Naturally-occurring leptospirosis in northern fur seals (Callorhinus ursinus). A 4-year study of Northern fur seal (Callorhinus ursinus) leptospirosis in the Bering Sea has shown that in newborn pups Leptospira pomona is associated with a multiple hemorrhage syndrome. Adults may develop an interstitial nephritis and shed organisms in the urine. The hed prevalence, based on microscopic slide agglutination tests, ranged between 7.0% and 15.4% for adult females and 3-4 year old bachelor bulls, whereas nursing pups averaging 4 months of age had a prevalence of 2%. These results are used to conclude that leptospirosis is not acquired primarily on the breeding rookeries but rather is more frequently acquired subsequent to the  purps leaving the rookeries, presumably through the food chain during their first pelagic cycle.


Prevalence and effects of Parelaphostrongylus tenuis in a captive wapiti population. Prevalence of neurologic disease attributed to Parelaphostrongylus tenuis was investigated in a population of wapii (Cervus elaphus canadensis) enclosed in a 2080 ha. preserve. Brains of 44 animals harvested in 1973, 1974 and 1975 were examined grossly and microscopically. Prevalence of infection increased each year from 26.6% of the sample in 1973 to 64.3% in 1975. These data suggest that wapiti living close to white-tailed deer (Odocoileus virginianus) may have a high prevalence of infection, but many individuals may not show signs. Accordingly, routine histologic examination of natural mortality cases without supporting observations of clinical signs would be inadequate to define cause of death. While the effects of the parasite in the population studied did not produce a high herd mortality or a sudden die-off situation, the apparent greater susceptibility of the younger age-classes to the parasite would have a detrimental effect on population recruitment and might limit the growth of wapiti herds living in proximity to white-tailed deer that harbor P. tenuis.


Blindness in a coyote, Canis latrans, from the rolling plains of Texas. Gross and histopathologic lesions in the eyes of a blind coyote, Canis latrans, collected in King County, Texas are discussed. The animal was in good condition and its age estimated at 7 years. The left globe presented with a superficial corneal erosion, a small punctate erosion, and an apparent lenticular opacity. Histologically, there was a mild anterior uveitis and lenticular degeneration with thickening of the anterior lens capsule, cataractous cortex with Morgagnian globules and bladder cells, and a dense nucleus. The right eye was a firm phthistic globe with thickened extraocular muscles and opaque cornea. Histologically, this presented as an adherent leucoma with partial loss of intraocular contents (retina, iris, and lens), intraocular bone undergoing haematopoiesis, a small granulomatous lesion with foreign body adjacent to the optic nerve in the dural sheath, and gliosis of the optic nerve. The loss of this eye probably resulted from a penetrating injury of the globe with partial loss of intraocular contents. Lesions noted in the eye may be interpreted as an acquired lenticular degeneration of the complicated type.


Myobacteriosis in turtles: cutaneous and hepatosplenic involvement in a Phrynops hilari. Mycobacteriosis in a Phrynops hilari (side-necked turtle) was characterized by multiple caseating granulomas in the liver and spleen; pulmonary involvement did not occur. Granulomatous inflammation and organisms also were present in the skin, suggesting a cutaneous route of entry with hematogenous spread to visceral organs. Review of the four cases of chelonian mycobacteriosis in the literature indicated that pulmonary tubercules and plastral ulcerations are typical manifestations. The Mycobacterium species usually involved is M. chelonei.


Dermatophilus dermatitis enzootic in deer in New York State and vicinity. In a recent 2-year period Dermatophilus congolensis infection, ranging from mild to very severe, was found in 15 white-tailed deer (Odocoileus virginianus) taken in southeastern New York State (12) adjacent New Jersey (2) and central Vermont (1). The host range for Dermatophilus congolensis is given.


Aspergillosis in common crows in Nebraska, 1974. During fall 1974, approximately 1,000 to 1,500 common crows (Corvus brachyrhynchos) died of aspergillosis in south-central Nebraska. The birds were debilitated, lethargic and dyspneic. On necropsy, typical lesions of aspergillosis were found in the lungs and air sacs. Histopathologic examination revealed granulomatous lesions around fungal hyphae in the respiratory system.


An epornitic of avian cholera in waterfowl and common crows in Phelps County, Nebraska, in the spring, 1975. In the spring of 1975, many species of waterfowl and common crows (Corvus brachyrhynchos) were found dead in Phelps County, Nebraska. About 25,000 water fowl and at least 3,000 crows died in the epornitic. Few waterfowl were seen dying, but the crows experienced a chronic illness during which they became debilitated and were lethargic and dyspneic. Gross and microscopic lesions in the waterfowl were typical for acute avian cholera. The crows had dark, firm areas within the lungs, loosely adhered yellow fibrous material in the pericardial sac and air sacs and, occasionally, liver abscesses. Microscopically, focal purulent pneumonia was present and a fibrinopurulent exudate overlaid a granulomatous reaction on the heart and lung surfaces. Isolation of Pasteurella multocida serotype 1 confirmed the diagnosis of acute and chronic avian cholera in the waterfowl and crows, respectively.


Rusa deer (Cervus timorensis) as a host for the cattle tick (Boophilus microplus) in Papua New Guinea. The rusa deer (Cervus timorensis) is more resistant to the cattle tick (Boophlilus microplus) than are Britsh breed cattle in Papua New Guinea. The average yield of replete female ticks from deer was 1.6% (0.3-3.2%) as compared to 11.2% (3.4-23.1%) from calves. Ticks from deer were more slender, lighter in weight and produced fewer eggs (mean 1,800) than did ticks from calves (mean 2,200) but the deer was shown to be an effective host. A cervid population can maintain a tick population in the absence of bovine hosts thus presenting an important factor in eradication programs. Nutritional stress appears to result in a higher seasonal prevalence of infestation amongst males and non-pregnant females.


[Study on cephaloridine concentration in bone marrow (author's transl)]. Cephaloridine (CER) concentration in the bone marrow of tibia was examined 1, 2, and 3 hours after intramuscular injection of 1 g. CER concentration in the bone marrow of tibia 1 hour after injection was 26.0+/-8.927 microng/ml. Ratio to serum was 78.5%. CER concentration in the bone marrow of tibia 2 hours after injection was 20.6+/-5.003 microng/ml. Ratio to serum was 87.3%. CER concentration of bone marrow of tibia 3 hours after injection was 14.8+/-4.79 microng/ml. Ratio to serum was 91.9%. Difference of concentration between in bone marrow and serum was not statistically significant. Penetration capacity of CER into the bone marrow of tibia was excellent.


[Neuromuscular blocking properties of tobramycin, dibekacin and ribostamycin in man (author's transl)]. Neuromuscular blocking properties of tobramycin (Tobracin 60mg), dibekacin (Panmycin 100 mg) and ribostamycin (Vistamycin 1g) were studied in man during anesthesia and surgery by observing the effects of these antibiotics on muscle twitch tension. These antibiotics alone did not show any neuromuscular blocking action in the therapeutic doses. The neuromuscular blocking action of d-tubocurarine chloride was potentiated by the intravenous administration of 1g of ribostamycin. Tobramycin 60mg did not show remarkable effect, but dibekacin 100mg produced a slight potentiating effect on the action of d-tubocurarine. The enhancement of the action of d-tubocurarine was anatagonized by edrophonium and calcium. The action of succinylcholine chloride was not affected by tobramycin or ribostamycin, but it was potentiated transitorily by dibekacin. It is advisable to pay attention to possible respiratory depression when ribostamycin and dibekacin and used in combination with non-depolarizing muscle relaxants and/or anesthetics.


[The clinical effect of antibiotics in the macrolide family on bronchial asthma. Non-antimicrobial actions of oleandomycin [author's transl)]. Non-antimicrobial actions of oleandomycin (triacetyloleandomycin and oleandomycin phosphate) were studied in patients with bronchial asthma. Twenty-one cases of the disease without associating infections entered the study, and they were given 750mg of oleandomycin or triacetryloleandomycin in three divided doses daily for two weeks. Clinical manifestations and laboratory findings were compared to assess the effectiveness of the antibiotic therapy between the three 2-week periods before, during and after the therapy. Improvements in clinical manifestations were attained in 11 of 21 cases (52.3%), and last after discontinuance of the therapy in 8(38.1%). The blood level of 11-OHCS as determined by the Demoorr's fluorescence method increased by greater than 20% at the end of thearpy in 7 of 18 cases (38.9%). In 5 of the 7 cases favorable responses were seen clinically to the oleandomycin therapy. The serum IgE level determined by the radioimmunosorbent test was compared before and after the therapy to reveal that oleandomycin caused decrease of IgE in 10 and increase in 9 of 20 cases examined. The oleandomycin therapy resulted increases by greater than 20% of the vital capacity and FEV 1.0 in 2 and 3, respectively, of 15 cases. Jaundice in association with elevations of the GOT, GPT and alkaline phosphatase developed in one patient, and generalized skin eruption in another. Both of these cases were given triacetyloleandomycin.


Quantitative estimation of serum Ss level: changes upon the development of autoantibodies, environment and acute inflammation in inbred mice. The level of the fourth complement component was quantitated in sera from several inbred strains of mice of various ages. In NZB and NC mice, which are known to produce autoantibodies spontaneously, the level of C4 increased from one month to six months of age, maintained high C4 levels until 10 months but showed a gradual decrease in serum C4 beginning at one year of age. Direct and indirect Coombs' antibodies were detected after 6 months of age in both strain. C4 level in BALB/c and C57BL/6J mice were relatively  constant throughout their life span. In order to determine whether or not antigen-antibody complexes induce the elevation of serum C4 level, either rabbit anti-mouse IgG serum or normal rabbit serum was injected intravenously into BALB/c mice. Sera obtained at various times were tested for C3 and C4 by single radial immunodiffusion. The results indicate that the C4 level elevated after the injection of rabbit anti-mouse IgG, but C3 levels did not change after the same treatment. Normal rabbit serum did not induce a detectable change in C3 and C4 level under the conditions used.


