Management of aphakic pupillary block. A new argon-laser approach. This communication concerns 9 cases of aphakic pupillary block with high intraocular pressure, which were managed successfully by means of a new argon-laser technique. This new approach consisted in the application at the collarette zone of the iris, 1.5 mm from the pupillary border, of a mobile argon-laser beam of variable intensity, ranging from 250 to 500 mW, of constant time (0.5 sec) and of fixed spot size (200 micron m). In some instances the beam was moved parallel and in other cases vertically to the pupillary border in the direction towards the ciliary portion of the iris. This technique ensures maximum retraction of the pupillary border, corresponding to the line of application, coupled with the least possible damage to the iris and a minimum of applications. Simultaneously with the retraction the posterior synechiae of the iris are detached and the outflow of the aqueous trapped in the posterior chamber released.


14 cases of cavernous degeneration of the optic nerve. After a brief bibliographical introduction the author's report on 14 cases of cavernous degeneration of the optic nerve, based upon the study of 1,831 autoptic cases. All the subjects examined showed lesions of a senile degenerative type in the vessels afferent to the retro-laminar segment of the optic nerve. The pathogenetic mechanism of the lesion under examination seems therefore to be attributable to ischaemic cause of a chronic type. Myopia and glaucoma, if present, would also seem to contribute, as they cause disorders of the blood system in this region.


Dark adaptation in diabetics.

Dark adaptation in diabetics. Dark adaptation in diabetics was recorded with Goldmann-Weeker's adaptometer and analysed according to the stages of retinopathy by Scott. Dark adaptation curves in diabetics were divided into three groups; normal dark adaptation; subnormal one which showed normal first curve of dark adaptation and impaired second curve; abnormal dark adaptation which showed impaired dark adaptation in the whole course. The cases with normal dark adaptation were found to be few in the stages Ia, II and IIIa of retinopathy. Subnormal dark adaptation was rarely found in the stages Ia, II, IIIa and IIb of retinopathy. Abnormal dark adaptation was recorded in most patients with diabetic retinopathy and found in all th stages of retinopathy. A 5% level of significance was statistically recognized in the thresh old at 35 min after light adaptation between the stages IIIa and IIIb of retinopathy. From this viewpoint, significance in severity of diabetic retinopathy was discussed.


Management of dysthyroid optic neuropathy. The diagnosis of dysthyoid ophthalmopathy is based on clinical observation of characteristic ophthalmic abnormalities. Proper diagnosis and initiation of treatment should not be delayed because a patient is found to be euthyroid. Although visual problems in dysthyroid ophthalmopathy are uncommon this disorder can result in permanent severe visual loss if optic neuropathy is not detected early and managed properly. Oral corticosteroid therapy and surgical decompression both seem to have a place in the treatment of dysthyroid ophthalmopathy with optic neuropathy.


The encircling Silastic 3 mm band without cautery in retinal detachment surgery. Retinal detachment with tears can be cured by scleral buckling by synthetic material pressure retino-choroidopathy without cautery (diathermy, cryo- or photocoagulation) to tear edges on conditions: (1) To use the encircling Silastic 3-mm band (equatorial or oblique according to tear site) giving a permanent buckle. The segmental buckle may recede reopening the tear and its retino-choroidopathy effect may not be sufficient to seal the tear. (2) Not to evacuate the subretinal fluid leaving the ocular tension at end of operation a bit high [about 25 mm Hg in the first operation and 5 mm Hg (Schøtz) in the recent reoperation above the preoperative level]. The synthetic material pressure retino-choroidopathy seals the tear and lowers the ocular tension in subsequent days with beter buckling. (3) As these conditions may not be attained, it is wiser to use minimal diathermy or cryo-therapy to seal the tear.


[Uniocular aphakia--conventional contact lenses and aniseikonia]. Ehrich and Kolbegger show in their papers that aniseikonia should not prevent binocular functions in a uniocular aphakia. This is contrary to our own experiences. In this paper we suggest that the results of Ehrich and Kolbegger must be worse in spite of their final conclusions. Their hypotheses are discussed.


Congenital lobar emphysema.

Congenital lobar emphysema. Congenital lobar emphysema is frequently a life-threatening disorder presenting in infancy. The diagnosis should be considered when the patient shows signs of respiratory distress and the x-ray demonstrates the characteristic hyperlucent lobe with compression of the surrounding lung tissue. The morphologic aspects and pathogenesis are not clearly defined, although it is thought that an abnormality of bronchial cartilage is probably associated with the development of lobar emphysema. The results of treatment by lobectomy are excellent, and the mortality with surgery is low. Consideration of nonsurgical management is worthwhile in mildly affected or asymptomatic patients. Long-term follow-up of both groups indicates a very favorable prognosis in this disease entity.


Atrial flutter. Tracing an elusive arrhythmia. Seven bried case reports representing variations of atrial flutter point up important considerations bearing on diagnosis: situations predisposing individuals to atrial flutter with 1:1 atrioventricular conduction, the need for special care in placing ECG leads for continuous monitoring, the use of carotid sinus massage to unmask atrial flutter, the infrequent but not rare association of Wenckebach block, the possible presence of diffuse disease of the conduction system, the possibility of initiation of atrial tachyarrhythmia by a premature atrial impulse, and possible inherent limitations of routine ECGs.


Perioperative antibiotic prophylaxis and prosthetic valve endocarditis. A study of twenty-five cases of prosthetic valve endocarditis suggests that the antibiotics used for perioperative prophylaxis may alter the type and antibiotic sensitivity of organisms which subsequently infect the artificial valves. Based on the results of this study, the authors have been able to modify their prophylactic regime to encompass these organisms and to predict the antibiotics most likely to be effective in the treatment of prosthetic valve endocarditis in their unit. No single prophylactic or therapeutic regime will be equally effective in all centres, but by examining the different types and sensitivities of bacteria which cause prosthetic valve endocarditis in a locality, antibiotic regimes can be chosen which best suit the local situation.


Active treatment of ganglia in children. One hundred and twenty-eight children, admitted for active treatment of ganglia around the wrist, hand, ankle or foot are reviewed. The methods of treatment are discussed. The most satisfactory results were obtained by excision (7-2% recurrence) and incision with a tenotome (11% recurrence). The overall recurrence rate was 19%. The ganglia around the wrist had the highest rate of recurrence.


Interaction between warfarin and sulphamethoxazole. A patient is described in whom there was strong circumstantial evidence of an interaction between warfarin and co-trimaxazole. To test the validity of this hypothesis a series of in vitro and in vivo human studies were untaken. The results indicate that interaction may occur in which the sulphamethoxazole moiety of co-trimoxazole displaces warfarin from its binding sites on plasma albumin. Nevertheless, this interaction occurs only at high plasma levels of warfarin and is most likely to be clinically significant only in patients receiving high doses of warfarin who have low plasma albumin concentrations. These studies indicate that the use of co-trimoxazole is not contra-indicated in patients receiving warfarin therapy, but care should be exercised, especially in patients with high plasma warfarin:albumin ratios.


Leuco-erythroblastosis following withdrawal from glucocorticoid therapy. Leuco-erythroblastosis has many known associations (Burkett, Cox and Fields, 1965; Weick, Hagedorn and Linman, 1974; Retief, 1964), but the only ones related to drug therapy are the well established response to haematinics (Burkett et al., 1965) and one possible case following anti-epileptic therapy (Retief, 1964). The case described below is of leuco-erythroblastosis following steroid withdrawal in a young man with primary polymyositis.


