[Simultaneous extra-corporeal oxygenation and haemodialysis in intesive medicine (a case report) (author's transl)]. In the field of intensive care there is a rise in the number of patients with distrubed or defunct vital functions, in whom multilateral therapy on traditional lines fails. The necessity of introducing new forms of treatment has been the occasion for the development of a universal perfusion device for temporary artificial multiple-organ substitution in the Faculty of Medicine at the Martin Luther University Halle-Wittenberg. This apparatus makes possible the substitution of, or support for, the functions of lungs, kidneys and liver singly or combined, via the extracorporeal treatment of the blood. The shortterm use of the apparatus is intended to provide, in addition to functional substitution of the organs, the best possible conditions for the regeneration of damaged organs. A critical account is given of the clinical application of the apparatus.


[Control of the position of cava catheters by intraatrial ECG (author's transl)]. The precise position of a cava catheter can be defined by registration of electrocardiogramm by means of this catheter. The rather simple method by the use of a liquid filled catheter is briefly described, according to the improved method by Halter and Urthaler. Those electrocardiographic potentials, characteristic for each part of the right atrium, allow precise positioning of the tip of the catheter. By continuous registration of atrial electrocardiogram the catheter can be placed exactly between vena cava superior and right atrium. Furthermore, the possibility of registering atrial potentials by this simple means provides immediate recognition of atrial arrhythmias in cardian emmergencies.


[Ventricular fibrillation as complication of the application of a cava-catheter (author's transl)]. We report a case of ventricular fibrillation provoked by a cava catheter. Corresponding to literature we try to demonstrate the possibility of lethal cardiac arrhythmias being provoked by the cava catheter advancing into the right heart.


[Closing volume and ventilatory distribution disturbances (author's transl)]. Ventilatory disturbances are induced by airway closure associated with an increase of the venous admixture from alveoli with a low ventilation-perfusion-ratio. Closing volume was measured by single breath nitrogen washout curves and correlated with ventilatory disturbances derived from multiple breath nitrogen washout curves and an inspiratory gas distribution index (IDI). There was present a close correlation between the closing volume in relation to the functional residual capacity and the IDI. With rising closing volume in relation to functional residual capacity a deterioration of the inspiratory gas distribution with increasing venous admixture was observed.


Postnatal growth of the dorsal lateral geniculate nucleus of the cat. The postnatal growth of the dorsal part of the lateral geniculate nucleus (LGNd) is studied in paraffin sections through the brains of 32 cats of known age. The changes in shape and position of the LGNd are described and it is shown that its volume increases from about 3.4 mm3 at birth to about 26.4 mm3 in the adult cat. When this value is corrected for shrinkage, the volume of the LGNd in the adult cat turns out to be about 44 mm3. The detailed measurements reveal that during the second and third week of postnatal life there is a particularly steep increase in volume and that the final values are already reached at around the 40th day. Concomitant with the increase in volume there is a decrease of the number of cells per unit volume of grey matter. In the binocular segment of lamina A the number of cells decreases from about 470 per (0.1 mm)3 at birth to between 95 and 130 per (0.1 mm)3 in the adult cat. Separate measurements of nerve cells and neuroglial cells indicate that the absolute number of nerve cells remains fairly constant during postnatal life, whereas between the second and sixth week a great number of neuroglial cells are newly formed.


The vestibular nuclei in the domestic hen (Gallus domesticus). I. Normal anatomy. The topography and the cyto- and fiber architecture of the vestibular nuclear complex in the domestic hen are described as seen in transverse and horizontal thionine and myelin impregnated section. The subdivision of the nuclear complex arrived at from these studies is discussed the light of some experimental studies of the fiber connection of the vestibular nuclei in birds and compared with the well known organization of the vestibular nuclei in mammals. Six main vestibular nuclei are identified, the superior nucleus, the nucleus Deiters ventralis, the nucleus Deiters dorsalis, the tangential nucleus, the medial nucleus and the descending nucleus. In addition two cell groups (the cell group A and B) lying in close relation to the other nuclei are described and considered as parts of the vestibular complex. The map of the vestibular complex arrived at is largely in agreement with the maps presented by most earlier authors on other species. Furthermore, it appears that the organization of the vestibular complex in birds is more similar to the organization of the complex in mammals than hitherto recognized.


Effect of chronic centrifugation on the structural development of the musculoskeletal system of the rat. 25 female Sprague-Dawley rats were placed on a 3.66 m radius centrifuge and subsequently exposed almost continuously for 810 days to 2.76 G. Compared to normal gravity controls, the most noticeable effect of hypergravity was the inhibition of growth of the centrifuged animals. The rats exposed to hypergravity showed on average a smaller femur length (-6.5%), a smaller cross-sectional area (-7.7%, when expressed linearly, i. e. (area/pi)1/2), and smaller outer and inner cross-sectional radii (linearly -9.3% and -12.3%) at the mid-shaft of the femoral bones. The growth inhibition of 3 hind-leg muscles was on average significantly less ranging from (-3.5% to -4.1%), compared to the growth inhibition of the linear dimension of the femur. Statistically there was no difference in the slope and elevation of the regression of the square-root of the cross-sectional area divided by pi on the length of the femur between centrifuged animals and their 16 age matched controls. In the weight control group of 24 animals, comprised of 34,74, and 102 day old rats, the corresponding regression line was parallel and lower in elevation by -12.8%, compared to the line for the centrifuged and age control groups. But, compared to the regression derived from all control animals ranging from 34 to 840 days of age, the cross-sectional area at the mid-shaft of the femur was 8.4% greater in the rats exposed to 2.76 G for 810 days. The slopes of the regression of the outer radius at mid-shaft on the length of the femur were the same in the centrifuged group and in the weight and age control groups of animals. But, the regression lines differed in elevation by -4.4% on average between the centrifuged and age control animals. The line for the regression of the inner radius at the mid-shaft on the length of the femur was parallel and lower in elevation by -7.6% in the centrifuged animals compared to the line for the age controls. But, compared to all control animals living at normal gravity, the outer radius was increased by 3.0% and the inner radius was decreased by 5.7% in the animals exposed to 2.76 G for 810 days. Since the centrifuged animals were all 840 days old, while the controls were from 34 to 840 days old, only further experiments comparing centrifuged and control animals of the same age at various growth stages will be able to furnish evidence for an unambiguous bone hypertrophy. The regressions of the cube-root of body weight on length of the femur deviate significantly in the 3 groups of animals. The heavier rats of the age control group have relatively shorter femurs than the lighter animals. The opposite applies to the centrifuged and the weight control groups of rats. Although the rats on the centrifuge are markedly smaller in overall body size than the controls, they exhibit on average the same absolute muscle weights as the animals at earth gravity, if rats of the same overall body size are compared...


Effect of chronic centrifugation of the musculoskeletal system of the dog. Sixteen male Beagle dogs, 293 to 509 days old, were exposed almost continuously for 3 months to 2.0 G on a 7.9 meter radius centrifuge. The dogs were maintained on the centrifuge, by means of a specially designed automated waste disposal and life support system. As compared to the mean values of normal gravity controls, centrifuged dogs showed no differences in femur length; cross-sectional area, outer and inner radii at mid-shaft of the femur; dry weights of the biceps femoris, quadriceps femoris, and gastrocnemius muscles. It was shown by analysis of covariance that chronic centrifugation has no effect on the relationship between the length and the cross-sectional dimensions at mid-shaft of the femur. Photon absorptiometry, however, revealed significant mineral content increases averaging 1.5% at 3 sites, i.e., at the 1/4, 1/2 and 3/4 length of the femur.


On the variability of form and vascularization of the cat carotid body. The compact carotid body shows, according to the source of the animals, a variability with respect to location, shape and vascularization which is similar to that found in the human carotid body and that of the dog. Aside from the ovoid forms which had been assumed to be characteristic, carotid bodies were found which either lie flat on the stem vessel or embrace it. Vascular supply is achieved not only by the occipito-pharyngeal trunk but also by the external carotid, ascendent pharyngeal and occipital arteries via one to more than three side branches. The findings are also relevant for the physiological investigation since they reveal that the function of the carotid body does not closely depend on its marcro architecture.


Early terminal degeneration of cerebellar climbing fibers after destruction of the inferior olive in the rat. Synaptic relationships in the molecular layer. The cerebellar molecular layer in adult rats has been studied with the electron microscope at several early and consecutive survival times following 3-acetylpyridine intoxication. Climbing fiber (CF) terminals underwent a fast process of electron-dense degeneration which became apparent from 16 hours onwards. A small proportion of degenerating terminals were depleted of vesicles and filled with a dark flocculent and granular homogeneous matrix. Microtubular changes in degenerating CF tendrils were observed. CF terminals were found in relation with every Purkinje cell in normal animals and completely disappeared within 72 hours after the treatment. CF synapses were found on Purkinje dendritic and somatic thorns, sometimes also on the dendritic shafts or even on the Purkinje soma. Convincing evidencd of synaptic contacts of CF varicosities on either basket or stellate cells could not be obtained. CF synapses with Golgi II cell dendrites in the molecular layer were described. Decrease in the number of post-synaptic dendritic thorns normally assigned for CF synapses was observed consequential to CF anterograde degeneration. The observations are consistent with previous conclusions drawn from light microscopic studies that the clearing up of CF debris in the molecular layer is completed within the short  time of three days, and that the inferior olive seems to be the only source of CFs.


Mechanical properties and histology of cortical bone from younger and older men. Tensile breaking load, strength, strain, modulus of elasticity and density plus the histological structure at the fracture site, were determined for 207 standardized specimens of cortical bone from the embalmed femur, tibia, and fibula of 17 men from 36 to 75 years of age. The men were divided into a younger group (41.5 years old-avg)) and an older group (71 years old-avg). Specimens from younger men had a greater average breaking load, strength, strain, modulus and density than those from older men. The percentage of spaces in the break area was greater in specimens from older men, but specimens from younger men had a slightly greater percentage of osteons, osteon fragments, and interstitial lamellae. The number of osteons/mm2 and of osteon fragments/mm2 was greater in specimens from older men but the average area/osteon and area/osteon fragment was greater in specimens from younger men. Thus, there are quantitative and qualitative differences in the histological structure of bone from younger and older men. Differences in the tensile properties of bone from younger and older men can be explained by histological differences in the bone.


