[The effect of an inhibitor of erythropoiesis on the metabolism of tissues of various organs]. The nucleus of the bone marrow cells was shown to be the source of humoral inhibitor of erythropoiesis and to inhibit the oxidative metabolism in the bone marrow. However, the nucleus intensifies aerobic oxidative metabolism in the kidneys. Therefore the nucleus of the bone marrow cells was suggested to regulate the formation of erythropoietin in the kidneys.


[Changes in the cardiac and "sleep--wakefulness" cycle rhythms following isoproterenol administration to white rats]. The heart-rate during sleep-wakefulness cycle did not significantly change after isoproterenol administration. However, both the duration of R--R intervals and their dispersion became sharply increased. The observed shifts were least obvious during the slow-wave sleep. The bradycardia periods during paradoxical sleep in rats are supposed to be a beneficiary background for further suppresion of the sinus automatism up to sinoauricular blockade. The data obtained suggest that the heart-rate during wakefulness can be a reliable enough evidence of its oscillations in other phases of the cycle. The revealed changes of the sleep structure involved increasing part of paradoxical stages in the total time of sleep in animals when measuring it starting from the 5th day after the sympathomimetic administration.


[Pressor reflexes and changes in sympathetic impulsation and the responses of intestinal and renal vessels]. In acute experiments on cats, the ganglio-blocking agent (hexonium 2 mg/kg) revealed no high-amplitude impulsation (over 15 mcV) in the branches of intestinal and kidney nerves. Simultaneously, no responses of the small intestine and kidney resistance vessels to constriction of the carotid arteries were observed. The constrictory and dilatory responses of the capacitance vessels in the same organs, after the above dose of the ganglioblocking agent, are preserved and correlated with the character of changes of the lowamplitude (equal to or lower than 15 mcV) impulsation persisting in the intestinal and kidney nerves. The post-ganglionar sympathetic fibers conducting high-amplitude discharges are suggested to be mainly responsible for the reflex responses of the resistance vessels, while the low-amplitude fibers--for responses of the capacitance vessels.


[The relationship between lung volume and discharges of individual groups of pulmonary stretch receptors]. In 120 lung stretch receptors of the cat, the volume threshold, impulse frequencies in the end of inspiration and in various volumes of inflation or defleation of the lung, were studied. Low-threshold (25%), high-threshold (60%), and intermediate (15%) endings were revealed. Two types of low-threshold and four types of high-threshold receptors were singled out. Nerve fibers from various types of the lung stretch receptors were found to have similar conduction velocities.


[The hydrodynamics of the superficial cortical nephrons of the rat kidney during a diuretic response]. Diuretic response to administration of mannitol, furozemide, ethaerynic acid, and euphyllinum was invariably followed by a considerable dilation of the lumen of proximal and distal tubular of the kidney surface nephrones. Simultaneously, a considerably reduced flow of the tubular fluid was always observed except after euphyllinum administration, the latter being followed by acceleration of the flow. Questions of interrelationships between the nephrone's hydrodynamic characteristics and the processes of glomerule filtration and tubular reabsorption of the fluid and electrolytes, are discussed.


[The effect of body temperature on biochemical changes in the blood during adaptation to cold]. The changes of the body temperature, intensity of oxidative processes, glucose content in the blood, and unesterified fatty acids (UEFA) content in the serum of the homeotherm organism were studied at +5 degrees C. The initial (1--3) coolings induced mobilization of carbohydrate and fat energetic reserves, using the blood free glucose and the serum UEFA for heatproduction. This caused hypoglycemia in some of the animals. Further (4--13) coolings were characterized by considerable fluctuations of the parameters. Excessive release of UEFA from the fat stores and their enhanced oxydation coincided with a small drop of the body temperature and a decrease in glucose concentration in the blood. By the 26th-35th exposures the animals became adapted to the temperature +5 degrees C. In the adapted organism, the prevalence of UEFA oxydation coincided with the prevalence of the free glucose entering the blood. This suggests that, in the cold-adapted organism, oxydation of UEFA keeps up the body temperature while using the blood glucose is restricted. This may be of importance for a steady maintenance of glucemic homeostasis in cold.


Lifetime probability of additional births by age and parity for American women, 1935-1968: a new measurement of period fertility. A new fertility measurement, probability that a woman of specified parity and age will bear a given number of births in her remaining lifetime, is proposed in this article. The measurement is a summary index of a set of age-parity-specific birth probabilities and in a particular case it is conceptually analogous to the total fertility by birth order but free from the influence of the parity distribution. Fertility of American women for the period 1935-1968 was studied by use of such lifetime probabilities. It appears that the trend of fertility of high birth orders has been parallel with that of low orders. Initiation of the recent decline in fertility depends on parity and age of woman.


Constructing fertility tables for Soviet populations. Because the 1970 Soviet Union census does not provide information on the age structure of men and women separately by sex and according to their ethnic affiliation, the 1959 USSR census data serve as the basis to infer knowledge about ethnic fertility. The model takes into account (1) the total number of births in 1960, estimated from the child-woman ratio in 1959, (2) the age structure of women in 1959, and (3) the assumed pattern of age-specific birth rates structured in terms of the modal age at childbearing and the length of the fertility age span. The results show that Ukrainians among the Slav populations ranked as the lowest with 2.07 children born per woman. Their total fertility contrasts with that of Kazakhs native to Central Asia, who reportedly according to Soviet sources had 7.46 children per woman in 1958-1959, and whose estimated rate is around 8.59 children. Extreme variations appear in the estimates of fertility among nationalities of the Caucasus region, Volga Basin, and to a lesser degree in Siberia. Official Soviet calculations of crude birth rates and age-specific rates for 15 Union Republics in 1967-1968 are transcribed and compared with the estimates for nationalities in 1959-1960. The same theoretical model used to generate the Soviet rates may be adapted under different assumptions to non-Soviet populations in other situations where the data are scanty or incomplete.


A modification of a continuous time model for first conception. The interval between marriage and the first conception leading to a live birth plays an important role in the determination of fertility components. Several probability models (Potter and Parker, 1964; Singh, 1961, 1964, 1967) based on varying sets of assumptions relating to this interval have been propounded in the recent past. All of them are based on the assumption that the females under study are susceptible to conception at the time of marriage. However, in certain situations, where some of the females already pregnant at the time of marriage report to have conceived within a short interval following marriage, this condition is not satisfied and these models become unsuitable. A probability distribution which is an inflated form of the continuous model proposed by Singh, for the time of the first conception leading to a live birth, is presented in this paper. It describes reasonably well the data on first conception times in the context of premarital conceptions. Simple expressions for the maximum likelihood estimators of the parameters involved in the model are obtained and a method for finding the asymptotic covariance matrix of the estimators is outlined. The model is applied to four sets of data.


Parity patterns of birth interval distribution. A simplified model is presented for the measurement of inter-live birth interval distributions. Comparative analyses of "effective fecundability," the mean length and variation of postpartum infecundity, and the parity progression ratio based on this measurement model are presented using data from U.S. marriage cohorts and from an Indian sample. Parity differentials in these reproduction parameters are investigated, and the ramifications for fertility estimate and projection discussed.


Immigration policies and trends: a comparison of Canada and the United States. This paper discusses recent migration to North America with reference to the 1962 and 1967 Canadian immigration regulations and the 1965 United States Immigration and Nationality Act. Despite the similar emphasis on manpower and kinship criteria as the basis for the admission of immigrants, differences between Canada and the United States exist with respect to the importance of immigration for the respective economies, the organization of immigration, the formal regulations, and the size and composition of migrant streams. After an examination of the volume, origin, and occupational composition of immigration to Canada and the United States, flows between the two countries are studied. The paper concludes with a scrutiny of changes in immigration regulations which are pending in both countries.


The anatomy of the parotoid gland in Bufonidae with some histochemical findings. II. Bufo alvarius. The gross and microscopic anatomy of the venom producing parotoid glands of Bufo alvarius has been studied by light and electron microscopy. Histochemical reactions for the presence of venom constituents and of components in biochemical pathways in the synthesis and release of venom were performed. The gland is composed of numerous lobules. Each lobule is an individual unit with a lumen surrounded by a double cell layer. Microvilli of the outer layer interdigitate with microvilli of the inner layer. Cells of the outer layer resemble smooth muscle cells, are rich in adenosine triphosphatase and glucose-6-phosphatase, and contain numerous pinocytotic vesicles, glycogen granules and various organelles. These organelles include "crystalloids" of what seem to be highly organized agranular reticulum. These outer layer cells probably function in some aspects of venom synthesis, active cellular transport and contraction in the discharge of the secretory product. The inner cell layer demonstrates a positive chromaffin reaction, contains steroid material, various organelles, some pinocytotic vesicles and glycogen granules, and appears devoid of a plasmalemma on its inner surface. This layer is probably involved in venom formation and release via an apocrine type of secretion. Bufo alvarius parotid gland shows significant morphological and histochemical differences from that of B. marinus and more nearly resembles a typical steroid producing organ.


Duration of early visual experience and visual cliff behavior of chicks. Visual cliff behavior was studied in 120 chicks as a function of 22, 46, 70, 94, or 118 hr of rearing in a deep or shallow environment. Preference for the deep side of the visual cliff increased directly with duration of depth-rearing but was uninfluenced at any duration of shallow-rearing. Although qualitative differences existed in the behaviors of those shallow- and deep-reared chicks which crossed the cliff, the loss of depth avoidance by the latter group appeared to be specific to the rearing and testing apparatus.


Developmental patterns of seizure susceptibility in inbred strains of mice. Samples of mice from each of 6 inbred strains were tested for audiogenic and electroconvulsive seizures at 5 ages (14, 21, 28, 35, and 42 days). A moderately large within-strain correlation (.67) was found, indicating that developmental patterns of susceptibility to audiogenic and electroconvulsive seizures are similar within each strain. The finding of an even larger between-strain correlation (.91) indicated that strains which are highly susceptible to audiogenic seizures are also likely to be highly susceptible to electroconvulsive seizures. In a 2nd experiment, whole brain norepinephrine and serotonin were assayed in each of 5 inbred strains at 21 and 42 days of age. Results were consistent with the hypothesis that levels of these amines are inversely related to seizure susceptibility. Mice from strains which were susceptible to seizures at 21 days of age had significantly lower levels of norepinephrine and serotonin in brain than did 42-day-old, seizure-resistant animals.


