The dilemma of family planning in a North Indian State. An empirical study of the family planning program and its clients in the rural areas of Allahabad Division of Uttar Pradesh in India was undertaken in 1971-1972. While family planning acceptance in this region is low, interviews with villagers and family planning staff suggest that organizational shortcomings of the program may help to explain the low level of acceptance. The reported level of contact between the program field staff and the village population was unexpectedly low. The paper discusses a number of administrative problems within the family planning organization, especially at the level of the primary health center. It is concluded that in designing family planning programs, efforts should be made to minimize organizational requirements.


Neurological outcome of prolonged coma survivors of out-of-hospital cardiac arrest. Nine adult survivors of out-of-hospital presumed cardiogenic cardiac arrest, who remained unresponsive for longer than their third hospital day and who eventually were discharged from the acute care hospital, are reported. Their neurological outcome fell into three distinct categories: (a) a persistent vegetative state, (b) able to follow some simple commands but requiring total nursing care, and (c) able to perform most activities of daily living but unemployable because of marked organic deficits.


Modernism and contraceptive use in Colombia. This analysis addresses the question of whether fertility can be lowered without the prior occurrence of the social and economic changes that have come to be labeled modernization. The data show that there exists in Colombia a relatively high level of motivation to control fertility that, for many women, is not coupled with both knowledge of and access to a method of contraception. For the "traditional" woman, the problem may not  be lack of motivation so much as lack of access to methods that she is aware of, such as the pill, and lack of knowledge of methods that require few resources of supplies, such as rhythm and withdrawal.


Reversibility of the chronic post-stroke state. Forty patients with cerebral infarction associated with occlusion of the internal carotid artery (ICA) or the middle cerebral artery (MCA) were treated with hyperbaric oxygenation (HO). EEG analyses were performed regularly in order to assess the course of the cerebral lesion. Patients in an early post-stroke stage (III B) and patients in a chronic post-stroke stage (IV) had the changes in EEG analysis and neurological distributed evenly between these two groups.


Diplopia and involuntary eye closure in spontaneous cerebellar hemorrhage. Spontaneous cerebellar hemorrhage is of difficult clinical diagnosis. The causes can be varied, but the hemorrhage is most often associated with hypertensive cardiovascular disease. The neurological symptomatology is complex and often misleading. The diagnosis is mainly dependent of familiarity of the eye signs seen in this disease. Among these, the spontaneous unilateral eye closure is presented as an additional striking manifestation. The displacement of the brain stem by the hematoma is frequently associated with a seventh nerve palsy on the side of the hemorrhage. The patient in an effort to obviate the diplopia caused by the gaze dissociations and extraocular motor palsies, has only the option to close the eye on the noninvolved side of the face, and thus the eye remaining open is on the side of the cerebellar hematoma. This paper presents reports of two patients with these symptoms.


The integrity of tubular cell function after preservation in Collins' or Sacks' solution. Collins' solution is an excellent medium for kidney preservation by simple cold storage before transplantation. Efforts by Sacks et al. to improve this technique by modifying the composition seemed promising. A comparison between ability of these two media to preserve the tubular cell was attempted. The viability of the tubular cells was evaluated by measuring the 125 I Hippuran uptake in cortex slices taken from kidneys preserved for 24 and 48 hr in the respective solutions. Kidneys exposed to as well as kidneys not exposed to warm ischaemia were used. Collins' solution was found to be superior in protecting the cell function. Nonetheless intracellular oedema during preservation was greater after preservation in this solution as compared with cells preserved in Sacks' solution.


The theory of high-altitide corrections to the U.S. Navy standard decompression tables. The cross corrections. The theoretical basis for the Cross high-altitude corrections to the USN Standard Decompression Tables is derived. Providing corrections are made for depth and ascent rate and if no decompression stops are made, a dive at altitude can be transformed to a dive at sea level for which the theoretical tissue responses are mathematically similar to the altitude dive. The transformation fails if decompression stops are required due to the fact that the stop criteria used in the USN Tables do not obey the same rule of transformation. It is shown that the failure of the high-altitude correction is expected to be conservative.


Narcotic potency of N2, A, and N2O evaluated by the physical performance of mouse colonies at simulated depths. The physical performance of colonies of deer mice was studied in various inert gas environments at pressures up to 31 ATA. The mice were housed in habitats wherein their diurnal running activity and social interactions could be monitored. By transferring the portable habitats and mouse colonies to a high pressure chamber, the effects of elevated inert gas pressures were studied in socially and ecologically intact surroundings. Analysis of wheel-running performance showed that either 1.1 atm nitrous oxide, 7.2 atm argon, or 20.5 atm nitrogen reduced running activity to 50% of its control value. Behavioral observations revealed a deterioration of physical performance and social interaction with increasing inert gas pressures. A comparison was made between ED50 (the dose that will depress a particular response by 50%) values obtained by studying wheel-running activity and those published for single-reflex responses.


Coral-algal associations: capacity for producing and sustaining elevated oxygen tensions in situ. Net oxygen production during photosynthesis by all plants requires adaptation to intracellular O2 tensions in excess of 0.21 ATA. The symbiotic association of zooxanthellae (algae) in the tissues of many actinozoans and hydrozoans (corals and anemones) suggests such an adaptation in these tissues as well, and raises the question as to degree. Oxygen production by zooxanthellae in a single coral head of Montastrea cavernosum was monitored daily in situ in a closed, recirculating 15-liter system. The net photosynthetic activity repeatedly raised the PO2 to more than 0.5 ATA, indicating that even higher tensions existed in the coral's tissues in order to cause this increase and suggesting that coral tissue may represent another example of an oxygen-adapted tissue.


An audiometric survey of Navy divers.

An audiometric survey of Navy divers. The pure tone audiograms of a diverse group of U.S. Navy divers were examined across four major variables: (1) number of years of Navy diving experience, (2) previous noise exposure history, (3) previous history of barotrauma, and (4) type of equipment used, i.e. scuba and helmet. The results obtained suggest that these variables had only minimal effects on auditory sensitivity and that when the hearing of these divers was compared to a normal population of nondivers, no significant differences were detected. A comparison of these findings with those in the existing diving literature was then made.


Respiratory gas exchange and lung perfusion in man during and after head-out water immersion. The respiratory gas exchange for O2, CO2, and CO has been studied in nine healthy male subjects before, during, and after head-out water immersion. Distribution of lung perfusion and ventilation were determined by quantitative double nuclide scintigraphy (131J and 99mTc) and by argon washout, respectively. The well-known decrease of PaO2 and increase of AaDO2 during immersion is accompanied by a decrease of the CO-transfer factor. Ventilation in relation to functional residual volume does not change significantly, whereas distribution of lung perfusion becomes more even, with an increase in the apical lung zones. Immediately after the end of immersion, PaO2 increases rapidly, exceeding the initial value under dry conditions. At the same time, lung perfusion is shifted markedly more towards the basal lung regions, exceeding the gravity-induced blood pooling in the erect subject under dry conditions. The observed changes tend to normalize within 2 min. The changes of respiratory gas exchange during and immediately after immersion can be explained by changes of the inequality of the ventilation-perfusion ratios.


Closed-system habitat for high pressure exposures of animal colonies. A deep-diving system has been designed for use with colonies of small rodents at pressures up to 170 ATA. The system consists of a triple-envelope arrangement in which a modular habitat serves as the animal living quarters. The habitat contains provisions for temperature control, gas analysis, and measurement of physical performance and social interaction; it also contains food and water supplies. The surrounding envelope (an acrylic box) is used to control the composition of the gaseous environment presented to  the animal colonies. The outermost envelope (a high pressure chamber) maintains the desired pressure conditions. Colonies of five deer mice have been successfully studied at pressures up to 100 ATA. Their performance has been evaluated during 1- to 4-day exposures to various gaseous environments.


Responses of the cardiovascular system to carotid sinus nerve stimulation. The changes in blood pressure, heart rate, cardiac output and blood flow in the femoral and common carotid arteries on carotid sinus nerve stimulation (CSNS) were studied in chloralose anaesthetized dogs, both with spontaneous heart rhythm and during atrial pacing. Stimulation of the sinus nerves with impulse trains and with impulses of constant frequency had almost equal effects on the blood pressure. The former had a greater effect on the heart rate; these findings verified earlier observations. The reductions in cardiac output followed those in heart rate. During atrial pacing the stroke volume was reduced on CSNS. The total peripheral resistance, regional peripheral resistances and input impedance of the vascular bed of the femoral artery were calculated. The initial effects of CSNS varied in relation to the prestimulation total peripheral resistance and to stimulation frequency. Differences between stimulation with a constant frequency and the intermittent types, with the same number of impulses per cardiac cycle, were negligible as regards effects on stroke volume, blood flow and regional vascular resistances. CSNS caused changes in input impedance of the vascular bed of the femoral artery which were very similar to those observed earlier on intraarterial injection of vasodilator drugs. The different effects of intermittent and constant frequency CSNS on the heart rate in dogs with intact vagal nerves and no clamping of the common carotid arteries might be caused by asymmetries in the autonomic effects on the S.A. node. The neurophysiological mechanisms are discussed. It is deduced that greater reductions in blood pressure with intermittent stimulation are only obtained in the pre-existence of a high sympathetic tone.


Thymic diseases as revealed by a series of consecutive thymectomies and biopsies from the thymus. A series of 85 thymis biopsies and specimens from thymectomies were re-examined. Forty-five of these were taken from patients with myasthenia gravis. A relatively low frequency of thymitis (57%) was found in these patients, while the frequency of thymoma (9%) was as expected. Two cases of thymitis in thyrotoxicosis were included in the material. In all, 22 thymomas of various kinds (18% of the total material) were diagnosed. A fairly low proportion of these thymomas (18%) were from patients with myasthenia gravis.


Inhibitory effect of dextran 40 upon thrombin-induced fibrin deposition in rat lungs. The effect of dextran 40 upon thrombin-induced fibrin deposition in rat lungs was studied. A quantitative method employing isotope-labelled fibrinogen was used to determine the amount of fibrin in the lungs. It was shown that pretreatment was dextran 40 suppressed the accumulation of fibrin in the lungs after injection of thrombin. This was not due to redistribution of the fibrin to other organs but appeared to be a result of decreased intravascular coagulation. It seemed unlikely that the finding could be explained by an effect of dextran upon fibrinolysis.


Splenectomy--a surgical panorama.

