Vascular complications of intra-aortic balloon pumping. Vascular injury or occlusion from intra-aortic balloon pumping (IABP) that results in actual or potential limb ischemia occurs more frequently than reported. In a series of 79 IABP patients, 36 lived long enough to have the balloon catheter removed; thirteen (36%) of them had vascular complications. The complications were in three patients with an injury at the insertion site, eight patients with arterial thromboses, and two with arterial occlusion by the large balloon catheter. Local artery revision, thrombectomy alone, or thrombectomy with femorofemoral cross-over grafting was required in 11 patients. Femorofemoral crossover graft was utilized when arterial occlusion would have ordinarily required premature balloon removal or when immediate arterial occlusion by the catheter was recognized at the time of balloon insertion. This was preferable to transferring, replacing, or discontinuing IABP, since the same factors that led to thrombosis in the first place would have eventually come into play again. Patients should be observed frequently and have Doppler limb pulse determinations every four hours to avoid ischemic catastrophies. Proper IABP weaning and the use of a Fogarty catheter at the time of balloon removal is mandatory to prevent complications. Femorofemoral crossover graft is indicated for ischemic limbs when IABP must be continued.


Selective intracavitary and coronary hypothermic cardioplegia for myocardial preservation.Clinical, physiologic, and ultrastructural evaluation. Intraoperative myocardial protection was evaluated in two groups of patients undergoing coronary surgery in whom different techniques for cardiac arrest were utilized. In group A, profound selective myocardial hypothermic (15 to 18 C) arrest was achieved by perfusing a coolant (7 to 10 C) into the left ventricular cavity and the coronary circulation. The average anoxic arrest time was 82.5 +/- 27 minutes. In group B, ventricular fibrillation and moderate hypothermia were used. Group A patients showed rapid physiologic recovery, low average myocardial creatinine phosphokinase (MB-CK) isoenzyme levels (7.8 IU) , and a well-preserved myocardial ultrastructure. In group B, three patients showed abnormal physiologic recovery; six patients needed postoperative inotropic support; and in seven patients, electron-microscopy revealed irreversible focal changes. The average MB-CK isoenzyme level was 85.6 IU. Analysis of our data demonstrates that when myocardial protection during coronary bypass grafting is achieved by selective profound intracavitary and coronary cooling, there is physiological, ultrastructural, and biochemical evidence of less intraoperative myocardial damage than when ventricular fibrillation is applied.


Myocardial revascularization after acute myocardial infarction. Revascularization of the myocardium was performed in 25 patients two to eight hours after acute myocardial infarction (MI). The intra-aortic balloon pump was used in 11 patients. Thirteen patients received revascularization within four hours of onset of MI; all survived the operation. Seven patients were studied postoperatively; ten of 12 grafts (83%) were patent. There was a considerable decrease in left ventricular (LV) dyskinesis and an improvement in LV function. Among 12 patients in whom revascularization was performed for more than four hours' duration after the onset of MI, ten survived. Six were studied postoperatively; six of nine grafts (66%) were patent. There was an increase in LV dyskinesis, with deterioration in LV function. In three patients, ECG evidence of Q wave persisted in spite of absence of dyskinesis postoperatively. The interval during which revascularization of acute infarction produces acceptable results in less than four hours.


Prolonged pulseless perfusion in unanesthetized calves. Nonpulsatile left ventricular (LV) bypass was achieved in nine alert, active calves for periods of up to two weeks using a centrifugal blood pump. Data were compared to prebypass control values and to results obtained from seven calves that underwent nonthoracotomy, retrograde LV cannulation, and pulsatile bypass for up to 35 days. Nonpulsatile flow produced an increase in heart rate of 20% (P less than .05) and an increase in aortic pressure of 10% (P less than .05). Cardiac output and systemic vascular resistance were similar in both groups for three days; thereafter, vascular resistance decreased as cardiac output progressively increased. Serum renin, lactate, and pyruvate values remained normal; creatinine clearances were not significantly different than control values, and there were no significant changes in body weight. These data indicate no untoward effects as a result of prolonged pulseless perfusion.


Chronic testing of a pacemaker that needs recharging only once every four years. Since 1967, three series of rechargeable single-cell silver-mercuric oxide-zinc pacemakers have been implanted in dogs with complete heart block. The five nonhermetic units in series 1 failed after less than or equal to 18 months, primarily due to prototype cell deficiencies, although one cell functioned for eight years. The six units in series II contained improved cells, but failed due to gradual transepoxy fluid absorption after less than or equal to 31 months. All rechargeable cells were salvaged and dried, and, seven years after their manufacture, they continue to power pacing circuits. Series III now totals 20 doubly hermetically sealed units, tested for up to three years (total more than 300 months or 26 years), with no pacemaker failures. Accelerated tests indicate a minimum life of more than 50 years. A clinical trial is in progress.


The value of scintiangiography in arterial disease. Arterial visualization using the gamma camera was achieved by peripheral intravenous injection of technetium pertechnetate Tc 99m 253 times in 200 patients. This technique, which successfully images the arterial tree to the level of the wrist and ankle, was validated by blind comparison of the scintiangiograms with contrast arteriograms or surgical findings or both in 93 studies. Although scintiangiography has less resolution than contrast arteriography, it provides quantitative and other important supplementary information in the diagnosis and management of patients with arterial disease. Scintiangiography has accurately diagnosed arterial occlusions (atherosclerotic, traumatic, and embolic), true and false aneurysms, and arterial stenoses. Patients sustaining trauma to the extremities may be evaluated by scintiangiography as a screening technique. Postoperatively, scintiangiography has replaced contrast arteriography for assessing patency of grafts and completeness of thromboembolectomy and for the long-term follow-up of these patients.


Predictability of surgical response in renovascular hypertension. One hundred sixteen patients underwent operation for renovascular hypertension from 1962 through 1975; 64% had aortorenal reconstruction and 36% had nephrectomy. Sixty-six percent were cured and 19% were improved. Rapid sequence intravenous pyelography, radioisotope renography, and renal arteriography were equal in ability to detect renovascular hypertension. Bilateral renal biopsy specimens had excellent prognostic value when performed in a graded semiquantitative manner. Plasma renin activity was the most consistently useful criterion for prediction of surgical cure if the following requirements were used: (1) elevated peripheral plasma renin activity, (2) elevated renin from the affected kidney, and (3) suppressed renin secretion from the contralateral kidney. An angiotensin II antagonist, saralasin acetate, used in six patients before operation in an attempt to identify those whose hypertension depended on angiotensin II activity, produced a depressor response correlating well with the surgical result.


Is 80 years too old for aneurysmectomy?

Is 80 years too old for aneurysmectomy? The records of 111 patients, 80 years of age or older, with a primary diagnosis of abdominal aortic aneurysm(AAA) showed that 86 patients underwent aneurysm resection and grafting. Ruptured AAAs (n=30) were associated with an operative mortality of 74%. By contrast, AAA resection in the expanding aneurysm group (n=19) and in the elective surgery group (n=44) was associated with a 10% and 2% mortality, respectively. Thus, resection of a nonruptured AAA in 63 octogenarians was carried out with an overall mortality of 4.7%. While nearly half of the patients had cardiac disease detected preoperatively, the elective group demonstrated a low incidence of previous myocardial infarction (7%) and congestive heart failure (8%). Concomitantly, the incidence of myocardial infarction (6%) and congestive heart failure was relatively low after AAA resection. Significant postoperative oliguric azotemia was observed in only 5% of the nonruptured patients. Long-term survival was comparable to that of the general population over the age of 80 years. The quality of life enjoyed by these patients was not adversely affected by AAA resection. By contrast, 50% of patients treated conservatively died of ruptured AAA. Physiologic rather than chronologic age should determine selection for AAA resection in the octogenarian.


Abdominal aortic resection in thoracic dissection. Dissection nearly always begins in the thorax, but it commonly extends into the abdominal aorta, which may become the focal point of the disease. We report five patients who illustrate the surgical management of this disease variant. Clinical manifestations included retroperitoneal rupture, expanding false aneurysm, and lower aortic occlusion. All patients had an aortic bifurcation graft, with reentry of the false lumen at the renal level. Two patients also had thoracic-aortic resection or plasty or both. Although one patient had thoracic aortic rupture at the five-year interval, these abdominal aortic resections provided effective palliation in all. This successful experience in managing complex dissections shows that when aortic dissection extends into the abdomen, resection of the distal aorta with a reentry procedure may be appropriate therapy.


"Blue toe" syndrome. An indication for limb salvage surgery. We describe 31 patients in whom proximal lesions in the arterial tree were identified as probable sources of emboli causing the "blue toe" syndrome. This syndrome consists of acute digital ischemia caused by microembolization to the digital arteries from a proximal source via a patent arterial tree, as evidenced by an otherwise well-perfused foot. It is closely analogous to the transient ischemic attacks of the brain, and carries the same potential for serious tissue loss because of repeated embolic showers. The prompt delineation and eradication of the embolic source is of prime importance, in addition to restoration of arterial continuity. Along with the other well-known features of chronic severe ischemia, that is, rest pain, gangrene, etc, the "blue toe" syndrome is therefore an indication for limb salvage surgery.


Pediatric vascular trauma. Manifestations, management, and sequelae of extremity arterial injury in patients undergoing surgical treatment. Twenty pediatric patients with a mean age of 9.2 years exhibited 21 injuries to arteries of an extremity and underwent operation. Included were 12 iatrogenic injuries and nine non-iatrogenic penetrating injuries. Femoral, brachial, popliteal, radial, axillary, iliac, and tibial arteries were sites of vascular trauma. Long-term follow-up, averaging 36 months, was possible in 14 patients. Postoperative scanograms, digital impedance plethysmographic studies, and bone age roentgenograms were routinely obtained. Limb length disparities greater than 5 mm, extremity blood pressure differentials greater than 10 mm Hg, and bone age retardation were encountered. Proper treatment of pediatric patients with acute arterial injuries of an extremity requires early operative intervention and continuous postoperative follow-up during years of active growth. If chronic arterial insufficiency ensues, arteriographic studies should be obtained and arterial reconstruction undertaken.


