Electrophysiology of barbiturate withdrawal in the spinal cord. Cats were made physically dependent on sodium pentobarbital using the "maximally tolerable" dosing technique. All animals treated this way receive equieffective doses chronically and all become severly dependent. After 5 weeks of treatment each cat displayed withdrawal signs indicative of severe physical dependence. At specific times after the last dose, electrophysiological measurements of spinal cord segmental reflex function were made. Under brief volatile anesthesia, a C1 spinal section was performed. The lumbar spinal cord was exposed by laminectomy and a hindleg was dissected to provide peripheral nerves for stimulation. Recordings were taken from ventral roots L7 and S1 that had been cut near their exits through the dura. Following single, supramaximal sciatic nerve shocks, monosynaptic (2N) responses were not altered during withdrawal, but both the amplitude and duration of polysynaptic response and of afterdischarge were increased withdrawing cats. The rate of 2N synaptic recovery, measured by a paired stimuli technique, was found to be increased during withdrawal. The 2N pathway was able to transmit more effectively during repetitive stimulation since there was less decrement in response during transmission. The relationship between post-tetanic potentiation and tetanic frequency was shifted toward lower frequencies. The size of the motor neuron pool, estimated by maximum post-tetanic potentiation, and the 2N discharge zone were not altered. Background discharge ("noise") was increased during withdrawal.


Correlation between the in vivo and an in vitro expression of opiate withdrawal precipitated by naloxone: their antagonism by l-(-)-delta9-tetrahydrocannabinol. Guinea pigs treated with a single s.c. injection of a slowly released morphine suspension (300 mg/kg) exhibited a quantifiable withdrawal syndrome after naloxone injection (0.01-10 mg/kg s.c.). Ileum removed from such animals responded to naloxone (1-300 ng/ml) by contracting. These contractions could be blocked by scopolamine or tetrodotoxin. Both the in vivo and in vitro responses were specific for the opiate-dependent state and were dependent on naloxone dose. Time courses of the development and decline of the two responses were similar. Weaker opioids, pentazocine and codeine, were less effective than morphine in producing a dependent state and sensitizing ileum to naloxone. 1-(-)-delta9-Tetrahydrocann abinol [1-(-)-delta9-THC] antagonized the effect of naloxone on ileum without affecting responses to acetylcholine. 1-(-)-delta9-THC produced a stereospecific, dose-dependent (1-10 mg/kg p.o.) inhibition of naloxone-precipitated withdrawal in guinea pigs and rats that was more complete than and different from that produced by sedatives. Pentobarbital inhibited withdrawal only at doses that produced ataxia. 1-(-)-delta9-THC had a biphasic effect on locomotor activity of guinea pig in the dose range that inhibited withdrawal, stimulation at 1 mg/kg and depression at 3 to 10 mg/kg. Our results suggest that cannabinoids may be useful in opiate detoxification. The inhibition by 1-(-)-delta9-THC of the action of naloxone in "dependent" ileum seems to be via reduction in acetylcholine release. Whereas the end result of 1-(-)-delta9-THC action in brain may not necessarily be a reduction in acetylcholine release as in ileum, the mechanism by which it produces this effect in the ileum model may explain its ability to antagonize withdrawal.


Drinking patterns as predictors of alcohol withdrawal reactions in DBA/2J mice. Individually housed DBA/2J mice were fed a liquid diet in which ethanol supplied 33% of the calories. The level of physical dependence that developed was estimated by scoring convulsions, elicited by handling the mice, after discontinuing the alcohol diet. The severity of the withdrawal reaction increased progressively with duration (5-12 days) of alcohol administration. A 2-day period on the diet produced no withdrawal reaction. Pretreatment of the mice with alcohol in their drinking water slightly increased the subsequent intake of the liquid diet. "Effective" alcohol intake was defined as uninterrupted alcohol consumption above 10 g/kg/day. Withdrawal scores correlated better with effective intake than with total intake under a variety of conditions. We interpret this to mean that brief interruptions in drinking (1 day) may allow the accrued physical dependence to disappear. On the basis of their effective alcohol intake, mice could be assigned to nondependent, moderately dependent or severely dependent groups for further study of the nature of physical dependence.


Reinstatement of vaginal cycles in aged female rats. Old constant estrous and young cycling control rats were injected with L-dopa, 200 mg/kg, for a period of 14 days. L-Dopa reinstated vaginal cycling in the old rats and it did not affect the vaginal cycling in young rats. Likewise, 200 mg/kg of L-tyrosine reinstated vaginal cycling. The effect of L-dopa on old rats was blocked by pimozide, by high doses of MK-486 and Ro 4-4602, and by fusaric acid. High doses of phenoxybenzamine or L-propranolol did not alter the L-dopa effect on old rats. A low dose of MK-486 or Ro 4-4602 increased the efficacy of L-dopa in reinstating vaginal cycling. These results suggest that L-dopa reinstates vaginal cycling in old rats by stimulating dopamine receptors. The possibility that a simultaneous stimulation of norepinephrine alpha and beta receptors and/or a decrease of central nervous system serotonin is necessary for this effect is discussed.


The effect of dopamine on neurohypophysial hormone release in vivo and from the rat neural lobe and hypothalamus in vitro. 1. The rat hypothalamus (containing the supra-optic nuclei, paraventricular nuclei, median eminence and proximal pituitary stalk) has been incubated in vitro and shown to be capable of releasing the neurohypophysial hormones, oxytocin and arginine vasopressin, at a steady basal rate about one twentieth that of the rat neural lobe superfused in vitro. 2. The hypothalamus and neural lobe in vitro released both hormones in a similar arginine vasopressin/oxytocin ratio of about 1-2:1. However, when release was expressed relative to tissue hormone content, the hypothalamus was shown to release about three times as much arginine vasopressin and six times as much oxytocin as the neural lobe. 3. Dopamine in a concentration range of 10(-3)-10(-9)M caused graded increases in hormone release from the hypothalamus in vitro to a maximum fivefold increase over preceding basal levels. The demonstration that apomorphine also stimulated hormone release whereas noradrenaline was relatively ineffective suggested that a specific dopamine receptor was involved. A separate cholinergic component in the release process was indicated by the finding that acetylcholine stimulated release to a maximum fivefold increase in concentrations of 10(-3)-10(-9)M. 4. The fact that the isolated hypothalamus can be stimulated by dopamine and acetylcholine to release increased amount of oxytocin and arginine vasopressin raises the question of the origin and fate of the hormones released in this way. The possibility that they could be released into the hypophysial portal circulation from median eminence to affect the anterior lobe of the pituitary is discussed. 5. In similar doses, both dopamine and noradrenaline injected into the lateral cerebral ventricles of the brain of the anaesthetized, hydrated, lactating rat caused the release of arginine vasopressin and oxytocin. Apomorphine release both hormones but at a higher dose level and to less effect than the catecholamines. 6. The hormone release induced in vivo by dopamine could be prevented by the prior administration of haloperidol or phentolamine and these antagonists were equally effective in blocking the hormone release due to noradrenaline. The involvement of a specific dopamine receptor was more clearly implicated by the use of pimozide which completely inhibited the hormone release due to dopamine and apomorphine but not that due to noradrenaline. 7. It is suggested that the release of neurohypophysial hormones can be stimulated via a dopaminergic nervous pathway in addition to a cholinergic one. The possibility that the osmoreceptor mechanism for the release of antidiuretic hormone from the neural lobe of the pituitary may involve such a dopaminergic pathway is discussed.


The effect of transmural pressure on pumping activity in isolated bovine lymphatic vessels. 1. Isolated preparations of bovine mesenteric lymphatics containing about seven valved segments were cannulated and set up in a perfusion system so that, when the preparation was not contracting, the inflow and outflow pressures were exactly equal and there was no flow through the preparation. 2. Transmural pressure was varied by raising or lowering the inflow and outflow pressures simultaneously by the same amount. 3. The isolated vessels showed rhythmic spontaneous activity; it consisted of quick contractions which spread rapidly over the entire preparation, each followed by a rapid relaxation and a diastolic pause. 4. With each contraction, the preparation decreased in both length and diameter and generated an outflow pressure which pumped fluid in the direction determined by the orientation of the values. 5. Raising the transmural pressure in the preparation increased the output of the preparation; this was achieved by an increase in both the frequency and force of the individual contractions. 6. It was concluded that bovine lymphatics could propel fluid by their intrinsic activity at a rate which was related to the degree of distension of their walls.


Tonoplast action potential in Nitella in relation to vacuolar chloride concentration. The action potential of Nitella internode was studied in relation to K+ and C1- concentrations in the vacuole. When the vacuole of Nitella pulchella was filled with an artificial solution with extremely low C1- concentration, a diphasic action potential (DAP) was observed. T he first phase consists of a rapid depolarization followed by a relatively rapid repolarization, and the second one consists of a strong hyperpolarization followed by a gradual return to the resting potential. When the cell was stimulated immediately after the generation of DAP, a monophasic action potential which resembles an action potential of the natural cell was observed, indicating that the DAP consists of two components with different refractory periods. The refractory period of the component responsible for the depolarizing is shorter than that of a component responsible for the hyperpolarizing phase. Measuring the plasmalemma potential and vascuolar potential separately, it was demonstrated that the hyperpolarizing component of DAP originates from the tonoplast. The action potential of the tonoplast, in contrast with that of the plasmalemma, could be generated independently of concentration of K+ in the vasuole. Since the maximum amplitude of hyperpolarization decreased significantly by increasing C1- concentration of the vacuole, it is concluded that the tonoplast is very sensitive to C1- during excitation.


Effect of a diet with high levels of protein and fat on colon carcinogenesis in F344 rats treated with 1,2-dimethylhydrazine. Female inbred F344 rats fed diets containing high levels of beef protein and fat or high levels of soybean protein and corn oil and treated with 1,2-dimethylhydrazine had a greater incidence of colon tumours than did rats fed diets that had normal levels of such components and were treated similarly. The source of fat and protein had no major influence on the incidence of colon tumors.