Splenectomy--a surgical panorama. A five-year material of splenectomies (1970-74) is presented. The material was divided according to the indications for splenectomy as follows: radicality (Group I), iatrogenic hemorrhage Group II), traumatic ruptures (Group III), hematological cases (Group IV) and miscellaneous cases (Group V). There was a large increase in the hematological group over the period due to the addition of splenectomy in the staging procedure for Hodgkin's disease. The mortality was highest in group I and lowest in group IV, as also was the incidence of complications. No patient with Hodgkin's disease died of the operation and the staging laparotomy for this disease, which gives valuable information, thus seems sufficiently safe to warrant routine use.


Studies on the non-adenomatous glands in patients with a solitary parathyroid adenoma. The properties of the non-adenomatous glands in 22 cases of primary hyperparathyroidism due to solitary adenoma were studied. The mean glandular and parenchymal cell weight was somewhat lower than that found by others in glands from euparathyroid subjects. In almost all glands the dark chief cells predominated. This cell type indicates endocrine activity. With some exceptions the glandular endocrine activity seems to be less pronounced than in the concomitantly resected adenoma. Histologically there was no apparent signs of atrophy or hyperplasia in the nonadenomatous glands. The clinical relevance of the findings is discussed.


The concordance of respiratory fluctuations in oesophageal and central venous pressures. Respiratory fluctuations in oesophageal and central venous pressures were recorded in 13 healthy subjects and compared with respect to phase and amplitude concordance. An average divergence in phase of nearly 180 degrees was obtained, with large inter-individual variations. Disregarding phase the amplitude of the respiratory central venous pressure was found to be, on the average, a good 1/4 of that of the oesophageal pressure in the supine posture, and a good 2/3 while the subjects were sitting. These figures also varied considerably. It is suggested that the findings might be referred to competition between a central venous pressure raising effect of inspiration enhanced venous return, and a central venous pressure depressing effect of the inspiratory fall in intrathoracic pressure. The partitioning of costal and abdomino-diaphragmatic breathing is considered of great significance to the outcome of this competition. It is concluded that the oesophageal balloon catheter technique for estimation of transpulmonary pressure cannot simply be replaced by the central venous catheter technique in healthy subjects. Its application in patients with certain pulmonary disorders, however, might be more successful.


Acute pancreatitis and hepatic necrosis in the acute afferent loop syndrome. A histopathological study in the rat. The morphological changes in the liver and pancreas during the first 12 hours in the acute afferent loop syndrome were studied in rats with a Billroth II gastric resection. Two essentially different types of changes were found in the pancreas. One was a coagulative necrosis without an inflammatory reaction, which has been found after instillation of bile, bile salts and the detergent sodium lauryl sulphate into the pancreatic ducts. The other type of pancreatitis was an intense, acute purulent inflammation often with bacteria visible in the histological sections. In the liver, large areas of necrosis were often encountered, sometimes mixed with polymorphonuclear leukocytes and bacteria, in a few cases combined with thrombi in small portal veins. The changes in the pancreas occurred very rapidly; only 4 hours after occlusion of the afferent loop there were signs of pancreatitis in some cases and 12 hours after occlusion there was an acute pancreatitis in all cases.


Treatment of extensive renal calculi with extracorporeal surgery and autotransplantation. Two patients with large calculi in solitary kidneys, treated by ex vivo stone extraction and autotransplantation, are presented. The results show this to be a valuable therapeutic modality for difficult renal calculi where an in situ approach would be hazardous.


Multilocular cystic kidney.

Multilocular cystic kidney. Two cases of multilocular cystic kidney are reported. Current concepts of pathogenesis are reviewed. Treatment by total nephrectomy is advocated when the contralateral kidney is normal; partial nephrectomy should be reserved for those cases in which the contralateral kidney has reduced function or is absent.


Renin-dependent hypertension in children with reflux nephropathy. In children with reflux nephropathy renin-dependent hypertension may develop. Two girls with reflux nephropathy, hypertension, elevated plasma renin activity, but normal (Case I) and near normal (Case 2) serum creatinines are described. These cases suggest that reflux nephropathy can activate the renin-angiotensin system and that the renin inhibitors, methyldopa and propranolol, an useful in managing this type of hypertension.


Congenital hydronephrosis of lower segment in duplex kidney. Congenital hydronephrosis of the lower segment in duplex kidney was treated in 12 patients. This uncommon abnormality carries the risk of calculous formation, chronic urinary tract infection, and functional failure of the involved segment. Diagnostic problems encountered included differentiation from tumor, obstruction by a calculus, and hydronephrosis due to reflux. Treatment was individualized according to severity of hydronephrosis and presence or absence of specific complications. Mild obstruction could be treated nonsurgically while the patient was closely observed for evidence of stone, infection, or worsening of obstruction. Available surgical procedures include end to side or side to side pyeloureteral anastomosis, plastic widening of a narrowed obstructive site, removal of calculus with relief of obstruction, and heminephrectomy.


In vitro cytotoxicity studies in bladder and renal cell cancer. Attempts to obtain cell lines from bladder and renal cancer patients were done in 42 patients, with success to obtain primary cultures in 25 and long-term cultures in 7. Cell-mediated and humoral immunity was demonstrated in both tumors by microcytotoxicity in vitro. No cytotoxicity could be deomonstrated against target cells obtained from metastatic cancer tissue. Abrogation of cell-mediated immunity by serum factors was demonstrated. No recurrence was obtained in the group of patients showing positive lymphocytotoxicity during follow-up.


Management of neoplasms in vesical diverticula. Two cases of neoplasms occurring in vesical diverticula are presented, and the pertinent literature is reviewed. It is suggested that a patient with a neoplasm in a vesical diverticulum be staged by surgical exploration and be accorded the same aggressive management as any patient with an infiltrating vesical neoplasm.


Anterior bladder tube in radical retropubic prostatectomy. Six patients with a minimum of ten months' follow-up have undergone reconstruction of the urethra by anterior bladder tube after radical retropubic prostatectomy; 4 void well and are continent, 1 is incontinent, and 1 has severe stricture.


Cefazolin and cephalexin levels in prostatic tissue and sera. A study was carried out on 18 patients given cefazolin intramuscularly and 17 patients given cephalexin by mouth preoperatively prior to transurethral resection of the prostate. Prostatic tissue and serum levels of the two drugs were determined and contrasted with previously reported mean inhibitory concentrations. It was found that cefazolin was present in the sera and prostatic tissues in levels greater than was cephalexin and that cefazolin frequently exceeded the minimum inhibitory concentrations necessary for sensitive organisms to be affected, whereas cephalexin did not. Therefore, it would appear that cefazolin would be preferable to cephalexin in treatment of acute bacterial prostatitis.


Bacterial prostatitis: treatment with trimethoprim-sulfamethoxazole. Fifteen patients with chronic bacterial prostatitis were treated with trimethoprim-sulfamethoxazole for three months. In 60 per cent of the patients a recurrence of chronic bacterial prostatitis developed during a follow-up period of from one to two and one-half years. It appears that factors other than a diffusion barrier to effective antimicrobial agents into the prostatic gland are responsible for the persistence of chronic bacterial infections of the prostate.


Paraurethral cysts in female neonate.

Paraurethral cysts in female neonate. Paraurethral cysts in the female neonate are uncommon lesions. All reported cases have either ruptured spontaneously or responded to simple marsupialization. However, complete urologic evaluation is mandatory because they simulate ectopic ureteroceles in appearance. Herein is reported our experience with 5 patients. The etiology, embryogenesis, natural history, differential diagnosis, and treatment are discussed.


High renin hypertension associated with renal cortical cyst. A fifty-seven-year-old patient with a five to one elevation of right renal vein plasma renin activity associated with a large, simple cortical cyst of the right lower pole is presented. Marsupialization of the cyst was associated with improvement in the patient's hypertension and the finding of bilaterally equal renal vein renin activity three months postoperatively. Possible mechanisms for hypertension are discussed in context of the experimental models of Goldblatt and Page in such lesions as cortical cysts of large size causing hydronephrosis, vascular stretching, or renal parenchymal compression.


Papillary renal cell carcinoma six years after renal cystectomy. A papillary renal cell carcinoma developed in this patient in the same position that six years previously had undergone unroofing of a benign cyst. The discussion includes a brief review of the relationship between renal cyst and carcinoma.


Recurrent partial priapism.

Recurrent partial priapism. Exploration of an unusual case of a painful, recurrent, perineal mass revealed partial priapism of the right corpora cavernosa. Etiology is speculative and no definitive therapy is offered.


Ureteritis cystica after treatment of cyclophosphamide-induced hemorrhagic cystitis. A case is presented in which ureteritis cystica developed following formalin instillation for treatment of cyclophosphamide-induced hemorrhagic cystitis. It is not known whether this complication, not previously reported, is a result of the cyclophosphamide, the formalin, or a combination of both. Patients being considered for formalin instillation should be studied by cystography for evaluation of vesicoureteral reflux. Alternative methods to formalin instillation should be considered in patients with reflux.


Cystic changes in adult human kidneys after ureteral obstruction: microdissection studies. Five kidneys from patients suffering from ureteral obstruction were selected for the study; from each, 100 nephrons and 20 collecting ducts were studied using Darmady's microdissection technique. Whereas three kidneys showed macroscopic cysts, microscopically, all kidneys displayed dilation and diverticulation of the nephrons particularly of the loop of Henlé and of distal convoluted tubules. Some dilatation of the collecting ducts was also noticed.


Chronically infected and postdiversionary bladders: cytologic and histopathologic study. Cytologic and histopathologic study of 36 patients demonstrated an 86 to 92 per cent incidence of squamous metaplasia of the bladder among patients with chronically infected bladders and a 64 per cent incidence in patients with postdiversionary bladders left behind. The relationships of infection, inflammation, squamous meetaplasia, and squamous cell carcinoma of the bladder are reviewed. It is postulated that the same carcinogenic factors which induce transitional cell carcinoma might cause squamous cell carcinoma if the epithelium had previously undergone squamous metaplasia.


Penile metastases from bronchogenic carcinoma. A case of secondary penile carcinoma originating in the lung is reported. Modes of metastases to the penis, treatment, prognosis, and a brief review of the literature are given.


Cytology of transitional cell carcinoma in situ of urinary bladder with extensive prostatic involvement. Cytologic differences in the urine of 6 patients with transitional cell carcinoma in situ (CIS) of the urinary bladder with and without prostatic duct involvement are described. In the former group, there was an admixture of CIS cells along with many bizarre malignant cells which increased with time and showed malignant criteria indicative of changes more than CIS alone.


Unusual presentations of hypernephroma.