Emergency carotid artery surgery in neurologically unstable patients. Although angiography and carotid artery surgery are illadvised in patients with acute, profound stroke, there is no consensus on the management of patients with stroke in evolution, waxing and waning neurologic deficits, or crescendo transient ischemic attacks. This type of clinical picture was associated with a critical, unstable lesion of the internal carotid artery in each of 12 patients. Emergency angiography permitted identification of the lesions responsible for the varying neurologic manifestations, and emergency carotid thromboendarterectomy produced prompt, complete recovery in all but one patient, who had a total carotid occlusion, received no operation, and died of a cerebral infarction. Based on our experience with these 12 patients, an aggressive diagnostic and therapeutic approach is recommended for patients with acute unstable cerebrovascular disease.


Spontaneous dissection of the internal carotid artery. The arteriographic diagnosis of spontaneous, nontraumatic dissection of the internal carotid artery was made in 19 patients and confirmed at operation in ten. The tapered narrowing beginning in or about the carotid bulb and ending at the bony canal was a consistent finding. Four patients had associated aneurysm formation. All but one patient developed an acute hemispheric neurologic deficit as the initial symptom. The deficit was transient in ten and prolonged in eight. The dissection occurred in the outer layers of the media. None of the surgical specimens showed atherosclerosis. Surgical methods of management included segmental resection and grafting, thrombectomy and intimectomy, dilation, and simple ligation. Considerable improvement of luminal diameter occurred in six of seven patients whose arteries were left undisturbed.


Simultaneous bilateral carotid endarterectomies. Twelve patients with bilateral symptomatic lesions of internal carotid arteries have had bilateral carotid endarterectomy at single operations without complications. These were patients up to age 80 who had prior mycardial infarction, stroke with recovery, and hemispheric and nonhemispheric episodes. Neurologist's clearance and three- or four-vessel intracranial-extracranial angiography preceded all operations, which were performed with the patient under general anesthesia. Stump pressure measurements were the principal guideline of adequacy of collateral flow and predictor of safe outcome. The safety of this concept of bilateral operations during one anesthesia can eliminate uncertainties of sequence and timing, obviate delay and indecision, and avoid the hazards of a second anesthetic-operative experience.


[Basic changes in neurons in the peripheral regions of the human nervous system during pathologic processes (electron microscopic study)]. Compensatory-adaptational and reparative reactions were studied in bodies, processes, receptors and synapses of the human peripheral nervous system and in the innervated substrate (myocardium, kidney, liver) by means of electron microscopy. An extreme increase of the electron density of macromolecular protein formations of specific elementary particles was revealed, in particular, in the outer layers of the hypertrophid mitochondria cryst membranes at 50000.000 magnification. These particles are considered as mitochondria precursors.


[Nervous apparatus of the walls of the celiac trunk and its branches in man]. The impregnation methods in total laminated preparations and histological sections were used to study the nervous apparatus of the celiac trunk and its branches in humans of either sex and different age. It consists of milti- and unipolar cells, periadventitial, adventitial and muscular nervous plexuses, separate nerve trunks and plexuses and single myelinated and non-myelinated nerve fibres terminating with non-encapsulated and encapsulated nerve endings.


[Effect of vagal denervation of the cerebral vessels on cerebellar neurons]. Under study were the neurons of the cerebellum cortex of adult cats after a right-side transection of the vagus nerve cranially to its ganglion. The neuron structure was studied in frontal 10-20 mu thick paraffin sections stained with thionine after Nissl 1, 2, 10, 20 days and 1, 2, 3 months after operation. Pathomorphological alterations of neurons were revealed in all layers of the cerebellum cortex. The alterations were of bilateral character, but were more pronounced in the operation side.


[Senile changes in the intraorganic lymphatic bed of human facial skin]. The alterations in the intraorganic lymphatic bed of the skin of human cheeks, lips, the red edge included, were studied macro-microscopically in cleared preparations with preliminary injection taken from human corpses of either sex from 55 to 89 years of age. Considerable atrophic processes were established to take place in the lymphatic bed of the face skin after 55 years of age. The superficial lymph capillary network can not be detected completely by the age of 70. The reduction of the profound capillary network and intraorganic lymph vessels proceeds. Diverticula of various shape make their appearance on the rest of lymph capillaries and vessels, the contours of the lymph capillaries and vessels undergo considerable changes.


[Cellular ultrastructure of developing conglomerates of fresh water sponges]. The fine structure of cells of the conglomerates formed after dissociation of tissues of fresh-water sponges has been studied. In the development of the conglomerates of Ephydatia fluviatilis an important role is played by amoebocytes and choanocytes. In amoebocytes the shape of the nucleus, the mitochondria structure, the Golgi complex and endoplasmic reticulum have been found to change. In choanocytes, in addition to changes of organoids, the structure of the collar and flagella are subjected to desorganization. They have great plasticity and are able to re-differentiate in pinacocytes according to their position in the conglomerates. The transformation of amoebocytes and choanocytes into pinacocytes is accompanied by a successive modification of the nucleus and the cytoplasmic structures. In redifferentiation of amoebocytes the amount of Golgi apparatus zones decreased, the content of vacuoles of different size and the amount of elements of the agranular endoplasmic reticulum increased, and the defined nucleus disappeared.


[Development of the ultrastructural organization of the rat neurohypophysis during postnatal ontogenesis]. The development of structural components of the posterior hypopysis lobe of rats, the development of the neurosecretory activity of the hypothalamo-hypophyseal nervous system and the establishment of its function as a single system within the first three weeks after birth (1, 7, 14 and 21 days) as well as embryos of the 20th and 21st days of development were studied electron-microscopically. It has been established that the pituicytes of the posterior lobe of the hypophysis of newborn rats are represented by a single type of cells and are completely differentiated. On the 21st day they are in different morpho-functional states and consist of dark and light cells. By the 14th day of development a considerably increased amount of the neurosecretion is observed. By the 21st day the density of neurosecretion granules per a preparation unit does not change. The basal layer of the capillaries is formed not definitely by the birth time; on the 14th day the organization of the vessel wall is almost similar to that of mature animals. The Herring bodies make their appearance on the 21st day after birth. The hypothalamus and neurohypophysis of rats are functionally active before birth. After birth their neurosecretion activity is well pronounced while the hypothalamo-hypophyseal nervous system is not mature yet. By the time of getting sight this system is almost formed and sufficiently active.


[Structural characteristics of the axons of nerve cells of the cat motor cortex]. The axons of both pyramid and stellate neurons have a great number of ramifying collaterals which are considered in a comparative aspect. The both types of nerve cells are characterized by almost similar systems of the branching of axons, types of collaterals and end structures. The neurons are distinguished due to progressive development of one features of the axon structure and to a certain reduction of the others. In extreme forms the stellate cells have a well developed pericellular network, not coming outside the limits of the branching of their dendrites, while the pyramid cells are characterized by the mighty development of the main trunk and the absence of recurrent collaterals. Between these forms there are transitional forms.


[Electron microscopic study of the rat submaxillary gland during development]. Cytological changes in the submaxillary glands of rat embryos of the 14th-21st days of the intrauterine development and of 7-day-old rats were studied electron microscopically. The cytoplasm of the salivary gland primordium cells of the 14-day embryo was found to possess multiple polysomes, the canals of the granular cytoplasmic network (GCN) being solitary. The latter elongated in the process of embryonic development, and later predominant development of GCN was observed in basal portions of the acinar cells. At early stages of the gland development the GCN was often observed to approximate mitochindria. The laminar complex in the course of embryonic development enlarges its size and at later stages it has a well differentiated appearance in the acinar cells. Secretory inclusions make their appearance in the forming cells of acinuses long before birth, the composition of the embryo gland secretion being somewhat different from that of adult animals. Differentiation of acinuses and striated parts of the salivary tubules is well pronounced in the embryonic period while no signs of appearance of granular portions of the salivary tubules are observed both in light and electron microscopy either in embryos or in 1-week-old rats.


[Period of degeneration and features of the laminar distribution of the visual nerve endings in the midbrain tectum of the steppe turtle (Testudo horsfieldi, Gray)]. A study of ultrastructural changes in the neuronal terminals of optic fibres at the level of tectum opticum (TO) in different periods after unilateral enucleation has revealed the process of degeneration in the optic system of Testudo horsfieldii as well as in Emysorbicularis L. to take a considerable time: from two weeks to six months. The character of destructive changes and the mode of utilization of desintegrated elements are dissimilar in different groups of retinal axons in the optic nerve and their terminals in TO. A comparison of the degeneration periods and the character of the changes in the optic fibres has made it possible to establish the following approximate correlations: all the nerve terminals of myelinated fibres degenerate after the "dark" type, whereas the terminals of non-myelinated axons are subjected to other kinds of transformations ("light", vesicular", neurofilamentous", "glycogen"). The analysis of the distribution of degenerating nerve terminals in the TO layers has demonstrated that there is a regularity in localization of different nerve terminals at certain levels of TO which is indicative of the layered organization of retino-tectile connections. Considerable differences in the neuronal and synaptic organization of TO have been revealed as well as in the character and the time of destructive changes of retino-tectile fibres after enucleation in T. horsfieldii and E. orbicularis.


[Cytoarchitectonics of the vestibular nucleic of the brain of the dolphin (Delphinus delphis)]. Specific features of the structure of the vestibular complex of Cetaceans correlating with specific features of the structural functional organization of these representatives of aquatic mammals were detected in a cytoarchitectonic investigation of the topography and strucutral organization of nuclei of the vestibular complex performed in Delphinus delphis and compared with the organization of the corresponding structures of the brain of man and chimpanzee.


[Comparative morphometric study of sensory neurons of the cerebral and spinal cord ganglia following transection of their processes]. The morphometrical study of sensory neurons g. nodosum of the vagus nerve and spinal ganglia after transection of central and peripheral  processes has established similar reactions of the neurons of these ganglia. The sensory neurons respond to the transection of peripheral processes by phenomena of retrograde degeneration. No retrograde degeneration was observed in the neurons after transection of central processes. The diminution of the size of the nerve cell bodies, their nuclei and nucleoli was noted at the period of maximally pronounced phenomena of retrograde degeneration as well as fragmentation and peripheral displacement of the Golgi apparatus, increased amount of satellites adjacent to retrogradely changed neurons.