A case of paraparesis due to extramedullary haemopoiesis in HbE-thalassaemia. A 24-year-old female with haemoglobin E-thalassaemia who presented with paraparesis of 18 months' duration was found to have spinal extradural extramedullary haemopoietic tissue extending from T4 to T9. Complete neurological recovery followed laminectomy. The importance of prompt diagnosis and treatment, of this unusual complication of extramedullary haemopoiesis, before the spinal cord is irreversibly damaged is stressed.


Diaphragmatic flutter.

Diaphragmatic flutter. A case is reported of diaphragmatic flutter with an unusually long duration of symptoms. The patient described demonstrates many of the classical features of this disorder.


Carcinosarcoma of the adult kidney.

Carcinosarcoma of the adult kidney. Carcinosarcoma of the adult kidney is a very rare tumour and there are only a few well documented cases in the literature. In this report such a tumour is described from a 50-year-old white male, which progressed very rapidly with widespread metastases. Histologically, the tumour consisted of renal cell carcinoma and fibrosarcomatous components. The interesting features in this case were that both the carcinomatous and sarcomatous elements of the tumour exhibited metastases separately to various organs.


Co-existent eosinophilic gastroenteritis and hypothalamic-pituitary dysfunction. A case of eosinophilic gastroenteritis in a 42-year-old man is described. The patient had diarrhoea, faecal blood loss, a protein-losing enteropathy, malabsorption of fat, xylose and vitamin B12. Co-existent hypopituitarism, diabetes insipidus and hypothalamic dysfunction was demonstrated. Complete clinical recovery occurred with pituitary replacement therapy alone. The association of this endocrine abnormality with the picture of eosinophilic gastroenteritis has not previously been described.


Polyradiculoneuritis and Mycoplasma pneumoniae infection. A patient with severe Mycoplasma pneumonia developed polyradiculoneuritis and respiratory failure. The acute phase of the illness was complicated by a myocarditis, and recovery of neurological function was slow. Residual left hemidiaphragmatic paralysis was present 1 year after onset of the illness.


[Asbestosic pleural calcifications and the associated pathology (study of 32 cases)]. The presence of calcified pleural plaques together with asbestos professional exposition is the sign of patent dust inhaling and can be related to asbestos pathology. The observations on a homogeneous group of 32 cases of asbestosic pleural calcifications are analyzed. The frequency of malignant pleural and bronchial tumours (2 pleural mesothelioma, 3 bronchial epithelioma) is classical. That there was no serious pulmonary fibrosis can be attributed to the conditions of dust inhaling. There was a relatively  high frequency of pleural effusions, the benignity of which could not always be ascertained. Therefore, besides the convincing facts, the precise study of cases with calcified pleural plaques (pleural antecedents, circumstances of the discovery, evolution) could be a rough way of appreciating the frequency of benign asbestos pleurisies.


The effects of developmental and/or direct lead exposure on FR behavior in the rat. In the present study, 21-day old female rats were exposed to daily doeses of 750 mg/kg of lead acetate via restricted water intake regimen for 70-80 days prior to mating. Treatment was then continued throughout gesation and nursing. At weaning, litters from half of the treated and control mothers were placed on treatment for the remainder of the experiment. This manipulation yielded four groups for testing: Group Pb/Pb, developmental and direct, postweaning exposure; Group Pb/C, developmental exposure only; group C/Pb, direct exposure only; and Group C/C, no exposure to lead acetate treatment. Beginning at 42--49 days of age, offspring were shaped to bar press on a Fixed Ratio 20 (FR20) schedule of reinforcement and then received 20 sessions each 20 min in length. Analyses revealed that Group Pb/Pb received significantly fewer reinforcements/min across sessions that the other three groups and also took significantly longer to emit each 20 response block. Contrary to previous reports in the literature, it is suggested that rats may not be impervious to postweaning lead exposure, particularly when there is a history of developmental exposure.


Elevation of aversive threshold in rats by intra-amygdaloid injection of morphine sulphate. Bilateral micro-injection of morphine sulphate (10 microgram, 20 microgram) into the cortico-medial amygdala produced a dose-dependent increase in aversive threshold. Similar injections into the basolateral amygdala or caudate-putamen failed to have any consistent effect on aversive thresholds. Whilst overall activity levels remained unaffected by morphine injection into either amygdaloid site, caudate animals exhibited a significant decrement in total activity in response to both morphine and control injections. Results are discussed with reference to a possible role for limbic mechanisms in morphine analgesia.


The effect of 6-hydroxydopamine on habituation of activity in the developing rat pup. The role of brain catecholaminergic mechanisms in habituation of activity was investigated in rat pups treated with 6-hydroxydopamine (6-OHDA). Intracisternal administration of this agent in the neonatal period resulted in a permanent and significant depletion of brain dopamine to 35.5% of controls while brain norepinephrine remained unchanged. Activity levels in normal developing rat pups increased rapidly between 15-22 days, then declined at maturity (26 days), while activity in 6-OHDA treated animals during this peak period of behavioral arousal increased to a significantly greater degree than that of their littermate controls. Habituation of activity, defined as the decrement of spontaneous activity, was calculated by regression over the first 30 min of observation. At both 5 and 8 days of age 6-OHDA and control rat pups exhibited low levels of activity whose decrease with time did not differ significantly and this pattern continued through 12 days of age. However, by 15 days of age activity in control animals declined by 19% each 10 min period compared to only a 10% decline found in 6-OHDA animals. At 19 days normal rat pups declined by 10% compared to a significantly reduced decrement of 3% found in treated animals, but these differences were no longer apparent by 22, 26, or 29 days of age. Our results are consistent with the notion that habituation of activity is a complex phenomenon mediated in part by catecholaminergic systems.


Psilocybin: biphasic dose-response effects on the acoustic startle reflex in the rat. The startle reflex was measured in 7 groups of 10 rats each after intraperitoneal injection of saline or 0.25, 0.50, 0.75, 1.0, 2.0, 4.0 or 8.0 mg/kg psilocybin. Low doses (0.75-2.0 mg/kg) increased startle amplitude whereas high doses (4.0-8.0 mg/kg) depressed startle. Selected low (0.71 mg/kg) or high (5.70 mg/kg) doses of psilocin also had a biphasic dose-response effect on startle comparable in magnitude to equimolar doses of psilocybin. This biphasic dose-response relationship of the indole hallucinogen, psilocybin, on startle is consistent with the hypothesis that startle is increased when the firing rates of midbrain raphe neurons are selectively inhibited but is depressed when neurons postsynaptic to raphe cells are also inhibited.


Effect of alpha-amanitin on brain RNA and protein synthesis and on retention of avoidance conditioning. The effect of a sublethal dose of alpha-amanitin given intraventricularly to rats on retention of passive and active avoidance conditioning has been studied, together with the effect on brain RNA and protein synthesis in vivo. The toxin brings about a significant impairment of retention of both passive and active conditioning in rats poisoned 6 hr or 24 before training. Brain RNA synthesis is decreased at 6 hr after poisoning, whilst protein synthesis decreases at a later stage (not before 12 hr after poisoning). Thus in rats poisoned with alpha-amanitin memory consolidation is impaired when RNA synthesis is decreased, and before protein synthesis is affected.


