Pepstatin, an ascites retardant of L1210 tumor-bearing mice. The effect of pepstatin on the kinetics of ascitic fluid accumulation in L1210 tumor-bearing mice (DBA/2) was observed. Following inoculation of 1.5x10(6) tumor cells, untreated mice reached a peak of fluid accumulation on day 6 and remained at this level until death on day 9. A "lag" phase of 4 days occurred before fluid accumulation was seen. Pepstatin administered SC in a single dose of 80 mg/kg during the lag phase, significantly retarded fluid accumulation as compared to untreated animals. Pepstatin administered following fluid accumulation was much less effective. We concluded that pepstatin prevents fluid accumulation rather than acts as a diuretic agent. The term "ascites retardant" is suggested for the pharmacologic actions of pepstatin, since it prevents fluid accumulation without diminishing the cell count.


Effect of different doses of BCG on an allogeneic cell-mediated antitumor response in mice. The effect of BCG on the development of cell-mediated cytotoxicity (CMC) in the spleens of allogeneic tumor-bearing (C57BL/6 X A)F1 mice was studied. BCG-treated tumor-bearing animals elicited a stronger CMC response than did the untreated tumor-bearing animals. Furthermore, the degree of activation was dependent on different doses of BCG, so that if the BCG was administered at doses above or below the optimum dose, a less marked stimulation of the CMC resulted. The combination of BCG given before the tumor implant plus an intratumor inoculation resulted in a significantly higher CMC than did either treatment alone.


Glycosyltransferase levels in tumors metastatic to liver and in uninvolved liver tissue. Elevated levels of three plasma glycosyltransferases were associated with neoplasia in cancer patients, notably those with tumor metastatic to liver. We examined levels of sialyltransferase, galactosyltransferase, and fucosyltransferase in metastatic tumor and apparently uninvolved host liver tissue in attempts to delineate possible sources of elevated plasma enzyme levels. Highest levels of fucosyltransferase activity were found associated with tumor tissue; in contrast, sialyltransferase and galactosyltransferase activity was often highest at the tumor-liver interface.


Cell proliferation in human cutaneous squamous cell carcinoma. Squamous cell carcinoma (SCC) of the skin, a fairly slow-growing locally invasive tumor that occasionally matastasizes, was studied in 12 patients in vivo with the use of intralesional tritiated thymidine as a marker for cell proliferation kinetics. Analysis of the cell cycle of the germinative population revealed that the duration of S-phase was 12.5 hours; G1-phase, 28.8 hours; mitotic period (M-phase), 2 hours; G-pahse, 6.9 hours; and the total germinative cell cycle, 50.2 hours. The application of cell kinetics to programming chemotherapy for skin cancer with phase-specific cytotoxins was discussed.


Hormonal status of breast cancer. III. Further analysis of ovarian-adrenal dysfunction. Detailed studies of urinary steroids in patients with breast cancer and normal controls have shown that abnormal aging processes and depressed corpus luteum function were associated with the presence of this form of cancer. The ratio of androsterone to tetrahydrocortisol, an index of the aging process, was significantly lower in a breast cancer group than in a normal group at both premenopausal and postmenopausal stages. In premenopausal women, the ratio decreased in the order of rural controls, urban controls, and patients with breast cancer. It was indicated that the ratio may serve as a measure of risk for breast cancer. Aside from the general depression of menstruation-dependent steroids, breast cancer was associated with disproportionately low excretions of prenanediol and pregnanetriol within the menstruation-dependent steroid family. The notion that this finding reflects the delay or complete failure of ovulation was supported by a reduced parturition rate of our patients with breast cancer as compared with that of our normal controls. The physiologic significance of steroidal disturbances was considered in relation to the genesis of breast cancer.


Relationship between steroid excretion patterns and breast cancer incidence in Israeli women of various origins. A nationwide study of the steroid excretion patterns in postmenopausal Israeli migrant women demonstrated differences between high- and low-risk groups for breast cancer in the following variables: age at first parturition, number of pregnancies, number of live births, height, and weight. The direction of the differnces was in line with those observed for breast cancer patients. The groups also differed in the exretion of estriol, 17-ketosteroids, and allotetrahydrocortisol. Multiple regression analysis revealed that the exretion of estriol was significantly lower in population groups in whom breast cancer incidence was high. Possibly this trend--which has also been observed in adolescent and premenopausal women--reflected environmental influences on peripheral estrogen metabolism.


Surgical aspects of intestinal ascariasis. At the University College Hospital, Ibadan, Nigeria, a common differential diagnosis of acute abdomen is intestinal ascariasis. This condition mimics many causes of acute abdomen so that accurate pre-operative diagnosis depends mainly on a high index of suspicion.The purpose of this paper is to call attention to this condition which is prevalent in tropical countries, where preventive and social medicine have not reached their peak, and to review the pathological processes resulting from this disease.


Care of the patient with a critical illness. A method of care applicable to all forms of critical illness is presented. A patient is considered to be critically ill when he is threatened with hypoxia. According to this concept, procedures to understand and solve problems of critical care are coordinated and unified. The relevant physiology and monitoring of the components of the oxygenating system are described. The treatment of patients with impaired function of these components is described.


The gold button technique for intraoral interstitial implants with iridium-192 seeds. The higher the radiation dose, the better is tumor control. High tumor doses are feasible only by interstitial irradiation. To achieve uniform dose distribution throughout the area or volume of implant, one has to use established distribution rules. In straight tube technique we have to use heavy endloading to compensate for uncrossed ends. In implants for intraoral lesions, heavy endloading gives a high dose to the opposing normal mucosa. The new gold button technique considerably reduces the dose to the normal mucosa, thus minimizing the morbidity.


Cancer of the prostate in blacks.

Cancer of the prostate in blacks. The exact etiology of adenocarcinoma of the prostate gland remains an enigma. However, there appears to be a clear-cut mandate to search for, and to eradicate if possible, all infections of the genital tract including prostatitis. Diets with adequate zinc or zinc supplements should be considered. Sexual practices could be more closely scrutinized. Finally, an urgent appeal is made for intense investigation of this malady.Two cases of prostatic carcinoma are presented and pertinent literature is reviewed.


Albright's syndrome in a Nigerian: a case report. A Nigerian male with typical features of Albright's syndrome will be described. Although the lesions were predominantly unilateral, his main complaint was that of severe facial deformity. He had a radical excision of the facial lesion which was followed by a rapid recurrence. The differential diagnosis of Albright's syndrome will be discussed.


Success rate of detoxification from methadone maintenance in an ambulatory care unit. The success rate of detoxification of patients on methadone maintenance in four outpatient clinics is studied. In comparison with patients in an in-house program, or a hospital environment, the study group did relatively poorly. It is felt that a confined and carefully structured therapeutic environment is much more likely to produce patients who are amenable to successful detoxification from hallucinogenic drugs, than is a walk-in clinic.


Pulmonary edema: an anatomic, pathophysiologic, and roentgenologic analysis. Pulmonary edema is a complex subject. Knowledge of the anatomy of the distal air space is essential to the understanding of the pathophysiology of pulmonary edema.Histological evaluation of experimental pulmonary edema in dogs by Staub et al using the quick freeze method indicates that the edema begins in the interstitium. An x-ray examination at this time would be interpreted as negative or normal. Similarly, with only partial filling of the alveolus, a negative reading may be given.A method for classification of pulmonary edema by mechanisms is reviewed.Cases of pulmonary edema caused by different etiologies are presented for an overview of the problem.


The drug insert and the physician's concern. The package insert has achieved an increasingly important role, not only as a device to communicate prescribing information to physicians, but also as a key element in the standards used to determine the liability of physicians for adverse drug reactions. Regulations recently proposed by the FDA illustrate the significance of the package insert from the governmental perspective. This paper deals with the impact of these regulations on the medical profession.


A closed-flow water caloric system.

A closed-flow water caloric system. This paper describes a new method and apparatus to induce nystagmus. Flow of fluid into the ear to induce nystagmus is eliminated by utilization of a closed-flow system. A probe adapted for insertion to a standardized depth into the ear, provides a flow-through path for nystagmus-inducing liquid while expanding in response to the pressurized liquid to conform to the contours of the external auditory canal and tympanic membrane. Thermal conductivity through the membrane-like probe material permits heat exchange between the flowing liquid, and the external auditory canal and/or tympanic membrane to induce nystagmus.At this time, the authors can state only that the quality of nystagmus produced is similar to that produced by current conventional methods. In the small number of patients tested, discomfort appeared to be almost negligible. The system appears to be a promising improvement dependent on the establishment of accurate parameters for diagnosis.


Adverse effects of intravenous cannabis tea. Adverse effects occurred in four youths after intravenous injection of an aqueous cannabis-seed tea, which was prepared by boiling the seeds. The effects were immediate and included nausea, vomiting, abdominal pain, watery diarrhea, chills, fever, hypovolemic shock, hypotension, and non-oligemic transitory renal failure. Other manifestations included persistent hypoglycemia, tachycardia, gastrointestinal bleeding, conjunctival hemorrhage, injury, jaundice, splenomegaly, leucocytosis, myalgia, arthralgia, motor weakness, and prostration. Ischemia was noted on electrocardiogram (EKG). All manifestations appeared to reverse within weeks, but these effects had been potentially fatal.


Non-Hodgkin's lymphoma in Ibadan, Nigeria. One hundred patients with non-Hodgkin's lymphoma were admitted to the University College Hospital in Ibadan, Nigeria between 1960 and 1975. Their cases have been analyzed with respect to clinical findings, histological classification, and response to therapy. There was a preponderance of males over females (2:1) and the majority of the patients (87 percent) had reticulum cell sarcoma. Therapy consisted mainly of single-agent chemotherapy but a few patients had either surgical excision combined with chemotherapy or multiple-agent chemotherapy. The results of treatment were poor because of the very high default rate, late presentation, inadequate supply of drugs, and lack of radiotherapeutic facilities.


Osteomyelitis of the calcaneus secondary to heel pad puncture: a case report. Heel pad puncture, a well-established procedure for obtaining hematologic samples from infants, may be complicated by acute osteomyelitis of the calcaneus. One such case is presented which involved a 3½-month-old female. Physicians are cautioned that calcaneal osteomyelitis should be suspected if soft tissue swelling and erythema are present around the heel area.