[Comparative cytologic study of nephron structure in higher vertebrates]. A comparative study of the cytological characteristics of the epithelial lining of the nephron and collecting tubules was performed in 9 species of reptiles, 19 species of birds and 12 species of mammals. Representatives of each class of higher vertebrates were shown to have certain specific features of the epithelial lining of different parts of the nephron. Differentiation of various areas of the proximal part of the nephron proceded in phylogeny with different intensity and the maximum specialization was characteristic of the most proximal portion of this part of the nephron. In the cells of the proximal parts of nephrons of some reptiles there were phenomena of apocrine secretion. Evolution of the distal part of the nephron developed to form a loop and differentiation of the distal convoluted segment. The higher differentiation of the epithelial lining of the nephron distal part in birds and mammals, unlike in reptiles, seems to be associated with a more considerable functional specilization of this part. In the cytochemical characteristics of the epithelium of the uriniferous and collecting tubules of kidneys of higher vertebrate animals there are common regularities in the distribution of RNA, proteins and some enzymes. The polysaccharide content is maximum in the epithelial cells of kidneys of reptiles.


[Effect of thyrotropic hormone on the ultrastructure of the endothelium of thyroid gland perifolicular capillaries]. Under study was the alteration in the ultrastructure of the thyroid epithelium and endothelium of perifollicular capillaries influenced by exogenous thyrotropic hormone. The results obtained show that there is a direct relationship between the dosage of the injected thyrotopic hormone, the degree of the ultrastructural changes in the time of their appearance. It has been established that the alterations in the perifollicular capillary endothelium ultrastructure make their appearance and become maximum practically simulataneously with the alterations in the thyroid epithelium ultrastructure. The increased functional activity of the endothelium, thinner walls of capillaries and the appearnace of a greater amount of fenestrations against the background of the thyroid stimulation are likely to be factors contributing to penetration of non-hormonal iodine products (iodine tyrosines and products of incomplete hydrolysis of thyroglobulins) into the circulation, which can be observed under certain pathological conditions accompanied by increased thyrotropic stimulation--such as diffused toxic goiter and diffuse non-toxic goiter.


[Age and dynamics of protein and RNA concentration in sheep oocytes]. There exists a definite age rhythm of the amount of RNA and protein in Graaf's vesicle oocytes in the postnatal life of the sheep. The lowest quantities of these components were found in the prepubertal lambs; maximum was recorded in 1,5-2,5 year ewes and later the amount of these components decreased and the oocyte of 8,5 year ewes contained 24% less general protein and 69% less RNA than 1,5-2,5 year ewes. As the oocyte grows the amounts of the protein and RNA change. A primordial follicle oocyte contains 250 +/- 15 rel. units of general protein while a Graff's follicle oocytes has three times more (767 +/- 67 rel. unit). The corresponding data for the cytoplasm RNA are: 87,5 +/- 5 rel. units and 163 +/- 18 rel. units which means a 2 times increase.


[Structure and cellular organization of the osphradium of Limnea stagnalis L]. Light microscopy was used to study the structure and cellular organization of the osphradial organ of the pulmonary mollusque L. stagnalis. The osphradium unites the epithelial canal and the ganglion consisting of two cell populations. On the internal surface of the V-shaped osphradial canal there are three zones of cells: secretory, villous and epithelial. The villous zone of the canal is related with sensory bipolar and multipolar neurons of the ganglion. The irritation percepted by these cells seems to be transferred through numerous zones of neuropile to large unipolar neurons of the ganglion cortical layer.


[Structure of the collagenous framework of skeletal muscle]. The architectonics of the collagenous framework of skeletal muscles of man and rats was studied by methods of rastral and translucent electron microscopy. The structure of the collagenous framework in the field of endomysium, perimysium and muscular tendinous connection is shown to be different which is determined by the morphological features of these structural components of the skeletal muscle. In the endomysium and perimysium the collagenous framework consists of fibrils and fibres of different thickness which form a complicated anastomosing network around muscular fibres and, penetrating the basal membrane, sustain the structural interrelation between them. In the area of the muscular-tendinous connection the collagenous fibres invade the basal membrane between the sarcleemma protrusions and from ramifying endings on its surface. The obtained data suggest that the functional role of the collagenous framework is to unite the muscle fibres into a single system, to synchronously transfer contractions of muscle fibres to the tendon and possibly to partly participate in the process of relaxation of the muscle after contraction.


[Holography and the possibility of its use in applied anatomy]. The article deals with some methods of holography (holograms with inclined reference beam, in three-dimensional media after Yu. N. Denisiuk, holographic interferometry) as applied to studying anatomical objects. Approximate optical schemes and photographic copies of holograms of separate objects are presented. The comparative analysis of different methods enabled the authors to recommened for practical use the method of obtaining holograms in three-dimensional media for documentation of anatomical investigation and storage of information, holographic method of obtaining contour maps of the surface for quantitative characteristics of individual properties of the object and the method of double exposure for studying static and dynamic deformities.


[Lacrimal glands of dogs and cattle in the light of histologic and histochemical findings]. The secretion of the lacrimal glands and the glands of the third eyelid of dogs and cattle contain neutral polysaccharides, sialic acids, chondroitin sulfate acids A,B and C. In dogs the secretory cycle including the phase of hydratation occurs inside acinuses in the cattle the phase of hydratation takes place in excretory ducts. The stroma of the eye orbit glands contains a great amount of active plasmocytes providing the secretion with immunological activity.


[Double system of ganglionic neurons in the retina]. The work is devoted to an unusual distribution of large neurons of the ganglionic layer of the retina in the cow and horse-in the shape of double systems. The cells forming the double system are referred to the morphological type of alphacells comprising the minority of the total number of all ganglionic cells, being found mainly in peripheral parts of the retina. The methods used were silver impregnation, cytological, histochemical and biometrical techniques. General morphological parameters are established with relatively close disposition of perikaryons from one another. Functional mutual substitution of "twin-cells" of adaptational character is supposed resulting from the necessity of rapid and exact visual analysis.


[DNA synthesis in cells of mouse corneal epithelium]. Method of autoradiography was used in order to study the kinetics of population of the cornea epithelium cells of mice. Intervals of different duration were found to exist in the DNA synthesis within the limits of S-period of one mitotic cycle. On the basis of personal and literature data a hypothesis has been put forward of a successive pattern of replication in the cells of eukaryots according to which synthesis of a fragment of the DNA daughter thread (or a chromosome subunit) occurs at each moment in a restricted site of a single matrix thread of DNA (matrix chromosome subunit). No DNA synthesis takes place at this moment in the complementary site of the second matrix thread (matrix chromosome subunit), the fragment (chromosome subunit) of one matrix thread being somewhat larger than the complementary fragment (chromosome subunit of the other matrix thread.


[Changes in the ultrastructure of the anterior lobe of the pituitary after subjecting animals to cooling]. Stress reactions caused by extreme factors have a common nonspecific main component-a release of ACTH into the blood stream and increased functional activity of corticotropic cells of the anterior lobe of the hypophysis. Qualitative properties of the acting agents depending on their nature determine other adaptive changes of hormonal and metabolic processes in the organism after the interference. The study of the dynamics of the ultrastructure of glandular cells of the rat's hypophysis anterior lobe after a single severe cooling has revealed a sharply pronounced early mobilization of thyreotrops. The increased thyreotropic activity is an additional specific component of stressor reaction which is caused by cooling. The electron microscopic study of the structure and topography of glandular elements has revealed a cycle of functional-morphological changes completed within a day after the exposure.


[Effect of temporary ischemia with subsequent recirculation on the ultrastructure of glomerular capillaries and nephrons]. The influence of temporary ischemia followed by recirculation on the ultrastructure of glomerular capillaries and some portions of the nephron was studied in 20 albino rats which were subjected to compression of the vascular bundle of the left kidney for 30 min., 1, 2 and 3 hours followed by recovery of the blood stream in the ischemic organ for 3 hours (with a simultaneous nephrectomy of the right kidney). The electron microscopic analysis has established that the amount of micropinocytic vesicles become markedly increased within 3 hours following 30-min. ischemia of the kidney with the recovery of blood circulation in the cytoplasm of endotheliocytes of glomerular blood capillaries. With increased terms of the left kidney ischemia (1, 2, 3 hs) the ultrastructural changes in endotheliocytes increased. There appeared microclasmatosis of the internal plasmalemma of endotheliocytes, the flattened peripheral part of the cytoplasm underwent considerable destruction. Swelling of microvilli of the brush border and vacuolization of the cytoplasm were observed in nephrocytes of the proximal part of the nephron in short-term ischemia (30 min) followed by the recovery of circulation for 3 hours. Longer periods of ischemia (1, 2, 3 hs) casued destruction of the brush border. There appeared secondary lysosomes, in mitochondria there occurred discomplexation and lysis of cristae.


[Efferent projections of the ventral portion of the putamen to the frontal, parietal and temporal regions of the cat cerebral cortex]. Following the electrolytic lesion of putamen (rostral and caudal parts of the ventral field) of the cat's brain, degenerating endings of axons in the cerebral cortex were revealed ipsi and heterolaterally in frontal sections of the brain impregnated after Nauta--Gygax and Wiitanen. The projections were organized topically: the rostal part of putamen was projected to anterior parts of the cortex (motor and premotor, orbito-insular and S zones), while the caudal part sended the fibres to the occipital and auditory fields of the cortex and S2 zone.