Unusual presentations of hypernephroma. Two cases with varying presentations of renal adenocarcinoma are reviewed. The first patient manifested an unsuspected hypernephroma on intravenous pyelogram for ureteral colic by demonstrating a distorted collecting system and peripelvic extravasation of contrast material. The second case report is one of spontaneous subcapsular renal hemorrhage with hypernephroma.


Congenital renal dysplasia: Osathanondh-Potter type ii polycystic kidneys. Congenital renal dysplasia represents a group of nonhereditary kidney malformations frequently encountered in infants and children. The dysplasia may involve one or both kidneys totally or segmentally. The clinical presentation and prognosis depend on the extent of renal involvement and further development of the dysplastic renal tissue as well as the severity of coexisting malformations in other organs. The unifying factor in each instance is the characteristic histologic appearance of the dysplastic renal tissue. Congenital multicystic kidney and multilocular renal cyst are the best known members of the group. Radiologic features in conjunction with the clinical picture can suggest the correct diagnosis in most cases.


Renal cell carcinoma masquerading as obstructive uropathy. A case of renal cell carcinoma without renal vein involvement is presented in which the intravenous urogram demonstrated only a persistent nephrogram suggestive of obstructive uropathy.


Electromyographic and gas urethral pressure profile. A new technique for recording urethral pressure profile is described. The method consists of a simultaneous combined electromyographic and gas urethral pressure profile recording. Normal and pathologic patterns are described. The method provides information on the correlation between intraurethral pressure and activity in the periurethral striated musculature and has proved useful in the assessment of neurologic dysfunction of the urethra.


Intraocular lenses: complications, complication factors, and adverse conditions in lens implantation surgery. During the surgical act of lens implantation a fairly large number of minor and major complications are a result of inexperience of the surgeon. Some of them are due to ill-advised attempts to insert lenses in difficult cases. Most complications can be prevented by following a number of basic surgical rules for lens implantation.


Retinal accidents in pseudophakia--intracapsular vs extracapsular surgery. A follow-up of 120 pseudophakic eyes of 85 patients that underwent surgery for senile cataract showed a definite superiority of extracapsular surgery over intracapsular surgery as far as the longterm fate of the retina concerns. Comparable series have been chosen. Retinal detachment did not occur in extracapsular eyes that never had posterior capsulotomy, and occurred most often after intracapsular surgery. Signs of previous or existing maculopathy were searched for with the usual tests (funduscopy, visual acuity, Amsler test) and moreover with Haidinger's brushes test. The macula turned out to have least suffered after extracapsular surgery without capsulotomy and most after intracapsular surgery. Haidinger's brushes test is a valuable tool for the detection of postoperative macular edema.


Late hyphema due to wound vascularization. In 1972 I reported that focal deep vascularization of the stromal wound may lead to hyphema months or years after cataract surgery. It results from ingrowth of episcleral vessels which terminate in capillaries at the inner edge of the incision site. Blurred vision occurring spontaneously or following minimal trauma, or physical strain is the primary symptom. Minimal episodes of bleeding are easily overlooked or mistaken for iridocyclitis. Gonioscopy usually reveals a small clump of vessels or the actual bleeding site. The trauma of the gonioscopy may precipitate bleeding.


Cataract extraction by the intracapsular methods and by phacoemulsification: the results of surgeons in training. The results of 63 phacoemulsifications performed by 14 resident ophthalmologists (surgeons in training) were compared to their first 112 intracapsular cataract procedures. Although the number of complications was greater in the eyes undergoing intracapsular operations, the final visual acuities obtained by either procedurewere similar: visual acuities in the range of 20/20 to 20/30 were found in 80.7% of intracapsular cataract operations and in 83.3% of phacoemulsification procedures. Visual acuities of 20/50 or better were found in 90.3% of intracapsular cataract extractions andin 88.8% of phacoemulsification procedures. Cylindric correction of higher power was required to correct astigmatism associated with intracapsular cataract surgery as compared to phacoemulsification. The results of irrigation-aspiration of soft or traumatic cataracts performed in 20 eyes with needle and syringe were compared to results of 19 eyes operated on by use of the Cavitron-Kelman irrigation-aspiration handpiece. The incidence of postoperative secondary membrane requiring discussion was similar for both procedures. The basis for setting up a successful program for resident training in phacoemulsification is discussed.


New dimensions in ocular pharmacology 1975. Progress is painful. This is certainly true in drug therapy. No drug in clinical use is devoid of toxicity, and all ophthalmologists are aware that no human being should be exposed to needless risk. On the other hand, the potential harm done to present and future generations by lack of adequate therapy for many diseases makes it imperative that new drugs, despite their associated hazards,continue to be introduced into research and practice. If an ophthalmologist accepts these thoughts, he also must accept a commitment to understand the effect of drugs in disease, the predisposing factors leading to drug reactions and interactions, the effect of disease on drugs, before he uses them.


[Extracorporeal fixation of liver slices onto the system of "artificial kidney" apparatus]. On 36 experimental dogs a new dialyser "liver-kidney" was tested, in which along with the process of dialysis some functions of the liver were carried out on account of placing in the apparatus homologous liver slices 2-3 mm thick. The data of biochemical studies of animals blood have evidenced satisfactory results. The dialyser with heteroliver slices assisted in two patients with hepato-renal failure. One of them made a good recovery and was discharged from the clinic, a favourable immediate result was obtained in the second patient.


[Changes of certain indicators of gas exchange and hemodynamics under conditions of long-term peridural anesthesia after lung resection]. A continuous peridural anesthesia after pulmonary resection was conducted in 200 patients aged from 3 to 72 years. The anesthesia would contribute to a prompt normalization of ventilatory indices and acid-base balance in early terms, it also improves hemodynamics. This method of postoperative anesthesia enabled the authors to reduce the number of tracheobronchial obturations in the surgical department from 8.4% to 5.1%.


[Selection of surgical method in aortic coarctation]. An experience with 64 operations for aortic coarctation is summarized. The author suggests some simple mathematical calculations allowing in each particular case a selection of an optimum variant of surgical intervention. The main task is to restore a normal diameter of the aorta. Of 64 operated subjects 2 patients died, both of them were operated upon in later terms.


[Postoperative chondritis and osteomyelitis of the ribs and sternum]. Postoperative chondritis and osteomyelitis of the ribs and sternum were observed in 90 of 4620 operated patients. The main causes contributing to the development of this complication are errors in treatment of cartilages during thoracotomy and suppurative complications in the pleural cavity or in the operative wound. A radical removal of the affected costal and sternal portions as early as possible is considered to be the method of choice in treatment of chondirtis and osteomyelitis of the ribs and sternum.


[Comparative characteristics of the methods of management of the pleural cavity in nonspecific empyema]. The author failed to reveal some essential advantages of any of five methods employed for sanation of the pleural cavity in empyema. The method of active aspiration and irrigation of the cavity with antiseptic and antibiotic solutions is felt to be mostly rational.


[Tracheobronchography in patients with pleuro-pulmonary complications after lung resection]. Tracheobronchography was performed in 79 patients with different bronchopleural complications after lung resection. In 38 of 42 patients with pleural empyema the presence of bronchial or bronchiolar fistula was found, residual pleural or pleuropulmonary cavities were noted in 24 patients, recurrent tuberculosis or bronchiectases--in 13. The results obtained in contrast investigation of the tracheobronchial tree allowed a proper selection of the method of treatment for different complications, a determination of the extent of a reoperation and prevention of recurrent complications following the repeat surgery.


[Aftereffects of long-term stay of foreign bodies in the bronchi]. The author have observed 132 patients with foreign bodies in the bronchi. In 32 of them foreign bodies have been staying in the bronchi for 1 day and longer (up to 24 years). Pathological changes in the lung due to the presence of foreign bodies in the bronchi and the rational therapy are described.


[Multiple peptic ulcers complicated by perforation and profuse hemorrhage]. Among 65 patients with ulcer perforation in the abdominal cavity and profuse gastroduodenal hemorrhage in 11 patients (16.9%) multiple and complicated ulcers were observed. In 4 patients multiple ulcers with perforation and hemorrhage were revealed during the operative procedure, in 2--only in reoperation and in 5--at autopsy. Of 11 subjects under observation 7 patients died. After an early extensive resection 4 patients made a recovery.


[Surgical treatment of post-thrombophlebitic syndrome]. Under observation were 125 patients with postthrombophlebitic syndrome of the lower extremities. Along with the routine surgical methods of treatment the authors suggested and performed in 30 patients a new operative procedure--communicotomy, that consists in separation of the superficial and profound venous systems in the lower crural third via a separate incision in the upper crural third. To this end a new instrument--a communicotome was devised. Indications to some or other kind of surgery were elaborated by the authors. 76% of patients showed an improvement within the terms from 1 to 6 years postoperatively.


[Method of compression arthrodesis of the ankle and foot joints]. A modified F.R. Bogdanov arthrodesis of the talocrural joint is described. The authors employed an external compression with three Kirschner pins, inserted in the tibial, calcanial and scaphoid bones. Late results of the operation were followed up in 20 patients. A complete correction, osteoankylosis of arthrodesized joints and rehabilitation of the weight-bearing function of the foot and extremity, as a whole, were gained in all patients.


[Possibilities of prevention of posttraumatic fat embolism]. Hypocoagulation induced artificially with anticoagulants of an indirect action in patients, subjected to osteotomy of the femoral bone, resulted in diminishing of the intensity of fat globulemia and a decrease in the average size of fat globules, thus lessening the risk of fat embolism.


[Certain characteristics of surgical treatment of fractures of the lateral segment of the pelvic ring]. The author reports the results of surgical therapy for fractures of the lateral pelvic arch in 19 patients. The technic of metallic osteosynthesis is described. In 17 patients good and satisfactory issues were gained. In 2 cases the displacement of fragments failed to be eliminated in late terms of the operation, and functional results proved to be poor.


[Acute appendicitis in young children].

[Acute appendicitis in young children]. Ninety two children aged up to 3 years and operated upon for acute appendicitis were observed. The clinical picture of appendicitis is described, and some diagnostic difficulties are noted. The mortality due to appendicitis in this group of patients was 15.2%.


The unified concept of shock.

The unified concept of shock. In summary, the shock syndrome has a variety of causes although the same net physiologic insult results. The disease is a deficiency in tissue metabolism brought about by decreased capillary blood flow and cellular hypoxia. The therapeutic regimen employed in any given patient is dectated by the initial cause of shock as well as the physiologic changes that have occurred in the patient. Fluid and electrolyte therapy is the primary method of treatment. Modification of solutions and use of additional drugs may be indicated.