Absence of effects of corticosterone given at 22 days. Mice given a single large dose of corticosterone at 2 days of age, and tested when adult, have shown lasting alterations in operant behavior, associated with reductions in cerebral weight and DNA content. When mice were given corticosterone at 22 days, no changes appeared in cerebral weight, DNA, or in operant behavior, but an apparent decrease did occur in open-field activity. The results suggest that the effects of corticosterone treatment at 2 days on the developing brain are mediated by one or more types of sensitivity to the steroid that have been largely lost by 22 days.


Rapid changes in cerebral blood flow and initial visual experience in the developing chick. A single eye of young chicks was sewed shut for various times. Regions contralateral to and primarily or secondarily innervated by the sutured eye had a reduced rate of cerebral blood flow in comparison to the corresponding ipsilateral regions. However, upon reopening the sutured eye after 2 days, these contralateral regions (optic lobes and cerebral hemispheres) exhibited a rapid increase in cerebral blood flow to a level significantly above that in control ipsilateral areas. The duration of this effect was considerably prolonged in chicks that were monocularly sutured immediately after hatching without prior exposure to light. Chicks that had 1 week of normal vision before monocular suture did not show this overcompensatory effect. If the period of monocular suture was extended to 7 days before restoration of vision to the occluded eye, the overcompensatory vascular effect was delayed. The maximal effect was apparent only upon the 1st exposure of an eye to major visual input. A possible relation exists between this rapid increase in regional blood flow and the period when visual imprinting could normally be expected to be maximal.


The influence of incubatory photic stimuli on chicks' visual intensity preference for approach behavior. Incubating chicks were presented with a high-intensity or low-intensity photic flicker stimulus, or with no photic stimulation. The chicks were tested at 16 hr posthatching for approach behavior, or at 96 hr for imprinting performance to the 2 visual flicker stimuli. The data were analyzed in accord with the arguments of whether those stimuli that effectively elicit approach behavior are determined by interaction between maturation and experience or by a genetic program. The results show that prehatch exposure to photic flicker stimuli affects initial approach behavior and imprinting performance, supporting the interaction position in opposition to the genetically programmed position.


The development of response to continuous auditory stimulation in rats treated neonatally with 6-hydroxydopamine. This study investigated biochemical substrates of the continuous stimulation effect, i.e. the developmental phenomenon whereby continuous stimulation depresses arousal level. Neonatal rats were injected intracisternally with 6-hydroxydopamine. Motility, heart rate, and brain amines were measured in theses animals, as well as in injected and noninjected control animals, at 14 and 28 days of age in an own-control design with and without continuous auditory stimulation. Brain norepinephrine was significantly and inversely related to the magnitude of the continuous stimulation effect and experimental-control differences increased with age. These results indicate that an intact catecholaminergic system is necessary for the mediation of increased arousal during stimulation.


Audiogenic priming in DBA/2J and C57BL/6J mice: interactions among age, prime-to-test interval and index of seizure. C57BL/6J mice, not susceptible to audiogenic seizures (AGS) on the 1st exposure to an acoustic stimulus, were exposed to the acoustic stimulus for 1 min and then tested at some later date (acoustic priming). They were first exposed at either 8, 16, 19, 22, or 28 days of age, and then tested for AGS 2-16 days after priming. DBA/2J mice, susceptible to AGS on the 1st exposure to intense noise, were exposed to the acoustic stimulus at 26 days of age, and then again 2-14 days later. Data indicate that the incidence of AGS upon the 2nd exposure to the acoustic stimulus is a function of age at priming, the prime-to-test interval in days, and the index of seizures. In the case of DBA mice, later effects are also dependent on the initial level of seizure.


Department of Medicina, Faculdade de Medicina da Universidade de São Paulo, Brazil. The acute and late phases of insulin secretion were studied in mongrel dogs before and after the induction of mild alloxan diabetes. Fasting glucose and insulin levels were unchanged from pretreatment values. The alloxan-diabetic dogs had significantly decreased early-phase insulin responses to glucose pulses (0.5 gm./kg.) and slower plasma glucose disappearance rates. In contrast, these mildly diabetic dogs achieved comparable insulin levels and higher glucose levels during a four-hour 40 mg./min. glucose infusion than pre-alloxan control values. Similar findings in human congenital mild diabetes have been interpreted as beta cell insensitivity or impedance to efficiency of plasma glucose uptake. The present observations in alloxan-induced mild diabetes in dogs suggest that reduced early-phase secretion and intact later phase of insulin secretion are not dependent on genetic determinants and may be induced in a model of acquired diabetes.


Growth hormone levels in diabetes. Correlation with the clinical control of the disease. We carried out contemporaneous daytime blood sugar and growth hormone (HGH) determinations in eight juvenile and six middle-aged diabetics under both poor and good metabolic control. A continuous blood sampling technic was used. The following results were obtained: 1. HGH values in poorly controlled diabetics were higher and more fluctuating than in normals of a corresponding age. 2. After good control was reached, a significant HGH decrease was observed in all patients but one. In this condition HGH levels were normalized in middle-aged diabetics but not in juvenile ones. In the latter group HGH values, even if decreased, were persistently higher than in controls of the same age. 3. No difference was observed between newly diagnosed diabetics and patients known to have had diabetes for some years. Our data support the suggestion that HGH abnormalities in diabetes are a consequence of the metabolic disturbance.


Tumor hypoglycemia: deficient splanchnic glucose output and deficient glucagon secretion. Fasting hypoglycemia occurred in a patient with a histologically benign mesothelioma; the serum insulin was low (2-4 muU./ml.), as was the glucose utilization rate. Splanchnic glucose output was markedly decreased on direct measurement (21 mg./min.; normal: 108-180 mg./min.). Splanchnic uptake of gluconeogenic substrates plasma glucagon was low normal during hypoglycemia and responded poorly to oral and intravenous alanine. The nonsuppressible insulin-like (NSILA-s) and somatomedin-like activities of the serum were not elevated, and the tumor did not release insulin-like activity on incubation nor did it contain somatostatin. The marked decrease in splanchnic glucose output was the principal cause of hypoglycemia, was associated with an apparent decrease in glycogenolysis, and was at least partly due to deficient glucagon secretion. The relationship of the tumor to these defects is unclear. The tumor may have secreted an unknown insulin-like material affecting primarily the liver and/or pancreatic alpha cell. The approach used here may serve as a paradigm for the analysis of hypoglycemia not caused by excessive insulin.


Growth of rabbit aortic smooth-muscle cells cultured in media containing diabetic and hyperlipemic serum. Smooth-muscle cell cultures were grown from thoracic aortas of normal and diabetic rabbits. The effect of diabetic rabbit serum on the growth of these cultures was studied both in the first, rapid-growth phase and the following, more "stationary" phase of growth. Control experiments were carried out on normal sera to which glucose had been added. The concentrations of cholesterol, phospholipid, and triglyceride were same in both normal and diabetic sera. Media containing diabetic serum stimulated the growth of cultures significantly in both phases (2p less than 0.01). This occurred in experiments utilizing cells from normal as well as from diabetic rabbits. Control media containing normal serum with added glucose had no such effect. The growth-promoting effects of diabetic serum and of hyperlipemic serum from nondiabetic rabbits were of the same order of magnitude. Autoradiographic studies showed that the number of 3H-thymidine-labeled cells increased significantly after culture in diabetic serum (2p less than 0.005). Cells cultured from the very beginning in diabetic serum or normal serum with added glucose were significantly larger than cells grown in control serum (2p less than 0.05 and 2p less than 0.01, respectively). Cells grown in hyperlipemic serum were significantly smaller than those grown in normal serum (2p less than 0.01). These results indicate that diabetic serum contains a factor or factors that stimulate the arterial medial cell to excessive growth. This factor is not glucose, insulin, or lipid. The results may be of relevance for the understanding of human diabetic macroangiopathy.


Effect of insulin on the exaggerated glucagon response to arginine stimulation in diabetes mellitus. The effect of insulin on the glucagon response to intravenous arginine was studied in eight juvenile-type and six adult-onset diabetics. In the juvenile-type diabetics, concomitant administration of insulin significantly blunted the glucagon response from a mean maximal rise of 310 +/- 54 pg./ml. to only 184 +/- 39 pg./ml. (p less than 0.01), about the same as in nondiabetics. In the adult-onset patients, however, insulin had no effect, the mean maximal rise being 250 +/- 50 pg./ml. without insulin and 307 +/- 71 pg./ml. with insulin (N.S.). This study demonstrates that in juvenile-type diabetics concomitant administration of supraphysiologic quantities of insulin can reduce the exaggerated glucagon response to intravenous arginine to normal, whereas in the adult-type group, it has no apparent effect.


Hemoglobin AIc as an indicator of the degree of glucose intolerance in diabetes. Hemoglobin AIc concentration, fasting blood sugar, response to an oral glucose tolerance test, and skeletal muscle capillary basement membrane thickness were measured in diabetic patients. Hemoglobin AIc concentration correlates with both response to a glucose tolerance test (r = 0.82, p less than 0.001) and fasting blood sugar (r = 0.62, p less than 0.001). The correlation of hemoglobin AIc concentration with glucose tolerance is independent of fasting blood sugar concentration (partial r = 0.61, p less than 0.005), whereas that of hemoglobin AIc with fasting blood sugar probably reflects the relationship between fasting blood sugar levels and glucose tolerance (partial r = 0.22, p less than 0.05). Hemoglobin AIc levels do not correlate with basement membrane thickness ( r = 0.15, p less than 0.05).


The effect of oxytetracycline on the response to insulin of diaphragm muscle and on lipid synthesis in vivo and in vitro in the ob/ob mouse. The insulin sensitivity of the peripheral tissues in ob/ob mice treated with oxytetracycline was assessed both in vivo and in vitro by measuring the effect of insulin on the incorporation of glucose into glycogen in diaphragm muscle and on the incorporation of glucose and 3H2O into lipids in epidymal adipose tissue. The results indicated that OTC treatment improved the insulin sensitivity of muscle but not that of adipose tissue. The results presented also indicated that oxytetracycline treatment led to a decrease in the basal incorporation of lipids into the liver in vivo and the adipose tissue in vivo and in vitro. The results are discussed in view of the relative importance of liver and adipose tissue in the lipid metabolism of ob/ob and lean mice and in view of results obtained by other workers on the effects of B-cell cytotoxic agents.


Diabetes, prediabetes and uricaemia.