Quick increase of pulmonary blood flow in response to an acute alveolar hypoxia in human subjects. The effects of acute alveolar hypoxia on pulmonary blood flow were studied in upright standing human subjects by means of a constant expiration technique combined with continuous analysis of the C2H2 fraction in the expired gas. The subject rapidly and deeply inhaled a gas mixture containing 4.87% C2H2, 0.99% O2, N2 for balance and exhaled the alveolar gas via a constant flow valve. The Po2, of the alveolar gas fell to 37.6+/-5.6 mmHg. The C2H2 curve showed a clear downward inflection 7 to 10 sec after the completion of washout of the dead space gas. This inflection indicates an increase of the C2H2 uptake rate produced by an increase in pulmonary blood flow. The pulmonary blood flow calculated for the time range of 10.0 to 12.5 sec after the establishment of acute alveolar hypoxia (6.5+/-1.11/min) was significantly larger than the blood flow under normoxia (5.5+/-0.91/min). This increase associated with a quick rise in systemic arterial blood pressure which was probably induced by a chemical reflex.


Effect of ions and drugs on the plateau potential in the circular muscle of pregnant rat myometrium. Effect of Na, Ca, anions and isoprenaline on the plateau potential in circular muscle of 11- to 13-day pregnant rat myometrium were investigated using the double sucrose gap method. During the plateau potential, which amounted about 15-20 mV and lasted for 10-20 sec, the membrane conductance increased initially, then decreased. The amplitude and duration of the plateau potential increased by raising the external Ca concentration to between 0.3 and 3 mM, and decreased when the concentration was increased more. The plateau was prolonged in low Na solutin (54 mM). When 154 mM Cl was replaced with Br the plateau was prolonged, however, the plateau was nearly suppressed when Cl was replaced with benzene sulphonate or isethionate. Isoprenaline increased membrane conductance and depressed the plateau. It was concluded that a decrease in K conductance was largely responsible for the plateau potential, and an inward Ca current may have contributed to its formation.


Effects of ions and drugs on the negative afterpotential in the longitudinal muscle of pregnant rat myometrium. Effect of Na, Ca anions and drugs (isoprenaline, TEA, procaine) on the negative afterpotential in the longitudinal muscle of pregnant rat myometrium were investigated using the double sucrose gap method. The negative afterpotential having a peak amplitude of about 15 mV decayed initially rapidly then slowly, the total duration being about 1 sec. Raising the external Ca concentration up to 10 mM or reducing Na to 54 mM increased the amplitude of the negative afterpotential. Replacement of Cl with Br enhanced the negative afterpotential and and replacement with benzene sulphonate or isethionate depressed it. The application of 10 mM TEA increased, while 10 mM procaine reduced the amplitude of both spike and negative afterpotential. 10(-10)-107(-8)g/ml isoprenaline depressed the negative afterpotential dosedependently, while leaving the spike potential nearly unaffected. It was concluded that the negative afterpotential was composed of a least two ionic mechanisms, one of Cl origin, the other of Ca origin.


Ionic mechanism of water receptors in the laryngeal mucosa of the rabbit. The effects of various ions on water response was studied by recording unitary discharges in single superior laryngeal nerve fibers of the rabbit. The water response was strongly influenced by anions. The inorganic anions used were divided into two groups. One group consisted of anions which depress the water response (depressing anions), the depressing action sequence being SCN- greater than Br- greater than than Cl- greater than I- greater than NO-3. Another one consisted of anions which facilitate the water response (facilitating anions), the facilitating action sequence being citrate greater than SO34- greater than IO-3 greater than F- greater than BrO-3 greater than acetate. Physicochemically, facilitating anions belong to "the water structure-making ions" group; on the other hand, depressing anions belong to "the water structure-breaking ions" group. SO34- weakened the depressing effect of Cl- when the concentration of Cl- was below 60 mM, and enhanced it when the concentration was above 60 mM. Na+ and Li+ had no appreciable effect on the water unit activity, but K+ had a weakly stimulating effect. It is concluded that an outflux of anions through the membrane stimulates the water receptor while an influx of anions depresses it, and SO34- facilitates Cl- permeability. The mechanism of the facilitating effect of SO24- on Cl- permeation is discussed in terms of the interaction between the water structure surrounding the ions and the receptor membrane.


Effect of hemolysin produced by Vibrio parahaemolyticus on membrane conductance and mechanical tension of rabbit myocardium. The mechanisms of the action of hemolysin extracted from Vibrio parahaemolyticus in the S-A node and right atrium cells of rabbit were studied by means of the single sucrose gap and isometric tension recording methods. Hemolysin caused the membrane to depolarize reversibly without affecting the action potential generating mechanism. Lowering of [Na+]o inhibited membrane depolarization in the presence of hemolysin while the readmission of normal Tyrode solution induced depolarization. Tetrodotoxin (TTX) barely antagonized the depolarizing action of hemolysin but slowed the rate of development of depolarization. Therefore, this depolarization is considered to be primarily due to the increase in conductance to Na which TTX may not block. The dose-response relationship was obtained by measuring a change in membrane resistance. The concentration necessary to yield one-half of the maximum reduction of the membrane was determined to by 7.5 micrograms/ml. Accumulation of Na within the cell may be responsible for an increase of twitch tension observed during the action of a low concentration of hemolysin. On the other hand, a higher concentration of hemolysin seemed to promote exchange of intracellar Na with extracellular Ca, especially when the Na concentration of the perfusing solution was reduced, and led to stronger contracture.


The electrogenic sodium pump and conductance changes in the post-tetanic hyperpolarization of crayfish median giant axons. The mechanism of post-tetanic hyperpolarization (PTH) occurrence was investigated using the intracellar recording technique. The median giant axon of a crayfish abdominal nerve cord was repetitively stimulated to elicit PTH. When the membrane potential was hyperpolarized by intracellularly applied currents, PTH reversed its sign. K+ removal from the external medium increased the size of PTH and shifted its reversal potential in the hyperpolarizing direction. This results shows that an increase in K+ conductance contributes to the formation of PTH. In a K+-free medium, the size of PTH was reduced by replacement of Na+ with Li+ in the external medium, by application of ouabain or DNP, or by cooling. These procedures shifted the reversal potential in the depolarizing direction. These findings are interpreted as showing that, with K+ absent, PTH is partly due to the activity of electrogenic Na pump. With lowering of external Na+ concentration, PTH became larger and the reversal potential moved in the hyperpolarizing direction. The experiment suggests that Na+ conductance is also increased when PTH is elicited because one expects the amount of Na+ entering per impulse and the activation of the Na pump to be reduced by reducing Na+ concentration in the external medium. It is concluded that PTH in the median giant axons of crayfish is produced by at least two mechanisms. One is an increase in activity of the electrogenic Na pump, and the other is an increase of membrane conductance to K+ and Na+.


Effects of gastrointestinal hormones on the electrical and mechanical activities of the cat small intestine. Effects of gastrointestinal hormones on the electrical and mechanical activities of the smooth muscle of the cat small intestine were examined. Both spontaneous electrical and mechanical activities of the intestinal smooth muscle were inhibited by tetragastrin, pentagastrin and pancreozymin. The spike activity and the phasic contraction of the smooth muscle were depressed by these hormones while the slow waves were maintaned. On the other hand, secretin showed an excitatory action on the mechanical activity of the isolated preparation of smooth muscle. Spike activity disappeared and the level of tone was increased gradually. The inhibitory and excitatory actions of each hormone on the mechanical activity were not abolished by the application of atropine and tetrodotoxin. Furthermore, the inhibitory effects of pentagastin and pancreozymin on the smooth muscle were not antagonized with phenoxybenzamine or propranolol. These results suggest that the inhibitory actions of pentagastrin and pancreozymin on the smooth muscle were not mediated by alpha or beta receptors and not due to the stimulation of an inhibitory nervous system in the gut. Antagonistic relations between secretin and pentagastrin and also between secretin and pancreozymin were observ ed. The mechanisms of the actions of gastrointestinal hormones are discussed.


Specific pressor activity and stability of synthetic angiotensins. Specific pressor activity of Asp1-Val5-antiotensins I and II was determined by a 4-point assay in rats against various synthetic angiotensins. Specific pressor activity of various angiotensins was also obtained from the dose-blood pressure-response (DR) curve, using a single angiotensin sample per rat. Comparison of two values showed that two angiotensins interacted in the 4-point assay, yielding a potentiation factor of 0.465-1.373. Therefore, specific pressor activity from DR curve is more reliable, because two angiotensins are not able to interact. Potency ratio on a molar basis of Asp1-IIe5-angiotensin I, Asp1-Val5-angiotensins I and II, Asn1-Val5-angiotensin II (Ciba Lot-094691), and Asp1-Val5-Ser9-angiotensin I against Asp1-IIe5-angiotensin II were 0.76, 0.91, 2.02, 0.50, and 1.39, respectively. Asp1-Val5-angiotensin II had twice the pressor activity of Asp1-IIe5-angiotensin II. Lyophylized Asp1-IIe5-angiotensins I and II kept desiccated at --20 degrees C, were stable for 27 months. Solutions of 100, 10, and 0.8 microng/ml were stable for 12, 8, and 6 months at--20 degrees C, respectively.


Effects of 1-methyl-5-chloroindoline methylbromide (S-6) on Renshaw cells of cats. Effects of 1-methyl-5-chloroindoline methylbromide (S-6) on Renshaw cells were investigated in cats anesthetized with pentobarbital sodium. S-6 proved to have little effect on spike discharges of Renshaw cells when administered intravenously, but the agent electrophoretically applied revealed excitatory effects which resembled the action of methacholine and such effects were blocked by intravenous administration of atropine. It was conlcuded that (1) S-6 is impermeant to the blood brain barrier and (2) the excitatory action of S-6 on Renshaw cells is muscarinic in nature.


Effect of clonidine on blood pressure, heart rate and body temperature in conscious rats. Effects of clonidine on blood pressure, heart rate and rectal temperature in conscious rats were examined. Clonidine (0.1-1 mg/kg s.c.) caused a prevailing pressor response and dose-dependently a fall in heart rate and body temperature. The pressor response to clonidine (0.3 mg/kg s.c.) was completely reduced by phentolamine (10 mg/kg s.c.), chlorpromazine (10 mg/kg s.c.) but not by hexamethonium (30 mg/kg i.p.), guanethidine (30 mg/kg s.c.) or reserpine (5 mg/kg s.c. 18 hr + mg/kg i.p. 4 hr prior to clonidine). Conversely, a remarkable potentiation of the pressor response to clonidine was observed after treatment with reserpine. The bradycardia with clonidine (0.3 mg/kg s.c.) was significanlty reduced by phentolamine, chlorpromazine or atropine (5 mg/kg s.c.) but was potentiated by reserpine. The hypothermia with clonidine (0.3 mg/kg s.c.) was not influenced by phentolamine or atropine but was significanlty potentiated by chlorpromazine. From the above results it is suggested that the prevailing pressor response to clonidine in conscious rats is due to a stimulation of peripheral alpha-adrenoceptors, the bradycardia with clonidine is exerted through the sympathetic pathway and the baroceptor-vagal reflex, and that the hypothermia with clonidine is mainly due to the central mechanism.