Characterization of polysome-associated RNA from influenza virus-infected cells. Virus-specific polysome-associated RNA (psRNA) and RNA after dissociation of polysomes were analyzed by direct hybridization with unlabeled viral RNA (vRNA) and complementary RNA (cRNA). psRNA after a 30-min pulse with [3H]uridine contained 28% labeled cRNA, 70% host RNA, and no vRNA. After dissociation, psRNA sedimented heterogeneously. Heavy RNA (greater than 60S), ribosomal subunit RNA (rsuRNA, 30-60S), free mRNA (fmRNA, 10-30S), and light RNA (less than 10S) contained 16%, 54%, 70% and 28% cRNA, respectively, but no vRNA. When actinomycin  D (AcD) was added at 2 h postinfection, the nature of the psRNA depended on the concentration of AcD and the condition of the labeling. At AcD concentrations of 1 mug or more per ml, no detectable vRNA or cRNA was associated with polysomes. At 0.2 mug of AcD per ml (a concentration that partially inhibited cRNA synthesis)  and 2 h of labeling at 2.5 h postinfection, psRNA contained 40% viral-specific RNA, which included both vRNA and cRNA in almost equal amounts. When polysomes were dissociated, however, viral-specific fm RNA from AcD-treated cells contained exclusively cRNA and no detectable vRNA. Increasing amounts of labeled vRNA were present in the heavy region of the gradient (and in the pellet), which also contained varying amounts of cRNA. The labeled vRNA appears to be associated with polysomes in a cesium chloride density gradient (rho = 1.525 g/ml). Although we have ruled out the trivial explanation of viral ribonucleoprotein contamination,the nature of the complex containing both polysomes and vRNA is unknown.


Three structural polypeptides coded for by minite virus of mice, a parvovirus. Purified full and empty virions of minute virus of mice were separated on CsCl gradients, and their polypeptides were examined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The empty particle contains two polypeptides, A (83,300 daltons) and B (64,300 daltons), which are 15 to 18% and 82 to 85%, respectively, of the virion mass. The full particle contains the single-stranded DNA genome, proteins A and B, and a third polypeptide, C (61,400 daltons). Again A is 15 to 18% of the protein mass, but the amounts of B and C vary inversely in different preparations of full particles. These polypeptides comprise greater than 99.6% of the protein in either virion, and their molecular weights and molar ratios are independent of the species of host cell on which the virus is propagated, They are not found in uninfected cells, and no protein component of uninfected cells copurifies with either virion under our conditions. Pulse-chase experiments show that the three proteins are synthesized only after virus infection and are therefore probably virus coded. Sequential harvesting from the nuclei of cells infected under one cycle growth conditions shows an increase in the proportion of C in full particles as infection progresses, suggesting that C is derived from B in a late maturation step.


Transcription of the genome of adenovirus type 12. III. Maps of stable RNA from productively infected human cells and abortively infected and transformed hamster cells. The adenovirus type 12-specific mRNA and the stable nuclear RNA from productively infected KB cells, early postinfection, from abortively infected BHK-21 cells, and from the adenovirus type 12-transformed hamster lines T637 and HA12/7 have been mapped on the genome of adenovirus type 12. The intact separated heavy (H) and light (L) strands of adenovirus type 12 DNA have been used to determine the extent of complementarity of the mRNA or nuclear RNA from different cell lines to each of the strands. More precise map positions have been obtained by the use of the H and L complements of the fragments of adenovirus type 12 DNA which were produced with the EcoRI and BamHI restriction endonucleases. The results of the mapping experiments demonstrate that the mRNA's isolated early from productively and abortively infected and from two lines of transformed cells are derived from the same or similar regions of the adenovirus type 12 genome. The map positions on the adenovirus type 12 genome for the mRNA from the cell lines as indicated correspond to regions located approximately between 0 and 0.1 and 0.74 and 0.88 fractional length units on the L strand and to regions between 0.63 and 0.74 and 0.89 and 1.0 fractional length units on the H strand. The HA12/7 line lacks mRNA complementary to the region between 0.74 and 0.88 fractional length units on the L strand. Similar data are found for the nuclear RNA, except that the regions transcribed are more extensive than those observed in mRNA. The polarity of the H strand has its 3'-end on the right terminus in the EcoRI A fragment, and the L strand has its 3'-end on the left terminus in the EcoRI C fragment. Thus, the H strand is transcribed from right to left (1 = leftward strand); and the L strand is transcribed from left to right (r = rightward strand). The designations H and L refer to the relative heavy and light densities of the two strands in polyuridylic-polyguanylic acid-CsCl density gradients. The EcoRI C-H and D-H complements have been shown to be part of the intact L strand; thus, there is a "reversal in heaviness" on the left terminus of the viral DNA.


Intracellular forms of adenovirus DNA. V. Viral DNA sequences in hamster cells abortively infected and transformed with human adenovirus type 12. The persistence of viral DNA in BHK-21 cells abortively infected with human adenovirus type 12 has been investigated using reassociation kinetics. No indication of an increase in the amount of viral DNA per cell has been found. On the contrary, the amount of intracellular viral DNA sequences decreases rapidly after infection. Thus, free adenovirus type 12 DNA does not replicate in BHK-21 cells. The influence of the multiplicity of infection on the amount of persisting adenovirus type 12 DNA has also been explored. The viral DNA sequences persisting in four lines of hamster cells transformed in vitro by adenovirus type 12 at various multiplicities of infection have been quantitated and mapped by reassociation kinetics experiments using restriction endonuclease fragments of 3H-labeled adenovirus type 12 DNA. All the EcoRI restriction nuclease fragments of the adenovirus type 12 genome are represented in each of the four cell lines. Individual fragments of the viral genome are represented in multiple copies in non-equimolar amounts.


Surgical validation of angiographic studies of renal lesions. We reviewed 428 renal arteriograms done during a 5-year period to document the accuracy of angiography in the diagnosis of renal mass lesions and non-function. Subsequently, 198 kidneys (46%) were explored for treatment and diagnostic confirmation. Of the kidneys explored 87 (44%) were radiologically diagnosed as benign cysts. At exploration 6 diagnostic errors were proved, including 3 malignant and 3 benign lesions. The falsely negative malignancy rate was 3% in this category. The angiographic diagnosis of definite tumor was proved to be 100% accurate at operation. However, 3 tumors were benign, representing an 8% falsely positive diagnosis for malignancy. Of the kidneys explored 8% were angiographically diagnosed as being indeterminate. A variety of lesions were found, including 1 benign tumor, 1 malignant tumor and 5 inflammatory lesions. Two malignant lesions were found when exploring angiographically defined hydronephrosis. The remaining kidneys explored carried various diagnoses and were all proved to be correct surgically. Operative mortality was 0.5% but 9 kidneys with benign lesions were sacrificed owing to diagnostic indecision.


Radiographic findings immediately after urethral rupture: an experimental study and case reports. Herein are reported the results of radiographic studies made immediately after experimentally produced partial and complete urethral ruptures. In cases of partial rupture retrograde urethrography demonstrated extravasation of dye at the site of injury and contrast medium in the bladder. In cases of complete rupture retrograde urethrography demonstrated extravasation of dye at the site of the urethral disruption but no contrast medium reached the bladder because of retraction of the divided ends. Two case reports confirmed these findings.


Stage III germinal testis tumors: aggressive approach. We used aggressive individualized combinations of operation and cyclic actinomycin D therapy and/or irradiation for 12 patients with stage III germinal testis tumors, including 1 seminoma. Eight patients have survived free of tumor for 24 to 83 months. All but 1 survivor had retroperitoneal lymphadenectomy. Five thoracotomies and 4 neck resections were used to manage distant metastic lesions. Cyclic actinomycin D was used in 7 of 8 survivors. The experience with this series and a review of cases in the literature strongly suggest the need to eradicate the most common source of tumor seeding the distant metastatic sites from the retroperitoneal lymphatics. Eradication can best be accomplished by retroperitoneal lymphadenectomy and is indicated even in patients with a complete response to chemotherapy. A general treatment plan is suggested for stage III testis tumors: selective irradiation and chemotherapy for seminoma and an aggressive individualized combination of operation and chemotherapy with irradiation in some instances for non-seminomatous disease.


Differential susceptibility of L cells in the exponential and stationary phases to cadmium chloride. Comparative studies of the cellular toxicity and uptake of cadmium in L cells in the exponential and stationary phases were done. The LD50 of cadmium chloride to L cells in the exponential and stationary phases was 5.5 and 30.5 muM respectively and the cadmium content of L cells exposed to 5.4 muM cadmium chloride for 3.5 hr in the exponential and stationary phases was 0.123 and 0.065 mug/10(6) cells, respectively. These results suggest that the higher susceptibility of cells in the exponential phase to cadmium may be caused by an increased permeability of the cell membrane to cadmium.


Perceptual conflict between vision and touch. Although most of the studies support the conclusion that a perceptual conflict may be resolved in the visual dominance, a few suggest its prematurity and methodological problems. In the present study, the conflict was made by the instruction and the trick in order to keep the S's naivety, and the degree of conflict was varied. wthe visual comparison (vision), the haptic comparison (touch), the visual-haptic comparison (drawing by a pencil), and the haptic-visual comparison (production by the plasticine) were used as the comparison procedures. The result was that the perceptual conflict was resolved in a compromise between vision and touch. However, as the degree of conflict became greater, the judgements in the conflict tended to depend upon the comparison procedures. And in such a conflict taht the visual size was smaller than the tactual, the vision dominance tended to occur, and vice versa.


[Role of the intramural ganglion cells played in the motility of the large intestine of the tortoise, Geoclemys reevesii]. The development of the intramural plexuses in the tortoise, Geoclemys reevesii was inferior to that observed in the fowl: the meshes of both Auerbach's and Meissner's plexuses were coarser, and consisted of less number of nerve fibers. Occasionally, a small ganglion was seen at the crossing points of the meshes. The average number of nerve cells contained in the ganglion was estimated to be 1500/cm2, being about half as much as that estimated in the fowl. When the mucosa of a colon in vitro was stimulated mechanically by stroking or chemically with 1/10 N HCl, the excitability of the colonic muscle was raised at the region oral to the stimulated spot, but lowered at the region anal to it. These effects were abolished by applying a ganglion-blocking agent, hexamethonium (10(-6) g/ml), to the mucosa. When the intraluminal pressure of a colon in vitro was raised from 0 to 3-12 cm H2O, the colon was distended at first but soon contracted powerfully. The contraction became extremely reduced or was abolished when hexamethonium (3.5X10(-7) approximately 1X10(-5) g/ml) was added to the saline solution in which the colon was immersed. The results indicate that the intramural ganglion cells serve as the center of the intrinsic mucosal reflex.