Kinetics of intraepithelial lymphocytes in the small intestine of thymus-deprived mice and antigen-deprived mice. The kinetics of lymphoid cells within the epithelium of the small gut has been studied in various thymus-deprived mice and in antigen-deprived mice by the use of 3H-thymidine injections and radioautography. In thymus-deprived mice--including adult thymectomized, thymectomized and irradiated, neonatally thymectomized, and nude mice - and in germ-free mice decreased numbers of intraepithelial lymphocytes (IL) were found. On the other hand, the radioautographic results indicated that the remaining IL populations included both newly formed and long-lived lymphoid cells in the same percentages as found in sham-operated controls and normal mice. It is concluded that although the presence of the thymus and the antigen content of the gut is of importance to the maintenance of the numbers of cells in the lymphoid populations of the intestinal wall, the basic kinetics of these cell populations are preserved in deprived mice.


Variation in form of circle of Willis: some anatomical and embryological considerations. This work is based on a study of 62 circles of Willis (circulus arteriosus cerebri) from patients dead from diverse causes. We have described the wide diversity of variations found to be present in the arterial vessels that form the circle, we presented the frequency of the different variations, and finally we discuss the possible ontogenic cause of these variations.


Alterations in the fine structure of the prostate and seminal vesicle of rats treated with cyproterone acetate. Young adult male rats were treated with daily injections of 10 mg of cyproterone acetate for periods up to 16 weeks. Samples of the ventral prostate and the seminal vesicle were studied with the light and electron microscopes. Alterations visible with the light microscope included decreases in cell size, cytoplasmic basophilia, the size of the nucleolus, and the amount of luminal secretory material. Ultrastructural changes in the epithelium of both glands involved mainly the organelles that participate in the formation of secretions. Large declines were observed in the abundance of rough endoplasmic reticulum, size of the Golgi apparatus, and number of secretory vacuoles. Lipid droplets accumulated in the seminal vesicle epithelium, and lysosomes were numerous in both glands. Changes were first observed microscopically in the seminal vesicle after one week and in the prostate after two or three weeks. Maximal development of the alteration occurred after treatment for approximately eight weeks.


Recovery of rat prolactin cells following cessation of estrogen treatment. Estrogen treatment for one month in female rats caused some regression of somatotrophs, but induced an increase in the number of prolactin cells and caused these cells to hypertrophy. These stimulated prolactin cells showed extensive development of the granular endoplasmic reticulum which was often arranged in concentric whorls (Nebenkern). Most of the prolactin cells contained a small number of mature granules which were smaller in size than those of prolactin cells in control animals. These prolactin granules were round in sectioned profile and closely resembled the secretory granules of normal somatotrophs.


The skin of the giraffe.

The skin of the giraffe. The skin of the giraffe has the same general histological structure as that of other mammals, but there are notable features. The skin is heavily pigmented with the epidermis, pilary canals, and the outer cell layer of the apocrine duct richly melanized. Furthermore, melanotic dendritic cells are frequently found in the sebaceous glands, the entire length of the external root sheath, and the secretory tubules of the apocrine glands. The thick skin has a papillary dermis that extends to just beneath the secretory coils of the apocrine glands and bulbs of hair follicles and an equally thick reticular layer below these structures. The hair follicles do not grow in clusters, and with some regional variations, have associated sebaceous glands, apocrine glands, and arrectores pilorum muscles. Only the large hairs have a prominent medulla. In such specialized regions as the eyelids, nose, and lips, the apocrine glands are surrounded by cholinesterase-reactive nerves but the glands on the general body surface are not. The only specialized nerve receptors are hair follicle end organs found on every hair of the eyelids, nose, and lips, but only rarely elsewhere.


Microblebs of intestinal epithelial cell microvilli of Citellus tridecemlineatus. The presence of microblebs arising from the lateral surfaces and tips of microvilli of intestinal epithelial cells of thirteen-lined ground squirrels. Citellus tridecemlineatus, is reported. Microblebs measure approximately 50 nm in diameter and are bounded by a unit membrane which is continuous with the unit plasma membrane of the microvilli. It is suggested that such microblebbing reflects the rapid turnover of microvillar contents, membrane and surface coat.


Fine structure of tracheo-bronchial epithelial nerves of the cat. The nerves in and immediately under the epithelial layer of the trachea and primary bronchi of the cat are studied with the electron microscope. The axons are unmyelinated and contain microtubules and mitochondria. Epithelial axons are observed throughout the entire epithelial layer, but, are usually concentrated in the basal area immediately above the basal lamina. Most axons are near the basal cells; others are in the vicinity of granulated cells or occur in the intercellular spaces between other columnar cells. A few of the epithelial axons are large and crowded with axoplasmic mitochondria. The possibility that some epithelial axons may have sensory functions is discussed.


Ciliated and secretory epidermis produced from embryonic mammalian skin in organ culture by vitamin A. When skin from the upper lip of 12-day embryonic mice was grown for ten days in organ culture with 5.7 mug retinol added per ml of biological medium, keratinization was suppressed and a ciliated and secretory epithelium was produced. Ultrastructural features of this epithelium are described. At this very early stage mouse epidermis is thus similar of chick epidermis in its ability to undergo radical metaplasia in response to vitamin A.


Metabolism of methoxyflurane in man.

Metabolism of methoxyflurane in man. Excretion of methoxyflurane was studied in 12 patients receiving anesthesia in a closed rebreathing circuit at a constant alveolar concentration of approximately 0.24 per cent. The mean methoxyflurane uptake was 18 g (range 7.6-31 g) during a mean time of anesthesia administration of 2 hours, 18 minutes (range 55-309 minutes). An average of 19 per cent of the uptake was recovered unchanged in the exhaled air after anesthesia. Urinary excretion of organic fluorine, fluoride, and oxalic acid was equivalent to 29, 7.7 and 7.1 per cent of methoxyflurane uptake, respectively. Approximately a third of the uptake remained unrecovered. It is postulated that a portion of the unrecovered drug became permanently bound to tissues and hence its excretion was delayed beyond the period of the study.


Kinetics of methoxyflurane biotransformation with reference to substrate inhibition. The kinetics of biotransformation of methoxyflurane by rat hepatic microsomes in vitro was studied. The rate of biotransformation as measured by analysis of metabolites continued to increase even at near-saturation concentrations of the anesthetic. Methoxyflurane biotransformation followed either an unbounded curve with empirical formula y = a ln(bx + 1) or an asymptotic curve with formula (see article) No substrate inhibition was observed. Total fluoride Vmax of 135.1 mmumol F-/mg protein/30' was increased to 931.9 by phenobarbital induction; free fluoride Vmax from 39.2 to 403.2. Thus, enzyme induction shifted biotransformation to the production of greater amounts of inorganic free fluoride metabolites than organic fluoride-containing metabolites. Phenobarbital induction caused qualitative as well as quantitative alteration in the biotransformation of methoxyflurane.


Inhibition of cell-mediated cytotoxicity by halothane and nitrous oxide. Killing of tumor cells by lymphoid cells is important in cell-mediated immunity and defense against cancer. The authors determined that halothane, in vitro, inhibits the killing of YAAC-1 ascites tumor cells from A/jax mice by sensitized peritoneal exudate cells from C57/Black/6 mice. Lysis of tumor cells was quantitated by release of 51Cr into the culture medium. Inhibition of cell-mediated cytotoxicity ranged from 5 per cent in 0.5 per cent halothane to 44.7 per cent in 2.5 per cent halothane exposure. A 12 per cent inhibition of cytotoxicity by 80 per cent nitrous oxide was not statistically significant, but was of a magnitude near that of an equipotent concentration of halothane. The inhibition of cytotoxicity by halothane and nitrous oxide observed in vitro may partially account for the inhibition of cytotoxicity observed when patients undergo surgical operation.


Absence of cellular hypersensitivity in patients with unexplained hepatitis following halothane. In-vitro tests of cell-mediated immunity were performed using blood obtained from subjects with unexplained hepatitis following halothane anesthesia to determine whether sensitization to potentially antigenic products of halothane metabolism might exist. Both lymphocyte transformation and leukocyte migration-inhibition tests were undertaken in the presence of trifluoroacetylated human serum albumin. All tests in the presence of these potential antigenic complexes were negative. The results support the view that cell-mediated hypersensitivity to trifluoroacetylated proteins does not contribute to the pathogenesis of hepatic dysfunction following halothane anesthesia.


Pharmacokinetics of naloxone in rats and in man: basis for its potency and short duration of action. Using a specific and sensitive radioimmunoassay, naloxone concentrations in the brains and sera of rats were measured at intervals for four hours following iv injection (5 mg/kg). Decrement curves of naloxone were compared with those after iv injection of morphine (5 mg/kg). Serum concentration of naloxone at 5 minutes was 1.45 +/- 0.1 mug/ml (mean +/- SE) and that of morphine was 1.0 +/- 0.08 mug/ml. Their serum half-lives from one to four hours were approximately the same, 30-40 minutes. With naloxone, the brain-serum concentration ratios ranged from 2.7 to 4.6. Concentration of naloxone in the brain declined parallel to that in the serum. However, with morphine the initial brain concentration was approximately one tenth that in the serum (0.096 +/- 0.04 mug/ml). The brain morphine concentration was sustained for one hour, while serum morphine concentrations declined from 1.0 to 0.19 mug/ml during this period. Two minutes after iv injection of naloxone HCl (0.4 mg) in nine healthy volunteers, the serum drug concentration was 0.01 +/- .001 mug/ml. At 5 minutes, 97 per cent of the administered dose was no longer found in the serum, the serum concentration being 0.004 +/- .0003 mug/ml. From 20 minutes to two hours after injection, the calculated mean serum half-life of naloxone was 64 minutes. These results suggest that the rapid penetrance of naloxone into the brain and the high brain-serum concentration ratio contribute to its rapid onset of action and potency as a narcotic antagonist. The rapid decline of naloxone concentration in the brain found in the animal model, in contrast to that of morphine, could be the basis for its relatively short duration of action.