Veterinary information: the current situation and future trends. Veterinary science is well supplied with abstracting and indexing hournals. Both experience and an investigation undertaken for the Food and Agriculture Organisation indicate that they are comprehensive in scope and subject coverage. Computer operation of information services is now routine, and mechanised alerting and retrospective services are available. A veterinary round table was set up in 1973 by the Commission of the European Communities to attempt to improve veterinary information. The round table is conducting a detailed study of the value of the available machine information systems to veterinarians and is compiling a multi-lingual thesaurus. In addition, it is investigating the need for a new review journal, methods of recording animal disease incidence and variations in the needs of the different types of veterinarians for information. The use of machine information systems is expected to become more widespread in the near future. Many will be available on-line, a method of working which offers great advantages in speed and flexibility of operation.


The prevalence of Gasterophilus intestinalis and G nasalis in horses in Ireland. During the months October-May inclusive 90-8% of horses slaughtered at an abattoir near Dublin and 66-9% of those at an abattoir near Belfast were infected with Gasterophilus intestinalis; 28-6% of horses at the former abattoir harboured G nasalis while none of the horses examined at the latter abattoir was found to be infected with this species.


Chronic renal failure in dogs: a comparative clinical and morphological study of chronic glomerulonephritis and chronic interstitial nephritis. Chronic renal disease is an important clinical problem in dogs. Until recently, diffuse renal fibrosis with chronic renal failure has been attributed mainly to chronic interstitial nephritis, itself considered to be the end stage of acute leptospiral nephritis. A clinical and morphological analysis of eight cases of chronic glomerulonephritis is described and a comparison made with eight dogs suffering from severe chronic interstitial nephritis. Clinically and biochemically, the two diseases were virtually indistinguishable, both resulting in uraemia. A possible distinguishing feature of chronic interstitial nephritis was the anaemia which was absent from chronic glomerulonephritis cases. Morphologically, the two diseases appeared to be distinguishable on three grounds; the pattern and severity of fibrosis, the degree of fibrin deposition and the immunofluorescence findings.


Ectopic ureter in the bitch.

Ectopic ureter in the bitch. Ectopic ureter in the dog is only sporadically reported.  A case in an adult golden retriever is described.


Observations on Isospora suis infection in a minimal disease pig herd. Faeces samples from 11 sows and their litters and intestinal contents and scrapings collected from 56 piglets at the time of slaughter were examined for Isospora suis. The findings indicate that oocysts with sporoblasts can be found in faeces samples 24 hours after collection; the prepatent period is about six to nine days and the patent period three to eight days (adjudged under non-experimental conditions); piglets in an infected herd are normally resistant to natural infection for the first three weeks of life. Infection is followed by the development of an active immunity which is not affected by the stress of farrowing.


[Angioscanning in the diagnosis of tumors of the soft tissues of the extremities]. The results of radioisotope scanning in 70 patients with tumors and nontumor lesions of soft tissues of the extremities are presented. It was found that angioscanning with macroalbumin-iodine-131 (MAA-J-131) allows visualization of malignant tumors of soft tissues.


[External respiration in radiation treatment of patients with breast cancer]. The data on the ventilatory status in 119 patients subjected to combined therapy are reported. Roentgenodynamic investigation of the ventilation indicated changes in the mechanism of the latter on account of a limitation of the ventilatory function of muscle realizing inhalation. Ventilatory disturbances induced by irradiation of the chest are accompanied with functional compensation. Normal gas metabolism is provided by hyperfunction of the lung and respiratory muscles on the intact side.


[Diagnostic laparotomy in patients with lymphogranulomatosis]. The authors' experience with 80 diagnostic laparotomies with the removal of the spleen, performed in patients showing lymphogranulomatosis, is summarized. As a result of surgery in 40 patients the stage of the diseases was revised and therapeutic policy was altered, that is felt to warrant the risk of surgical intervention.


[Differentiation of tumors of the anterior wall of the stomach from neighboring intact areas by the method of multichannel gastrography]. By means of simultaneous multichannel recording of stomach biopotentials from the surface of the anterial abdominal wall, an active electrode being situated above tumor, we are able to recognize the decreased electric activity of the anterior gastric wall area, involved by cancer process. Multichannel electrogastrography from the body surface makes it possible to determine the boundary between the tumor and adjacent intact areas of the anterior gastric wall clearly enough.


[Limits of the spread of cancer of the rectum (morphological study)]. Fifty five postoperative preparations were studied morphologically after radical surgery for rectal cancer. The distal intramural spread of adenocarcinoma was noted in 18.5 per cent. Orthograde lymphnodes were involved in 43.1%, retrograde ones - in 18%. The tumor growth in perirectal cellular tissue was manifested mainly in the area of the principal tumor. The safe level of rectum cutting is 4.5cm down the tumor. It is recommended to take into a careful consideration the limits of intra- and extramural spread of tumor for the performance of sphincter-preserving operations.


[Mitotic cycle in cell cultures infected with oncogenic type-12 adenoviruses]. Oncogenic adenovirus of type 12 in the culture of rat embryo fibroblasts, in which it induces an abortive infection, and in HEp-2 culture, whereas it shows reproduction and causes lytic infection, in the early stationary phase causes shortening of the mitotic cycle and its separate periods. Reduction of the mitotic cycle duration occurs on account of shortening of the presynthetic stage and DNA synthesis stage. This property of the virus is in agreement with its capacity to stimulate proliferation of infected cells and is likely to be one of the necessary conditions for development of malignant transformation.


[Acetylation reaction in mice in the normal state and in tumors]. Studies of peculiarities of acetylation with the use of sulfadimidine showed the distribution of female white non-bred mice into two groups - with high and low activity. In C3H/He mice a relatively high activity of sulfadimidine acetylation was observed, while in C57BL/He mice a low activity of acetylation was noted. The growth of transplanted melanoma B-16 in C57BL/He mice and sarcoma 37 and sarcoma 180 in non-bred mice resulted in an increased activity of sulfadimidine acetylation. The use of w-sodium methylpantothenate (an antagonist of pantothenic acid) failed to show an increased activity of sulfadimidine acetylation and inhibited the tumor growth.


[Mechanism of the induction of asbestos mesotheliomas in the pleura of rats]. The first group of non-bred rats was injected intrapleurally 20 mg of benzene extracted chrysotil-asbestos dust in saline; the second group of rats was injected 20 mg of the same dust but with benz(a)pyrene absorbed on it (0.4 mg). Pleural mesotheliomas were observed in 48.57% of cases in the first group and in 41.37% of cases in the second one. The difference was not significant. There was no difference in the percentage of premesotheliomatous lesions. But, in the second group tumors of other organs were found. The role of asbestos pollution by carcinogenic hydrocarbons in the genesis of lung cancer and pleural mesothelioma is discussed.


[Influence of diazan on the mitotic cycle of leukemia L1210 cells]. By means of a autoradiographic method the effect of diazane - a new antitumor substance from the diasoketones class, on the mitotic cycle of leucimia L 1210 has been studied. Diazane in single administration was found to inhibit the development of leucemic process during 2 days. This substance reduces considerably the DNA synthesis intensity in cells, due to that the mitotic activity of cells is markedly reduced. It was demonstrated that diazane during 8 hours blocked the transfer of cells from a presynthetic stage into the DNA synthesis phase. But this substance does not influence the transfer of cells from the premitotic period into mitosis. The substance delayes continuously (during 36 hours) the division of cells being in a phase of the DNA synthesis during its injection. In later terms although multiplication of these cells would be restored, but its intensity is decreased.


[Distribution of ftorafur in the organism of experimental animals]. Intravenous injection of phtoafur in experimental animals induced the appearance of the biologically active substance in the organism. The concentration of the active substance in blood and organs, reaching its maximum during the first hour, was retained for a long time: an appreciable fall in the substance levels was noted only 12 hours following its injection. In blood and organs of animals with a sensitive tumor levels of the active substance are considerably lower than in intact animals. This seems to condition the therapeutic effect of the drug.


[Survival of patients with inoperable stomach cancer treated with 5-fluorouracil]. Late results of treatment in 71 patients are analysed. The survival during 2 years following tentative laparotomy in 35 patients, treated with 5-fluoruracil with a clinical effect (objective and symptomatic improvement), was reliably higher than the survival of patients treated without any effect. The comparable groups of patients did not differ in the extent of tumor spread, however, in patients treated with the effect the time elapsed since tentative laparotomy up to the initiation of chemotherapy was reliably longer than in those treated without any effect. It is assumed that the duration of this period is an indirect index reflecting the rate of tumor growth in different patients. With this in mind, it is suggested that the longer survival of patients, treated with 5-fluoruracil with the effect, may be related with a more favourable course ofthe tumor process in these patients, as compared with those treated without any effect.


[Experience in the diagnosis and treatment of cancer of the rectum]. The results of diagnosis and treatment of rectal cancer in 92 patients are analysed. Four clinical forms of rectal cancer were differentiated: with predominant local signs, with predominant general symptoms, with an asymptomatic course and with signs of functional disorders in pelvic organs. In these cases dyselectrolitemia, manifested in hyponatriemia, hypokaliemia and hypochloremia, was noted. According to phase analysis data of the cardiac activity in these patients the myocardial contractility is diminished. Abdomino-anal resection of the obturatory apparatus of the sigmoid is felt to be the operation of choice in rectal cancer, if permitted by tumor localization, its size and anatomical features of the sigmoid.


[Cancer of the rectum (according to data of the Rovno District Oncological Dispensary)]. The results of diagnosis and treatment of 255 patients with rectal cancer, treated in Rovno Province dispensary since 1950 to 1974, are analysed. A 5-year survival made nearly 50% and was dependent on the stage of the disease.


[Experience in the treatment of early forms of cancer of the cervix uteri]. The results of treatment of 378 patients with early forms of cervical cancer are presented. In 185 patients with intraepithelial cancer electroexcision and common extirpation of the uterus was employed, and in 193 patients with early invasive cancer different therapy was used: surgical (routine and extensive hysterectomy), combined and associated radiotherapy. The terms of observation for 3, 5 and 10 years indicated a cure in 97.1% of patients with intraepithelial cancer and in 98.4% of patients with early invasive cancer of the uterine cervix.


[Endolymphatic infusions in oncological patients]. Utilization of endolymphatic infusions against the background of the impaired barrier function of lymph nodes is inherent in a higher rate of tumor metastasization. The hazard increases in cases when tumore cells in the lymph system (especially in the thoracic duct) are in a free state, and substances dilating lymph vessels are employed. Therefore, endolymphatic infusions should be accomplished taking into account all the factors that could lower either directly or indirectly the barrier function of the lymphatic system.