[On gastric corpus-pyloric antrum inhibitory reflexes (author's transl)]. Twenty eight adults dogs fasted over night were used under Nembutal anesthesia. The influences of distension of the pouch which was made on gatric corpus on the motility of gastric pyloric antrum were investigated. The following results were obtained. 1) Any changes were not observed on the motility on gastric pyloric antrum by distension of gastric corpus pouch by a pressure of 20 mmHg, but a stepwise elevation of the lumen pressure of the pouch from 50 mmHg to 100 mmGh, elicited a remarkable relaxation of the tone and inhibition of motility of the pyloric antrum. These inhibitory responses were not abolished by the bilateral cervical vagotomy or by the bilateral splanchnicotomy respectively, but these inhibitory reflexes were disappeared completely after the transection of both extrinsic nerves. 2) The inhibition of motility of gastric pyloric antrum were also elicited by the electric stimulation of the central cut end of vagal branch or of splanchnic branch which innervated the gastric corpus respectively. 3) It may be concluded that the reflex pathways of the gastric corpus-pyloric antrum inhibitory reflexes involve not only in vagus nerves but also in splanchnic nerves.


[An experimental study on the mechanism of bile excretion of the choledochoduodenal junction (author's transl)]. The present study was undertaken to elucidate the mechanism of bile excretion of the choledochoduodenal junction (ch-d junction) in rabbits, especially regarding it's structural and physiological independence from the duodenum. For this purpose muscular anatomy of the ch-d junction and relationship between the electromygoraphic spike potential of the juncture and the intracholedochal pressure were investigated. 1. There were demonstrated proper circular muscle and proper oblique muscle in the ch-d junction, which appeared independent from the duodenal muscle. There existed A MUSCULAR SPHINCTER at the terminus of the common bile duct, but it's muscle fibers did not appear continuous with the duodenal muscle fibers. 2. The rhythmical changing curve of the intracholedochal pressure was parallel with appearance of the spike potential but had absolutely no correlation with the duodenal one. 3. The attitudes of the ch-d junction and the duodenum to the neural control were compared. The spike generation by Neostigmin METHYLSULFATE WAS EQUALLY OBSERVED IN THE CH-D JUNCTION and the duodenum and the spike inhibition by Hyoscin-N-butylbromide was also equally observed in both of them, SUGGESTING THEIR innervation was probably common.


[Fluorescein angiography of anterior segment of the eye (author's transl)]. This method can supply an unreplaceable iconographic document in order to follow the course of illness. A certain distinction between tumoral and nontumoral lesions is not possible. But this method is useful in the treatment of vascularized leucoma because it shows us the exact locus where the laser must be applied before the corneal graft is made.


[Laser-photocoagulation of macular holes (author's transl)]. In severe cases of degenerative macular cysts or holes laser lesions were placed on the temporal or nasal lip of the hole, to preserve the central vision of the right side. In early cases with good visual acuity only 2 narrow beam lesions, were placed to prevent progression of the disease. Control examinations revealed no decrease of visual acuity in most of the cases. In some cases even a little improvement of visual acuity was observed.


[Monthly mortality of elder babies (author's transl)]. Neonates during the first month usually die in November and December, older babies (2nd-12th month) in Jan., February and March. In the first group mortality is lowest in the summer, in the second group in the autumn. In the older babies differences between individual months are much greater. They are statistically highly significant.


[Fototherapy of neonatal hyperbilirubinemia. Results of its clinical application (author's transl)]. The application of fototherapy according to the indications listed by Maisels (1972, Abb. 1) has brought about a 67% reduction in exchange transfusions in comparison to the controll period proceeding this new regimen. This reduction of the need of exchange transfusions was especially striking in cases of hyperbilirubinemia of full term babies without blood group incompatibilities and in A B O incompatibilities with mild hemolysis. In typical Rh-incompatibility the number of repeat exchange transfusions diminished by 75%. The serum bilirubin levels of 206 consecutive low birth weight infants were prospectively investigated. 77 infants (37%) reached a serum bilirubin level of 10 mg% and were treated with fototherapy. Only 9,6% of these lowbirth weight infants had maximum serumbilirubin levels of 12 mg% or more and only 1,5% had levels of 15 mg% or more. Fototherapy reduces the risk of Kernikterus in Low birth weight babies to a minimum and it can reduce the risks and the costs of treatment for many icteric full term babies by reducing the number exchange transfusions needed. Inspite of its simplicity and effectiveness it has to be stressed that fototherapy should only be used under well defined indications and in a technically correct way.


[Anophthalmia and accompanying malformations (author's transl)]. Six children with bilateral or unilateral anophthalmia were described. Malformations of the face and the extremities, stunted growth, hydrocephalus, muscle hypotony and mental retardation in varying degrees and combinations were also found. The genesis is not clear. With two siblings who exibited a combination which has not been described previously of anophtalmia on one side and microphthalmia on the other together with a cutaneous hexadactyly, the fact that the combination occurs in both children and that the mother exibits a "incomplete form" (?) of the ophthalmologic symptom tends to indicate that the cause is genetic.


[Vater or Vacterl syndrome (author's transl)]. Analysis of malformations in 65 newborns with limb anomalies, 39 with esophageal atresia with tracheoesophageal fistula, and 41 with anal atresia confirmed the nonrandom tendency for the defects of the VATER or VACTERL syndrome to associate together. 11 new patients with 4 or more of these anomalies were compared with 41 previously reported cases. There was good agreement with reference to the frequency of the major malformations noted in the VACTERL association. While anal atresia was not so common in our patients, cardiac anomalies and radial limb dysplasia occurred somewhat more frequently. In accordance with previous findings we also emphasize a single umbilical artery as one of the malformations in the spectrum of the VACTERL association (V = vertebral defects and vascular anomalies). Because of the high incidence of rib anomalies in our patients and in earlier cases with complete medical records it is suggested that the scope of the VACTERL association should be enlarged by this malformation. Thus the R in VACTERL would stand not only for renal defects but als for rib anomalies. Furthermore, the spectrum of anomalies could be extended by auricular defects (A = anal atresia and auricular defects). When one of these VACTERL components is found attention should be drawn to the possibility of the presence of the other associated anomalies. The developmentally correlated malformations seen in the VACTERL syndrome are generally sporadically observed. At the present time the etiology is unknown but heterogeneity is suggested. Although a causal relationship between maternal intake of progesteron/estrogen during the vulnerable period of embryogenesis and the VACTERL syndrome has been suggested, none of the mothers of our patients were exposed to these hormones during early pregnancy. Cytogenetic investigation in one patient and his mother showed a so-called marker chromosome 9 (C9qh+ variant) which is difficult to interpret at the present time.


[Intestinal suction biopsy in childhood of experiences during 1968-1975 (author's transl)]. From 1968 to 1975 532 intestinal suction biopsies were obtained in 371 children and adolescents using the paediatric Watson capsule. The youngest patient was 2 months old; a 9 months old infant has the lowest body weight of 3 520 g. Mucosal specimens were mainly taken from the upper jejunum. The whole procedure mostly required not more than 30 minutes. No serious complications were seen. Due to technical troubles several attempts were ineffective; the rate of successful biopsies was 89%. The paediatric Watson capsule proved to be easy to handle, mostly reliable, and therefore very suitable for intestinal biopsy in childhood. The dissecting microscope and histological findings were classified into four groups: normal mucosa, slight, moderate and severe mucosal lesions. Severe lesions were almost only demonstrated in patients with coeliac disease: in the active phase, in the early phase of remission under gluten free diet and during gluten loading or normal diet respectively, furthermore in an infant with protracted diarrhoea and in a child with agammaglobulinemia. A flat mucosa is not pathognomonic for coeliac disease but a constant morphological attribute and conclusive for diagnosis. Moderate mucosal lesions were seen in the remission of coeliac disease or during gluten loading and in some cases with protracted diarrhoea of infancy and with chronic malabsorption of unknown origin, furthermore in a child with immunoglobulin deficiency and in another one with iron deficiency anemia. The examination with the dissecting microscope can be performed very easily and makes obvious a very exact diagnostic information which is completed by the histological examination.


[Differential diagnosis and course of the idiopathic juvenile osteoporosis (author's transl)]. A case of a twelve year old boy with idiopathic juvenile osteoporosis is reported. The disease is characterized by onset in the prebubertal or pubertal age. The initial complaint is deep pain of the extremities, followed by a decrease in growth and multiple fractures of the spine and lower extremities. Radiologically a severe generalized osteoporosis is shown. Diagnosis depends on the results of clinical and x-ray examination, bone histology studies and the ruling out other forms of osteoporosis, those due to other disease of bones, renal diseases and metabolic or endocrine disturbances. Spontaneous remissions usually follows 2-4 years of disease. A specific treatment is not known.


[Medulloblastoma and pineoblastoma in monozygous twins (author's transl)]. Clinical and neuropathological findings in monozygous twin sisters are reported. Twin I died at age 5 months from a cerebellar medulloblastoma, whereas her sister died at age 16 months from a pineoblastoma. The tumors are considered similar referring to histogenesis, structural peculiarities and growth. Therefore, the twins are seen as concordant for the tumor type.


[Primary generalization in alveolar rhabdomyosarkom (author's transl)]. Rhabdomyosarcomas are surpassed in frequency only by neuroblastomas and Wilms' tumors in pediatric oncology. An unusual variant is the primarily generalized alveolar rhabdomyosarcoma. Reviewing a case history, diagnostic, differential diagnostic and therapeutic problems are discussed. Cure appears to be unobtainable at the present time; nevertheless an aggressive approach by modern therapy seems justified as prolonged symptomfree intervals are possible without considerable side effects.


[Kleinschmidt's syndrome (author's transl)]. This is a case-report about a 4 year old boy with "cherry red" epiglottis, purulent meningitis and pleuropneumonia. Purulent meningitis and pleuropneumonia are not complications of treatment of "cherry red" epiglottis but an entity caused by Hemophilus influenzae-infection and is called Kleinschmidt's syndrome (Hemophilus influenzae type B-infection-syndrome). This severe illness is successfully treated if recognized early enough. At present, chloramphenicol is the therapy of choice. Intubation or tracheotomy are important but supportive measures.


