Pulmonary damage following pulmonary microembolism in the dog. Effect of various types of treatment. In the present study the pathogenesis of the pulmonary damage following infusion of thrombin in combination with a fibrinolysis inhibitor, AMCA, in the dog was elucidated. An important mechanism in the development of the pulmonary damage following infusion of thrombin and AMCA seems to be an increased vascular permeability in the pulmonary microvasculature leading to pulmonary oedema. The question whether this pulmonary damage can be prevented by antihistamine (mepyramine maleate), antiserotonins (methysergide, reserpine) antiprostaglandins (acetylsalicylic acid, indomethacin, polyphloretin phosphate), 'anti-inflammatory agents' (methylprednisolone, calcium) or an anti-adrenergic agent (phenoxybenzamine) was investigated. None of these agents did prevent the lung damage following thrombin and AMCA. In order to study the possible role of bronchoconstriction, the complement system and the kinin system for this damage dogs were also artificially ventilated with an increased end-expiratory pressure, decomplemented with cobra venom factor or treated with Trasylol respectively. Neither were these treatments effective in preventing the pulmonary damage. The findings of the present study suggest that the permeability increasing substance involved in the pathogenesis of the pulmonary damage following thrombin and AMCA is not histamine, serotonin, prostaglandins or bradykinin. Therefore another, still unknown factor, may be of greater importance for this damage.


Induction of endogenous fibrinolysis inhibition in the dog. Effect of intravascular coagulation and release of free fatty acids. Possible mechanisms underlying the development of fibrinolysis inhibition following trauma were studied. In order to investigate the role of intravascular coagulation dogs were subjected to infusions of thrombin or endotoxin, which both caused an increase in urokinase inhibitor activity in serum after 24 and 48 hours. The inhibitor increase following thrombin infusion was not, however, prevented by previous defibrinogenation with Defibrase or by induction of thrombocytopenia with antiplatelet serum, suggesting that neither platelets nor fibrinogen are necessary for the post-traumatic occurrence of fibrinolysis inhibition. In all groups subjected to infusion of thrombin an increase in plasma free fatty acids (FFA) was observed. The role of this increase for the development of fibrinolysis inhibition was tested by infusion of norepinephrine alone and in combination with nicotinic acid. Norepinephrine caused an increase of FFA after 2 hours and in urokinase inhibitor activity after 24-48 hours. Both of these were diminished by high doses of nicotinic acid, indicating that the release of FFA rather than intravascular coagulation might be the principal mechanism underlying the occurrence of fibrinolysis inhibition following trauma.


Heme compounds in the plasma in small bowel ischemia in the rat. The early diagnosis of acute mesenteric occlusion presents a difficult problem in abdominal  surgery. In a study on rats the relation between graded small bowel ischemia and the concentration of heme compounds in the plasma was investigated. The ischemia was produced by ligation of terminal vessels at the mesenteric margin of the intestine (mesenteric end arcades) or the superior mesenteric artery. Heme compounds were assayed by a benzidine method developed by Crossby et al. The concentration of heme compounds in the plasma was higher in animals with various grades of intestinal ischemia than in animals subjected to laparotomy alone. This increase was noted as early as 4 hours after induction of moderate and severe grade of ischemia. The results indicate that an increase in plasma concentration of heme compounds takes place at an early stage of moderate and severe small bowel ischemia following mesenteric vascular occlusion but not until after 48 hours in mild ischemia. The clinical value of this method has to be tested in a clinical study.


Vasopressin tachyphylaxis. A study in conscious man. The effects of repeated intravenous constant infusion of lysine-8-vasopressin (LVP) in a series of 12 conscious patients with portal venous catheters were studied. The portal venous pressure fell, the arterio-portal venous oxygen difference and the systolic and diastolic blood pressures rose and the heart rate decreased. Although no signs of tachyphylaxis were seen in portal venous pressure, systolic blood pressure or heart rate, they were observed both in the arterio-portal venous oxygen difference, indicating a tachyphylactic reaction in the effects on splanchnic blood flow, and in the diastolic blood pressure.


Effect of vasopressin on regional splanchnic blood flows in conscious man. In 11 conscious normovolaemic patients with acute or chronic pancreatitis the effect of a continuous intravenous infusion of lysine-8-vasopressin, 5 IU/70 kg b.w./20 min on the portal and the hepatic venous blood flows was studied by using multiple portal catheters, oxygen saturation measurements and an indicator dilution technique with continuous infusion of 133Xe into the portal vein or its tributaries. During vasopressin infusion the total hepatic blood flow, estimated by the Bradley technique with indocyanine green dye, was reduced to 61% of the value at rest. Owing to the simultaneously occurring streamlining of the portal venous flow with incomplete mixing of indicator and blood, the portal and hepatic venous blood flows could be measured in only 3 of 9 patients. The reduction in the portal venous blood flow during vasopressin infusion was more marked than the decrease of the total hepatic flow, corresponding to a calculated increase of the hepatic arterial flow of 50%. Total splanchnic oxygen uptake and extrahepatic splanchnic oxygen uptake were unchanged during and after infusion of vasopressin. Thus, changes in splandhnic blood flow could be estimated from changes in arteriovenous oxygen differences. Also by this method a more pronounced reduction in the portal venous than of the hepatic venous blood flow was observed. The decrease during vasopressin infusion of the superior mesenteric venous flow was more marked than that of the splenic vein. The splanchnic circulatory changes may be different for other doses of vasopressin and in cirrhotic patients with higher hepatic arterial blood flow fractions.


The effect of glucagon on total liver blood flow after occlusion of the hepatic artery. A study in anesthetized, normotensive dogs. It has earlier been shown that the hormone glucagon has the property of increasing liver blood flow both in normotensive dogs as well as in dogs in hemorrhagic shock. This study was done to evaluate the effect of glucagon given in normotensive dogs after occlusion of the hepatic artery. Glucagon was given in a single dose of 50 mug/kg bodyweight. The study shows that glucagon under these circumstances increased total liver blood flow 67% compared to an increase of 3% in a control group. The increase is statistically significant compared to the effect of placebo injection in a control group. A benefit of the hormone is suggested in man in surgical situation where occlusion of the hepatic artery becomes necessary.


Healing of a crush injury in rat striated muscle. 4. Effect of early mobilization and immobilization on the tensile properties of gastrocnemius muscle. Tensile properties of partially crushed gastrocnemius muscle were studied and compared with the uninjured control muscles of 185 rats after treatment by mobilization on the treadmill or immobilization in a softened plaster cast. Two to 42 days after a reproducible injury induced to the left calf of the rat, load-deformation curves were registered from both gastrocnemius muslce and several parameters were assessed from the curves. The rupture site was studied macroscopically as well as histologically. In injured muscles the rupture was usually observed at or near to the injury (92%) when in intact muscles the rupture most often (94%) occurred at the muscle belly. The decrease in breaking strength and energy absorption due to the injury was rather constant (20-25%) on day 2 after trauma. Thereafter in mobilized muscles these values, as well as those of elastic stiffness, returned to the level of the uninjured control muscles more rapidly than in immobilized muscles, where a decrease in tensile properties at the end of the first week was on an average 20-30% and fell still further to 30-40% towards the end of the immobilization period (21 days). Three weeks after the removal of the casts these values in the previously immobilized muscles had not yet reached the level of the controlateral control muscles.


Ideal cholecystectomy: in an early stage at an early age. Two consecutive series of patients operated for gallstone disease were compared. One series emanated from a Swedish hospital in which an active surgical policy had been practised for many years while the other stemmed from a Swedish hospital in which the attitude towards surgery had been conservative. In this latter hospital there were more cases with biliary duct stones, especially hepatic duct stones. There were also more cases with jaundice, more cases with acute cholecystitis with high fever, more cases with protracted postoperative fever and with infection of the wound and more cases with a lengthy stay at the hospital. Responsible for all these differences were the older age groups. The conclusion is that the ideal treatment for gallstone disease is early operation, i.e. operation in an early stage and at an early age.


Carcinoma of the stomach. A ten-year material. 1959-68 220 patients from Aust-Agder County were admitted to the Central Hospital with carcinoma of the stomach. The material is analysed and discussed. The average age of the patients was 69.4 years. A palpable tumour was found in 96 patients (46%); of these 6 survived 5 years. A short case history is connected with a better prognosis. One hundred and forty-nine patients (71.3%) underwent laparotomy, and the tumour could be removed in 94 cases (45%). The standard treatment has been partial gastrectomy according to Billroth II. Better results can possibly be achieved if the diagnosis is made at an earlier stage, which means before the tumour causes classical symptoms. Early gastrectomy is recommended in cases of ulcer of the stomach or X-ray negative dyspepsia.


Pregnancy after jejuno-ileostomy because of obesity. In four cases of pregnancy after jejuno-ileostomy because of massive obesity intestinal absorption was adequate for the nutrition of both the baby and the mother. It appears that such an operation because of obestiy does not contraindicate later pregnancy; In one case postoperative loss of body weight probably made pregnancy possible. In extremely adipose women who are for some unknown reason infertile and wish to have a child a shunt operation might perhaps be offered.


Studies on Crohn's disease. 1. The relationship between Yersinia enterocolitica infection and terminal ileitis. Patients with terminal ileitis or regional enterocolitis have been examined for signs of infection due to Yersinia enterocolitica serotype 3. The patients were grouped according to the length of preoperative history. Among 18 patients with preoperative symptoms of one week or less there were nine with positive signs of Yersinia enterocolitica infection. None of these patients developed the chronic form of Crohn's disease while two of the primarily Yersinia negative patients progressed to the chronic form. Among nine patients with preoperative symptoms of one week to three months there was one patient with positive signs of Yersinia enterocolitica infection. This patient has remained healthy whereas seven of the negative ones progressed to the chronic form of Crohn's disease. None of the patients with established Crohn's disease of the chronic form had signs of recent Yersinia infection. The findings indicate that patients with acute terminal ileitis and positive signs of Yersinia infection are not likely to progress to the chronic form of Crohn's disease. Bacteriologic and serologic investigation for Yersinia infection are therefore of prognostic value.