Studies on increased bile formation produced by polyoxybenzenes in rats. Mechanism of hypercholeretic effect of three polyoxybenzenes, 2,4,6-trihydroxypropiophenone (THPP), 4-methylumbelliferone (4-MU) and 3-(2',4',5'-triethoxybenzoyl)propionic acid (AA-149), was studied in rats. Biliary clearance of 14C-labeled erythritol indicated that all the choleretics increased canalicular bile production. AA-149 excreted in the bile chiefly as the glucuronide provided no significant osmotic drive for bile formation. Both the biliary bile acid concentration and total biliary excretion of bile acids were lower in the rats treated with THPP, 4-MU or AA-149 than in control rats. These choleretics were also effective in the isolated rat liver perfusion system, in which concentration and output of biliary bile acids were low. Thus, it was unlikely that bile acids were involved in the hypercholeresis induced by the choleretics. THPP, 4-MU and AA-149 increased biliary excretion of sodium both in the biliary-cannulated rats and in the isolated rat liver perfusion system. It was concluded that the hypercholeresis induced by THPP, 4-MU and AA-149 was due to an enhanced formation of the bile acid-independent fraction of canalicular origin, probably mediated by the active transfer of sodium into the canaliculi.


Autotransfusion in the emergency department of a community hospital. The Bentley-100-Autotransfusion System was used in eight cases in the emergency department of St. Francis Hospital of Lynwood. The majority of the patients sustained massive chest trauma and the amount of blood salvaged ranged from 1,600 to 14,000 cc. Although the clotting factors and platelet counts altered greatly during the first postoperative days, they returned to normal within 72 hours. The advantages, disadvantages, and controversial areas in autotransfusion are discussed.


Diagnosis of myocardial contusion in blunt chest trauma. Of 20 patients with blunt chest trauma who underwent cardiac scanning, serial electrocardiography and cardiac monitoring to rule out myocardial contusion, four had positive cardiac scans. All four had electrocardiographic abnormalities: three had nonspecific ST-T wave changes, and the fourth had electrocardiographic evidence of an acute subendocardial infarction. Of the 16 patients with negative scans, five had normal electrocardiograms. In the remaining 11 patients, factors other than myocardial contusion were suspected causes of electrocardiographic abnormalities. On the basis of this data, electrocardiogram changes in the traumatized patient have various causes. Cardiac scanning appears to be a useful adjunct to electrocardiography in confirming the presence of myocardial contusion.


Conservative management of fingertip amputations. A method of conservative treatment of fingertip amputations, allowing for spontaneous healing of the defect, was evaluated in a one-year study involving 17 consecutive patients and 21 amputations. Six presented with exposed bone in the lesion. These injuries healed with excellent results in terms of maintenace of maximum finger length and minimization of cosmetic deformity and functional disability. Rapid retrun to work was possible in most cases and morbidity associated with surgery was avoided.


An emergency department radiology audit procedure. An audit was done to ascertain the concordance of radiographic interpretation by the emergency physician and the radiologist. In 8,021 radiographic procedures during the two-month study, concordance of interpretation was found in 97.6%. The primary area of interpretation difficulty was chest radiographs. Specifically, there was limited agreement (10 of 45 films, 22%) regarding the reading of inflammatory processes. Despite this, 40 of the 45 patients (89%) whose chest radiographs were reviewed received proper therapy. The findings in five radiographs were deemed to be significant enough to possibly lead to changes in management.


The continuing emergency care clinic: improving patient compliance with follow-up care. Traditionally, emergency patients have been noted for high rates of noncompliance with appointments in outpatient clinics for follow-up care. S study of cases referred for follow-up care at the outpatient clinic of The Medical College of Pennsylvania showed that less than 20% of the patients kept their appointments. To cope with this problem, a Continuing Emergency Care (CEC) clinic was established on the assumption that a change in structural environment could change noncompliance behavior patterns. The clinic is a small unit near the emergency department, separate from the larger hospital outpatient clinic area. Patient compliance data were collected on each case referred to the CEC clinic during a three-month period. Findings showed a threefold increase in appointment compliance over the previous study in which referrals were made to the hospital clinics.


A unique approach to evaluation of emergency care. A quality care evaluation system was designed to serve as a framework for on-going research in the area of quality assurance in emergency medicine. It included a set of basic evaluation tools, such as direct observation of patient care, record review and analysis, and patient follow-up interview for outcome. These tools are used in an attempt to quantify relationships between quality care and patient outcome.


Pedestrian injuries near disabled vehicles. Six cases of pedestrians injured near disabled vehicles and treated at Denver General Hospital are reviewed, with special attention paid to their cause. All occurred next to disabled or stopped vehicles. The serious injuries sustained could be avoided with public education.


Intravenous regional anesthesia.

Intravenous regional anesthesia. A series of 33 patients who underwent intravenous regional anesthesia for treatment of orthopedic and surgical procedures is reported. Intravenous regional anethesia is a safe and reliable alternative to general or other regional anesthesia techniques for use in the emergency department. The technique is easily mastered and requires minimal special equipment. The agent of choice is lidocaine in a dosage of 3 mg/kg administered as a 0.5% solution. Complications are few and are usually related to rapid systemic absorption of the anesthetic agent or minor mistakes in technique.


Application of a versatile instrument for production of cutaneous anesthesia without needle penetration of the skin. A self-contained jet injector, the Syrjet Mk II, can be used for needleless injection of anesthetic agents into the skin and subcutaneous tissues. Although designed for dental use, its compact size, simplicity, and versatility make it suited for many medical applications where a relatively small anesthetic field is desired, especially in children. It provides an anesthetic area for the introduction of standard hypodermic needles for more extensive tissue infiltration, or for definitive anesthesia for procedures such as marrow aspiration, biopsies, small lesion excision, and in certain field blocks such as digital or facial sensory. It is significantly free of side effects and complications.


Subcutaneous emphysema.

Subcutaneous emphysema. Subcutaneous emphysema is most often associated with thoracic pathology. The case is presented of a middle-aged woman with shock, abdominal distention and rigidity, and subcutaneous emphysema which resulted from a spontaneous gastric rupture. Subcutaneous emphysema has a variety of origins, including infections and rents in the respiratory tract, gastrointestinal tract, and the skin.


Pellagra: an analysis of 18 patients and a review of the literature. The clinical and laboratory features of 18 adult pellagrins are reviewed. Only four patients (22%) had the full trial of dermatitis, diarrhea and dementia. Dermatitis alone occurred in six(33%), dementia in five(28%) and dermatitis and diarrhea in three(17%). In one patient, dermentia was the initial sign of a relapse. Steatorrhea was found in six patients and was usually associated with marked alopecia. Edema without evidence of cardiac failure was present in seven patients. A diffuse increase in slow wave activity on the electroencephalogram was characteristic in patients with dementia. Fever occurred in 14 patients, and an infection was documented in 10 of these. Common laboratory abnormalities included a normochromic, normocytic anemia, lymphopenia, eosinopenia hyperuricemia, and low serum levels of albumin, urea, cholesterol, carotene, potassium, calcium, and magnesium. Adrenal and thyroid function were normal, but a low serum T4, high serum free T4, and an elevated T3 resin uptake were frequently observed. These abnormalities were corrected with treatment of the underlying nutritional disorder. In two patients initially treated with thiamine alone, and in one who received inadequate amounts of niacin and protein, there was marked deterioration of mental function, which responded to administration of niacin and proper diet.


The activated partial thromboplastin time as a monitor of heparin therapy: a warning. The degree of correlation between the whole blood clotting time (WBCT) and the activated partial thromboplastin time (APTT) was evaluated in 42 patients receiving intermittent intravenous heparin therapy. Correlation between the two tests was found to be poor (correlation coefficient 0.52), primarily for reasons related to characteristics of the APTT system employed. The relationship in vitro between the APTT and the level of heparin was evaluated and found to vary widely over a range of heparin concentrations. This study emphasizes the marked variability between various APTT systems and the dangers involved with substituting the APTT for the WBCT to monitor heparin without appropriate initial evaluation.


[Bietti's crystalline fundus dystrophy (author's transl)]. Two cases of Bietti's crystalline fundus dystrophy are presented. The crystals in the posterior pole are associated with a diffuse tapeto-retinal degeneration. The functional symptoms are less severe than in pigmentary retinopathy.


[Traumatic lesions of the optic chiasma (author's transl)]. Traumatic lesions of the chiasma are few when one considers its anatomical position. They happen after severe direct or indirect traumas with or without skull fractures, and with or without macroscopic lesions. Microscopic lesions are characterised by contusion. Clinically the visual loss goes together with bitemporal defects and with bilateral hemorrhagic papillar oedema. Early complications are hematoma of the optochiasmatic space and perichiasmatic meningitis: among delayed complications optochiasmatic arachnoiditis prevails.


[Anthropogenic catatacts (author's transl)]. The traditional theories of senile cataract formation have one common denominator. Nearly all the agents and factors heretofore ascribed as causes of cataract formation have some element involving a potent crosslinking agent. The factors considered in this paper include endocrine and metabolic factors, involutional and hereditary influences, nutritional deficiencies, osmotic changes, ionizing radiation, ultraviolet light, altered capsular permeability, and the cumulative effects of subliminal exposure to noxae. Throughout life, the human lens is exposed to the influence of numerous potent crosslinking agents and it now appears that the cumulative actions of crosslinkage is the chief cause of senile cataracts. If this theory proves to be correct, it will offer some hope that cataract formation can be retarded by agents which counteract crosslinkage or by avoidance of excessive exposure to crosslinking agents.


[Operations for glaucoma: long-term results (author's transl)]. The author compares the long-term results of operations for glaucoma with or without scleral flap and also the operation of angiodiathermocoagulation.


[Orbital pseudotumor with thrombocytopenia and myasthenia (author's transl)]. A 13-year-old girl presented first with an inflammatory pseudotumor of the orbit. A biopsy showed lymphoid hyperplasia. A few months later the patient developed an idiopathic thrombocytopenia. Six months later she developed a myasthenia. The latter responded well to a thymectomy and the orbital pseudotumor disappeared with radiotherapy. The possible connection among these three diseases is discussed.