Human C-peptide. Part I: Radioimmunoassay. Synthetic human C-peptide bearing a Tyrosine group at its amino end is labelled with 125iodine using chloramin T or hydrogen peroxide and lactoperoxidase. The results are compared applying both methods. Antiserum to synthetic human C-peptide (without Tyrosine) which was partially compared to rabbit albumin, is raised in guinea pigs and goats. Goats show to be superior to guinea pigs concerning antibody production. The so-called "hook effect" phenomenon is observed in setting up the standard curves for the radioimmunoassay. Monotonically decreasing standard curves are obtained on dilution of antiserum with a high antibody titer which was produced by repeated immunization in goats. Free C-peptide and C-peptide bound to antiserum are separated with the anxion exchange resin Amberlite. Using this separation technique we excluded unspecific binding of labelled C-peptide to protein fractions in serum of diabetics. The sensitivity of our radioimmunoassay is approx. 0.3 ng C-peptide/ml serum. Intra- and interassay variability are below 10%. Human proinsulin is the only substance found to crossreact with the antiserum.


Vagal and hormonal influences on gastric secretion in duodenal ulcer disease. Current concepts on the pathophysiology of gastric hypersecretion in duodenal ulcer disease have been presented and the role of vagal nerves and gastrointestinal hormones particularly gastrin has been discussed. Duodenal ulcer patients form a heterogenous group with regard to the gastric acid and pepsin secretion and gastrin release. They may differ from healthy subjects by several wall defined defects including an increased mass of parietal and peptic cells, increased capacity to secrete acid and pepsin, increased vagal drive to the parietal cells, hyperreactivity of antrum, decreased effectiveness of antral and duodenal autoregulatory mechanisms, defective release of secretin, increased gastric emptying and defective removal of gastric acid load from the duodenum. Very little is known what proportion of duodenal ulcer patients suffer from various pathologic disturbences and what are the mechanisms underlying these changes.


Galactorrhea in a male stump-tailed macaque (Macaca arctoides). A male Macaca arctoides imported as an adult in 1966, has demonstrated bilateral galactorrhea since 1973. The animal has not shown any clinical signs of gynecomastia, ill health, or reproductive failure. A sample of the secretion expressed from his nipples contained 2-5% lactose.


The influence of filter top caging on the transmission of pinworm infections in mice. The effectiveness of filter top cages in preventing infection of mice with pinworms, Aspiculuris tetraptera and Syphacia obvelata, was investigated by introducing mice from a pathogen-free colony into a colony in which both types of pinworms were enzootic. Half of the pathogen-free mice were maintained in filter top cages, while the remainder were held in similar cages without filters. All mice thus introduced were killed and examined after 3-8 week exposure periods. No pinworm were recovered from mice in 17 of 18 cages with filter tops while mice in 12 of 16 cages without filter tops were infected.


Effect of alcohol and diet on 3H-leucine incorporation into brain and liver protein. I. Acute intoxication and vitamin deficiency in rats. In rats receiving a normal diet, ethanol administration reduced the incorporation of labeled amino acids into brain protein and increased incorporation into liver protein, but in rats fed vitamin-deficient diets alcohol did not significantly affect amino-acid incorporation.


[Histopathology of mucoceles infiltrated with steroids]. The authors have had the opportunity to treat eight cases of lip mucocele with intralesional infiltration of Triamcinolone Acetonide (Kenacort). In three cases there was complete regression of the lesion after a variable period of time between the first and the fourth infiltration. In five cases the results were negative. The patients who reacted positively to treatment were followed-up for a year afterwards.


[Anular centrifugal erythema on the site of injection of hormone preparation in oil suspension]. An erythema annulare-like lesion following the intramuscular injection of a suspension of estrogen and progestative mixture in purified olive oil is described by the authors. The eruption appeared 9-10 days after the injection and relapsed after each injection. The histological picture was compatible with erythema annulare.


[False basalnomas and false cutaneous metastasis of visceral cancer. Apropos of 7 observations of eccrine carcinoma]. After a review of the bibliography on the subject of eccrine sweat gland carcinomas, the authors emphasize the confusing terminology used for the designation of these cases and the difficulties for a correct clinical and histological diagnosis of these tumors. According to the data obtained from the study of 7 personal cases, the most characteristic features of the eccrine carcinomas could be the following: 1) From the clinical standpoint--Appearance of a single tumour, lasting unmodified for a long period of time.--Tendency to reccurrence of the neighbouring areas after tumour excision, and to a slow progression through the superficial lymphatic channels.--Appearance of distant metastasis a long time after the original lesion. These metastases are observed, a) on the regional lymph nodes, b) on the superficial lymphatic channels and c) in some cases in the skin by intraepidermal growth. 2) From the histological point of view--Localisation in the deep dermis of the tumoral masses in the original lesion.--Acinar or tubular structures. Abundant nitoses and considerable indifferntiation of the cellular elements.--Tendency to the formation of empty peritumoral spaces separating the tumoral masses from the connective tissue by the retraction caused by the fixative.--Styloid or trabecular growth surrounding the main mass of the tumor.--Two types of cells can be observed in some tumours; large cells with a clear cytoplasm and small deeply-stained cells resembling the mioepithelial cells.--Tendency to the formation of clear cell tumoral masses.--Squamous metaplasia of isolated cells or groups of cells.--Presence of PAS-positive cytoplasmatic granulations in some cellular elements.--Degenerative changes with secondary cystic formations.--Frequent features of tumoral lymphangitis. 3y From theions.--Frequent features of tumoral lymphangitis. 3) From the cytological standpoint Staining in yellow of the cytoplasms of the tumour cells with the Panpanicolau method. 4) From the ultrastructural standpoint--Impossibility of classifiying the cells into serous or mucous due to the considerable anaplasia.--Absence of eccrine-apocrine differentiation, of ductal formation and of embrionary sweat cell features.


[Polymorphic light dermatitis. Photobiology and photoprotection]. It is possible in the majority of patients with polymorphic light eruption to produce lesions experimentally. Only the reproduction of the clinical reaction is significant for the diagnosis. Irradiation is carried out in the same test area two or three times with a dose of up to eight times the minimal erythema dose. Sunlight is the best agent for the evaluation of this protocutaneous disorder. A localised area of the skin can be exposed to midday sunshine about half an hour on three consecutive days. But sunlight has the disadvantage of having a variable ultraviolet emission at different times. It is necessary to differentiate lupus erythematosus and photocontact dermatitis, which may produce identical reactions. Other light sources are the hot quartz lamp, fluorescent tube "sun lamp", solar simulator and the monochromater. Patients with polymorphic light eruption are sensitive to light in the range 300 to 320 nm. but some of them are sensitive to savelengths shorter or longer than this range. The methods of protection against solar radiation which have been tried include: 1) Avoidance of sunlight; 2) Promotion of melanin hyperpgimentation and thickening of the stratum corneum-by controlled exposure to sunlight; 3) Application of a film of a chemical compound that will act as a physical screen and absorb, scatter or reflect damaging radiation; 4) Chemical modification of the stratum corneum by topically applied substances which can conjugate chemically or be absorbed onto the stratum corneum and filter the damaging rays. Many authors at present consider the use of alcoholic solutions of para-aminobenzoic acid (PABA) to be the most effective method of preventing reactions from exposure to sunlight. Pathak and Fitzpatrick showed that 5 % PABA in 70 % ethanol and 2,5 % Escalol 506 in 65 % ethanol is the most effective sunscreen against radiation of the sunburn spectrum. A dihydroxyacetone (DHA) and naphthaquinone (lawsone) sunscreen provides photoprotection for all types of photosensitivity throughout the whole UV spectrum even into the visible region. Systemic photoprotection: The administration of beta-carotene to patients with erythropoietic protoporphyria has resulted in amelioriation of their photosensitivity. Antimalarials are valuable therapeutic agents and are highly effective in controlling cutaneous lupus erythematosus, polymorphic light eruption and occasionally solar urticaria.


[Hydroa vacciniforme, a well defined photodermatosis (clinical, histopathological and photobiological aspects, apropos of 3 personal cases]. Three cases of "hydroa vacciniforme" are reported. The clinicopathological findings are emphasized. In two cases the patients presented keloids on the blister scars and in one of them there was association with focal epilepsia. The occular complications in the "hydroa vacciniforme" are uncommon but severe. The studies of cellular photobiology ("in vitro" irradiation of lymphocytes with U.V. rays) showed an imapirement of the ADN dark1repair, as demonstrated by other authors.


[Lipid composition of the normal skin].

[Lipid composition of the normal skin]. Thirty six specimens of normal human skin were obtained from persons of both seces, diferent ages and localizations. Each lipid extract (Ex L) was analyzed by thin layer chromatography. After separation and development, the areas were determined by densitometry. The results are given in percentages for each development. Statistical studies were carried out for each variant (sex, age, and localization) and for each lipid fraction. According to results, the following data are of interest: 1) Underlined results on table V, are significative. 2) The variant: sex, does not change the results. 3) Squalene (Esc) is absent on plasma. 4) Cholesterol esters (EC) are age and localization dependant. 5) The total amount resulting from the addition of monoenoics (EM) and dienoics (ED) esters, is constant (approximatively the 75 % of EC). 6) EM are prevalent in skin, and the ED in plasma. 7) Phospholipids (FL) are not constant. 8) The results depend particularly on the localization of each specimen. Thin layer chromatography is a good qualitative method, but the densitometry is not an exact method, as a 5-10 % of error is usually accepted. Our results gave only an idea of the lipid components of normal human skin, but this data can be applied as a tentative pattern por subsequent studies in pathological cases.


[Contact dermatitis caused by plastic pockets on trouser]. An hitherto undescribed type of contact dermatitis in a series of 16 patients is described by the authors. The lesions were localized in the anterior and anterolateral aspects of the thighs and were sharply limited in the area contacting the trouser pockets, manufactured with synthetic fabrics. In 17 patients of this series there was a concomitant dermatitis in the exposed areas of the face and hands. The authors described the processing in the manufacture of these pockets, the end step being the obtention of poliamide, through different precursor substances. The poliamide is treated with different aditives giving rise to the nylon fiber, which is used to manufacture the definitive tissue. A list of adequate allergens and their concentrations used in the 16 patients is given in the paper. The results of the patch tests and the fact that all the clinical symptoms of the patients disappeared after the withdrawal of the tissue pockets and substitution by cotton tissue give a reasonable basis to the hypothesis of contact dermatitis caused by this tissue. However, the true specific allergen is not demonstrated yet.


[Pseudoxanthomatous mastocytosis with aspects of nervus elasticus]. A case of mastocytosis is presented by the authors. The lesions appeared in early childhood with the typical appearance of urticaria pigmentosa. With the course of the years they changed becoming micropapular and assuming the appearance of the clinical picture described by Griffiths and Daneshbod as pseudoxantomatosis mastocytosis, although some clinical and histological aspects resembled the morphology and structure of the "nevus elasticus".