Myocardial function and metabolism in the conscious dog and during halothane anesthesia. Chronically catheterized dogs were studied awake and during anesthesia with high and low concentrations of halothane to assess the relationship between cardiac function and metabolism. Low concentrations of halothane (0.79 per cent endtidal) increased heart rate and decreased left ventricular stroke volume, stroke work, and dP/dt without producing other hemodynamic changes. However, similar heart rate increases produced by atrial pacing in awake animals increased aortic pressure and cardiac output and decreased left atrial pressure. Consequently, the halothane-induced tachycardia partially compensated for the negative inotropic effect of the halothane. High concentrations of halothane (1.74 per cent endtidal) further increased heart rate and elevated left atrial pressures. Cardiac output, stroke volume, stroke work, aortic pressure, LV dP/dt, myocardial blood flow and oxygen consumption were markedly decreased. Myocardial glucose extraction was also decreased. Myocardial oxygen extraction was unchanged, and lactate extraction rose with both concentrations of halothane. Consequently, the dose-dependent negative inotropic effect of halothane resulted in a decrease in cardiac oxygen demand which was equal to or greater than the decrease in oxygen delivery. Whether the same relationship would be seen in the ischemic heart is yet to be demonstrated.


Pressure antagonism of barbiturate anesthesia. The losses of righting reflex produced by various doses of phenobarbital in mice at 1 atm O2 versus 1 atm O2 plus 102 atm He were determined. The resulting dose-response curve at pressure gave an ED50 that was 64 per cent larger than the ED50 at 1 atm. This increment is essentially the same as that found for gaseous anesthetics under similar test conditions. The quantitative similarity of the results of pressure reversals of barbiturate and inhalational anesthetics suggests that the mechanisms or sites of action of these agents are similar. However, the dose-response curve at 103 atm was steeper than that at 1 atm. This raises an alternative possibility that anesthetics and pressure bear no mechanistic relationship to each other, but rather that pressure produces a generalized central nervous system stimulation that would antagonize any depressant effect.


Brain-blood partition coefficients of 85Krypton at 37 C and 29.5 C. To permit utilization of the Kety-Schmidt technique for measuring cerebral blood flow during hypothermia, the brain-blood partition coefficients for 85krypton at 37 C and 29.5 C were determined in a series of cats. At 37 C the partition coefficient for 85krypton was 1.092 +/- 0.009; it was 0.931 +/- 0.007 (SE) at 29.5 C. These values were significantly different from each other (P less than .001).


Stability of pseudocholinesterase in stored blood. No significant change in pseudocholinesterase levels was observed in random specimens of whole blood stored for as long as 30 days. Levels in plasma anticoagulated with heparin or ethylenediaminetetraacetic acid declined only slightly. Therefore, massive transfusions do not contraindicate succinylcholine administration.


[The effect of chlordecone (Kepone) on the laboratory colonies of the Pharaoh's ant Monomorium pharanois]. The control of the Pharaoh's ant Monomorium pharaonis is very difficult because of the social way of life in this insect pest. In regard to the reported good suppressing results of Chlordecone we analyzed the mode of action in this compound at laboratory colonies of the pharaoh's ant. Commercial gel and granular formulations as well as selfmade baits have been tested. The best results showed the granular bait on the basis of ground nut butter, while the effects of all of the others was much weaker. The pure gel, developed for cockroach control, was like the application in drinking water without success. The treatment of the colonies after a starvation period of 60 hours improved all of the effects. Sterility (fertility, fecundity) in the surviving queens was not measurable. For practical control measures the often recommended prebaiting is not at all desirable. The action on the worker ants is good, but the special mode of action based on the selective mortality in the queens and its detailed effects are unknown. Through the early absence of queens in the colonies will be induced in many cases a production of new sexuals, which compensate the success of the poison and allow the colonies to recover. The treatment leads faster to an eradiction if the ET90 to workers mortality reached earlier than that in the queens. Successful control of pharaoh's ant will Chlordecone should be considered with reserve. Nethertheless Chlordecone is in the present situation of pharaoh's ant control one of the best so far known organic-synthetically insecticides.


[Incidence and damages inflicted by simuliid flies in the GDR district of Schwerin]. Systematic faunal studies in the district Schwerin showed at the present time there are 3 more or less damage-biotopes existing in the districts of Perleberg, Ludwigslust and Parchim; 5 river sources can be considered as potential sources, 5 are temporary and 2 are ephemeral whilst in 3 further areas environmental influences such as effluent impairs the flow of the river and the developmental stages of Simuliidae were not observed.--The following species were found: Boophthora erythrocephala, Wilhelmia salopiensis, Wilhelmia equina, Odagmia ornata, Eusimulium aureum and Eusimulium lundstroemi.--The damage statistics covering the period 1966--1971 showed in the district of Schwerin, due to Simuliid attacks, 38 cattle died, 170 were seriously ill; in 1967 5 horses were seriously ill; in 1971, 3 pigs died and 27 were seriously ill.--The symptoms were manifested by pathological petechiae, scabs and oedema, also by insufficiency of the heart and circulatory system, diminished performance and growth disturbance. In severe cases heart and circulation failure occurred, paresis, coma and death followed.--The real economic significance of the Simuliid attacks rest with its strong and prolonged distrubance in young animals, as well as in pronounced irreparable diminished performance in diseased dairy cattle.


[Metacercaria in the invertebrates of the Madras coast]. In planktonic and benthic invertebrates of the Madras coast, Bay of Bengal, six Metacercariae have been reported. Four species are from planktonic intermediate hosts. They were found in Ctenophora, Leptomedusa and the gastropod Janthina. They belong to the Hemiurate, Fellodistomatidae and Lepocreadiidae. Two species are from benthic molluscs and belong to the family Monorchiidae respectively to the subfamily Halipeginae. We can expect that the adults of three species are not described.


[Assitrema eichleri gen. et spec. nov., a new trematode species from the Indian Ocean]. A new trematode Assitrema eichleri gen. et spec. nov. is described. The host is a Macrurid (Cory-phaenoidid) fish. The morphology of this flatworm is very aberrant. Therefore it was necessary to erect a new genus in POCHE family Isoparorchidae.


[Plerocercoid infestation of the Thailand reptiles in the Berlin Zoo]. Plerocercoids were found under the skin and in the body cavity of Ahaetulla nastua, Boiga multimaculata, Trimeresurus purpureomaculatus, and Varanus dumerilii, imported from Thailand. Starting with these plerocercoids the cestode cycle was experimentally traced in the laboratory (Lueheela = Spirometra sp.). Domestic cat and domestic dog served as definitive hosts, native copepods at first intermediate hosts, native anurans, reptiles, and chicken as second intermediate hosts and paratenic hosts. Fishes and a Rhesus Macque were shown to act as paratenic hosts. The ferret was only suitable as paratenic host but not as definitive host. The adult worm in the definitive host periodically cast off the whole strobila corresponding to a cyclic appearance of eggs in the faeces.


The transition from sitting on eggs to sitting on young in ring doves, Streptopelia risoria: squab-egg preferences during the normal cycle. Ring doves of both sexes sit on young squabs after hatching in much the same manner as they sit on eggs before hatching, but this study demonstrates that the preferred stimulus varies with the state of the animal. A simultaneous squab--egg choice test was given on days 1, 4, 10, and 13 of incubation and on the day following hatching in normal reproductive cycles of experienced and naïve male and female ring doves. Naïve doves were more likely than experienced doves to choose eggs throughout the cycle (P less than 0-005) and, overall, eggs were more likely to be chosen during early incubation and squabs posthatching (P less than 0-005).


Fibrinogen-related antigen concentrations of blood serum of normal cows, as measured by the tanned erythrocyte hemagglutination-inhibition immunoassay. Serum fibrinogen-related antigen concentration values were determined in normal cows, using a tanned erythrocyte hemagglutination inhibition immunoassay. The geometric mean value for serum fibrinogen-related antigen was 6.60 mug/ml. The upper and lower 95% prediction limits for the 38 cows tested were 12.76 and 3.42 mug/ml, respectively.


Electrocardiographic changes after induced hypercalcemia and hypocalcemia in cattle: reversal of the induced arrhythmia with atropine. The relationship between the Q-oTc interval of the ventricular complex of calves and cows and the total calcium and calcium ion activity was quantitated. A proportional relationship of the Q-oTc existed between total calcium concentrations in the plasma of 5.5 to 8.2 mEq/L and calcium ion activities of 0.75 to 3.2 mEq/L. At higher calcium concentrations, the relationship was curvilinear and very variable. The Q-oTc interval was lengthened during induced hypocalcemic states and shortened during hypercalcemic states. Hypercalcemia seemed to decrease atrial activity and increase ventricular activity, as evidenced by the appearance of bradycardia, sinus arrest, and ectopic ventricular beats. Vagal activity seemed altered by the changes in plasma calcium concentrations and involved in the production of the arrhythmia, because atropine could abolish the arrhythmia created by the infusion of the calcium solutions.


Sequential sterile autolysis in the ovine fetus: macroscopic changes. Sterile intrauterine autolysis was experimentally produced in 28 ovine fetuses in the last 3rd of gestation by umbilical artery ligation. The fetuses were retrieved by cesarean section after periods of sterile intrauterine autolysis ranging from 0.5 to 168 hours. The following autolytic changes, frequently reported as significant lesions in infectious abortions in cattle and sheep, were observed: subcutaneous blood-tinged gelatinous edema, blood-tinged fluid in the serous cavities, renal cortical softening, uniform reddish brown tissues, hepatic friability and mottling, and cloudy yellow to cloudy red abomasal contents. The appearance of these and other autolytic changes corresponded to sterile sequential autolytic changes reported in the rabbit fetus and used to determine duration of retention of stillborn infants and are of comparative biomedical significance. The sequential autolytic changes may be used as an index to duration of retention after death of a ruminant fetus and provide a basis for reappraising various infective abortifacients common to ruminants by allowing separation of specific lesions from strictly autolytic changes.