[Treatment and follow-up of retinal tears associated with avulsed overlying retinal vessels (author's transl)]. The present clinical study is based on 17 cases of a specific clinical entity, which is characterised by a retinal break without retinal detachment, the tear being spanned by an avulsed patient retinal vessel invariably adjoining the operculum. The vessel was in the vitreous cavity and formed an arch above the break. All cases began with a sudden decrease or loss of visual acuity due to the rupture of the avulsed vessel and the occurrence of hemorrhages within the vitreous. These hemorrhages recurred in the course of the follow-up of the patients which lasted from 1-8 years. The recurrence of the bleeding was in most instances related to the mobility and the size of the vessel overlying the break. During treatment the cases were divided into two groups, group 1 comprising cases which were subjected only to light-coagulation, whereas in the cases of group 2 scleral buckling was performed in conjunction with cryopexy or light-coagulation. The comparatively best results were achieved in group 2. This condition is rare and amounted to only 1.5% of our total number of cases of retinal tears treated with light-coagulation during the last 8 years.


[A modified goniotrephination technique (procedure to secure more permanent drainage) (author's transl)]. Two modified operative techniques using non-absorbable synthetic material based on the goniotrephination are described. The material used is embedded under the scleral flap at the trephination site. The procedure aims at creating a more stable and eventually a more permanent drainage. Both techniques are dealt with in detail, and the clinical results regarding the first twelve cases are reported covering an observation period of one to six months.


[The cilia of the lacrimal sac epithelium SEM studies (author's transl)]. On the basis of SEM studies it has been shown that the cilia are arranged into groups of 10 to 40 in the individual epithelial cells of the lacrimal sac. The cilia have a length of 15 to 20 micron.


[On the pathology of ocular malignant melanoma (author's transl)]. From pertinent cases a contribution to the pathology of melanoma is published here. The histological structure of melanoma in the various eye tissues is dependent on the properties of the tissue in which the melanoma grows. By means of an example we have tried to throw light on the question of the differential diagnosis between a primary tumor and a metastatic deposit, although a single case cannot be used as proof. An intraocular degenerate melanoma and a melanomametastasis in the conjunctiva after a skin tumor are also demonstrated.


[Fibrin adhesion (orientating animal experiments) (author's transl)]. For some time fibrin adhesion is successfully used instead of sutures in different branches of surgery. We tested in animal experiments whether this method can be used for a sutureless closure of perforating corneal and corneoscleral wounds. Our results up to now do not show us any such possibility.


[Conjunctival grafting. Experiences with lyophylized donor-tissue (author's transl)]. Firstly the different methods of surgical replacement of the conjunctiva are discussed. Despite certain disadvantages buccal mucosa is often transplanted. More useful and easier is the use of lyophilized human donor conjunctiva. In 10 years we have operated on 110 eyes in 76 patients according to this method. In some eyes conjunctiva of different donors was used, often the whole conjunctival sack had to be reestablished. A brief description is given of winning the donor material, or surgical grafting technique and results, and one of the case histories of the patients is given. No transplant rejection occured, probably because there are no specific proteins or enzyme activities in the lyophilized tissue. Sometimes in pemphigus and similar diseases the tissue will again be included into areas of contracture. After chemical injuries and burns the end of inflammatory signs should be awaited before grafting.


[Idiopathic retinal detachment and congenital anomaly of vitreo-retinal insertion (author's transl)]. V-shaped retinal defects which are usually parallel to the equator, develop as a congenital anomaly at the insertion of vitreous fibrils. The vitreous overlying these retinal areas is without structure. Progressive degenerative-sclerotic areas, equatorial degeneration-or lattice degeneration can develop in the region of these vitreo-retinal adhesions.


[Enucleation yesterday and today (author's transl)]. From 1963 to 1973 379 eyes were removed surgically. This represents a constant ratio during this eleven year-period of 2.1% of the in-patients and 2.3% of the patients treated surgically. Mostly elderly patients were affected, men more often than women. The ultimate reason for enucleation was uncontrollable pain in most of the cases. The most frequent cause for the loss of the eye were penetrating injuries (31.1%) and intraocular tumors (30.6%). Histology was done in 83.6% of the cases. Amongst 116 eyes enucleated for intraocular tumors or suspicion of tumor-growth no tumor was seen microscopically in seven cases. In 7 out of 118 eyes (5.1%) encleated for glaucoma absolutum a malignant tumor was found.


[Ipsilateral rotational autokeratoplasty (author's transl)]. Within 2 years 14 rotational autokeratoplasties were performed with a trephinediameter of 7 to 8 mm. 7 of these patients were children less than 15-years-old. The indications were the following: central corneal opacities due to vascularised congenital anomalies (e.g. Peters' anomaly), after burns and in combination with extensive post-traumatic anterior synechiaes requiring reconstruction of the anterior segment. 11 eyes were followed up for at least 6 months. There were no intra- or postoperative complications, and significant visual improvement resulted in 8 eyes in spite of the complex preoperative situation. In view of our encouraging experience we recommend that ipsilateral rotational autokeratoplasties should be considered in special complex corneal opacities more often, particularly in children.


The haemoglobin types of mice.

The haemoglobin types of mice. The haemoglobin types of 27 inbred strains of mice have been determined. Besides the common types, Hbb-s and Hbb-p, 2 strains were found with Hbb-p. Affinity between strains with the Hbb-p type and asiatic mice seems likely. The influence of storage  on the polymerisation of Hbb-d and Hbb-p, the possibility of distinguishing between homo- and heterozygote Hbb types, and the possible existence of a 4th haemoglobin type, are discussed.


Diseases of lower vertebrates and biomedical research. The historical and present role of lower (non-mammalian) vertebrates in biomedical research is discussed. Examples are given of disease problems and experimental studies. It is suggested that lower vertebrates may prove of increasing value in this field in the future.


An easily dismantled pig pen for long-term radiation exposure. A pen to hold individual miniature pigs during long-term radiation exposure studies has been designed and used. Wooden construction results in low cost and minimizes radiation scatter problems associated with higher density materials. An automatic water system is provided.


Studies on Tyzzer's disease: isolation and propagation of Bacillus piliformia. Mice from a colony with subclinical Tyzzer's disease were treated with prednisolone in order to activate a Bacillus piliformis infection. From the livers of these mice the organism was isolated and serially passaged in embryonated eggs. It  resisted heating at 75 degrees C for 20 minutes and was still infective after storage at -80 degree C for 24 days, but not for 52 days or more.  Infectively was maintained for more than a year by storing infectious  liver tissue at -190 degrees C.  B. piliformis was also isolated from the liver of a mouse with naturally-occurring Tyzzer's disease and maintained for more than 300 passages. Mice inoculated with different egg passages developed fatal Tyzzer's disease and B. piliformis was reisolated from their livers.


Postnatal development of the testes in the cuis, Galea Musteloides. Testicular development to 9 months of age has been studied. Seminiferous tubule diameter increased in a linear manner between 13 and 65 days of age, and there was a steep increase in testicular weight with age. At about 9 months the animals weighed 400-500 g and total testicular weight was about 10 g. This relatively large testicular size was correlated with high sperm density in the semen. Spermatogenesis commenced at about 21-25 days of age, when the first spermatids were found. Spermatozoa appeared in a small proportion of seminiferous tubules by 31-35 days of age, and were seen in the epididymides of an animal of 31 and another of 34 days. Epididymal spermatozoas were consistently present in large numbers after 60 days and this correlated with the increased frequency of mature seminiferous tubules. Leydig cell size increased rapidly from 13 to about 60 days, then remained constant. Inferences have been drawn from this and the study of spermatogenesis about the level of testosterone secretion. The results indicate that the male cuis is almost fully grown and sexually mature by about 90 days of age.


Inorganic ions in the intestinal and caecal contents of germ-free and conventional chickens. In 4-week-old chicks that had been maintained on 3 different diets, caecal weights were lower in germ-free than in conventional birds eating practical but not semipurified diets. There were no consistent differences in total sodium, potassium and chloride ions in the contents of the small intestine. In germ-free chicks the caecal wall muscle appeared lacking in tone and  there was a lower concentration of chloride ions in the contents, but there was no caecal enlargement comparable to that in germ-free rodents.


Foreign serum-induced pancreatitis in mice. II. Secretory disturbances of acinar cells. As previously reported, pancreatic acinar cell necrosis and inflammation develop in mice a few hours after one intraperitoneal injection of foreign serum. However, sublethally injured acinar cells exhibited notable increases in both zymogen granule numbers and amylase activity, observed within 3 hours and increasing with time. These two changes were coupled with a progressive decrease in the secretory response to pilocarpine and were preceded by significant disturbances in pancreatic tissue concentrations of sodium and potassium. We conclude that (1) the granule increase results from an induced disturbance of the granule exocytosis mechanism while granule formation continues and, therefore, (2) the granule secretory process is more sensitive to the serum injury mechanism than is the zymogen synthesis process. Although the granule increases developed in acinar cells throughout most of the nonnecrotic gland and persisted for at least 24 hours, acinar cell necrosis was maximal in extent--approximately 25% of the gland in severest form--by 12 to 15 hours. We conclude, therefore, that the increase in granules is neither the primary determinant nor initiator of acinar cell death. The latter is likely caused by disturbed plasma membrane functions, sufficient in some cells to result in  lethal changes in ion and fluid composition. The injury mechanism, which permits granule formation to go on in the face of impaired granule exocytosis, is yet to be worked out. The possibilities are discussed in relationship to the reactivity of foreign sera for target cell plasma membranes.


Osteogenesis imperfecta congenita: evidence for a generalized molecular disorder of collagen. Collagen from bone (femur and calvarium), rib cartilage, skin, tendon, sclera, and cornea has been isolated and purified from a deceased 4-day-old infant with osteogenesis imperfecta congenita. Amino acid analysis indicated that the content of hydroxylysine was doubled in bone collagen and increased by 55% in that of cartilage as compared with  age-matched normal tissues. The levels of covalently bound glucose and galactose were proportionately increased in both collagens. Collagen purified from other tissues revealed smaller increases in lysyl hydroxylation. These data suggest that at least one form of osteogenesis imperfecta congenita is associated with a molecular alteration of collagen involving hydroxy-lysine and that this alteration is particualrly marked in collagens obtained from calcifying tissues.