[Associative connections of the visual area of the neuronally-isolated cat cortex]. The associative pathways of the visual zone (fields 17 and 18) of the neuronal-isolated cortex of the cat were studied by the methods of Nauta-Gygax and Fink-Heimer. The cortex was isolated by the method proposed by M. M. Khananashvili (1961) by means of transection of projectional systems of the fibres connecting the cortex with subcortical structures in the site of their maximum concentration-in the internal capsule. Fields 17 and 18 were shown to have short associative pathways running both within the limits of the fields proper and to fields 17, 7 and to Clara-Bishop region disposed in the depth of the suprasylvian fissure. The site of termination of the associative libres was all layers of the cortex in some degree. It is assumed that the cytoarchitectonical fields in the neuronal-isolated cortex during conditioning interacts by means of intracortical fibres shown in the present investigation.


[Sex-specific features of the construction and cellular composition of the superior tracheo-bronchial lymph nodes in adults]. Specific features of the internal structure and the cellular composition of the superior tracheobronchial regional lymphatic nodes in man under normal conditions with reference to sex were studied in 18 corpses of men and 14 corpses of women from 21 to 60 years of age. Conventional histological methods were used. The superior tracheobronchial lymphatic nodes in men and women were found to be arranged according to a common plan, but to differ in a number of signs. In humans of either sex the cortical plateau prevailed over the medullary substance in the section made though the hilus of the node, but the ratio of the cortical and medullary substances is different in men and women. In men there are less follicles both containing and not containing the light centers than in women. The cellular composition of the superior tracheobronchial lymphatic nodes is extremely polymorphic but is more or less constant in each structural component in men and women.


[Plastic properties of the venous bed of the brain following disengagement of the external jugular veins at different stages of ontogenesis]. The capacity of the venous bed in the brain being great, even inconsiderable changes of the vein lumen can cause severe changes in the blood circulation without an enlargement of the cranial cavity volume. The progressing venous stagnation in the brain is a severe disease of not only the brain but also the whole organism. So, we attempted to study the character of compensatory redistribution of the pial venous system of the cerebrum in occlusion of both exterior jugular veins and to establish its developmental accomodative properties. The work has been performed on 45 dogs. The plasticity of the cerebral pial veins was found to drop with age, their reserving capacity-to grow and their carrying capacity-to decrease. Three successive phases are characteristic of the compensatory-adaptational changes: diffuse dilatation of the venous network, appearance of collaterals and their development against the background of reduction of the surrounding venous network.


[Hypokinetic chamber].

[Hypokinetic chamber]. The proposed construction of the hypokinetic chamber provides a sufficient restriction of the motor activity in a natural position of the animal for investigating the state and functions of organs, and systems under hypokinesia, does not disturb the function of vitally important organs, does not mispresent the results of experiments, allows to change the size of the chamber according to the changing size of the animal. The chamber is simple in using lasting, hygienic, requires the least labour and time to take care of animals.


[Method of natural periodization of processes]. The method of natural periodization of processes based on objective quantitative account of the dynamics of changing of certain parameters is described. The natural periodization has been established by analysis of the data dynamic series, the distribution of observation terms being made with regard for the a priori taken rate of changes of the parameters under study. The possibility to compare different parameters has been achieved by using centrated approximated data. The discovering of natural periods can be performed by analysis of the group of centrated data. The variation of the variation coefficient of centrated ordinates in each temporal point can be calculated for objectivization of the evaluation. The investigation of developmental changes of the thyroid of A/H mice with employment of methods of morphometry and quantitative histochemistry is taken as an example.


[Study of aseptic inflammation using the scanning electron microscope]. A focus of inflammation in the subcutaneous connective tissue in white rats was investigated in a scanning electron microscope. Lymphocytes, polyblasts, macrophages, fibroblasts, collagenous fibres, gigantic multinuclear cells, vessels are described. Similiarity in the form and structure of the surface in agranulocytes of the blood, polyblasts and macrophages was established. A considerable change in morphology of fibroblasts, particularly in the period of synthesis os of the cell, was observed. Collagenous fibres and fibroblasts played a leading role in the creation of the supporting-mechanical carcass and in spatial structure of the regenerating connective tissue.


[Ultrastructural changes in articular cartilage in rheumatoid arthritis]. Electron microscope studies of the articular cartilages removed in the course of the operation on 6 patients with rheumatoid arthritis were carried out. The processes of destruction of chondrocytes and the cartilaginous matrix in different regions of the articular cartilage were traced. In the surface areas of the drastically changed cartilage there were observed leucocytes of the synovial fluid, and in deeper areas--disintegration of chondrocytes and extracellular disposition of lysosomes and altered organellas, destroyed cartilaginous cells. In these areas destruction of collagenous fibres was particularly intensive. In areas of the tissue remote from the destuction hypertrophy of chondrocytes due to hyperplasia of various organellas and the Golgi complex in particular were noted. In the Golgi zone granules of glycogen were detected. No mitoses were observed. Apparently, the enzymatic destruction of the cartilaginous matrix in rheumatoid arthritis could proceed at the expense of the activazation of the synovial fluid lysosomes and lysosomes of chondrocytes themselves. A reparative regeneration of the disintegrating matrix was realized mainly because of hypertrophy of the functionally preserved chondrocytes.


[Repair processes in the liver in viral hepatitis]. Reparative processe were studied on bioptic specimens taken from 190 patients with virus hepatitis. Figures of nitosis, amounts of binuclear and polyloid hepatocytes served as criteria of regneration. Phenomena of regeneration were shown to continue during the entire period of the disease. They were most pronounced in the areas adjacent to the zone of lesion of the parenchyma. A leading reparative process was intracellulr regneration.


[Changes in the adrenal glands in menigococcemia]. Post-mortem morphological, histochemical, and morphometric investigations of the adrenals in 46 deceased patients who suffered from meningococcemia with and without lesions of the meninges were carried out. The control group was composed of 7 practically healthy persons who had perished suddenly as a result of craniocerebral trauma. It was shown that the adrenals might often be seriously damaged in meningococcemia without clinical and morphological signs of meningitis. Hemodynamic disorders, in particular, involvement of the vessels of the microcirculatory bed, contributed considerably to the lesions of the adrenals. However, even in meningococcemia free from signs of meningitis, in a number of cases individual areas of the cortex retained a high functional activity. In meningococcemia combined with lesions of the meninges, despite considerable damage of the cortical layer, in the majority of cases there were evidences of the tense functioning of the adrenal cells.


[Morphology of pneumopathies and their role in the development of asphyxia neonatorum]. Histories of deliveries and development records of 44 newborns with penumopathies who had died on the first days of life in the presence of phenomena of the syndrome of respiratory disorder were analysed and the newborns' lungs were morphologically investigated. The investigation made it possible to single out the following forms of pneumopathy in newborns: edematous-hemorrhagic, hyaline, atelectatic, aspirated, and mixed. In the majority of cases the syndrome of respiratory disorder was a sequela of hypoxia of the intrauterine origin which continued during the first hours and days of life after birth. Such "primary asphyxia" may lead to the development of pneumopathy in a neonate. On the other hand, "secondary asphyxia" in many cases represent sequelae of penumopathy destructural and functional immaturity of the pulmonary tissue, hypoxia, a higher permeability of vessels of the microcirculatory bed, spasm of small pulmonary arteris contributed considerably to the development of penumopathies.


[Malignant giant cell tumors of soft tissue]. Clinco-morphological characteristics of malignant giant cell tumours of soft tissues in 31 patients are presented. Microscopically, the tumours consisted of histiocyte-like mononuclear cells possessing a phagocytic capacity, stretched out fibroblast-like cells forming collagen fibres, multinuclear giant cells of the type of osteoclasts. Three morphological variants were singled out: 1/ predominantly round-polygonal-cellular (histiocyte-like), 2/ predominantly spindle cell (fibroblast-like) and 3/ mixed. Clinically the tumours were divided into 2 groups: superficial (in 8 patients) and deep ones (in 23 patients) developed in skeletal musculature, deep fasciae and tendons, retroperitoneally, as well as in the mammary gland, mesentery of the small intestine, the stomach. The superficial tumours were characterized by relatively low malignancy. Prognosis in the majority of patients with deep tumours of soft tissues was unfavourable. The authors share the opinion of the investigators who consider these tumours to be a malignant variant of giant cell tumours of vagina tendinis and, bearing in mind the unestablished histogenesis of these tumours, think it expedient to retain the term "malignant giant cell tumours of soft tissues".


[Functional morphology of the lymphoid apparatus in experimental mammary cancer (quantitative histochemical study)]. A histological investigation of the mammary glands and lymph nodes as well as a quantitative histoenzymological investigation of the content of nucleic acids and the activity of a number of enzymes were carried out. A reaction of the lymph nodes to tumour growth was established. A uniform type of this reaction justifies the assumption about a generalized response of the peripheral lymphoid tissue. The quantitative histochemical investigation revealed the specificity of the regional node response. A clear-cut dynamics on functional-morphological indices in the zones of T- and B-lymphocytes distribution with early activation of hydrolytic enzymes was observed. At the development stage of tumours a reverse ratio of nucleic acids contents and the activity of enzymes of eneryg metabolism was detected. This  dissociation seems to be of importnace in realization of tumour growth in the mammary gland.


[Characteristics of morphological manifestations of the leukemic process developing against a background of regenerating hematopoietic tissue]. Cyto- and histological changes in the spleen, liver, and other organs of mice of 2 lines with leukosis transplanted against the background of regeneration of the hemopoietic tissue were studied. The reparative regeneration of the hemopoietic organs was caused by preliminary administered hydrocortison. The regeneration of the hemopoietic tissue temporary inhibited proliferation of leukemic cells. Moreover, less pronounced leukemic infiltration was noted in the organs, their size increased more slowly and retained longer the histological structure. Better results were obtained on the experimental model of leukosis with a moderate rate of growth and at early stages of regeneration. Basing on the analysis of the morphological substrate, interaction between regeneration of the hemopoietic tissue and leukemic growth the authors draw a conclusion about the activation in the regenerating tissue of mechanisms of natural anti-tumour protection.