Primary torsion of the whole greater omentum. A case report and review of the literature. A case of primary torsion of the whole greater omentum is described. The patient was admitted to the hospital for severe abdominal pain. An emergency operation revealed that the whole greater omentum had twisted around its pedicle and was strangulated and gangrenous. The omentum was removed. The patient's recovery was uneventful. The literature is reviewed and discussed.


Optimal suction system for dissection work in surgery. A new system for improved suction in surgical dissection work is presented, in which the suction tube end has slits. The air suction capacity of the pump is 30 litres a minute, and the maximal vacuum pressure in the systems is limited to -0.3 at by means of a membrane pressure regulator. This system allows a continuous atraumatic suction with adequate suction capacity and convenient operation.


Electroencephalographic study of children during ketamine anesthesia. EEG was recorded on nine occasions of ketamine anesthesia in eight children. Two of the patients were neurologically normal and six were under investigation for various neurological disorders. The EEG during the catatonic phase of ketamine anesthesia is characterized by alternating high amplitude delta complexes and periods of fast activity. The two cases which in the routine EEG showed focal paroxysmal activity did not show any electroencephalographic aggravation or clinical seizure during ketamine influence. One case exhibiting a subcortical type of epileptiform activity showed a marked potentiation of this activity with ketamine. On routine neurological examination during the catatonic phase of ketamine anesthesia the pharyngeal reflex was generally weak and failed altogether in two cases and corneal reflexes were absent in three cases.


Halothane-induced liver damage: an analysis of the material reported to the Swedish Adverse Drug Reaction Committee, 1966-1973. An analysis of 94 reports to the Swedish Adverse Drug Reaction Committee of patients with liver injury after surgery and halothane anaesthesia (including 13 fatal cases) has not been able to reveal any other factors responsible for the liver injury than the halothane administration. Eighty-two per cent of the total material and 12 out of 13 fatal cases had had multiple exposures. Our results suggest that the liver injury becomes more severe after repeated exposures; maximum serum bilirubin and SGOT values are higher after an increasing number of halothane exposures.


Thoracic epidural analgesia-II: prolongation in the early postoperative period by continuous injection of 1.0% bupivacaine. Sixteen patients were given thoracic epidural analgesia at the T5-T6 level with 2 ml of 1.0% bupivacaine solution plain for pain relief after upper abdominal surgery. In 13 cases the analgesia was prolonged by continuous injection of 1.0% bupivacaine for 24 or 48 h. Onset time and segmental spread of the analgesia are presented as well as segmental spread, intensity of the blockade, and peak expiratory flow rates during prolongation. Signs of tachyphylaxis were noticed, and also signs of accumulation of bupivacaine in plasma. A high incidence of urinary retention occurred. The method is not considered to be ideal for pain relief after upper abdominal surgery.


Brain energy metabolism during the process of dying and after cardiopulmonary resuscitation. In order to study the problem of how fast and to what degree severe hypoxic brain tissue changes are reversed after reoxygenation, we challenged the viability of the brain by exposing experimental animals to anoxia of such a duration that cardiopulmonary resuscitation was just possible. The brain tissue concentrations of glucose, lactate, pyruvate and of ATP, ADP, AMP and phosphocreatine were determined. Two series of experiments were carried out. In the first, groups of rats deprived of oxygen for 1, 2, 4 and 6 min were studied in order to show brain tissue changes in the period of impending death as well as the changes coinciding with the onset of clinical death (blood pressure zero). In addition, one group maintained at a rectal temperature of 37 +/- 0.5 degrees C and ventilated for 60 min with an oxygen free gas mixture was included aimed at representing a state of irreversibility. In the second series, restitution after 6 min of no oxygen supply was studied 10 min, 1/2 h, 1 h, and 2 h after cardiopulmonary resuscitation. Attempts were also made to correlate biochemical changes to EEG status and to clinical recovery. The restitution study showed that oxidative phosphorylation of the brain tissue was rapidly resumed with normalization of the adenylate energy charge in all animals in which the pump function of the heart could be restored by our artificial means. However, there was a strikingly poor correlation between recovery of mitochondrial function and restitution of EEG or clinical recovery. Thus, it seems likely that a delayed functional restitution is not due to energy failure but to other biochemical changes or to biophysical alterations not revealed by the present type of study.


The postanesthetic antiemetic effect of premedication with dehydrobenzperidol before ether anesthesia. A study was performed to evaluate the antiemetic effects after ether anesthesia when dehydrobenzperidol (DHB) and pentobarbital were used for premedication and to compare these effects with halthane anesthesia when pentobarbital was used as premedication. Eighty-four patients undergoing minor surgical operations were randomly divided into three groups. The patients received ether and ether DHB 0.2 mg/kg or pentobarbital 2 mg/kg for premedication, or halothane and pentobarbital 2 mg/kg for premedication. The complaints of nausea and vomiting were recorded 24 h after anesthesia. We found that DHB compared to pentobarbital had a greater antiemetic effect after ether anesthesia, but the difference was not significant (P greater than 0.05). However, if only persistent nausea and vomiting were considered, the difference was significant (P less than 0.05). The incidence of nausea/vomiting after ether anesthesia with DHB as premedication was a little higher compared to halothane anesthesia with pentobarbital as premedication, but the difference was not significant (P greater than 0.05). However, if only persistent nausea/vomiting was considered, the incidence of complaints was equal in the two groups. It is concluded that when used for premedication to ether anesthesia DHB seems to lead to less postanesthetic nausea/vomiting than pentobarbital. Further DHB seems able to reduce the incidence of nausea/vomiting after ether anesthesia roughly to the level of that seen after pentobarbital premedication for halothane anesthesia.


Evaluation of a new spirometer based on a fluidistor technique. Using a mechanical model and human subjects a new spirometer based on fluidistor principles was evaluated. At normal minute volumes the fluidistor was accurate to within +/-5% when compared with a Bernstein spirometer. It underread at low volumes and overread at high. Prolonged expiratory time constant as well as the use of gas with low density increased the error. The instrument was somewhat sensitive to variation in breathing frequency and gas flow pattern but insensitive to moisture. The resistance to gas flow of the instrument itself was fairly high. The fluidistor is based on a sound and simple principle (no movable parts). It proved to be stable and easy to handle and accurate enough for clinical use in anaesthesia and intensive care. The tendency of the spirometer to underread at low flow and to overread at high flow could possibly be substantially reduced if the instrument was provided with several flow heads so that the oscillation volume could be individually adapted to the gas flow rate to be studied.


Pindolol (Viscén) in persistent ventricular fibrillation. A case report. The beneficial effect of a beta-blocking agent (pindolol), given as an adjuvant to DC-shock and lidocaine therapy in a case of heart resuscitation is reported. A 65-year-old female patient was operated for an abdominal aortic aneurysm. At the conclusion of the operation, which was prolonged and difficult, the patient developed alternating ventricular tachycardia and fibrillation. Within a time interval of 50 min electrical defibrillation was performed 20 to 25 times, and as much as 1100 mg of lidocaine was administered. Simultaneously, combined internal/external cardiac massage was performed. The patient's arrhythmia continued to recur after defibrillation until pindolol in dosages of 0.2 mg had been given twice intravenously. A permanent sinus rhythm was then achieved.


The effect of nitrous oxide on oxygen consumption and blood flow in the cerebral cortex of the rat. The effect of 70% nitrous oxide upon cerebral oxygen consumption (CMRo2) and cerebral blood flow (CBF) was studied in artificially ventilated rats. The control groups consisted of unanaesthetized animals in which a stress-induced increase in CMRo2 and CBF was prevented by previous adrenalectomy, or by administration of a beta blocker (propranolol). There were no significant differences in CMRo2 between animals ventilated with either N2O or N2. It is concluded that if nitrous oxide depresses cerebral metabolism the depression cannot exceed 10%.


Temporal lobe epilepsy. Etiological factors and surgical results. Seventy-four patients with temporal lobe epilepsy, resistant to medication, who in 1960-1969 underwent unilateral temporal lobe resection at Rigshospitalet, Copenhagen. In only 12 patients was no etiological factor found. In three-quarters of the patients a peri- or postnatal injury was the suspected etiology of the epilepsy; and in one-third, a history of complications in the actual and/or abnormal outcome of a previous pregnancy was recorded. Only seven patients had experienced febrile convulsions. Patients with certain combinations of etiological factors, including encephalitis, have a poor prognosis regarding relief from seizures. Patients in whom an abnormal outcome of the mother's previous pregnancies is recorded have a poor prognosis as regards psychiatric normalization. Apart from this no correlation has been found between the surgical results and the numbers or types of the various etiological factors.


Pneumoencephalographic findings in various primary and secondary muscular disorders. Pneumoencephalography was carried out in 23 patients with various muscular disorders, i.e. spinal neurogenic atrophy, classified as Wohlfart-Kugelberg-Welander's and Charcot-Marie-Tooth's diseases, and muscular dystrophy. EEG-registrations and psychological testing were carried out. Pneumoencephalography revealed ventricular enlargement and cortical changes in 17 out of 23 cases. Changes were found in all three groups studied; cortical changes were, however, only found in the neurogenic atrophy groups. Cases where there clearly might be exogenous causes for ventricular dilatation were excluded. The changes found, therefore, supposedly form an integral part of the disease process. It should be emphasized that the precaution does not entirely exclude a traumatic etiology in some cases. EEG-registrations (pathological in three out of 20 cases) as well as psychological evaluation (pathological in six out of 14 cases) supported the assumption of organic brain changes. Pneumoencephalography, however, seemed to be the most sensitive parameter for unveiling brain involvement in these disorders.


Interferon in the serum and cerebrospinal fluid in patients with multiple sclerosis and other neurological disorders. The presence of interferon (IF) was investigated in serum and cerebrospinal fluid (CSF) from neurological patients. Significant titres of IF were found both in the serum and in the CSF in about half of the patients suffering from acute encephalitis and from multiple sclerosis (MS), but not in patients suffering from various non-inflammatory disorders in the central nervous system (CNS) or in the peripheral nervous system (PNS), and not in the serum of healthy blood donors. Significant IF titres in the CSF were regularly associated with significant titres in the serum, but the converse was not true. Interferon levels were not correlated to cell counts in the CSF; nor to concentration of IgG and albumin in serum and CSF; nor to presence of electrophoretically oligoclonal IgG patterns; nor to hemagglutinating and gel-precipitation antibodies against measles. IF levels were lower in the serum of patients having reduced serum/CSF ratios for measles antibody than those with normal ratios. The data may indicate that MS is linked to factors which induce IF production in the CNS.