Experimental model of focal sclerosis. I. Relationship to protein excretion in aminonucleoside nephrosis. An experimental model of focal sclerosis (FS) following chronic administration of aminonucleoside (AMNS) is described in rats with pathologic features similar to those observed in human steroid-resistant idiopathic nephrotic syndrome. Six groups of rats were given intraperitoneal injections of either 0.9% normal saline or aminonucleoside (13 mg. per 100 gm. of body weight); four groups underwent a right nephrectomy on day 22; a second series of injections of saline or aminonucleoside were then administered to all six groups: group I (five animals), saline-saline; group II (10 animals), AMNS-AMNS; group III (10 animals), AMNS-nephrectomy-AMNS; group IV (five animals), AMNS-nephrectomy-saline; group V (five animals), saline-nephrectomy-AMNS; group VI (five animals), saline-nephrectomy-saline. A relationship between the percentage of glomeruli with focal sclerosis and the total amount of protein excreted during the course of the experiment was observed (r=0.80). An apparent threshold level of protein excretion essential for the development of FS was also noted in that all rats excreting greater than 2.2 integral units developed FS whereas those excreting less than this amount did not. The highest incidence of FS was seen in rats that had received AMNS after unilateral nephrectomy: 62% of glomeruli with FS in group III and 26% in group V; whereas no FS was seen in groups I and VI or in rats evaluated 7 to 23 days after a single injection of AMNS. These studies indicate a quantitative relationship between the breakdown in the permeability barrier to protein and the ultimate development of FS. The prior demonstration of epithelial cell alteration in acute AMNS disease and the morphologic changes presented in this and the subsequent paper (Velosa JA, Glasser RJ, Nevins TE, Michael AF: Lab Invest 36:527, 1977) support the concept that irreversible epithelial cell injury may be the primary event in the development of FS.


Glycoprotein synthesis, transport, and secretion by epithelial cells of human rectal mucosa: normal and cystic fibrosis. The synthesis, transport, and secretion of glycoprotein by human rectal epithelium from normal volunteers, patients with cystic fibrosis, and their disease-free siblings were studied by autoradiography of rectal biopsies pulse-labeled with 3H-glucosamine and maintained in organ culture for various intervals of up to 24 hours. Human rectal goblet and columnar cells transported 3H-glucosamine-labeled secretory products at a substantially slower rate than do comparable colonic cells in smaller mammals. Within any one biopsy sample, the movement of labeled mucus in goblet cells varied widely among cells. Even with individual cells, labeled mucous granules often did not move in concert toward the apical cell surface. Average transport time in the cells of six cystic fibrosis patients and six sibling controls did not differ significantly from those of four adult controls. The carbohydrate composition of glycoprotein secretions of rectal epithelial cells was investigated by comparing autoradiographs of 3H-glucosamine-labeled biopsies with those labeled with 3H-fucose, 3H-N-acetylmannosamine, and 35S-sulfate. The patterns of incorporation of these four precrusors into normal goblet and columnar cells suggested that both cell types may alter the quantity and composition of newly synthesized glycoproteins as they migrate, mature, and senesce. Incorporation patterns in cystic fibrosis biopsies were indistinguishable from those of sibling or adult controls. With the techniques used, no abnormalities of epithelial glycoprotein production were detected in cystic fibrosis rectal mucosa.


Colchicine-induced Mallory body formation in the mouse. Long term griseofulvin treatment of mice results in the development of Mallory bodies (MB), Griseofulvin application apparently "primed" the liver cell for MB formation, and the hepatocytes were then able to respond almost immediately with MB to a griseofulvin challenge even after a 1-month griseofulvin-free period. Colchicine, in contrast to cytochalasin B, also induced MB under these latter experimental conditions. Since intermediate filaments increase in various types of cells in response to antitubulin agents, this observation further supports the hypothesis that MB are related to intermediate filaments.


The Chediak-Higashi syndrome of cats.

The Chediak-Higashi syndrome of cats. Initial clinical, genetic, cytochemical and ultrastructural studies have characterized the Chediak-Higashi syndrome in cats. Three cats with Chediak-Higashi syndrome were found in a single line of 27 Persian cats, and three additional affected cats were produced from two prospective breedings of the original line. The disorder was characterized genetically as an autosomal recessive condition. All cats in the line with the combination of yellow eye color and "blue smoke" hair color exhibited the disorder. Four of the five cats examined had bilateral nuclear cataracts as early in life as 3 months of age. No increased susceptibility to infectious disease was observed. A bleeding tendency was noted. Abnormally large eosinophilic, sudanophilic, peroxidase-containing granules were observed in the neutrophils of the granulocytic series of blood and bone marrow by electron and light microscopy. Granules of eosinophils and basophils were also enlarged. Light microscopic studies of hair and skin revealed enlarged melanin granules. These manifestations were similar to those in man, mink, cattle, mice, and the killer whale with Chediak-Higashi syndrome. Cats are the sixth species in which this genetic disease has been reported.


Intercellular junctions in "shock lung". A freeze-fracture study. Intercellular junctions in the alveolar epithelium and in the capillary endothelium in lung from five dogs after hemorrhagic shock (mean blood pressure, 40 mm. Hg for 3 hours) and from five control dogs were observed in the electron microscope using the freeze-fracture technique. Following shock zonulae occludentes (tight junctions) in the alveolar epithelium showed alterations in substructure that were not present in control animals. These changes were morphologically similar to those reported in junctions altered after exposure to osmotic gradients with marked degradation and disappearance of junctional strands. The appearance of tight junctions in the capillary endothelium, which were of a rather poorly organized "leaky" type in control animals, was generally unaltered after shock. Disintegration and disappearance of junctional strands in "focal" regions, however, were occasionally observed. The increased pulmonary capillary permeability observed physiologically after hemorrhagic shock could be explained by such alterations of endothelial zonulae occludentes.


Cell contacts and polysomes in irradiated human jejunal mucosa at onset of epithelial repair. Epithelial ultrastructure was studied in the jejunal biopsies of irradiated cancer patients at early stages of mucosal regeneration 1 to 3 days after completing treatment. Major changes in the typical atrophic areas lacking villi were the following: (1) Cell contacts were loose between surface epithelial cells lacking signs of degeneration with extracellular gaps visible between the lateral membrane interdigitations. (2) Numerous processes from such epithelial cells extended into the underlying basement membranes and sometimes, especially in crypt areas, came into close contact with processes from underlying mesenchymal cells. (3) The epithelial cells often had enlarged nucleoli with granular threads. Increased amounts of epithelial cells were also seen with numerous membrane-free polysomes. The study suggests that at the onset of jejunal epithelial regeneration in man an epitheliomesenchymal cell interaction takes place similar to that described in normal gut development in laboratory animals. The possible significance of the close contacts between epithelial and mesenchymal cells, also seen in crypt areas of regenerated epithelium, is discussed in the light of mechanisms proposed for tissue interactions. The noticed increase in polysomes is interpreted as a morphologic sign of activated protein synthesis in the differentiating cells of the epithelium.


The effect of pregnancy on the growth of primary methylcholanthrene sarcoma isografts. Primary isografts of a highly immunogenic methylcholanthrene tumor were injected into pregnant C57/BL mice. Tumor growth was studied and compared to isografts injected into virgin C57/BL mice preimmunized with fetal antigens. Significant in vivo enhancement of MCA tumor growth was noted in both intra-and interstrain pregnant mice compared with virgin controls. In addition, active preimmunization of virgin mice with hybrid fetal liver did not result in rejection of primary tumor isografts, suggesting that fetal antigens did not contribute to the immunogenicity of this MCA tumor.


Active immunization against spontaneous tumors in mice. The incidence of spontaneous tumors was studied in a group of 136 female mice and in another group of 138 females after a sublethal dose of total body irradiation. Of the nonirradiated mice 10.2% developed mammary tumors, and 8% developed lung tumors. Of the irradiated mice 19.5% developed mammary tumors, 21.7% ovary tumors, 24.5% lung tumors, and 7.9% tumors in other organs. A vaccine was prepared for only mammary and ovary tumors through an original technique. The results showed a signficantly lower incidence of tumors in another two groups of mice that were immunized: in 80 nonirradiated vaccinated femal mice, mammary tumors decreased from 10.2% to 2.5%, and in 78 irradiated and vaccinated female mice, mammary tumors decreased from 19.5% to 8.9% and ovary tumors from 21.7% to 3.8%. Lung tumors also decreased in the latter group, suggesting a common factor protecting the immunized mice.


The treatment of gastric cancer with combined surgical resection and chemotherapy. A series of 156 patients with gastric cancer during a 15-year period were reviewed retrospectively to determine the effectiveness of combined surgery and adjuvant chemotherapy. The patients were divided into a 9-year prechemotherapy period and a 6-year chemotherapy period. Review of the data revealed an increase in the incidence of distant disease. The utilization of surgery as the only mode of treatment declined. Combination surgery and adjuvant chemotherapy utilization increased. Comparison of survival for surgery vs. adjuvant chemotherapy, expressed as percentage of survivors for each year, revealed an increase at 1 and 2 years with no difference at 3 years for all stages. A similar comparison for patients with regional spread showed an increase at 1,2 and 3 years with no difference therafter. The 5-year survival was 5% for both groups. The data has suggested that surgery and adjuvant chemotherapy increases 1-,2-, and 3-year survival rates but does not affect the longterm results.


Cardiovascular involvement by invasive thymomas. We have observed 74 cases of thymoma from 1968 to 1974. Six cases of invasive (malignant) thymoma presented in an unusual fashion with signs and symptoms of cardiovascular disease and superior vena caval syndrome. The clinical, pathological, and roentgenographic features of these cases are presented. The literature concerning cardiovascular involvement by thymoma is reviewed and discussed.


Oral cancer in Puerto Rico.

Oral cancer in Puerto Rico. All cancer cases diagnosed in Puerto Rico are analyzed and registered in the Central Cancer Registry. The incidence of oral cancer in Puerto Rico is fourth-highest in the world. (In 1972 oral cancer accounted 72% of all cancers in males in Puerto Rico.) A review of the data revealed important contrasts with reported statistics from the continental United States (e.g., 75.6% of the cases in Puerto Rico were initially treated by radiation, compared with 15.3% of the cases in Western New York States.


The survival of inoperable breast cancer treated with radiotherapy and radiotherapy followed by mastectomy. Forty-five patients with locally advanced breast carcinoma were treated by radiotherapy. Twelve of them became operable and were operated. After 3 and 4 years in comparable clinical stage the rate of metastases in the nonoperated group was 78.6% and in the operated 75%. The survival after 3 and 4 years in comparable clinical stages was similar. In more advanced stages the survival was worse. Considering the trauma of mastectomy and the similar survival obtained in our material, an international trial should be performed to decide whether inoperable breast cancer becoming operable after radiotherapy should be operated.