[Human warts by Papovavirus. Clinical, histological and ultrastructural correation]. A clinical, histological and ultraestructural study of 6 cases of epidermodisplacia verruciforme (E.V.). A comparisson with comun warts, plane warts and condilomas are made from this study. The authors attain the conclusion that the E.V. is a precancerous genodermatose in which there is special susceptibility in face to Papova virus group. The E.V. has a typical histological and ultraestructural picture quite diferent from those of the warts. The main characteristic in the presence of an intranuclear vacuole visible at the conventional microscope which is also seen at the electronic microscopy. This vacuole is composed by fibrilar materia and has a peripheric um in which is possible to see abundant viruses. The authors make the first description of intranuclear inclusion in the E.V. Some clinico-evolutive and histological pecularities are underlined in the epidermodisplastia carcinomas. The authors sugest the possibility that the different Papova human tumors could be caused by different Kinds of virus.


[Esophageal manifestations of pemphigus vulgaris]. The fibroscopic examination of a case of pemphigus vulgaris is described. The author postulate the fibroscopy as routine examination in the pemphigus with oral lesions.


[Levels of selenium in urine after treatment of pityriasis versicolor with a 1.0% selenium sulfide]. The treatment of pityriasis versicolor by the topical application of selenium sulfide 1% was studied in two groups of patients. Diagnosis and response to therapy was determined by clinical observation. Wood's light fluorescence, and direct microscopic examination. The efficacy of three different therapeutic regimes was studied in one group by the application of the drug to the entire skin for either five minutes, fifteen minutes, or twelve hours for eighteen days. Each method proved equally effective in resolving the infection. Therefore, the cutaneous application of selenium sulfide 1 % for five minutes daily for eighteen days is the recommended treatment for pityriasis versicolor. The percutaneous absorption of selenium sulfide was also studied in another groups who applied the drug to the entire skin for five minutes for eighteen days. Fluorimetric analysis of urinary samples collected on the third and thirteenth days of treatment revealed no significant increase in the excretion of selenium as compared to pretreatment levels. Systemic toxicity was not observed in any of the patients treated. The results suggest that the selenium sulfide is absorbed poorly from the skin and is a safe and effective therapy for pityriasis versicolor.


[Treatment of female gonorrhea. Therapeutic results with pivampicillin-probenecid and penicillin procaine-probenecid combinations]. A controlled trial of the relative efficacies of procaine penicillin G and pivampicillin for single dose treatment of uncomplicated gonorrhea in female was performed. Confirmation of the disease was obtained by bacteriological isolation of Neisseria gonorrhea from uretral, cervical or rectal exudates inoculated in suitable media. Based upon their previous experience, the authors used probenecid, along with both antibiotics, as a way of increasing the effectiveness of these drugs. Twentynine patients received probenecid 1 g. followed by oral pivampicillin, in a single dose of 1,4 g. Therapeutical results were evaluated in twenty-four, with clinical and bacteriological cure of eighteen. The other group included fifty-two patients treated with probenecid 1 g. followed by a single intramuscular dose of 3.000.000 U. of procaine penicillin G. The therapeutical results in the last group were evaluated in forty patients, with clinical and bacteriological cure of thirty-three. According to the above mentioned results procaine penicillin G seems to offer a slightly superior probability of cure.


[Treatment of drug resistant scabies].

[Treatment of drug resistant scabies]. Thirty patients suffering from scabies who had previonsly received other kinds of treatment were administered "Metrifonate" at daily doses of 10 mg./kg. b.w. during two consecutive days repeated every week and associated with atropine sulfate. The number of weeks lapse until the treatment finished was as follows. (see article.) Four patients developed intolerance, but it was transitory (nausea and vomiting). Cures (skin lesions and prutitus) were obtaind in 29 our of 30 cases.


[Epithelioise sarcoma. A myofibroblastoma tumor]. A case of epithelioid sarcoma in a 48 year old man is described by the authors. The ultrastructural study showed the presence of abundant cellular elements showing some features closely similar to those of the so-called myofibroblasts. These were: folds in the nuclear membrane, abundant rough endoplasmic reticulum, thick bundles of microfilaments resembling those of the smooth muscle, junctional complexes and degenerative changes (lipid droplets and autophagic vacuoles). These findings suggest the possibility that the epithelioid sarcoma could be a neoplasia originating from the myofibroblasts.


[Chromomycosis in Iberia].

[Chromomycosis in Iberia]. A 66 year old, Spaniard, born at Sueca (Valencia Province), was found infected with "Fonsecaea pedrosoi". His lesion, located in the inner aspect of the right arm, appeared when he was 7-8 years old, and progressed very slowly until he migrated to Venezuela, at 42. Thereafter it progressed more rapidly and started to hurt. Treatment included administration of 5-flucytosine at the daily dose of 150 mg./kg. during 4 and a half months and thermotherapy by means of a permanent adhesive tape on the lesion during 6 months. Eleven months after completion of the treatment, the patient is asymptomatic. This is the second case of chromomycosis originating in the Iberian peninsula. The importance of climate, clothing and age is discussed with reference to epidemiology of chromomycosis. The isolated strain of "F. pedrosoi" is the first one from the same region: its cultural characteristics and virulence among mice are studied and reported with some details. We think that in Europe, and especially in the Mediterranean countries, cases of chromomycosis did possibly occur, which were labelled as tuberculosis verrugosa or vegetans pyoderma owing to their histological picture.


[Technical considerations for the massive practice of hair transplantation]. Based upon his broad experience of over 2.000 transplant operations, the author notes the frequent patients refusals of multiple sessions and suggests adaptations of the Orentreich technique, to obtain a new modified single session operation allowing insertion of up to 250 to 300 hair plugs. After giving a detailed description of the technical modifications related to the anesthesia, hemostasis, biological integrity of the transplants, local blood supply and other problems, which had to be solved in order to obtain valid results within a record time, the author presents his final results.


[Immunotherapy of disseminated common warts with dinitrochlorobenzene]. Immunotherapy with DNCB was used on patients with numerous, widespread common warts. These warts had not responded to usual therapeutic methods. Immunotherapy was very successful and left no persistent supervision. It is recommended for cases such as those described, but not for routine treatment of isolated warts.


[Evaluation of the efficiency of corticosteroid preparations in the treatment of psoriasis]. The therapeutic efficacy of a w/oily lotion of desoximethasone 0.25% in the treatment of psoriasis was assessed by comparing the results with those obtained with a w/oly lotion of triamcinolone acetonide 0.10%. The comparison was performed by means of a double-blind intraindividual design. The assessment of results was done with a graphic method previously described which permits evaluation of velocity, intensity and duration of morbistatic effect. Twnety six patients were selected, all of them presenting bilateral long-standing, continuous and non-regressive psoriasis in order to avoid spontaneous remissions of the disease. The results showed a higher percentage of improvement with higher intensity, velocity and duration of therapeutic effect of desoxymethasone in comparison with triamcinolone.


[Miconazole per os in tinea and deep mycosis]. For the last 6 years we have been using Miconazole cream in the treatment of tinea and vaginal candidiasis. We think that it is at least as good as the best drugs for this purpose, but consider it difficult to decide about its superiority. Therefore we refrain from describing this part of our experience in detail. We have employed Miconazole "per os" at the daily doses of 24-28 mg./kg. in treating 3 cases of tinea corporis or cruris by "Trichophyton rubrum". Symptoms ceased in 3 days; mycologic examination turned negative in 2 weeks; treatment ended in apparent cure in 3 weeks. We have employed Miconazole "per venam" and "per os" in the treatment of: mycetomata (2) by "Streptomyces somaliensis", without success; mycetoma by "Madurella grisea" (1), without success; chromomycosis by a 5-flucytosine resistant strain of "Cladosporium carrionii" (1), without success; paracoccidioidosis (5) with lesions in mouth and lungs, with good results; leishmaniasis by "Leishmania brasiliensis" (1), without success; mucocutaneous disseminated candidiasis (1), with very good results. Tolerance has been excellent: but pruritus appeared from the third week with 600 or more mg. "per venam", in several patients. Doses varied between 10 and 50 mg./kg./day. One patient, who suffered with candidiasis, is taking 50 to 30 mg./kg./day since more than a year ago and, being a child, he is feeling well and growing to be normal. We recommend employing Miconazole against systemic canidiasis, sulpharesistant paracoccidioidosis and assaying it further in tinea (at least, in griseofulvin-resistant cases).


[Diagnosis and therapy of liver echinococcus (author's transl)]. From 1970 to April 1975 42 patients were treated for Echinococcus of the liver at the Bonn University Dept. of Surgery. There were 33 cases of E. cysticus and 9 cases of E. alveolaris. These two types of Echinococcus, different in parasitology and epidemiology present different clinical manifestation of disease with different course and prognosis. Angiography with celiaco- and superselective hepaticography are decisive for diagnosis. Therapy can only be surgical with total removal of the parasites. In E. cysticus this is almost always possible by enucleation-resection or pericystectomie following evacuation of the cyst and instillation of 20% sodium-chloride or formaldehyde. Such radicality is the exception in E. alveolaris. Here partial resections, biliodigestive and hepatodigestive anastomoses as palliative measures are carried out predominantly to ensure bile passage.


CO2 laser laryngoscopy in a variety of lesions. We have had the opportunity to employ the CO2 surgical laser with suspension laryngoscopy and microscopic adaptations to treat a variety of laryngeal conditions over two years. Each type of laryngeal condition is discussed, and the benefits of laser management is evaluated. This type of laryngeal management is compared with other forms of treatment such as the standard surgical approaches, electrocautery, and cryosurgery.


Hyperprolactinaemia: its physiology and investigation. Since the establishment of a sensitive and specific radioimmunoassay for serum prolactin levels, very rapid progress has been made in the understanding of the physiology of prolactin and its role in human disease. Hyperprolactinaemia is now known to be a common finding in many conditions. Up to 20% of women with unexplained functional secondary amenorrhoea have an elevated serum prolactin level. Reduction of serum prolactin levels to normal, by removal of a prolactin-secreting tumour or by treatment with bromoergocryptine, results in a restoration of normal menstrual cycles and fertility. This paper outlines the control of prolactin secretion and discusses the mechanisms which result in secondary amenorrhoea. A new method of investigation  of hyperprolactinaemia is proposed which localizes the site of abnormality which results in an elevation of serum prolactin levels.