Epidemiology of Parkinson's disease in Finland. This investigation was conducted to clarify the epidemiology of Parkinson's disease in Finland. A community survey was made in a selected area in southwest Finland in addition to an analysis of Finnish mortality statistics for Parkinson's disease. The annual mortality rate from Parkinson's disease was found to average 2 per 100,000 population. Almost 70 per cent of the deaths occurred between 65-79 years of age. The total and age-specific mortality rates for males were greater than those for females whereas the proportionate mortality rates were almost identical. This was considered to indicate that suggestions of greater male prevalence, based on mortality statistics, do not appear justified. On prevalence day, Dec. 31st, 1971, 484 patients with Parkinson's disease (of which 444 were personally examined) lived in the area of investigation (population 402,988), the prevalence rate being 120.1 per 100,000 population. The highest annual incidence rate was 16.6 per 100,000 population. The age-specific prevalence rates showed a rapid increase after the 50th year of age. The greatest prevalence was shown by the age group 70-79 years of age in which almost 0.8 per cent of the population are affected. Age-specific incidence rates also displayed an increase after the 50th year of age. The greatest incidence was observed in the age group 70-79 years of age in which almost 1 per 1,000 of the population are annually affected by the disease. A difference between the sexes was demonstrable in the prevalence and incidence rates showing greater values for females, but in the age-specific frequencies the differences were reduced. This probably reflects the difference between the age structures of the male and female populations, suggesting that both sexes have a similar risk of being affected by the disease. The permanent age structure shown by idiopathic patients in comparison with previous investigations as well as the increased mean age and proportionate decrease of postencephalitic patients was found to be in disagreement with the cohort theory according to which all parkinsonian patients are previously victims of encephalitis lethargica.


Disturbances of micturition in Parkinson's disease. During the years 1970-1974, a total of 44 patients referred by neurologists to the Urological Laboratory were classified in the following groups: paralysis agitans (27), postencephalitic parkinsonism (5), cerebral arteriosclerosis and parkinsonism (7) and cerebral arteriosclerosis and parkinsonism, suspected (5). Bladder function was assessed on the basis of cystometry and urodynamic investigation. A high frequency of supranuclear bladder paresis (SNP) was found, although unequally distributed in the different diagnostic groups. Stereotactic operations on the thalamic nuclei seemed to be correlated with SNP. The question was raised whether SNP was part of the parkinsonian syndrome or merely signs and symptoms related to ageing.


The electrocardiogram in young adults with ischaemic stroke. Electrocardiograms in young adults with ischaemic stroke were analysed for abnormalities within 24 h after the onset of symptoms. Fifteen patients out of 44 had some ECG abnormality, mainly ST-T changes, sinus tachycardia and minor disturbances of intraventricular conductance. In most cases the ECG abnormality could be attributed to some extracerebral cause. It is concluded that ischaemic brain lesion per se never, or very rarely, affects the electrocardiogram.


Representation of cutaneous afferents by fluoride-resistant acid phosphatase (FRAP)-active terminals in the rat substantia gelatinosa rolandi. While transection of the sciatic nerve results in a complete ipsilateral extinction of FRAP activity in respective segments of the rat spinal cord, cutaneous denervation of the hind leg induces a patchy disappearance of this same enzyme in the Rolando substance. The possible participation of FRAP in metabolism of the primary sensory transmitter substance, its relation to substance P and its involvement in gating mechanisms are discussed.


Biphasic response on oral glucose tolerance testing in myotonic dystrophy. Oral glucose tolerance tests have been carried out on 40 patients with myotonic dystrophy, and 50 hospitalized control patients. A biphasic response was found in 19 myotonic dystrophy patients (49 per cent), compared with 12 of the control population (24 per cent). In 9 patients with myotonic dystrophy (23 per cent), the height of the second peak was greater than or equal to 20 mg/100 ml, the corresponding figure for the control group being 2 patients (4 per cent) (P less than 0.005).


Basal metabolic rate in patients with hydrocephalus. On the cause of lowered basal metabolic rate in myotonic dystrophy. Myotonic dystrophy seems to have a hypometabolism of non-thyroid origin. The hypometabolism could hypothetically be caused by : 1) reduction in muscle mass, 2) hydrocephalus ex vacuo, an integral part of the disorder, or 3) the basic disease process itself. Possibility 2) was explored by determining basal metabolic rate (BMR) in 41 patients with dilatation. A BMR of less than -10 per cent was found in eight cases. The ventricles were categorized in three groups according to width. No decrease in mean BMR was found in cases with a marked ventricular enlargement. Thus, ventricular dilatation per se does not seem to lead to hypometabolism.


Quantitative development of choroid plexuses in chick embryo cerebral ventricles. Quantitative development of choroid plexuses in cerebral ventricles of chick embryos was investigated by means of the planary projection of the choroid plexuses from the time the plexuses reached a consistent flattened structure. Choroid plexuses in the lateral cerbral ventricles were studied from day 6, the plexus in the third cerebral ventricle from day 8, and the plexus in the fourth cerebral ventricle from day 11 of incubation. Regardless of the microscopic origin of these choroid plexuses, their development reached a growth maximum on day 15 of incubation, after which there was a slight regression. The regression was gradual in the plexus of the third cerebral ventricle but a transient enlargement of plexuses in the laternal and in the fourth cerebral ventricle was observed between days 18 and 19. The enlargement of choroid plexuses in the lateral cerebral ventricles was caused by a flattening of the villi, whereas that of the plexus in the fourth cerebral ventricle was caused by thinning and yawning of the villi. The area of choroid plexuses in the lateral cerebral ventricles was six or seven times larger than the sum of the areas of the remaining choroid plexuses.


Effect of hydrocortisone on the growth of choroid plexus and composition of cerebrospinal fluid in the developing chick embryo. The effect of hydrocortisone on the telencephalic choroid plexus and on the osmolarity and ionic compositon of CSF was studied 48 hours after its administration onto the chorio-allantoic membrane of chick embryos on days 11 and 13 (20 mug per egg) or on day 17 (40 mug per egg). Hydrocortisone significantly reduced the choroid plexus area on days 13 and 15 but was ineffective on day 19. The topical analysis of these choroid plexuses, influenced by the steroid, pointed to a decrease of the growth activity in those parts whose proliferation was intensive. The transient population of villi in the apical part of these plexuses was the most sensitive. Those parts, being morphogenetically inactive or whose morphogenetic changes were not caused by the cellular proliferstion, were not affected significantly. The osmolarity of CSF increased significantly during the investigated period simultaneously with an increase in the sodium and chloride concentration while the concentrations of potassium did not change significantly. Hydrocortisone evoked a precocious increase in the osmolarity of CSF on days 13 and 15. Contemporarily, the potassium concentration in CSF was elevated while the steroid failed to change the sodium and chloride concentrations.


Homocarnosinosis. 2. A familial metabolic disorder associated with spastic paraplegia, progressive mental deficiency, and retinal pigmentation. Homocarnosine, the brain-specific dipeptide of gamma-aminobutyric acid (GABA) and histidine, was found to be elevated in the CSF, i.e. approximately 20 times the mean control level, in two brothers and one sister. All three were similarly afflicted, i.e. with a progressive spastic paraplegia, progressive mental deterioration and retinal pigmentation. A sister was healthy, and there was no other occurrence of similar symptoms in the family. The clinical symptoms in the affected individuals seem to differ from those in other reported families. The unaffected sister, the father and two maternal aunts exhibited a normal CSF homocarnosine level, whereas the mother, who showed no definite clinical symptoms, showed a markedly elevated CSF homocarnosine level. The explanation for the latter finding remains obscure.


A comparison between agar gel electrophoresis and CSF serum quotients of IgG and albumin in neurological disease. CSF and serum was obtained from 216 patients with neurological or psychoneurotic symptoms and the concentrations of albumin and IgG were immunologically determined. The IgG/albumin index, calculated as the quotient of the CSF/serum ratios of IgG and albumin was compared with electrophoresis on agar gel. In "normal" cases, the IgG/albumin index was between 0.26-0.66. Pathological electrophoresis, i.e. with two or more IgG bands in the gamma globulin region was found in 85 per cent of the MS patients; in 29 per cent of the patients with a possible demyelinating disease; in 41 per cent of patients with CNS infection; and in 4 per cent of patients with other neurological disorders; whereas an increased IgG/albumin index ( greater than 0.66) was found in 88 per cent of the MS patients; in 43 per cent of the patients with a possible demyelinating disease; in 50 per cent of the patients with CNS infection; in 11 per cent of patients with immunological disorders; and in 18 per cent of patients with other neurological diseases. The increase of the IgG/albumin index was sometimes moderate (0.67-0.90), except in patients with MS, syphilis and other CNS infections, where a pathological electrophoresis combined with an IgG/albumin index above 1.0 was found to be a valuable support for the clinical diagnosis.


Multiple sclerosis and Hodgkin's disease in Denmark. There has been a hypothesis that Hodgkin's disease in young adults and multiple sclerosis may have related causes because the age of clinical onset and the geographic distribution of both are similar. This hypothesis was tested for data in Denmark. Detweeen 1943-62, the average annual incidence rate for Hoadgkin's disease in Denmark was 2.25 per 100,000 population (2.68 male and 1.83 female). Between 1951-69, the average annual death rate for Hodgkin's disease was 2.15 per 100,000 (2.66 male and 1.64 female). The average annual incidence rate for multiple sclerosis in Denmark was calculated from age at onset for 2,481 prevalent cases of 1949, the 1940 population, and an average annual incidence of 128.86 cases for 1939-45: the average annual incidence rate per 100,000 was then 3.35 (3.00 male and 3.69 female). Age specific incidence and death rate for Hodgkin's disease in Denmark each showed a bimodal curve, with one peak at age 25-29 and the other at age 70-74; this was found for each sex, with male rates consistently higher than female. The age specific incidence rates for multiple sclerosis were clearly unimodal with a peak at age 25-29 more definite in females than males. Rates for MS were notably higher for young females than males but about equal by sex for those over the age of 30. The geographic distribution of multiple sclerosis within the counties (amter) of Denmark was markedly non-random, with the major concentration of high prevalence areas middle Jutland and on to Fyn. Geographic distribution of Hodgkin's disease, whether for the young or the old, and whether from incident or death cases, showed no significant variation from a homogeneous distribution. In formal testing there was no correlation of any Hodgkin's distribution with that of MS. A review of the Hodgkin's data for distribution in the United States, on which the original hypothesis was based, suggests the variation there may be little more than reporting artifact. Accordingly, we conclude that there is no relation between distributions of these two disorders, and the factors they do appear to have in common are either quite non-specific or of questionable validity. Thus there is no reason to believe that multiple sclerosis and Hodgkin's disease, even in the young, share a common etiology.