The strip graft as a means of hairline replacement. The strip-graft hairline replacement is a surgical procedure requiring meticulous tissue handling and attention to detail. Even then, the unpredictability of successful "takes" causes the cosmetic surgeon some concern. When combined with the original Orentreich autograft technique it can be valuable in the surgical treatment of male pattern baldness.


Another look at pseudotumor cerebri.

Another look at pseudotumor cerebri. Thirteen black patients with diagnoses of pseudotumor cerebri (benign intracranial hypertension) were treated in Howard University (Freedmen's Hospital) between 1962 and 1974. These patients presented features similar to others reported with this syndrome as regards age, sex, habitus, menstrual irregularities, treatment, and prognosis. There was no suggestion of higher incidence of the syndrome in blacks. This paper emphasizes the unknown etiology. Only a complete patient work-up, including hemoglobin genotype, endocrine study, pulmonary function tests, blood and cerebrospinal fluid gases and, where applicable, brain Po(2), Pco(2) and pH can serve as a reasonable prelude to an experimental model for studying the pathophysiology of this poorly understood syndrome and a more rational basis for therapy. A review of the literature dealing with suspected etiology, diagnosis, and therapy is also presented.


The natural history of electrical injury. The natural history of electrical injury, exclusive of electrical flash burns, was determined in 64 patients. These patients sustained relatively small burns (x=11%); only nine patients (14%) had burns greater than 25%. Forty-six patients suffered 114 major complications. EKG abnormalities occurred in 36%, including major cardiac arrhythmias in ten patients. One-fourth of the patients developed neurologic sequelae (CNS-8, peripheral-8). Electrical vascular injury with subsequent arterial occlusion was responsible for many of the major amputations. Nineteen patients required 32 amputations (digits-17, hand-1, foot-2, leg-3, arm-9). Early patient referral and vigorous fluid resuscitation minimized renal failure (1.5%) and mortality (3.1%). Early fasciotomy and vigorous debridement appeared to decrease wound sepsis (8%), but apparently had little if any effect on major limb salvage. The unsolved problems of electrical injury, namely neurological and vascular sequelae, are major contributors to the high morbidity of electrical injury.


Indications for thoracotomy following penetrating thoracic injury. The treatment of penetrating thoracic injuries has been reviewed in both civilian and military series. Although most surgeons agree that closed that closed thoracostomy drainage is the initial treatment of choice, the timing of early thoracotomy and perhaps cardiorrhaphy upon patients with penetrating thoracic injuries remains controversial. The purpose of this study was to determine which patients will require immediate thoractomy or cardiorrhaphy following penetrating chest injury. Over a two-year period 190 patients with penetrating thoracic injuries were treated. Of 53 patients who required immediate thoracotomy, 31 suffered cardiac wounds. Seventy-nine patients required laparotomy for associated intra-abdominal injuries. The mortality rate was related to exsanguinating hemorrhage or postoperative intra-abdominal sepsis. Cardiopulmonary complications were rare in the absence of intra-abdominal sepsis and could not be attributed to the thoracic injury or thoracotomy. Indications for immediate cardiorrhaphy or thoracotomy are: 1) location of the entrance wound (70% in upper mediastinum); 2) blood pressure on admission less than 90; 3) initial thoracostomy blood loss greater than 800 cc; 4) radiographic evidence of retained hemothorax; and/or 5) clinical evidence of pericardial tamponade.


Improved retention of stroma-free hemoglobin solution by chemical modification. The major problems requiring solution before full-scale evaluation of stroma-free hemoglobin solution (SFHS) in a clinical environment are its high oxygen affinity and relatively short intravascular retention time. Through postmanufacture chemical modification of SFHS we have been able to improve both properties as determined in in vitro and in vivo studies. Permatization of SFHS with pyridoxal 5'-phosphate (PLP) does not affect oxygen-carrying capacity and improves the P50 and intravascular retention. This chemically modified hemoglobin is worthy of further evaluation.


Chronic monitoring of head injury with an implantable ventricular module. An elementary technique for discontinuously measuring intracranial pressure, ventricular chemistry, cellularity, and topography, employing percutaneous needle tapping of an implanted module consisting of a Rickham reservoir-ventricular catheter for the chronic monitoring of severe head injury patients is presented. The intracranial pathophysiological conditions (increased ICP, persistent CSF cellularity, xanthochromia and elevated protein levels, and hydrocephalus) occurring in seven so instrumental patients recovering from such injuries are reviewed. The simplicity, safety, and multidiagnostic capability of the system are emphasized.


Autogenous venous interposition grafts in repair of major venous injuries. 1) This review of 51 former Vietnam casualties who had lower extremity venous injuries repaired using autogenous interposition venous grafts is the largest series of this type of venous repair to be reported. Nevertheless, additional information is needed, including more extensive phlebographic documentation of the current status of venous reconstructions. 2) The results of these venous repairs performed by essentially a different surgical team in every case are encouraging. Only one patient, or 2.0% of the total, developed thrombophlebitis in the postoperative period and this was transitory in nature. No patients developed pulmonary embolism. There was no edema in the postoperative period in 66.6% of the total. During the longterm followup, only six patients, or 11.8%, had residual edema. This is in marked contrast to a similar number of patients followed in the Registry who had ligation of popliteal veins following trauma with persistent edema in 50.9%. 3) Although this study remains incomplete, the favorable data should stimulate interest in performing additional repair of major lower extremity venous injuries utilizing autogenous venous grafts. Expanded experimental and clinical research is needed to define a readily available conduit of variable sizes which can be utilized successfully in reconstruction of the low-flow venous system.


Factors limiting extremity function following vascular injury. The clinical management of 47 patients with vascular injuries of the extremities is presented with emphasis on functional results. The method of restoration of vascular continuity or the presence of associated fractures or venous injury had little bearing on either the success of arterial repair or functional result. The most significant factor adversely affecting restoration of extremity function was the presence of associated major proximal nerve injury.


Primary repair of colonic injuries: a clinical evaluation. Fifty-seven patients with colonic injuries were treated by primary repair with or without exteriorization. Forty-six of these had other associated major intra-abdominal, intrathoracic, and musculoskeletal injuries. All had minimal contamination of the peritoneal cavity and were operated upon within 6 hours of injury. None showed any evidence of anastomical leakage or breakdown. Minor complications occurred in 12 patients (21%). Two deaths (3.5%) resulted, but neither was attributable to the repair of the colon; one died from renal failure and the other from pulmonary embolism. On the basis of this study, it is concluded that most isolated injuries of the colon resulting from low-velocity bullets and sharp objects can be closed primarily if peritoneal contamination is minimal and antibiotics are administered immediately after injury, during operation, and post-operatively.


A study of the treatment of pit viper envenomization in 45 patients. Forty-five patients with snake bite were studied: 33 were classified nontoxic and 12 toxic. There were no deaths and four complications in the nontoxic group; two deaths and three complications in the toxic group. The data suggest that rapid recovery is generally to be expected in nontoxic patients regardless of the form of local therapy. The risk of antivenin complications outweighs the minimal therapeutic benefits when administered to most nontoxic patients. If nausea and vomiting are the only manifestations of systemic toxicity antivenin may not be necessary for rapid and complete recovery. The combination of hypotension and bleeding diathesis represents a particularly severe form of toxicity that may result in death if adequate systemic and supportive therapy is not rapidly instituted.


The dominance of vertebral column fractures associated with neurologic deficits among survivors of light-plane accidents. The vertebral injuries sustained by 13 survivors of four light-plane crashes were reviewed. Eight patients sustained major nonvertebral injuries. Eleven patients sustained 18 lower thoracic and/or upper lumbar fractures. Eighty-five per cent of the fractures involved T12, L1, L2, or L3. Seven patients sustained vertebral burst fractures; ten sustained vertebral flexion fractures. In nine patients these vertebral fractures had associated fracture-dislocations of the posterior pedicles. Eight of these nine patients (89%) developed neurologic deficits of the conus medullaris and/or cauda equina. The severity and time of onset of these neurologic deficits were similar for the occupants of each aircraft. Downward vertical deceleration and rotational violence were the dominant forces which inflicted the vertebral column fractures which resulted in neurologic deficits.


Profile of pediatric drowning victims in a water-oriented society. Drowning accounts for 32% of all pediatric accidental deaths in Dade County, Florida. Swimming pools, primarily home pools, are the most common site, 38%; followed by canals, 27%; lakes, ponds and rockpits, 13%; and the ocean and bay, 11%. The majority of drowning victims could not swim and were dead at the scene of the accident. Most pool victims were white, male, and 3 years old. Most victims were thought to be engaged in a non-pool related activity before the accident. Children who drowned in lakes, ponds, and rockpits, canals, and the ocean and bay were usually of school age and unsupervised. Black children had a higher rate of drowning than white children in these sites. Recommendations to prevent drowning: 1) Community education programs; 2) Safety fence around the perimeter of swimming pool; 3) Higher water levels in pools; 4) Investigation of "drown-proofing" instructions for preschool children; 5) Mandatory swimming and water safety instructions in public schools; 6) More supervised public swimming sites.


Regional categorization and quality of care in major trauma. A statewide evaluation of major inpatient trauma treatment was completed demonstrating the relationship of emergency medical service categorization and quality of trauma care. Demographic and organ injury data provided guidelines for preventive and medical education emphasizing the need for more practical sessions. The differences between the review process of primary care physicians and specialists was also discussed.


Abdominal injuries in automobile accidents: review of care of fatally injured patients. Hypovolemia continues to be an important cause of death in patients who die as a result of vehicular trauma. Diagnosis and treatment of a series of 127 patients who died with blunt abdominal trauma from automobile accidents during 1969-1974 in Vermont are reported. The most frequent errors in the cases reviewed were failure to recognize and adequately treat hypovolemia, and to appreciate the urgent need for surgery. Death on the X-ray table while allowing persistence of hypovolemia was the common denominator in four of the five victims who died of ruptured spleens in the emergency departments, after having arrived alive following vehicular trauma. Forty-seven per cent of all reported deaths in automobile accidents had blunt abdominal trauma. Of those with blunt abdominal trauma who arrived alive, 26% might have survived with appropriate treatment which should have been available.


