure sores and urinary infection were almost nonexistent, but beneficial effects on the primary cerebral lesions were more difficult to demonstrate.


Cerebral atherosclerosis in Japanese. Part 4: relationship between lipid content and macroscopic severity of atherosclerosis. In order to evaluate chemically the macroscopic scoring methods for severity of arteriosclerosis in the cerebral arteries, concentrations of total lipids, esterified and free cholesterol and lipid phosphorus were compared to the macroscopic severity of lesions in the cerebral arteries obtained from 376 Japanese persons after unexpected death. An increase of cholesterol content was correlated significantly with an increase of Baker's score and/or Gore's atherosclerotic index. The correlation coefficient between Baker's score and total or esterified cholesterol was the highest among the tested correlations (r = 0.82, n = 376).


Cerebral atherosclerosis in Japanese. Part 5: relationship between cholesterol deposition and glycosaminoglycans. Concentrations of various lipids and glycosaminoglycans (GAG) in the intima of the grossly normal and atherosclerotic cerebral arteries were compared with those of the aorta and coronary arteries. The lowest percentage of esterified cholesterol (EC) in total cholesterol, and of chondroitin sulfate-4/6 (CS-4/6) in total glycosaminoglycans and the highest percentage of heparin sulfate (HS) in total GAG are the characteristic features of the normal intima of normal cerebral arteries when compared with those in the aorta and coronary artery. In the cerebral arterial intimas, but not in the aorta or coronary arteries, there was a significant positive correlation between contents of EC and percentage and total content of CS-4/6. Atherogenesis in cerebral arteries is discussed in comparison to that of the aorta and coronary vessels.


Angiographical extravasation of contrast medium in hemorrhagic infarction. Case report. Leakage of the contrast medium was noted on angiograms of a patient whose autopsied brain disclosed typical pathological findings of hemorrhagic infarction. The case was a 63-year old woman with mitral valve failure, who suddenly had loss of consciousness and right-sided hemiplegia. The left carotid angiography performed six hours after onset demonstrated middle cerebral arterial axis occlusion, and the second angiography performed three days after onset displayed recanalization of the initially occluded artery as well as extravasation of the contrast medium. Fourteen days after onset the patient died and an autopsy was performed. The brain demonstrated perivascular punctate hemorrhages in the area supplied by the middle cerebral artery, and neither hematoma nor microaneurysm was disclosed pathologically. A short discussion is given on the possible relationship between recanalization and hemorrhagic infarction. The clinical assessment of hemorrhagic infarction has not been established successfully.


A prospective study of cerebrovascular disease in Japanese rural communities, Akabane and Asahi. Part 1: evaluation of risk factors in the occurrence of cerebral hemorrhage and thrombosis. An epidemiological study of cerebrovascular disease in Akabane and Asahi, Japan, was made. (These cities are located near Nagoy, Japan.) The study population included 4,737 men and women aged 40 to 79 at the time of entry into the study. There were 4,186 persons who were examined and, of these, 264 cases of cerebrovascular attacks were observed between 1964 and 1970. The incidence rate of stroke in those persons not responding to the survey was 15.9 times higher than in those persons examined according to person-year observation in Akabane. The risk factors for cerebral hemorrhage and thrombosis were evaluated by age-adjusted and sex-adjusted relative risks. The predisposing factors to cerebral hemorrhage appeared to be high blood pressure, high left R wave, ST depression, T abnormality, capillary fragility counts, previous medical history of stroke and albuminuria. For cerebral thrombosis, the predisposing factors appeared to be high blood pressure, ST depression and funduscopic sclerotic findings, and those factors assumed to be significant were glycosuria and smoking habits. Ocular funduscopic abnormality was the most prominent risk factor for cerebral thrombosis, while high blood pressure and ECG abnormalities were highly related to cerebral hemorrhage. It was suggested that those subjects with a relatively higher blood pressure may have a higher relative risk of cerebral hemorrhage than those with a lower (normal range) blood pressure. A previous or family history of stroke also appeared significantly related to cerebral hemorrhage.


Transient responses of cerebral blood flow and ventilation to changes in PaCO2 in normal subjects and patients with cerebrovascular disease. In the present study, the dynamics of the cerebral blood flow (CBF) and ventilatory response to hypercapnia was investigated in a group of patients with a cerebrovascular disease and compared to responses measured in a group of normal volunteers. There was a significant correlation between the rapidity of the transient CBF and ventilatory responses and the severity of the cerebrovascular disease. While the steady state CBF response showed no such correlation, the steady state ventilatory response was reduced in patients with severe cerebrovascular disease. Various explanations for the differences in the dynamic responses of CBF and ventilation in patients with mild or severe cerebrovascular disease compared to normal subjects are considered. Measurement of these circulatory and ventilatory responses may be sensitive means for assessing the changing statls of patients with cerebrovascular disease.