Ovine campylobacterosis: preliminary studies of the efficacy of the in vitro serum bactericidal test as an assay for the potency of Campylobacter (Vibrio) fetus subsp intestinalis bacterins. An in vitro serum bactericidal test was developed to assess the efficacy of Campylobacter fetus bacterins. Four experimental monovalent bacterins (either serotype C or A-2) and 2 commercial bivalent bacterins (a "suspect" and an "efficacious" bacterin) with aluminum hydroxide adjuvant were administered to sheep and rabbits from which antiserums were then prepared. The different vaccines were evaluated by comparing the in vitro bactericidal activity of the sheep and rabbit antiserums. Results of the in vitro tests were compared to the protection induced in vaccinated ewes which were orally exposed to C fetus. The sheep and the rabbit antiserums after they were heated at 56 C for 30 minutes were unable to exert a killing effect on C fetus cells. Addition of a fresh homologous complement source to the heated antiserums was necessary to demonstrate the in vitro bactericidal capacity. In the comparison of the suspect and the efficacious commercial bacterins, which both reportedly contain serotype C cells, there was a statistically significant difference in bactericidal activities for serotype C cells of antiserums from sheep 14 days after the 2nd vaccination. There was a corresponding significant difference in the antiserums from rabbits 14 days after the 2nd vaccination. Proportionally, more abortions and stillbirths were observed in the ewes vaccinated with the suspect bacterin and then orally exposed to C fetus-serotype C cells than in those vaccinated with the efficacious bacterin. The results indicated that the ability of vaccinated sheep to overcome infection is reflected in the in vitro bactericidal capacity of antiserum from the animal. Since 89% of the variation in sheep antiserums from 14 days after 2nd vaccination can be accounted for by rabbit antiserums from 14 days after 2nd vaccination, the in vitro bactericidal capacity of rabbit antiserums probably provides a reliable index of the protective effect of bacterins containing serotype C for ewes exposed to the homologous serotype.


Digital computer analysis of the QRS complex of the dog, using the McFee axial system. Digital computer analysis of the canine orthogonal electrocardiogram was performed on 30 clinically normal dogs, as recorded by the McFee axial system. The spatiogeometric properties calculated included: time duration of QRS, time integral of QRS, eigenvalues of the QRSsE loop, eigenvectors, spatial magnitude, and spatial velocity. Electrocardiograms were recorded by FM tape recorder, analogue-to-digital conversion performed, and the analytical procedure utilized the IBM 360/75 digital computer controlled by a FORTRAN G source program. The QRS complex and spatial values were qualitatively similar to those in other reports.


Controlled evaluation of fenbendazole as a bovine anthelmintic. Calves experimentally infected with Haemonchus, Ostertagia, and Cooperia, and to lesser degrees with Trichostrongylus, Oesophagostomum, Nematodirus, and Bunostomum were used in a controlled experiment to record the anthelmintic efficacy of a benzimidazole compound methyl 5-(phenylthio)-2-benzimidazolecarbamate at dosage levels of 3.5, 5, and 7.5 mg/kg bodyweight. With the 3 dosages, reductions of Haemonchus were 96.7, 99.2, and 99.8%; of Ostertagia, 97.2, 97.2, and 99.5%; and of Cooperia, 99.9, 99.9, and 99.9%. Pronounced reductions were also recorded for Trichostrongylus, Nematodirus, Oesophagostomum, Trichuris, and Capillaria, but these populations were too numerically small or too unevenly distributed within the control groups to be given much emphasis. The experimental parasitic populations which developed in the 10 control calves amounted to 91, 763  worms (total).


Ultrastructure of blood platelets in cattle with East Coast fever. The sequence of ultrastructural changes of bovine platelets during the fatal course of East Coast fever was swelling; formation of vacuoles,  pseudopodia, and indentations; then thrombocytorrhexis and degranulation; and finally, thrombocytolysis. These changes led to thrombocytopenia and release of serotonin, resulting in petechiations and pulmonary edema.


Effect of nematode parasite infection on the performance of stocker cattle at high stocking rates on coastal bermudagrass pastures. Studies were conducted during the summer of 2 successive years (1971 and 1972) to determine the effects of gastrointestinal nematode parasitism on performance failure of stocker beef steers grazed at high stocking rates on Coastal bermudagrass pastures. During each of the 2 years, 3 groups of steers were rotated at 7- to 10-day intervals on sets of three 1.63-ha pastures from mid-May to late October. (Each group was maintained on a given set of pastures.) In the 1971 program, from mid-May to early August (phase 1) each group consisted of 48 steers for a stocking rate of 29.6 steers/ha. From early August to late October (phase 2) the number of steers per group was reduced to 36 (stocking rate of 22.2 steers/ha) to improve the plane of nutrition. In the 1972 program, 2 groups were stocked at 48 steers per group (29.6 steers/ha) and a 3rd group was temporarily stocked with 58 steers (10 additional steers) to provide 2 animals each month for necropsy evaluation of worm burdens. With exception of the monthly removal of 2 steers from the 3rd group, the stocking rate in 1972 remained intact for the entire grazing season. In 1971, the 3 groups (groups 1, 2, and 3) were treated with thiabendazole (2 doses, 16 days between doses) before grazing. Parasite burdens and levels of pasture contamination were low initially and body weight gains were good during the 1st 3 months of grazing (phase 1). In the 2nd half (phase 2) of the grazing program, 1 group of steers given free-choice supplemental feed (1% of body weight/steer each day) and treated with anthelmintic (thiabendazole; 2 doses, 18 days between doses, during August) and another group, given supplemental feed only, had significantly better weight gains than did the 3rd group, not given supplemental feed nor treated with anthelmintic. There was no weight gain advantage derived from the reduced stocking rate in phase 2. Tracer calves, which were allowed to graze on pastures, developed an increased level of infection after August. Fecal egg counts in the principal steers and recovery of infective larvae from pasture paralleled the infection level in tracer calves. Necropsy evaluation of steers from groups 1, 2, and 3 at the end of the 1971 program indicated a similarity in total worm counts, but in the group not given supplemental feed nor treated with anthelmintic there was more generalized inflammation and a greater number of lesions in the abomasum (Ostertagia) and the caudal portion of the intestine (Oesophagostomum). Steers in the 3rd group also were in poorer condition. Initial worm burdens in the 3 steer groups (groups 4, 5, and 6) were low at the start of the 1972 program. One group was given freechoice supplemental feed (0.5% of body weight/steer each day) and treated with anthelmintics (thiabendazole in the 1st dose, levamisole in the 2nd dose, 12 days between doses, in May and August) and another group was given supplemental feed throughout the summer; the 3rd group was treated with anthelmintics (in May and August)...


Serum testosterone and estrogen concentrations in the Holstein-Friesian bull after successive ejaculations. The testosterone and estrogen concentrations in venous serum of 4 mature Holstein-Friesian bulls were determined by radioimmunoassay before and after each of 3 consecutive semen collections taken at 1-hour intervals. The hormonal concentrations were highly variable for the 2 steroids, but uniform in their patterns after the bulls had ejaculated. After the 3rd semen collection, marked changes in hormonal concentrations did not occur.


Critical tests with oxibendazole against gastrointestinal parasites of ponies. Twenty ponies were allotted to 4 groups of 5 ponies each, and oxibendazole was orally administered at dose levels of 5, 10, 15, and 20 mg/kg. In the 3 groups of ponies given the largest doses, efficacy against 3 species of Strongylus was between 92 and 100% and that against small strongylids of the genera Cyathostomum, Cylicocyclus, Cylicodontophorus, and Cylicostephanus was more than 99%. All adults and 95 to 100% of larvae of the pinworm Oxyuris equi were removed. In the group of ponies given 5 mg/kg, 86 to 100% of the large strongylids and 84 to 100% of the small strongylids were removed, as were all larval and adult pinworms. Trichostrongylus axei was found only in 4 of the 5 ponies given 5 mg/kg; results were encouraging, but not consistent. Almost all of the Parascaris equorum were found in this group of ponies; no anthelmintic activity was detected at this dose level. Oxibendazole removed approximately 99% of small strongylid 4th-stage larvae. No efficacy against the larval stages of Gasterophilus intestinalis and against Habronema spp and Setaria equina was observed.


Effect of helium on maximal expiratory flow in patients with asthma before and during induced bronchoconstriction. The effect of breathing helium on maximal expiratory flow at 50 per cent of vital capacity (V50) was studied in 27 patients with asthma during remission and during induced bronchoconstriction. Nine patients gave a history of asthma induced by exercise; two had asthma due to timothy pollen allergy, and the remaining 16 had asthma due to exposure to western red cedar. Bronchoconstriction was induced by exercise in 10 patients, timothy pollen in 4 patients, methacholine in 4 patients, and red cedar in 16 patients. During remission, the increase in V50 with helium (deltaV50He) was greater than 20 per cent in 22 patients who were classified as responders; deltaV50He was less than 20 per cent in the remaining 5 patients, who were classified as nonresponders. There was a significant correlation between the severity of airway obstruction as measured by V50 and the response to helium, both during remission and during induced bronchoconstriction; however, there was no correlation between helium response and specific airway conductance. In general, patients who were responders during remission remained responders during induced bronchoconstriction, and nonresponders remained nonresponders, regardless of the method of challenge or the type of reaction (immediate verus late). There were a few exceptions in which a responder became a nonresponder during severe bronchoconstriction. The results of this study suggest that in most patients with asthma, the site of airway obstruction is likely to be in the large airways and, in most cases, remains constant in an individual asthmatic; however, an asthmatic who is a helium responder may become a nonresponder during severe bronchoconstriction.


The value of precipitating antibodies in screening for hypersensitivity pneumonitis. To evaluate the usefulness of precipitin tests as a screening method to detect hypersensitivity pneumonitis, we compared persons with precipitins to organic antigens with precipitin-negative subjects from the same population of 1,072 office workers participating in a health survey examination. Thirty-three of the 53 persons with preciptins to Micropolyspora faeni, Thermoactinomyces vulgaris, T. candidus, pigeon serum, aspergillus, alternaria, pullularia, penicillium, cephalosporium, trichoderma, and phoma were matched according to age, sex, height, and smoking habits with precipitin-negative subjects. The subjects completed a self-administered standard questionnaire, they were interviewed and examined, chest radiograms were taken, and pulmonary functions were evaluated at rest and during mild and moderate exercise. No significant differences were found between the 2 populations in any of the pulmonary function measurements. In addition, clinical and radiologic evidence failed to distinguish between the 2 groups. No cases of hypersensitivity pneumonitis were found. In this population, precipitins had no apparent relationship to long disease. The frequency of precipitins was considerably higher than the frequency of hypersensitivity pneumonitis. We concluded that the detection of hypersensitivity pneumonitis in population surveys attempting to establish prevalence of the disease cannot be accomplished by the simple analysis of serum precipitating antibodies but requires, in addition, a more complex analysis of historical, radiologic, and immunologic data.