Effects of melanocyte-stimulating hormone (MSH) and melatonin on passive avoidance and on an emotional response. The present experiment investigated the opposite effects of synthetic alpha-MSH and Melatonin on acquisition and extinction of a passive avoidance response (PAR) and on emotionality, as indexed by defecation, in the PA box. It was found that intraperitoneal (IP) administration of alpha-MSH delayed extinction and increased defecation responses whereas IP administration of Melatonin facilitated extinction of the PAR and decreased defecation. The present experiment confirmed MSH-Melatonin opposition on memory and on the defecation response.


Flash evoked potentials from rat superior colliculus. In view of reports that the superior colliculus evoked potential from rats is uniquely sensitive to toxic gases, the present study characterized normal flash evoked potentials from unanesthetized rats. The waveform was complex, with at least 5 positive and 5 negative peaks. The waveform originated in the SGS layer, and some components were stable over time if conditions of light intensity, stimulus frequency and dark adaptation were held constant. The greater complexity of the waveforms reported here compared to those described by others can be attributed to both an intense flash stimulus and unanesthetized preparation.


Carbon monoxide and flash evoked potentials from rat cortex and superior colliculus. In view of the conflict between qualitative reports that flash evoked potentials from superior colliculus (SC) and visual cortex (VC) of rats are uniquely sensitive to low levels of carbon monoxide (CO), and a more quantitative report that the visual cortex evoked potential is not sensitive to low levels of CO, the present report documents the effects of different concentrations of CO upon flash evoked potentials from these areas. The amplitude of the P3-N4 component from the SC evoked potential demonstrated the best dose/effect relationship, increasing up to levels of 38% carboxyhemoglobin (COHb). Latencies were affected only when COHb levels reached 55%. The use of the visual system to determine effects of toxic agents upon the central nervous system in discussed.


A modified push-pull system for the localised perfusion of brain tissue. A method for monitoring the outflow of a push-pull perfusion system is presented. This modification possesses the following important advantages: (1) Inadvertent induction of expansion lesions is avoided, (2) Flow rates can be reduced from the usual 50-200 microliter/min to 0.6-1.7 microliter without decreasing the probability of detecting occlusions, (3) Incidence of occlusions is reduced, (4) Up to 30--40 perfusions can be performed at each of several sites in the brain of a single animal over a period of several months. The modified system has been used successfully to administer neurohumoral agents to the brain of rats and to determine the release of endogenous substances into the perfusate.


[Stuttering and neurosis].

[Stuttering and neurosis]. Neurotic mechanisms have been found to be involved in the majority of cases of stuttering. Therefore, the treatment of this particular disorder should include different amounts of psychological treatment depending upon the role that such mechanisms are playing in the multifactorially determined etiopathogenesis of stuttering. The relationship of the symptomatology of stuttering to neurotic reactions and developments is described with reference to a typical clinical example. The description of the case, in which an attempt is made to determine the causes of the disorder, is followed by a discussion, relative to stuttering, of the classification of neuroses recommended in 1969 for use in the German Democratic Republic and taken as a base for this work.


[Relationship between (perceived) maternal rearing behavior and personality characteristics of behaviorally disturbed children and juveniles]. A survey of the literature on methodological problems associated with, and results of, the diagnosis of parental educational attitudes and practices as viewed and experienced especially by those receiving education is followed by a report on an investigation of the maternal educational behavior perceived by behaviorally disturbed children and juveniles of male sex. Correlative results obtained from the evaluation of questionnaires confirm the interrelation of disturbed (maternal) emotional relations to children and abnormal behavior shown by children. The inclusion in the diagnostic practice of reports given by those receiving education on the educational behavior shown by parents or other persons in whom the right of education is vested is considered to be a necessary and useful supplementary method.


[Neuropsychological parameters of droperidol-induced psychoses]. To each of twelve normal subjects 140 to 200 mg of droperidol were administered. The psychopathological (temporary hallucinatory syndrome), electroencephalographic (distinct posterior theta groups), electromyographic and electroneurographic (H amplitude depression), as well as electrocardiographic (tachycardia, extrasystoles) results are discussed with reference to possible mechanisms of action.


[Development of the comprehension of localization in deranged consciousness]. The controversy between narrow localisationism and equipotentialism which exists even nowadays shows that these two trends are not in a position to solve the localisation problem. The attempts to localize consciousness either in the cortex or in the subcortex and the area of the third ventricle should be considered groundless, as well as the assumption that the cortex only gives the contents of consciousness while the source of consciousness is found in the area of the third ventricle. Consciousness represents the synthesis of the psychical activity. The basic weak points of both trends arise from the very formulation of the question discussed, from the striving to find the solution of the localisation problem without bearing in mind the physiological processes which lie in the basis of the higher psychical functions, i.e. behind the processes of the higher nervous activity, as well as from the incorrect understanding of the conceptions of "function" and "centre". Thanks to the school of I. P Pavlov and his followers the prerequistions have been created of a new trend in the field of the localisation problem--the teaching of the dynamic localisation of the cerebral function.


[Group-therapy system of treatment in a psychiatric ambulatory]. The group-therapeutical system of treatment used by the outpatient department of the Leipzig University Mental Hospital is described. Individual forms of therapy and their indications are discussed. Some therapeutical principles are outlined. And attempt is made to report some of the experience gained using this system of treatment.


[Bioelectric activity in cases of childhood masturbation]. In a total of forty-five cases of masturbation practiced by children EEG derivations were made before, during, and after anticonvulsive treatment. The results obtained confirm the clinical experience showing that the observed seizure-like phenomena have no relation whatever to forms of epilepsy.


[The psychopathology of suicidal tendencies]. Suicidality should not, in consideration of the present studies and the experience gained by the author, be considered a disease 'sui generis', but rather a symptom only. The etiopathogenesis of "nonpsychotic" suicidality is discussed with particular reference to the psychopathology thereof. Acts of suicide are most often part of "lasting affective reactions". In a certain number of cases suicidality is the symptom of an emotional disturbance or functional nervous disease resulting from psychic maldevelopment, which is usually characterized by a relatively small number of general symptoms and where conscious acts are impaired by unconscious conflicts.


[Localized 4-sec and rhythm in the EEG]. The author, after presenting diagnostic criteria and interpretations of the 4-sec. rhythm in the brain potential record, describes a case where this symptom is localized in the right occipital region. He also points out that further elucidation should be possible by a differential establishment of indications.


[Follow-up examinations of long-term hospitalized patients with seizures]. Clinical, neurological, hematological, chemical, roentgenological, and bioelectrical results obtained from a total of 28 hospitalized male sufferers of epilepsy were compared, within a catamnestic period of 5 years, with data reported in the literature. Combination therapy resulted in freedom from attacks in 50% of the patients. Symptoms of cerebellar lesions were observed to develop in about 60% of the cases where therapeutical doses were used for treatment. Major changes in the blood picture, hepatic lesions, or disturbances of ossification could not be observed. From the results obtained in these studies conclusions are drawn for the long-term therapy of epileptics.


[The problem of polyneuropathy in methaqualone medication]. Thirteen years after the introduction of methaqualone into therapy, investigators (namely, Finke, Spiegelberg, and Suchenwirth), by reference to individual cases, pointed out the possible development of polyneuropathies. This has not so far been confirmed despite worldwide use of the drug. Experiments on rats, which were conducted by the present authors, show a statistically significant decrease in maximum motor conduction speed, which is believed to be functional disorder. Clinical symptoms or nervous structural variations in the sense of polyneuropathy could not be observed.