[Role of genealogical studies for the prevention of malignant neoplasms]. Based on clinico-genealogical studies of 219 cancer patients, whose relatives suffered neoplastic processes, it was concluded that a hereditory factor plays a definite role in cancer morbidity. It seems to be rational to single out the relatives of the proband as a high-risk group in malignant tumor morbidity and to keep them under a dispensary control.


[Problem of classifying malignant lymphomas]. The classification of malignant lymphomas (ML) after Rappaport is characterized by precise criteria and contributes to a mutual understanding of morphologists and clinicians. The detection of a nonspecific esterase activity facilitates the identification of ML cell elements, since the enzyme activity is insignificant in lymphocytes and intensive in histiocytes. Moreover, the method facilitates to diagnose nodular forms of ML since it aids in revealing the compression of lymph node stroma with tumor foci.


[Prospects for sanatorium-health resort treatment of oncological patients]. The current opinion that oncological patients subjected to radical treatment are not allowed to be directed to sanatoriums and resorts should be revised. It is necessary to plan joint investigations of oncologists and specialists or resort cure to determine exactly indications and contraindications to subsequent cure of such patients under sanatorium conditions in early terms after cessation of radical therapy. Patients, previously treated for malignant tumors and showing no signs of recurrence or metastases, may be directed to appropriate sanatoriums for treatment of concomitant lesions, but without applying mudtherapy, ultraviolet irradiation and general heat procedures.


[Role of the hypothalamus in the formation of antitumor resistance]. The development of Brown-Pearce tumor in rabbits is accompanied with regular changes in the functional activity of the hypothalamic zone, related close enough with the regulation of adrenal cortex functions and immunological processes. In electrostimulation of the posterior hypothalamus median zones an accelerated resorption of the tumor, inoculated subcutaneously, was noted. The destruction of the posteromedian hypothalamic structures resulted in a sharp fall of corticosteroids level in the organism and a decreased intensity of generally persistant immunity to repeat inoculations of Brown-Pearce tumor. Thus, the fact of the immunocompetent system being ready to realize protective reactions for preservation of the genetic constancy of the organism is conditioned by the hypothalamo-hypophyseal-adrenal system functional activity.


[Transcortin binding capacity in the blood plasma of rats with a growing sarcoma 45]. It was shown that at the 10th day of sarcoma 45 growth the content of transcortine bound and free 11-oxycorticosteroids (11-OCS) in plasma of rat peripheral blood was increased. At the 30th day of the tumor growth the content of total and protein bound 11-OCS was decreased, accordingly by 57 and 61%. Following single hydrocortisone injections in intact rats and rats with sarcoma 45, on the 10th day of its growth, a marked increase in the content of bound 11-OCS was noted, as compared with animals receiving saline solution. On the 20-30th day of the tumor growth such effect was not observed. On the 20-30th day of sarcoma 45 growth 8-9% of the value of exogenic hydrocortisone, bound to blood plasma transcortins in intact rats, were found to be tracortin bound.


Storage of human platelets by freezing.

Storage of human platelets by freezing. Prolonged, probably indefinite storage of viable and functional human platelets is now possible by freezing with dimethylsulfoxide (DMSO). These platelets have a nearly normal survival upon reinfusion and are capable of sustained hemostatic effectiveness in thrombocytopenic patients. Adaptation of the freezing technique for large-scale usage has more recently been achieved. The method is mainly based on the following principles: (1) use of plasma for suspension of the platelet concentrate; (2) gradual addition (0.5% every 2 min) of DMSO to a final concentration of 5% and its gradual removal; (3) a slow cooling rate of about 1 degree C per min and rapid thawing (in 1 min); (4) use of a polyolefin plastic bag for freezing; (5) a washing medium of 20% plasma in Hanks' balanced salt solution; (6) final resuspension of the platelets in 50% plasma in Hanks' solution.


Direct observation of immunoglobulins on the erythrocyte membrane. A modification of the sublimation procedure for observation of cell membrane exteriors is described. By retaining basic advantages of the freeze-fracture technique, without actual fracturing of the sample, high quality replicas can be produced on which molecules such as immunoglobulins can be identified and mapped on extensive areas of the erythrocyte membrane surfaces. The method can be used for direct observation of antibodies without recourse to labelling with other marker molecules, such as for example ferritin. In addition, direct visualization of clumping of red cells, as induced by such antibodies, is feasible.


Characterisation of autoantibodies to erythrocytes in autoimmune haemolytic anaemia by chloroquine. Chloroquine splits autoantibodies from erythrocytes of patients with autoimmune haemolytic anaemia in vitro. After the removal of chloroquine from the samples the autoantibodies can be identified in the eluates. With one exception the autoantibodies of patients with idiopathic autoimmune haemolytic anaemia (AIHA) and severe haemolysis were completely split from the cells, whereas the autoantibodies of patients with symptomatic AIHA and moderate anaemia, of patients with diseases unrelated to haemolysis, and of healthy persons, were not completely split from the erythrocytes. In general, autoantibodies, which are associated with severe haemolysis, were more easily split from the red cells by chloroquine. The eluted IgG incomplete warm autoantibodies were only in part specific to Rh antigens. The Rh specificity does not correlate with the absence of presence of increased haemolysis. The inhibition of the autoantibodies and the splitting or 'loosening' of the antigen-antibody linkage with the immunocomplex by chloroquine could be responsible of a longer survival of autoantibody-coated red cells in patients with AIHA.


Percutaneous radiofrequency trigeminal gangliolysis in the treatment of tic douloureux. The treatment of tic douloureux was dramatically altered in 1962 with the demonstration that carbamazepine (Tegretol(R)) alone or in combination with diphenylhydantoin sodium (Dilantin(R)) was effective in controlling the painful paroxysms. However, 30 percent of the patients so treated have not been successfully managed and some type of surgical therapy is required to control their pain. A wide variety of surgical alternatives are available but they all trade a sensory deficit for pain relief and have a significant risk of morbidity and mortality. Experience with percutaneous radiofrequency trigeminal gangliolysis has indicated that this new technique is capable of producing lasting relief of tic douloureux in as many as 95 percent of the patients. To date there have been no deaths from this procedure and a very low incidence of minor complications. It achieves this high success rate at the expense of only partial sensory deficits restricted to a circumscribed area of the face. No other surgical alternative carries such a high long-term success rate with a low complication rate. We believe that percutaneous radiofrequency trigeminal gangliolysis has become the surgical treatment of choice for tic douloureux.


Airborne bacterial contamination of operative wounds. Both the numbers and species of airborne bacteria were studied during 263 surgical procedures. The numbers of bacteria isolated were reduced by 95 percent in a horizontal laminar flow room compared with a conventional room and a further 4 percent reduction occurred when a suction-mask system was used. The species of bacteria isolated differed notably at the operative site where a slit sampler was used, as compared with the instrument table and the periphery of the room where settling plates were used. Studies done during simulated surgical operation suggested that light fixtures, pass-through doors, floor contamination and the draped patient were not important sources of airborne contamination in this horizontal laminar flow system. The exact role of airborne bacterial contamination of operative wounds in the development of clinical wound infections is still unknown. Therefore, installation of laminar flow systems must be considered unnecessary at this time.


Prenatal diagnosis and genetic counseling. Since the early 1960's knowledge regarding human genetics has increased at an exponential rate. Because genetics was not commonly taught in medical schools before the late 1960's, this review article is intended to acquaint physicians or refresh their knowledge regarding chromosomal, mendelian and multifactorial inheritance and the indications for prenatal diagnosis. Establishing an accurate diagnosis and mode of inheritance is essential in identifying and selecting those families at risk for genetic disease in their offspring. Medical genetics is evolving as a specialty in order to provide consultation and, if needed, management of those families who would benefit by genetic services. Families who would benefit from genetic counseling include, for example, those in whom any of the following conditions is present: known chromosomal disorders, known disorders due to mendelian inheritance, mental retardation of unknown origin, failure of sexual maturation or failure of sexual development, congenital malformations, floppy infant syndrome or leukemia.A list of more than 70 disorders now detectable in a fetus by means of amniocentesis provides a beginning in the prevention of genetic disease. Knowledge regarding these diseases allows a physician to provide families with accurate risk figures so that they may make informed decisions about having children. Also, a compassionate and nonjudgmental approach to counseling is essential. Decisions, in the final analysis, must be made by the family but aided and supported by the physician.


Excretion of phenol red and its glucuronide in the dogfish shark. 1. The biliary and urinary excretion of phenol red and its glucuronide was measured in dogfish sharks, Squalus acanthias, in both intact animals and animals with biliary fistula. 2. Phenol red is extensively metabolized to its glucuronide by the dogfish shark and both forms of the compound are actively transported into bile and urine. 3. Both compounds are transferred from plasma to urine and bile against a large concentration gradient; the transfer process is saturable most easily in the renal compartment but also in the hepatic compartment; and both excretion routes for the free drug and the glucuronide are inhibited by probenecid. 4. There were no significant differences in the 48 h biliary excretion of total (free + glucuronide) phenol red, but the urine or intact fish contained two-fold more total drug than did animals with fistulae.


Metabolism of 14C-DDT in the mouse and hamster. 1. When 1,1-bis(p-chloro(14C)phenyl)-2,2,2,-trichloroethane (DDT) was fed to CF-1 mice and Syrian golden hamsters, conjugates of bis(p-chlorophenyl)-acetic acid (DDA) were the major urinary metabolites. As well as DDA-glycine, DDA-alanine and DDA-glucuronic acid previously identified, a new conjugate with serine is reported. 2. Small amounts of non-polar metabolites were detected in urine. Mouse urine contained DDE, whereas this was never detected in hamster urine. The relevance of this finding to the tumorigenicity of DDT in mice, compared with its inactivity in this respect in hamsters, is discussed.


Effects of insecticide synergists on microsomal oxidation of estradiol and ethynylestradiol and on microsomal drug metabolism. 1. Oxidation of estradiol and ethynylestradiol at ring A and ring B by rat liver microsomes and NADPH-regenerating system in vitro is inhibited by the two arylimidazole insecticide synergists, 3-bromophenyl-4(5)-imidazole and 1-naphthyl-4(5)-imidazole, but not by the benzothiadiazole insectide synergists 6-nitro-1,2,3-benzothiadiazole and 5,6-dimethyl-1,2,3-benzothiadiazole. The Ki of the most potent inhibitor, 1-naphthyl-4(5)-imidazole, was 3 X 10(-6) M. 2. 6-Nitro-1,2,3-benzothiadiazole (10(-6) M), which did not inhibit hydroxylation of the estrogens, inhibited oxidation of aniline and demethylation of ethylmorphine, p-nitroanisole, and aminopyrine by 30-70%. 5,6-Dimethyl-1,2,3-benzothiadiazole inhibited only demethylation of p-nitroanisole and aminopyrine. From these results the presence of different hepatic microsomal mixed function oxidases may be inferred. 3. 1-Naphthyl-4(5)-imidazole, the most potent inhibitor of hydroxylation of drugs and estrogen rings A and B, also inhibited microsomal estrogen-16alpha-hydroxylation. 4. These data show that insecticide synergists may effect the breakdown of estrogenic hormones in the organism.