Nephrotic syndrome associated with gastric cancer. A patient whose nephrotic syndrome was controlled by steroids and cyclophosphamide was found to have gastric cancer. After removal of the tumor and discontinuing the steroid therapy, no recurrence of the clinical signs of nephrotic syndrome appeared, but moderate proteinuria persisted. The literature regarding the association of nephrotic syndrome with malignancies is reviewed.


Use of computed tomography in the detection of pulmonary nodules. The ability of computed tomography of the lungs to detect pulmonary nodules was compared with that of conventional chest roentgenography and whole-lung tomography. Computed tomography detected more pulmonary nodules in 10 of 29 patients studied with both computed tomography and whole-lung tomography. Computed tomography of the lungs is the most accurate noninvasive method available for detecting pulmonary nodules.


Results after hemiarthroplasty of the hip using a cemented femoral prosthesis. A review of 109 cases with an average follow-up of 36 months. Hip arthroplasty using the Thompson femoral prosthesis with methyl methacrylate fixation was performed on 109 hips in 106 patients. During an average follow-up period of 36 months, 26 patients died. Fifty-one procedures were performed for fresh fractures of the femoral neck and results were satisfactory in this group provided the patient was minimally active. Results were unsatisfactory in patients who had idiopathic avascular necrosis (18), painful, failed noncemented prostheses (6), and osteoarthritis (3). In these last three groups, one-half required conversion to total hip arthroplasty and an additional one-third had pain. Reoperation was required in 22 cases. Intraoperative death occurred in one elderly patient after insertion of cement. Results suggest that the primary indication for this procedure is in the minimally ambulatory or nonambulatory elderly osteoporotic patient who has a fresh fracture of the femoral neck.


Feminizing adrenal adenoma in a boy. Case report and literature review. Feminizing adrenal tumors in young boys are rare; such patients initially show bilateral gynecomastia, and may have signs of virilization. We present a patient with bilateral gynecomastia, left adrenal adenoma, and elevated estrogen levels but normal levels of 17-ketosteroids.


Sympathetic nerve hyperactivity in high-renin hypertension effects of saralasin infusion. We found increased levels of catecholamines in some patients who had high-renin hypertension. To study relations between angiotensin and the sympathetic nerves further, we infused saralasin, a blocker of angiotensin II, into 11 hypertensive patients being evaluated for renovascular hypertension. There were variable responses of mean arterial pressure, plasma renin activity, and norepinephrine levels. When high-renin hypertensive patients with increased levels of norepinephrine were compared with those having high renin and normal levels of norepinephrine, they showed a lesser decrease in mean arterial pressure--5 +/- 5% versus 14 +/- 4%, P less than 0.05--a decrease in plasma renin activity of 20 +/- 17% versus an increase of 77 +/- 24% (P less than 0.01), and a decrease in norepinephrine levels of 42 +/- 7% versus an increase of 10 +/- 23% (P less than 0.05) (means +/- SE). The evidence suggests that patients with high-renin levels are heterogeneous and that the primary mediator of the hypertension is sympathetic tone hyperactivity in those with increased levels of norepinephrine and angiotensin excess in those with normal levels of norepinephrine.


Serum dopamine-beta-hydroxylase activity and blood pressure. The purpose of the studies reviewed here was to investigate the role of inheritance in the regulation of human serum dopamine-beta-hydroxylase (DBH) activity. DBH is a catecholamine biosynthetic enzyme that is localized to catecholamine-containing vesicles, is released with catecholamines from sympathetic nerves and the adrenal medulla, and is found in serum. It has been suggested that serum DBH activity might be a useful and convenient measure of sympathetic nervous system function. DBH activity was measured in blood from large, randomly selected populations of children, adolescents, and adults and in blood of relatives of children with very low serum DBH activity (less than 50 units). The results of sibship and pedigree analyses of data from families of probands with very low enzyme activity were compatible with autosomal-recessive inheritance of very low serum DBH activity. In addition, the results of studies of immunoprecipitable serum DBH were compatible with a genetically mediated decrease in the quantity of DBH protein in the blood of subjects with this allele. No significant correlation of serum DBH activity with either systolic or diastolic blood pressure was found in a large, randomly selected population of children.


Agreement among three different indices of sympathetic nervous system activity in essential hypertension. Although plasma norepinephrine concentration often is elevated in patients with essential hypertension, the relevance of this to the pathogenesis of the blood pressure elevation remains uncertain. If the high concentration of plasma norepinephrine truly indicates sympathetic nervous system overactivity, it should be accompanied by hemodynamic features suggestive of sympathetic cardiovascular stimulation. This proposition was tested, and in part confirmed, in a study performed on 21 patients who had mild essential hypertension and on 11 normal subjects. Among hypertensive patients, plasma norepinephrine concentration was related to cardiac function but not to the level of the blood pressure or to total peripheral vascular resistance. Plasma norepinephrine concentration correlated significantly with heart rate and cardiac preejection period index at rest and with changes in cardiac output, heart rate, and preejection period after cardiac beta-adrenergic blockade produced by propranolol, 0.2 mg/kg intravenously. Patients with an elevated plasma norepinephrine concentrations (9 of 21) showed features of sympathetic cardiac stimulation, manifested by an elevated mean cardiac index and heart rate at rest and by normalization of both after treatment with propranolol. Thus, substantial agreement existed among three commonly used indices of sympathetic nervous system activity--plasma norepinephrine concentration, general hemodynamics at rest, and the hemodynamic response to pharmacologic autonomic blockade.


Biochemical and morphologic study of catecholamine metabolism in spontaneously hypertensive rats. Catecholamines and catecholamine-synthesizing enzymes have been studied quantitatively in specific brain areas of spontaneously (genetically) hypertensive rats by means of a combination of sensitive enzymatic-isotopic methods and a microdissecting technique. Changes in catecholamine metabolism were found to be localized to regions of the brain implicated in the regulation of blood pressure. Noradrenaline levels were decreased in specific nuclei of the anterior hypothalamus and in the nucleus interstitialis striae terminalis ventralis. The activity of the adrenaline-forming enzyme, phenyl-ethanolamine-N-methyl transferase, was increased in the A1 and A2 areas of the brain stem. These results implicate catecholamine-forming neurons in the hypothalamus and brain stem in the development of spontaneous hypertension in rats.


Central nervous system actions of clonidine in hypertension. Among 42 patients converted from clonidine to another antihypertensive medication, few sympathomimetic side effects were observed if the clonidine dosage had been less than 1.2 mg daily. Among a majority of 14 patients who had been taking larger doses, the previously reported syndrome of sympathetic hyperactivity was observed. It is particularly important to follow up patients who discontinue clonidine when this drug has been taken in excess of 1.2 mg daily.


Changes in albumin uptake during the lifespan of human fibroblasts in vitro. It has been suggested that a deterioration of cell membrane functions in cell populations with a limited lifespan in vitro could explain the loss of division potential either through changes in permeability of in cell attachment. We analyzed membrane function measuring the uptake of iodinated human serum albumin (125ISA) at different passages during the lifespan in vitro of human adult lung fibroblasts. Monolayers were incubated with 100microng/ml 125ISA. One and sixty minutes later, cultures were washed and the cell bound radioactivity was determined; these values correspond respectively to adsorption and net uptake. Our results show a significant increased uptake of albumin by aging cells. The changes in cell permeability, however, are apparent only late during the life span. Old cultures were also more susceptible to the stimulatory action of polyornithine (PLO) on protein uptake. Results obtained with PLO on young cells showed that the cell takes up more albumin when there is membrane danage leading to leakage of proteins. These findings suggest that the increased uptake of albumin and the suceptibility to PLO are signs of membrane damage in cells that have reached the end of their lifespans. In that case, an increased protein uptake would be the prelude to cell death.


Age related changes in the lipids of the microsomal and the mitochondrial membranes of rat liver and kidney. The lipid contents of the microsomal and mitochondrial membrane fractions of liver and kidney were determined in 6 and 24 month old rats. A significant age related increase in the molar ratio of cholesterol/phospholipid was observed in all membrane fractions. A significant age related reduction of phospholipid was noted in the microsomal fractions of liver and kidney. The relative amount of phosphatidylethanolamine was found to decrease in all membrane fractions during aging. Membrane glyceride content, however, remained relatively constant with age. Significant increase in oleic acid was seen in the neutral lipid of both liver and kidney and in the polar lipid of kidney. Significant increase in docosahexaenoic acid and significant decrease in linoleic acid were seen in the polar lipid of the liver membrane fractions. Possible alterations in membrane physiochemical properties and in membrane function due to these age related lipid changes are discussed.


Rabbit erythrocyte survival following diminished sialic acid and ATP depletion. The limited deformability and ATP depletion was considered by some authors to be the factor limiting the life span of old red blood cells (RBC) in circulation. Others believed that sialic acid on the RBC surface determines their life span. We compared the life span of 51Cr labelled, neuraminidase treated rabbit RBCs with ATP depleted by incubation at 37 degree C rabbit RBCs. Osmotic fragility, agglutinability, glucose-6-phosphate dehydrogenase (G6PD) and hexokinase activity and ATP levels of these cells were determined. Desyalated RBCs were removed from the circulation within 24 hours. ATP levels, G6d and hexokinase activity and osmotic fragility were normal in these cells. The agglutination by poly(L-lysine) was affected by the loss of surface charge on these cells. Half the ATP depleted RBCs were out of the circulation within three days. Reconstitution of ATP by reincubation with adenosine, elevated the ATP levels to about 80% of their original level, but survival of these cells did not improve. Analysis of sialic acid showed tha 50% of it was removed during the incubation for ATP depletion. The low ATP level and loss of sialic acid fromt he RBC membrane appeared to be conincidental rather than dependent on each other. The latter appears to be a primary factor in red cell survival.