[Metoclopramide (Cerucal) side-effects in the form of extrapyramidal disorders in combination with an other antidepressive agent]. The authors, by reference to a patient showing acathisia and other dyskinetic disorders following the administration to him of small doses of metoclopramide (Cerucal) and clomipramine, which is a thymoleptic, discuss extrapyramidal disorders attendant upon the therapy of larvated depressions or depressions accompanied by gastrointestinal disorders.


Cardio-respiratory synchronisms: synchrony with artificial circulation. Rabbits with an artificial cerebral circulation can synchronize their respiratory rhythm with the pump stroke. There is evidence that the responsible kypernetic system is of a very elementary nature. The efficacy of the system is considerable and the experimental set-up as a whole offers itself as a model to search for drugs to increase the synchronizing potentialities.


The influence of various benzo-pyrones on acid and neutral protease activity levels, the cells from which they may arise and their importance in the resolution of lymphoedema. The availability of digestable material to a phagocyte determines not only the rapidity and completeness of digestion but the amount of lysosomal enzyme which reaches the extracellular compartment and the circulation. The measurement of enzyme activities in thermally injured limbs has shown the benzo-pyrones to enhance acid protease activity. There is much evidence to suggest this activity originates from macrophages which enter the thermally injured regions in great numbers. In this paper the administration of benzo-pyrones to animals with lymphoedema is reported to enhance neutral protease activity levels. This activity is not associated with mononuclear cells but with the neutrophils. Although additional histological work must be done to confirm the presence of neutrophils in lymphoedematous tissues there is evidence to suggest the increases in neutral protease levels arise from neutrophils and that in lymphoedema it is these cells which are acted upon by the benzo-pyrones. They then cause the removal of protein by enhancing its lysis either within the cells or in the extracellular compartment.


[Experiences with the hemorrhagic shock in immature pigs (author's transl)]. In 74 immature pigs a hemorrhagic shock (3 hrs duration: mean arterial pressure 40 mm Hg) was established (NORTON 1972). Following this systemic stress all animals developed stress-lesions of stomach and duodenum. In comparison to other stress-models porcine hemorrhagic shock seems to be qualified to study pathogenesis, prophylaxis and therapy of gastric stress-lesions: Pigs correspond best to humans in their gastro-intestinal physiology, hypotension simulates one of the most important surgical causes of stress complications and stress-lesion produced by this model have a marked similarity to those of humans. In contrast to these advantages there are some problems in using this model: Prompt and dangerous electrolyte imbalance following correction of disturbances in acid base equilibrium; irreversible shock following protracted hypotension (3 hrs). For this reason 19% of all piglets died before (1 animal), during (10 animals) or immediately after shock (3 animals). By careful observation of the mentioned problems, however, this experimental model combines a high incidence of stress-lesions with a low rate of casualities.


[The Göttinger minipig as a laboratory animal. 3. Communication: iron-, copper- and zinc-values in blood-serum]. Serumvalues of iron, copper and zinc were determined by atomic absorption. The results of two collectives (juvenile and adult animals) which were kept under SPF-conditions were compared with the corresponding values of man.


The effects of zinc on the morphology of sickle red blood cell ghosts as observed by scanning electron microscopy. The objective of these studies is to define the role of zinc in RBC ghost morphology specifically in comparison to the echinocytogenic effects of calcium. Erythrocyte ghosts were prepared from patients with sickle cell anemia, treated with zinc and/or calcium and the resulting cell morphology studied by scanning electron microscopy. Our results showed that zinc consistently and significantly antagonized the echinocytogenic effect of calcium. A simple log linear statistical model was used to evaluate the data and supported this conclusion. We discuss the potential significance of these findings to the effect of zinc treatment on patients with sickle cell anemia.


Mass transfer properties of gases in fluorocarbons. The solubility and diffusion coefficient of oxygen and carbon dioxide were measured in both the pure and emulsified of two fluorocarbons, perfluorotributylamine and perfluorobutyl perfluorotetrahydrofuran. The solubility coefficient and the diffusivity of oxygen in the pure form of the fluorocarbons decreased with decreasing partial pressure of Oxygen (PO2), but the solubility coefficient and the diffusivity of carbon dioxide were independent of its partial pressure. The solubility and diffusion of oxygen in the emulsified form of the fluorocarbons followed the pattern expected from the behavior of oxygen in the pure fluorocarbon. The experimental results suggest that there exists a physical and/or chemical interaction between oxygen and the fluorocarbons, and this interaction is more pronounced at partial pressures below 150 mm Hg. Comparisons of the oxygen content in the fluorocarbon emulsions with that in whole blood show that at PO2 of 760 mm Hg, the oxygen content in the fluorocarbon emulsions is approximately one-half that in whole blood, but at PO2 of 50-150 mm Hg, the oxygen content in the emulsions decreases to values which are less than one-tenth that of whole blood.


[Functional and morphological studies on intestinal mucosa of the rat under chronic glucagon application (author's transl)]. Chronic application (20 days) of glucagon in pharmacological doses induces mucosal transformation of the hyperregenerative type in the small intestine of the rat. This transformation is characterized by decreased villi, and increased crypt length. The morphological changes are accompanied by a reduction in glucose absorption in vivo as well as by decreased activities of lactase, sucrase and maltase. The findings demonstrate that hyperglucagonemia is not the cause for hyperplastic mucosal transformation, which is found in the experimental diabetes in the rat.


[The influence of catecholamines and sekretin on the serum-gastrin-concentration in rabbits (author's transl)]. 27 rabbits underwent infusion of epinephrine, norepinephrine and secretin. Gastrin concentration patterns were determined in serum before, during and after the infusion. There were no significant increases during epinephrine and norepinephrine infusion. During secretin and a combined secretin-epinephrine infusion there was a significant rise in serum gastrin concentration. The gastrin secretion pattern in rabbits influenced by catecholamines and secretin is in complete contrast to human conditions. That means that rabbits can only be used with a certain reserve in gastroenterologiccal experiments.


Structural and functional studies on the transformation of the intestinal mucosa in rats with experimental diabetes. Twenty days after the onset of alloxan-induced diabetes, a villous hyperplasia has developed in the intestines of rats having free access to food. The transformation is characterised by a considerable increase in the area of the villous surface, caused by an enhanced mitotic activity in the crypts. The absorption of glucose or methionine by jejunal loops, whether expressed in terms of serosal area or villous area, is unchanged at this stage. On the other hand, the specific activity of certain disaccharidases and dipeptidases in crude mucosal homogenates is greater in diabetic animals, but quantitative histochemistry revealed no changes in the activities of alkaline phosphatase, leucine amino-peptidase and non-specific esterase in the individual enterocytes. Thus the biochemical changes may simply reflect the hyperplasia of the mucosa. The blood sugar level does not appear to be directly responsible for the mucosal transformation; however, the positive correlation between the daily food intake and the villus height suggests a role of hyperphagia and consequent increased luminal nutrition in the development of the hyperplasia.


Use of a modified thromboelastograph to evaluate effects of acetylcysteine on sputum. This work deals with a modification of a thromboelastograph which enables to measure both in vitro and in vivo effectiveness of mucolytic substances. A simple method is described for building up a comparative diagram of the effectiveness of several drugs; a diagram which is of interest from both a pharmacological and a clinical point of view.