Metabolism of etidocaine in man.

Metabolism of etidocaine in man. 1. Etidocaine and eight metabolites excreted in urine of man have been detected by g.l.c. and investigated by g.l.c.-mass spectrometry. 2. Five metabolites have been identified by comparison with authentic compounds as 2-amino-2'-butyroxylidide, 2-N-ethylamino-2'-butyroxylidide, 2-N-propylamino-2'-butyroxylidide, 2.6-dimethylaniline and 4-hydroxy-2,6-dimethylaniline. 3. The structure of one of the remaining three metabolites is proposed to be 2-methyl-N3-(2,6-dimethylphenyl)-5-ethyl-4-imidazolidinone. 4. The amounts of etidocaine and seven of its metabolites excreted in a 48 h urine following epidural administration to a patient have been estimated. Approx. 31% of the dose was accounted for.


Reaction pathways of in vivo stereoselective conversion of ethylbenzene to (-)-mandelic acid. 1. Mandelic acid formed in vivo from ethylbenzene as well as from various oxidation intermediates was laevo mandelic acid and was of surprisingly high optical purity. 2. Reaction sequences are proposed for the stepwise oxidation of ethylbenzene to mandelic acid. 3. Although the initial hydroxylation of ethylbenzene to methylphenyl-carbinol is stereoselective, the optical activity of mandelic acid is not established at this point since the optical centre is destroyed in the second step, dehydrogenation to acetopheneone. 4. Acetophenone appears to be a precursor of not only mandelic acid and benzoylformic acid but benzoic acid as well. 5. The route from acetophenone involves conversion to omega-hydroxyacetophenone and subsequent reduction to glycol and/or oxidation to phenylglyoxal. 6. The configuration of mandelic acid is determined either during reduction of hydroxyacetophenone or reduction of phenylglyoxal.


Bile and urine as complementary pathways for the excretion of foreign organic compounds. 1. The urinary and biliary excretion in the rat of 30 aromatic compounds with mol. wt. of 100-850, and largely excreted unchanged, has been studied. 2. These compounds fall into three groups as regards their pattern of elimination, which is related to mol. wt: group 1, with mol. wt. less than 350 and the major route of elimination the urine. When urinary excretion is prevented by ligating the renal pedicles the biliary excretion remains low. group 2, with mol, wt. of 450-850 which are excreted predominantly in bile. Even when the bile duct is obstructed, only small amounts of these compounds are found in urine. group 3, with mol. wt. of 350-450, which are eliminated extensively in both urine and bile. When one of these routes is blocked excretion by the other increases. 3. These studies emphasize the interrelationship of urine and bile as excretory routes for organic compounds. Urine and bile are complementary pathways; the extent of urinary excretion is greatest for the compounds of lowest mol. wt. and tends to decrease as mol. wt. increases and biliary excretion becomes more extensive.


Comparative metabolic study of nimetazepam and its desmethyl derivative (nitrazepam) in dogs. 1. Blood levels of nimetazepam after oral administration to dogs were relatively low at early periods after dosage and reached peak levels (7-7-7-9 mug equiv./ml) after 8 h. The time course of blood levels was similar after oral administration of its desmethyl derivative (nitrazepam) to dogs. Blood levels of the latter, however, were low compared with nimetazepam and reached a peak (5-2-6-3 mug equiv./ml) after 4 h. 2. Recoveries of nimetazepam in urine and faeces were 46 and 52% of the dose for 0-24 h, 27 and 34% for 24-48 h and 4 and 6% for 48-72 h, while those of its desmethyl derivative (nitrazepam) were 63 and 71% for 0-24 h, 12 and 21% for 24-48 h and 2 and 3% for 48-72 h. 3. At least four kinds of reaction were involved in the biotransformation of nimetazepam and its desmethyl derivative (nitrazepam): (i) demethylation at N-1 (ii) hydroxylation at C-3, (iii) subsequent glucuronic acid conjugation of 3-hydroxy derivatives and (iv) reduction of the nitro group at C-7 to an amino group. Reaction (i) proceeded very rapidly in dogs, so that the blood metabolites of nimetazepam were closely similar to those of nitrazepam. For both drugs, the major blood metabolite was nitrazepam. Reaction (ii) was rapidly followed by reaction (iii), and glucuronides were predominantly excreted in urine. Reaction (iv) as well as reaction (iii) are important in the excretion of both drugs. The subsequent acetylation of 7-amino group, however, did not occur in dogs as it did in mice and rats.


Urinary excretion of methaqualone-N-oxide in man. 1. Oral administration of therapeutic doses (250 mg) of methaqualone (Melsed) to adult human subjects gives rise to the urinary excretion of methaqualone-N-oxide. This metabolite has been identified by chromatography and mass spectrometry and quantitatively determined by reduction with titanium trichloride to methaqualone which was then determined by g.l.c. 2. The N-oxide accounts for 5-9% of the dose in 24 h. 3. 2-Nitrobenzo-o-toluidide, a possible oxidation product of methaqualone-N-oxide, has not been detected. 4. The urinary excretion of unchanged methaqualone is less than 0-3% of the dose. The ease with which methaqualone-N-oxide is thermally converted to methaqualone casts doubts on the previously published figures for the urinary excretion of methaqualone.


Urinary excretion of c-hydroxy derivatives of methaqualone in man. 1. Six monohydroxy metabolites of methaqualone have been identified by g.l.c.-mass spectrometry in the urine of healthy human subjects who received therapeutic doses (250 mg) of the drug (Melsed) daily for ten day. 2. The three major metabolites were 2-methyl-3-(2'-hydroxymethylphenyl)-4(3H)-quinazolinone, 2-methyl-3-(2'-methyl-3'-hydroxyphenyl)-4(3H)-quinazolinone and 2-methyl-3-(2'-methyl-4'-hydroxyphenyl)-4(3H)-quinazolinone. Three minor metabolites in descending order of importance were 2-hydroxymethyl-3-o-tolyl-4(3H)-quinazolinone, 2-methyl-6-hydroxy-3-o-tolyl-4(3H)-quinazolinone and 2-methyl-8-hydroxy-3-o-tolyl-4(3H)-quinazolinone. 3. The 8-hydroxy metabolite is identified as a urinary metabolite or methaqualone in humans for the first time.


Development of liver microsomal oxidations in the chick. 1. Liver microsomal preparations from chick embryos (1 day before hatching) and from 1-7 day old chicks were assayed for oxidative drug-metabolizing activity with aminopyrine, aniline and naphthalene as substrates. 2. Activities for all three substrates were highest in preparations from 1 day-old chicks. These were more than twice as active as the 7 day-old preparations and about three times as active as those from the embryos. 3. The increase in drug-metabolizing activities in newly-hatched chicks was the same for either sex and persisted for 3 days before declining towards the 7 day-old levels. 4. The developmental time-course fo the liver microsomal drug-metabolizing activities was independent of any factor in the 105 000 g supernatant fractions and of such microsomal parameters as cytochrome b5 and cytochrome P-450 content, and NADPH-cytochrome c reductase activity, but was related to changes in NADPH-cytochrome P-450 reductase levels. 5. Treatment of 7 day-old chicks with exogenous inducers, 3-methylcholanthrene or phenobarbital sodium (100 mg/kg, intraperitoneally) brought about maximal stimulation of microsomal activity as 18-24 h. The time-course of this induction was reflected by changes in microsomal cytochrome P-450 content and NADPH-cytochrome P=450 reductase activities. 6. Some induction of  liver microsomal drug metabolism in 7 day-old chicks could also be brought about by injecting certain lipid-soluble egg yolk extracts.


Metabolism of 3-(hydroxymethyl)-8-methoxychromone in the rat. I. Absorption, tissue distribution and excretion. 1. Two 14C-labelled preparations of 3-(hydroxymethyl)-8-methoxychromone were used to study the absorption, tissue distribution and excretion of isotope after oral administration to rats (20 mg/kg). 2. 14C, presumably from the labelled hydroxymethyl side-chain, was eliminated extensively as 14CO2. This excretion was triphasic; kinetic constants were calculated for each phase. 3. The major excretion route was via the kidney although significant quantities of isotope were excreted with the faeces. Isotope did not accumulate in tissues.


Metabolism of 3-(hydroxymethyl)-8-methoxychromone in the rat. II. Classification and identification of urinary drug metabolites. 1. Five metabolites were isolated from the urine of dogs dosed with 3-(hydroxymethyl)-8-methoxy[4-14C]chromone. These were identified as 8-methoxychromone, 2-hydroxy-3-methoxyacetophenone, 3-(hydroxymethyl)-8-hydroxychromone, 8-hydroxychromone and 2,3-dihydroxyacetophenone. 2. These compounds were also present in the urine of rats treated with labelled drug, together with unchanged drug and two intermediate metabolites, 3-carboxy-8-methoxychromone and 3-(carboxymethyl)-8-hydroxychromone. 3. In addition to the unconjugated labelled compounds, glucuronides and sulphates were identified. 4. Quantitative data were obtained for all of the 20 labelled compounds in rat urine. 5. A scheme is presented for the biotransformation of 3-(hydroxymethyl)-8-methoxychromone in rats and dogs, and a mechanism for scission of the gamma-pyrone ring is suggested.