Ureteral injuries due to external violence: 10 years' experience with 59 cases. Fifty-nine cases of traumatic ureteral damage are presented. Gunshot wounds comprise the majority (52/59). Need for a high index of suspicion and aggressive diagnostic measures is stressed. The effects of missile velocity on the ureter are noted. Prompt operative management is advocated: choice of procedure depends on the location of the ureteral defect. Urinary complications occurred in 11/59 (19%). Four complications resulted from operative techniques no longer recommended. The death rate of 10% is related to the high incidence (57/59) of associated visceral and vascular injuries.


Fat embolism prophylaxis: a study of four treatment modalities. Significant coagulation and blood gas changes may occur with uncomplicated extremity fractures. To more accurately define the effect of therapy on these changes, a prospective study of 58 patients with uncomplicated fractures was undertaken. An initial group of 10 selected patients was studied to determine the changes with "standard therapy." The remaining 48 patients were then randomized into five groups: control, increased fluid intake, increased glucose intake, aspirin, and massive steroids. The patients were studied on 5 consecutive days. Treatment of patients in the latter four groups with aspirin or steroids resulted in significant normalization of blood gases, coagulation proteins, and platelet numbers when compared to controls. These measurements in patients treated with fluid loading or increased glucose intake were not significantly different from controls.


Evaluation of peritoneal lavage and local exploration in lower chest and abdominal stab wounds. One hundred twenty-three patients with lower chest and abdominal stab wounds were evaluated. If chest wounds were located between the two anterior axillary lines and abdominal examination was negative, peritoneal lavage was performed. If abdominal wounds were located between the two anterior axillary lines and physical examination was negative, local exploration was performed followed by lavage if local exploration was positive. Patients with negative lavage were observed and those with positive lavage were operated upon. Of the patients in this selected series 69.9% were spared an operative procedure. The incidence of negative laparotomy was 4.1%. It is concluded that the combination of local exploration and peritoneal lavage will increase diagnostic accuracy, eliminate unnecessary hospitalization, and reduce the number of negative laparotomies.


Rabies in the Arab Republic of Egypt: III. Enzootic rabies in wildlife. Five hundred and thirty-two rodents (10 species) and 112 other wild mammals (six species) were examined for rabies infections in Egypt. Rabies virus was isolated from the brains of three (1-2%) of 249 Gerbils, Gerbillus gerbillus and one (1-8%) of 56 foxes, Vulpes species. In neutralization tests these isolates were found to be identical to classical rabies virus. Significant numbers of rodent and other wild mammal species need to be examined before they may be excluded as possible reservoirs of rabies virus in Egypt. Based on initial findings it may be wise to reevaluate antirabies treatment for rodent bites occurring within the Arab Republic of Egypt.


[Renal angiomyolipomas. 9 cases (author's transl)]. Renal angiomyolipoma is a benign mesenchymatous tumour. Whether isolated or associated with phacomatoses, they are histologically identical and the hypothesis which suggests that isolated angiomyolipomas represent a forme fruste or tuberose sclerosis is attractive. The tumour is benign and resembles a carcinoma clincally and radiologically, to such an extent as to lead to confusion. Improved knowledge and more detailed study of radiological documents should avoid their always being, in the words of R. Couvelaire" a constant operative or histological surprise". However whilst there remains no doubt as to its benign nature, the association of true malignant tumours is possible and even seems frequent, which takes us back to the starting point and, given the difficulty of the pre-operative differential diagnosis with a carcinoma; we prefer to opt for extended nephrectomy when operation is indicated.


[Renal heamangioma (author's transl)].

[Renal heamangioma (author's transl)]. Two cases of renal haemangioma. The literature is reviewed, 150 cases being presented. The aetiology is variously taken to be a tumour or malformation. The predominant clinical sign is haematuria. The authors stress the difficulty of making the diagnosis preoperatively. Amongst the various histological types, the cavernous variety is the most common. Treatment is essentially surgical though radiotherapy has centain indications.


[Diagnostic and therapeutic of arteriovenous fistulas (author's transl)]. The clinical signs of 2 arteriovenous fistulas are discussed and compared with the literature. Arteriovenous fistulas following percutaneous kidney bioposies are very frequent. Most of them are not to be treated. In contrast to the common spontaneous closure of these fistulas in the kidney periphery, central arteriovenous fistulas should be operated always by partial resection.


[The surgical treatment of urinary stress incontinence following hysterectomy or operation for genital prolapse (author's transl)]. Thirty patients suffering from stress incontinence of urine following hysterectomy or operation for genital prolapse underwent operation after study of the colpocystogram. This examination, practically painless and free of risk, visualises pelvic visceral kinetics and is felt by the author to be essential. It confirms the existence of stress incontinence, reveals the usual cause, detects associated abnormalities and indicates the appropriate surgical technique. The method of treatment was paramedial or medial fixation of the uterus, vagina or residual cervix to the public promontory, complemented in some cases by excision of the pouch of Douglas or posterior myorraphy. Apart from in certain special cases (irritable tirgone syndrome) the cure of mictional problems can be guaranteed.


[Reno-colic fistula, spontaneous rupture of the ureter, triple urter: ureterocoele: an unusual combination (author's transl)]. The authors report a case which is exceptional both on the basis of the association of malformations present as well as the presenting complications. Right triple ureter with ectopic implantation. Spontaneous fistulisation into the colon of a supernumerary pelvis. Rupture of a megaureter into the retroperitoneal space, the initial episode. Finally, double ureter on the left with ureterocoele. The difficulty of precise diagnosis before operation is emphasised. The latter did not permit immediate complete assessment of the lesions, the discovery and treatment of which required several operations.


[Priapism in a 13 year old boy. Caverno-spongiosal anastomosis with a successful result (author's transl)]. Idiopathic priapism is rare and even more so when it affects a pre-pubertal child. The authors study this curious disorders on the basis of one case and show the value of caverno-spongiosal anastomosis, even when carried out late.


Transcription of the genome of adenovirus type 12. IV. Maps of stable late RNA from productively infected human cells. From human KB cells productively infected with adenovirus type 12, mRNA and stable nuclear RNA were isolated late (42 h) after infection. Using restriction endonuclease fragments of adenovirus type 12 DNA, mRNA and stable nuclear RNA sequences were mapped on the viral genome. Late after infection, preferentially the r (= rightward) strand is transcribed into stable nuclear RNA, whereas the l (= leftward) strand is expressed only to a minor extent. Adenovirus type 12-specific mRNA originates from the following sections on the viral genome: 0 to 0.11, 0.18 to 0.20, 0.27 to 0.49, 0.56 to 0.63, 0.68 to 0.84, and 0.89 to 0.92 fractional length units on the r strand and 0.11 to 0.16, 0.22 to 0.27, 0.50 to 0.54, 0.62 to 0.66, 0.855 to 0.865, and 0.93 to 1.0 fractional length units on the l strand. Self-complementary viral RNA isolated at 42 h postinfection anneals to 70 to 80% of each strand of the viral genome.


Envelopments of Sindbis virus: synthesis and organization of proteins in cells infected with wild type and maturation-defective mutants. The synthesis and organization of Sindbis virus structural proteins was investigated in BHK cells infected with wild-type virus (SVHR) or temperature-sensitive (ts) mutants defective in maturation. Cells infected with ts-23 or ts-20 (complementation groups D and E) were similar in the polypeptides synthesized at the nonpermissive temperature and differed from SVHR-infected cells in that the envelope protein E2 was not cleaved from the PE2 precursor. Data from experiments utilizing pulse-chase procedures or protein synthesis inhibitors indicated that although infectious virions were released from cells infected with these mutants in shift-down experiments, the particles were produced almost exclusively from proteins synthesized after the return to permissive temperature. This suggests that a stable complex may be formed among the structural proteins before budding. A membrane fraction isolated from cells infected with either ts mutants or SVHR contained the PE2, E1, and C polypeptides, whereas E2 was restricted to fractions obtained from SVHR-infected cells. Although equivalent amounts of virus-specific protein were synthesized in cells infected with either mutant and the cells contained qualitatively the same proteins in the isolated membranes, cells infected with ts-23 did not have virus-specific proteins exposed on their surface that could be detected by ferritin-conjugated antibody-labeling procedures or lactoperoxidase-mediated iodination. In contrast, ts-20-infected cells had significant amounts of viral protein, mainly E1, that could be detected on the plasma membrane by either procedure. Iodine was incorporated into E1 and E2 on the surface of SVHR-infected cells in the same relative amounts as seen in iodinated virions. PE2, however, although present in membranes, could not be iodinated on the surface of infected cells under any of the conditions used in this study. We also monitored the relative efficiency with which these viral proteins could be removed from intact cells by dilute solutions of nonionic detergents. The results indicated that E2 was most efficiently removed, followed by E1. PE2 (the precursor to E2) and C remained associated with the cell and could be subsequently isolated in the membrane fraction.


Genome RNAs and polypeptides of reovirus serotypes 1, 2, and 3. The virus-specific double-stranded genome RNA and polypeptides present in virions and cells infected with the three mammalian reovirus serotypes have been examined by co-electrophoresis in several different polyacrylamide gel systems. The double-stranded RNA and polypeptide species previously described for type 3 Dearing were found to have corresponding species in the other serotypes examined. In each serotype several RNA and polypeptide species were found to have different electrophoretic mobilities from the corresponding RNA or polypeptide species of type 3 Dearing. The combination of electrophoretic variants among the RNAs and polypeptides of the reovirus serotypes gave electrophoretic markers in all 10 of the reovirus genes. The usefulness of these electrophoretic markers in "mapping" the reovirus genome is discussed.


Genetic mapping of regA mutants of bacteriophage T4D. SP62, a mutant of bacteriophage T4 shown by Wiberg et al. (1973) to be defective in regulation of T4 protein synthesis, was shown by complementation tests to define a new gene, regA, and by intergenic mapping to lie between genes 43 and 62. The mapping involved crossing SP62 with a quadruple amber mutant defective in genes 42, 43, 62, and 44, selecting all six classes of amber-containing recombinants caused by single crossover events, and then scoring the presence or absence of SP62 in these recombinants. In addition, 15 new, spontaneous regA mutants were isolated, and 13 of these were mapped against each other; a total of eight different mutation sites were thus defined. Most of the new mutants were isolated as pseudorevertants of a leaky amber mutant in gene 62, according to Karam and Bowles (1974), whereas one was identified by virtue of the "white ring" around its plaque, a phenotype possessed by all the regA mutants at high temperature, SP62 was renamed regA1, and the new mutants were named regA2, regA3, etc.