Relationship between pulmonary embolism, airway obstruction and hypersensitivity of the airways in dogs: influence of partial vagus nerve blockade. Experiments in dogs showed an increase in deltaPoes/100 ml TV after embolization which returns to normal after blocking the vagus nerves, indicating an increase in airway resistance. A marked sensitization to ACh inhalation by embolism with both blood clots and glass beads was demonstrated. This hypersensitivity is vagus-dependent.


[Comparative study by body plethysmography and spirometry with the helium dilution method in patients with tuberculosis]. The persisting defects after treatment of tuberculosis in 51 patients were evaluated by a simultaneous measurement of the functional residual capacity (FRC) using the body plethysmograph and the helium dilution method. In most patients large volumes of trapped air were detected by the difference of two methods of measurement. The amount of trapped air showed to be dependent of the other pulmonary parameters obtained: Tiffeneau index, FRC measured by body plethysmography, difference between predicted and measured FRC.


Nomogram for estimating standard PaO2 and alveolar-arterial gradient for oxygen during ventilation with room air. Standard arterial oxygen pressure is a calculated value which must be in arterial blood in the given lung function when all conditions of estimation are standard--PACO2 40 mm Hg, barometric pressure 760 mm Hg and respiratory exchange ratio 0.85. For practical purposes, a nomogram was constructed for estimating SPaO2 and arterial alveolar oxygen difference during breathing with room air. It will give us a possibility of comparing estimations made in different conditions. The mean error for AaDO2 is 0.4 mm Hg, which is acceptable for clinical purposes.


Continuous measurement of respiratory resistance in asthmatic children. In 13 children (7-13 years old) with bronchial asthma in remission, respiratory system resistance was continuously measured by the forced oscillation method at 10 Hz, using on-line digital computer analysis. Corrections were made for mouth impedance which was determined from a prior Valsalva maneuver. Functional residual capacity was also periodically determined by the body plethysmographic technique in order to allow calculation of specific respiratory system conductance (SGRS). The total observation period of 45 min consisted of quiet breathing interrupted by vital capacity maneuvers. In a single-blind design, eight children were given 0.15 mg isoproterenol sulfate from a proprietary spray delivered in the beginning of an inspiratory vital capacity maneuver while five received a placebo (freon propellent alone). A significant increase in SGrs (+53%) was observed 75 sec after isoproterenol sulfate administration. SGrs peaked after 2 min (+ 61%) and remained elevated significantly for 10 min. No significant changes occurred in the placebo group. The immediate decrease in SGrs which was observed following control vital capacity maneuvers, was prevented by isoproterenol sulfate but not by the freon propellent. Our findings suggest that although peak bronchodilation does not occur before 2 min following isoproterenol sulfate inhalation, an effect, namely prevention of bronchoconstriction induced by a deep breath, is already detectable within seconds.


Effect of unilateral vagus blockade on allergen-induced airway obstruction: results of short- and long-term experiments. Unilateral application of ascaris extract on segment bronchus as the influence of contralateral vagus blockade on reflex bronchoconstriction was studied on four boxer dogs in a first group (A) of experiments: ascaris extract was applied in liquid form directly through a catheter into the right segment bronchus. This application was repeated after contralateral vagus blockade and once more after its lavage. All the animals showed an increase of airway resistance under local application of ascaris extract which could not be avoided by contralateral central vagus blockade. In the second group (B) isolation of unilateral vagus for reproducible performance of blockade as a long-term model was investigated in three boxer dogs for 7 weeks and the influence of this method of unilateral vagus blockade on exposure to allergen aerosol was studied. The unilateral blockade of the nerve vagus was again always successful in decreasing the reflex bronchoconstriction following allergen inhalation. The effect of unilateral section of nervus vagus 3 weeks after this vagotomy was tested on two boxer dogs. Reflex bronchoconstriction following ascaris extract inhalation can be avoided by unilateral section of the nervus vagus the first time after section. Three weeks after this unilateral vagotomy, the reflex bronchoconstriction becomes managed by the remaining vagus trunk to the same degree as observed by bilateral intact vagi.


Rhythmic phrenic nerve activity and respiratory activity in spinal dogs. The possibility of respiratory activity in adult spinal dogs was reinvestigasted with emphasis placed on the contribution of the phrenic nerves and diaphragm. Under chloroform anesthesia, the spinal cord was transected at either the C1 or C2 level. After spinal transection and occlusion of the blood flow to the head, anesthesia was discontinued. In 6 dogs spinal rhythmic respiratory activity was induced by administration of doxapram HCl, 3-5 mg/kg i.m., while in 2 dogs such activity occurred spontaneously. The observed cyclic changes in intrapleural pressure correlated with unilateral phrenic neurogram. The bursts frequency of the phrenic nerve activity was altered by the artificial positive-pressure respiration synchronizing the phrenic activity with the respirator. This suggests that afferent reflexes can modulate this spinal, cyclic phrenic nerve activity. This study demonstrates that the phrenic nerve and the diaphragm play a major role in spinal respiratory activity.


Histamine H1- and H2-receptors in the cat and their roles during alveolar hypoxia. We sought to define the roles of H1-and H2-receptors in the cat and to evaluate the roles of these receptors during alveolar hypoxia. In pentobarbital anesthetized cats, we found that histamine infusion (1.1 microgram/kg/min for 3 min) increased cardiac output and decreased pulmonary and systemic vascular resistances. However, when cardiac output was held constant, histamine infusion induced pulmonary vasoconstriction. Histamine infusions after H1-and H2-receptor blockade (chlorpheniramine and metiamde, respctively) indicated that H2-receptors mediated systemic vasodilatation. In the lung, H1-receptors mediated vasoconstriction, and H2-receptors mediated vasodilatation. Hypoxia (10% O2) caused large increases in pulmonary vascular resistance which were not blocked by H1-, H2-, or combined H1- and H2-receptor blockade. In the intact cat, histamine does not appear to mediate hypoxic pulmonary hypertension.


Respiratory responses of ducks to simulated altitude. Domestic ducks were exposed to simulated altitudes of 0, 3000, 6000, and 9000 m in order to study the respiratory changes that take place. We found that the respiratory minute volume (VE,BTPS) increased with altitude, the increase being due to increased respiratory frequency while tidal volume (VT, BTPS) showed only minor changes. The quantity of air moved (VE, STPD), however, remained nearly unchanged with increasing altitude. The oxygen extraction, calculated as 1--(FIN2FEO2)/(FEN2FIO2), remained constant at about 0.28 up to 6000 m and declined to 0.17 at 9000 m. The fractional gas concentrations (FO2 and FCO2) in exhaled air and in the interclavicular and posterior thoracic air sacs changed only little up to 6000 m, but at 9000 m FO2 increased and FCO2 decreased. The relative constancy of expired and air sac gas up to 6000 m seems remarkable. However, when applied to current models of air flow in the avian respiratory system the results seem fully explainable and permit a detailed analysis of the functioning of the avian respiratory system.