Parkinson's disease treated with Sinemet or Madopar. A controlled multicenter trial. 92 patients with Parkinson's disease not previously treated with levodopa were considered as eligible for this triple-blind trial. Patients were allocated at random to treatment with either levodopa + benserazide ratio 4:1 (Madopar) or levodopa + carbidopa ratio 10:1 (Sinemet) using dosage schedules recommended by the manufacturers which they had to adhere to for 6 months. Unless prohibitive side-effects occurred daily maximum dosage of 800 mg levodopa + 200 mg benserazide respectively 1,500 mg levodopa + 150 mg carbidopa were obtained after 6 weeks and 3 weeks, respectively. The effect of the two schedules on the Parkinsonian symptoms were equal and appeared equally fast. The frequency of gastrointestinal side-effects and involuntary movements were significantly higher and more severe for Sinemet than for Madopar. These side effects are usually symptoms of levodopa overdosing, but whether or not a different dosage schedule with Sinemet would have given fewer side-effects without concurrent lower efficacy remains open to speculation. The treatment schedules did not differ with regard to other side-effects and influence on blood pressure. Neither treatment seemed to influence liver function, renal function and hematological parameters in a statistically way.


Clonus depression by propranolol.

Clonus depression by propranolol. Propranolol administered i.v. to spastic patients was found to be capable of depressing clonus. The drug exerts its action on the spinal cord but does not influence dynamic spindle activity or alpha-motoneurone activity as tested by the T (Achilles tendon) and H reflexes. It may disinhibit the tonic stretch reflex. Thus, clonus is dependent not only on dynamic spindle activity but also on another, probably inhibitory, mechanism.


Damage of skeletal muscle in rats by immunoglobulins. I. Pathophysiological data and lightmicroscopic observations. An experimental model of the autoimmune process was developed to study the pathophysiological and structural changes in immunomyopathies. Immune-sera derived from three muscle proteins--myofibril, myosin and actin--produced immunomyopathies for study. The pathophysiological data show that the general muscle efficiency began to decrease with the early stages of treatment and reflected a severe disorder to muscle function with the progression of time. Parallel changes were also observed by light microscopy.


Damage of skeletal muscle in rats by immunoglobulins. II. Ultrastructural studies. An experimental model of the autoimmune process was developed to study the ultrastructural aspects of immunomyopathies. Every type of muscle fibre organelle was affected and the severity of injury increased in direct proportion to time following immunization. It is suggested that ultrastructural methods are useful in studies concerned with the analysis of structural aspects of experimental immunomyopathies.


Chronic tonsillar herniation: an attempt at classifying chronic hernitations at the foramen magnum. A system is presented for the classification of chronic herniations of the cerebellar tonsils in the absence of space-occupying intracranial lesions, based on a survey of the literature and 13 own cases. The Arnold-Chiari malformation in adults typically involves herniation of the cerebellar tonsils instead of herniation of the vermis as is typical when it occurs in infancy. Identification of chronic tonsillar herniation with the Arnold-Chiari malformation in adults was thought to require at least one other sign of the Arnold-Chiari complex, e.g. a medullary deformity. Cases for which chronic herniation and sclerosis of the cerebellar tonsils present as the only nervous lesion are classified as "chronic tonsillar herniation". Such cases may manifest with neurological symptoms during adult life, or they may be found incidentally at autopsy. Attention is drawn to the occurrence of chronic tonsillar herniation in 7 infants and children where it apparently represents a cause of sudden unexpected death. The overlap between chronic tonsillar herniation and the Arnold-Chiari malformation of adults is discussed in regard to the frequence of associated osseous anomalies, hydrocephalus and syringomyelia.


Influence of ouabain on the fine structure of teleost retina. In this study the effect of intraocular injection of 10 mul 10(-5) M ouabain on the retinal fine structure of the cyprinide teleost Carassius carassius is described. The final concentration of the drug in the eye-bulb was approximately 3-10(-6)M. After 8--24 h the ouabain application produces alterations in the retinal ganglion cells, that progress subsequently to necrobiosis. The outer horizontal cells of the inner nuclear layer show a severe cytoplasmic swelling that is reversible and disappears 8 days after ouabain injection. Amacrines, bipolars and receptor cells are relatively insensitive to the ouabain-induced Na+-K+-ATPase-inhibition. The differential susceptibility to ouabain in the retina possibly reflects a cell-specific pattern of Na+-K+-ATPase-activity or -concentration, whose physiological significance is discussed.


Sudanophilic leucodystrophy: report of a case with tigroid demyelination of the centrum ovale. A 17-year-old girl with negative familial and personal history developed a progressive neurologic disorder characterized by cortical amaurosis, metal deterioration and spastic tetraparesis. Death occurred one year after the onset of symptoms. Histopathologic examination of the C.N.S. showed the presence of extensive, discontinuous demyelination of the white matter of the centrum ovale, with preservation of perivascular myelin islets, associated with massive fat degradation, loss of axons and severe astroglial proliferation. This case belongs to the group of sudanophilic leucodystrophies, being an atypical case, a transition between pure sudanophilic leucodystrophy and the group of Pelizaeus-Merzbacher's disease.


Postoperative restoration of muscle strength after intramedullary nailing of fractures of the femoral shaft. The maximal isometric muscle strength of hip abduction, knee extension and knee flexion was measured in 23 patients operated on for femur diaphyseal fractures and fitted with a stable intramedullary Küntscher nail after reaming of the medullary cavity. The trauma, the immobilization and the surgery influenced the musculature of the operated as well as the intact leg. The muscle power recovered in a couple of years, but even after 2-6 years a significantly reduced power was found in the knee extensors, and a probably significant reduction in the power of the knee flexors in the operated leg when the two legs were compared. Malrotation of the fracture seemed to adversely affect the recovery of muscle power.


Mechanical properties of dried defatted spongy bone. A study has been made of the compressive strength, compression at rupture, limit of proportionality, compression at the limit of proportionality and the modulus of elasticity of spongy bone from vertebrae and tibias. The specimens were obtained from autopsy subjects of both sexes aged 14 to 89 years. There was a qualitative deterioration of most of the strength parameters with age, and also differences between the sexes and between vertebrae and tibia. Spongy bone was found to have the unusual mechanical property that, despite rupture, its compressive strength often steadily increased; this was especially the case for vertebrae from young males.


Tibial torsion in untreated congenital clubfoot. Current methods of measurement were reassessed by the study of tibial torsion in 1000 normal legs using the tropometer, the caliper and X-rays. No significant difference in the reproducibility of results was found and the simpler clinical methods appeared to be satisfactory for practical purposes. The spontaneous evolution of leg torsion in clubfoot was studied in forty-two neglected and previously untreated cases, who were seen for the first time after they had begun walking. Comparison with the torsion observed in the legs of healthy children of a corresponding age proved that untreated clubfoot is not associated with pathological torsion. The place of rotation osteotomy in the treatment of clubfoot is discussed.


The incidence of Achilles tendon rupture. During the years 1950-1973, 229 cases of Achilles tendon rupture were diagnosed in the city of Malmö. More than half of the injuries were caused by sporting activities, the most common being badminton and football (soccer). Ruptures caused by injuries other than sports injuries were found in considerably older subjects. During the period investigated the incidence of Achilles tendon rupture increased in the city more than could be accounted for by changes in the population. This increase could only be partly explained by the increasing interest in sporting activities in the population at risk.


A comparison of plantar flexion torque with and without the triceps surae. Torque generated about the ankle joints during maximum isometric contraction of the plantar flexor muscles was measured on a subject 4 months after unilateral excision of the entire triceps surae. Resulting torque output on the operated limb was 327 kg-cm, or 38 per cent of the 871 kg-cm total for the sound limb.


Physical properties of fluorosis bone.

Physical properties of fluorosis bone. The bones of two patients, one with a moderate and one with a severe chronic industrial fluorosis (stage I-II and stage III), and the bones of three control persons were examined. The following parameters were determined: the fracture load, the fracture load/unit area (resistance to pressure) of the body of the first lumbar vertebra, the bending strength of the neck of the femur and of the lower third of the femur, the fracture load/unit area and the modulus of elasticity of femoral slices 2 cm thick and of precisely defined cylinders from the femoral cortex. The microhardness according to Vickers on the cross section of the femur was also determined. The results obtained are discussed with regard to fluoride therapy of osteoporosis.


Postoperative wound infection after implant and removal of osteosynthetic material. Osteosynthetic material was implanted and removal in 972 consecutive operations in the upper and lower extremity. Early post-operative wound infection developed significantly more often after osteosynthesis than after removal of the implant; neither sex nor age influenced significantly the frequency of wound infection. The latter was higher when insertion or removal of material was performed in the lower extremity than in the upper extremity. The hip and ankle regions were involved most often. Staph. aureus and Staph. albus predominated among the Gram-positive infections; gram-negative infections, however, occurred remarkably frequently, E. coli being the most common organism isolated. To decimate exogenous and endogenous contamination of the wounds during operation, aseptic and antiseptic measures should be reinforced. In operation in a region proven to carry a higher post-operative infectious risk, i.e. the hip and ankle, it is suggested that antibiotics should be administered at the time of osteosynthesis.