Diabetes, prediabetes and uricaemia. Three diabetes surveys carried out at two yearly intervals on 10000 men aged 40 years and over have enabled us to compare four groups of subjects with regard to their serum uric acid level in relation to carbohydrate metabolism.  Prediabetics, that is, persons who screened negative at previous surveys and subsequently developed diabetes, had  a higher mean uric acid level than normals (p less than 0.001). Their uric acid level was considerably higher than in diabetics, who had a mean value lower than normals (up to p less than 0.001). Men, without diabetes, but having an abnormal GTT were found to have a mean value higher than the normals at each survey.


Effects of metformin on insulin resistance after injury in the rat. Hyperglycaemia and insulin resistance occur after injury. The effects of the antidiabetic biguanide metformin in injured rats have been studied in order to elucidate the cause of these effects. Metformin (120 mg/kg S. C.) produced a significant hypoglycaemic effect after a 20% dorsal scald but did not affect the blood glucose concentration in non-injured rats. The hypoglycaemic effect did not result from increased insulin secretion. It was associated with a reduction in liver glycogen and an increase in blood lactate concentrations, suggesting that the drug acted by promoting peripheral glucose utilization. This was confirmed by measuring the clearance rate coefficient of [5-3H]glucose. This rate coefficient was significantly increased by metformin treatment (140 mg/kg S. C.) in scalded rats, although it was not affected in non-injured rats. Intravenous glucose tolerance in scalded rats was not improved, probably because of the increased lactate concentration. Metformin (120-160 mg/kg) also produced a hypoglycaemic effect in rats after a 4 hrs period of bilateral hind-limb ischaemia, suggesting that similar metabolic changes occur after these two types of injury.


[A study of atrio-ventricular conduction in subjects with the Lown-Ganong-Levine syndrome (author's transl)]. Eight subjects with the Lown-Ganong-Levine syndrome were studied by means of His bundle recordings during sinus rhythm and during atrial pacing. During sinus rhythm in all cases, the A-H interval was lesser than the mean value observed in 10 control subjects. Atrial pacing at rates up to 190/min produced three types of responses. Four patients showed an initial increment in A-H interval, followed by a plateau response at higher rates. One patient showed an initial increment and a plateau response in A-H interval at low and intermediate rates, followed by a sudden and conspicuous increment at higher rates, indicating conduction of impulse through the A-V node, due to refractoriness of the by-pass tract. Three patients showed a progressive increase in A-H interval similar to that of normal subjects but to a lesser degree. The possible mechanisms for the different types of response are discussed.


[Familial sick sinus syndrome. Observations on three cases studied (author's transl)]. Three siblings with sick sinus syndrome (SSS) are described. In each case, electrocardiogram, Hisian electrogram and sinus node recovery time were recorded, both in basic conditions and under the effect of drugs. In two cases a permanent pacemaker uas applied. The clinical and instrumental investigations were extended to 24 out of 33 cases included in the complete genealogical tree; three cases with arrhythmias were identified (atrial and ventricular extrasystoles and atrial fibrillation). From a genetic point of view, the SSS seemed to segregate a dominant autosomic character with a lower frequency of the disease in the descendants then expected, which is probably due to their low age.


[A rare case of endocardial fibroelastosis in the left atrium simulating mitral stenosis (author's transl)]. A rare case of primary endocardial fibroelastosis, involving only the left atrium, simulating mitral stenosis is reported; the clinical and hemodynamic features which led to the diagnosis of mitral stenosis are described. The authors discuss the data upon which a differential diagnosis between the two similar diseases can be established. The suggest that isolated fibroelastosis of the left atrium could have been developed slowly because of ipoxia of the left atrium for agenesia of the circumflex coronary artery. An operation of endotelial decortication of the left atrium is described.


[Fibroplastic parietal endocarditis with Löffler's hematic oesinophilia (author's transl)]. The clinical data and autopsy findings in a case of Löffler endocarditis are reported. The differential diagnosis with endocardial fibrosis of East Africa is discussed. On the basis of their histological findings and recent literature the authors suggest that endocardial fibrosis follows the organization of successive fibrin layers.


[Hemochromatosic cardiomyopathy. Report of a case with registration of his bundle potentials and hemodynamic examination (author's transl)]. A case of idiopathic haemochromatosis in a young adult aged 23, with pre-eminent cardiac symptoms is described. The cardiac symptoms consisted of heart failure and various types of arrhythmias (atrial and ventricular tachycardia, AV block). The haemodynamic studies revealed a biventricular diastolic hypertension; the cineangiocardiography showed a diffuse hypokinesis of the left ventricle and mitral regurgitation.


[Serial analysis of "P-terminal force-V1" (PTF-V1) in acute myocardial infarction (author's transl)]. P-terminal force on horizontal plane (PTF-V1) has been studied following clinical and statistical criteria in 122 subjects with acute myocardial infarction (A.M.I.) and in a control comparable group. Also the other parameters of the P-wave have been analysed. PTF-V1 is a more reliable sign than the last and has shown some modifications in connection with the clinical changes in A.M.I. The more pathologic values have been found in anterior myocardial infarction and in infarction with pump failure. There has not been possible to find so strict relation between pathologic PTF-V1 and mortality.


[Coronary spasm and acute coronary insufficiency (author's transly)]. A series of cases illustrating a spectrum of acute coronary episodes associated with transient subepicardial injury, namely the variant form of angina, angina intermedia with electrocardiographic changes similar to those of the variant angina, acute myocardial infarction complicated by variant angina with electrocardiographic changes localized to the infarcted area, acute myocardial infarction preceded and followed by variant angina, is presented. The role of a coronary spasm as a common mechanism of the above mentioned episodes is postulated. Coronarographic demonstration of this mechanism is produced.


[A new mitral valve prosthesis (Cooley-Cutter). Experiences on 241 cases of valvular replacement (author's transl)]. A new mitral valve prosthesis (Cooley-Cutter) is described, which incorporated a low profile design, an excentric sewing cuff, a full flow orifice, a controlled regurgitation for self-washing and symmetrical peripheral flow. The new prosthesis has a titanium double-caged frame, a Pyrolite carbon poppet and a Teflon knit sewing cuff. We have attempted to incorporate in the design of this new prosthesis tre most favorable features of each of many types of prosthesis used at the Texas Heart Institute since 1962. Isolated prosthetic mitral valve replacement for severe congenital or acquired valvular disease was performed in 541 patients from June 1971 to ne 1975. Of these, 66 patients received a concomitant aortocoronary bypass and 31 tricuspid annuloplasty. In 72 patients a malfunctioning mitral prosthesis of other types was replaced with the new Cooley-Cutter prosthesis. There were 49 early deaths (9.1%) and 33 late deaths (6.1%). The most gratifying results were a low incidence of late thrombo-embolic phenomena (1.8%) and absence of hemolisis, malfunction, infection and material failure of the prosthesis.


[Morphological aspects and electrophysiological evaluation of the vectorcardiogram in inferior myocardial infarction (author's transl)]. The purpose of the paper is to evaluate the vectorcardiographic characteristics of the QRS in inferior myocardial infarction, now extended and modified in the light of recent advances in electrophysiology. The VCGs (Frank system) of 70 patients with old inferior myocardial infarction were analyzed. The most important parameters previously considered by others and the behaviour of the different vectorial groups were considered. The results of the analysis of these parameters were concordant with those obtained by others. The morphologic evaluation of the QRS on different planes allowed our cases to be divided into five vectorcardiographic groups. The evaluation of the morphological aspects of the QRS for a more sure diagnosis of myocardial infarction, specially considering false positive cases, was considered from the semeiological point of view. Moreover, it was shown that some alterations of VCG cannot be apparent electrocardiographically. The electrogenetic meaning of vectorcardiographic alterations, probably related with depth and width of necrosis and with conduction disturbances in the subdivisions of left bundle branch, were evaluated.


[Quantitative evaluation of the systolic displacement of the left ventricle profile. A cineventriculographic study (author's transl)]. A new method for evaluating the systolic displacement of the left ventricle profile is proposed. It rests on the definition of an intracardiac axis and the identification of equivalent points on cardiac end-systolic and end-diastolic silhouettes separately. Displacement in then evaluated by means of vector methods. The results in ten normal subjects are reported. Systolic displacement is visualized by means of maps, uhich reflect the geometric properties of left ventricle normal contraction.


[Cardioangiographic evaluation of the left ventricular volume: an analysis of the various formulas used (author's transl)]. In recent years, mono and biplane cardioangiography has been used to calculate the left ventricular volume. In order to evaluate the reliability of the various methods currently most used, a study of 14 hearts removed during autopsy was carried out. The left ventricle was filled with a mixture of paraffin and Lipiodol, the hearts were then X-rayed in anteroposterior projection (AP), laterolateral (LL) and left oblique posterior (OPS) at 30 degrees. The ventricles were opened and the real volume of the cost was obtained by means of the measurement of the volume of displaced liquid. The left ventricular volume was calculated using the methods of Dodge and coll., Sandler and Dodge, Greene and coll. and Kennedy and coll. The data obtained were statistically worked out. With all the tecniques used, there was a good correlation between values of true volume and the volume calculated with the angiographic methods. The coefficient of correlation varied between 0,940 (Dodge and coll. method) and 0,979 (Sandler and Dodge method). A more detailed analysis however, demonstrated that in the hearts with lower volumes, the correlation coefficient is lower and completely unsatisfactory with the methods of Kennedy and coll. and the method of Greene and coll. In these cases some indexes of ventricualr function (stroke volume, ejection fraction) may be not reliable.


[Permanent endocardiac electric stimulation. Observations on 1125 patients (1 January 1966-31 August 1974)]. The authors report on nine years' experience with permanent endocardial pacing in the treatment of various conduction disturbances. Their experiences relate to 1125 patients; 2208 pacers were used. The age of the patients ranges from 60 to 80 (85%), 15% referring to the left decades, minimum 17 - maximum 94. Fixed rate pacers were used in 41% of cases, QRS synchronous or QRS inhibited pacers were used in 59%. Average life of pacers varies from 8.5 to 28.3 months; the average life of fixed rate pacers is higher. Complications and causes of failures, among which electrode dislodgement is the most relevant and frequent, as well as the relative therapeutical treatments, are described. Early mortality is about 1% and late mortality 8-9%: the survival rate calculated altogether after 9 years' treatment with implantable pervenous pacing is about 24%.