Transfer of N2O, CO and HTO in the artificially perfused guinea-pig placenta. The fetal vascular system of the guinea-pig placenta at term was perfused with a dextran solution at a rate of 3.6 and 9 ml/min, while the uteroplacental (maternal) blood flow was adjusted to 4-18 ml/min. N2O, CO, and tritiated water (HTO) were added to the perfusion fluid. The effectiveness of placental transfer of these substances, i.e. the actual transfer related to the maximum transfer occuring when the fetal vein equlibrates with the maternal artery, was calculated. It was found that the effectiveness of the CO transfer was 98% (SD = 2%). The effectiveness of the N2O transfer was about 90% (SD = 6%) when the maternofetal flow ratio was two and about 75% (SD = 13%) when the ratio was one. The effectiveness of the transfer was the same for HTO and N2O. It was concluded: (1) The vascular and diffusional shunts on the fetal side of the placenta are only 2%. (2) The placenta has the properties of a countercurrent system in which the effectiveness of gas transfer is decreased by about 25% at a flow ratio of one and by 10% at a flow ratio of two by inhomogeneity of the maternofetal flow ratio. (3) The diffusional resistance for HTO is unmeasurabbly small; its transfer is solely limited by blood flow.


Velocity of oxygen uptake by partly saturated adult and fetal human red cells. The rate of oxygen uptake by human adult and fetal red cells at 37 degrees C was measured at saturations from zero up to 75% using a double-beam stopped-flow apparatus. Results were expressed in two ways: as k'c, the velocity constant for O2 uptake by the cells, and as theta standard, the number of ml of O2 (STPD) which would be taken up in 1 minute per torr of PO2 difference between the outside and inside of the red cells, by blood with an O2 capacity of 20 vol%. At zero saturation, k'c for adult cells was 99 and for fetal cell was 89 millimolar-1-sec-1. At low saturations there was little changes in adult or fetal k'c but at higher saturations k'c rose and at 75% saturation was 3-4 times its value at zero saturation. In fetal cells, k'c was about 10% less than for adult cells. This difference was statistically significant at low saturations but at higher saturations there was much scatter in the results and the difference between adult and fetal cells was not significant. As saturation rose theta showed little or no change up to 75% saturation. Theoretical analysis of the factors affecting k'c suggested that its rise with increasing SO2 was due to a lowering of the concentration of intracellular deoxyhemoglobin rather than to any increase in reaction rate of oxygen with the hemoglobin molecule.


Training and exercise change respiratory properties of blood in race horses. Effects of training and exercise on blood respiratory properties were investigated in standard-bred race horses. Training caused an increase in the circulating O2 capacity at rest from 18.4 to 21.0 vol%, and in the O2 capacity during exercise from 24.9 to 30.3 vol%. An increase in the in vitro oxygen affinity [P50(PH 7.4, 37.9 degrees C)] of about 2 mm Hg correlated with a decrease in the red cell concentration of 2,3-diphosphoglycerate (DPG) from 6.35 mM-1-1(E), erythrocytes. Trained horses also showed an acute lowering of the red cell DPG concentration after maximal exercise. The physiological significance of the increases in O2 capacity and O2 affinity are discussed and a hypothesis presented to explain the possible relationship between changes in spleenic size, total red cell volume and red cell DPG concentration.


Reduction in inspiratory activity in response to sternal vibration. It has been shown previously that there is a reduction in tidal volume in response to longitudinal sternal vibration at 100 Hz. In the present study it was shown that the effect of such vibration is to reduce tidal volume (VT) and prolong inspiratory time (ti) in such a way that points from vibrated and non-vibrated breaths fall on the same VT:ti curve. This indicates that the normal mechanisms which terminate inspiration are unaffected by vibration. The effect of vibration is simply to reduce the rate at which inspiration proceeds. This was illustrated here when vibration reduced the rate of fall of intrapleural pressure during inspiration, and also reduced the instantaneous ventilation at any level of chemical drive. Electrophysiological recordings made here from phrenic motoneurones support these findings. It is concluded that sensory nerves in the chest wall, which can be excited by vibration, can inhibit inspiration.


Cutaneous respiration in three freshwater teleosts. Cutaneous oxygen consumption and oxygen uptake from the external medium were investigated in three species of freshwater teleosts:eel(Anguilla anguilla L.)(silvered stage), trout (Salmo gairdnerii R.) and tench (Tinca tinca L.). The oxygen consumption of the skin is the same in the three species: 4.5 nmol-cm-2-min-1. It accounts for 35% of total Mo2 in the eel; 23% in the tench, which lives in poorly oxygenated water; and 13% in the trout living in highly oxygenated water. Cutaneous oxygen consumption is equal to (Salmo and Tinca) or greater than (Anguilla) cutaneous oxygen uptake from the external medium. Consequently, the skin in these three species is not an oxygen exchange for the benefit of other organs.


The relation between hypoxia and CO2-induced reflex alternation of breathing in man. Four healthy young volunteers, selected for the responsiveness and steadiness of their breathing, were studied in rest and mild exercise while receiving alternate inspirates of low and high PCO2 (0 and 8.6 kPa). PACO2, oscillated between ca. 6 and 7.5 kPa (45-55 torr). PAO2 was held steady at 4-7 levels between 6 and 28 kPa (45-210 torr). Thirteen separate inspiratory and expiratory variables (volumes, times, flows) were recorded and tested for reflex alternation. Matched controls were performed. Responses were generally small in relation to the scatter. Reflex alternation of any one variable was not always evident. The incidences of the responses were, in descending order, inspiratory flows and volumes, expiratory flows and volumes, expiratory duration; inspiratory duration alternated seldom, and then with only small amplitude. Reflex alternation was more likely to be observed in hypoxia than in euoxia or hyperoxia. A tendency for the incidences to be greater in exercise than at rest was not significant, but the amplitudes of alternation showed a significant difference in favour of exercise. In a substantial minority of experiments the amplitude of reflex alternation was significantly and positively correlated with hypoxia (1/(PAO2--C)). Alternation also occurred frequently in another substantial minority of experiments in which, however, there was no significant amplitude-hypoxia correlation. It was concluded that these two groups probably differed not so much in the form of the amplitude-hypoxia relation as in respect of the extent of the scatter in the observations. The results are consistent with interaction of non-steady-state with steady-state signals at the arterial chemoreceptors.


Separation of the inspiratory and expiratory reflex effects of alternate-breath oscillation of PACO2 during hypoxia. Four healthy young men and women, selected for the responsiveness and steadiness of their breathing, were studied in rest and mild exercise (58 runs) while receiving alternate inspirates of low and high PCO2 (0 and 8.6 kPa). PACO2 oscillated between ca. 6 and 7.5 kPa (45-55 torr); PACO2 was held steady at more than one level between 6 and 9.6 kPa (45-72 torr). Using cross-correlation analysis, the phase relations were determined between the alternating PACO2 and the following reflex outputs: mean inspiratory and expiratory flows (VI and VE) and the reciprocal of the duration of expiration (1/TE), the two expiratory variables being lumped together for purposes of expression, but not of calculation. T1, being relatively unaffected alternating PACO2, was not re-studied (see companion paper). The common patterns of significant reflex alternation were: VI alone, usually in phase (with PACO2), 24%; VE alone, usually in phase, 17%; both inspiratory and expiratory variables, in phase with CO2 and each other, 15%; both inspiratory and expiratory variables, the expiratory being out of phase with both CO2 and with the inspiratory, 23%. Some runs showed a mixture of phase relations. In 71%, end-expiratory lung volume (VL,E' formerly called FRC) alternated significantly. It is concluded that expiratory events can be influenced by peripheral chemoreceptors independently of inspiration.