Tissue reaction to methyl methacrylate monomer. A comparative study in the rabbit's ear on the toxicity of methyl methacrylate monomer of varying composition. The aim of the present investigation was to evaluate if a bone cement monomer with a high concentration of accelerator (N,N-dimethyl-p-toluidine) is more toxic than a methyl methacrylate monomer, free from accelerator. 1) No difference in the acute local toxicity between CMW, Simplex-P and pure methyl methacrylate monomer was seen. 2) By gas chromatography. N,N-dimethyl-p-toluidine was shown to be water soluble to a small extent. Any bone cement monomer in current use can be fully dissolved in saline to a concentration of about 1 per cent.


Free graft of fascial tube in flexor tendon repair in the digital sheath of the hand. An attempt at a composite tissue autograft. Various reconstructive methods have been reported for cicatricial tendon beds. Since 1970, when the flexor tendon gliding mechanism of the finger has been damaged in the area of "no man's land" and conditions are less than optimal for conventional tendon grafting, the authors have attempted to graft a fascial tube including tendon and paratenon of the palmaris longus. The technique is described and the results reported.


Chordoma in Finland.

Chordoma in Finland. During the period 1953-1971, 20 cases of chordoma were reported to the Finnish Cancer Registry. Twelve of the patients were males. The mean annual (crude) incidence of chordoma in Finland was 0.30/10(6) in males, and 0.18/10(6) in females. Fifteen of the tumours were sacral, three vertebral, and two cranial. Local recurrences were common, and distant metastases were observed in 60 per cent of the cases; this exceeds the proportion usually mentioned in the literature. The commonest treatment was surgery combined with postoperative high-dose irradiation. The relative 5-year survival rate was 35 per cent, and the 10-year rate 18 per cent.


Multiple non-contiguous injuries to the spine. Over a period of 4 years, 120 patients with an identified neurologic defect secondary to spinal cord injury were admitted to the UCD-Sacramento Medical Center. Of these cases five (4.2 per cent) were found to have multiple non-contiguous injuries to the spine which would have been capable of producing complete neurologic loss at either level. Proper treatment is dependent on diagnosis, and correct diagnosis is dependent on the awareness that multiple non-contiguous injuries to the vertebral column can occur in victims of severe motor vehicle accidents.


Cervical spondylolisthesis.

Cervical spondylolisthesis. A case is reported of cervical spondylolisthesis in a 12-year-old girl. The cervical spondylolisthesis has not progressed in the 2 years of observation.


The Moore vitallium femoral-head prosthesis in fractures of the femoral neck. A follow-up is given of early and late results in 109 arthroplasties with the self-locking Austin T. Moore vitallium femoral head prosthesis in fractures of the femoral neck on 106 patients. Operative indication was usually fresh medical fracture of the femoral neck in an elderly woman, or its late complication. The surgery was performed in a unit for general surgery also engaged in pre- and postgraduate teaching activities. Many operations were performed by residents engaged in general surgery or orthopaedics. Point scores according to a modification of Merle D'Aubigné's classification showed excellent or at least good results in 81 per cent of the 69 mobile patients. Because of deteriorated general physical condition 11 patients were chronically bed-ridden. Five patients could not be reached. In three instances the prosthesis was removed. 21 patients died, three during the stay in hospital and 18 later for reasons not connected with the operative procedure. The mortality during 40 months of observation corresponded fairly well to that expected in the age group for the population as a whole.


Intertrochanteric osteotomy in the treatment of Perthes' disease. Intertrochanteric osteotomy has been carried out in 34 children with Perthes' disease. Five weeks after the operation the patients were allowed to move about freely. The average postoperative follow-up period was 27 months. At that time the results seemed to be at least as good as those of Thomas' splint therapy. The varus-derotation osteotomy performed in the initial stage accelerated the process of reossification and seemed to prevent subluxation. According to our findings it is worthwhile correcting the subluxation even in cases with irreversible changes.


The effect of intertrochanteric osteotomy on the venous drainage of the femoral neck in Perthes' disease. Intraosseous femoral neck venography was performed both pre- and postoperatively on 30 patients with Perthes' disease. At the time of the operation (osteotomy) and the preoperative venographies, the disease was in the initial stage in 16 patients, in the fragmentation stage in eight patients and in the restitution stage in six patients. As shown previously the venous drainage of the femoral neck preoperatively, in the initial and fragmentation stages of the disease, was different from the venous pattern of the healthy (control) hips in every case, indicating an obstruction of the venous flow. 4-15 months after the osteotomies this venous obstruction had disappeared completely or almost completely in most cases. This normalization happened sooner than expected on the basis of our findings with conservatively-treated patients.


Intraosseous pressure in the femoral head and greater trochanter before and 1-3 years after osteotomy for osteoarthritis of the hip joint. To elucidate the long-term effect of osteotomy upon the intraosseous pressure in osteoarthritis of the hip, pressure measurements in the femoral head and greater trochanter were performed in 22 patients before intertrochanteric osteotomy and 11.5-33.5 months later, on the occasion of removing the osteosynthesis material after the osteotomy had healed. Preoperatively the mean pressure in the femoral head was higher (35.0 mmHg) than in the greater trochanter (23.4 mmHg). At follow-up the mean pressure in the femoral head had fallen, but not significantly (0.10 less than P less than 0.20). A significant reduction in pressure (0.001 less than P less than 0.005) was found in 10 patients in whom the primary pressure was high (exceeding 35 mmHg) and in 16 patients seen at follow-up less than two years after the osteotomy (0.01 less than P less than 0.02), whereas with a longer observation period there was a tendency towards an increasing pressure. The trochanteric pressures accompanied the pressures in the femoral head, but without significant changes. No close correlation was found between intraosseous pressure and pain at rest. The operation had a good clinical effect, especially upon the pain at rest. A reduction in intraosseous hypertension may be a contributory cause, but the tendency to another increase in pressure after a long observation period indicates the possibility of a subsequent recurrence.


Studies on the anatomy of the facial nerve. The present study on the anatomy of the human facial nerve is based on the results of a series of gross dissections, and histological and electro-diagnostic examinations. From our findings it follows that there is a definite spatial orientation of the peripheral branches in the facial nerve trunk. The results of the morphologic studies are in agreement with those obtained by electric stimulation combined with electromyography.


[Reactions of mucous membrane in middle ear]. Antibiotic therapy has transformed classic picture of otitis media, especially as a result of changed immunological conditions. Histopathology of the mucous membrane has shown badly inflamed and healing areas close together. Cellular proliferation, as in granulomas and adhesion formation, has now become more important than purulent complications. The middle ear drainage, normally provided by good function of the eustachian tube and a drum perforation have now become a focus of interest. A blocked tube and an intact eardrum cause not only serous otitis media but, when untreated, otitis media chronica adhesiva as well. We have studied these problems histologically, histochemically and cytologically.


Histopathological alterations of the mucosal folds in chronic otitis media. The autogenesis and evolution of the mucosal folds were studied. They play an important part in the immunological defense system of the middle ear. The anatomy and topography of these mucosal duplications together with their pathophysiological effects explain the clinical development in the various forms of middle ear infection and disturbances of the aeration of the middle ear in case of an open and well functioning Eustachian tube.


Secretory otitis media. Comparison of nasal and aural cytology. Aural and nasal cytology is compared in a series of 105 patients with secretory otitis media (SOM). In aural smears the cellular picture consisted mainly of lymphocytes, leukocytes and phagocytes but eosinophils and basophilic cells were absent. In the nose, the most frequent cells were leukocytes, while lymphocytes were seldom seen in greater numbers. Increased numbers of eosinophils were found in 20% of the patients. IgE values in the serum of 69 patients and in 8 aural effusions were mostly within normal limits and SOM could not be considered to be a result of circulating IgE-dependent reaction. Cytotoxic leukocyte test with food allergens to test this etiologic factor in SOM is at present in progress.


Ultrastructural study of taste buds at rest and after stimulation, and comparative study between type III cell and Merkel cells. Changes in the pore region of the cell membrane have been studied in order to learn if this region plays an active part in the preneural phase of taste. We have observed, though not consistently, that the pore size is variable and that their contents are not constantly amorphous or homogeneous. The results are not so significant, however, as to allow of the formulation of any firm conclusions. The similarity between type III cells and Merkel cells (cells of the tactile system) was surprising. The probable role of the type III cell in taste is discussed.


Scanning electron microscopic studies of the staples in normal and in some pathological and experimental conditions. By means of the electro-scanning microscope we were able to demonstrate the three-dimensional bony structure of the normal stapes, and the variations in structure of the different stages of otosclerosis. One case of osteopsatyrosis is also discussed. The callus formation in an experimentally fractured footplate is compared with otosclerosis.


Regeneration in the VIII nerve.

Regeneration in the VIII nerve. After transection of the VIII nerve in the inner meatus, 95% of the cochlear neurons and practically all efferent fibres degenerate and disappear. In long-term survivals, different phenomena indicate the regeneration properties of many, probably efferent or vestibular nerve fibres. The few remaining afferent neurons react to the lesion of their central axon with enormous proliferations of their peripheral branches in the organ of Corti.


Postural behaviour and motion sickness.

Postural behaviour and motion sickness. One of the acting techniques used in Kyogen, a classical Japanese stage comedy, prompted two questions: why is it that one may suffer from motion sickness as a car passenger, but, as a driver, escape its effects? And how can one learn postural adjustment against motion sickness by repeatedly travelling in vehicles?


Technical variations in clinical ostial patency tests. The usefulness of nasopharyngeal-antral pressure difference recording as a part of clinical ostial patency testing is demonstrated by statistical calculations from 507 patency tests. This method offers a quick confirmation of the comparison of pressure variation measured by anterior rhinomanometry and by antral pressure recordings which are the main elements of a consecutive patency test. In addition, the nasopharyngeal-antral recording has many of the advantages of a simultaneous patency test. When this difference recording is applied, the nasal reference pressure recording can also be omitted without any loss of information sought by the patency test.


Social handicap among workers with noise-induced hearing loss. A thorough examination of hearing and hearing loss among workers in the saw- and papermill industries in northern Sweden showed that even a serious hearing loss does not give the expected social handicap.