[The battery-state control. A new possibility for the control of pacemakers. Preliminary report (author's transl)]. After a brief examination of the technical problems of current pacemakers, with special reference to the battery state control, the authors present a new technique for such control. A power stabilizer able to generate a standard pulse of 4.3 in every condition of battery charge has been fitted on the power supply of a fixed rate pacemaker of normal production. By activating (through an external magnet) such apparatus, it is possible with an easy oscilloscopic measurement to obtain the real value of the battery voltage. Thus the comparison with previously taken measurements and the errors connected with the repetition of such measurements can be avoided. The stimulation rate and the pulse duration corresponding to the discharged state of the batteries can also be known in advance. The data obtained from the first two controls are reported.


[The reliability of several polycardiographic indices in the quantitative evaluation of mitral stenosis (author's transl)]. In 21 patients with pure, isolated mitral stenosis, four hemodynamic parameters were studied. They were obtained by left and right cardiac catheterization and were: the mean pulmonary artery wedge pressure, the diastolic mitral gradient, the stroke volume and the mitral valve area with one or more parametres amd polycardiographic indices, to verify the reliability of the quantitative evaluation of mitral stenosis by noninvasive methods. The polycardiographic indices of Yigitbasi (r = 0.76) and Wells (r = 0.65) were best correlated with the mean pulmonary wedge pressure. The only index with a moderate correlation (r = 0.60) with the mitral diastolic gradient was that of Wells. The LVET/PEP index has only a mediocre correlation with the stroke volume (r = 0.50). The Oreshkov index was the only one among those studies to correlate at all significantly with the mitral valve area (r = --0.62). The investigation confirms the practical use of noninvasive methods in predicting the pulmonary wedge pressure, whilst the indices of Wells and Oreshkov seem less satisfactory in prediction both for the mitral diastolic gradient and the mitral valve area.


Manometric studies of the human pylorus. The human gastroduodenal junction was investigated by means of simultaneous measurements of pressure and potential difference between skin and mucosa. An accurate and circumferentially sensitive miniature transducer assembly failed to reveal a zone of elevated pressure at the gastroduodenal junction of 8 fasting, healthy, young subjects. Additional studies were carried out with a six-lumen perfused catheter system, in which three of the pressure-transmitting catheters had openings arranged circumferentially at the same axial level. Measurements of pressure and potential difference were obtained basally during intraduodenal infusion of hydrochloric acid and after intraduodenal instillation of olive oil. In only 1 of 10 subjects was a tonic elevation in pressure recorded simultaneously by all three leads at the gastroduodenal junction. The normal human pylorus, therefore, is not reliably demonstrable as a high pressure zone.


Manometric studies on the human pyloric sphincter. Effect of cigarette smoking, metoclopramide, and atropine. Pyloric sphincter pressure was assessed with water-perfused polyvinyl tubes. Smoking one cigarette significantly decreased the basal pyloric pressure, whereas 10 mg of metoclopramide as an intravenous bolus increased the pyloric pressure in normal subjects and in patients with gastric ulcer with low basal pressure. Duodenal acidification with 0.1 N HCl significantly increased pyloric pressure. Atropine 15 mug per kg, subcutaneously prevented the rise of pyloric pressure in response to acid infusion into the duodenum.


The effect of 16,16-dimethyl prostaglandin E2 on meal-stimulated gastric acid secretion and serum gastrin in duodenal ulcer patients. The effect of intragastric and intraduodenal 16,16-dimethyl prostaglandin E2 (dm PGE2) on meal-stimulated gastric acid secretion and gastrin release was studied in patients with inactive duodenal ulcer. Compared to placebo, doses of 0.75, 1.00, 1.33, and 1.77 mug per kg of dm PGE2 instilled into the stomach inhibited meal-stimulated gastric acid secretion by 61 to 94% (P less than 0.01). The 1.00, 1.33, and 1.77 mug per kg doses inhibited acid secretion significantly (P less than 0.05) more than an optimal dose of propantheline bromide. Intragastric dm PGE2 (1 mug per kg) was significantly (P less than 0.05) more effective than intraduodenal dm PGE2 (1 mug per kg) in inhibiting both gastric acid secretion and gastrin release. After 1.33 and 1.77 mug per kg, some patients experienced abdominal cramps, or diarrhea, or both, but at doses of 1.00 mug per kg or less no apparent untoward side effects were observed. It is concluded that 16,16-dm PGE2 significantly inhibits meal-stimulated gastric acid secretion and gastrin release, and may be of therapeutic value in patients with peptic ulcer provided it is free of untoward side-effects with chronic administration.


CEA levels in fluids bathing gastrointestinal tumors. A controlled prospective study was undertaken to determine if fluids which bathe malignancies may contain carcinoembryonic antigen (CEA) earlier in the course of gastrointestinal cancer than does plasma of the same patient and may offer a better means for diagnosis. CEA titers were normal (less than 2.5 ng per ml) in the plasma of 42 healthy volunteers. Normal CEA levels were also found in the plasma and in the colonic mucus of 14, the gastric juice of 18, duodenal drainage of 10, and bile of 11 normal control subjects. The colonic mucus of 3 patients with ulcerative colitis, gastric secretions of 5 benign gastric ulcer patients, bile specimens from 11 normal control subjects and from 5 gallstone patients contained CEA at concentrations below 2.5 ng per ml. Positive CEA titers were found in the fluids bathing tumors of all 23 patients with colonic carcinoma, 9 of 17 patients with gastric carcinoma, and all 6 patients with pancreatic carcinoma. In contrast, positive CEA titers were found in the plasma of only 16 of 23 patients with colon carcinoma, 6 of 17 patients with gastric carcinoma, and 4 of 6 patients with pancreatic carcinoma. Among 46 patients with gastrointestinal malignancies, CEA was detected in significant concentrations in the plasma of 26 patients and in fluids bathing tumors of 38 patients. These results indicate a significant association of adenocarcinoma of the colon with CEA-positive colonic mucus (P less than 0.01) and suggest the usefulness of assaying CEA in fluids bathing tumors for the detection of gastrointestinal malignancies.


Validation and application of a radioimmunoassay for serotonin. A radioimmunoassay for serotonin (5-hydroxytryptamine) has been developed, validated, and applied to the measurement of serotonin in blood and platelet-rich plasma. Six rabbits immunized with serotonin diazotized to a DL-p-aminophenylalanine-bovine serum albumin conjugate yielded anti-serotonin antibodies. In the radioimmunoassay, antibody-containing plasma (1:100) is incubated with 0.2 pmoles of [3H]serotonin, EDTA, and either serotonin standards or unknown samples (0.1 ml). Blood levels of serotonin are measured in a protein-free supernatant prepared by water lysis of heparinized blood followed by protein precipitation using zinc hydroxide. This assay is sensitive to 100 pg of serotonin and has demonstrated insignificant cross-reactivity with a number of serotonin analogues at their normal circulating concentrations. Validation has been achieved by obtaining comparable values for normal blood serotonin concentrations by radioimmunoassay and by spectrophotofluorometry as well as by demonstrating that dilutions of endogenous serotonin in rabbit blood and blood from a patient with the carcinoid syndrome were superimposable on a standard calibration curve. In 55 normal human subjects the mean whole blood serotonin concentration was 168 +/- 13.4 ng/ml (mean +/- SEM) (range: 31 to 442 ng/ml). In 15 normal volunteers the mean radioimmunoassayable serotonin concentrations in whole blood and platelet-rich plasma were 337 +/- 40 ng/10(9) platelets and 341 +/- 37 ng/10(9) platelets, respectively. Incubation of blood with PGE1 to inhibit in vitro platelet aggregation before radioimmunoassay resulted in a significant fall in measurable serotonin activity in platelet-poor plasma (from 15.3 +/- 3.0 to 6.4 +/- 1.2 ng/ml). Seventeen normal human volunteers demonstrated a rise in circulating serotonin activity to a mean of 362.1 +/- 16.9 ng/ml at 30 min postcibal after a standard test meal, which was significantly (P less than 0.02) greater than the mean fasting level of 198.1 +/- 37.0 ng/ml. Five fasting controls did not show a rise in circulating serotonin levels when sampled at these intervals. These data suggest release of serotonin, presumably from the intestine, after a meal and make serotonin a candidate hormone in gastrointestinal physiology.


The effects of highly selective vagotomy on exocrine pancreatic function in man. Exocrine pancreatic function was studied after meal stimulation and intravenous hormone stimulation with secretin and cholecystokinin in 10 patients with duodenal ulcers before, and 3 to 4 months after, highly selective vagotomy. Hormone stimulation was also performed in 10 healthy volunteers. Meal stimulation test results pre- and postoperatively were not certainly different, but it was concluded that the test technique was inappropriate to the study, not least because no correction of aspirated volumes is possible. Such correction was possible in the intravenous hormone studies. A gastroduodenal tube with a balloon to occlude the pyloric canal was used, and tracer was infused into the duodenum. Results of this latter study showed that patients with duodenal ulcer display an increased basal secretion volume and an increased trypsin output during hormone stimulation. After highly selective vagotomy, basal secretion volume fell, tending to normal, while the stimulated secretion volume and bicarbonate and enzyme output were unchanged.


Effect of first part of duodenum on gastric emptying in dogs: response to acid, fat, glucose, and neural blockade. Five dogs were prepared, each with a gastric and duodenal fistula (5 cm distal to the pylorus), to study the inhibitory role of the first 5 cm of the duodenum on gastric emptying. The basic design of the experiments was to instill the test meal (300 ml at 37 degrees C, containing phenol red 40 mg 1(-1)) into the stomach and collect it at 1- or 2-min intervals for 10 or 20 min from the duodenal fistula. As the test meal emptied from the stomach it bathed the first 5 cm of duodenum and thus stimulated the appropriate receptor. A Foley catheter with an inflated balloon prevented passage into the second part of the duodenum. Test meals of hypertonic glucose (15%, 865 milliosmoles kg-1) or 20 and 80 mM of sodium oleate emptied at the same rate as water when allowed to bathe the first 5 cm of duodenum, whereas test meals of 100 mM of HCl were slowed. In further studies using neural blocking agents, the emptying of water meals was slowed with subcutaneous atropine sulfate (0.03 and 0.15 mg kg-1), intravenous hexamethonium chloride (10 mg kg-1), and norepinephrine bitartrate (0.04 mg kg-1). The emptying of 100 to 120 mM HCl meals was slowed by subcutaneous atropine sulfate (0.03 and 0.15 mg kg-1), intravenous norepinephrine bitartrate (0.04 mg kg-1), and the intravenous alpha-receptor blocking agents phenoxybenzamine HCl (2 mg kg-1) and phentolamine (2 mg kg-1), was unaffected by intravenous hexamethonium chloide (10 mg kg-1), and was unchanged (1.0 mg kg-1) or slightly slowed (2.0 mg kg-1) by the beta-receptor blocker propranolol. In contrast, acid test meals were emptied at the same rate as water when treated with intravenous guanethidine monosulfate (2 mg kg-1) or intramuscular reserpine (1 mg kg-1), indicating that the acid inhibition was mediated by an adrenergic mechanism. The emptying of water meals was unchanged by these two drugs. The authors suggest that the first 5 cm of duodenum contain receptors for inhibition of emptying of acid but not for fat or hypertonic glucose. Furthermore, the neural blocking studies indicate that the inhibitory effect of acid in the first part of the duodenum is an adrenergic mechanism which appears to be neither alpha nor beta-receptor-mediated.