[Cytogenetics of Paget's disease of bone]. The authors studied the karyotype in blood and marrow of 34 patients with Paget's disease and compared the results with those of a control group of the same age. Structural abnormalities are more frequent in the blood than in the marrow, but there is no significant difference in comparison with the abnormalities in the control group. Ionizing radiations and drugs do not seem to be responsible for the abnormalities encountered. The numerical abnormalities are characterized by an increase in the number of hypodiploidies, particularly involving the chromosome groups A, B and D, whereas chromosomal damage affecting the C and G groups is less than normal. These abnormalities were encountered in a limited number of patients. The authors discuss the significance of these chromosomal abnormalities in the more general context of the genetics of Paget's disease.


[Correlation of parathormone determination and bone biopsy in primary hyperparathyroidism]. Eleven patients with primary hyperparathyroidism confirmed by histologic examination were subjected to a comparative study of the results of quantitative determination of parathormone and of quantitative bone biopsy. Quantitative radioimmunologic determination of parathormone was carried out with the aid of an N-terminal specific anti serum, while the histologic features studied were the periosteocytic and osteoclastic absorption surfaces. On the basis of a combination of the results of these two techniques, the diagnosis could be made in all the cases studied. A statistically significant correlation was observed between the results of quantitative determination of parathormone and those of histologic examination of the surfaces of periosteocytic lacunae (r = 0.63; p = 0.05).


[Identification of the crystals observed in the destructive arthropathies of chondrocalcinosis]. Study of the synovial membrane and cartilage demonstrating two destructive arthropathies of the knee diagnosed in subjects with articular pseudogout. Scanning electron microscopy reveals the presence of many crystals on the surface of the cartilage and the synovium and in the depth of the cartilage. These can be grouped into two families on the basis of dimensions and morphology. The first consists of those shaped like arrowheads and are large (80-100 microns long.) They were formally identified using Weissenberg's technique; dihydrated calcium hydrogenophosphate (CaHPO4.2H2O) is involved here. In the second family the crystallogenesis is different (prism or lozange-shaped) and the crystals themselves have not been identified with certainty because of their tiny size (20 microns). The hypothesis is proposed that the crystals of dihydrated calcium hydrogenophosphate properly belong to the destructive arthropathies of pseudogout; while not necessarily its cause, they may help explain its development.


[Study of 728 cases of children with acute articular rheumatism, divided into 2 similar groups observed at an interval of 10 years]. A group of 364 children treated for acute rheumatic fever between 1955 and 1961 was compared with a similar group of 364 cases matched for age between 1965 and 1972, treated in the same fashion. In the second group an increase was found in the percentage of first attacks compared with relapses, indicating an improvement from prophylaxis. Cardiac involvement on admission, in first attacks, is equally common in both groups but more severe in the first group: in relapses, the severity of cardiac involvement increases with the number of previous attacks. The course of the carditis with corticosteroid treatment is the same in both groups. The reduced severity of the cardiac involvement in first attacks in the recent group suggests a role played by earlier diagnosis, antibiotic therapy previous to hospitalization, or variations in the epidemic nature of the disease.


The clinical significance of increased plasma levels of liver-synthesized coagulation factors in liver disease. The first plasma Factor II-VII-X value after admission to the hospital was higher than 90% in 29% of 38 common duct stone patients, in 9% of 33 patients with bile duct obstruction due to pancreatic carcinoma, and in 3 of 5 patients with cholestatic drug reaction. In contrast, the admission value was above 90% in only one of 89 patients with acute hepatitis and in none of 8 patients with a hepatocellular drug reaction. Therefore, a high plasma Factor II-VII-X activity in a patient with liver or biliary tract disease seems to be a rellained by an increased protein synthesis in the liver.


Gastric acid secretion in patients with symptomatic hiatus hernia and effect of a modified Belsey MK IV repair on gastric acid secretion. Fasting, basal, and pentagastrin-stimulated (6 microgram/kg body weight) gastric acid secretion was assessed in 53 patients with radiologically verified sliding hiatus hernia without stricture formation. There was no difference in the acid secretory variables between patients with heartburn and those with heartburn and pain. A study of the acid secretory variables in 34 patients before and 3 months after a modified Belsey MK IV repair for symptomatic hiatus hernia showed that after the repair the pH of basal secretion had risen, and that the volume of basal secretion as well as basal and peak acid output had been reduced. These changes must probably be ascribed to an unintentional vagotomy during the operation. It is concluded that in the evaluation of a surgically established barrier against gastro-oesophageal reflux in terms of oesophageal pH, changes in gastric acid secretion should be taken into consideration.


Light and electron microscopical studies of parietal cells before and one year after proximal gastric vagotomy in duodenal ulcer patients. In 4 duodenal ulcer patients the morphology of parietal cells has been studied before and one year after proximal gastric vagotomy (PGV). The average basal gastric acid secretion of the 4 patients was reduced from 9.2 m.mol/h before to 0.9 m.mol/h one year after PGV (90% reduction). The reduction in acid secretion was not accompanied by changes in the morphology of the parietal cells. Light microscopical studies indicated that the average cell size was about the same before and one year after PGV. Electron micro scopical studies showed only negligible changes in the parietal cell ultrastructure.


Lithogenic index of bile after jejunoileal bypass operation for obesity. Lithogenic index of cholecystokinin-stimulated, fasting, duodenal bile was determined in 12 obese patients before and 1-2 months after end-to-side jejunoileal bypass operation, either including 37.5 cm jejunum and 12.5 cm jejunum and 12.5 cm ileum or 12.5 cm jejunum and 37.5 ileum. The index did not change significantly after bypass with short ileum, whereas a four-fold, significant increase was found after bypass with long ileum. Surprisingly, the results may suggest that the lithogenicity of gallbladder bile increases when the length of the functioning ileal, relative to the functioning jejunal, segment in jejunoileal bypass is increased.


Transmural ionic fluxes and electrical potential difference in the human jejunum during perfusion with a dihydroxy bile acid. Perfusion studies of the proximal jejunum were performed in healthy volunteers to define the influence of glycochenodeoxycholic acid (GCDC) 2.5 mmol/1 on the net movements of water and electrolytes, the bidirectional fluxes of sodium, potassium, and chloride, and the transmural electrical potential difference (PD). The flux data supported the notion that active sodium transport is inhibited by luminal GCDC, which on the other hand elicits active secretion of chloride. PD was 3 +/- 1 mV, lumen negative, and was not influenced by GCDC. The flux data fit a previously proposed model for the GCDC effect.


Biochemical gradients in the human gastric and duodenal mucosa in relation to basal acid outputs. The separations and measurements of adenine-adenosine, adenosine monophosphate (AMP), adenosine diphosphate (ADP), adenosine triphosphate (ATP), lipid phosphates (lipid-P), ribonucleic acid (RNA) and deoxyribonucleic acid (DNA) were carried out in the mucosa of the corpus, antrum, and duodenum of patients with decreased, normal, and increased basal acid outputs (BAO). The results were calculated in correspondence to 1.0 mg DNA value. The results indicate: 1) the biochemical composition of the corpus and antral mucosa alters with increase of BAO; 2) a significant difference was found between the biochemical compositions of the mucosa of the corpus and antrum in patients with normal and increased BAO; 3) no significant difference was observed in the biochemical components of duodenal mucosa with different BAO.