Role of infection in chronic bronchitis. Twenty-five patients with chronic bronchitis were studied intensively from 1968 to 1972. Viral, bacteriologic, mycologic, and mycoplasmal studies, both serologic and cultural, were carried out in an attempt to determine the role these agents play in exacerbations. All of the usual viral agents associated with exacerbations and 2 members of the coronavirus group, 229E and OC43, were detected. One third (33.6 per cent) of the 116 exacerbations observed could be related to viral infection or Mycoplasma pneumoniae (1 exacerbation). Viral infection was also noted to occur during periods of remission but was more commonly associated with periods of exacerbation(P less than 0.001). No interrelationship between viral and bacterial infection was apparent and neither Streptococcus pneumoniae nor Haemophilus influenzae was present more frequently in the sputum of patients in exacerbation. However, the number of S. pneumoniae organisms present in the sputum was significantly greater (P=0.04) during exacerbation than during remission and their presence was significatnly correlated with increases sputum purulence (P LESS THAN 0.01). This was not true of H. influenzae. Ampicillin was effective in clearing the sputum of S. pneumoniae but not of H. influenzae; the reverse was true of tetracycline.


Chronic nonspecific respiratory disease in Berlin, New Hampshire, 1967 to 1973. A further follow-up study. The 1967 sample of Berlin, New Hampshire was resurveyed in 1973 by means of a standard questionnaire on respiratory symptoms and by simple tests of pulmonary function. Measurements of the levels of air pollution showed a decrease in the number of suspended particulates and an increase in the concentration of sulfation. These values were close to the Federal Primary Standard. No differences in respiratory symptoms, prevalences of chronic, nonspecific respiratory disease, or pulmonary function were detected. Within the limitations of this study, we concluded that the Federal Primary Standards for sulfur dioxide and total suspended particulates are probably adequate to protect the public.


Use and withdrawal of amantadine chemoprophylaxis during epidemic influenza A. A controlled investigation of chemoprophylaxis with amantadine hydrochloride during an epidemic of influenza A was performed in nonimmune students. Illness was significantly decreased and serologic evidence of infection reduced by treatment. During the post-treatment period, while influenza was still prevalent, an accelerated rate of infection occurred among persons previously protected by chemotherapy. When used, chemoprophylaxis should be continued until influenza is no longer prevalent or, preferably, should be combined with vaccine administration to ensure protection after treatment.


The effect of betamethasone on pressure-volume characteristics of nonfetal rat lungs. Betamethasone was administered to rats for 28 days, and body weight, lung weight, and descending pressure-volume relations were measured in their excised lungs. In rats treated with corticosteroid, lung and body weights increased less rapidly than in control rats, but the ratio of lung wet weight to body weight and the per cent dry weight remained the same in both groups. The absolute lung volume was significantly greater at each pressure in the control rats; but when expressed per lung weight, the lungs of rats treated with corticosteroid held more air. When corrected for lung size, the only difference in the lung pressure-volume curves between groups existed at transpulmonary pressures of 0 and 5 cm H2O, where the lungs of the rats treated with betamethasone contained more volume, whether inflated with air or with saline. We concluded that betamethasone administered to nonfetal rats has little influence on the lung's pressure-volume characteristics, which cannot be ascribed to differences in lung size.


Ventilatory response to carbon dioxide in young athletes: a family study. Ventilatory response to carbon dioxide (deltaVE/deltaPCO2) was measured in 23 teenage swimmers chosen by their coach for their potential for future athletic success. Siblings and parents of these swimmers were also studied. We found a strong relation between siblings' de;taVE/DELTAPCO2, whether or not they were swimmers (r=0.71, P less than 0.01). A weaker relationship was found between mother's and children's deltaVE/DELTAPCO2 (r==0.39, P less than 0.01). No association was found between swimming training and deltaVE/deltaPCO2. One swimmer 12 years of age had an extremely low deltaVE/PCO2 (0.42 liter per min per mm Hg) She was the only swimmer among these 23 potential champions to achieve international success in endurance events in the 2 years after the study. We concluded that family factors are important determinants of a subject's deltaVE/PCO2 and suggest that measurement of this aspect of chemical drive to breathing in young athletes may help identify those most likely to succeed in endurance events.


Acute hypersensitivity pneumonitis in the rabbit. I. An animal model with horseradish peroxidase as antigen. An experimental model of acute hypersensitivity pneumonitis was developed in rabbits using horseradish peroxidase as antigen. The lesion, produced by aerosol challenge with horseradish peroxidase 21 days after a single parenteral immunization with horseradish peroxidase and complete Freund adjuvant, was characterized by diffuse infiltration of respiratory bronchioles and of alveolar ducts and walls with approxomately equal numbers of mononuclear cells (lymphocytes and  macrophages) and polymorphonuclear cells. This lesion, which was specific for the antigen, was distinct from the variable granulomatous component that was directly attributable to the use of complete Freund adjubant. Development of the lesion did not correlate with the humoral immune response, as indicated by antigen-binding, precipitin, and homologous passive cutaneous anaphylaxis assays, by negative serum transfer studies, by lack of correlation with immediate and intermediate Arthuslike) skin reactivity, by absence of electron microscopic and immunofluorescent evidence for immune complex processes, and by lack of evidence for complement activation. Development of the lesion did correlate with delayed (12- to 48-hour) skin reactivity, although rigid identification of cell-mediated immunity was not possible on histologic examination.


Airway visualization by tantalum inhalation bronchography. A novel technique for the generation of tantalum aerosols (aerodynamic mass median diameter, 5.8 mum; sigma g, +/-2.14) for inhalation bronchography via the mouth was applied in 26 anesthetized dogs. Ventilatory patterns during periods of aerosol inhalation were controlled by either bilateral electrophrenic stimulation of the diaphragm (EPS), or by intermittent, negative pressure at the body surface (INPV). We studied patterns of tracheobronchial deposition with regard to both the sites of particle deposition longitudinally along airways within lobes, and the topographic distribution of aerosol among the lung lobes. Bronchographic patterns were accordingly studied after inhalations by either (1) EPS and INPV in the supine posture with constant tidal volumes, but varied inspiratory flow (30 to 90 liter per min); or (2) EPS with constant tidal volume and peak inspiratory flow in the prine, right, and left lateral decubitus body positions. Under all airflow conditions, the aerosol was deposited on the surfaces of ciliated airways. Deposition was nearly entirely confined to subsegmental bronchi and above with vigorous inspirations, but extended distally to subsegmental bronchi in greater proportion with decreases in the inspiratory flow. Airways among the basal lung lobes were particularly subject to distal subsegmental and bronchiolar deposition with low rates of inspiratory airflow. Regionally, the aerosol was deposited preferentially in dependent lung lobes after inhalations with EPS in the right and left lateral decubitus positions, and in the basal lung lobes with EPS in the supine posture. A greater caudocranial uniformity in lobar aerosol distribution occurred with inhalations by INPV in the supine posture, and by EPS in the prone posture. The canine model strongly suggests that for clinical inhalation bronchography, nonhomogeneities in lobar deposition may be averted by inhalations in multiple body positions, and that deposition of the aerosol may be confined to ciliated airway surfaces by inertial impaction accompanying high rates of inspiratory airflow.


The glycoprotein-degrading potential of peripheral leukocytes in cystic fibrosis. In this study, the potential problems and discrepancies in cill culture techniques were avoided by isolating leukocytes from the peripheral blood of patients with cystic fibrosis and healthy human volunteers and preparing homogenates to determine the specific activities of 5 lysosomal enzymes involved in the degradation of glycoproteins. Four lysosomal hydrolases involved in the breakdown of the carbohydrate side chain were assayed using artificial substrates. The fifth enzyme, aspartylglucosamine amido hydrolase, which cleaves the linkage between this side chain and the peptide backbone, was assayed with natural substrate. No differences in enzyme activities between the 2 leukocyte sources were observed. Because no enzyme activities were deficient and no compensatory increases were noted, we concluded that the thick, glycoprotein-rich, exocrine secretions in cystic fibrosis cannot be attributed to a defect in their catabolism.


Airway responses to methacholine in allergic and nonallergic subjects. After inhalation challenge with methacholine, bronchoconstrictor responses were produced in allergic subjects with asthma and hay fever as well as nonallergic subjects. Our results indicate that allergic persons possess a greater pulmonary responsiveness to inhalation of this parasympathomimetic agent than nonallergic subjects; however, patterns of response were different in the 2 types of allergic subjects, those with asthma and those with hay fever. Whereas both types of allergic subjects responded with changes in specific airway conductance when nonallergic subjects did not, only asthmatic subjects differed from nonallergic subjects when comparisons of spirometry were made. These data suggest that there is hypersensitivity of both central and peripheral airways in asthmatics and in the larger central airways of nonasthmatic allergic subjects.


The maximal expiratory flow-volume curve. Normal standards, variability, and effects of age. From a randomly selected population representative of the white population of Tucson, Ariz., satisfactory flow-volume data were obtained for 3,115 persons. Data from the 746 subjects who were totally free of symptoms or history of cardiorespiratory disease and who had never smoked were used in determining "normal" prediction equations for spirometric parameters and maximal expiratory flows. The maximal expiratory flow-volume curve showed considerable intersubject variability, but little change in shape of the mean maximal expiratory flow-volume curve was seen with advancing age when the effects of disease, insult, or injury were excluded.


Risk estimates for chronic bronchitis in smokers: a study of male-female differences. Data from a study of chronic bronchitis and obstructive airway disease prevalence in an urban population were used to obtain estimates of the risk of these diseases in smokers and to detail the effect of cigarette smoking on the observed male: female ratio of these diseases. Standard questionnaires and measures of pulmonary function were used. Eighty-two per cent of the observed prevalence of chronic bronchitis could be attributed to cigarette smoking, and 66% of the over-all population rate was attributed to smoking. Both men and women showed a linear increase in chronic bronchitis prevalence with increased smoking. The risk of chronic bronchitis was greater for men than women in all smoking categories, but no differences in decrease in pulmonary function could be observed. Data from comparable studies were assessed and were shown to corroborate the observation that men appear to be at a greater risk for chronic bronchitis, but less clearly so for obstructive airway disease. This excess risk does not appear to be due to a difference in cigarette consumption.