Bacteriophage T4D head morphogenesis. VIII. DNA-protein associations in intermediate head structures that accumulate in gene 49--mutant-infected cells. We have utilized the gene 49(-) mutant-infected cells of bacteriophage T4D to accumulate large numbers of nucleic acid-protein intermediate head structures. These heads were used as substrates for experiments in the investigations of the mechanism of DNA packaging. Specifically, we have examined: (i) the susceptibility of the DNA in these structures to digestion by a variety of nucleases after a series of increasing temperature pulses from 25 to 100 degrees C, (ii) the physicochemical characteristics of the DNA inside these heads, and (iii) the mechanism by which proteins are displaced from the interior of the head after treatment with basic proteins. We isolated DNA from these gene 49(-) heads by use of gradient centrifugation procedures. The DNA had a molecular weight of 8 x 10(6) and a density of 1.697 +/- 0.005 g/cm(3), and it contained a short resistant fraction (SRF) which, when associated with the gene 49(-) heads, exhibited AT-protected regions that were not susceptible to micrococcal nuclease digestion. Such a fraction may contain pieces which are important in the initial association of the DNA with the prohead. Exposure of the gene 49(-) intermediate capsid structures to basic proteins, such as bovine trypsin inhibitor, lysozyme, and l-polylysine-70, caused a displacement of an amorphous-appearing structure which may be a complex of the gene 49(-) DNA and interior components of the capsid (e.g., internal proteins, polyamines). Our general conclusion is that in the gene 49(-) intermediate head structures which are only partly filled with DNA, this DNA is held inside the head by strong electrostatic linkages with interior polypeptides and polyamines.


Adenovirus strand nomenclature: a proposal. Thirty-six scientists have agreed to standardize the nomenclature of DNA strands of all adenovirus serotypes according to certain criteria.


Placebo versus allopurinol for renal calculi. Certain patients with recurrent calcium oxalate calculi will show a mild uricacidemia and/or uricosuria. A prospective blind study was begun in 1970, comparing placebo to allopurinol in the management of these patients. The 92 patients had been followed for a minimum of 6 months to 5 years before the code was broken. It is demonstrated clearly that there is a placebo effect in the management of renal calculous disease. It also has been shown that the only event that clearly separates the 2 groups is complete cessation of calculous formation. Allopurinol is effective in 61 per cent of the patients and these successes usually can be identified after 1 year of treatment.


A comparative study of open surgical and percutaneous renal biopsies. Percutaneous renal biopsy was performed on 171 patients during the same interval as an open surgical biopsy was done on 100 patients in the same hospital. Patients who underwent an open biopsy had more severe renal dysfunction and hypertension than those who had a percutaneous biopsy. Tissue adequate for diagnosis was obtained in 100 per cent of the open biopsies. The kidney was reached in 88 per cent of all percutaneous biopsies with tissue adequate for diagnosis in 82.5 per cent. Of 87 patients biopsied with image-amplification fluoroscopy renal tissue was obtained in 97 per cent with tissue adequate for diagnosis in 92 per cent. No nephrectomies were done and no deaths occurred in either group. Our complications and yield by percutaneous biopsy compared favorably to those of other series. Further, open biopsy in a high risk population was associated with a high yield of tissue adequate for diagnosis with no increase in complications. Procurement of renal tissue need rarely be denied a patient if a biopsy is clinically indicated.


Preoperative diagnosis of renal angiomyolipoma. Six cases of renal angiomyolipoma are reviewed. In 5 of these 6 cases a characteristics radiolucent fat sign was present overlying the renal mass. In 10 cases of hypernephroma selected only on the basis of a tissue diagnosis and the availability of a pre-injection scout film this sign was not present. The recent literature is reviewed on the radiographic diagnosis of angiomyolipoma. We conclude that angiography is not reliable in the differentiation of angiomyolipoma from hypernephroma. However, demonstration of a radiolucency on the pre-injection scout film is virtually pathognomonic of angiomyolipoma. Tomographic cuts without contrast injection may increase diagnostic accuracy.


Unsuspected renal tumors associated with renal cysts. A series of renal tumors associated with renal cysts is presented. Prior to surgical exploration appropriate diagnostic studies failed to indicate evidence of the presence of neoplastic lesions. The importance of surgical exploration of avascular "benign" renal masses is emphasized.


Sterol synthesis in cultured human renal cell cancer. Studies on sterol synthesis in cultured human renal cell carcinoma were conducted in an attempt to elucidate the mechanism by which clear cell tumors accumulate cholesterol in the cytoplasm. Cultured renal cell carcinoma requires serum lipoproteins for optimal growth. In some renal cell carcinomas cellular cholesterol content was significantly higher than that present in cultured kidney cells under similar conditions. Renal cell carcinoma synthesizes sterols from labeled acetate. The rate of sterol synthesis is inversely proportional to the levels of exogenous cholesterol in the growth medium, suggesting the presence of a negative feedback mechanism. In addition, the conversion of 27-carbon-atom sterol precursors to cholesterol appears to be slow and inefficient under the presnt conditions. We conclude that an aberrant regulation of cholesterol synthesis cannot be invoked necessarily to explain cholesterol accumulation in renal cell carcinoma.


Fracture of the penis with associated laceration of the urethra. Two patients with rupture of the urethra secondary to sexual trauma are described. Our results with the surgical treatment of such injuries are reported and the potential etiologies are postulated. One patient had an excellent result, while the other had a residual urethral stricture.


Embryologic considerations of diphallus and associated anomalies. Two patients, 1 adult and 1 infant, with complete duplication of the penis are described. The adult had a single bladder, a bifid scrotum, a low abdominal wall hernia, separation of the symphysis pubis, bilateral inguinal hernias, rectal prolapse, bilateral vesicoureteral reflux and bilateral staghorn calculi. The infant had duplication of the bladder, hypoplasia of the left kidney, lumbosacral anomalies, a hypoplastic left lower extremity, an imperforate anus, a infraumbilical wall hernia and separation of the symphysis pubis. A survey of the anomalies accompanying the 2 main types of diphallus (shaft and glans, and glans alone)showed that there was a preponderance of anomalies of posterior structures such as colon, bladder and spine in the shaft and glans diphallus, and a higher incidence of isolated exstrophy of the bladder in diphallus of the glans alone. The embryogenic implications of these findings are discussed.


Multiple germ cell tumors: reports of 3 cases, 1 with 3 primary lesions. Tumors may develop in both testes, either concomitantly or sequentially. We herein report 3 cases of bilateral testicular neoplasms. One patient had concomitant seminomas of the testes and another had sequential germ cell tumors separated by an 11-year interval. The third patient is an unusual case in that he had bilateral testicular germ cell tumors diagnosed concomitantly 8 years after irradiation of an extragonadal, histologically proved, seminoma in the mediastinum. Evidence suggests that all 3 sites, each testis and the mediastinum, were primary lesions. Standard methods of therapy should be used in the treatment of malignancies.


The response of metastatic retroperitoneal seminoma to chemotherapy. Two patients with advanced metastatic seminoma were treated with radiation therapy, triple-drug chemotherapy and radical surgical resection. In 1 patient the seminoma was radiation-recurrent and radiation-resistant, while in the second patient the metastatic seminoma encroached upon both kidneys and could not be irradiated initially for fear of bilateral radiation nephritis. Both tumors were reduced in size markedly by the chemotherapy and the residual mass was excised in each instance. One patient was free of the tumor 18 months after treatment, while the other patient had recurrence in a distant area after 16 months. The marked responsiveness of both tumors to triple-drug chemotherapy emphasizes the importance of an aggressive approach to advanced metastatic seminoma, including radiation therapy, chemotherapy and surgery.


Elevated bone marrow acid phosphatase: the problem of false positives. Bone marrow acid phosphatase values were studied in 24 patients (12 men and 12 women) selected at random, including 6 at autopsy. False positive results were noted in 8 of the 18 patients who were alive and in all 6 patients studied at autopsy. The possible causes for these falsely elevated results are discussed. The bone marrow acid phosphatase is a test of poor specificity and should not be used as the sole test on which vital decisions regarding management of the patient are based.


A comparison between lymphangiography and pelvic node dissection in the staging of prostatic cancer. On 40 consecutive patients with prostatic cancer who had pedal lymphangiography during the initial evaluation and, subsequently, underwent pelvic node dissection or biopsy, a surprisingly high number had falsely positive (59 per cent) or negative (36 per cent) x-ray findings. Initially the tumors were considered clinically to be stage B in 24 cases, stage C in 13 and stage D in 3. After lymph node dissection only 17 tumors were still considered to be stage B and 7 were stage C, while 16 tumors were actually stage D. This surgical staging is important for the further management of the patient as well as the prognosis, Pedal lymphangiogrpahy alone is unreliable for accurate assessment of the regional lymph node status in clinically localized prostatic cancer.


Intercostal nerve block with flank incision. We studied the postoperative course of 20 consecutive patients with T10 to 12 flank incisions, half of whom had intraoperative bupivacaine intercostal nerve blocks. The nerve block patients required less pain medication (p less than 0.001), ambulated 3 days earlier (p less than 0.001) and took a regular diet 2 days sooner (p less than 0.01) than the control patients.


The clinical value of lymphangiography: are the nodes surrounding the obturator nerve visualized? Twenty-five patients subjected to pelvic node dissection for urologic malignancies underwent bilateral pedal lymphangiography preoperatively. Postoperatively, 50 samples of the nodes selectively removed from the regions surrounding the obturator nerve were radiographed. All 50 samples revealed the presence of radiopaque dye. The lymph nodes surrounding the obturator nerve represent the first point of lymphatic metastases in carcinoma of the prostate and the bladder. Their visualization by lymphangiography emphasizes the importance of such a diagnostic study for the correct clinical staging of these diseases. The lymphatic anatomy of the pelvis is reviewed and compared to the radiological findings in lymphangiography.