Subcortical arteriosclerotic encephalopathy (Binswanger's disease). A vascular etiology of dementia. A 51-yearold man with moderate intermittent hypertension had a rapidly progressive, profound dementia in the absence of significant localizing neurological signs. Postmortem examination disclosed the vascular alterations and diffuse white matter degeneration which characterize subcortical arteriosclerotic encephalopathy (SAE) or Binswanger's disease. The case underscores the need to consider vascular disease as an etiology of dementia -- even in the absence of focal neurological deficit.


Primary non-traumatic intracranial hemorrhage. A municipal emergency hospital viewpoint. The devastating natural history of 138 consecutive admissions for non-traumatic intracranial hemorrhage to a major emergency care municipal hospital is reviewed. Sixty-four percent of the patients had demonstrable intracranial hematomas while 36% had mainly subarachnoid hemorrhage. Hypertension was a related condition in 43% of the parenchymal hematoma patients, while proved aneurysms accounted for 74% of the subarachnoid hemorrhage patients. There was only a 14% survivorship for patients requiring emergent surgery. All operated hematoma patients survived delayed surgery with improved level of responsiveness. The overall mortality was 74% for intracranial hematoma patients and 58% for aneurysm-caused subarachnoid hemorrhage patients.


Dynamic response of the intracranial system in the conscious dog to papaverine hydrochloride. The influence of papaverine on the intracranial system of the dog was studied by measuring the pressure-depth-time response for the intact intracranial system, i.e., for the subarachnoid and subpial compartments. This was accomplished by a measurement system which provided an accurate pressure-depth determination and a uniform rate of transducer insertion. Distinct regions of the intracranial system (subarachnoid, transitional, and subpial) were identified from inflections in the pressure response curve. The test parameter, brain relative stiffness (BRS), was obtained by determining the slope of the pressure response values within the subpial region. This parameter is a measure of the "stiffness" or elasticity of bring tissue within the test configuration. A bolus injection of papaverine (1 mg per kilogram, i.v.) caused an increase in the transitional region, a compensatory reduction in the subarachnoid space, and an increase in BRS. It is postulated that at normotensive arterial blood pressure, cerebrovascular expansion caused by papaverine resulted in increased brain tissue elasticity, i.e., an increase in the pressure-depth response for the subpial region. Possible implications for this increase are discussed. Experiments should be conducted in which local blood flow studies are coupled with measurements of brain elastic response.


Amoebic liver abscess in Rhodesian Africans. Eighty-eight African patients with amoebic liver abscess are described. The diagnosis was readily made in pyrexial patients who had right-sided upper abdominal pain, an enlarged, very tender liver and signs at the right base. However, in apyrexial subjects (10%) and where abdominal pain was absent (7%), the diagnosis was considerably delayed. Five children (7%) were seen under the age of five, four of whom died because the diagnosis was not suspected. It is particularly emphasized that there should be a greater awareness of this condition in this age group. Amoebae were found in only a small percentage of stool (14%) and pus specimens (11%), while biopsy of the abscess edge yielded 40%. The relative values of a positive amoebic latex test (82%) and an elevated alkaline phosphatase (71%) are noted. In only half the aspirations was the classical anchovy sauce appearance seen. Metronidazole is the drug of choice with repeated aspirations for large abscesses. Mortality was 13-5%, occurring mainly in the extremes of life.


Heavy Trichuris infection and amoebic dysentery in Orang Asli children. A comparison of the two diseases. Children with heavy Trichuris infestation were compared with paediatric amoebic dysentery patients and normal children. Heavy Trichuris infestation was diagnosed by visualization of worms on anoscopy. Patients with heavy Trichuris infection had a longer duration of disease, more frequent hospitalization and a higher rate of rectal prolapse than did patients with amoebiasis. Five Trichuris children also had clubbing. Trichuris patients had lower mean haematrocrits (27%) and serum albumin (3-3 gm%) than did patients with amoebiasis (32% and 3-7 gm% respectively). Coinfection with Shigella and Salmonella was significantly increased in patients with heavy Trichuris infection compared to both amoebic and control group children. Trichuris patients were infected with Entamoeba histolytica more frequently (46%) than normal children. Heavy Trichuris infection is the probable cause of symptoms and signs seen in these patients.