Disordered gustatory acuity in liver disease. Disordered gustatory acuity was demonstrated in 22 patients with acute viral hepatitis and in 16 patients with chronic liver disease utilizing subjective responses and objective measurements of detection and recognition thresholds and scaling for NaCl, sucrose, HCl, and urea. In patients with early hepatitis and those with chronic liver disease, the magnitude and the uniformity of the threshold elevations were comparable, implying that disordered gustatory acuity reflects disordered hepatic function per se. Patients with acute hepatitis showed a significant fall in taste thresholds (improvement in acuity) as the hepatitis waned, indicating that the gustatory defect is reversible. This disorder of gustatory acuity may contribute to the anorexia commonly found in patients with liver disease.


Electrophoretic identification of an isoenzyme of amylase which increases in serum in liver diseases. Isoenzymes of amylase were studied in serum from 72 persons by means of polyacrylamide gel electrophoresis and a direct saccharogenic assay for amylase activity. In 37 normal individuals, there were two major peaks of amylase actvity with mobilities similar to pancreatic and salivary amylases. In 11 patiets  with acute pancreatitis, the area of activity corresponding with pancreatic amylases increased disproportionately. Electrophoretic patterns of amylase activity in normal and pancreatitis urine were almost identical to the respective serum patterns from the same persons. In contrast, a prominent slower-moving peak of amylase activity occurred in the serum of 8 of 12 patients who had hyperamylasemia associated with various liver diseases. Traces of this third peak were identifiable in one-third of normal serum specimens, but no increases in its activity were observed in any specimen from 11 patients with pancreatitis or from 12 other patients with hyperamylasemia unassociated with liver disease. The slower-moving peak was absent from the urine of patients whose serum contained it. The origin of the slower-moving serum amylase appearing in patients with liver disease is not established by these studies. It is possible either that a hepatic amylase is liberated from damaged liver cells or that the metabolism of an amylase not originating in the liver is altered as a result of liver dysfunction.


A refractory case of hepatic amoebiasis. A 39-year-old man had three separate episodes of hepatic amoebiasis despite one course of emetine and chloroquine, two courses of metronidazole, and one prolonged course of chloroquine. Asymptomatic intestinal amoebiasis was first detected after his third episode of hepatic disease, and his eventual cure followed an intensive regimen designed primarily to treat the intestinal infection. It seems likely that the intestinal amoebiasis had been present undetected since the onset of hepatic disease and had served as the source for reinfection of the liver.


Spontaneous hepatic artery thrombosis with infarction of the liver. Extensive infarction of the liver, initially thought to be halothane hepatitis, is described. The patient developed severe right upper quadrant abdominal pain and abnormal liver function tests after amputation of the leg. The correct diagnosis was made by percutaneous needle biopsy of the liver which demonstrated a large area of avascular necrosis. The patient recovered, indicating the remarkable ability of the liver to maintain function despite ischemic injury. The patient died later from an acute myocardial infarction, and at autopsy thrombosis of the hepatic artery and multiple hepatic infarcts were confirmed.


[The diagnosis of corpus carcinoma (Differentialdiagnostic importance of history- and clinical criteria in post-menopausal hemorrhage) (author's transl)]. Among 1554 patients with post-memopausal hemorrhage over 7 years one half were due to benign causes, the other in almost equal parts to carcinoma of the fundus or cervix. Ca of the fundus is more likely when post-menopausal bleeding occurs at a relatively old age, a late menopause and a long interval between menopause and post-menopausal bleeding. Nulliparae more often have Ca of the corpus than in the cervix or have benign changes. The trias known for the corpus Ca: adiposity, diabetes and hypertension is confirmed. An enlargement or softening of the uterus and myomatous changes also indicate Ca. Anatomical and clinical criteria permit not only a detailed assessment of post-menopausal bleeding but also a definition of cases at risk before bleeding occurs and give an indication for detailed investigations.


[Cytology of mamma-secretion -- results at a laboratory (author's transl)]. Results of cytological examination of mammasecretion in 1252 patients are analyzed. 85.2% were negative. 30 patients (2.4%) showed a suspect or positive result. Of 22 biopsies 9 showed histologically a carcinoma, in the others there were proliferative changes. In contrast there were 3 cases of mamma carcinoma in whom cytology was negative. In all these clinical and mammographic findings gave proof. The possibility of negative histologic results combined with positive cytology is shown to be due to inexpert biopsy. Comparing results with galactography, cytology of mammasecretion which is pathologic is recommended as an additional technique.


[The problems of prophylactic chemotherapy, the second-look operation and the maintenance of the remission in the treatment of ovarian cancer (author's transl)]. The results of the treatment of 1022 ovarian cancers were reviewed and the problems of prophylactic chemotherapy, a second look operation and the maintenance of the remission were studied. In ovarian cancers of stage 1 and stage 2, a post-operative prophylactic chemotherapy is useful only in cases with tumor cells in the secretions of the pouch of Douglas or in the ascites and in cases where a sensitivity to the chemotherapy can be assumed. In about 50% of primarily inoperable stage 3 ovarian cancers, the random treatment with cyclophosphamide (Endoxan) results in a clinical remission. A significant five year cure rate can only be obtained if the uterus and the adnexa are removed. Radical operation during the remission appears to be very important for survival of the patient. For the maintenance of the remission continuous chemotherapy for at least 2 years following treatment by operation and radiotherapy is necessary.


[The clinical significance of deficiency coagulopathy in relationship to consumption coagulopathy (authors' transl)]. A deficiency coagulopathy may lead to a coagulation defect in the presence of massive blood loss which is characterized by a dilution of the coagulation factors especially a dilution of the plasma fibrinogen and the platelets and a dilution of their function. Hemorrhages which are triggered by a coagulation defect (consumption coagulopathy) may be aggravated by the additional loss of coagulation factors. The combination of a coagulation coagulopathy with a deficiency coagulopathy results in a bad prognosis. A case of deficiency coagulopathy and a case of consumption coagulopathy with additional deficiency coagulopathy are reported, the clinical importance and the management of these conditions are discussed.


[Experimental and clinical investigations on the effects of carbon dioxide gas during hysteroscopy (author's transl)]. The acute toxicity, lethal dosage and mechanical effects of carbon dioxide gas were studied in the waking dog by intravenous and intra-arterial insufflation. The threshold dosage for toxicity was 400 ml per minute in the dog. The important factor in the toxicity was not the total volume of carbon dioxide but the volume per unit of time. Metabolic acidosis was responsible for changes in the EKG, the heart rate and the respiratory rate. These findings are discussed in relationship to the usage of carbon dioxide gas for hysteroscopy in the human female. During carbon dioxide gas hysteroscopy blood gas analyses were done in 40 patients. 28 patients had a hysteroscopy under general anaesthesia and 12 patients under local anaesthesia. It was found that the volume of carbon dioxide used for the creation of a pneumometra in hysteroscopy has no side effect. The necessary gas flow is too small for toxic side effects or mechanical side effects such as a gas embolisation.


[On the optimal method of delivery in breech presentation (author's transl)]. Between 1966 and 1974, 90% of 581 single breech presentations were delivered vaginally. The incidence of Caesarean Section was 9.5%. The overall perinatal mortality was 14%. After elimination of premature deliveries under 1000 grams, stillbirth prior to labour and non-viable anomalies, the perinatal mortality was 5.6%. The perinatal mortality in infants over 2500 grams was 0.69%.


[Dignity of morgagni hydatids (scanning-electronoptical and light-optical investigations (author's transl)]. Scanning-electronoptical and light-optical investigations were performed on 25 Morgagni-hydatids being a special type of parovarial cysts and not descending from the Fallopian tube. An epithelium similar to that of the Fallopian tube was found not depending to cyclic changes. In one case atypical papillary growth with disorder in cellular differentiation causing in an increased proliferation could be demonstrated. As hydatids belong to parovarial cysts, they may become malignant and therefore should be exstirpated in any case.


[Cervical perforation due to a copper-T device placed following abortion (author's transl)]. Report on a patient who had a Copper-T intrauterine device placed following abortion. The vertical arm of the device perforated the cervix and resulted in cervicitis and endometritis.


[Ski boots from an orthopedic point of view]. 1. A ski-boot should have an adequate arch support and a variable, as well as an exact fitting of the dorsal part. This can be achieved with flow, foam, air or wax. 2. Isolated pressure of compression systems of different kinds should be avoided (e.g. pressure of buckles above the ankle). New results are demonstrated by the possibility of putting on the boot from behind and having the buckles at the back of the boot. 3. The strap from ankle to foot has to be continuous to avoid pressure points. 4. It should be possible to walk and stand in a ski-boot without either muscular strain or pressure on the knee-joint. In addition, the sole has to give an optimal grip also on icy ground to prevent slipping.


[Ski boot rim fracture: tension-optical study]. Most of the models of ski-boots used today end up at the weakest area of the tibia. They should be disregarded for medical and statistical reasons because the maximal bending point lies at the minimal diameter of the tibia. A ski-boot with a joint, splinting more than the distal third of the calf and ending approximately at the mid-point of the tibia elasticity, offers an important safety to the skier. Together with a safety binding the risk of an accident of the so-called "fracture of the border of the ski-boot" can be further reduced.


[The fatal ski accident].

[The fatal ski accident]. This investigation analyzes 18 fatal skiing accidents which happened from 1959 to 1975. Deadly accidents caused by avalanches were not taken into consideration. The results of the authors were compared with reports of altogether sixty similar injuries due to skiing accidents. 46% of the fatal accidents were caused by crashing against hindrances. Half of the accidents happened during high-speed-skiing or downhill-competition. More than two-thirds of the wounded skiers died of head injuries. Therefore it is highly recommended to wear a suitable headprotection while skiing downhill.