Electrical stimulation of the rectal ampulla causing reflex voiding. Electrical stimulation of the rectal ampulla resulted in a desire to void and defecate in 11 patients with an intact nervous system. There was a contraction of the detrusor and the rectal ampulla with relaxation of the anal sphincter. Electrical stimulation of the rectal ampulla and anal sphincter has clinical applications in patients with incontinence of, or inability to empty, the lower urinary tract or fecal system.


Changing concepts in the urodynamic evaluation of children. Urodynamic evaluation was performed in 46 children with myelodysplasia, spinal cord injury, enuresis, postoperative incontinece, sacral agenesis and recurrent urinary tract infection. The basic study consisted of voiding cystourethrography followed by the simultaneous recording of intra-abdominal and intravesical pressure with external urethral sphincter electromyography. Urethral pressure profile, urinary flow rate and anal sphincter electromyography were performed selectively. There was no correlation between the clinical neurological level and the cystometric pattern in patients with spinal cord lesions. Bladder-external sphincter dyssynergia was associated with a high post-void residual urine in children with hypertonic bladders, while in children with hypotonic bladders dyssynergia did not affect the post-void residual. Since, urinary symptoms bore little relationship to urodynamic findings in our study we recommend complete evaluation of children who have persistent disturbances of micturition.


Crawford modification of Denis Browne hypospadias procedure. At Alder Hey Children's Hospital 96 hypospadias repairs were performed from 1969 to 1975, using the Crawford modification of the Denis Browne procedure. The technique is decribed in detail. A 7.29 per cent fistula rate occurred in 69 distal penile, 18 penile, 8 penoscrotal and 1 perineal repairs. The advantageous difference between the Crawford modification and the original description of Denis Browne is that the meatus is placed well onto the glans penis.


Matrix stones.

Matrix stones. A scanning electron microscopic examination of matrix stones, which have been obtained from a 27-month-old Japanese boy with congenital hydronephrosis, revealed a rough fibrous net structure with small depositions of calcium phosphate. We believe that fibrous matrix may be the primary constituent and that the matrix stone may be the consequence of calcium deposition to it.


Echinococcal cyst of the kidney.

Echinococcal cyst of the kidney. A renal echinococcal cyst presenting with ureteral obstruction is described. Characteristic diagnostic features, including renal angiography, are discussed. Whereas partial nephrectomy is appropriate for a small closed renal cyst, total nephrectomy is indicated for most large or open cysts.


Regression of renal cell hepatic metastasis following removal of primary lesions. Although spontaneous regression of metastatic renal cell carcinoma occurs it is so uncommon that it should not be considered the primary basis for recommending removal of the asymptomatic primary lesion. Such a recommendation should be made when other treatment modalitis are available to augment the factors influencing the patient-tumor interface. Spontaneous regression of a documented solitary liver metastatic lesion is reported. Removal of the residual hepatic lesion failed to prolong the patient's life.


Pyocystis.

Pyocystis. A case of pyocystis occurring in a woman after supravesical urinary diversion for complicated neuropathic bladder is reported. Treatment consisted of a vaginal vesicostomy. Indications for the precedure and the problems associated with it are discussed with special emphasis on sexual intercourse.


Congenital bladder duplication and diverticulum. Evaluation of urinary infection in a 5-month-old male infant revealed duplication of the prostatic urethra and bladder. Associated anomalies were a right bladder diverticulum, left vesicoureteral reflux and bowel duplication.


Capillary hemangioma of the male urethra: case report with literature review. The seventeenth case of hemangioma of the urethra is reported. A review of the literature supports our own experience that this growth tends to recur locally. It is our opinion that an initial wide resection should be performed. The margins of the removed lesion must be uninvolved or recurrence is almost certain.


Propantheline as a diagnostic tool--a serious complication. Propantheline bromide is a synthetic quaternary ammonium compound widely used in urologic patients to block the action of acetylcholine at the postganglionic nerve endings of the bladder's parasympathetic innervation. It is used clinically in a wide range of doses in ambulatory outpatients as well as hospitalized patients. To document its effects on the bladder, test doses are given with a cystometrogram documenting the dynamic changes. Herein we report a case of serious cardiac toxicity from a diagnostic test dose.


Segmental intrarenal catheterization in renin-mediated hypertension. Segmental renal vein blood was collected in 9 hypertensive patients who had a focal renal lesion on excretory urography and/or a high peripheral plasma renin activity. The main renal vein catheterization was normal in all patients. Segmental renal vein catheterization demonstrated a renin-producing lesion in 3 patients, all of whom were cured of the hypertension postoperatively. Segmental renal vein catheterization is safe and allows the recognition of increased renin production from focal lesions of the kidney that may not be demonstrated radiographically or by main vein catheterization.


Recurrence of renal tuberculosis 29 years after therapy. A case of renal tuberculosis in a man when he was 23 years old is reported. He was treated with streptomycin and reported routinely for followup examinations. When the patient was 52 years old, 29 years after treatment, he had a positive urine culture from the remaining kidney. Triple drug therapy was administered and has been effective. The need for lifelong examination of patients with renal tuberculosis is justified.


Avulsion of the ureter from both ends as a complication of interruption of pregnancy with vacuum aspirator. A case of avulsion of a ureter from the pelvioureteral junction and its discharge through the vagina during an attempt to interrupt pregnancy by suction is presented. The preoperative and operative findings are described, as well as the mechanism that caused this kind of trauma. The proposed management of such a case is discussed.


Cyclophosphamide hemorrhagic cystitis requiring urinary diversion. Hemorrhagic cystitis secondary to cyclophosphamide is a well recognized and unique urologic complication of this widely used agent. Cessation of the drug and supportive care are usually sufficient for management but refractory cases are difficult to treat and potentially life-threatening. A review of the pathology and treatment of this disorder is presented with specific reference to a patient requiring urinary diversion.


Testicular scan, diagnosis and followup for torsion of testis. Testicular scan is an important method to improve the preoperative diagnosis of torsion of the testis. We used this method to diagnose torsion of the testis and for 3-month followup studies we correlated the followup scanning with testicular biopsy. We believe that one should always attempt to leave the twisted testicular portion in the scrotum because some vital cells might still be functioning.


Allergic prostatosis.

Allergic prostatosis. The first case of prostatic eosinophilic infiltration treated with antihistaminic therapy is reported. Histological specimens before and after treatment are included.


A case of parathyroid carcinoma concurred with hyperplasia: an electron microscopic study. A case of parathyroid carcinoma is reported. The histology of the parathyroid glands disclosed carcinoma in 1 gland and chief cell hyperplasia in another. Therefore, we recommend careful exploration of all parathyroid glands. An electron microscopic feature of parathyroid carcinoma is presented.


Iatrogenic renal artery thrombosis.

Iatrogenic renal artery thrombosis. Renal calculi were removed from 2 women--in 1 case by renal bisection and in the other by nephrolithotomy. In each case a small bulldog clamp was applied to the renal artery for less than 30 minutes. Both patients suffered renal artery thrombosis necessitating nephrectomy. When the histories of these patients were reviewed the common factor found was oral contraceptives, suggesting that oral contraceptives may predispose to renal artery thrombosis.


Renal aneurysmectomy in the ex vivo setting. The use of ex vivo dissection and reconstruction as definitive surgical management in 3 cases of renal artery aneurysms is presented. The indications, rationale for therapy and review of technique are discussed.


Renal lymphangioma.

Renal lymphangioma. Lymphangioma cavernosum of the kidney is a benign tumor. Metastasis has not been found in any of the 20 cases reported to date. The sex ratio of patients is 1.5 to 1, favoring female subjects. Average patient age is 33.7 years. Treatment has consisted of nephrectomy in 18 patients, since the possibility of a malignant tumor could not be eliminated preoperatively.


Early treatment of ureteral injuries found after gynecological surgery. Five consecutive patients with 7 ureteral injuries found after gynecological operations were treated conservatively. The complications ensuing this type of management are reported briefly. Twenty more consecutive patients with 27 ureteral injuries were treated immediately after diagnosis and definitively. Important points of technique are 1) little attempt to stay extraperitoneally, 2) sacrifice of all abnormal ureter, 3) re-establishment of ureteral continuity between a normal ureter and the bladder by usual means, 4) peritoneal closure only when easy, 5) adequate drainage and 6) use of antibiotics. The results obtained were excellent. Early and definitive treatment of ureteral injuries found after gynecological operations seems to be the safest and easiest type of management in all cases.


Ileal trigonal urinary diversion: 5-year followup evaluation. We anastomosed the intact, undisturbed vesical trigone to the isolated ileal conduit in 24 patients, most of whom have been followed for 5 years. None of these patients has had any pyelographic evidence of upper tract deterioration. There have been no episodes of pyelonephritis, no hydronephrosis, no renal stones and only 4 of the 46 renal units have demonstrated reflux. These data indicate unsurpassed protection of the upper tracts in those patients with neurogenic bladder dysfunction.


Colonic adenocarcinoma: a delayed complication of ureterosigmoidostomy. Two cases are reported of adenocarcinoma of the colon developing 26 and 33 years after the patients had undergone ureterosigmoidostomy. The literature is reviewed and the clinical implications are discussed.


Augmentation enterocystoplasty: a critical review. Augmentation cystoplasty appears to offer a successful long-term solution for patients with small contracted bladders of almost any etiology. If proper indications are observed the procedure is well tolerated. With refined urodynamic diagnostic techniques our over-all failure rate of 35 per cent can be expected to decrease. Contraindications of the procedure include azotemia (creatinine clearance less than 40 cc per minute), vesical malignancy, neurogenic bladder with spastic pelvic floor (that cannot be modified) and young boys (mucus problems). In addition, patients with a strong psychiatric history should be approached with caution. The non-functional contracted bladder in which the cause of prior diversion is unclear or was performed because of an apparent outflow obstruction that spontaneously has been corrected by rest during the period of supravesical diversion also should be approached with care.


Is cystectomy a safe procedure in elderly patients with carcinoma of the bladder? Often total cystectomy is not advocated in elderly patients for the treatment of carcinoma of the bladder. A group of 25 patients more than 70 years old were reviewed to determine if cystectomy is a reasonable therapeutic alternative in elderly individuals. Since there was satisfactory survival and no immediate operative mortalities elderly patients should not be denied this form of therapy on the basis of age alone. A higher incidence of postoperative complications was noted in the patients treated previously with radiation therapy.