Further contribution in the densitometric study of the labyrinthic capsule with special reference to the bottom of the internal auditory meatus. The quantity of minerals in the labyrinthic capsule of the basal coil and of the separating wall facing the internal auditory meatus in different life periods was determined by the densitometric method. The quantity of minerals is reduced in the labyrinthic capsule and in the separating wall in spite of the bone apposition and increasing thickness of the separating wall.


Postauricular (12 msec latency) responses to acoustic stimuli in patients with peripheral, facial nerve palsy. The postauricular (12 msec latency) response to a loud click stimulation was investigated in 23 patients with facial nerve palsy. Of these patients 21 had an intracranial cause for the facial palsy and 2 had an extracranial cause. Only in those with the extracranial facial nerve damage could the response be obtained from both sides. When the nerve was damaged intracranially there was no response on the paralysed side. This seems to indicate that the posterior auricular muscle is the effector of the presumed sonomotor reflex arc involving the cochlea, cochlear nerve and nuclei, undetermined brainstem pathway, facial motor nucleus, facial nerve and the muscles supplied by it.


Effects of acoustic trauma on corti's ganglion. The ultrastructural features of Corti's ganglion cells were studied in guinea pigs subjected to a wide-band plain 100 dB SPL white noise (12 hr/day for 30 days). Regression was primarily observed in cells belonging to the 2nd turn and took the form of detachment of the membrane from the myelin sheath, and cytoplasmic retraction to the point of destruction of the entire cell. Intensely osmiophilic myelin bodies were frequent in Schwann cells, and in gangliar cells and their sheath. Multivesicular bodies were also common. A description of the regression noted in the myelin fibres is given. Attention is drawn to the fact that regression was not observed in sheathless fibres and cells; the latter formed about 5% of the ganglion population.


Measurement of oxygen tension in human perilymph. The oxygen tension of the human perilymph has been determined without complications by using a technique based upon the polarographic principle. Carbon dioxide produced the most marked increase in oxygen tension in the human perilymph. No change in the perilymphatic PO2 was observed after administration of eupaverine and low molecular weight dextran. 5% CO2-95%O2 has been found to be the gas mixture producing the largest increase in oxygen tension in the human perilymph, without side effects. In order to achieve maximal oxygenation of the perilymph, the therapeutic administration of 5% CO2-95% O2 should continue for at least 30 minutes. At this preliminary stage it is not possible to assess the accuracy of the presented technique in determining the presence of a vascular disorder of the inner ear in patients.


Clinical application of auditory nerve responses recorded from the ear canal. The practicality of recording auditory nerve responses in the routine practice of an otologist is demonstrated. Such recordings are particularly useful when the course of treatment requires a distinction between central or peripheral disorders. They are also helpful when it is difficult to obtain a valid audiogram. The electrical recordings from the auditory nerve can, in combination with standard audiological, otological and neurological examinations, present a more accurate picture of the patient's condition.


Uptake and release of alcohol by homograft tissues in tympanoplasty. Alcohol is known to produce severe cochlear damage and it is possible that deafness as a complication of tympanoplasty can be caused by alcohol which remains in homograft materials after inadequate washing. An investigation was made in which the quantity of alcohol taken up by ossicles, cartilage, temporalis fascia, dura and ear-drum was estimated. The rate of release of alcohol from such materials into saline during washing was also measured. The amount absorbed was found to depend upon the nature of the material, its weight and its surface area. The rate of release of alcohol from these materials differed significantly for each material.


Sound localization with phase audiometry. A 500 Hz pure tone is presented binaurally with earphones. The tone is adjusted to give a midline impression at confortable loudness level. An electronic variable time delay line unit and a generator for randomizing the shift of the phase lag of the signal to the right or to the left ear, respectively, are used. By shortening the time delay the threshold of the recognition of the phase difference is reached. At every test sequence the tone is first presented in the center of the head without delay and then with delay. The patient runs the test by indicating in which ear the tone is heard. The phase difference is thus gradually reduced from 500 musec down to a threshold value of about 48 musec equal on right and left ears in normal-hearing subjects. The results of phase audiometry on subjects with normal hearing and with different types of hearing losses are in good agreement with the results of sound localization tests in free field. Phase audiometry seems to be of especial value in diagnosing retrocochlear lesions.


Ultrastructural investigations on the degenerative and regenerative processes in chorda tympani in bell's paralysis. Our ultrastructural findings in investigated cases of Bell's palsy have demonstrated that the degenerative changes did not proceed at the same speed from the onset of the paralysis--in other words the regeneration changed in accordance with the topography of the nerve. Although the endoneural sheath preserved its integrity, swellings in the Schwann cells have attracted much attention. Furthermore the perineural tissue presented changes which were closely correlated with the degenerative and regenerative processes due to paralysis. In addition to these findings, although the interval between the onset of paralysis and the operation was the same in all our cases, the observation of a more severe degenerative picture of the nerves in the female patients may seem to be an interesting finding, but to the lack of an adequate number of cases which would enable a statistical evaluation, we are strongly, of the opinion that this subject deserves further study.


The effect of steroids on differentiation and function of cultured, mononuclear cells. When monocytes had differentiated to macrophages during 8 days of culture in vitro without being exposed to steroids, neither the engulfement nor the digestion step of phagocytosis was found to be influenced by cortisol or the other steroids tested. This indicates that cortisol has no direct effect on the phagocytic function of macrophages in doses below 10(-1) mg/ml. Continuous exposure to cortisol during the period of differentiation resulted in a dose dependent inhibition of the differentiation of monocytes to macrophages. Testosterone, deoxycorticosterone and tetrahydrocortisol in concentration of 10(-1) mg/ml, tested in the same way were found to be toxic to the cells. In lower concentrations, however, these steroids were found to have no effect on the cultured cells. The impaired differentiation of monocytes is suggested as an additional explanation of the reduced number of macrophages appearing at the site of inflammation during cortisol treatment.


The interplay between target organ concentrations of lymphocytic choriomeningitis virus and cell mediated immunity in baby mice. Circumstantial evidence has been presented which supports the view that the fatal LCM virus infection is due to an immunological conflict in the host animal. Hitherto, this outcome of the infection has only been observed in intracerebrally infected mice. In the present study, the intraperitoneal infection in young mice was investigated and the results revealed a new example of this immunological conflict. In mice infected a few days after birth, concentrations of the virus in the brain are high, while the CMI response is non-measurable. If the infection is induced when the mice are 28 days old or more, there is little virus in the CNS, but a strong CMI response can be demonstrated. All the mice in these two age groups survive. If mice are infected when they are 17-19 days old, however, they raise a moderate CMI response nine days after infection and, at the same time, their brains contain virus in high titres. The mortality among mice infected at this age is 100%, indicating that this combination is fatal. The lives of these animals can be saved by anti theta serum or if they are transplanted with syngeneic lymphoid cells sensitized to LCM virus. Our results strongly suggest an interplay between, on the one hand, the spread and the magnitude of the virus infection in the brain and, on the other, the cell mediated immune response. This interplay seems to be decisive for the clinical outcome of the LCM infection in mice.


Act of swallowing in the fixed larynx.

Act of swallowing in the fixed larynx. In a 16-year-old female, complete stenosis of the larynx and hypopharynx developed as a consequence of the ingestion of lye cristals. Supraglotic laryngectomy, plastic surgery of the hypopharynx and antethoracic oesophagus were performed and the upper aero-digestive tract reconstructed. The dilated larynx remained fixed by the surrounding fibrous tissue, but the sphincteric action of the mobile vocal cords was partly salvaged. In that condition, the act of swallowing could be reestablished. The pathophysiology of this new mechanism of swallowing is discussed.


[Enzyme diagnosis of human parotid glands and its problems]. The gland-specific enzymes amylase, lysozyme and kallikrein the activities and their dependence on the speed of salivation were studied  in normal persons. In these investigations the specification or standard ranges for differentiated secretion states is useful. In contrast to amylase activity, the activities of lysozyme and kallikrein weaken appreciably with increasing speed of salivation. The activity secreted, as measured in time units, increases. In the case of a diseased parotis, a comparison of enzyme activities with the standard values will show a significant reduction of lysozyme and amylase activity in the chronic processes. Acute inflammation affects the amylase activity slightly, but raises the lysozyme activity significantly. Parotid mixed tumours probably do not lead to any changes in the enzyme activities. The splitting up of amylase into isoenzymes by polyacrylamide gel electrophoresis and its possible importance for the diagnosis of pathological processes are discussed. First results of the splitting up of the parotid lysozyme are reported.


Fragments of immunoglobulins in human faeces. Fab-fragments of IgG were easily demonstrated in extracts of faeces from healthy infants and children. Employing immunoelectrophoresis with antisera to whole human serum and to Fab-fragments of IgG, a marked precipitation line, likely to represent such fragments, was evident in the cathodal or gamma-region. Usually no precipitate was formed with antisera specific for gamma-heavy chains or Fc-fragments of IgG. Presumably IgG in the gut is partially destroyed before being excreted with faeces. Results of immunoelectrophoresis, gel filtration as well as polyacrylamide gel electrophoresis, using antisera to alpha-heavy chains, indicated the presence of fragments of IgA in some faecal extracts. Fragments of IgA could not be demonstrated in IgA-deficient patients, and no fragments of either class, or only traces of Fab-fragments of IgG, were found in agammaglobulinaemic patients. No antibody activity against rabbit erythrocytes was found in gel filtrations containing such fragments; any reaction was not observed either in the direct agglutination test or in a modified antiglobulin test.


Middle ear transmission losses caused by tympanic membrane perforations in cats. Losses (determined by measuring microphonic responses) were essentially identical, regardless of whether produced by admittance of sound into the middle ear via perforations in the tympanic membrane (TM) or in the bulla. With SPLs monitored directly at the TM, losses increased at 12 dB/oct with inverse frequency for f less than 1 kHz, a pattern determined by the changes in the (calculated) net sound pressure acting from front and back on the TM. Clinically, hearing losses due to TM perforations are frequency-independent. The difference between the two situations has mainly to do with the use of precalibrated SPLs in Clinical Audiometry.