[Appendicitis in infants].

[Appendicitis in infants]. Results from cases of appendicitis occurring during the first three years of life are compared with those found in the literature. In the Departments of Surgery and Paediatrics in the University of Köln-Lindenthal 26 cases of appendicitis occurred in this age group between 1960 and 1975. The majority of cases were of the advanced forms of the disease in which the appendix was already perforated. Successful operations were performed in 25 children, but in a 12-day old infant the disease was diagnosed only at autopsy. An early diagnosis is imperative, and can only be deduced from a thorough diagnosis and compilation of symptoms.


[Chronic posttraumatic osteomyelitis. 2. Circulation problems]. Blood volume and total body water was determined in 20 patients suffering from chronic posttraumatic osteomyelitis and compared to the values from 15 healthy volunteers. Only patients who were unable to leave the bed, showed a marked decrease in circulating blood volume of more than 10%. Total body water remained essentially unchanged.


[Biodynamics of the hip joint. The elasticity of the human femur and its importance]. Pauwels' biomechanical analysis of hip joint function shows that the dynamic forces acting on the joint can be large. In these techniques, spring mechanisms are being used to neutralize dynamic forces. The question remains as to whether such a mechanism in humans exists in the vicinity of the hip joint, i.e. in the femur. Fresh human femoral bones were put under axial stress and their qualities examined. Different spring qualities were found in the various femora; and by comparing these, 6 groups were established which were then subjected to statistical analysis. More than half the bones examined possessed good spring qualities. A practical example proves that the spring qualities of the femur are apt to absorb a considerable amount of kinetic energy during the axial stress and thus lessen the vertical mechanical strain vector of the hip joint.


[The hip joint arthrodesis. A clinical and experimental study on the effective ankylosis of the hip joint]. It could be demonstrated by clinical, electromyographical, biomechanical and experimental investigations that only a flexed position of 25-30 degrees in medial position between abduction and adduction and in an external rotated position of 5-10 degrees of arthrodesis of the hip the impairment of the periankylotic locomotor centers is minimal.


[The fiberglass dressing with a hinge and its value in the care of ski injuries]. Casts for immobilisation of a limb with an artificial external joint can be made light and stable using fiberglass material, because the application of a joint is possible with less material as it is possible using a conventional cast.


[Hormonal regulation of human mammary function]. This review summarises our present knowledge on the endocrine aspects of human mammary function. The fact is stressed that much of the knowledge on mammary function is based on animal studies, and therefore caution must be exercised in drawing conclusions as to mammary function in humans from such experiments. Some recent aspects of mammary function especially in humans are also summarised, as evaluated through 2-bromo-alpha-ergocryptine (CB 154). Special emphasis is placed upon the role of prolactin in the initiation and maintenance of human lactation, some phylogenetic aspects of this hormone are also discussed.


[Chronic posttraumatic ostemyelitis. 3. Immunopathological aspects]. 3. Immunological aspects 90 patients suffering from chronic posttraumatic osteomyelitis were examined immunologically. In 10-20% of the patients serum immunoglobulin levels were changed. Only 45% of the patients with staphylococcal infection had a positive anti-staphylolysin titer. In 10% of the patients so-called wound-specific antibodies were demonstrated; their possible autoimmune origin is discussed. A comparison of three groups of patients according to the immunological reactivity "hypoimmune", "humoral hyper-immune" and "cellular hyperimmune" showed that the worst clinical courses were observed in patinets with established delayed type hypersensitivity.


[Anorectal manometry. A new method for the evaluation of continence, incontinence and chronic constipation]. 643 ano-rectal electromanometric investigations were carried out in 438 children with different ano-rectal diseases including myelomeningocele, Hirschsprung's disease, anal atresia and chronic constipation, as well as in healthy premature, new-born and older infants. The reliability of the recorded physiological and pathological parameters was found to be significant in 87,2%. Electromanometry is shown to be an important new method of assessing ano-rectal continence.


[Adenomatous hyperplasia of the corpus endometrium and the endocervix. Origin, severity and therapy]. An excessive endogenous or exogenous stimulation by estrogen induces adenomatous hyperplasia of the endometrium. The age of the patient and the origin of the estrogenic stimulus however influence the morphology of the hyperplasia. Those resulting from exogenous estrogen rapidly regress after the estrogen is discontinued. To cure hyperplasias brought on by endogenous estrogen, however, therapy with high doses of gestagen is required.


[Chronic posttraumatic osteomyelitis. Attempt at oral autovaccine therapy]. 18 patients suffering from chronic posttraumatic osteomyelitis were treated by oral autovaccination. 11 patients showed significant improvement of clinical condition. The therapeutic effect was evaluated by a scoring system considering the wound morphology, the bone radiology and the erythrocyte sedimentation rate. The most pronounced clinical improvements were observed in patients with established delayed type hypersensitivity against staphylococci.


[Therapeutic results with delta tomanol B, a new form of the so-called "Tubingen bomb". Experiences from a general practice]. 98 patients suffering from spinal syndromes, acute inflammatory arthropathies, neuritides and one case of polyneuropathy were treated with Delta-Tomanol B. As a result, it can be stated that Delta-Tomanol B provides a quick analgesia and, in general a good therapeutic effect with an excellent tolerance. It should be stressed moreover that the mode of application of Delta-Tomanol B, which contains 4 active principles in a stable solution for injections (3 ml!) is very simple: but one ampule has to be opened and drawn up. This is an important advantage of Delta-Tomanol B in comparison with the existing comparable preparations.


Human high denisty apolipoprotein A-I-lysolecithin-lecithin and sphingomyelin complexes. A method for high yield recombinations to lipoprotein complexes of reproducible stoichiometry. High denisty apolipoprotein A-1 (apoLp A-I) has been prepared in a chromatographically and immunochemically homogeneous form. This apoprotein forms trimeric and tetrameric aggregates in aqueous solutions at higher concentrations. ApoLp A-I has been recombined in almost quantitative yield in the presence of lysolecithin with phosphatidylcholine and sphingomyelin to particles of reproducible stoichiometry. Lysolecithin is not required for the interactions of lecithin and sphingomyelin with the apoprotein A-I or for the stability of these complexes. Dialysis removes most of the lysolecithin without the loss of lecithin and sphingomyelin. ApoLp A-I-lecithin particles have a molecular weight of 200 000 and contain 50 molecules lecithin and 25 of lysolecithin. ApoLp A-I-sphingomyelin complexes contain 50 sphingomyelin and 13 lysolecithin molecules. The former particles show up as discs of 100 A diameter, and the latter particles are 250 A in diameter. Their thickness was estimated as 25 A in the apoLp A-I lecithin and 60 A in the apoLp A-I-sphingomyelin particles. ApoLp A-I and lysolecithin form complexes whose densities depend on the lysolecithin concentration. Lysolecithin enhances the binding of phosphatidylcholine to apoLP A-I, yielding lipoprotein complexes with decreasing density. The yield of apoLp A-I-sphingomyelin-lysolecithin complexes is proportional to the lysolecithin concentration. The ratio of apoLp A-I to sphingomyelin in all these complexes remains constant.


[On uroporphyrinogen formation: Studies with 1-aminomethyl-3, 8, 13, 18-tetra(2-carboxyethyl)-2, 7, 12, 17-tetracarboxymethylbilinogen (author's transl)]. The preparation of the aminomethyl-bilinogen which results from formal "head to tail" condensation of porphobilinogen is described. The chemical cyclocondensation of this compound at pH 7.4 yields uroporphyrinogen I. Enzymatic studies with enzyme preparations from Propionibacterium shermanii, which synthesize uroporphyrinogens from porphobilinogen, show that the rate of cyclisation is increased by these enzymes and indicate that the bilinogen also might be used for uroporphyrinogen III formation. This is also suggested by studies on the formation of cobyrinic acid from [4-14C]5-aminolevulinate via uroporphyrinogen III in the presence of the aminomethylbilinogen by cell-free extracts from Clostridium tetanomorphum.


Plant microbody proteins. II. Purification and characterization of the major protein component (SP-63) of peroxisome membranes. The major component of membranes of microbodies from green leaves of Lens culinaris is a protein of a subunit molecular weight of 63 000. This protein, referred to as SP-63, seems to be unique to microbodies and could not be detected when plastids or mitochondria were analyzed. It is probably a structural protein and is thus not solubilized by cholate, Triton X-100, chloroform/methanol, or 0.2M KCl. Solubilization from purified membranes was achieved with guanidinium chloride or sodium dodecylsulphate. The protein was separated from minor contaminating components by chromatography on Sepharose 4B or Sephadex G-150 employing 0.1% sodium dodecylsulphate or 4M urea as eluent. It was shown to be homogeneous upon sodium dodecylsulphate gel electrophoresis and did not give a positive glycoprotein stain.


Further studies on the three-step-increase in activity due to the aromatic amino acids B24-26 (-Phe-Phe-Tyr-). Using a reaction suite which was suggested by Ruttenberg [5] for the semisynthesis of insulin variants, insulin hexamethyl ester was digested by trypsin, then the N-terminal amino groups of the resulting desoctapeptide insulin pentamethyl ester were protected with the Boc residue. The free carboxyl group of the arginyl residue (B22) of this product was coupled to two different series of synthetic peptide methyl esters: I) Gly-OMe, Gly-Phe-OMe, Gly-Phe-Phe-OMe, Gly-Phe-Phe-Tyr-OMe and II) Gly-Ala-OMe, Gly-Phe-Ala-OMe, Gly-Phe-Phe-Ala-OMe, Gly-Phe-Phe-Tyr-Ala-OMe. Removal of all protecting groups yielded the corresponding insulin variants. The syntheses of these peptide methyl esters are described. Following the original prescription of Ruttenberg[5], we were not able to prepare the desired variants. That is why we were forced to change some important details of the Ruttenberg[5] recipe. The activity determinations by the mouse fall test showed the weak activity (ca. 4%) of the desoctapeptide insulin (C-terminus Arg B22). This activity increases drastically in three steps, when the amino acids Phe, Phe, Tyr (B24-26) are added successively to the insulin trunk. Coupling of Gly-Phe yields 14%, -Gly-Phe-Phe 36%, and -Gly-Phe-Phe-Tyr 61% of the biological activity (cryst. insulin=100%). The same peptides, elongated at their C-terminis with an alanyl residues (see above, series II) yield higher activities. Coupling these peptides to the arginyl residue B22 increases the activity as follows: -Gly-Phe-Ala, 36%, -Gly-Phe-Phe-Ala, 59%, and -Gly-Phe-Phe-Tyr-Ala, 91%. Comparing the activities of the variants with the C-termini-Gly-Phe-Phe (36%) and -Gly-Phe-Ala (36%) or -Gly-Phe-Phe-Tyr (61%) and -Gly-Phe-Phe-Ala (59%), it becomes clear that the aromatic amino acids Phe (B25) and Tyr (B26) can be substituted by Ala without loss of activity. In our preceding work (published 1969-1973 [3, 6-8]), we synthesized successively shortened insulin B-chains which yielded, after combination with natural A-chain, practically the same activity values as we have now obtained with the Ruttenberg semisynthesis. As we have already mentioned l.c.[1-4], it is obvious that the activity of insulin proceeds from the arginyl residue (B22) and is only intensified by the aromatic amino acids (B24-26). We[2,3] observed the same three-step increase in activity in the case of our synthetic oligopeptides Arg-Gly-Phe, Arg-Gly-Phe-Phe and Arg-Gly-Phe-Phe-Tyr (B22-26), which we assume to be the active region of insulin (1971[2]).