Metabolism of alkenebenzene derivatives in the rat. II. Eugenol and isoeugenol methyl ethers. 1. The metabolites of 3,4-dimethoxyallylbenzene (eugenol methyl ether) and 3,4-dimethoxypropenylbenzene (isoeugenol methyl ether) in the rat were identified and quantitatively determined by g.l.c. and g.l.c.-mass spectrometry. 2. The major metabolic reactions of 3,4-dimethoxyallylbenzene were oxidation of the allylic side chain to 2-hydroxy-3-(3,4-dimethoxyphenyl)-propionic acid, 3,4-dimethoxybenzoic acid and 3,4-dimethoxycinnamic acid, the two latter being largely excreted as their glycine conjugates. The formation of the hydroxy acid presumably involved epoxidation of the double bond and subsequent hydration to the diol whereas the formation of 3,4-dimethoxycinnamic acid and 3,4-dimethoxybenzoic acid involved migration of the double bond and the formation of cinnamoyl intermediates. Other reactions were O-demethylation to 4-hydroxy-3-methoxyallylbenzene (eugenol) and 3-hydroxy-4-methoxyallylbenzene in equal amounts, oxidation to 1-(3,4-dimethoxyphenyl)-2-propen-1-ol, hydroxylation of the benzene ring to a hydroxy-3,4-dimethoxyallylbenzene and oxidation to 3,4-dimethoxyphenylacetic acid. The formation of 1-(3,4-dihydroxyphenyl)propane was found to be carried out by the rat intestinal micro-organisms. A total of at least 63% but as much as 95% dose was accounted for. 3. The major metabolic pathway of 3,4-dimethoxypropenylbenzene was via the cinnamoyl derivatives, leading to the formation of 4-hydroxy-3-methoxycinnamic acid (ferulic acid), 3,4-dimethoxycinnamic acid and 3,4-dimethoxybenzoic acid, the two latter being excreted largely as their glycine conjugates. Other reactions were O-demethylation to 4-hydroxy-3-methoxypropenylbenzene (isoeugenol) and 3-hydroxy-4-methoxypropenylbenzene in equal amounts, and oxidation to 3,4-dimethoxyphenylacetic acid and 4-hydroxy-3-methoxyphenylacetone. Epoxidation of the side chain appeared to be a minor metabolic reaction with the propenyl derivative. 4. The biliary metabolites of 3,4-dimethoxyallylbenzene and 3,4-dimethoxypropenylbenzene were identified and most of the urinary metabolites were also found in the bile.


The effect of prolonged administration of allylisopropylacetylurea to rats on cytochrome P-450 and other liver haemoproteins. 1. The effect of long-term administration, including recovery, of allylisopropylacetylurea to rats was investigated. 2. In the liver, cytochromes P-450, b5, catalase and 5-aminolaevulinic acid synthetase were measured. Serum glutamate-pyruvate, transaminase, glutamate-oxalacetate transaminase and alkaline phophatase were determined to assess cell damage, while urinary coproporphyrin and uroporphyrin were measured to assess the degree of porphyia. 3. In the liver the lowering of cytochrome P-450 and catalase was paralleled by an increase in 5-aminolaevulinate synthetase. Cytochrome b5 was only marginally affected. 4. Rats recover well from long-term treatment with high doses of allylisopropylacetylurea and revert to normal values for parameters measured. 5. A mechanism for the intracellular action of allylisopropylacetylurea on cytochrome P-450 and other haem-containing compounds is presented.


Stereospecific inversion of l-alpha-methylfluorene-2-acetic acid to its d-enantiomer in the dog. 1. After administration of dl-alpha-methylfluorene-2-acetic acid to dogs, the optical rotation of the drug in blood increased with time. Of the total drug in blood, the d-enantiomer increased from 61 to 80% between 3 and 24 h after administration; by 384 h it was 100%. 2. Both l- and d-enantiomers had plasma half-lives and excretion characteristics similar to those of the dl-racemic mixture, indicating that the increase in the proportion of the d-enantiomer was not due to more rapid excretion of the l-enantiomer. 3. Studies of optical rotation and circular dichroism demonstrated that the l-enantiomer was converted to the d-enantiomer in the blood of the dog, but the d-enantiomer remained unchanged. After administration of the l-enantiomer, the d-enantiomer increased from 26 to 71% of the total drug in blood between 0-3 and 2 days after administration; 14 days after dosing, almost all of the drug was present as the d-enantiomer. 4. Isomerization of l-alpha-methylfluorene-2-acetic acid to its d-enantiomer also occurs in rat, monkey and man.


Metabolism of a benzothiazine compound (SQ 11,579) by the intact rat, isolated perfused rat liver, and rat-liver microsomes. 1. The metabolic dispositions of a benzothiazine compound (SQ 11,579) by the intact rat, isolated perfused rat liver, and rat-liver microsomes have been investigated, and the results compared. 2. The drug was well absorbed after oral administration to rats and was widely distributed in all tissues, which, with the exception of brain, had higher concentrations of the drug, its metabolites, or both, than did plasma. 3. Metabolism by rat-liver microsomes included N-oxidation, N-demethylation, S-oxidation and aryl hydroxylation. Metabolites hydroxylated in the aromatic ring were excreted only in bile, both by the isolated perfused rat livers and by anaesthetized bile-duct-cannulated rats. 4. Liver perfusion of the benzothiazine or its monodesmethyl analogue (V) resulted in temporary cessation of the flow of perfusate through the organ. The benzothiazine sulphoxide (IV) had only a slight effect on the flow of liver perfusate, but IV followed by I caused the flow of perfusate to cease.


Metabolism in rats and man of piromidic acid, a new antibacterial agent. 1. Metabolism of the antibacterial, piromidic acid (5,8-dihydro-8-ethyl-5-oxo-2-pyrrolidinopyrido[2,3-d]pyrimidine-6-carboxylic acid) was investigated in rats and human subjects. Ten metabolites and the unchanged drug were found in the urine and the bile of both species after oral administration. 2. Metabolites were identified by comparison with authentic materials, except for the unstable metabolite, M-VI, for which a probable structure is proposed. The metabolic pathway of piromidic acid involved hydroxylation in the pyrrolidine ring to give the 2- and 3-hydroxy-derivatives (M-II and M-V). M-II was further metabolized to the corresponding gamma-aminobutyric acid derivative (M-IV) and the 2-5-dihydroxypyrrolidine derivative (M-VI) which was further metabolized to the 2-amino-pyridopyrimidine carboxylic acid (M-III). Piromidic acid, M-V, M-II, M-III and M-IV were partly excreted as respective glucuronides. 3. Metabolites, except glucuronides, exhibited antibacterial activity; M-V and M-II showed greater activity than piromidic acid. 4. The metabolism of piromidic acid is discussed in relation to the physicochemical properties of the drug and its metabolites.


Delayed type hypersensitivity in guinea pig infected subcutaneously with Naegleria fowleri Carter. A soluble fraction, derived from Naegleria fowleri trophozoites disrupted by freeze-thawing, was tested for antigenic properties. Intradermal injections of this preparation were administered to guinea pigs previously infected subcutaneously with viable N. fowleri. Delayed hypersensitivity to the antigen and loss of weight, the diagnostic symptom of visceral naegleriasis, were observed in the surviving animals. Fifty percent of the guinea pigs, however, did not lose weight and had a reduced reaction to the antigen. The apparent differences in the immunocompetence of guinea pigs inoculated subcutaneously and intranasally with N. fowleri are compared.


Prevalence and pathology of Hepatojarakus bandicoti Sood et Parshad, 1973 (Trichostrongylidae:Nematoda) in natural infections of rodents. The prevalence and pathological changes in the liver and biliary system of field rodents due to Hepatojarakus bandicoti Sood et Parshad, 1973 have been worked out. Higher infection rates occurred in Tatera indica and Bandicota bengalensis than in other field rats and mice. In heavy infections, the liver became grossly enlarged, hard and pale, and showed the presence of white scars on its surface and in the parenchyma. White nodules are commonly seen on the bile ducts due to heavy infections. Histologically the liver showed a changed lobular structure, cellular infiltrations, pycnotic nuclei of the hepatic cells with deposition of haemosidirin granules. Hypermorphosis of the biliary epithelium with its denudation, resulting from the creeping action of the worm seemed to be a common tissue response.


Schistosomiasis at Loum, Cameroun; Schistosoma haematobium, S. intercalatum and their natural hybrid. A survey of 500 schoolchildren in Loum in 1968 revealed an overall infection rate of 54.2% with Schistosoma intercalatum and this was the only species of schistosome encountered. In 1972 a number of children were found to be passing schistosome eggs in their urine and these eggs ranged in shape and size from the forms characteristic for S. haematobium to those of S. intercalatum. Preliminary laboratory studies demonstrated that hybridisation between the two species was occurring. Subsequent field surveys showed that the snail hosts for the two parasites (B. rohlfsi for S. haematobium and B. forskali for S. intercalatum) were both present in the river Mbette and its tributaries in Loum and the distribution of the two snail species coincided closely with the distribution of the schistosomes in the human population. Detailed study of a small group of children passing hybrid eggs in their urine revealed that few of them were passing eggs in their faeces and that those eggs which were found in faeces were not viable. Analysis of schistosome egg-shape by plotting cumulative size-frequency data on probability paper demonstrated that the graph obtained from a natural hybrid series was different from that given by a known mixture of the two separate species. The hybrid series included a number of exceptionally large eggs resembling those of S. bovis but isolation of these eggs and subsequent laboratory passage of the parasites showed that they were part of the series and were not evidence of the presence of a third species. Hybridisation experiments in the laboratory showed that the cross S. haematobium male X S. intercalatum femal is fully viable but that the reverse mating is not successful, thus accounting for the failure of the faecal eggs recovered from children with hybrid infections. Histological results from laboratory passaged hybrids suggest that the Ziehl-positive staining reaction of the egg-shells of S. intercalatum may be a recessive character. The observations reported here indicate that S. haematobium has only recently become established in Loum and that it is, through introgressive hybridisation, replacing the indigenous S. intercalatum. A suggested explanation for the change in the parasite fauna is offered and this depends upon ecological changes resulting from forest clearance and agricultural development providing improved conditions for the spread of B. rohlfsi, the snail host for S. haematobium. It is suggested that, in contrast to recent reports on the spread of S. intercalatum, this species is in fact retreating and being replaced by S. haematobium in areas where forest clearance is taking place. In conclusion it is suggested that introgressive hybridisation of this kind may have been responsible for the evolution of certain characteristic local strains of African schistosomes.


Protein metabolism in Isoparorchis hypselobagri. Isoparorchis hypselobagri was maintained in a non-nutrient medium containing streptomycin and penicillin to prevent bacterial growth for a period of 12 hours. The parasites were kept under aerobic conditions at a suitable temperature of 30 degrees C. The protein content in Isoparorchis hypselobagri ranged from 56.25% to 67.5% with an average of 63.5%+/-4.6 of dry seight of the tissue. The nitrogen of Isoparorchis hypselobagri excreted as ammonia, after 12 hours of starvation was 3.04% of the total body nitrogen and as uric acid 1.6% of total body nitrogen.


Amino acid composition in Isoparorchis hypselobagri. The free amino acids of Isoparorchis hypselobagri have been determined by the chromatographic method (two-dimensional ascending). These are: leucine, valine, proline, alanine, glycine, glutamic acid and aspartic acid.