Comparison of questionnaires: the BMRC and NHLI respiratory questionnaires and a new self-completion questionnaire. Interviewer-administered National Heart and Lung Institute (NHLI) and British Medical Research Council (BMRC) respiratory questionnaires were compared with each other and with a self-administered questionnaire of our own design in 2,350 adults enrolled in a longitudinal community study. There was a basic 10% disagreement between responses to any 2 questionnaires for all questions that inquired about a perception of a complaint or a disease, but much less disagreement for more factual questions, such as those concerning smoking. Little effect was noted from minor variations in wording, order of questions, method of administration, inclusion of other questions, or time between questionnaires (as long as this interval was less than 1 month). For questions with similar wording, the BMRC and NHLI questionnaires yielded very similar results in terms of over-all prevalence of responses, relationships to answers on an independent questionnaire, and inter-relationships of positive responses. The new self-completion questionnaire used in this study detected more abnormalities and better delineated cough and phlegm "syndromes" than either the NHLI or the BMRC questionnaire, and we believe that self-administration was a very satisfactory technique in the type of population surveyed in this study.


Chronic pulmonary histoplasmosis with declining complement fixation titers and persistence of positive sputum culture. A case report. A patient with culturally proved chronic pulmonary histoplasmosis was treated with amphotericin B. Complement fixation titers decreased but sputum cultures remained positive for Histoplasma capsulatum 5 months after original therapy. Lobectomy and a subsequent course of amphotericin B were necessary. Exceeding the minimal inhibitory concentrations of amphotericin B did not eradicate the organism and declining complement fixation titers failed to have prognostic significance.


Cutaneous histoplasmosis.

Cutaneous histoplasmosis. Cutaneous lesions as a manifestation of histoplasmosis, primarily a disease of the respiratory system, are rare and most commonly appear secondary to progressive dissemination. A patient with documented progressive, disseminated histoplasmosis, having been treated previously with amphotericin B, presented on a second occasion with cutaneous lesions as the chief complaint. Biopsy and cultures of these lesions were positive for Histoplasma capsulatum. A review of the English literature revealed only 7 reported cases of secondary skin histoplasmosis in the past 20 years. All patients, including the current one, either had diseases associated with depressed immunity or were receiving steroid therapy.


Bacteremic Acinetobacter Herellea pneumonia with survival: case report. A case of community-acquired pneumonia with Acinetobacter calcoacetium var. anitratus (Herellea vaginicola) is presented. Initial leukopenia and spare leukocytes in the sputum, followed by prolonged leukocytosis and fever, were unusual features of this case. The clinical significance and current antimicrobial drug therapy of acinetobacter infections are discussed.


In vitro demonstration of specific IgE in phthalic anhydride hypersensitivity. Clinical sensitization to phthalic anhydride occurred in a worker who developed symptoms of rhinorrhea, lacrimination, and wheezing after exposure to this chemical. Positive skin tests, provocative bronchial challenges, and a high serum titer of specific IgE (by the radioallergosorbent test) to phthalic anhydride corroborated his clinical hypersensitivity. Bronchial provocation studies using alcoholic-saline solutions of phthalic anhydride and phthalic anhydride dust resulted in immediate airway obstruction. The successful identification of specific IgE by the radioallergosorbent test demonstrates that this can be a useful in vitro technique for corroborating sensitization to this chemical.


Sepsis complications in endoscopic retrograde cholangiopancreatography. The overall complications rate with endoscopic retrograde cholangiopancreatography (ERCP) has been justifiably small. However, serious septic sequelae have resulted in extended morbidity and occasional mortality. This occurs following successful cannulation and the injection of contrast media in two clinical conditions: (1) when ductal obstruction impairs proper drainage and (2) when a pseudocyst is injected. The initial experience at Walter Reed and Madigan Army Medical Centers with 71 attempted ERCP procedures includes two cases of pseudocyst abcess. Although this represents only a 2.8 per cent overall incidence of infection, it constitutes a 33.3 per cent rate in the six patients with pseudocysts evaluated. Therefore, it is recommended that routine ERCP be contraindicated in suspected pseudocysts.


Ingested foreign bodies of the gastrointestinal tract. Seven case reports of ingested foreign bodies are presented. Although ingestion of foreign bodies may be a frequent occurrence, 80 per cent of documented ingested foreign bodies pass through the gastrointestinal tract spontaneously. The most frequent victims of foreign body ingestion are children, denture-wearing adults, and the mentally ill. Most foreign bodies are best managed by "intelligent neglect". Some require surgical removal because of perforation hemorrhage or obstruction. The ileocecal region is the most common site for perforation. Close observation for signs of perforation, hemorrhage, and/or obstruction is mandatory.


Efficiency of tube paracentesis without lavage in detecting minimal intraperitoneal bleeding. Tube paracentesis without lavage yielded a positive result in an injured child whose condition was clinically stable and who would otherwise have undoubtedly been observed briefly in the hospital and then discharged. On the basis of the positive paracentesis alone, laparotomy was performed which revealed a very minimal injury of the splenic capsule and intraperitoneal bleeding measured at less than 25 cc. The case is presented because it offers evidence in favor of the efficiency of this technique in detecting intraperitoneal bleeding. This case combined with previous experience leads us to believe this is a very useful tool in the evaluation of patients with blunt abdominal trauma.


The role of pericardiotomy in treatment of pericarditis with effusion. Experience with 23 patients with pericarditis and pericardial effusion is discussed. The methods of drainage with their relative merits are mentioned, as are the etiology of pericarditis, signs and symptoms of the disease as well as various techniques for establishing the diagnosis.


Obturator hernia: report of a case and brief review of its status. The only case of obturator hernia in over 230,000 admissions is discussed. In the review of the recent English literature, a total of 30 cases, including our own, was collected. Characteristics of the condition were analyzed. The median age of the patients was 67 years; the majority were females in a ratio of 9:1 and both sides were equally affected. This entity occurs with the signs and symptoms of small bowel obstruction and, in almost one half of the patients, the pathognomonic Howship-Romberg sign.


Transomental hernia.

Transomental hernia. Transomental hernia is a very rare condition with less than 50 cases reported. This hernia nearly always causes bowel obstruction and may result in a high mortality rate because of strangulation and gangrene. A typical case of transomental hernia is presented and the literature is reviewed with emphasis on the need for early diagnosis and operation.


Paracecal hernia: case report and review of the literature. A case of paracecal hernia successfully treated operatively is described. Review of the literature revealed 145 previously reported cases. Our case is added. Pertinent anatomy predisposing to paracecal hernia is reviewed. Roentgenographic signs of paracecal hernia are presented. Clinical signs and symptoms are discussed.


Primary adenocarcinoma of lung in a child: review of the literature. A rare case of primary bronchogenic carcinoma in a 6-year-old child is presented. Review of the literature reveals an additional 38 cases from which observations are made. Although an usual lesion in childhood, bronchogenic carcinoma does occur and should be considered early for appropriate therapy and for prognosis to be favorably affected.


Ruptured abdominal aortic aneurysms: review of 33 cases treated surgically and discussion of prognostic indicators. Over an eight-year peroid at NCBH, 33 patients were operated for ruptured abdominal aortic aneurysm. Factors associated with an increased mortality included preoperative blood urea nitrogen levels of more than 20 mg per cent, severe preoperative hypotension, duration of symptoms of less than 24 hours, free peritoneal rupture and blood transfusions of greater than 19 units. Preoperative hypotension was the most selective preoperative prognostic parameter. From a review of this and other reported series, it was concluded that reduced mortality from ruptured abdominal aortic aneurysm can best be achieved by prompt diagnosis followed by surgical treatment before cardiovascular collapse can occur.


Oblique muscle splitting incision for cervical laminotomy. A muscle-splitting incision for cervical disc disease is described. It is based upon sound surgical principles. There have been no wound complications in the last 60 patients treated by the authors. Its most stringent demand is that the surgeon be familiar with the anatomical planes to be certain of the level which he wishes to explore.


Staging laparotomy for Hodgkin's disease. We reviewed 39 patients with untreated Hodgkin's disease who underwent staging laparotomy and such cases in the English literature over the past two-and-a-half years. In the group of institutions in our compilation, the accuracies of clinically positive and negative judgments of liver involvement were 28 per cent and 95.4 per cent respectively, while in our institution the accuracies were 100 per cent and 95 percent respectively. The accuracies of the clinically positive and negative determinations of splenic involvement were 61.2 per cent and 67.3 per cent respectively after histological examination, whereas we had accuracies of 100 per cent and 74 per cent respectively. The accuracies of the clinically positive and negative determination of lymph nodes were 72.1 per cent and 86.7 per cent respectively, whereas the results were 70.6 per cent and 100 per cent respectively in our 39 cases. The percentage of complications was 10 per cent and the mortality rate was 0.9 per cent among 719 staging laparotomies. The common complications were atelectasis, pneumonia, wound infection and dehiscence, abscess, intestinal obstruction and thrombocytosis. We think more aggressive staging laparotomy should be performed for Hodgkin's disease under one surgeon or one surgical team.


Wound dehiscence after cholecystectomy and salmonella infection. A case of a wound dehiscence following a Salmonella wound infection is reported. Cholecystectomy for the typhoid carrier state is not an uncommon operation and carries the risk of Salmonella wound infection in about 7 per cent of the cases. Wound dehiscence with this type of infection has not previously been reported.


Emphysematous cholecystitis: report of a case. A case is reported of emphysematous cholecystitis that occurred seven months after vagotomy and hemigastrectomy (with Billroth II reconstruction). It was successfully treated by means of initial cholecystostomy and interim cholecystectomy six weeks later. Although it has been urged by some that an emergency operation is always indicated in this condition, in the case presented, the timing of the operation was determined by the overall clinical picture of the patient.


Patient acceptance of local anesthesia for breast biopsy. Three out of every four patients undergoing breast biopsy found the outpatient local-anesthesia method acceptable in this study. Patient acceptance was greater among those who experienced less pain and anxiety. This suggests that acceptance could be increased by more complete preoperative explanation to the patient, adequate premedication, properly administered local anesthesia and gentle technique. Acceptance would also probably be far greater in a private practice setting than in the instititutional and sometimes impersonal setting of a large federal hospital. Breast biopsy under local anesthesia has not compromised survival rates or increased local recurrence. When it is done on an outpatient basis, hospital costs have been reduced at least threefold. It is apparent, then, that patient objection is not a deterrent to the use of breast biopsy under local anesthesia on an outpatient basis. For patients with dominant breast masses, this modality can be added to any plan of management which seeks to reduce patient risk and inconvencience, diminish hospital costs and alleviate bed demand all without impairing diagnostic accuracy or long-term survival.