Bile acid glucuronides, II[1]. Isolation and identification of a chenodeoxycholic acid glucuronide from human plasma in intrahepatic cholestasis. The isolation of a glucurono-conjugate of a bile acid has been performed from human plasma in a case of chronic intrahepatic cholestasis. By means of a series of chromatographic steps, esterification with diazomethane and acetylation a mixture of methylester polyacetates of steroid glucuronides was obtained, which could be separated by thin-layer chromatography. Methyl 7alpha-acetoxy-3alpha-O-(methyl 2, 3, 4-tri-O-acetyl-beta-D-glucopyranosyluronate)5beta-cholan-24-oate, synthesized via the Koenigs-Knorr condensation reaction, was used as reference substance. From comparison of the chromatogrphic behaviour and the mass spectrum of the natural compound and the synthetic product the structure of the bile acid derivative isolated from plasma could be established as a peracetylated methylester of chenodeoxycholic acid-3-beta-D-glucuronide.


Bile acid glucuronides, III[1, 2]. Chemical synthesis and characterization of glucuronic acid coupled mono-, di- and trihydroxy bile acids. The synthesis of bile acid-3-beta-D-monoglucuronides has been accomplished via the Koenigs-Knorr condensation reaction using methyl 2, 3, 4-tri-O-acetyl-1-deoxy-alpha-bromo-D-glucopyranuronate as coupling reagent. Chemical characteristics as melting points, elemental analyses, IR-spectra, isobutane-chemical ionization mass spectra and, in case of the derivative of 3alpha-hydroxy=5beta-cholanoate, NMR-spectra were recorded and can serve as a means of identification of these recently detected naturally occurring derivatives of bile acids in isolation procedures from biological sources.


Oxidative side reactions during dansylation of SH-compounds. Dansyl chloride can act as an oxidizing agent on compounds which are easily oxidized. During the reaction of mercaptanes, e.g. cysteine, homocysteine, cysteamine, with dansyl chloride, the corresponding disulfides are formed and dansyl chloride is reduced to 5-dimethylaminonaphthalene 1-sulfinic acid. This reaction is so rapid that the normal dansylation can take place only after complete oxidation of all SH-compounds. Therefore only the dansyl derivatives of the corresponding disulfides are formed during normal dansylation of SH-compounds. If different SH-compounds are present in the reaction mixture mixed disulfides are formed as well. These can be separated by microchromatography on 3 X 3 cm micropolyamide sheets. Dependent on the concentration of dansyl chloride, 6 or even 15 different dansylated disulfides are formed from three different SH-compounds so that interpretation of these chromatograms is difficult. The actual dansylmercaptanes (e.g., dansylcysteine, dansylhomocysteine, dansylcysteamine) can be prepared by reduction of the dansylated disulfides with suitable reducing agents.


Expanding a sheltered workshop to replace nonpaying patient jobs. Mental hospitals with large numbers of inactive chronic patients often have a history of hospital farms and shops that provided meaningful, though unpaid, occupation to hundreds of patients. The reforms of work programs brought about by the Souder v. Brennan decision were long overdue, the author says, but the resulting termination of work programs in many hospitals means many benefits to patients have been lost. At one state hospital, many of the jobs eliminated by the Souder decision were replaced by an expansion of the hospital's sheltered workshop, which operates under a work activities center certificate. A project in which patients made and assembled parts for unpainted wooden toys was responsible for much of the expansion.


[A comparison of two tests for rheumatoid factor: latex test and l-agglutination (author's transl)]. Positive and negative reactions of latex test (LX) and streptococcal L-agglutination (LA) were correlated significantly with one another. However, in approximately 70% of the sera tested only one test was positive, LX at a much higher rate than LA. Postive rheumatoid factor tests were found in 117 patients with rheumatoid arthritis and in 595 patients with other diseases, exclusive of connective tissue diseases. Among the seropositive patients with rheumatoid arthritis, a positive reaction was seen in 85% and 71% by LX or LA respectively. Patients with nonrheumatic diseases showed positive reactions at a rate of 3,1%, with 2,3% and 1,7% in LX or La respectively. This shows that LA is less sensitive, but more specific as compared with LX. With increasing age of the patients, the rate of "nonspecific positive" reactors in patients with nonrheumatic diseases increases, more strongly for LX than for LA. The distribution of positive tests (LX positive, LA positive, or both positive) was analyzed in various groups of patients. The rate of positive reactions in both tests is significantly higher than patients with rheumatoid arthritis; it further increases with the severity of the disease. In cases with positive CRP, the rate of sera positive in both tests is higher, equally in patients with and without rheumatoid arthritis. In patients with nonrheumatic diseases an elevated serum gamma-globulin is associated with positive reactions in both tests and with positive LX. In all other grouping of patients, the rheumatoid factor tests did not yield significant deviations from chance distribution, as determined by chi2 analysis.


[Detection of HBSAG in cerebrospinal fluid by means of a radioimmunoassay technique (author's transl)]. HBSAg was demonstrated radioimmunologically in cerebrospinal fluid in 7 out of 11 seropositive children with acute viral hepatitis B (1/2), fulminant viral hepatitis (0/1), chronic active hepatitis (2/4), chronic persistent hepatitis (1/1), cirrhosis (1/1), and asymptomatic carrier status (2/2). Counterelectrophoresis and complement fixation test lacked the necessary sensitivity to detect the antigen even in patients with high serum concentrations. The pass over of the cerebrospinal barrier appears to be dependent of the serum titer. Some neurologic symptoms in the early stage of acute viral hepatitis are probably connected with the appearance of HBSAg in cerebrospinal fluid. It is however unlikely that central-nervous-system dysfunctions observed in association with fulminant viral hepatitis and coma result from a direct effect of HBSAg or hepatitis B-virus. In chronic carriers the cerebrospinal fluid probably contains the antigen more frequent. The cerebrospinal fluid of HBSAg-positive patients has to be regarded as an infectious agent.


Acquired resistance to ticks. I. Passive transfer of resistance. Guinea-pigs developed resistance to larvae of the ixodid tick, Dermacentor andersoni, after one infestation. Resistance was characterized by guinea-pigs allowing fewer larvae to engorge (5-15%) during a second exposure than during an initial infestation (70-90%). Larvae feeding on resistant hosts weighed less than larvae engorging on a host with no previous exposure to ticks. Evidence is presented which indicates that this resistance can be passively transferred with viable lymph node cells, but not with serum, from resistant guinea-pigs. Recipients of cells from such resistant animals allowed significantly fewer larvae to engorge than did controls previously unexposed to ticks. This was not so in recipients of immune serum. The protection provided by passive transfer of cells from a resistant donor was not as complete as the protection afforded by natural exposure.


Cell-mediated cytotoxicity. Characterization of the effector cells. Isolated human mononuclear cells were fractionated according to their membrane characteristics or physical properties. Adherent cells were depleted by filtration through glass columns; phagocytic cells were removed by iron treatment and cell subpopulations capable of forming rosettes with sheep erythrocytes (E), erythrocyte-antibody-complement (EAC) and chicken erythrocyte-antibody complexes (CEA) were separated by centrifugation of Ficoll-Hypaque gradients. The functional activity of the cell subpopulations obtained was assayed by testing PHA-induced cytoxicity (PIC), antibody-dependent cytoxicity (ADCC) and blast transformation by PHA. The results of this study demonstrate that: (1) cells reacting in PIC and ADCC assays are different, adherent and phagocytic cells being necessary for full expression of PIC and not for ADCC; (2) PHA induces direct blast transformation of purified E-RFC in the absence of PIC cytotoxic cells; (3) cell populations specifically enriched in E or EAC rosette-forming cells are not cytotoxic neither in the PHA nor in antibody mediated cytotoxic assays; (4) cells participating in ADCC can be selectively purified by centrifugation of CEA rosettes.


Studies on lymph humoral factor. Evidence for a lymphocytopoietic factor in rat thoracic duct lymph. Normal rats were injected with the partially purified material extracted from the thoracic duct lymph which was collected from normal syngeneic rats. The cellular changes in the peripheral lymphoid tissues and thymus were examined cytologically and histologically. The intravenous injection of the lymph extract into normal syngeneic rats resulted in increase in weight of lymphoid tissues. Histologically, a massive proliferation of large pyroninophilic lymphoid cells and an increase in mitotic index was detected predominantly in the thymus-dependent areas and thymic cortex. In spleens from rats injected with lymph extract, the marginal zone bridging channel was shown as one route for the translocation or mobilization of newly borne lymphoid cells to the venous circulation. Similar lymphocytopoietic activity, but to a lesser extent than lymph extract, was also detected in lymph plasma, serum and serum extract. The lymph extract was shown to be non-immunogenic in syngeneic rats. It is suggested that the effects of the lymph extract on lymphoid cell proliferation are due to the presence of a lymphocytopoietic factor in body fluid, particularly in the lymph.


Evidence for the secretory transport mechanism of intestinal immunoglobulin. The ultrastructural distribution of IgM. The intracellular localization of IgM in porcine intestinal tissue has been studied by immunoelectron microscopy and immunofluorescence. IgM was demonstrated in vesicles in the cytoplasm of crypt epithelial cells particularly in the supranuclear region. It was also shown in the ergastoplasmic cisternae of plasma cells in the intercryptal lamina propria. The findings are compared with those of a previous similar study on secretory IgA and their implications for possible mechanisms of selective transport are discussed.