[Cryptococcosis of the central nervous system]. A case of cryptococcosis of the brain in a male patient 47 years of age is described. Duration of the disease--about one year. Clincally it was accompanied by epileptic seizures with loss of consciousness. Diagnosis of cryptococcosis was made following the histological investigation of a part of the brain removed in connection with tumour. Morphologically, there was detected an area of necrosis and aggregation of yeast-like fungi with the typical of cryptococcus oval form and felatinous capsule showing intensive colouration when stained by Hochkiss' method. The pathogenic agent was detected in the spinal fluid of the patient and in the tissue culture.


[Thanatogenesis].

[Thanatogenesis]. The analysis of classifications of causes of death contained in handbooks and manuals of pathological anatomy and forensic medicine revealed their contradictory character, inconsistency with the principles of logic, division according to one basis only; in these classifications of causes and circumstances leading to death. The author recommends to distinguish: a classification of causes of death (biological) and a classification of circumstances accompanying death (of social-legislative character).


[Graphical recording of the state of the basal cerebral vessels and focal changes in the brain]. A method of graphic registration of the length and diameter of vessels of basis cerebri is suggested. The registration is carried out on special cards--punch cards with due account of the structure of the circle of Willis, with subsequent collation of these indices with focal changes in the brain. The method is graphically clear and may be used in research work, as well as in the practice of a pathoanatomist in documentation of an autopsy report and for demonstrations in clinico-anatomical conferences.


[Total proteins of the cerebrospinal fluid obtained by punction of the cisterna magna: normal values. Variations related to sex]. The total protein content of CSF collected from the cisterna magna (cisternal fluid) of 98 patients (58 males and 40 females) with no neurological diseases was determined by the colorimetric method devised by Lowry and co-workers. This method has been previously chosen based mainly on it's sensitivity, accuracy and low fluid consumption. The CSF samples were normal with regard to pressure, color, citology and it's content in glucose, chloride and urea. Complement fixation tests for syphilis and cisticercosis, as well as the globulin tests (Pandy, Nonne--Appelt and Takata-Ara) were negative. The average value and the normal range of cisternal fluid total protein was calculated for the mixed population (males and females). The mean protein value was 26.78 mg/100 ml, the lower and upper limits were respectively 13.20 and 40.36 mg/100 ml. These data are higher than those stated in some publications, and factors that could interfere in the different results mentioned in the literature are briefly discussed. Since the statistical analysis of the results showed that the mean total protein concentration in males (28.76 mg/100 ml) was higher than in females (23.91 mg/100 ml), normal limits for each sex were established: 16.96 to 47.13 mg/100 ml for males and 14.76 to 42.76 mg/100 ml for females.


Cephalic measures in normal pre-school children 3 to 7-years of age. In a study designed to determine standards for the Developmental Neurological Examination (DNE) several measures of the head were also recorded. The study consisted in the examination of 200 children, half from each sex, 40 from each age group (3 to 7-years of age). These children were selected among 755 normal pre-school-age children, living in the city of São Paulo, Brazil). The criteria for selection were both anamnestic and clinic. The following measures of the head were recorded: cephalic perimeter, biauricular and antero-posterior distances (Diament, 1967). A new cephalic index (nCI) was also determined (Diament, 1968). This index is useful in detecting changes in head shape mainly in cases of precocious cranioestenosis (Diament, 1968; Facure, 1972). The statistical analysis consisted in determining means and standard errors for each measure. For the new cephalic index it was shown through the Kruskal-Wallis test that there were no significant difference between age and sex. Therefore we considered all groups together to find out the tolerance region for the new index which turned out to be given by the interval: 0.848-1.002. This result is based in 186 cases since 14 were excluded because of some problems in the recording process. Therefore we expect with a conficence of 95% that the above interval covers 90% of the population, in the 3 to 7 years age-groups independently of sex.


[Neurologic evolution of children of low birth weight]. The prematurity is still an important problem for either pediatricians and neuropediatricinas. All the mechanisms that can produce lowbirth weight, are not known, although many of them are related to genetics and environmental intra-uterine factors. Having in mind tha study of the development of such type of children, a group of investigators has been working for 9 years now, envolving aspects related to the Pediatry, Social Pediatry, Neuropediatry, Psychiatry, Otorhynolaringology, Ophtalmology and Odontology. In this study they are trying to envolve all the possible aspects on growth and development of children with lowbirth weight. In 189 children, 129 were followed during several years. Most of them were observed up to 5 years of age and few of them up to 9 years of age. The children were divided into three groups as follow: Group I-Children with weights under 1.750 g; Group II-Children with weights between 1.751 and 2.000 g; Group III-Children with weights over 2.001 g and under 2.500 g. The neurol-gical tests were done according to the used system at the Neurologic Clinic of the Faculty of Medicine (University of São Paulo). The present work starts with a general revision on the most important existent papers on the prematures neurological evolution. After presenting his own results, the authors make a correlaction of the neurologic evolution with the developmental quotient (DQ), which were gotten through Gesell's tests and its variations, in order to verify the existence of what is known as "continuum of lesion" of Knobloch and col.


An electrophysiological investigation of skeletal muscles in polymyositis. An electrophysiological study has been made of the extensor digitorum brevis, thenar and hypothenar muscles in 25 patients with chronic and acute polymyositis. It was found a reduction of the number of functioning motor units in some patients with chronic polymyositis and only in one of those affected by acute polymyositis and only in one of those affected by acute polymyositis. The sizes of the surviving units suggested that the results could be explained in terms of a primary muscle involvement mainly in acute polymyositis, while in chronic polymyositis a combination of primary and neurogenic involvement of muscle fibers might take place.


The spectrum of myopathies in the city of São Paulo. A review of all myopathic patients treated at the Neurologic Clinic of the Medical School of the University of São Paulo during the past 15 years  is reported. A total of 466 cases were examined and distributed as follows: 56% of progressive muscular dystrophy; 31% of myasthenia gravis; 6% of polymyositis; 4% of myotonic dystrophy; and the remainder of several different diseases (central core disease, Kearn-syndrome, myotonia congenita, adynamia episodica hereditaria, diabetic myopathy and Eaton-Lambert syndrome). Enzymatic dosages, electromyography, muscle biopsy, electrocardiography and genetic counselling are also reported.


[Considerations on low pressure hydrocephalus]. The physiopathological conditions of the normal pressure hydrocephalus syndrome are analysed. Within a group of 21 patients with clinical sintomathology pertaining this entity, only were 10 selected with a clinical, radiological and cisternografic indubitable diagnosis. It has been noticed that in spite of the stricked selection only a 50% of them have been beneficed by the application of a low pressure valve. Then, the hypothesis that the disease is a multicausal syndrome appears, which by an identical physiopathologic process produces or exhibits a similar clinical, radiological and cisternographic picture. Only those patients on whom the mechanical problem is solved would be beneficed by neurosurgery.


[Association of neuromotor retardation and chromosome lqH report of a case]. A case of neuromotor retardation in association with chromosome 1qh's reported. Chromosomes analysis of the patient and three relatives showed increased long arm on the n. degrees 1 chromosome, in all of them. However it is wmphasized that the clinical feautre could be secondary to various non genetics factors, also.


[Werdnig-Hoffmann disease: report of two cases?]. Two cases of familial spinal muscular atrophy with onset in infancy are reported. The author makes an attempt to categorize them and concludes by Werdnig-Hoffmann disease.


Adjuvant nitrosourea therapy for glioblastoma. An attempt was made to evaluate the potential advantages of chemotherapy in the treatment of 62 patients with glioblastoma. Twenty-four of the 62 patients received adjuvant nitrosourea chemotherapy with carmustine (BCNU), lomustine (CCNU), or semustine (methyl CCCNU) in addition to surgery and radiotherapy. Thirty-three of the 62 patients were involved in a controlled, prospective, randomly allocated study. Quality or quantity of survival was not prolonged in patients who received chemotherapy. Age greater than 64 years, a severe postoperative neurological deficit, or the onset of symptoms less than 12 months prior to surgery were associated with a worse prognosis. The valid evaluation of the effect of a form of treatment on survival in patients with glioblastoma is contingent on the regorous avoidance of preselected factors that may predispose the treated group to a more favorable prognosis.


Thiamine triphosphate levels and histopathology. Correlation in Leigh disease. Thiamine and thiamine triphosphate (TTP) values were assayed in various brain regions in 11 controls and 13 patients with subacute necrotizing encephalomyelopathy (SNE, Leigh disease). The TTP values of normal brain were 5% of the total thiamine value. The relative TTP (or % TTP) level was consistently low in the pons, midbrain, and cerebellum of all the SNE brains. Twenty-five percent of the SNE brains had normal TTP levels in the frontal region. The TTP values correlated with the degrees of pathologic involvement in all sampled regions of the brain except the cerebellum. The concentration of thiamine in the mammillary bodies exceeded its concentration elsewhere in both control and SNE brains. The finding of low TTP levels in morphologically abnormal regions supports the hypothesis that TTP deficiency is etiologically related to SNE.


Fluorometric determination of pyruvate and alpha-ketoglutarate in cerebrospinal fluid and plasma of infants and children. A simple test that screen for metabolic disorders. Levels of pyruvate and alpha-ketoglutarate in the cerebrospinal fluid (CSF) of 26 children, aged 4 months to 5 1/2 years, with febrile seizures and of 19 children, aged 4 months to 14 years, with the diagnosis of epilepsy were not different from values seen in 119 "normal" children 8 days to 14 years of age. The CSF samples from 24 adults, 24 to 81 years of age, suspected of having a herniated disk were also examined. In the pediatric age group, the data showed a highly significant downward trend of CSF and plasma alpha-ketoglutarate values with age; pyruvate values did not change. A correlation of the values of the two keto acids in the blood and CSF of 42 other children without apparent neurologic disease was also made. Findings in a child with thiamine deficiency suggest that CSF alpha-ketoglutarate may be a more sensitive indicator of deficiency than plasma alpha-ketoglutarate or pyruvate. Measurements of these keto acids in plasma and CSF may be diagnostically useful in a variety of metabolic disorders. Findings in 155 children from birth (20 minutes) to 17 years of age without neurologic disease are submitted as a standard of reference.