The effect of steroids on adhesiveness, rosette-forming ability and survival of cultured, human mononuclear cells. The effect of different steroids on human mononuclear blood cells during the first 90 minutes of culture in vitro was tested. Cortisol and testosterone were found to increase the ability of lymophocytes to adhere on plastic surfaces. None of the other steroids tested exhibited this effect. Cortisol and corticosterone were found to reduce the number of surviving macrophages in the culture dishes, tested 4 to 8 days after the exposure to the drugs. No lysis of mononuclear cells could be detected following addition of cortisol in doses up to 10(-1) mg/ml. The findings support the previous statements that human lymphocytes are more cortisol-resistant than those of mouse, rat and rabbit.


Morphological observations of immunobiology of laryngeal cancer. Evaluation of the defensive activity of immunocompetent cells present in tumour stroma. A series of 104 patients with squamous cell carcinoma of the larynx was studied with regard to tumour-host interaction. Prognostic evaluation was based upon histologic grading and morphological evidence of host immune response, judged by the presence and degree of lymphocyte and plasma cell infiltration in tumour stroma. Histologic grade and lymphoplasma-cellular infiltration do correlate with the 5-year survival. The immune response, however, seems to be a favourable prognostic sign only for well differentiated tumours; in our series, all poorly differentiated neoplasms showed minimal or no cellular response. The survival rate increases with the increasing intensity of cellular response within each class of tumour cell differentiation. Small lymphocytes are the basic elements of cell-mediated immune response. After tumour antigenic stimulation they change into immunoblasts which in turn would produce "committed" lymphocytes which would recognize and destroy tumour cells.


Evaluation of three reverse passive haemagglutination methods and two radioimmunoassay tests to be used for the detection of hepatitis B surface antigen. Sensitivity and specificity of three reverse passive haemagglutination (RPHA) methods (Hepanosticon, Hepatest and Auscell) and of two solid-phase radioimmunoassays (RIA) (Austria-125 and Ausria II-125), all phase 3 tests for hepatitis B surface antigen (HBSAg), were compared with the sensitivity and specificity of an immunoelectroosmophoresis (IEOP) technique. By titration experiments the RPHA methods were shown to be 5-20 times more sensitive than the IEOP test, while RIA detected 5-10 times lower concentrations of antigen than the most sensitive RPHA test. In a study of sera drawn consecutively from patients with hepatitis B infections, the increased sensitivity of the test methods was according to the following order: IEOP, Hepanosticon, Hepatest, Ausria-125, Auscell, Ausria II-125. There were significant differences between all the methods except for that between Ausria-125 and Auscell. IEOP did not detect any false positives. If, however, RPHA tests were used, the incidence of nonspecific positive reactions would be in the range 0.5%-0.9%. The advantages of the individual test methods are discussed.


Human colostral IgA interacting with staphylococcal protein A. Human colostral IgA from three apparently healthy mothers were all divided into protein A reactive and protein A non-reactive fractions on a Sepharose-protein A column. The reactive fractions, giving no direct precipitation but co-precipitations, were found to interact with protein A through the Fc-region.


Tumor Fc receptors and tumor-associated immunoglobulins. Tissue sections and cell suspensions from ten malignant tumors were tested for Fc receptors using sheep erythrocytes sensitized by rabbit IgG antibodies. Surface bound IgG on cells from the same tumors were estimated using an antiglobulin consumption test with 125I labelled human IgG as reference. The amount of IgG present per 10(6) cells varied from less than 100 ng to approximately 600 ng. When these amounts of IgG were plotted against the Fc receptor activity of corresponding tumors, seven of the tumors were distributed along a line showing an inverse linear relationship; i.e. tumors with large amounts of IgG on their cell surfaces had the lowest Fc reactivity and vice versa. Cells from three of the tumors had lower amounts of IgG on their surface than expected from this relationship. However, the lack of correlation could be explained by the focal distribution of the Fc positive tissue within non-reactive tissue. The cells from these areas presumably carry less IgG on their surface and thereby reduce the quantity of IgG calculated per 10(6) cells. Prolonged washing of tumor sections resulted in stronger Fc receptor activity, and correspondingly washed cells had lower amount of IgG on their surface. Presumably the Fc receptor can bind IgG in vivo.


Influence of antibodies and thermolabile serum factors on the bactericidal activity of human neutrophil granulocytes. The influence of serum natibodies and thermolabile serum factors on the intracellular killing of Staphylococcus aureus by neutrophil granulocytes has been examined using a method which facilitates a precise in vitro evaluation of the phagocytic and bactericidal activities of human polymorphonuclear leucocytes. The bactericidal activity of the granulocytes was significantly less pronounced in the presence of serum absorbed with Staph. aureus or inactivated at 56 degrees C for 30 minutes than in the presence of untreated serum. Specific antibodies seemed to stimulate the intracellular killing of bacteria more than thermolabile serum factors.


Influence of IgG, F(ab')2 and IgM on the phagocytic and bactericidal activities of human neutrophil granulocytes. The phagocytosis and intracellular killing of Staphylococcus aureus by humans granulocytes in the presence of immunoglobulin preparations have been examined. Isolated IgG from pooled human serum induced phagocytosis and intracellular killing of bacteria. F(ab')2 fragments had no significant effect, indicating that the Fc piece of the IgG molecule is of importance not only for the phagocytosis but also for the intracellular killing of bacteria. Isolated IgM stimulated the phagocytosis to a minor extent, with no enhancement of the bactericidal activity.


Macrophage proliferation and activation during Toxoplasma gondii infection in mice: relationship to lymphocyte stimulation. Macrophage proliferation and activation as well as lymphocyte stimulation in the peritoneal cavities of mice were investigated during the course of a Toxoplasma gondii (Beverly strain) infection. Macrophage proliferation had started already after day one and reached a first peak on day 2 (3H-thymidine labelling index approximately 6%). This proliferation was not accompanied by any notable lymphocyte stimulation. An equally high L.I. for macrophages was found after injection of 0.9% saline. From day 3-4 and peaking on day 7-11, a considerable blastoid transformation of lymphocytes occurred (maximum L.I. for lymphoid cells approximately 20% on day 7). In parallel with this blastoid response, a substantial macrophage proliferation took place (L.I. approximately 8%). Large numbers of activated macrophages also appeared during this period, DNA synthesizing cells were found even among the most highly activated macrophages. The results indicated that the early and the late macrophage proliferations were stimulated by different mechanisms.


Acute disseminated phycomycosis in a patient with impaired neutrophil granulocyte function. A 13-year-old girl with no previously known predisposing disease developed phycomycosis involving the left lung, pleura and shoulder, the left side of the neck, the left thigh, the kidneys and the brain. Prolonged amphotericin B therapy resulted in clinical improvement, but the disease was wide-spread when the patient died 5 months after debut of symptoms from a subarachnoid haemorrhage due to fungal destruction of the basilar artery. During hospitalization, a marked reduction in the bactericidal activity of circulating neutrophil granulocytes was repeatedly demonstrated and the endotoxin stimulated nitroblu tetrazolium test was negative. Together with the demonstration of granuloma formation and the accumulation of lipid-laden histiocytes in the spleen, lymph nodes, bone marrow and the thymus, these findings indicate that the patient had a less severe form of chronic granulomatous disease.


Spinal cord vascularity. I. Extraspinal sources of spinal cord arteries in man. The arrangement of extraspinal sources of the spinal cord arterial supply in man is more complicated than previously described, especially with regard to the origin and branching of the aortic segmental arteries. The fact that other arteries in the neck than the vertebral artery, such as the costo-cervical trunk and the ascending cervical artery may contribute to the supply of the cervical cord is confirmed, and also the occurrence of two or more spinal branches from different sources entering the same intervertebral foramen. Frequent occurrence of two or more segmental arteries arising from a common stem and variations in the branching of the subcostal arteries were found; their functional significance on the spinal cord circulation is not known. The fact that no significant anterior root artery was ever seen at the level of the vascular anomaly suggests that the anomaly is of no clinical importance. Nevertheless, obstruction of a common stem entail the risk of spinal cord infarction due to involvement of an important posterior root artery. On the other hand, the spinal cord seems to be fairly well protected against ischaemic injury following limited interference with the extraspinal arteries due to a profuse supply of intra- and extraspinal collaterals.


Kinematic analysis of experimentally provoked scoliosis in pigs with Roentgen stereophotogrammetry. A three-dimensional method to analyse the kinematics of the spine has been applied to four pigs with experimentally provoked scoliosis. The advantages and limitations of the method are discussed and some interesting facts concerning the provoked curves are emphasized.


Secretin and epinephrine combined in celiac angiography. Celiac angiography was performed in 39 patients without pharmaceuticals, with epinephrine or secretin alone and with secretin and epinephrine combined. With secretin, and especially with secretin together with epinephrine the visibility of pancreatic arteries, capillaries and veins increased with a consequent improvement in information. Normal small veins such as the choledochal and the pancreaticoduodenal veins have proved to be of great diagnostic value. With secretin and epinephrine combined abnormal veins and nearly always abnormal capillaries became contrast filled in malignancy of the pancreas.


Hemangioma of the liver. Report of two cases. Two cases of hepatic hemangiomas are described diagnosed by angiography and controlled by repeat angiography after 2.5 and 6 years, respectively. The radiologic appearance is described and although it varies, angiography must be considered the safest method of diagnosis; biopsy is contraindicated. Steroid therapy seems to be a possible mode of treatment.


Coronary angiography with diatrizoate and metrizamide. Comparison of ionic and non-ionic contrast medium effect on coronary blood flow in dogs. The non-ionic contrast medium metrizamide produced a smaller coronary flow increase than the ionic medium diatrizoate after injection into the main left coronary artery in dogs and had also a shorter transit time through the coronary vessels. The coronary veins were better filled with metrizamide. The reduced coronary flow effects of metrizamide compared to ionic contrast medium and the improved venous filling makes metrizamide a favorable contrast material for use in coronary angiography.


Contrast media: quantitative criteria for designing compounds with low toxicity. Toxicity of contrast media that are ionized iodobenzoic acids or their derivatives is highly correlated with lipid solubility, as measured by the octanol/water partition coefficient. New contrast media have been designed with lower lipid solubility than media in current use, taking into account the additive-constitutive nature of the partition coefficient of an organic compound. If these contrast media are chemically stable, they should also be less toxic. It remains to be tested whether the relation between clinical toxicity and lipid solubility applies to non-ionized contrast media as well.