Recurrent pancreatitis and jaundice: report of a case in an eleven-year-old girl. An 11-year-old girl had recurrent pancreatitis and jaundice caused by fusiform dilatation of the common bile duct, a variant of choledochal cyst. The treatment was Roux-en-Y choledochojejunostomy and cholecystectomy. There has been no recurrence of symptoms during subsequent follow-up.


Teratoid tumors of the mediastinum.

Teratoid tumors of the mediastinum. Anterior mediastinum is the third commonest location for teratoid tumors besides the ovaries and the testes. Although there is still some confusion about the classification of these tumors, most authors now agree that the term dermoid cyst should be used for cystic lesions containing ectodermal and mesodermal elements. Teratoma should be reserved for solid or cystic lesions containing derivatives of all the three germ layers. The clinical manifestations offer no clue to their malignant potentiality. Chest roentgenogram, tomogram and esophagogram are useful, and aortic arch studies may be indicated in some cases to exclude aortic aneurysms. Surgical excision offers the best method of diagnosis and treatment. The prognosis is excellent for benign teratoids but poor for malignant teratoids, especially in children and young adults.


Carotidoesophageal fistula complicating carcinoma of the esophagus: report of a case. A case of carotidoesophageal fistula complicating carcinoma of the esophagus is reported for the first time in Iran. Review of the literature up to 1972 revealed four previous reports of this complication and only 92 reported cases of aortoesophageal fistula due to carcinoma of the esophagus.


[Cloverleaf syndrome. Presentation of four cases (author's transl)]. Four cases of cloverleaf syndrome are presented. Authors agree with recent opinions that this alteration is a significant indication that may be presented by diseases which develop craniosynostosis very early (acrocephalosyndactyly, thanatophoric, dwarfism, Crouzon's disease, etc.). Etiopathogenic considerations are made about morphology and prognosis in this disease of unknown etiology.


[Digestive associated malformations in esophageal atresia. A study of 125 patients (author's transl)]. The incidence of digestive malformations associated to esophageal atresia and tracheoesophageal fistula is reviewed in a series of 125 surgically treated patients during the last five years' period. A correlation is drawn with other associated malformations. Its influence upon the mortality rate is stressed.


[Caudal regression syndrome (report of 4 cases) (author's transl)]. Four cases of caudal regression syndrome with partial or complete sacrococcigeal agenesis are presented. One of them also had agenesis of the last lumbar vertebrae. Urinary, gluteae and inferior limb malformations were found in all four. Special emphasis is placed on the importance of the early knowledge of these malformations in order to avoid secondary effects to neurogenic bladder (urinary infections, vesico-ureteral reflux, hipofunctional kidney) caused by a delayed diagnosis. Maternal diabetes in one case and skeletal alterations (hexadactily, lack of one hand) in another were found among the family history. A very uncommon association with Goldenhar's syndrome and Klippel-Feil's syndrome in one case, and with "situs inversus totalis" in another are described. The possible ethiologies of the syndrome are being discussed.


[Single ventricle and related anomalies. Anatomic findings in 30 cases. Diagnostic and therapeutic implications (author's transl)]. Anatomic characteristics are studied in 30 cases of single ventricle and related anomalies. Cases are distributed into 6 groups according to: a) the derangement in the expansión of the atrioventricular canal towards the "bulbus cordis", which may be either defective (groups I, II and III) or excessive (groups IV and V), and b) the hypoplastic nature of the ventricular septum (group VI). The most important conclusions are: 1) An L-bulboventricular loop was found in 43.47% of the entire material; all of them pertained to groups I, II and III. 2) A normal position of the great arteries was uncommon, being encountered in 13.4% of the cases. An aorta situated anteriorly and to the left was present in 30.43% of the cases included in groups IV and V. 3) Obstructive anomalies of either outflow tract were discovered in 66.6% of the entire material, regardless of the type of bulboventricular loop. 4) The left atrioventricular orifice was found to be abnormally small in 56.66% of the total case material and in 88.23% of the cases pertaining to groups I, II and III. 5) A mitral atresia was encountered in two cases pertaining to groups I and II. The criteria which have been used to admit cases with this association of anomalies have been established in previous publications by one of the authors of the present study. 6) The changes in the spacial orientation of the leaflets of the right atrioventricular orifice in cases with an L-bulboventricular loop are attributed to the rotation of the heart around its longitudinal axis which takes place in cases with levocardia and mesocardia. 7) A preoperative study as accurate as possible is necessary in order to establish a rational approach to the surgical management of these patients.


[CSF. changes in partially treated bacterial meningitis (author's transl)]. Review of 102 admissions of children (one month to seven years of age) with bacterial meningitis is presented. 46 of the patients (45%) had been treated previously with one or more antibiotics. Previous treatment made culture of CSF negative in a statistically significant (p less than 0.001) number of cases, mainly in meningococcal meningitis. There were no significant differences in the levels of CSF glucose, proteins and WBC's between both groups. A decrease of the percentage PMN/lymphocytes was found in the CSF of the partially treated group. In 7 out of 102 no more than two CSF pathological findings were present. In 5 or 7 CSF cultures were positive. In the other two there were pathological changes in CSF even with correct dosage of previous antibiotics. In 4 patients with positive cultures and little changes in CSF on admission, LP after 48 hours of correct treatment showed an increase in the alterations of CSF. This could mean that previous low dosage antibiotic treatment should not modify CSF findings enough not to make correct diagnosis.


Simplified perimetry.

Simplified perimetry. A simplified method of performing peripheral visual field examination with the Krimsky Eyecup is described. This technique is compared with Goldman perimetry in a series of patients with a variety of ocular pathology. The peripheral visual fields obtained by these two methods compare closely.


[Semiologic value of tonic-axial crises in children (author's transl)]. The tonic-axial crises described clinically and by electroencephalo-grams by Ouachi, Roger and Gastaut in 1961, are encountered with relative frequency in specific forms of infantile epilepsy and they establish the principal nucleus of the appearing manifestations in some cases of childhood epileptic encephalopathy. We have studied 43 epileptic children who have displayed tonic-axial crises, taking into consideration the absence or existence of concrete antecedents of cerebral attack, the moment of appearance of the tonix-axial crises in relation to the commencement of the critical manifestations, the type or types of epileptic crises, the circumstances of appearance of tonic-axial crises and its influence upon the further development of the child. Its physiopathology is questioned and the tonic-axial crises is considered as a semiologic crossroad in the evolution in the secondary generalized epilepsy.


[Oral-facial-digital syndrome in male (author's transl)]. One case of oral-facial-digital syndrome (Papillon-Léage and Psaume) is presented. This is the second one reported on a patient with normal male karyotipe. Clinical data and genetic aspects are commented in relation with this new case in a 46 XY male.


Solar retinopathy.

Solar retinopathy. Two cases of solar retinopathy following prolonged sun gazing are presented. Both patients were seen within an interval of 11 months, both with the diagnosis of schizophrenia paranoid type. These patients gave a history of sun gazing while praying to God, resulting in pigmentary disturbances of the macula, characterized by central and parafoveal depigmentation with perifoveal hyperpigmentation, as well as permanent impairment of vision in both eyes.


[Brain scanning in children (author's transl)]. This report is concerned with evaluation of brain scintigraphy in the detection of brain tumors in children. Brain scans have been reviewed in 309 cases and were evaluated in 182 patients; brain tumor suspicious was present in 41 childrens. True positive results were obtained in 73% of brains tumors and true negative results in 5% with other diseases. There were either false positive or false negative results in 21% of scans. Results are compared to other series reported, showing similar findings. Finally the importance of this type of investigation is stressed.


[Congenital malformations associated with esophageal atresia (author's transl)]. In 67 patients with esophageal atresia we have found associated congenital anomalies in over 80% and 10 children could be considered as carriers of Vater association. The various malformations are reported and their etiopathogenic factors considered.


The use of polyglycolic acid sutures in outpatient cataract surgery. The use of 7-0 polyglycolic acid (Dexon) sutures in 200 consecutive outpatient cataract extractions is described and compared with the use of 7-0 chromic gut sutures in 200 consecutive outpatient cataract extractions. The polyglycolic acid sutures appeared to be more comfortable to the patient than the chromic gut sutures, they absorbed at a constant, steady rate compared to a variable rate for the gut sutures and there were less postoperative complications with the polyglycolic acid sutures than with the gut sutures.


[Guillain-Barre's syndrome in childhood (author's transl)]. Seventeen cases of Guillain-Barré's syndrome aged between 14 month ans 7 years are studied from clinical, analytical and evolutives aspects. Neither sex nor season predominance occurs. Sixteen of the patients had a previous viral or bacterial infection. Difficulty in walking was the main symptom at the onset of illness. Arreflexia and motot paralysis were always symmetrical and ascending. Albumino-cytological dissociation in the C.S.F. was found in the whole group. An evolutive study was made of the recovery of movement, C.S.F. and tendon reflexes which occurred in this order except in two cases which showed abnormal evolution. We emphasize the extent and frequency of respiratory difficulties at the onset of illness. Some etiopathogenic aspects, the lack of specifity of the syndrome and the differences of the diagnosis with that of poliomyelitis are commented. We point out the lack of effect of the corticosteroids treatment and the positive effects of phisiotherapy after the acute stage.


Superior oblique tendon sheath syndrome: an unusual case. It is now recognized that the clinical findings of Brown's superior oblique tendon sheath syndrome can be caused by a variety of abnormalities. This has led to classification into "true" and "simulated" sheath syndromes. This report describes a case of simulated sheath syndrome caused by an anomalous fibrous band between the superior oblique tendon sheath and the upper nasal intermuscular quadrant. This unusual anomaly results in functional shortening of the sheath. Division of the band eliminated the restrictions on traction test and improved elevation in all fields postoperatively.