Hypersomnia with periodic apneas in acquired micrognathia. A bird-like face syndrome. We describe a syndrome characterized by acquired micrognathia, hypersomnia, and periodic apneas during sleep. Six patients affected with the syndrome underwent nocturnal and diurnal polygraphic recordings that demonstrated that during sleep there is an uninterrupted succession of apneas, primarily the obstructive type, analogous to those observed in Pickwickian syndrome. Simultaneous recording of pulmonary and systemic arterial pressure during sleep and repeated blood gas analyses have shown that as soon as the apneas appear there is a decisive increase in pulmonary and systemic pressure and serious alveolar hypoventilation. The hemodynamic and ventilatory changes are even more intense during rapid eye movement sleep. Tracheostomy, performed on five of our patients, is the only treatment producing complete clinical remission of the syndrome.


Cerebral ischemic events associated with prolapsing mitral valve. Twelve patients who had no evidence of arteriosclerotic cerebral vascular disease, lacked hypertension or coagulation defect, and had not been receiving contraceptive therapy had recurrent transient cerebral ischemic attacks (TIAs) and partial nonprogressive strokes. All had prolapsing mitral valve proved by angiocardiography. The average age was 38 years, compared with 62 years in a larger series of patients with TIA associated with arteriosclerosis. We propose that the ischemic events are related to emboli emanating from the abnormal mitral valve with or without an associated paroxysmal cardiac arrhythmia.


Medullary actions of tetanus toxin. An electrophysiological study in man. Brain-stem reflexes have been studied in four patients with generalized tetanus. Inhibitory cutaneous reflexes were abolished or severely depressed. The same held true, to a lesser degree, for excitatory cutaneous reflexes with long polysynaptic pathways. Proprioceptive reflexes behaved variably. The observations are discussed in regard to the possible sources of enhanced motoneuronal activity in tetanus. It is concluded that, besides depression of inhibitory synapses on motoneurons, interneuronal damage may contribute to the tetanus symptomatology.


Postradiation motor neuron syndrome.

Postradiation motor neuron syndrome. We report an unusual case of selective lower motor neuron syndrome (MNS) complicating whole neuraxis radiation therapy. Only three well-documented similar cases have been found in a thorough review of the literature. The syndrome has a stereotyped time course and is self-limited. We discuss here possible pathogenetic mechanisms and their relationship to motor neuron disease.


Mercury poisoning in a dentist.

Mercury poisoning in a dentist. We examined a dentist with chronic elemental mercury poisoning electrophysiologically. Motor conduction in the upper and lower limbs was normal. Sensory nerve action potentials in the ulnar and median nerves were normal, but could not be elicited in the superfical peroneal nerves. Conduction velocity of the sural nerves was normal, but the action potential amplitude was abnormal. Following treatment with penicillamine, sensory conductions in the lower limbs returned to normal.


The effect of acidosis in hypokalemic periodic paralysis. Metabolic acidosis was produced in two patients with hypokalemic periodic paralysis by the administration of ammonium chloride over a period of three days. The challenging test of glucose and insulin produced a substantially smaller reduction of both serum potassium concentration and muscle strength than when the patients were tested in normal acid-base balance. The findings agree with earlier work on acetazolamide, suggesting that metabolic acidosis provides protection against episodes of muscle weakness in periodic paralysis.


X-linked ocular albinism. An oculocutaneous macromelanosomal disorder. Three unrelated kindreds with the Nettleship-Falls type of X-linked ocular albinism were studied. Postmortem examination of the eyes of an affected man revealed the presence of macromelanosomes in the pigment epithelia. Skin biopsy specimens of this patient, seven other affected male, and nine carrier female kindred members revealed the presence of Fontana-positive and dopa oxidase-positive macromelanosomes within the epidermis and dermis. Although clinically this disorder has been considered to be a form of albinism confined to the eyes, these findings indicate that an unusual disturbance in melanosome production characterized by macromelanosome formation affects the skin and the eyes. Histopathologic study of the skin is a useful adjunct in the diagnosis of X-linked ocular albinism, both in the affected and the carrier states. Linkage studies confirmed the close association of the Xg blood group with this disorder.


Platelet function, blood coagulability, and fibrinolysis in patients with low tension glaucoma. Platelet function in vitro and in vivo and certain measurements of blood coagulability and fibrinolysis were examined in 12 patients with low tension glaucoma and the results were compared with those obtained in 12 normal subjects matched for age, race, and sex. The data obtained seem to indicate that patients with low tension glaucoma cannot be readily distinguished from individuals of similar age and sex not afflicted with this disorder by measuring these variables. Thus, a "hypercoagulable state," ie, a thrombotic tendency, does not appear to be of major importance in the pathogenesis of this disorder.


Past pointing in comitant strabismus.

Past pointing in comitant strabismus. Faulty egocentric localization or "past pointing" has been reported in the literature only in association with paralysis or paresis of extraocular muscles, or mechanical restrictions of the globe. A case of past pointing associated with comitant strabismus, without evidence of extraocular muscle paralysis, paresis, or restriction is presented. This is believed to be the first reported case of past pointing in a patient with a comitant deviation.


Acute dacryocystic retention.

Acute dacryocystic retention. Acute dacryocystic retention is a disease of adults under 50 years old due to a noninfective foreign body blocking the nasolacrimal duct. It is characterized by the sudden onset of severe unilateral facial pain without significant localized swelling or erythema. Palpation of the involved lacrimal sac reveals slight induration and marked tenderness. Percutaneous aspiration of lacrimal sac contents, followed by probing of the nasolacrimal duct, is usually curative.


Sympathetic pupillary tone in old age.

Sympathetic pupillary tone in old age. In an attempt to determine whether autonomic neural factors might be involved in senile miosis, we tested pupillary responses to agents acting on the ocular sympathetic system in old subjects and compared them to responses in young adults. Our results suggest that sympathetic tone is decreased in the elderly. The dilator pupillae muscle does not lose its sensitivity to norepinephrine with age.


An unusual case of congenital hypertrophy of the retinal pigment epithelium. Photographic documentation of enlargement of congenital hypertrophy of the retinal pigment epithelium is shown in a 42-year-old white woman. No other reports of enlargement have been made and previous articles have stated that these lesions do not grow.


Accommodative esotropia during the first year of life. Two infants developed accommodative esotropia during their first six months of life. One infant, whose age at onset was 4 1/2 months, had 4.50 diopters of hyperopia. The second infant, whose age at onset was 5 months, had 3.50 diopters of hyperopia. In both infants, the eyes completely aligned with hyperopic correction. Two points are stressed. First, when the amount of hyperopia exceeds +3.00, consideration should be given to an accommodative element as the cause of the esotropia, even if the child is only 4 to 6 months old. Second, even with small angles of esotropia, an accommodative element should be considered, if there is a substantial amount of hyperopia.


Ectopic meningioma of the superior orbital rim. An ectopic meningioma occurred on the upper orbital rim in a 33-year-old man. Removal of this tumor was difficult because of its wood-like consistency and numerous calcifications, but excision led to a good cosmetic and functional result.


Cerebro-hepato-renal syndrome of Zellweger. Ocular histopathologic findings. An infant who was the product of a full-term pregnancy was born with multiple congenital defects, including diffuse bilateral corneal opacification. He failed to thrive and died at the age of 4 days. Autopsy findings were consistent with those seen in the cerebro-hepato-renal syndrome. Histopathologic examination of both eyes, obtained at autopsy, demonstrated similar changes. The main pathologic findings in the anterior segment were bilateral, diffuse corneal edema associated with paracentral iridocorneal adhesions and focal attenuation of Descemet membrane. Both retinas disclosed a selective degeneration of the outer nuclear layers and photoreceptors, confined mainly to the macular region. Atrophy of the optic disc and nerve, with reactive gliosis and demyelination, were consistent with findings in the central nervous system described in this syndrome.


Endothelialization of filtering bleb in iris nevus syndrome. Late failure of a filtering cicatrix occurred in a patient who had had surgery to control the glaucoma associated with the iris nevus syndrome (Cogan-Reese). The internal surface of the filtration site, as well as the anterior chamber angle, proved to be lined by corneal endothelium that had laid down a new, thick basement membrane (Descemet). The new endothelium-basement membrane probably obstructed the flow of aqueous into the bleb. Endothelialization of a filtering bleb is not unique to the iris nevus syndrome; other causes are discussed.


Differential reactivity of rabbit iris and ciliary process to topically applied prostaglandin E2 (dinoprostone). The topical application of prostaglandin E2 (dinoprostone) is followed by massive swelling of the ciliary process, leading to substantial leakage of marker dye into the posterior chamber and directly into the region of the iris, where the primary ciliary processes insert. In contrast, blood vessels of the iris proper retain most of their normal barrier quality and do not leak Evans blue dye. The adrenergic innervation of the anterior segment remains normal in density and in quality after the topical application of PGE.


Tomographic measurements of in vivo cataracts by slit-lamp photography. A practical method for detecting in vivo cataracts has been developed using a commercially available slit-lamp camera and by utilizing a measuring grid photographic technique. The basis of the method is to photograph a series of slit-beam sections through a lens at varying angles to the optic axis. The areas of opacity show up as localized regions of light back-scatter where the opacities intersect the path of the beam. A set of measuring grids compensated for angle distortion have been prepared. These are superimposed on the appropriate photograph. By taking a sufficient number of sections through a cataractous lens, a tomographic representation of the opacities can be constructed using a lens map. An example of the procedure of three-dimensional mapping is presented using actual lens pictures. The photographic parameters used in this method are  explained in detail. The method achieves the goals of ease of use, reproducibility, and applicability to research and clinical studies.


Simplified photogrammetry of the optic disc. Simplified photogrammetry of the optic disc depends on axis-correct fundus photography. The evaluation can be initiated by a time-based method of photogrammetry that proves presence or absence of change of the object. The degree of change can be simply measured by a telemetric device that permits one to evaluate the third dimension from stereophotographs.