[Postinfectious antirabic vaccination of children with duck embryo vaccine and heterologous rabies hyperimmunity serum (author's transl)]. After contact with a rabies-infected rabbit, 31 Persons were submitted to complete vaccination treatment with duck embryo vaccine, comprising of injections of 1.0 ml each every fast night and two booster injections of 1.0 ml each, which were administered 10 and 20 days, respectively, after the end of the 14 days' vaccination series. After performance of intracutaneous and ophthalmic tests, 18 children received heterologous rabies immunserum (Behring) in a dose of 0.2 ml per kg of body weight before the beginning of the vaccination series. Six weeks after the start of the vaccination series neutralizing and complement-fixing antibodies (rate of conversion 100 per cent) were detected in all patients. The mean titre of neutralizing antibodies (mouse test 200 LD 50 Fixed virus, strain CVS) amounted to 1:140, that of complement-fixing antibodies to 1:41. Severe incompatibility reactions were not observed. Outpatient treatment with duck embryo vaccine therefore seems to be fully justified.


[Biogenesis of cellulolytic enzymes by Trichoderma ligorum on media with "inductor"]. Identical distribution of C2- and Cx-cellulase activities of enzyme complexes produced by Trichoderma lignorum on a medium with lactose, a soluble "inductor", and on a medium with cellulose was found by means of disc elestrophoresis in polyacrylamide gel. The maximum rate of synthesis of cellulases on the medium with lactose was registered during the highest deceleration, and even complete cessation, of the fungal growth. During this phase, only one electrophoretically homogeneous cellulase component with Rf of 0.44 possessing all types of the cellulase activity is present in the cultural broth. In the course of growth of the fungus on cellulose after 48 hours, also only one electrophoretically homogeneous component with Rf of 0.44 was found in the cultural broth when the rate of the substrate degradation was highest. The appearance of minor protein components with the activity of cellulase at later stages of cultivation after cessation of the fungal growth is supposed to be caused by modification of the main cellulase component with Rf of 0.44 by the growth medium.


Protocol-based computer reminders, the quality of care and the non-perfectability of man. To determine whether clinical errors can be reduced by prospective computer suggestions about the management of simple clinical events, I studied the responses of nine physicians to computer suggestions generated by 390 protocols in a controlled crossover design. These protocols dealt primarily with conditions managed (e.g., elevated blood pressure) or caused (e.g., liver toxicity) by drugs. Physicians responded to 51 per cent of 327 events when given, and 22 per cent of 385 events when not given computer suggestions. Neither level of postgraduate training (first-year postgraduate or third-year post-graduate) nor the order in which physicians served as study and control subjects had statistically significant overall effect on the results. It appears that the prospective reminders do reduce errors, and that many of these errors are probably due to man's limitations as a data processor rather than to correctable human deficiencies.


[Experience with radio isotope myelography from neurosurgical aspects (author's transl)]. Experience with Radio Isotope Myelography is reported here. 169Yb-DTPA as a tracer was intrathecally injected at lumbar region in twenty three patients with various spinal cord lesions. The first scanning is perfomed after comfirming by gamma-camera that the tracer reaches to the lesion, the second and the third scannings are done according to the ascending rate of the tracer. (I) Normal scintimyelogram (A) In normal case, the shape of the Radio Isotope Myelogram well corresponds the shape of anatomical subarachnoid space. (B) In normal adult cases, the tracer comes up to the cisterna magna in 20-25 minutes after the lumbar injection. Therefore, the scintimyelographic diagnosis should be made not only by the shape but also by the ascending rapidity of the tracer. (II) Abnormal scintimyelogram Abnormal scintimyelograms could be summarized as following three categories. (A) "Delay": It means delay of the ascending of the tracer. Besides, "Transient delay" found in a case of Arnord-Chiari's malformation was proposed. (B) "Partial block": It meas a defect at the level of the lesion. This "Partial block" were observed in cases of spinal cord angioma, cervical spondylosis and spinal cord tumor etc. (C) "Complete block": It means the stagnation of the tracer below the lesion. To sum up, Rario Isotope Myelography, especially in partial block, can more easily and more sensitively represent the maximum extent of the spinal cord lesion than other myelographic study or angiographic one. On the other hand, we can not qualitatively diagnose about the lesions by its indistinct border.


[On the miliary intracranial aneurysm --its significance in subarachnoid hemorrhage (author's transl)]. Clinical use of four-vessels angiography increased the frequency of detection of intracranial aneurysm in patients who had episode of subarachnoid hemorrhage. However, some cases of subarachnoid hemorrhage did not show intracranial and intraspinal source of bleeding angiographically. Bjökesten and Troupp pointed out that some cases who were negative in angiography may have a very small intracranial aneurysm. Hassler described the minute aneurysm sized less than 2 mm in diameter from finding autpsy of the cases of subarachnoid hemorrhage and he emphasized that source of subarachnoid hemorrhage in tow cases were ruptured minute aneurysm. From the authors' experiences of ten very small intracranial aneurysms, the authors' advocated a name of miliary intracranial aneurysm in clinical practice. The author's criteria of the miliary intracranial aneurysm are as follows: (1) the miliary aneurysm grew from the wall of main trunk of intracranial artery, (2) the maximum diameter and height of protrusion of the miliary intracranial aneurysm are less than the diameter of parent artery. Ten miliary intracranial aneurysms are divided into two groups, one is the miliary intracranial aneurysm which is source of subarachnoid hemorrhage and the other is an accessory aneurysm bedise the another ruptured main aneurysm. These two groups were 5 aneurysms respectively. The majority of the accessory miliary intracranial aneurysms were observed in middle cerebral artery but the ruptured miliary intracranial aneurysms were observed in internal carotid artery, anterior communicating artery and middle cerebral artery. When the clinical symptom occurred at the time of rupture of miliary intracranial aneurysm compare with the one by rupture of usual major intracranial aneurysm, clinical symptom due to meningeal irritation was not different with each other but disturbance of consciousness and other neurological symptom were slight in miliary intracranial aneurysm cases. Angiographic diagnosis of miliary intracranial aneurysm is difficult, because differentiation of the miliary intracranial aneurysm from the loop or angulation of small artery is difficult in routine angiogram. In the case who showed questionable shadow as miliary intracranial aneurysm, the repeated angiography under modified direction of X-ray and modified head position of patient is required. The magnification cerebral angiography of three fold is also useful in diagnosis of miliary intracranial aneurysm. The intracranial treatment of miliary intracranial aneurysms were done by coating except one case whose aneurysm was clipped.


[Etiopathogenesis of salaam seizures].

[Etiopathogenesis of salaam seizures]. The author reports an analysis of 83 cases of salaam seizures in children from the standpoint of their aetiopathogenesis. In accordance with Jeavons she separates a group with congenital nervous system damage and a group of children who developed initially normally but in whom an acquired factor, most often of allergic character, caused nervous system changes manifesting themselves with salaam seizures. The comparison of both groups demonstrated a number of significant differences. The author believes that it would be wrong to consider all children with salaam seizures as a homogenous group because the only common factor in them is the occurrence of seizures. The author regards that it is insufficient to explain the type of EEG changes and the type of seizures as determined by the degree of nervous system development. Additional factors must exist, and fetal injury is this factor in the group of congenital seizures while in the group of acquired seizures the allergic factor is probably responsible. The isolation of both groups is important mainly from the standpoint of prognosis and treatment since in the group with acquired disease an acute cerebral process is the cause, in contrast to the group congenital damage, and the process is amenable to successful treatment if this treatment is applied sufficiently early. In the congenital group the prognosis is usually unfavourable in view of the underlying cause which is congenital encephalopathy acquired in the first place in pregnancy.


[The bone scintigraphy in eosinophilic granuloma (author's transl)]. The significance of bone scintigraphy using 99mTc-polyphosphate or 99mTc-diphosphate in the diagnosis of eosinophilic granuloma was discussed on the basis of our experience with four cases. The summary is following: 1. On diagnostic procedure of eosinophilic granuloma, it was found that abnormal RI accumulation in the bone scintigram was more marked than that in the ordinary brain scintigram. 2. The bone scintigram of eosinophilic granuloma showed more accurately the extent of skull involvement of cellular infiltration than the plain skull X-rays or brain scintigram. Accordingly, the bone scintigram was helpful for neurosurgeon in planning the operative procedure and determining the extent of removal of the involved skull. 3. The plain skull X-rays show the size of skull defect, and the brain scintigram reveals the size of the size of granuloma per se, as well as soft tissue involvements. We can conjecture the stage of the diseases by comparison between the findings of bone scintigram and those of above procedures: plain skull X-rays and brain scintigram. Viz, the bone scintigram showed more extensive areas of RI accumulation including the surrounding cellular infiltration in the acute stage, but the same size of the lesions shown by the ordinary brain scintigram and plain skull X-rays is chronic stage. Furthermore, we discussed the possibility of the differential diagnosis between eosinophilic granuloma and other neoplastic bone diseases, such as intracranial metastatic tumors and multiple myelomas etc., by further experience with the bone scintigram.


[Colloid cysts of the third ventricle --report of one operated and one autopsied case (author's transl)]. Colloid cysts of the third ventricle are considered as a relatively rate benign tumor, consituting approximately 0.5% of the whole brain tumors, but the surgical cases have rarely been reported in Japan. In this paper, two cases of colloid cyst are reported and the pathogenesis, the importance of the clinical diagnosis and dramatic results after complete extirpation was emphasized. In Case 1, a 29 year-old right handed male, who showed definite symptoms of increased intracranial pressure without lateralizing signs, was diagnosed as colloid cyst of the third ventricle, and operated on with dissecting microscope on April 20, 1973. The colloid cyst was totally removed and postoperatively V-A shunt was performed for adhesive arachnoiditis. Patient did well after surgery and has returned to the previous work. In Case 2, a 41 year-old male, who suffered from sudden onset of severe headache and bouts of frequent vomiting, was admitted to Tokyo Wome's Medical College Hospital on October 11, 1974. Right cerebral angiography revealed findings of increased intracranial pressure and third ventricle tumor was suspected. On October 13, progressively disturbed consciousness occurred. Immediate ventricular tap and continuous ventricular drainage could not regain consciousness and patient expired on October 30. In necropsy, colloid cyst to the third ventricle was found. As far as these are concerned, these cysts might be reasonably said as ventricular epithelial origin in view of the operative and histological findings. Some emphasis was also made in terms of dissecting microscope in removing this tumor, completely preserving the ventricular walls as well as the terminal veins under magnification.