Radiation-induced bladder tumors.

Radiation-induced bladder tumors. A recent 25-year experience with patients treated for carcinoma of the uterine cervix who subsequently had bladder tumors is presented. Of the 3,091 patients treated 2,674 had received radiotherapy and 8 suffered vesical malignancies of varied histopathological type 6 months to 20 years after irradiation. This incidence rate is 299.9 per 100,000, which is 57.6 times that of the general female population. Benign radiation reactions of the bladder and the possible etiology of radiation-induced bladder cancers are discussed.


Surgical treatment of erectile impotence with inflatable penile prosthesis. Thirty-nine men with erectile impotence were treated with surgical implantation of an inflatable penile prosthesis. The patients were followed for 6 months to 2 years. Thirty-five patients (90 per cent) have expressed long-term satisfaction with the appearance and performance of the prosthesis. Major complications developed in 9 patients (23 per cent), requiring 12 subsequent operative procedures.


Non-specific granulomatous prostatitis.

Non-specific granulomatous prostatitis. Between 1963 and 1972, 86 patients with non-specific granulomatous prostatitis were seen. Symptomatology was suggestive of a lower urinary tract infection in the majority of the cases. The most important feature on prostatic examination was the likelihood of confusion with prostatic carcinoma. Management by whatever means yielded uniformly good results. The natural history of this disease seems to be that of gradual resolution.


Accuracy of transurethral resection of the prostate versus transrectal needle biopsy in the diagnosis of prostatic carcinoma. Transurethral prostatic resection for obstructive uropathy often yields malignant tissue in a significant number of patients with prostatic carcinoma. A comparison of the diagnostic accuracy of transurethral prostatectomy and transrectal prostatic biopsy in 139 patients who had both procedures demonstrated no significant difference. It is suggested that patients with obstruction and suspected prostatic carcinoma, who are not candidates for curative treatment, should have transurethral prostatectomy to relieve the obstruction and to confirm the diagnosis simultaneously.


Gynecomastia demonstrated on the bone scan. Bone scans with 99mtechnetium diphosphonate were performed on 2 patients with gynecomastia induced by diethylstilbestrol therapy for adenocarcinoma of the prostate. Neither patient had evidence of bone metastases but both scans revealed increased isotope concentration over the anterior rib cage at the lateral margin of the chest wall, corresponding in location to the hypertrophic breasts. This observation may be related to similar radionuclide uptake in normal and abnormal female breasts. One should not mistake the finding of gynecomastia for metastases of the ribs.


Salmonella infection and the genitourinary system. Six cases of severe salmonella genitourinary infection and a case of salmonella septicemia after prostatectomy are reported. The mechanism whereby the urinary tract is involved in salmonellosis is described, as are the different manifestations of genitourinary salmonellosis. Host factors predisposing to the development of genitourinary salmonella infection include other urologic pathology, malignant neoplasms and states of depressed immunity. Recommendations are made with regard to the diagnosis and management of this sometimes lethal condition.


Surgical management of major renal trauma: a review of 102 cases treated by conservative surgery. A review is presented of 102 patients with significant renal trauma seen in the last 5 years. All patients underwent exploratory laparotomy for abdominal trauma and had associated urologic injuries, which were managed by conservative surgery. Forty-eight patients had non-expanding retroperitoneal hematoma and were treated expectantly. Nine patients needed exploration and drainage only, while 18 had some form of renorrhaphy. Four patients underwent repairs of renal pelvic injuries, 12 underwent partial nephrectomy and 11 underwent repairs of renal pedicle injuries. A conservative approach to renal trauma is emphasized.


Auscultation of urinary flow.

Auscultation of urinary flow. Urinary flow in the male subject is associated with turbulence at the bladder neck. This turbulence is associated with the production of a sound in the healthy male subject, transmitted to the perineum.


Staghorn calculi in children.

Staghorn calculi in children. Nineteen children who underwent extensive nephrotomies and anatrophic nephrotomies for staghorn calculi (bilateral in 4 cases) are presented. Proteus infection was the cause of the calculus in most cases. In the absence of recurrent stones, renal growth and function were excellent post-operatively. Stone recurrence was minimal if all calculi were removed and infection was controlled. Followup ranged from a few months to 13 years.


Renal adenocarcinoma in adolescence and childhood: emphasis on angiographic findings. Four cases of hypernephroma occurring in the first 2 decades of life are presented. Of these patients 3 were adolescents and 1 was a child. Angiography was used in 8 cases, including 6 that were reported previously and 2 from the present series. Sparse neovascularity, faint tumor stain and no arteriovenous shunting were the manifestations in 4 cases. Differentiation from Wilms tumor could be difficult in this circumstance.


Patterns of neurogenic bladder dysfunction in sacral agenesis. Patterns of neurogenic bladder disease were defined in 13 patients with sacral agenesis. Each patient demonstrated an individualized mixture of upper and/or lower motor neuronal deficits. The paucity of clinical parameters capable of identifying and assessing bladder dysfunction in these patients mandates complete neurourological evaluation and careful followup.


Infundibulopyelostomy for vascular obstruction of a middle infundibulum. The syndrome of nephralgia caused by vascular compression of a superior infundibulum of the kidney and its surgical resolution are reported. A case is presented to demonstrate that this syndrome also can involve a middle infundibulum, which can be treated by the same surgical technique.


The localization of intrarenal calculi during surgery. This is a summary review of past and present technology for accurate anatomical localization of calculi within the surgically exposed kidney. The methodology is applicable to reconstructive renal surgery for pathological processes other than calculi.


Pelvioplasty--patient selection.

Pelvioplasty--patient selection. An ever-increasing number of modalities provide diagnostic and predictive indicators for better patient selection in the treatment of ureteropelvic juncture obstruction. Contemporary histological studies and improved results have culminated in the selection of the dismembered pelvioplasty as the operation of choice. When the renal scan, renogram, renal biopsy or nitroblue tetrazolium studies are used fewer patients are subjected to a needless reconstructive operation. Dismembered pelvioplasty provides excision of the diseased ureter, reduction of pelvic redundancy and an opportunity for the "pacemaker" cells to function properly.


Initial complications and late results in dismembered pyeloplasty. A total of 109 dismembered pyeloplasties has been reviewed and examples of initial complications and their management are discussed. These early complications do not preclude excellent long-term results. Over-all followup studies show resolution of pain, hematuria and infection in the vast majority of patients. X-ray results have since, in general, improved or stabilized. No nephrectomies have been done subsequent to the repair of the hydronephrosis.


Early detection but delayed appearance of a bladder tumor. Herein is described a case of bladder cancer first detected by urinary cytology 20 years before a definite cystoscopic diagnosis could be established. To our knowledge, this represents the longest such interval on record. The case indicates the reliability of Papanicolaou studies of the urine, especially when tumor cells are identified.


Changes in grade and stage of recurrent bladder tumors. A retrospective study with adequate followup of 5 years of longer of 114 patients who had transurethral resection for cure or control of bladder tumors and in whom there were 1 or more recurrences is reported. There was recurrence of the tumor in a higher grade in 19 per cent of the cases and in a higher stage in 22 per cent. The interval between the treatment of the original tumor and a recurrence in a higher grade or state varied from 0.25 (3 months) to 27 years. When a low grade or low stage tumor recurs in a higher category in less than 3 years more aggressive treatment should be considered.


Pre-cystectomy radiation for carcinoma of the bladder: 17-year experience. Our experience with pre-cystectomy radiation for carcinoma of the bladder from July 1959 through June 1976 is presented. Pre-cystectomy radiation would appear to be beneficial in the management of patients with invasive bladder cancer. There is an impressive improvement in survival rates in those patients demonstrating reduction in staging after radiation. Our experience correlates well with other comparative series. Based on this 17-year experience guide lines are outlines for the subsequent management of patients with bladder cancer.


Vesicourethral anastomosis after radical prostatectomy: experience with the Jewett modification. The author's experience with the Jewett method of vesicourethral anastomosis after radical prostatectomy is described. Only 1 instance of stress incontinence has been encountered in more than 200 personal cases. The technique is described in detail.


Experimental models for the study of prostatic adenocarcinoma. The Dunning R3327H transplantable rat tumor is a well differentiated prostatic adenocarcinoma. The biological properties of this tumor have been characterized, and it appears that this animal model is well suited for studying the nature of prostatic cancer. The established tumor responds to castration therapy and this is subsequently followed by relapse to a predominant state of hormone insensitivity. Cell kinetic studies indicate that 70 to 90 per cent of the total tumor cells are hormonally sensitive, and a subpopulation of 8 to 30 per cent are hormone insensitive. The therapeutic relapse to androgen deprivation represents the continued growth of the clone of cells, which were hormone insensitive. It appears that this animal mimics the relapse of phenomenon observed in the hormone control of human prostatic cancer.


Management of patients in shock.

Management of patients in shock. Clinical study was conducted in the course of treatment of patients with hypovolemic and septic shock at Department of Traumatology, Osaka University Hospital. We have found large difference between data obtained in our study and experimental results obtained in animals. In hypovolemic shock of man, we could not observe "taking up phenomenon" to abdominal organs. Therefore, if the shock does not respond to transfusion and infusion, we must look for other causes. In patients whose shock state persisted more than 10 hours, death related to shock organs increased remarkably. The nature of septic shock in man is hyperdynamic state. Hemodynamic change during the development of septic shock from sepsis was described and the difference from experimental research on endotoxin shock in animals was discussed.


The use of the Björk-Shiley prosthetic valve in children under 10 years of age. Five children under 10 years of age were operated on with a Björk-Shiley disc valve. The mitral valve was replaced in four patients and the tricuspid valve in one. No hospital death, late death or thromboembolic episode was observed during the 155 patient-months of the follow-up. Moreover, a marked reduction in cardiomegaly was demonstrated to parallel the clinical improvement and low risk seen in adults. We feel that our experience might justify a more aggressive approach in the management of valvular disease in children of the younger age group.