["Zuggurtungs"-hip joint endoprosthesis (author's transl)]. On the basis of theoretical and experimental investigations to the problem of endoprosthetic replacement of the hip joint and the forces concerning the anchorage of the prosthesis a new model of prosthesis was developed and realized for practical use. In this paper this new "Zuggurtungs-Hüftendoprothese"  and the biomechanical principles are described in detail. The biomechanically derived postulations realized in the new prosthesis which are of primary importance to avoid the mechanical complications of loosening and breaking of the prosthesis are also decisive when optimal materials are used. They allow the implantation without bone cement by the primary acievable stable anchorage.


[Studies on the surface and new joint capsule of McKee-Farrar prosthesis implanted for several years (author's transl)]. These studies are intended as a critical contribution to the question, wether the McKee-Farrar (MF) prosthesis, on account of its stronger friction and the consequences of this, as compared to other models, still has its justification or wether these "secundary" manifestations indicate that this prosthesis should be abandoned. Studies on primary and secundary alteration of the surface were carried out on exchanged MF prosthesis with the aid of the grid electron microscope. The signs of wear are clearly visible and can be differenciated from production artefacts. The movement and deposit of abraded particles into the new joint capsule was studied qualitatively and quantitatively with the aid of radioisotopes. All samples showed an increased accumulation of chrome in the tissues as compared to cobalt. There is no indication of significant damage. On the basis of the results of these studies and on account of the favourable personal experience from a surgical and clinical point of view -- particulary with reference to minimal preparation of the acetabulum and ready replacement, the MF prosthesis will continue to hold its place as the standard model for total prosthetic hip joint replacement.


[Total hip replacement with isoelastic prosthesis in animals (author's transl)]. Uncemented fixation and low-fraction materials are the basis of this experiment. Plastics with an elasticity similar to the bone ("isoelasticity") show very propitious material qualities. The direct cementless incorporation of test bodies must be checked. In 63 sheep isoelastic total hip joints were implanted. After 2 till 51 weeks the animals were sacrificed and 44 specimen of hips and organs were explored macroscopically, radiologically, spherimetrically and histologically. The result was: 1. Plastic hip prosthesis are incorporated in the bone, but the boundary layer is built by a collagenous fiber tissue. 2. Loosening brings resoption of the bone and expansion of the structural changed soft tissue. 3. The transformation of the femoral cortex to osteoporosis is considered possibly as the consequence of an insufficient biological transfer of the weight. 4. Fractures of the femoral prosthesis-stem could not be observed. 5. The radiology allows at the pelvis prosthesis a concret statement concerning stability, on the femoral part a probable one. 6. The abrasion is minimal, the tissue reaction to abrasion products is unessential. 7. Small abrasion particles are carried of by the lymph tract and stored in the first regional gland. A more distant spreading is not demonstrable.


[Problems and results of Arthroplasty of the Knee Joint]. Since 1970 43 total knee arthroplasties were performed and the results of 34 operations reviewed. The average follow-up period was 2.4 years with a minimum of 6 months. We used 2 McIntosh, 8 Sledge, 9 Shiers, 8 Guepar, 3 Geomedic, 4 GSB prosthesis. The clinical results were very good in 56.2%. The failure and the high rate of loosening of the Shiers-Joint are stressed.


[Silent hip dysplasias (author's transl)]. Clinical and X-ray examinations for hip dysplasias in 500 babies in one ward showed 40% wrongly positive and 5.6% wrongly negativ (silent or masked) results, control of which necessiates roentgenograms in the second or third month or coltrolled spreading immediately after birth.


[Osseous bridging of the distraction gap in leg lengthening procedures (author's transl)]. The bony refill of the distraction-space in leg-lengthening operations is analysed by X-ray control and histological technic as well in animal experiments as clinical patients. Based on our observations a theory of the formation of bone is postulated: We figured out, that a) presumable besides the periosteal potentials of bone formation there are also other active mechanisms of bone growth to be found. b) frequently histological recognised formations of bones cannot yet be proved by X-ray, that means, that the X-ray changes follow the histological ones. c) optimal formation of callus needs most possible stability during the time of consolidation. d) most careful distraction prevents deformities.


[Wrist stabilization (author's transl)]. Based on our series of 48 wrist stabilization, the operative procedure and our modifications are described and the limits of this procedure discussed.


[Influence of age of the recipient on 85Sr uptake of tibia transplants in mice (author's transl)]. The 85Sr retention of syngeneic and allogeneic tibia grafts taken from 16-day-old mice was investigated using recipients of 16 days, 12 weeks and 1 year of age. 85Sr retentions of syngeneic grafts of the tibia were generally higher than those of allogeneic ones. Additionally, there was in all grafts an increased 85Sr uptake with increasing age of the recipients. Simultaneously an increased excretion of 85Sr was observed in the older recipients. This finding may be explained by the decreasing uptake of 85Sr by the whole skeleton of the older recipients, which was recorded by the decreasing 85Sr uptake of recipient tibiae, leaving more 85Sr in the common pool to be taken up by the grafts or to be excreted. However, the proportion of 85Sr uptake of syngeneic and allogeneic grafts was also changed with age of the recipients, leading to a decrease of the ratio 85Sr in syngeneic grafts versus 85Sr in allogeneic grafts of older recipients. This points to a decrease of the immunological response with increasing age of the recipients.


[Symptomatology in osteoarthrosis of the hip (author's transl)]. The pain symptom is examined in 91 hospitalized patients with osteoarthrosis of the hip. The impaired hipfunction, as determined by hip-rotation is compared to the severity of the arthrosis as determined by X-ray. Elected severe cases are contrasted as to their symptoms with patients suffering from still mild osteoarthrosis of the hip. Both groups consisted only of patients in whom the clinical severity grade conformed with the results of the X-ray. The differences between both groups are worked out.


[The operative treatment of recurrent and simple traumatic dislocations of the elbow by the method of Osborne and Cotterill (author's transl)]. The essential pathological defect causing dislocation of the elbow is failure of the postero-lateral ligamentous and capsular structures. A pocket of the capsule is created into which the head of the radius is received as it slides off its articulation with the humerus. Damage to the osteochondral surface of the radius and capitulum humeri is often significant in recurrent and also simple traumatic dislocations of the elbow joint. An osteochondral fracture may occur in simple dislocation happening but once and predispose for recurrent dislocation. For treatment of recurrent dislocation we prefer the simple method of Osborne and Cotterill because in our opinion it attacks the essential lesion. More complicated techniques such as bone blocks or tendon transfers, are believed to be less effective and unnecessary. Four patients with recurrent dislocation of the elbow joint were treated successfully by this method, based on an follow-ups of from 2 to 4 years. Encouraged by the results we transferred the method to the treatment of simple traumatic dislocations in 10 patients. A follow-up of these patients has shown that an early operation will give satisfactory functional results. In the meanwhile the method of Osborne and Cotterill has become a standard technique for the treatment of osteochondrosis dissecans too by the authors.


[Data on the pathogenesis of solitary juvenile bone cysts (author's transl)]. On the basis of the histologic analysis of 45 solitary (juvenile) bone-cysts the author reveals new aspects of the pathogenesis. I. Data on sex-age-localisation are referred to. II. Due to the hemosiderosis regularly manifesting itself in the loose connective tissue layer lining the cyst and owing to the similarity to the liquified hematomas to be found elsewhere in the organism, as well as on the basis of the specific blood-supply conditions of the spongiosa of the increasing metaphysis the author presumes the intramedullary hemorrhage--possibly occurring also without fracture--to be the primary change. III. In the lining layer of the cyst, as well as in the adjacent bony tissue the author frequently observed capillary stase and to a considerable degree lymphedemas (resorption insufficiency). On the basis of these data the author presumes that the following mechanism might be hold responsible for the persisting of the cyst: The congestive (anoxic) wall of the capillary gets permeable for the proteins. Hence the fluid of high protein content, filling the cyst is constantly replaced. It is emphasized that solely the lymphatic vessels are apt to convey proteins. On the basis, however, of the histologic phenomena (lymphedema) observed, the pericystic lymphatic system is in the stage of relative insufficiency.


[Biomechanics of human tendons: connection between stress relaxation and stress recovery (author's transl)]. 108 tendons of the m. extensor hallucis longus were examined with a tensile testing machine within 36  h after death. The specimen were kept at a resting length of 20 mm. After the "steady state" was reached by cyclic loading, the tendons were stretched up to a maximum load of 18 kp, then deloaded to a certain level and after that the elongation was kept constant. At high loading level the tension of the tendon decreases with time (relaxation). At medium and low loading level the tension increases slightly (mechanical recovery). Between that two regions there is a certain load, where the tension will not change with time (isorheological point). The position of the isorheological point depends on the velocity of the elongation. At low velocity (2 mm/min) the isorheological point is situated at 70%, at high velocity (12 mm/min) at 60% of the maximum load. One will find the maximum relaxation, when no deloading occurs. The mechanical recovery, however, has its maximum at 5--25% of the maximum load. But when the tendon is totally deloaded, there seems to occur no recovery. The maximum relaxation is 5 to 6 times larger than the maximum recovery. Supposingly the relaxation- and recovery-processses will happen at the same time but with different intensity depending on the loading level. At least the relaxation-process consists of different relaxation components with different relaxation times. This will explain the phenomenon of a "secondary relaxation": After a long time of registration the recovery will turn into a slight relaxation.


[What has brought us the Colonna plastic? (author's transl)]. From 1960--1967 a series of 34 hip joints with high dislocation were treated by Colonna capsular arthroplasty. 28 hip joints were followed up. Clinical results revealed excellent results in 3 hip joints, good results in 5 hip joints, fair results in 14 hip joints and poor results in 6 hip joints. 15 hip joints were without complaints. Radiologically there was only one hip with an excellent result, 8 times the result was good, 10 times fair and 9 times poor. Poor results tended to occur in hip joints with bilateral involvement and when deformation of the epiphysis developed. The capsular arthroplasty may be a useful operation if there is a consequent preoperative traction, a consequent splinting after the operation, a good technique according to Colonna's regimen and if the child is between 3 and 7 years old.