[Two cases showing subarachnoid hemorrhage from angioblastic meningioma and vascular hamartoma (author's transl)]. As a causative factor in spontaneous subarachnoid hemorrhage, vascular anomalies, especially aneurysm or arteriovenous malformation, have been generally recognized. On the other hand, subarachnoid hemorrhage from brain tumor and cryptic vascular malformation are rare. We experienced two cases showing subarachnoid hemorrhage from angioblastic meningioma and vascular hamartoma as an initial symptom. Case 1: A 48-year-old woman, who complained of severe headache and vomiting on Feb. 10th, 1972, gradually became lethargic. Lumbar puncture revealed moderately hemorrhagic C.S.F.. On the fifth day after the onset, she was admitted to our hospital. On admission she showed disorientation and disturbance of resent memory. Aphasia and agnosia were slightly observed. On ophthalmologic examination right homonymous lower quadrant hemianopsia was observed. The carotid angiogram showed slight square shift of the anterior cerebral artery to the right side, elevation of the middle serebral artery and a homogeneous tumor stain in the occipital region in capillary phase. A walnut sized tumor invading the middle portion of the left lateral sinus and showing firm adhesion to the tentrium was found. There was an intracerebral hematoma behined the tumor. The tumor, the tentrium and the lateral sinus were extirpated en bloc and the intracerebral hematoma was aspirated. Histologically, the tumor was angioblastic meningioma. Case 2: A 7-year-old boy, who complained of severe abrupt headache, nuchal pain and vomiting on Sept. 17th, 1972, became gradually lethargic. Lumbar puncture revealed hemorrhagic C.S.F., On the tenth day after the onset, he was admitted to our hospital. He showed confusion and agitation. The carotid angiogram showed an unrolling of the pericallosal artery, but no findings of space taking lesions. An air study indicated a globular filling defect protruding into the anterior horn of the right lateral ventricle. The tumor located in the laterobasal wall of the anterior horn was removed picemiel by transventricular approach. Histologically, the tumor was vascular hamartoma. Furthermore, we discussed various brain tumors showing subarachnoid hemorrhage as an initial symptom, its frequency and bleeding mechanism on the literature.


[Partial fenestration of the basilar artery--report of a case (author's transl)]. A 44-year-old male entered the hospital following an episode of subarachnoid hemorrhage on January 28, 1975. The left vertebral angiography revealed an anteriovenous malformation in the mesencephalon mainly feeded by the thalamoperforate artery and the medial branch of the posterior choroidal artery. A partial fenestration of the basilar artery was also demonstrated. The patient refused the surgical treatment for the arteriovenous malformation and was discharged on March, 28, 1975. Fenestration of the basilar artery develops by arrested or abnormal development at the first and second stage of the embryological process. Most basilar artery fenestration demonstrated by brain dissection and angiography are cases of a short segment duplication (partial fenestration) while duplication of the entire segment of the basilar artery (complete fenestration) is quite rare. Only six cases of angiographically revealed basilar artery fenestration have been reported so far in the literature. With increasing application of vertebral angiography, this developmental anomaly may be encountered more frequently.


[Brain abscess secondary to pulmonary arteriovenous malformation, case report (author's transl)]. A case of brain abscess in the right parietal lobe secondary to pulmonary arteriovenous malformation of the right lung is presented. A 27-year-old man was admitted for headache and left homonymous hemianopsia. CAG, VAG and brain scan detected brain abscess of the right parietal lobe which was successfully removed surgically. He had been noted to have generalized cyanosis and club finger which corresponded to polycytemia and hypercapnia on examination. Subsequently pulmonary arteriovenous malformation was found in the right lower lobe of the lung which was also successfully excised by thoracic surgeons. Brain abscess was caused by peptostreptococcus anaerobius.


[A case of intramedullary spinal schwanoma (author's transl)]. A rare case of intramedullary schwannoma of the spinal cord has been reported, The patient was a 30-year-old woman, who began to notice weakness in her right leg approximately 6 months prior to admission, followed 4 months later by numbness and weakness of the right arm. The above symptoms were progressively getting worse, and she was admitted to Hokkaido University Hospital on February 23, 1974. Neurological examination revealed slow speech, bilateral horizontal nystagmus, absent gag reflex and weakness of right trapezius muscle. Spasticity was noted in 4 extremities, in addition to right hemiparesis. All deep tendon reflexes were hyperactive, right more than left, with bilateral Hoffmann's and Babinski's signs. Vibration sense was diminished below the level of bilateral iliac crests. A tumor around the foramen magnum was suspected, however plain skull and neck, laminogram of cervical spines, vertebral arteriogram, fractional pneumoencephalogram and myodil myelogram failed to disclose abnormalities. Manometric Queckenstedt test showed a partial block on flexion, with CSF protein of 56 mg/dl. Air myelogram clearly visualized the presence of an intramedullary tumor at the level of the medullo-spinal junction. Subtotal removal of the intramedullary tumor at C1 was performed, which proved to be a schwannoma histologically. 14 such cases are reported in the literature and summarized on Table I, including our case. Clinical features of tumors around the foramen magnum are fairly complexed, and some radiological examinations might not be conclusive. It is stressed that air myelogram is extremely valuable in the diagnosis of lesions around the foramen magnum.


[Aneurysm of the great vein of Galen--report of a case (author's transl)]. A case of aneurysm of the great vein of Galen was reported in which craniotomy and clipping of a feeding artery arising from the left posterior cerebral artery was successfully performed. This 5-month-old girl developed progressive hydrocephalus from 2 months after birth. At 5 months the head circumference was 50 cm with tense enlarged fontanelle. Both eye balls were deviated downward. The deep tendon reflexes were hyperactive with bilateral ankle clonus and positive Babinski's sign. Mild cardiomegaly and hepatomegaly were also noted. Cerebral angiograms showed a large aneurysm of the great vein of Galen fed by a single enlarged arterial branch from the left posterior cerebral artery. After the evaluation of systemic circulatory status and under strict control of fluid transfusion craniotomy was performed. The feeding artery was clipped at its entrance to the aneurysm via left parieto-occipital interhemispheric approach. A rise in the mean arterial blood pressure of 20 mmHg was observed immediately following clipping. The postoperative course was satisfactory except for a left subdural fluid collection which required subduro-peritoneal shunt. The aneurysm was completely disappeared on the postoperative angiograms and the child is regaining the normal development. This is the first case of aneurysm of the great vein of Galen successfully operated in Japan. Clinical symptoms and signs, radiological features and operative treatment of the disease were reviewed from a total of 46 cases reported in the world literature.


Penicillin transport from cerebrospinal fluid. The passage of penicillin G from cerebrospinal fluid (CSF) was studied by continuous ventriculocisternal perfusion in conscious rabbits. The concentration of penicillin G in the perfusate, collected from the cisterna magna, was 76.5 percent +/- 1.0 (SEM) of that entering the ventricles (having adjusted for normal secretion of CSF). The mean concentration of penicillin G rose 15 percent (p less than 0.005) in the cisternal CSF after probenecid (2 mg per milliliter) was added to the perfusion fluid. We conclude that an active transport system removes penicillin G from the CSF; this mechanism can be inhibited by intraventricular probenecid. Our results are in accord with observations deriving from studies on anesthetized animals given probenecid intravenously or intraperitoneally.


Changes in size of normal lateral ventricles during aging determined by computerized tomography. One hundred thirty-five normal volunteers were examined by computerized tomography (CT) and their ventricular size was measured by planimetry. A pattern of change in ventricular size from the first through the ninth decades was discerned and quantified. A gradually progressive increase in ventricular size from the first through sixth decades was followed by a dramatic increase in the eighth and ninth. The range of normal ventricular size was relatively more wide in the eighth and ninth decades than in the first seven; thus, abnormalities of ventricular size may be more easily identified in younger than older subjects. These data are more valuable than those from pneumoencephalography or autopsy studies because CT is not subject to the artifact inherent in those procedures.


Misdiagnosis of spasm of the near reflex. A bilateral sixth nerve palsy portends serious disease of the central nervous system and precipitates extensive patient studies. Spasm of the near reflex, characterized by intermittent convergence, accommodation, and miosis, is a functional disturbance. Five patients with hysterical spasm of the near reflex erroneously diagnosed as a bilateral sixth nerve palsy are reported. The pupillary sign, intense miosis on attempted lateral gaze, is emphasized as an important clue to the correct diagnosis. Despite extensive investigation, no disease of the central nervous system was found. Neurotic or hysterical features were evident in every patient.


Adenyl cyclase abnormality in Duchenne muscular dystrophy: muscle cells in culture. Cultured muscle cells from patients with Duchenne muscular dystrophy differed from cells of normal individuals and of patients with other muscle diseases. In Duchenne cells, basal activity of adenyl cyclase of myotubes was higher and was not stimulated significantly by epinephrine or isoproterenol, as it was in fused control cells, and the response to fluoride was less. The genetic defect in this disease may be an abnormality of the sruface membrane of muscle.


Shuddering attacks in children: an early clinical manifestation of essential tremor. Six infants and children presenting with shuddering attacks had evidence and a family history of essential tremor. Although this association had not been recognized, the shuddering spells caused considerable concern and led to a wide range of diagnoses. The attacks start in infancy or early childhood, are brief, often associated with some posturing, and may be very frequent. They are benign and tend to become less frequent or to remit during the latter part of the first decade. The recognition of this syndrome should avoid unnecessary investigation and concern. The pathophysiology of shuddering attacks seems to represent an expression of the mechanism of essential tremor in the immature brain. The ultimate nature of these attacks will undoubtedly be clarified when a neurochemical basis for essential tremor is found.


Krabbe's leukodystrophy without globoid cells. Krabbe's infantile cerebral sclerosis with a prolonged course was present in a boy who became increasingly hypertonic during infancy and had an increased protein level in the spinal fluid. At 4 years he showed significant growth failure, profound mental retardation, spastic quadriplegia, bilateral optic atrophy, and depressed tendon reflexes. Conduction velocity in motor fibers of the median nerve had become progressively impaired. Autopsy at 5 years 10 months showed severe leukodystrophy with demyelination and gliosis. No stored breakdown products or globoid cells were seen in the brain. Galactosyl ceramide beta-galactosidase was virtually absent, and hardly any myelin was demonstrable on chemical and electron microscopic studies. The presence of globoid cells may not be essential for the pathologic diagnosis of Krabbe's leukodystrophy in the presence of appropriate enzyme deficiency.