[Nutrition physiological aspects in the treatment of obesity]. Obesity is one of the most common prosperity diseases. As a consequence of this disease there is a decrease in the expectation of life. Obesity is bascially caused by overeating. The low-caloric reducing diets are differentiated into a low-fat and high-carbohydrate form, and into a carbohydrate-free and high-fat diet. The metabolic advantages and the disadvantages of these two forms of low-caloric diets are discussed with respect to starvation metabolism. It is assumed that without ketoacidosis, at least 100-140 g glucose per day are required to meet the energetic demands of the central nervous system. Since the conversion rate of protein to glucose is about 2:1, during a carbohydrate-free diet about 200-260 g of protein per day would be necessary to meet the glucose requirements of the organism. As such a high-protein supply with food is almost impossible, ketogenesis in the liver must take place as a sort of "glucose-sparing mechanism". Only under these conditions, the otherwise extreme nitrogen catabolism can be avoided during an almost carbohydrate-free diet. However, using a fat-free (600 kcal) diet it is possible to furnish the glucose requirements of the central nervous system by the food supply. Therefore, a compensatory ketoacidosis is not required. Additionally, the fat-free diet does not contain cholesterol. In this way, the hypercholesterinemia which is a common feature in obesity is favourably influenced by the absence of foods of animal origin. Therefore, within a short period a marked decrease in serum cholesterol concentration results by the high-carbohydrate diet. The same is true for the concentration of free fatty acids and serum triglycerides. It is concluded that the high-carbohydrate low-caloric diet is suited best for reduction of body weight.


[Problems of the intravenous access--a new instrument for the vena cava catheterization by way of the internal jugular vein]. Experience with a new Braunula is reported. However, even with this new punction set the long-term peripheral application of certain solutions is not possible. For this reason, more and more central-vein catheters must be used. Comparing the advantages and disadvantages of the subclavian catheter of the jugularis interna catheter the latter is preferred. A new set for this method is demonstrated.


[Microfilters and blood transfusion].

[Microfilters and blood transfusion]. The use of microfilters for the transfusion of fresh blood and bank blood stored for 10 and 18 days is reported. No amorphous debris are found in the microfilter after perfusion of fresh blood. After perfusion of blood stored for 10 and 18 days, in two cases aggregates of platelets are found, amorphous debris, however, only in one case in the smallest mesh. On the other hand, in the 300 mu standard filter a passage of amorphous debris through the filter is often to be seen. It is possible that some manipulation has favoured this.


[Nutritional problems in diseases of the small and large intestine]. 18 patients with inflammatory bowel disease, among them ten with ulcerative colitis and 5 with Crohn's disease, were treated with the combined enteral-parenteral synthetic hypercaloric nutrition. By use of Vivasorb the clinical results were rather good. However, it was impossible to normalize the serumalbumin until the application of the formula diet BSD, enriched in amino acids. These experiences with BSD reveal much better results. All patients recovered nearly completely from their complaints and the clinical parameters went back to normal. Furthermore, it is easier to improve the flavour. The typical mode therapy is demonstrated on one patient with ulcerative colitis and one with Crohn's disease.


Central fractures of the acetabulum.

Central fractures of the acetabulum. A series of 26 patients with central fractures of the acetabulum is presented with a follow-up of 3-13 years. Three patients had undisplaced fractures. In the remaining 23, long-term results of treatment by traction in 15 and by primary open reduction in 8 have been compared. A numerical grading system has been used for assessment. Results in the non-operative group were generally poor, only 2 being satisfactory. Some of the poorest scores in this group were associated with initial roof damage. Three patients required secondary salvage procedures because of severe pain and disability approximately 2 years after injury. Of the open reduction patients, all with roof damage, 4 had satisfactory results. Reasons for failure is the remaining 4 patients are discussed. Galloping degeneration due presumably to irreversible intra-articular cartilage damage at the initial injury, developed in 2 patients in the non-operative group and in one in the operative group.


Instances in which intramedullary nailing of a child's fracture is justifiable. Two cases of fractures of the femur in childhood where internal fixation was indicated are described. Internal fixation of children's fractures is rarely justifiable (Blount, 1955), partly because of the rarity of non-union and partly because moulding usually corrects what may at first have been unacceptable deformity. Among the methods of internal fixation, Küntscher nailing for fracture of the shaft of a child's femur may seem to be the most difficult to defend. Nevertheless, there are occasions when it becomes necessary, although it might have been possible to avoid the operation by better care at the time.


A report of 3 cases of simultaneous Colles' and scaphoid fractures. Three cases of simultaneous Colles' and scaphoid fractures, one bilateral, occurring in a series of 422 Colles' fractures are presented. The factors necessary for the occurrence of such injuries are discussed.


Complications of fractures  of the clavicle. Most fractures of the clavicle unite without incident. The number and diversity of the methods of treatment in use suggest that in most cases good results are obtained despite medical supervision. Yet occasionally complications do arise. This paper describes two such cases and reviews the literature in search of a common factor to account for these complications. Cases presenting with early and late complications of fractures of the clavicle are described and the literature on the subject reviewed. The incidence of complications is highest in cases of direct violence to the shoulder region producing comminuted fractures. Surgical management is outlined in general terms. It is suggested that more prolonged and rigorous immobilization of cases "at risk" may reduce the incidence of non-union and prevent late neurovascular complications.


The use of plaster casts in the treatment of fractures of the femoral shaft. In order to relieve the pressure on an overworked fracture service, the early mobilization of patients with fractures of the femoral shaft in plaster casts was investigated. The cast is designed to have a weight-relieving function and to mould the soft tissues of the thigh around the fracture. Using this method, 40 patients were discharged from hospital in an average of 44 days from injury and all their fractures healed rapidly and successfully.


Tardy palsy of the radial nerve from a Monteggia fracture. A case of tardy palsy of the radial nerve, which developed 65 years after a Monteggia fracture that remained unreduced, is described. The weakness recovered sufficiently well for a tendon transference to bu unnecessary, partly because the patient was semi-retired. This condition is rare but comparison with the only two similar reported case of tardy radial and posterior interosseous nerve palsy associated with long-standing dislocation of the superior radio-ulnar joint suggests that the prognosis for recovery of such a palsy following excision of the radial head is better than might be expected.


Intra-articular fractures of the calcaneum. A method of reducing deformity of displaced, intra-articular fractures of the calcaneum is described, together with a programme of management aimed at restoring a painless and mobile foot. The clinical and radiographic results are presented in 41 patients treated over a 10-year-period, with a minimum follow-up of 2 years. The complications, none of which were serious, are described. The results are compared with a group of 52 patients whose fractures were treated over the same period by early movements without any attempt at reduction. Although disabling pain was not a notable feature in either group, more patients in the reduced group had resumed work of a heavy nature entailing climbing or walking on rough ground. Analysis of the figures suggests that this is related to the better function regained in the subtalar joint by this group.


Recurrent severe haemorrhage from false aneurysm following fracture of the femur. A case of traumatic false aneurysm presenting as recurrent exsanguinating haemorrhage from a surgical wound of the thigh is described. A plate, inserted to maintain reduction of a fracture of the femur, was removed during the third attempt to control the bleeding and only then was the source revealed. Diagnostic difficulty delayed definitive treatment.


Major venous injuries and bullet wounds. A review of the reported incidence, management and results of treatment of major vein injuries is presented and a brief account given of the mechanism of vascular damage by high-velocity bullet wounds. This paper reports 3 cases of isolated major venous injury caused by high-velocity bullets. Repair was performed in each case. Two patients survived with a good short-term clinical result. The third patient died during operation. The advantages of repairing injured veins are discussed.


A comparison of deaths from injury. 1947-56 compared with 1962-71. Deaths from injury occurring during a recent 10-year period at the Birmingham Accident Hospital were compared with those occurring during a similar period 15 years earlier. Reliable comparisons were not possible because of changes in policy that tended to reduce the delay in getting badly injured persons to hospital. The figures did show: 1. A slight increase in the number of deaths from domestic accidents which might account for: 2. A slight increase in the number of deaths following fracture of the femur. 3. A slight decrease in the number of deaths from road accidents. 4. A slight decrease in the number of deaths following head injury and a tendency for these deaths to be delayed in the second 10-year period. 5. Deaths following injuries of the trunk were mostly due to bleeding and some of these could be looked on as examples of failure in diagnosis or resuscitation or both. What still remains true is that prompt diagnosis and resuscitation, and well-judged definitive treatment offer the best prospect of reducing mortality. Accurate diagnosis may owe much to technical aids but it also requires observation of physical signs in the light of well-known patterns of injury.


A computer program to derive the rate equations of enzyme catalysed reactions with up to ten enzyme-containing intermediates in the reaction mechanism. The paper describes a program, designed for a desk-top computer, which can be used to derive the rate equations of enzyme catalysed reactions with up to ten enzyme-containing intermediates included in the mechanism. The program allows the rate equation to be presented in simplified forms of practical use and in a variety of formats.


A systems model of blood glucose control. A mathematical model for the short-term control of glucose is presented, focusing upon the role of the liver. Non-linear representation is provided, enabling complete system behaviour of the metabolic and endocrine processes to be analysed, including both basic auto-regulation and higher levels of control. The level of a priori knowledge incorporated in the formulation is maximised by including unit process dynamics, making direct use of known enzymological data. From simulation results, hypotheses concerning system structure are tested. Hormones are seen to be important in maintaining the biochemical environment, providing the coarse control. The dominant control of flux within the glucose metabolic pathways is intrinsic to the enzyme systems which can be looked upon as providing the fine tuning and auto regulatory effects.


Some aspects of a stochastic two locus selfing genetic model with selection and computer simulation. The present paper examines a specific genetic model as a finite Markov process, using the normal matrix approach. This model is the two locus selfing model with selection studied by Tan (1973), who used an eigenvalue approach. The properties of the process are analytically and numerically investigated and the effects of selection and cross-over on the transition from a heterozygotic parent through several generations of heterozygotic progeny are assessed. These results enlarge upon Tan's work and, in addition, present two new aspects of the model. In particular (1) the expected number of generations of heterozygotic progeny of genotype j that will descend from a heterozygotic parent of genotype i and (2) the variance of this number of generations about the mean value have not been previously considered.