The intraocular pressure: clinical aspects. Only a few conclusions can be mentioned: The IO pressure of the normal eye is not fixed, but shows spontaneous variations of pulsatory, respiratory, vasomotoric and diurnal type. The highest and lowest point of a 1 minute tracing can differ for 8 mm Hg. Very short acting tonometers are, therefore, less reliable than those with slower reactions, which will average some of the quicker oscillations. Normal limits of diurnal variations are 5 mm Hg with peaks below 25 mm Hg and differences between right and left eye of less than 4 mm Hg. The range of pressure of an eye is more important than a definite value which is true for the moment only. Factors which influence the IO pressure in healthy subjects are discussed in detail, such as age, sex, eye muscles, sports, muscular spasmus, child birth, position of the body, real or simulated tonometry, and mental stress. Difficulties in tonometry are discussed. In applananation tonometry, +/- 2.5 mm Hg must be accepted as the possible error of clinical results. This is not caused by any lack in the construction of the instrument, but by the combination of interobserver variation in reading the instrument, spontaneous pressure changea and an individually different decrease of pressure in consequence of repeated measurements. It is concluded that the rigidity of the living eye cannot be measured with a satisfactory  degree of exactness. For the clinical purpose of early diagnosis, the diurnal tension curve combined with the tonography test of the author are the best methods. Early normalization of intraocular pressure is the safest means to prevent damage of the optic nerve. In spite of the individual variations of pressure and the inaccuracies of any single tonometry, the present methods of tonometry are clinically sufficient to form an opinion about the diagnosis and also about the success of our treatment, the aim of which is to normalize the pressure through the 24 hours below 20 mm Hg.


[Corticosteroids in viral hepatitis (author's transl)]. 138 cases of viral hepatitis were selected among 27,000 pediatric clinical records corresponding to the years 1965-75. The clinical course of patients receiving corticosteroids during the acute phase was compared to that of the remaining patients, and an increased number of prolonged course cases was observed. At the same time, more frequent evolution to either aggressive forms or cirrhosis is suggested. Therefore, the authors discourage the use of corticosteroids in the treatment of common viral hepatitis.


Bias of the cover test in the diagnosis of alternating tropia. In the evaluation of patients with alternating tropia, all errors tends to falsely overclassify the fixation pattern as free alternation and underestimate monocular fixation. This bias is particularly undesirable in infants when the cover test is used because more direct measurements of visual acuity are not possible.


Change in weight of the human lens with age. When data in the literature are pooled, a large number of points become available for plotting the weight of the human lens as a function of age. Between mean ages 15 and 85 years, the values are described by L = 1.32 A + 141, where L is the Lens weight in mg and A is the age in years. The correlation coefficient was 0.977. There thus appears to be a continual, linear increase in the weight of the lens with age.


X-linked congenital nystagmus: a problem in genetic counseling. A pedigree with X-linked congenital nystagmus is presented. A mother wished information about prenatal sex determination. The large number of clinically affected female heterozygotes in the pedigree illustrates a potential problem in genetic counseling for this condition and possibly other X-linked disorders which affect the eye.


Topical epinephrine and cystoid macular edema. Epinephrine maculopathy occurred in one eye of a patient that spontaneously developed intraretinal cystic maculopathy in the other eye. The clinical and fluorescein angiographic apperance of the two conditions were identical. It is likely that the two conditions have a common organic denominator.


Tobacco smoking and glaucoma.

Tobacco smoking and glaucoma. Effect of cigarette smoking on aqueous humor dynamics in 70 normal males and 70 primary glaucoma patients was studied. A rise of intraocular tension of more than 5 mm after last puff of cigarette was taken as a positive result. It was observed that this test was positive in 37.1% of primary glaucoma patients and only in 11.4% in normal persons--a statistically significant difference. Cigarette smoking causes vasoconstriction and may be leading to rise in episcleral venous pressure and thus inhibiting aquenous outflow from the angle. This test can be used as a provocative test for primary glaucoma patients.


Vitreous fluidity in myopia.

Vitreous fluidity in myopia. Forth-eight eyes were examined to determine if degeneration and liquification of the vitreous could be determined by vitreous movement in subjects with myopia compared with subjects who had either emmetropia or hypermetropia. The difference in duration of vitreous movement for the myopes was significantly greater than that for nonmyopes (p less than 0.05).


Silicone intubation of the lacrimal system: pitfalls, problems and complications. The Quickert-Dryden method of silicone intubation of the lacrimal system has been modified to make it easier to perform and to avoid postoperative complications encountered by me during my experiences with 23 patients. Problems with the technique are identified and management of complications is discussed.


Injected mixture for hemostasis in dacryocystorhinostomy. A mixture of epinephrine and hyaluronidase, injected into the naso-orbital recess at the start of dacryocystorhinostomy and into the nasal mucosa immediately after bone penetration, appears to have a greater hemostatic effect than epinephrine alone. Surgical time is shortened by the reduced need for angular vessel ligation, suction, cautery of bleeding, and nasal packing. Postoperative ecchymosis and nasal clotting are also reduced.


Histopathological observations of presbycusis. Temporal bone histopathology of 17 aged patients who had spontaneous and gradually progressive bilateral sensorineural hearing losses associated with aging was studied. Six cases in the present material showed the gradually sloping audiometric curve; nine cases, abrupt high tone hearing loss; and two cases, the flat audiometric curve. The most prominent histopathological change in the inner ear was a decrease in the population of the spiral ganglion cells. However, diffuse senile atrophy was also often seen in the organ of Corti and the stria vascularis. A positive correlation between the degree of artheriosclerosis and the degree of sensorineural degeneration in the cochlea was not obtained in the present cases. Also, the correlation was not found to be consistent between the type of the audiometric curve and the localization of lesions in the sensory, the neural or the vascular elements in the cochlea. Our observations show that a certain type of audiometric curve does not necessarily indicate a lesion in a specific cochlear element.


Correlation of tubal function and volume of mastoid and middle ear space as related to otitis media. In 69 ears with chronic otitis media and nine ears with traumatic perforations tubal function the size of the mastoid air cell system measured planimetrically on roentgenograms and the functional volume of the air filled ear spaces were studied for any correlations. The roentgenographic area and the functional volume were also studied for any variation in the duration of the disease. A correlation was found between abnormally small volumes and impaired tubal function, probably due to mucosal damage of the whole system, i.e. Eustachian tube, middle ear and mastoid air cells. No such association was found between area and tubal function. The volume, but not the area, decrease with the duration of the disease.


Spastic dysphonia.

Spastic dysphonia. 130 cases of spastic dysphonia are reviewed with special emphasis on the etiology of the disorder. An analysis of the circumstances surrounding the onset of the disease points strongly to a psychogenic origin of the disease in, at least, the vast majority of the cases.


Schwannoma of the jugular foramen.

Schwannoma of the jugular foramen. Two cases of schwannoma limited to the jugular foramen are described. This entity may clinically and radiologically resemble glomus jugulare tumors so closely, that only careful histological examination of an adequate surgical tumor specimen can provide a definitive diagnosis. Since documentation of this form of neurogenic tumor is lacking in the literature, it suggests that the entity is very rare or that such tumors may be erroneously classified as glomus jugulare tumors. The two cases in  this study were managed surgically by subtotal removal via a wide transmastoid approach.


Delineation of cochlear glycogen by electron microscopy. Two techniques for the demonstration and identification of glycogen by electron microscopy were applied to the cochlear duct tissues of normal guinea pigs and chinchillas. A modified osmium tetroxide fixative (with potassium ferricyanide) has been described by De Bruijn to selectively stain the glycogen particle. Identification of the stained particle was effected by its selective removal from the tissue with amyloglucosidase, an enzyme specific in its degradation of the glycogen molecule. Glycogen particles were noted in several cell types within the cochlear duct, but concentrations were greater in outer hair cells of both species and in the stria vascularis of the chinchilla. The fact that amyloglucosidase completely  eliminated these particles from the liver of both species as well as cochlear tissue, led to the conclusion that these particles are indeed glycogen.


Effect of nicotine on cochlear function and noise-induced hair cell loss. Nicotine administered in high doses intravenously (1 mg/kg) and intracochlearly (10 mM) exhibited very little effect on guinea pig cochlear potentials. When administered chronically (1-20 mg/kg, i.p. for 20 days), nicotine demonstrated no effect on cochlear potentials or the number of observed hair cell scars monitored 21 days after the treatment was terminated. Neither chronic nicotine treatment (1-20 mg/kg, i.p. for 20 days) nor acute reserpine pretreatment (5 mg/kg, i.p. 24 hours before) altered the hair cell damaging effects of an intense pure tone (4 kHz, 126 dB SPL, 30 min). No nicotine ototoxicity was detected by the methods used in this study.


Auditory imperception.

Auditory imperception. The diagnosis, evaluation and treatment of learning disabilities involves many disciplines. The Otolaryngologist can play an important role in reducing the psychosocial-educational effects of perceptual hanicaps by being active in early diagnosis. This paper presents: 1) an overview of significant information pertaining to auditory perceptual problems and 2) suggestions for the clinican interested in identifying children with auditory perceptual defects.


Caloric-eye tracking pattern test: I. Visual suppression and the possibility of simplified differential diagnosis between peripheral and central vertigo. During the examination of patients who complain of vertigo or who have equilibrium disorders, it is often difficult to determine the etiology of the disorders, that is, to determine whether it is dependent on a peripheral or central vestibular disorder. To attempt to guess  the etiology in these cases, we devised a new method: the caloric eye-tracking pattern test. In normal subjects and in patients with peripheral disorders, as is well known, caloric nystagmus has little influence on the eye-tracking pattern. In contrast, in patients with central  vestibular disorders, caloric nystagmus evoked abnormalities on the eye-tracking pattern, either superimposed or saccades, in spite of the fact that the eye-tracking pattern before the caloric stimulation is normal. These findings result from the visual suppression mechanism to the vestibular nystagmus. We can say that the visual suppression to the vestibular nystagmus is evoked more strongly bu pursuing a moving visual stimulus than by gazing at a stationary target. These results are interesting, not only form the physiological view point, but also from the clinical view point. There is a possibility of the differential diagnosis between peripheral and central vertigo.


Effect of anesthesia on susceptibility to acoustic trauma. In an effort to ascertain whether differences in susceptibility to noise depend on general condition, awake and anesthetized guinea pigs were given a 4 kHz pure tone overstimulation under identical conditions. Cochlear hair cells were histologically examined four weeks after the noise exposure. The damage was localized in the upper part of the first turn and the lower part of the second turn. One fourth as much damage occurred in the anesthetized group. The distribution of damage in the four rows of sensory cells was different in the two experimental groups. In both groups of animals the damage was localized mainly to the outer hair cells, the first row sustaining the major damage.