The association of endemic elephantiasis of the lower legs in East Africa with soil derived from volcanic rocks. Endemic elephantiasis of the lower legs in Ethiopia, which reaches a maximum of 86-7 per 1,000 adults in affected areas, is related to the distribution of red clay soil derived from volcanic rocks, particularly basalt. Prevalence falls rapidly on leaving these areas. This observation has been tested in regions of non-filarial elephantiasis reported in Kanya and north-western Tanzania and further investigated in volcanic areas of Rwanda where the disease had not previously been reported. The same relationship is found to occur in these areas. The limitation to the lower legs of the barefooted section of the farming community suggests that the aetiological factor or factors enter by the feet. The occurrence at high altitude (over 1,200 metres) is noted and the predominance of basalt or basalt-like lava in each case is considered significant. The altitude governs rainfall and temperature and thus governs the type of soil produced. The soil produced from these rocks is rich in colloidal iron oxide, alumina and silica, to which a number of metallic ions are adsorbed. This soil is a reddish-brown clay which, when wet, is strongly adherent to the skin. The derived ions are known to be toxic to human tissue and absorption through intact human skin has been shown to occur experimentally. It is suggested that absorption of these irritants through the bare feet is responsible for the irreversible damage to the lymphatic channels. The present studies support the hypothesis that "high-altitude" elephantiasis of the lower legs in East Africa is a geochemical disease.


Absence of schistosomal glomerulopathy in Schistosoma haematobium infection in man. Kidneys were studied by light microscopy in 246 consecutive autopsies in Cairo, Egypt. Glomerulonephritis was not related to the presence or intensity of either S. haematobium or S. mansoni infection, and mesangial thickening and proliferation were also unrelated to schistosome infection. Acute and chronic pyelonephritis were also unrelated to the presence of schistosome infection.


A study of the symptom patterns of psychiatric referrals in a tropical diseases unit. Undoubtedly the commonest psychiatric conditions seen in patients from the tropics are reactive depression and hysterical illness. These may both be seen as responses to stress, often over a prolonged period. Although typical depressive and hysterical syndromes are seen in all races, severe tiredness seems to be the principal hysterical symptom amongst Europeans as opposed to bizarre somatic symptoms in Negroes and Asians. Headaches are an important depressive sign in Negroes and Asians. Diarrhoea and abdominal pains may be linked directly to anxiety and depression or may emerge as an unconscious defence against insoluble problems.


Kala-azar in Zambia: first report of two cases. Two autochthonous cases of kala-azar, the first such report of the disease from Central and Southern Africa, are described. Both patients presented with generalized macules, papules and nodules without ulceration and both also had tuberculosis. Amastigotes were cultured from blood and identified in skin, bone marrow, liver and spleen.


Laboratory evaluation of a new technique for counting microfilariae in blood. The technique involves taking a measured volume of blood (20-40 mm3) from a finger or ear prick on to a conventional 3 X 1 in microscope slide and lysing it with water. Microfilariae could either be counted immediately, whilst still alive, or the smear dried, fixed and stained. A comparison between counts of microfilariae in freshly prepared slides and stained slides showed that few microfilariae were lost in the staining process.


A retrospective serological suvey of Royal Marines previously exposed to Pseudomonas pseudomallei in South East Asia. Following the suggestion that it was possible that cases of melioidosis amongst those who had been exposed abroad in the past, might be escaping notice, 487 Royal Marines were examined by indirect haemagglutination studies. Four hundred and eleven of these subjects had served for variable times in areas where melioidosis has been known to occur in Indonesia and Malaya, between 1960 and 1974, occupied in activities in the jungle and paddy fields during which exposure to the disease was to be expected. No evidence of residual subclinical melioidosis was found and it seems unlikely that recrudescent disease will prove to be a problem in the future for English servicemen who have been in South East Asia.


Metabolism of IgM in the tropical splenomegaly syndrome. IgM metabolism was studied in five patients with the tropical splenomegaly syndrome and in five controls. The half-life and turnover time of I125 IgM was similar in the two groups. We conclude that the raised serum IgM levels found in patients with the tropical splenomegaly syndrome are not due to decreased IgM catabolism but are due to increased IgM production.


D-xylose absorption and jejunal morphology in African patients with pellagra (niacin tryptophan deficiency). D-xylose absorption tests and jejunal morphology have been shown to be unaltered in 12 African patients with pellagra when compared with normal values for Zambian Africa adults; that result is contrary to two previous investigations in India and Egypt respectively. A significant inverse association has been shown, however, between D-xylose absorption and serum immunoglobulin IgG and IgA concentrations; that is consistent with previous studies and probably reflects malabsorption of xylose in the presence of systemic infections. It is concluded that pellagra per se does not alter intestinal structure or monosaccharide absorption.