Effect of epinephrine on the contractions in the normal renal pelvis in man. A cineradiographic investigation. In 22 normal subjects a marked increase in the frequency and degree of contractions of the renal pelvis occurred after injections of 6 to 10 mug of epinephrine into the renal artery. Such injections may be used to increase the diagnostic value of cineradiography of the renal pelvis.


Plasma renin activity and hypertensive organ manifestations in 50-year-old males. From a screening examination in a randomly selected third of the 50-year-old male population in Göteborg, Sweden, a 10% subsample was selected as a reference group (n=80). All untreated persons with SBP greater than 175 or DBP greater than 115 mmHg on two separate occasions made up the hypertension group (n=35). The reference group and the hypertension group were subjected to the same investigations, including BP measurement before and after rest and determination of plasma renin activity (PRA), urinary sodium and norepinephrine excretion and GFR. Plasma renin activity was approximately normally distributed in both the reference and the hypertension group. Mean values were 0.78 +/- 0.18 and 0.65 +/- 0.17 ng/ml/h respectively, the difference being almost statistically significant (0.10 greater than p greater than 0.05). There was no difference with respect to sodium excretion between the reference group and the hypertension group. In the reference group, heart rate was positively correlated to PRA and to urinary norepinephrine excretion during the day. No linear correlation between PAR and BP was found, either in the reference group, or in the hypertension group. Sodium excretion during the day was positively correlated to GFR in the hypertension group, but not in the reference group. Compared to hypertensives with normal or high sodium excretion during the day, the hypertensives with low sodium excretion during the day were characterized by a higher BP, a lower GFR and a reversed diurnal rhythm of urine excretion. Thus, low sodium excretion seemed to indicate more severe hypertension with increased renal resistance during the day. The hypertension group was also divided with regard to sodium excretion into a low, normal and high renin group. The low renin group had the lowest GFR and with rising renin group (from low via normal to high) there was a significant increase in GFR and a significant decrease in resting BP. The results indicate that low renin hypertension is not a more mild, but indeed rather a more severe form of hypertension.


Hemodynamic effect of pindolol in essential hypertension with special reference to the resistance and capacitance vessels of the forearm. Ten patients, mean age 48 years, with essential hypertension of stage I and II according to the WHO classification, have been studied at rest and during work before and after on average 8 weeks oral treatment with a beta-adrenergic blocking agent, pindolol. The pindolol treatment caused a significant decrease in the systemic systolic and diastolic blood pressure, heart rate and cardiac output both at rest and during work. The systemic vascular resistance and the forearm vascular resistance decreased significantly after and during work, respectively. Forearm venous tone was significantly decreased at rest, during and after work. The plasma renin activity decreased. Three mechanisms seem to be involved in the antihypertensive effect of pindolol: 1) a negative chronotropic effect on the heart, 2) a decrease in peripheral vascular resistance, and 3) an increase in vascular capacitance affecting the venous return.


A blood pressure information campaign including mass screening for hypertension in Copenhagen Supermarkets. During its "Heart-week" in Feb. 1975, the Danish Heart Foundation drew the attention of the public to the importance of blood pressure measurements as a vital part of health control and prevention. In all, 24 thousand men and women attending supermarkets in Copenhagen took advantage of an offer to have their BP checked. 23% of the screened, who had systolic BP greater than or equal to age+110 (and this sum exceeded 145) and/or diastolic BP greater than or equal to 100 mmHg for all ages, were advised to contact a general practitioner for further evaluation. The campaign showed that it is possible to measure BP and obtain reliable results in an easy, quick, inexpensive and unorthodox way accepted by a public accustomed to free medical care.


Detection and characterization of middle-aged men with hypertension. In a health examination survey of more than 2,000 middle-aged men the prevalence of hypertension, defined as supine DBP greater than or equal to 105 mmHg and including those on treatment, was 7.5%. Half of the hypertensives were untreated. A satisfactory BP control was present in 27.6% of the total hypertensive population. Untreated hypertensives had a higher relative body weight and a greater skinfold thickness, indicating a greater degree of obesity, than a population sample from the same survey. They also had more hyperuricaemia, hypertriglyceridaemia and hyperinsulinaemia, fasting as well as during i.v. glucose tolerance test. However, when the hypertensives were compared to normotensive, weight-matched controls, most of these differences were eliminated. The findings indicate that the metabolic disturbances in hypertensives are associated with overweight and suggest that weight reduction might be beneficial not only for the BP but also for correcting the metabolic pattern.


Treatment of hypertension in middle-aged men. A feasibility study in a community. In a health examination survey of 2322 middle-aged men the prevalence of hypertension, defined as supine DBP greater than or equal to 105 mmHg and including those on treatment, was 7.5%. All untreated and those inadequately treated were invited to a hypertension clinic. One year's treatment in 86 men achieved a BP reduction of 29/17 mmHg in supine and 27/16 mmHg in erect position. This reduction was maintained for a three-year period and considered satisfactory in 80% of subjects. Propranolol, alone or in combination with other agents, was used in more than 80% of the cases. Special considerations in treating asymptomatic individuals are discussed.


Interstitial nephritis with acute renal failure following cardiac surgery and treatment with methicillin. Six patients developed acute renal failure 13-19 days after cardiac surgery with extracorporeal circulation. None of the patients had suffered from postoperative hypotension; slight hemolysis was present for only 1-2 days post-operatively. Acute renal failure lasted for 11-80 days in four patients. In two patients creatinine clearance stabilized at reduced values. Seven renal biopsies from the six patients showed severe acute interstitial nephritis with mononuclear cellular infiltration and distal tubular damage. No immune deposits were detected in glomeruli or tubular basement membrane. All six patients had been treated prophylactically with methicillin and the acute renal disease was probably elicited by this drug.


The effect on serum enzymes of intramuscular injections of digoxin, bumetanide, pentazocine and isotonic sodium chloride. Intramuscular injections of digoxin, bumetanide, pentazocine or isotonic sodium chloride have been given to 39 patients. We followed the serum concentrations of creatine kinase (CK), aspartate aminotransferase (ASAT), lactate dehydrogenase (LDH) and LDH isoenzymes for 4 days. Ten patients receiving 500 mug digoxin showed a significant rise in CK, which lasted for 48 hours, and 6 of them had CK values exceeding the upper normal limit. Pentazocine in a dose of 30 mg given to 9 patients caused a significant rise in CK and LDH isoenzyme 1, but in no case did the level exceed the upper normal limit. No rise in ASAT or total LDH was found after digoxin and pentazocine injections. No changes in enzymes were discovered after bumetanide or isotonic sodium chloride. In the diagnostic evaluation of acute myocardial infarction, a moderate rise in CK must be assessed with caution when the patients have received i.m. injections of drugs with osmolarity and pH outside the physiological limits.


Lysozyme activity in cerebrospinal fluid. The concentration of lysozyme (LZM) in cerebrospinal fluid (CSF) has been studied in 148 patients to evaluate its possible significance in the differential diagnosis of various diseases affecting the central nervous system (CNS). In the control group only 3 of 45 patients had detectable LZM in their CSF, the highest value being 1.3 mug/ml. The diabetic and epileptic groups did not differ from the control group. Of 8 patients with primary intracranial tumours, 4 had raised CSF-LZM levels. Twenty of 23 uraemic patients had elevated CSF-LZM, the highest value being 3.3 mug/ml. The highest values were found in patients with bacterial meningitis, tuberculous meningitis and leptomeningitis due to Aspergillus. A positive correlation was found between CSF-LZM and protein concentrations. The measurement of LZM may be of value in the diagnosis of inflammatory processes affecting the CNS and in the diagnosis of certain intracranial tumours.


Recurrent and reversible cerebellar ataxia with concomitant episodes of hyperthyroidism: a new autoimmune syndrome. A new disorder with possible autoimmune background is described in a 67-year-old man. He had experienced episodes of cerebellar ataxia induced by infections over the last 40 years. In 1963 he had thyrotoxicosis. The patient underwent bilateral subtotal thyroidectomy. Recently it has been possible to detect involvement also of his remaining thyroid gland, with findings compatible with hyperthyroidism concomitant with his cerebellar atixia.


Enhancing effect of radioresistant spleen cells on the primary immune response against sheep RBC by mouse spleen cells in vitro. Irradiated spleen cells cultured for 3 days, caused a stimulation of the primary in vitro immune response by normal spleen cells. These irradiated spleen cells were fractionated by velocity sedimentation and the fractions were tested for their stimulating activity. Only the macrophage enriched fractions were found to cause stimulation. The macrophages in these fractions were stuffed with erythrocytes and dead cells. The fractions enriched in thymus derived cells, had no effect on the immune response. Irradiated spleen cells cultured for 24 hours caused inhibition. It has not yet been determined whether this inhibition was due to some transient change in the macrophage population during incubation. The stimulating effect by the irradiated spleen cells from SPF mice was strongly reduced, which at least partly could be ascribed to the naturally occurring low number of macrophages in the spleens of these mice.


Relation of antigen-binding cells to immunological memory. Priming of mice with a conjugate of HSA with sheep red cells induced a high level of memory to HSA, with very little antibody production ("pure priming"). HSA specific antigen binding cells in the spleens of the primed mice were assayed by means of a rosette technique, using HSA conjugated to donkey red cells. Rosette formation was almost completely inhibited by soluble HSA, thus confirming that the RFC were specific for this antigen. Spleens of primed mice contained up to 0.6% RFC, as compared to 0.08% HSA specific RFC in the spleens of non immunized animals. Suspensions enriched in rosettes (containing up to 16% RFC) were prepared by centrifugation on BSA density gradients. Adoptive transfer experiments showed that the rosette rich fraction contained all the memory cells. A marginal level of memory could be transferred to irradiated recipients with 3000 rosettes. A comparable degree of responsiveness to HSA could also be transferred with 70,000 RFC enriched from spleens of non immunized mice, but only when injected together with primed, RFC depleted spleen cells. Kinetic studies showed that the level of memory correlated well with the number of RFC up to two months after priming. The number of RFC decreased at later time intervals (though remaining higher than in controls at all times), without a corresponding decrease in the level of memory. A change in the quality of the memory cell with time is postulated.