Electrophysiologic observations in the classical form of Pelizaeus-Merzbacher disease. In a 20-year-old patient with the classic form of Pelizaeus-Merzbacher disease, electroencephalograms during wakefulness were moderately diffusely abnormal, and an overnight polygraphic sleep recording showed distorted nonrapid eye movement sleep patterns without vertex sharp waves, K-complexes, spindles, or positive occipital sharp transients. Rapid eye movement sleep could be identified. Cerebral responses evoked by light flashes, clicks, and electric stimulation of the median nerves were abnormal.


Changes in motor innervation and histochemical pattern of muscle fibers in some congenital myopathies. Changes in motor innervation were compared with histologic and histochemical pattern of muscle fibers in three biopsies of central core disease, four biopsies of nemaline myopathy, one biopsy of myotubular myopathy, and three biopsies of mitochondrial myopathy. Evidence of collateral reinnervation was obtained only in one biopsy from central core disease. In other biopsies, no structural or ultrastructural abnormality of axis cylinders, myelin, or myoneural junction suggesting denervation were observed. The only relevant change found in centronuclear myopathy and to a lesser extent in nemaline myopathy was an unusual smallness and simplication of motor endings, suggesting delayed or impaired maturation. Muscle fibers strongly reactive for both adenosinetriphosphatase and nicotinamide-adenine dinucleotide diaphorase, observed in central core disease and mitochondrial myopathy, were not associated with increased terminal innervation ratio.


Antibody to acetylcholine receptor in myasthenia gravis. Prevalence, clinical correlates, and diagnostic value. Elevated amounts of antibodies specific for acetylcholine receptors were detected in 87 percent of sera from 71 patients with myasthenia gravis but not in 175 sera from individuals without myasthenia gravis, including those with other neurologic or autoimmune diseases. Antireceptor antibodies were not directed at the acetylcholine binding site of the receptor. Presence or titer of antibody did not appear to correlate with age, sex, steroid therapy, or duration of symptoms. Myasthenia gravis patients with only ocular symptoms had lower antibody titers, while the majority of titers in myasthenia gravis patients with thymoma exceeded the median titer of the myasthenia gravis group as a whole. Assay of antireceptor antibody should prove a useful test in the diagnosis of myasthenia gravis.


Cardiac myxoma: a diagnostic challenge for the neurologist. Three patients with left atrial myxoma presented with prominent neurologic symptoms and signs (cerebrovascular disease and/or syncope) within the past year. Two patients died because antemortem diagnosis was late or missed. One patient was successfully treated. Cardiac myxoma produces protean clinical manifestations that do not always include cardiac signs and symptoms. Neurologists may be called on for diagnostic consultation in patients who will prove to have cardiac myxoma. Unexplained transient ischemic attacks, cerebral infarction, or syncope (with possible features of seizure activity) are common neurologic manifestations of this disease. Additionally, systemic symptoms, signs, and laboratory data suggestive of collagen vascular disease or vasculitis are also often present. Echocardiography is a dependable noninvasive procedure for a confirmation of diagnosis in suspected cases.


A case of neuromyelitis optica (Devic's syndrome) in systemic lupus erythematosus. Clinicopathologic report and review of the literature. An interesting case of systemic lupus erythematosus (SLE) is presented in which the clinical onset of myelopathy strongly suggested demyelinating disease. Later, intracranial hypertension developed on two occasions. Postmortem examination showed the systemic lesions of SLE. In addition, demyelinating lesions were found in the spinal cord and the optic nerve, the neuropathologic picutre of Devic's syndrome, a variant of multiple sclerosis. We question whether some of the cases showing necrotic myelopathy might have an autoimmune pathogenesis.


Immunologic studies of a case of myasthenia gravis associated with pemphigus vulgaris after thymomectomy. A case of myasthenia gravis was associated with thymoma and pemphigus vulgaris. The bullous lesions developed after partial thymomectomy, cobalt (60Co) irradiation, and 3 days' extensive sunbathing, although a retrospective study of the patient's sera by quantitative indirect immunofluorescence method indicated that antiepithelial antibody already was positive before the clinical appearance of pemphigus vulgaris. Serial observation of the patient's clinical course and titrations of antiepithelial, antimuscle, and antithymus antibodies suggested a reverse relationship between the severity of myasthenia gravis and titers of antimuscle and anitithymus antibodies, and a parallel relationship between pemphigus vulgaris and antiepithelial antibody. Review of the literature suggests a close relationship between pemphigus vulgaris and myasthenia gravis and thymoma, particularly thymoma injured by medical procedures.


Autoradiographic studies of cultures of cerebrospinal fluid lymphocytes in nonsuppurative meningitis. Morphologic and autoradiographic studies of cerebrospinal fluid lymphocytes in nonsuppurative meningitis showed that, in addition to blast cells synthesizing DNA in response to mitogens, blast cells not incorporating thymidine were present. The autoradiographic studies also showed small lymphocytes of the usual sizes incorporating 3H thymidine, indicating that they were in the growth phase of the cell cycle. The magnitude of the response of CSF lymphocytes from patients with tuberculous meningitis to purified protein derivative appeared specific. A response of this degree may be of value in the early diagnosis of tuberculous meningitis.


Depth and direct cortical recording in seizure disorders of extratemporal origin. This study is based on 28 patients with intractable seizures in whom exclusively extratemporal or a combination of temporal and extratemporal electrodes were chronically implanted for the localization of the epileptogenic process and possible surgical treatment. Clinical and electrographic data are briefly summarized, the indications for the use of implanted electrodes are outlined, and the number and position of the electrodes and the findings in each individual case are given. Four illustrative examples are described in greater detail. Mainly on the basis of data derived from this particular technique of investigation, surgical treatment was eventually carried out in 14 patients. It is concluded that the use of implanted electrodes in seizure disorders of probable extratemporal origin can be of real diagnostic benefit in certain specific situations. In most instances, however, this technique simply serves to demonstrate the complexity of an apparently simple case or, of greater clinical consequence, might tend to oversimplify cases that are actually very complex. Indeed, many data in this study raise some doubts about the validity of the classic concepts of "focal" epilepsy.


Movement phosphenes in optic neuritis: a new clinical sign. Positive visual phenomena (phosphenes) elicited by eye movements have been described in normal individuals and in myopes with vitreous opacities. In the present paper we describe eye movement-induced phosphenes that appear to be related to optic nerve involvement in patients with optic neuritis and multiple sclerosis. This phenomenon is not associated with vitreous or retinal defects, nor is it similar to phosphenes observed in normal individuals. Instead, it shares many characteristics with the well-known Lhermitte sign and is believed to represent a similar phenomenon.


Fetal heart rate patterns preceding death in utero. Four cases of intrauterine fetal demise in term infants are presented. From these cases and other published reports, a sequence of fetal heart rate changes preceding intrapartum death is presented. Late or variable decelerations, if unrelieved or uncorrected, lead to baseline heart rate changes of tachycardia and loss of variability reflecting loss of fetal reserve and fetal distress. This is followed by an unstable heart rate, a sinusoidal pattern, or a rapidly changing fetal heart rate. The final event is a profound bradycardia just prior to fetal demise.


Ultrastructure of an ovotestis in a case of true hermaphroditism. A case of true hermaphroditism with bilateral ovotestes is reported. The karyotype was 46, XX. At laparotomy done at the age of 21 months a uterus, bilateral fallopian tubes, and bilateral gonads were observed. On frozen section examination, each gonad was shown to be an ovotestis. By light and electron microscopy, the only cellular abnormality observed in the ovotestes was the absence of primitive germ cells in the seminiferous tubules. The ovarian portion showed primordial follicles and normal follicular development.


The cellular response of the fowl small intestine to primary and secondary infections of the cestode Raillietina cesticillus (Molin). Infections of Raillietina cesticillus in the small intestine of the fowl caused a mononuclear leucocyte infiltration, which occurred in the tissues around the worm scolices and was especially prevalent in challenge infections. There was no evidence of vascular congestion or of a neutrophilic response, and the cellular reaction seemed to consist of a local proliferation of lymphoid tissue. Mast cell and pyroninophylic cell numbers increased in the intestinal mucosa of birds with longstanding primary infections and with secondary infections, but very little eosinlophil infiltration was detected and the globule leucocyte response was minimal. The infections had no effect on the numbers of theliolymphocytes and goblet cells. Challenge infections did not result in an increased level of serum antibodies, but more cells containing globulin seemed to be present in the intestinal mucosa of these birds. The interrelationships of the various cell responses to the cestode and the origin of the globule leucocyte are discussed in the light of previous work on helminth infections.


Changes in the hatch rate of Haemonchus contortus eggs between geographic regions. Vulvar phenotypes and the rate of development of eggs over a range of temperatures were used to compare Haemonchus contortus populations in New York State and Ohio. These parameters indicated that the westernmost boundary of the subspecies Haemonchus contortus cayugensis is the Chautauqua valley in New York. The Haemonchus ecotype in Ohio had a vulvar phenotype formula similar to that described for the subspecies Haemonchus contortus contortus. The relationship between slope and intercept of the regression of rate of egg hatch on temperature was different for morphs within ecotypes as well as between the New York and Ohio ecotypes. Linguiform-A appeared to be the cold-adapted morph in both ecotypes. Smooth was the warm-adapted morph in New York with linguiform-B filling that niche in Ohio.


The ultrastructure of the megakaryocytes in idiopathic thrombocytopenic purpura (ITP) in relation to thrombokinetics. The ultrastructure of megakaryocytes was examined in eight patients with idiopathic thrombocytopenic purpura (ITP) and the results were compared with those obtained from controls and with data obtained from platelet kinetic studies. Platelet production was significantly increased in (ITP) and related to the megakaryocyte number and volume. In all cases of ITP megakaryocytes containing tubular demarcation membranes were found. The granular content and the distribution of the demarcation membrane system in these megakaryocytes from cases of ITP were similar to those features seen in normal cells of the same degree of maturity. In three cases of ITP an increased content of a dilated demarcation membrane system was found in promegakaryocytes and granular megakaryocytes, in one of these cases with the additional formation of large membrane complexes. The ultrastructural findings lend support to the results obtained from the thrombokinetic studies namely that the megakaryocytes in the bone marrow react to thrombocytopenia with an increased production of platelets.