[Clinical experiences and experimental studies of false sensing with demand pacemakers (author's transl)]. False triggering with a ventricular triggered pacemaker and false inhibition with a ventricular inhibited pacemaker were observed in two patients with complete heart block. These arrhythmias were considered to be attributable to false sensing with a demand pacemaker. Both in vitro and in vivo studies were performed to elucidate the mechanism of these false sensings, and the false sensings were reproduced in a series of experiments. Loose contact of the tip of electrodes to myocardial tissue, refractory period, the distance between two electrodes, and the after potential and its dv/dt of pacemaker impulses are considered to affect the performance of demand pacers.


Radioisotope angiocardiographic evaluation of left ventricular function in cardiac patients. Left ventricular volumes were determined by means of ECG-gated RI angiocardiography, which were compared with volumes derived from contrast cineangiocardiography in 25 patients with various heart disease. There was a close correlation of end-diastolic and end-systolic volumes and ejection fraction between RI and contrast angiocardiography, although stroke volume yielded rather scattered values. In 46 of 52 patients with myocardial infarction left ventricular asynergy was demonstrated with our method. Mean velocity of circumferential shortening (mVcf) was exaggerated in patients with apical asynergy. mVcf derived from direct axis measurement yielded a higher value than that from area-length method. Left ventricular volume curve was constructed to obtain normalized systolic ejection rate during initial 100--200 msec after the start of ventricular depolarization. The index was in parallel to ejection fraction in every patient except in moderately severe hypertensive patients. End-diastolic compliance was calculated from Gaasch formula by obtaining pulmonary artery wedge pressure and end-diastolic volume, which was determined by injecting 99mTc pertechnetate into pulmonary artery through Swan-Ganz catheter. This way of access to patient with acute myocard infarction was most useful to evaluate the mechanism of elevated left ventricular end-diastolic pressure.


Clinical evaluation of myocardial contractility and its problems. Studies were performed to assess clinical applicability and usefullness of several non-invasive indices of myocardial contractility, especially, ET/PEP, Pd/ICT and (Pd/ICT)(AO/EO). In dogs preload, afterload or myocardial contractility was altered by durgs. The ET/PEP was influenced by preload as well afterload and PdICT by afterload, respectively. A correction of Pd/ICT with preload, (Pd/ICT)/(AO/EO)showed a satisfactory correlation to Vmas even when the preload and/or afterload were altered. In clinical cases, ET/PEP, Pd/ICT and (Pd/ICT)/(AO/EO) all changed following administration of positive inotropic substances. Moreover, in azotemic cases with primary change in preload the gradient of the Frank-Sterling's curve increased progressively and the entire curve was located upwards with increase of (Pd/ICT)/(AO/EO) value. In case of high-resistance type hypertension, nevertheless, (Pd/ICT)/(AO/EO) showed a tendency to change in association with alteration of its constituent factor Pd. Since there exists no absolutely perfect non-invasive index of myocardial contractility available for clinical application as yet, it would be appropriate to make overall evaluation of myocardial contractility by combined use of several indices, with underlying pathological conditions and characteristics of individual parameters taken into consideration.


Value of prophylactic oophorectomy in advanced breast cancer with parasternal lymph nodes metastasis. In order to improve the poor prognosis of advanced breast cancer cases with positive parasternal lymph nodes metastasis, prophylactic oophorectomy was performed in 25 unselected cases. In a retrospective study on the breast cancer cases operated on from 1958 to 1969, comparison of eight advanced breast cancer cases with positive parasternal lymph nodes metastasis after radical mastectomy of Halsted type and parasternal lymph nodes dissection with, and 17 cases without prophylactic bilateral oophorectomy was made with respect to the survival rate, the survival time pattern by Mantel-Haenszel's procedure in their entirety and the recurrence rate. These results suggest the effectiveness of prophylactic oophorectomy for the advanced breast cancer.


A small pulsatile pump for extracorporeal circulation. A new pulsatile pump was constructed with variable beat rate and the stroke volume, controlled systolic maximum pressure and a very steep built-up curve, to be used for extracorporeal circulation.


Perfusion cooling by pulsatile flow.

Perfusion cooling by pulsatile flow. Organ temperature changes and the temperature gradient between organs with cooling and rewarming were studied in rabbits using pulsatile flow perfusion. The temperature gradient between organs was within 3 degrees C. At the initial stage of cooling and rewarming, organ temperatures changed rapidly. During circulatory arrest, organ temperatures rose gradually. Brain temperature changes were similar to other organs.


Emergency department visits--a statewide survey. In a review by questionnaire of the emergency visits to 185 Florida hospitals, the number of annual estimated visits appears to exceed national estimates. In addition, the concept that in excess of 75% of patients are not true emergencies is not borne out. In spite of changes in the emergency medical services system, only 10% of patients came by ambulance or rescue vehicle. These patients were more likely to be seriously ill as attested to by the fact that 50% required hospitalization. Definitive care was provided for 80% of patients. Some 40% of Florida's emergency departments have full-time emergency physicians. Although nearly 70% of the emergency patients were seen by these physicians, 2.4% were seen by interns only, and a total of 10% were seen by house officers only. There was a great variety of referral patterns among the Health Service Agencies.


Hospital emergency department surveillance system: a data base for patient care, management, research and teaching. The Johns Hopkins Health Services Research and Development Center and Emergency Department have developed a processing and feedback mechanism to provide a data base for management planning, allocating available resources, research strategies to evaluate the quality of care and teaching programs to train physicians in emergency medicine. A 10% sample of all emergency department visits is randomly selected each day, and data collected on patient age, sex, race, marital status, mode of arrival, method of payment, census tract of residence, complaint, diagnosis, disposition, date of visit, and times of entry and departure. In addition, process data on nursing care are collected. A sub-sample is selected for telephone or household follow-up aimed at gathering outcome data as part of the surveillance study. Turnaround time from the subject's emergency department visit to provider's feedback is one month. Thus, an ongoing, current description of usage is available. Retrieval of data for longer time periods provides valuable information on daily, monthly and seasonal usage patterns.


Recognition of type 1 second degree atrial ventricular block during incomplete atrial ventricular dissociation in acute inferior myocardial infarction. Type 1 (Wenckebach) atrial ventricular blocks and accelerated junctional rhythms occur frequently and early in acute inferior myocardial infarction. Combined they present a puzzling arrhythmia. A systematic approach to interpretation and recognition of the RP interval is the critical determinant for conduction. Correct evaluation of these arrhythmias prevents unnecessary therapy.


EMS communication system in Osaka, Japan. Osaka prefecture, an industrial and commercial center in western Japan with a population of 7.4 million, is divided into 40 municipalities. Each municipality has an independent ambulance dispatching center to provide ambulances and rescue personnel information about availability of physicians and hospital beds in that municipality's receiving hospitals. An Emergency Medical Services Information Center (EMS-IC), equipped with a wireless network and memory devices, collects information on available specialits and vacant hospital beds every three hours from 300 hospitals and clinics in the whole prefecture and supplies them to physicians, ambulances, medical institutions, fire services headquarters, police departments, ambulance dispatching centers, medical societies and the Red Cross. EMS-IC can provide the name of the most appropriate medical institution to a running ambulance on request from rescue personnel. EMS-IC also stores information on bank blood and antiserum.


A thoracostomy tube for field and emergency department use. A small, easily insertable tube in combination with a one-way flutter valve serves as a quick but effective small chest tube for use in trauma both in the prehospital stage and the emergency department. The dart was effective in resolving pneumothorax in dogs and humans. Paramedics can be trained easily to use it.


Lung disease in reformed drug addicts: diagnostic and physiologic correlations. Pulmonary morphologic alterations secondary alterations secondary to intravenous drug abuse have been previously identified by histopathologic study of autopsy and biopsy material. Recent investigative efforts have been directed toward defining functional abnormalities that would allow for early clinical diagnosis. For this reason, 12 asymptomatic addicts were studied with roentgenography, spirometry, single breath diffusing capacity (DLco), 99Tc perfusion and 133 Xe ventilation scanning. Nine of the twelve were heavy cigarette smokers. None reported historical evidence of chronic bronchitis or right-sided endocarditis. The DLco was the only significant routine pulmonary function abnormality (p less than .001) observed in these patients. The DLco was significantly reduced even after correction for smoking habits (p less than .001). The decrease in DLco correlated with the number of perfusion defects detected by 99Tc scanning (r = -.560). There was no correlation between DLco and the number of defects on the 133Xe ventilation scan, age, pack-years smoked, or other routine pulmonary function tests. Further, there was no correlation between the number of perfusion and the number of ventilation defects. The data suggest that the decrease in DLco found in these addicts is the result of reduction of the pulmonary capillary bed secondary to vascular or interstitial granulomatosis.


Fever in the first eight weeks of life.

Fever in the first eight weeks of life. Sixty-one febrile infants in the first eight weeks of life were evaluated for serious, treatable illness. Infants with bacteremia could not be distinguished from non-bacteremic infants by height of fever, white blood cell count, absolute number of juvenile or mature polymorphonuclear leukocytes, or the presence of a focus of infection (meningitis excluded). The examiners' overall assessment ("clinical judgment") correctly identified eight of the nine infants with bacteremia as not being "well"; one 2-week-old with group B streptococcal bacteremia was "missed" clinically, This points up the limitation of clinical judgment in assessing febrile infants in the age group studied and supports an aggressive approach in the management of very young febrile infants.


[The Contractile Function of the Surviving Heart Muscle Following Coronary Occlusion (author's transl)]. Following acute myocardial infarction the functional load of the surviving heart muscle does increase considerably, leading to an increased release of adrenergic neurotransmitters with a consequent decrease in endogenous catecholamine stores. Within the first 24 h following infarction, a temporary decline in the high-energy phosphate content is observed in the surviving heart muscle; futhermore, a reduction in lactate extraction is noted. In the intact organism an increased shortening of the surviving heart muscle is noted as a consequence of the altered ventricular geometry and the increased release of catecholamines. If these effects are excluded by means of isolation and analysis in vitro, a decrease in contractile function could be demonstrated in the surviving heart muscle in the early phase following infarction; the response to positive inotropic interventions was depressed as well. These changes are reversible; six weeks following infarction a normal contractile behaviour is observed.