Macromolecular synthesis in human fibroblasts at 37 degrees and 42 degrees C during aging in vitro. A normal strain of human skin fibroblasts was pulse labelled at 42 degrees and 37 degrees C during intervals of the in vitro lifespan with 3H-thymidine, 3H-uridine and 14C-phenylalanine, precursors of DNA, RNA and protein synthesis, respectively. No increased heat lability could be detected in the relative profiles of precursor incorporation at the two temperatures until terminal stages of passage when a minor increase in heat lability appeared in RNA and protein synthesis. Early passage cells, grown in the presence of the substrate analogues, p-fluorophenylalanine or 5-fluorouracil, showed a moderate increase in relative heat lability but comparable patterns were not evident in drug-free cultures, even at terminal stages of passage. Although the results indicate that defects exist in enzyme pathways for macromolecular synthesis at terminal stages of growth and in the presence of analogues, they do not support the hypothesis that such defects are causal to the onset of cellular aging in vitro.


Effects of pyrazole treatment of physical status and brain biogenic amines in rats. The recovery of brain noradrenaline (NA) from a single dose of 100 mg/kg pyrazole was rapid, but after 500 mg/kg brain NA levels were still maximally reduced 3 days later and did not return to normal until 7 days after injection. The consumption of water followed a similar time course at this dose. Sub-acute experiments were carried out in two sets of animals: those with free access to food and water throughout the experiment and those which during the latter half of the experiment received a known, restricted quantity of food and fluid by gastric intubation. Diet restriction did not alter the pyrazole induced decrease in brain NA and potentiated the decrease observed in the heart. A significant increase in brain 5-hydroxyindoleacetic acid was observed with pyrazole 100 mg/kg in both diet schedules. In addition to the disturbances in food and water consumption, pyrazole also caused a decrease in locomotor activity which was only partly due to the starvation. Rectal temperature did not change. At the higher pyrazole dose in the rats fed by intubation there was incomplete emptying of the stomach. It is concluded that these many changes demonstrate the non-specificity of pyrazole and caution is advocated in its use combined with ethanol in research on experimental alcoholism.


Platelet monoamine oxidase, plasma benzylamine oxidase and liver mixed function oxidase in cirrhotic patients. Because it has been suggested that an accumulation of false neurochemical transmitters plays a part in the cardiovascular and neurological complications of cirrhosis it appeared worthwhile to study the level of monoamine oxidase in the liver and platelets of cirrhotic patients. In fact a decrease of such activities might explain the increase of false neurotransmitters observed in cirrhotic patients. Other enzyme were also tested: the plasma benzylamine oxidase activity and the liver mixed function oxidases. 13 cases of severe cirrhosis (B, C according to Child classification) and 10 cases of less severe cirrhosis (A according to Child classification) were studied in comparison to patients affected by cholelithiasis. A defect in the level of monoamine oxidase activity of platelets and liver was observed in some cirrhotic patients together with a decrease of the level of the liver mixed function oxidases.


Detection of platelet-bound IgG with 125I-labelled staphylococcal protein A. 125I-labelled protein A from Staphylococcus aureus binds effectively with platelets coated either with specific antibodies or with unrelated immune complexes. Protein A can therefore be used to measure these serum factors. A prior dilution of the serum enhances markedly the reactivity of the serum in idopathic thrombocytopenic purpura. This may be due to abolished inhibition exerted by normal monomeric IgG.


Low-resistance skin points that may coincide with acupuncture loci. Electrical resistance of skin was studied with the aid of a specially designed meter that compared the resistance per surface area of small skin points with that of the surrounding skin. In a systematic study of the hands, face and ears in five subjects low-resistance skin points were repeatedly found in characteristic loci, comparable in different individuals and symmetric about the body midline. The low-resistance skin points had diametres of 1.5 +/- 0.5 mm and their borders were abrupt. On the dry skin resistance values were around 10 kilo-ohms at the center of the points but around 3 mega-ohms in the surrounding skin. Voltages could also be recorded at these points, but they proved to be result of electrode polarization reflected at these points because of their low electrical resistance. The distribution of the low points in the hands, face and ears resembled that of classical acupuncture points.


[Cholecystectomy and experimental coloncarcinoma (author's transl)]. The influence of cholecystectomy on the development of carcinoma of the colon is investigated. The experimental results show a significant high rate of carcinoma of the colon induced by subcutaneous injection of 1,2-Dimethylhydrazin (DMH) in the mouse after cholecystectomy. After 10 weekly injections of 15 mg/kg DMH 70% of the animals with cholecystectomy developed carcinoma. Only 16% of the mice with similar treatment but without cholecystectomy had carcinoma. The cocarcinogenic effect of cholecystectomy is assumed to be due to the increased production of secondary bile salts by the colonic bacteria and the lacking of the resorptive function of the gall bladder for some carcinogenic substances passing through the liver. The background of this experimental studies is the clinical findings that 10% of patients with carcinoma of the large bowels had a cholecystectomy previously.


[A new method of bowel preparation (author's transl)]. Experience with whole-gut irrigation as a new method of bowel preparation in 50 patients undergoing surgery is described. The use of this technique the physiological records and the very satisfactory results are discussed. This new method should replace all other type of procedure of bowel preparation.


[Continence after low anterior resection (author's transl)]. In 28 patients we studied the fecal continence after low anterior resection of the rectum. After an usual proctological investigation we did in all patients measurements of the anorectal function, such as pressure measurement, electromyography and determination of the anal-rectal angle. In 12 patients a defecatogram was performed. Of the 28 patients with anastomoses lower than 8 cm only one was after 2 years still incontinent. All the other patients were completely continent. This fact could be proven objectively.


[Malignant degeneration of experimental ulcerative colitis of the rat following s.c. injection of 1,2-dimethylhydrazine (author's transl)]. Animal experiments were performed to answer the question whether ulcerative colitis is predisposed to malignant degeneration. Male Wistar rats were given aqueous solutions of degraded Carrageenan (4%; w/v). After induction of ulcerative colitis, 1,2-Dimethylhydrazine (DMH; 132 mg/kg body weight) was applicated during a period of 7 weeks. 17 of 18 rats developed multiple adenocarcinomas in the distal colon 15 weeks after the last injection of DMH. The Carrageenan induced colitis was localized predominantly in the distal part of the large bowel. Only 3 rats of a control group of 18 animals exposed to DMH only showed carcinomas of the colon. The difference is proven significant (P less than 0.01). Carrageenan for itself caused no malignancy. The results of the experiments demonstrate that, during ulcerative colitis, the colon of the rat is more susceptible to induction of cancer than the intact one.


[The treatment to the high gastric ulcer (author's transl)]. This is a report on 64 patients, who were operated on because of gastric ulcer situated near the cardia. We found the best results after the so-called step-like resection, which is preferable to selective vagotomy with excision of the ulcer and pyloroplasty because of the special conditions of the secretion of gastric juice in the case of high ulcers. Because of the danger of the development of a cancer in a B-II-stomach we prefer the B-I-anastomosis. For ulcers with stenosis of the esophagus a cardiofundectomy should be performed. Ulcers high on the greater curvature and in the fundus should be excised and a distal gastrectomy (B-I) should follow. The sole excision of the ulcer or the operation according to Kelling-Madlener are not recommended.


Lipomas presenting as parotid tumors.

Lipomas presenting as parotid tumors. Eleven cases of lipoma in the parotid region have been reviewed. Nine tumors were found to be compressing the lateral surface of the parotid gland (periparotidlipoma). One lesion was totally surrounded by salivary tissue, and another involved both the superficial and the deep lobes of a parotid gland (intraparotid lipoma). The tail of the gland was involved most frequently (six patients). The tumors were predominantly right sided (eight cases). All patients were treated by surgical excision. Only one tumor has recurred and this has apparently been successfully treated by a reexcision.


Oncocytic neoplasms of salivary glands: an ultrastructural study. The oncocyte is a peculiar cell found in the aging parotid gland. A precise definition of oncocytic tumors in now available using histochemical and electron microscopic techinques. Oncocytic carcinomas are very rare; only a handful have been cited in the literature. This is the first description of the electron microscope features of oncocytic carcinomas we can find in the literature. The cells of these carcinomas are characterized by mitochondrial hyperplasia, pleomorphism and atypism. The cells contained few other subcellular organelles and no myofilaments or glycogen as previously described in benign oncocytomas. In addition to these electron microscopic features, the clinical presentation, treatment, and biologic course of these three cases of oncocytic carcinoma and two cases of benign oncocytoma will be presented.


Oral manifestations of herpes simplex virus infections. Most individuals are infected with Herpes Simplex in childhood usually suffering a mild febrile illness of no consequence. Later some individuals suffer recurrent infections which appear as cold sores on the lip while others intermittently shed virus in the oro-pharygeal secretions. Adults uninfected in childhood may be exposed to viruses for example by kissing and develop an acute primary herpes with fever and gingivo-stomatitis occasionally requiring hospital admission. Awareness of this condition is required for diagnosis after which the majority of patients seen in otolaryngological practice need only supportive therapy, explanation and reassurance. Recurrent cold sores are no more that a nuisance in most patients, but occasionally they are severe and in others the cold sore may precipitate oral erythema multiforme. Unfortunately the treatments available for recurrent cold sores are rather unsatisfactory.


Facial injuries in hockey players.

Facial injuries in hockey players. As otolaryngologists become more involved with maxillofacial trauma, we are encountering an increasing number of athletic injuries. Ice hockey accounts for a large number of these facial injuries. The fast moving and random nature of the game, frequent body and equipment contact and lack of protective devices, predisposes the hockey player to facial injury. Because of the roughly tenfold increase in hockey participation over the last decade, the problem of facial injury prevention has become a significant public health problem in North America. Review of the medical literature shows a paucity of interest in the subject of facial injury prevention in hockey. Several articles have dealt with ocular injury, while other articles have dealt with the general subject of hockey injury with only scant attention paid to the facial area. A retrospective study was carried out to more clearly define the scope of the facial injury problem. Four levels of hockey play were examined. Individuals from the youngest and most inexperienced to seasoned professionals were studied. An individually completed questionnaire was received from players in each group. It is the purpose of this paper to indicate the rates of injury for the various types of facial trauma, present their mechanisms of occurrence and discuss means of preventing facial injury in hockey players.


Fractures of the orbital floor.

Fractures of the orbital floor. The charts of 324 patients treated for 363 orbital floor fractures between 1965 and 1973 were reviewed retrospectively. Of these, 38 (11 percent) were isolated floor fractures, 27 (8 percent) were rim and floor fractures, 168 (46 percent) were trimalar fractures and 130 (35 percent) were associated with complex facial fractures. On initial examination, 31 percent of the patients were found to have diplopia and 4 percent enophthalmos. Orbital prolapse was suspected in 31 percent of the patients. Thirty-seven percent of the patients had demonstrable ocular injury at the time of initial examination. Treatment was surgical in 336 of the fractures and non-surgical in 29. Of the surgical patients 140 had no support placed, 120 had antral support only, 51 had both antral support and orbital implant, and 20 had an orbital implant only. Postoperatively the incidence of diplopia was 8 percent in all patients, and 7 percent had enophthalmos. A smaller group followed for more than five months, were found to have diplopia in 17 percent and enophthalmos in 11 percent. Of the 29 patients treated non-surgically, none had persistent diplopia.