[The ultrastructure of the intraerythrocytic stages of Babesia herpailuri-trophozoites and merozoites after treatment with imidocarb (3,3'-bis-2-imidazolin-2-yl)-carbanilide (author's transl)]. The fine structure of trophozoites and especially of merozoites of Babesia herpailuri is described before and after treatment with Imidocarb (Wellcome). The mostly piriform to oval merozoites possess an outer membrane and a supporting membrane below. The intratorium consists of a polar ring, rhoptries micronemes and the sperical body which lies beside the big nucleus and next to mitochondria. The endoplasmic reticulum and invaginations are not clearly formed. The cellular changes of Babesia herpailuri, observed one hour after drug treatment in trophozoites and six hours later in merozoites, concern the form and function of the parasite: widening of the subpellicular endoplasmic reticulum and of the perinuclear space; sporadic dilatation of the endoplasmic reticulum of the merozoites (9 fig.). Damaged membranes, dissolution of the cellular membrane, disintegration of the nuclei as are known effects of the Berenil treatment to Babesia herpailuri, are not noted results after the Imidocarb treatment. The original membrane systems of trophozoites as well as of merozoites, remain unaffected by the drug as long as investigations were carried on (24 h). The satisfying prophylactic effect of Imidocarb as well as the insignificant cellular damages on merozoites may be due to the small feeding of hemoglobin.


[Late complications after cross-plate arthrodesis of the hip (author's transl)]. Cross-plate arthrodesis produces a problem of incongruence which cannot be solved by surgical skill Mechanical factors, not foreseeable before operation, produce an inevitable divergence of pulling and torsion forces with a high risk of losening of the implant and pseudarthrosis, particularly when the acetabulum is degenerated. The mechanical forces are shown in Fig. 6. The review of our cases shows that healing after cross-plate arthrodesis may follow three pathways.


[The acetabular roof formation of the operative treatment in CDH (author's transl)]. The acetabular roof construction is discussed in the open reductions, pelvic osteotomy and derotational osteotomy. Open reduction under 18 manth old, if without secondary change of the femoral head, gets sufficient acetabular covering. Pelvic osteotomy as the reconstructive manoeuver around 3 years old can also get a good acetabular condition.


[Regeneration of the synovia (author's transl)]. Thirteen knee joints of dogs were synovectomized, rearthrotomized after various periods of time and the capsule tissue histologically and submicroscopically evaluated. The synovial cell layer is differentiated into histiocytes and fibroblasts which are genetically related to the local fibrocytes of the remaining tissue or to the mononuclear cell elements of the blood. The cells produce a synovial membrane which rarely differs from the normal membrane. The prerequisite is functional stress. Fourteen weeks after the synovectomy, a normal ultrastructure was formed. The synovia was then capable of bearing strain. The regression of the dystrophic cartilage alterations, the adaptability of the cells to the altered demands and the particular cytoplasmatic structuring of the various cell types are to be understood as an expression of the efficiency of the synovial membrane. Clinical and therapeutic consequences were discussed. In regard to regeneration of the synovia in the diseased joint, a regeneration phase, an efficiency phase and an alteration phase were differentiated.


[The articular capsule in idiopathic hypertrophic osteoarthropathy (author's transl)]. The results of clinical roentgenological, cytological examinations as well as the histological examination of biopsy material with electron microscopy are reported for two cases of primary idiopathic hypertrophic osteoarthropathy. In both cases, a watchglass nail was present in the hands and feet; clubbed, distended knee, ankle and wrist joints; appositional enlargement of the shaft of the long bones; the hands and the phalanges of the foot as well as arthralgia and an hyperhidrosis. The morphological examination of biopsy material confirmed the already established increased periosteal bone enlargement. In addition, a fibrosis of the synovial membrane with thickening of the fibrous tissue matrix and increased vascularization of the synovial membrane could be established. Inflammatory processes could be excluded. The reported findings could be attributed to a generalized defect in hormonal or enzymatic regulation of the mesenchym. The vascularization can be explained as a reaction to the lengthening of the transit route between vessels and joint lumen. The thickening of the connective tissue together with the lengthening of the transit route is considered to be an essential causal factor in the arthralgic complaints of strain in hypertrophic osteoarthropathy.


[The brown coloring of the permanent cartilage tissue in old age (author's transl)]. The brown coloring of the permanent cartilage tissue in old age (demonstrated at the rib cartilage) is to be related to pigment deposition in cartilage cells and ground substance. There is a granular pigment present, which probably is a chromolipid. Unstained histological slides are best suitable for the presentation of pigments. In epiphysial joint cartilage (transitory cartilage tissue) the pigmentation of aging usually is only suggested. The appearance of pigment granulas is accompanied by various regressive alterations of cartilage tissue, especially with eosinophilia of the ground substance.


[Morbid anatomy and pathogenesis of spondylolysis and spondylolysthesis in childhood (author's transl)]. Histologic findings of 4 cases of spondylolysis and spondylolisthesis in childhood and their pathogenetic interpretation. The microscopic changes in the lateral gap of the vertebral arch in children are explained as due to stress in the growing intervertebral bones, as fatigue fractures in the widest sense, with a tendency to pathologic union and fibro-cartilagineous pseudarthrosis. During pathogenesis we distinguish between the "primary lysis", a stage of repair followed by defective healing and the resulting spondylolysis.


[Distal symphalangia with humeroradial synostosis, carpal synostosis and brachyphalangia of the thumb. A dominant syndrome (author's transl)]. In a family with genetically dominant joint aplasia, 12 of the 27 involved members in four generations had bilateral humeroradial synostoses; the rest, ventral luxation of the radius. In addition, various degrees of malformations and aplasia of the carpal, tarsal and interphalangeal joints as well as shortening of the proximal phalanx of the thumb were observed. All other similar cases described in the available literature differ significantly from those described here.


[Basic documentation by nonmedical personnel in an Orthopedic University Hospital (author's transl)]. A report was presented concerning the experience with the basic documentation of stationary and ambulatory patients in an orthopedic hospital for which the diagnostic code and the orthopedic-surgical code from the Commission for "Orthopedic Documentation" of the DGOT proved successful. It was particularly interesting to note that the same results were obtained by nonmedical personnel on the basic documentation as by interns and residents.


[Knee joint prosthesis with the geomedic knee joint (author's transl)]. Thirty-one cases of plastic knee joint operations were reported. Twenty-one patients were treated with the geomedic knee. The advantage of this joint is that only a small amount of bone must be sacraficed. The range of movement is better than that with a complete knee prosthesis with axis.


[The position of the supracondylar correction osteotomie during the treatment of the senile gonarthrosis (author's transl)]. The position of the supracondylar correction osteotomie during the treatment of the senile gonarthrosis is examined by controls of 17 patients with 21 performed osteotomies. The indication, the technique as well as the clinical and radiological results of the operation are critically dealt with. In case of a correct indication and when considering the contra-indication-like and existing strong osteoporosis, a distinct deficit of expansion and a most serious arthrosis-good results can be expected.


[About early operative treatment of osteochondrosis dissecans of the knee (author's transl)]. There is a report about eleven cases of juvenile osteochondrosis dissecans of knee-joints. In many cases symptoms are uncharacteristic. Therefore, exact X-ray-diagnostic is essential. Early operation by pinning with Smillie-pins seems justified. The nails remain, as the growth of the bone allows them to sink into the interior of the femoral condyles without harm. Observations during longer periods show good results. Apparently, this method of leaving pins in the bone has never been reported before.


[Localisation and pathogenesis of Morton's metatarsalgia (author's transl)]. Todays concept of Morton's metatarsalgia is seen as a pseudoneuroma of the plantar digital nerve. Since clinic and pathogenesis tally, one should abandon the idea that Morton's metatarsalgia consists of interdigital pain (mainly in the 3rd space) and accept it as a pfeudoneuroma due mainly to pressure on the plantar digital nerve.


[Gout, pseudo-gout or hyperlipoproteinemia? (author's transl)]. A number of patients with aseptic necroses of bone and hyperlipoproteinemia of types II and IV after Fredrickson are reported on. More than one half of them had hyperuricemia without symptoms of gout. The relationship between fat-, purine- and carbohydrate-metabolism are discussed. The clinical pictures of hyperuricemia, gout and hyperlipoproteinemia are shown to resemble each other. Differential diagnosis, particularly as related to aseptic necroses of bone, is discussed in detail.


[A contribution to the origin of lordotic curved back through persisting abdominal breathing (pBA) (author's transl)]. Man, once quadrupedal, purchased his erect posture at the cost of back problems arising in middle age if he does not successfully convert from quadrupedal (abdominal) breathing to bipedal (chest) breathing. Many persisting abdominal breathers (pBA) at rest go to health spas 4-5 times or more at public expense in order to relieve their lower back pain. Due to the persisting abdominal breathing at rest, however, very little improvement in the condition is possible. We must discover abdominal breathers as small children between the ages of 2 and 4 in the routine medical check-ups and re-train them. If this is not accomplished, the failure of a small child to convert when he learns to walk costs the public many millions of unneccessary marks a few decades later.


[Arm and hand prosthesis--today and in the future (author's transl)]. The hand must be taken in a required working position (necessary for eating, drinking, dressing and writing) in order it can touch and grasp. For that purpose a combined motion of all arm-joints is necessary. Hand-surgical procedures are of little value when the hand cannot be taken in such a working position. The problem of the upper arm prosthesis is the driving of the elbow because both the Hood-arm and the myoelectrically driven elbow joint bring no satisfactory functional results. The Tobelbader Hand is a self-powered prosthesis for patients who have a wrist stump. By means of this Tobelbader Hand the prehension can be dosed muscularly. The substitute of the amputated wrist by implantation of an endoprosthesis is discussed theoretically. For the first time to an amputee (with upper arm amputation on both sides) an endoprosthesis was implanted into the stump of the upper arm in order to drive the prosthetic elbow. By means of this artificial, however movable elbow joint the electrical artificial hand can be reliable taken into any wanted position for working.


[Changing position of the neutral vertebra in different stages of curve correction (author's transl)]. During the curve correction especially by means of modern technics the position of the neutral vertebra may change. Therefore the curve after operative treatment should be measured between the new vertebral bodies in neutral position to avoid measurement mistakes. This challenge is of special interest in follow-up studies.


[Problems of experiments on rats in orthopedics (author's transl)]. A small experimental study on rats in orthopedics shows that it is impossible to achieve constant bipedy as a basis for valid static and biomechanic investigations, particularly of the spine.