[Catamnestic and endocrinological investigations in women with idiopathic edema (author's transl)]. The clinical picture and the course of idiopathic edema is described after evaluating catamnestic questionnaires on 39 patients. It appears that the syndrome often occurs in other female family members, especially in mothers of propositi and that two thirds of patients have also suffered from symptoms of allergy. In contrast to observations of other groups, diabetes mellitus and slight hypoalbuminemia were found only in a few patients. Secondary hyperaldosteronism was almost exclusively observed in patients who had been taking diuretics during the last few days before the measurements were done. The plasma concentrations of 6 other adrenal steroidal hormones were measured in 33 patients. Only in few of them, mostly patients who had taken diuretics, increased level of 11-deoxycorticosterone, 18-OH-11-deoxycorticosterone and corticosterone were observed. Idiopathic edema does not seem to be a disease entity, but some prediposing factor related to the female reproductive system is likely to exist. Results of systematic psychosomatic studies in our patients will be reported later on.


Leukocyte response to somatostatin in normals and patients with bacterial leukocytosis. In normals and patients with acute bakterial leukocytosis synthetic somatostatin decreases cell count of stab neutrophils, neutrophils and eosinophils. After termination of somatostatin infusion a rebound phenomenon occurred. In healthy normals lymphocyte count increased during somatostatin infusion. This effect outlasts the end of infusion for more than 24 h. No significant effect could be demonstrated in patients with a bacterial leukocytosis.


Effects of antikaliuretic agents on cardiac electrophysiology--measurements in papillary heart muscle and in purkinje fibers. Electrophysiological parameters of myocardial excitability of heart muscle in vitro were studied under the influence of antikaliuretic diuretics. Potassium canrenoate, amiloride and triamterene were added in final concentrations of 5-440 mug/ml incubation medium. Resting and action potentials as well as refractory periods of single muscle cells and Purkinje fibers were measured by the microelectrode technique.--The antikaliuretic substances potassium canrenoate, amiloride and triamterene led to a significant concentration-dependent prolongation of action potential duration and, correspondingly, to a lengthening of the refractory period. Glycoside-induced shortening of the refractory period could be demonstrated to be antagonized by triamterene.--Results suggest that aldosterone antagonists, amiloride and triamterene may exhibit antiarrhythmic properties in the ventricular myocardium as well as in the conducting tissue. Drugs are equally effective when compared in molar concentrations. The application of antikaliuretic diuretics seems to be useful in the therapy of congestive heart failure with respect to their extrarenal cardiac effects, too.


[Radioimmunological estimation of digoxin in urine (author's transl)]. When separating free and antibody bound digoxin, dextrancoated charcoal suspensions in protein-free urine dilutions develop an improve sieve effect which improves with aging of the suspensions. On addition of albumin to the dilution medium (buffer), the adsorptive capacities become stabilized. In urine dilutions less than of 1:50, false positive digoxin concentrations were measured. Determinations of 0-5 ng digoxin/ml in the diluted urine (1:100) and in the buffer solution show identical results. The recovery of added digoxin (1 ng and 2 ng/ml) is 100%; the lower detection limit is 3.6 mug/l urine. Between-assay variation for means of duplicates shows in the main measuring range (1.5-2.8 ng digoxin/ml) a variation coefficient less than of 4.5%; for a commercial test this value is distinctly higher. Dihydrodigoxin is measured at 3% only. Application of this method for measuring cumulative glycoside elimination of 5 healthy persons (0.5 mg digoxin daily intravenously during 2 weeks) results in a minimal interindividual variation of 5.1%. In a test preparation with a bioavailability of 94.6% the variation is 5.2%.


[Intestinal absorption of digoxin in systemic sclerosis (author's transl)]. Gastro-intestinal absorption of digoxin was evaluated in 18 patients with progressive systemic sclerosis. In 8 patients a single-dose crossover study was performed after oral and intravenous administration of 0.5 mg digoxin by comparing the aera under the eight-hour plasma concentration curve. The fraction of the dose absorbed was diminished in 4 patients to less than 55%. There was a significant positive correlation between the extent of digoxin absorption and xylose renal excretion. In addition, steady state digoxin plasma levels and 24-h urinary excretion of digoxin were determined during maintenance therapy in 12 patients. In 6 patients renal excretion of digoxin was clearly less than in normal subjects during chronic dosing of the same digoxin preparation. This finding corresponded well with digoxin plasma levels below the usual therapeutic range in most of the patients. The impaired absorption of digoxin failed to correlate with the extent of the skin manifestation or the time course of the disease while there was massive oesophageal dysfunction in most of these patients. The results suggest that an inadequate therapeutic response to cardiac glycosides in patients suffering from progressive systemic sclerosis is at least partially due to impaired digoxin absorption. Similar problems could occur in therapy of the disease itself due to insufficient enteral absorption of drugs used in treatment of systemic sclerosis.


[Indocyanine green kinetics in newborns with non-hemolytic hyperbilirubinemia (author's transl)]. The kinetic parameters of indocyanine green elimination from blood were determined after an intravenous load of the dye in a dosage of 2-4 mg per kg body weight in 22 newborns with a non-hemolytic hyperbilirubinemia. Since the uptake of indocyanine green by liver is selectively carried out and the dye is not further metabolised, these kinetic parameters serve as measures for the performance of hepatocellular elimination. 11 of these newborns were treated 5 days previously with 7.5 mg phenobarbital per kg body weight. Compared to the untreated group, the serum bilirubin concentration significantly decreased after treatment with phenobarbital and the parameters of elimination of the dye from blood changed as described by saturation-kinetics. The maximal elimination-rate Vmax and the Michaelis-Menten-constant Km were significantly higher in newborns treated with phenobarbital (71.1 muMol/l-min and 356.4 muMol/l) than in the untreated ones (23.4 muMol/l-min and 100.0 mutmol/l). Kinetic data of indocyanine green elimination gathered in newborns treated with and without phenobarbital support the hypothesis that cytoplasmatic proteins oliver should facilitate the uptake of organic anions inclusively bilirubin into the liver cell. A defiency of such transport proteins may be one of the causes of non-hemolytic hyperbilirubinemia in newborns.


[Concentration of plasma glycosphingolipids in acute hepatitis (author's transl)]. There are mainly four neutral glycosphingolipids in human blood plasma: Monohexosyl, dihexosyl, trihexosyl and tetrahexosyl ceramide. In patients with viral hepatitis (n=21) during the acute phase all four fractions of plasma glycosphingolipids were elevated compared to healthy subjects (n=23). With the exception of trihexosyl ceramide all fractions demonstrated statistically striking elevations in the acute phase of viral hepatitis. Simultaneously in the acute phase of hepatitis triglycerides and cholesterol in serum were significantly increased. It is concluded the elevation of glycosphingolipid levels in plasma is a metabolic consequence of hyperlipoproteinemia. Furthermore it is supposed that a part of plasma glycosphingolipids is synthezised de novo by the liver like VLDL.


[State of the microscopic and crystalline structures, the microhardness and mineral saturation of human bone tissue after prolonged space flight]. The bone tissue removed by autopsy from the crewmembers of the orbital station Salyut-1 after their 23-day space flight was investigated histologically, crystallographically, biophysically and biochemically. The comprehensive studies showed good correlation of the parameters studied. The microscopic and crystalline structures of bone tissue of every skeletal bone tested (ox calcis, frmoral epiphysis and diaphysis, vertebrae, ribs, sternum) did not differ from the normal. The data were in agreement with the parameters of bone microhardness and mineralization which also remained within the normal limits. No pathological changes in the above parameters were noted. Greater packing of the crystal lattice, increased microhardness and mineralization of bone tissue can be attributed to the effect of exercises.


[Characteristics of the regional circulation and vasomotor regulation after a 2-month space flight]. The paper presents the results of rheographic study of regional hemodynamics of Soyuz-18 -- Salyut-4 crewmembers at rest and during orthostatic tests before and after their 63-day space flight. On the 1st postflight day a marked decrease of dicrotic and diastolic indices in hemispheric rheoencephalograms of both cosmonauts and in bimastoidal rheoencephalograms of V.I. Sevastyanov was noted. These events of cerebral and venous hypotension were followed in V.I. Sevastyanov by a noticeable increase in the cerebral pulse blood filling and in P.I. Klimuk by a slight decrease of the hemispheric blood filling. A marked asymmetry of rheoencephalograms, especially of the vascular tone, was detected. On the 1st postflight day orthostatic tolerance was diminished, particularly in P.I. Klimuk. He showed predominant phenomena of arteriolar and venous hypotension of cerebral vessels in the vertebral-basillary system and V.I. Sevastyanov exhibited hypotension primarily in the basin of the interior carotid artery. Responses of the regional hemodynamics to orthostatic tests in both cosmonauts improved continuously and reached the preflight level by the 16th postflight day.


[Circulatory studies in LBNP on board the "Saliut-4" orbital station]. Orthostatic tolerance of the Salyut-4 crewmembers was measured by means of LBNP tests (--25 mm Hg for 2 min and --35 mm Hg for subsequent 3 min). Orthostatic tolerance decreased, remaining, however, satisfactory throughout the 2-month flight. During LBNP tests the pattern of most cardiovascular changes inflight and on the earth was similar. In weightlessness heart rate increased reaching maximum preflight values; cardiac output and stroke volume decreased noticeably; the systolic time interval changed significantly. The recommended regimen of LBNP did not deteriorate the health state of the crewmembers and was adequate to predict their orthostatic tolerance. Criteria for the evaluation of the health condition of space crewmembers were developed.


[Dynamics of the orthostatic tolerance of cosmonauts after flights lasting from 2 to 63 days]. Changes in orthostatic tolerance were studied in 25 cosmonauts after their flights to 2 to 63 days in duration aboard the spacecraft Soyuz and the orbital station Salyut. Postflight orthostatic tolerance decreased to a greater extent in those cosmanauts in whom it was below the medium level preflight. Orthostatic intolerance increased with the  flight time. The development of orthostatic intolerance in the crewmembers of the Salyut station was significantly delayed due to better environmental conditions and countermeasures against adverse effects of space flight. An application of countermeasures against postflight orthostatic intolerance and a gentle regimen of readaptation are indicated. An exposure to prolonged weightlessness changes significantly the structure of orthostatic responses. This ought to be taken into consideration when inflight orthostatic tests are being evaluated and when countermeasures against postflight orthostatic intolerance are developed.