The fate of the articular cartilage in intracapsular fracture of the femoral neck (articular cartilage in femoral neck fracture). The fate of the articular cartilage of the hip joint with intracapsular neck fracture was studied by histological, histochemical and autoradiographic techniques and by using a polarized microscope and a scanning electron microscope. Cartilage specimens from 93 femoral heads and 7 acetabula were obtained from fractured hips 2 days to 4 1/3 years postfracture and from control hips with various disorders. The cartilage degeneration appeared 2 weeks after fracture and advanced steadily with time. The matrix was covered, invaded and ultimately replaced by the fibrous tissue. Chondrocyte viability, though it was lost from the surface, was recognized in the deep matrix even in the oldest fracture examined. It is concluded that the humoral factor directly caused by the injury as well as the biomechanical impairment, i.e. a loss of physical stress, may play an essential role in the pathogenesis of the degeneration. The possibility of regeneration was discussed.


[Aplasia of the tibia and reduplication of the femur (author's transl)]. Reduplication of femur has been reported previously in literature only in 11 cases. Two more cases are described and the etiology of this disease is discussed.


On modeling the ligamentous spine philosophy and implementation. The body's equilibrium is possible thanks to the integration of skeletal structure, vertebrae, ligaments and muscles to form one functional unity. The forces which determine posture are composed of two complementary systems, the ligamentary and the muscular systems, which together determine a dynamic act of balance. The ligaments operate mainly against the visco-hydraulic pressure of the nucleus pulposus and bind the vertebral bodies together, whereas the muscles exhibit an antigravity function and support spinal stability. A mathematical model based on a mixed theory of directed and oriented curves is proposed. Through this model it is possible to develop an exact theory governing the deformation of the ligamentous spine. This theory should be universal in the sense that it can be used to supply the spine in any of its environments.


[Bilateral fracture of the scapulae caused by a convulsive seizure (author's transl)]. The authors report a case of bilateral communicated fractures of the scapulae caused by a seizure of unknown etiology. The differential diagnostic problems and the mechanism of inquiry are being discussed.


[Behaviour of pertrochanteric fractures of the femur after condylar nailing under dynamical stress (author's transl)]. In continuation of our studies on dynamic tolerance after condylar nailing in pertrochanteric fractures, we have examined the femora of patients who died within the first 2 weeks after surgery and studied their stress tolerance. We appreciated the lack of the weight bearing medial cortical bone and the need for abduction at the fracture site by the behaviour under stress. The results under stress could be compared with an experimental fracture model. From these experiments conclusions have been made for the correct placement of condylar nails for their best static advantage.


Special audiometric test battery in 121 proved acoustic tumors. The usefulness of a special audiometric test battery was analyzed in relation to overall and individual test efficiency for the diagnosis of retrocochlear disease. Data were collected and analyzed from 118 patients with 121 surgically confirmed acoustic neuromas and were compared with an earlier report of 200 similar cases. While audiologic testing plays a major role in the identification of retrocochlear disease, the test battery is not highly efficient. Eleven percent of our neuromas had no audiologic signs and, therefore, escaped audiologic detection. The efficiency of individual tests range from 47% to 77%, while the difference in efficiency between the tone-decay test (77%) and the entire battery (89%) indicates the continued need for more than one test. The low efficiency of some of the components justifies reappraisal and revision of the present test battery.


[Homologous articular cartilage transplantation in animal experiments. Preliminary studies on sheep (author's transl)]. Homologous articular cartilage without subchondral bone instead of the usual osteochondral grafts was transplanted in sheep. The transplants were fixed to the host by a biological tissue adhesive based on fibrinogen clotting. Light- and electronmicroscopic studies showed viable transplants up to 7 months and a stable bony union with the host through endochondral bone formation. A additional external fixation of the joint after transplantation or the use of a conventional cyanoacrylate tissue adhesive failed to achieve positive results. The relations of these preliminary findings for restorative techniques of articular cartilage defects are discussed.


Cholesteatoma of the middle ear in human patients. An ultrastructural study. The structure of middle ear cholesteatoma obtained at surgical interventions in 12 patients was investigated by light and electron microscopy. Keratinizing squamous epithelium with underlying granulomatous, partly necrotic tissue showing signs of an acute or chronic inflammatory reaction was observed. Cholesterol clefts were only observed in two specimens in which a chronic hemorrhage was present. It is proposed that a cholesteatoma starts by immigration of epidermal tissue from the tympanic membrane. Destruction of the middle ear components and of the neighboring osseous walls results from invasion of squamous epithelium, underlying necrotizing connective tissue, and keratin.


The phenomenon of paradoxical nasal obstruction. Some patients with a fixed uninasal obstruction in whom the normal or patent side becomes temporarily obstructed because of the nasal cycle, and in whom the total nasal resistance is elevated, complain of nasal obstruction. It is when the normal side responds to the congestive phase of the nasal cycle that the patient becomes symptomatic; hence, the term "paradoxical nasal obstruction." Rhinomanometric tests, serial tomography, and direct patient observation allow confirmation of the phenomenon of paradoxical nasal obstruction.


Secretory otitis media. Late results of treatment with grommets. In 108 children (184 ears) with chronic secretory otitis treated with grommets, the condition at one-to-five years follow-up was compared with that at five-to-eight years follow-up. At the latter time, hearing was extremely good, 97.5% of the ears having a speech reception threshold (SRT) of 20 dB or less. However, only 67% of patients could be classified as cured by normal tympanometry. The remaining ears showed a negative middle-ear pressure of 100 to 300 mm H2O (25%), recurrent accumulation of secretion (1.6%), adhesive otitis (3.3%), perforation (1.7%), or cholesteatoma (1%). The eardrum was normal in 44% of patients, while in 25% it was diffusely atrophic, lax, or retracted.


An implantable electromagnetic sound source for speech production. Many operative and nonsurgical procedures have been designed for vocal rehabilitation following laryngectomy, but as yet a consistently successful solution with a negligible complication rate has failed to materialize. In our laboratory during the last two years, experiments have been carried out in dogs using active electromagnetic devices placed in the retropharynx as an energy source for speech production. An implantable porous coated stainless steel electromagnetic device energized from an externally controlled oscillator has been developed. Factors under investigation included biocompatibility of materials, durability, noise quality and intensity, together with the efficiency of the system. As a result of the favorable findings, it is envisaged that this system will soon be used in a carefully designed restricted clinical trial as a secondary procedure in those consenting cured laryngeal cancer patients who have failed to develop esophageal speech.


Osmolality changes in perilymph after systemic administration of glycerin. Blood osmolality was altered in guinea pigs by intravenous administration of glycerin (glycerol). After glycerin administration, serum osmolality increased rapidly, reaching a plateau within 15 minutes. Perilymph osmolality lagged significantly behind the increase of serum osmolality and equalled serum osmolality only after one hour. While perilymph osmolality responded to changes of serum osmolality, there was some time lag noted in the response of perilymph, suggesting the existence of a blood-labyrinth barrier. It was observed that this barrier is permeably to glycerin and water, suggesting the possibility of transient reduction of hydrostatic pressure in the labyrinth by the injection of an osmotic agent into the systemic circulation.


Carcinoma of the supraglottic larynx. A review of 221 cases. Between 1962 and 1971, 221 patients (197 men and 24 women) with carcinoma of the supraglottic larynx were treated at our institution. Most of the patients were in the sixth and seventh decades of life. In 89% of the patients, the epiglottis was involved. One hundred ninety patients underwent surgery, 161 for cure initially and 29 for salvage after radiation failure. Definitive surgery included laryngectomy in 117 patients and conservation procedures in 40. Fifty-five patients were treated by radiation for cure. Survival rates after laryngectomy or supraglottic laryngectomy were similar, but radiation therapy carried a poorer prognosis than did definitive surgery. Routine neck dissection was not necessary in all patients with supraglottic carcinoma.


Comparative study of pure-tone, impedance, and otoscopic hearing screening methods. A survey of native Indian children in British Columbia. A survey of 1,109 native Indian children in five communities in British Columbia was conducted to determine incidence of middle ear pathologic features and to compare impedance and pure-tone audiometry as hearing screening methods. Survey teams included a public health nurse, two otologists, and two audiologists. On ear, nose, and throat (ENT) otoscopic examination, the incidence of middle ear disease requiring treatment was 12%. Disease was most prevalent in the preschool- and primary school-aged children. Pure-tone audiometry yielded 62% normal and 19% abnormal results. Nineteen percent of the children could not be tested by this method. Impedance audiometry yielded 54% normal and 38% abnormal results on the stringent criteria used to define the parameters of normality. Eight percent of the children could not be tested. Since there was a high incidence of middle ear pathologic features in the preschool group of children who could not be successfully evaluated by pure-tone audiometry, it is suggested that further investigation of impedance audiometry be undertaken in order to define parameters that will provide the most reliable referral criteria.


The nasal bony dorsum and cartilaginous vault. Pitfalls in management. Our literature is replete with technical descriptions of rhinoplasty techniques designed to avoid certain complications. Analysis of 153 secondary rhinoplasties indicates that no procedure is immune to undesirable results and no specific technique can be employed to manage all potential problems. Critical scrutiny of these cases both preoperatively and intraoperatively indicated a decided recurrence of certain complications in the nasal bony dorsum and cartilaginous vault. Fifty-eight defects of the bony dorsum were encountered. These defects included open vault, wide dorsum, asymmetry, excessive or inadequate hump removal, abnormal nasofrontal angle, step deformities, and bony irregularities. Defects in the cartilaginous middle third of the nose occurred 91 times. These consisted to supratip prominence, valve collapse, asymmetry, and saddle deformity.


Postirradiation malignant salivary gland tumor. Information concerning the relationship between salivary gland tumors and prior exposure to radiation for benign conditions or by accident is slowly being gathered. As yet, no statistical confidence can be established in this relationship. Very likely, this confidence will require studies akin to those done on the problem of thyroid cancer and irradiation. Including the case reported here, 50 tumors of the salivary glands have been reported to have followed prior radiation exposure. Twenty-three of these tumors have been malignant, with the mucoepidermoid carcinoma the most frequent histological type. The latent period in salivary tissues is 20 or more years.