Nasofrontal-ethmoidal injuries.

Nasofrontal-ethmoidal injuries. Our experiences in managing 17 patients with nasofrontal-ethmoidal injuries is reviewed. The treatment of frontal injuries, cerebrospinal fluid leaks, and pseudohypertelorism is discussed.


Dental aspects of maxillofacial injuries. The chief progress of maxillofacial surgery in recent years has been the preservation and the retention of functional tissue. The recent advances in microvascular and reimplantation surgery are examples. Similarly the preservation of the masticatory apparatus is best served by the retention of all viable components. Additional benefits derived from this approach include the facilitation with alignment of the bony fragments, proper occlusion of the teeth and maintenance of the vertical relationship between the upper and lower jaws; in addition to the restoration of appearance and the functions of mastication and speech. Although injuries of the teeth and their supporting stuctures at first glance may seem to be simple problems, frequently they turn out to be complicated. The most common injury is partial avulsion of the alveolar bone with loss of attached teeth, which may produce a severe defect in the jaw bone. During healing there is additional resorbtion of alveolar bone, which is quite a normal physiologic phenomenon. Therefore, the eventual defect is likely to be more severe yet. For this reason more concern should be shown for these lesser injuries.


Mandibular fractures: a review of 156 consecutive cases. This report deals with a consecutive series of 156 mandibular fractures that were managed during a three-year period. The age and sex incidence are presented and the causative factors of the trauma are discussed. The fractures are classified according to anatomic site and laterality. The majority of the patients were treated with closed reduction techniques and the reasons for open reduction are tabulated. The results and complications of the treatment are enumerated. A conservative technique is described for open reduction of fracture-dislocations of the condylar head.


Mucous glands in the developing human rhinopharynx. In 42 fetuses and prematures, the entire mucosa from the rhinopharynx was stained by various whole-mount methods. The development, growth, spread, distribution, situation, and size of the glands were determined. The development starts in the 11th week below the tubal orifice, whence the glands spread to the entire rhinopharynx. The number increases gradually by about 60-70 glands a week. By the 23rd week, there are 1,100-1,200 glands in the rhinopharynx. After that juncture, there is presumably no further new formation. The density and size of the glands were at a maximum in Rosenmüller's recess, below the tubal orifice, and in the salpingopharyngeal fold, least anterior to the tubal orifice and at the junction to the pharynx. The role of the sero-mucous glands in the rhinopharynx under normal and abnormal conditions is dicussed.


Probocis lateralis: case report and embryologic analysis. A child with a lateral trunk replacing one side of the external nose is presented with a detailed X-ray study of the deformed head. In the explanation of the etiology and teratogenesis of this facial anomaly, the modern embryologic development of the head is reviewed and correlated with the findings of this anomaly. It is felt that the lesion responsible for a proboscis lateralis involves the organizer tissue for the naso-face. As a secondary phenomenon, the development of the maxillary process is retarded and a spectrum of defects, common to many mid-face derangements, is identified and explained.


[A little known source of lead poisoning: rasp and file manufacture (author's transl)]. Seventy-two subjects employed in rasp manufacturing and, especially, manual "engraving" were studied by the authors, mainly in order to find out whether lead poisoning could be induced by their particular working activity. Twelve subjects (16.7%) were found to have standard biological parameters for lead (blood lead, urinary delta-ALA and urinary coproporphyin levels) within normal limits. Twenty-five (34.7%) showed hematochemical and urinary signs of increased lead absorption, and 35 (48.6%) marks of lead poisoning, more or less severe. The manufacturing process was then studied and working places were inspected too. Finally, lead poisoning was found to be due to a small lead block, used by hand-engravers in order to avoid damages to the already engraved surfaces of the rasps. This survey leads therefore to the conclusion that rasp manual engraving has to be included among the working activities which can induce lead poisoning.


[Chronic broncopneumopathy and pneumoconiosis in workers employed in phosphoric acid production (author's transl)]. Thirty-five subjects employed in a phosphoric acid producing plant were studied by the authors. The investigation included: history, according to the C.E.C.A.  questionnaire for chronic bronchitis and emphysema; physical examination, chest X-ray spirometry and lung diffusing capacity for carbon monoxide by the steady state method (DLCOSS). High prevalence of chronic bronchitis (45.7%), obstructive spirometric impairment (37.1%), and decreased values of DlcoSS (31.4%) were detected. Two subjects were found to be affected with p 1/0 and 7 with p 0/1 pneumoconiosis. Such findings were significantly related to the lenght of working activity as well as to dust and gaseous fluoride (hydrofluoric acid, hexafluorosilicic acid and silicon tetrafluoride) exposure.


Scuba diving deaths: a review and approach for the pathologist. A series of 34 cases of SCUBA-related fatalities in military personnel from the files of the Armed Forces Institute of Pathology has been presented. It may be concluded that the potential problems that can occur in the hyperbaric aquatic milieu while using scuba are not completely appreciated by pathologists. The resulting investigations of such fatalities give little hard data relevant to such entities as true incidence of barotraumatic injuries, aseptic bone necrosis, and contaminated air supply, the interrelationship of human, environmental, and life support system factors in such fatalities, and the pathophysiologic sequences leading to drowning or death due to causes other than drowning. Hyperbaric pathophysiology is reviewed with the hope that more reasonable interpretations of cause and mechanisms of death will be possible, and the entities air embolism and decompression sickness are differentiated in a similar light. The importance of the type of SCUBA is discussed, through analysis of ten operational diving fatalities, and the possibility of anoxia, hyperoxic convulsions, and hypercapnia existing with the use of rebreather SCUBA is emphasized. A general approach to the medical investigation of a SCUBA fatality is given, under broad headings including on-the-scene investigation, clothing and equipment examination, external and internal examinations, and toxicologic examination.


Factors affecting contamination of blood samples for ethanol determinations. Contamination of blood samples collected for alcohol analysis from swabbing with an ethanolic antiseptic is minimal (less than 0.6 mg/100 ml or 0.0006 percent ethanol) when routine clinical technique is followed. When technicians were told to be deliberately sloppy, considerable contamination (89 mg/100 ml or 0.09 percent ethanol) occurred. The incidence and extent of contamination from banked blood intended for transfusions are minimal. Two percent of the 1,450 samples analyzed contained alcohol. The average blood alcohol concentration was 26 mg/100 ml or 0.03 percent ethanol. One microliter of rubbing alcohol per milliliter of whole blood, or one-tenth of a drop of rubbing alcohol per milliliter of whole blood, increases the BAC 56.5 mg/100 ml (0.06 percent ethanol) and 67.5 mg/100 ml (0.07 percent ethanol), respectively.


Microscopy of human fetal lung and the diagnosis of postnatal respiration. 1. The difficulty of correlating the microscopic appearances of the lungs in cases of stillbirth and early postnatal death with the results of hydrostatic tests in these cases is stressed. 2. Histologic criteria which depend on the presence of alveoli as evidence of extrauterine respiration are criticized. 3. The view is submitted that the alveolar pattern is the result of a normal developmental process occurring in utero, possibly accentuated by intrauterine fetal respiratory movements, but independent of extrauterine respiration. 4. The glandlike appearance of the lung which has been illustrated in standard textbooks as an example of unrespired fetal lung is probably seen only in relatively early embryos in whom the problem of respiration is unlikely to arise. 5. At or near term the alveolar pattern in the human fetus has developed, certainly in parts of the lung, to such a degree in utero that it cannot readily be distinguished from the pattern seen in the newly-born infant who has breathed for a short time in an extrauterine environment. 6. This view that the alveolar pattern is already fairly well developed at full-term makes for a more intelligible appreciation of the structural appearances seen in the immediately postnatal lung as well as of the physiology of respiration with the first extrauterine breath. 7. The views outlined for the development of the human lung in utero are completely corroborated by experimental studies on pig embryos, intraocular lung implants and the structure of sequestrated lung tissue unconnected with the respiratory tract. 8. Microscopic examination of the lungs may assist in determining fetal age. 9. The medicolegal significance of these observations is discussed.


Dietary control of the chain elongation of palmityl-CoA in rat liver microsomes. The rate of chain elongation of palmityl-CoA to stearyl-CoA in rat liver microsomes was studied in connection with the nutritional status of the rats. The microsomal chain elongation activity, which had been decreased by starvation for 48 hr, was rapidly increased to a high level on refeeding. The apparent Km value for malonyl-CoA in both normal and refed rats was the same, 1.2 X 10(4)M. Both cycloheximide and actinomycin D prevented the induction of microsomal chain elongation activity which was associated with refeeding. In addition, the activity of acyl-CoA hydrolase and the rates of esterification of acyl-CoA into phospholipids and neutral lipids in microsomes were not changed by the dietary alteration. These results support the conclusion that changes of the activity of microsomal chain elongation of palmityl-CoA in various nutritional status result from a rapid synthesis of new enzyme(s).


The phospholipids of rabbit type II alveolar epithelial cells: comparison with lung lavage, lung tissue, alveolar macrophages, and a human alveolar tumor cell line. The phospholipid composition of type II alveolar epithelial cells from the rabbit was compared with that of alveolar macrophages, lung lavage and lung tissue. In addition, the phospholipid composition of a human alveolar tumor cell line, which is morphologically similar to type II cells, was examined. Phosphatidylcholine accounted for 48% of the total phospholipid in the type II cells, 41% in the tumor cells, and 30% in the macrophages. Phosphatidylcholine was 51% disaturated in the type II cells, 54% in lung lavage, 39% in whole lung, 29% in lavaged lung and macrophages, and 16% in the tumor cells. Palmitic acid was the major fatty acid in phosphatidylcholine from all samples with the exception of the tumor cells in which almost half of the fatty acids were accounted for by oleic acid. The phospholipids of the type II cells were more similar to those of lung lavage, and thus surfactant, than to lung tissue and macrophages. This is consistent with their supposed role in surfactant production. The tumor cells, although morphologically similar to type II cells, were quite different with respect to phospholipid composition.