Intestinal bypass. A comparison between two different bypass operations and resection of the small intestine in rats. General nutrition, intestinal absorption and liver structure and function were compared in rats subjected to: 1) 90 per cent resection of the small intestine, 2) 90 per cent small intestinal bypass with end-to-side jejunoileostomy (ES bypass), and 3) 90 per cent small intestinal bypass with end-to-end jejuno-ileostomy and anastomosis between the excluded segment and the colon (E-E bypass). The E-E bypass group showed the highest mortality rate and the lowest body weight. In this group the haemoglobin concentration, the faecal fat excretion, and the liver function parameters were more abnormal than in resected rats. Rats with E-S bypass showed results in between the other two groups. In none of the animals was fatty infiltration or cirrhosis of the liver observed. It is concluded that intestinal bypass in rats has a more deleterious effect than resection, and this seems to be more pronounced when the excluded segment is anastomosed to the colon. Factors that might be responsible for this effect are discussed.


Heme catabolism in liver cirrhosis with portal hypertension after shunt surgery. Endogenous production of carbon monoxide (VCO), total and direct reacting serum bilirubin (TSB, DRB) were determined in 26 patients with liver cirrhosis and portal hypertension to evaluate the effect of various shunt operations on total heme catabolism. The material was divided into 3 groups. In group I, 11 patients not operated upon, mean VCO (+/- S.D.) was 18.4 +/- 6.0 micronmol/mmol total body heme per day (reference value 12.6 +/- 2.9). In group tii, 7 patients operated upon with subcutaneous transposition and a subtotal resection of the spleen, mean VCO (14.4 +/- 4.7) was not significantly raised. In group III, 8 patients operated upon with a modified distal splenorenal shunt, the highest mean VCO (26.1 +/- 9.0) was found. Mean TSB in the three groups was 34.8 +/- 29.2, 11.2 +/- 3.0, and 46.4 +/- 41.0 micronmol/l, respectively, and mean DRB 18.2 +/- 20.8, 3.7 +/- 1.0, and 26.8 +/- 34.1 micronmol/l, respectively. Estimated from preoperative laboratory values there was no difference in liver function between the three groups. The conclusion drawn is that heme catabolism, increased by 50% in liver cirrhosis complicated by portal hypertension probably due to a slight decrease in erythrocyte survival, tends to normalize after subcutaneous transposition and subtotal resection of the spleen. After spleno-renal shunting, on the other hand, a further increase in heme catabolism is seen. And so the increase in serum bilirubin often seen after the latter type of surgery is mainly related to a raised bilirubin production and not to a further decrease in liver function.


Radioimmunossay of secretin in human plasma. A radioimmunoassay is presented which employs 125I-labelled synthetic secretin, antibody against synthetic secretin, and standards prepared from pure natural porcine secretin. Secretin to be measured was extracted into methanol from heparinized plasma containing aprotinin, which together with cysteine hydrochloride was used as stabilizer throughout the assay. With polyethylene glycol separation, a within assay precision of 10% at 17 pmol/1 was found. The between assay precision was 15% at 17 pmol/1 and thelimit of detection 2.5 pmol/1 plasma. Accuracy was 70-85%. The immunoreactive secretin levels in human plasma increased from 4.5+/-0.5 pmol/1 (mean+/-S.E.M.) to 19.5+/-7.5 pmol/1 (mean+/-S.E.M.) after duodenal acidification (n=5). Pancreatic flow rate increased from 0.5+/-0.1 ml/min (mean+/-S.E.M.) to 4.8+/-0.5 ml/min (mean+/-S.E.M.), and bicarbonate output from 9.6+/-1.8 mumol/min (mean+/-S.E.M.) to 268+/-51 mumol/min (mean+/-S.E.M.) after duodenal acidification.


Prognosis of medically treated gastric ulcer. A prospective endoscopic study. During the study period 1972-74 gastric ulcer was demonstrated by endoscopy in 114 patients, 54 of whom were included in the present study. Forty-two were excluded because of ulcer showing incipient healing, superficial erosions, manifest or suspected malignancy, or indication for surgery. Eighteen patients were not included because of advanced age, complicating diseases, or refusal to have further examinations. The study comprises a treatment phase and a follow-up phase. The treatment phase ran from the first encoscopic demonstration of gastric ulcer until complete healing. During this period the patient was treated with antacids and anticholinergics and, if required by his condition, admission to hospital. During the treatment phase, endoscopy was performed at intervals of from 3 to 6 weeks until healing. During the follow-up phase endoscopy was carried out in the event of dyspeptic complaints that might indicate recurrent ulcer. The healing and recurrence rates for various periods were calculated by the aid of the life-table method. After 1 mo. of treatment 13% of the aptients exhibited healing, after 2 mo. 29%, after 3 mo. 41%, and after 12 mo. 79%. In one month 9% of the primarily healed ulcers had recurred, in 2 mo. 15%, in 3 mo. 22%, and in 12 mo. 43%. The healing rate is appreciably lower than results reported in the literature, whereas the recurrence rate is in closer accordance with previous studies.


Serum erythropoietin in myelomatosis.

Serum erythropoietin in myelomatosis. Erythropoietin activity in serum was measured using 59Fe incorporation into erythrocytes in protein-starved, hypoxic mice.  The activity in serum from 20 patients with untreated myelomatosis was not significantly different from that in 31 saline controls. Only three patients had detectable erythropoietin levels in serum: 0.24 IU/ml, 0.27 IU/ml and 0.50 IU/ml (standard B), respectively. The venous haematocrit was correlated positively with the glomerular filtration rate as measured by 51Cr EDTA-clearance. No correlation could be established between venous haematocrit and serum albumin or serum transferrin. The results are in agreement with the assumption of a defective erythropoietin activity due to renal failure in myelomatosis.


Erythrocytic glutathione peroxidase: its relationship to plasma selenium in man. Erythrocytic glutathione-peroxidase (GSH-Px) activity and plasma selenium concentrations were measured in 14 patients: 7 with iron deficiency and 7 with raised serum iron levels. The decreased enzymatic activity in iron deficiency was confirmed. Plasma selenium was significantly lower in patients with lower serum iron; furthermore there is a significant correlation between serum iron and plasma selenium concentrations. Another correlation even more significant was found between plasma selenium and enzyme activity in all the cases we studied. These data suggests that the importance of iron for GSH-Px activity may be merely due to its relationship with selenium and that plasma selenium concentration may be of critical importance for enzyme activity.


Cell kinetics in human cyclic neutropenia. Cell kinetics have been studied at several periods in a patient with typical cyclic neutropenia. Peripheral blood granulocyte labelling showed an increased destruction in the preleucopenic phase. Bone marrow colony-forming cells and blood leucocyte colony forming activity were normal or above the normal range. The major abnormalities were found in sequential studies of bone marrow proliferation measured by "in vitro" 3H-thymidine flash labelling. A fall in the labelling index of promyelocytes was observed in the second part of the cycle. Incubation of normal human bone marrow cells with patient's granulocytes showed a marked decrease in 3H-thymidine incorporation, compared with incubation with the same number of normal granulocytes. Human cyclic neutropenia seems to be due to a factor secreted by abnormal polymorphonuclears inhibiting myeloid proliferation.


An electron microscope study of the intercellular contacts between the erythroblasts of patients with hypersiderotic bone marrows. When stained and unstained sections of hypersiderotic marrow fragments are examined in the electron microscope, some of the ferritin molecules present between a variable proportion of the erythroblasts are found to be aligned more or less transversely. These linearly arranged ferritin molecules are particularly evident in regions in which the opposing cell membranes have been sectioned obliquely and may be confused with the septa-containing intercellular junctions characteristically present between some types of invertebrate epithelial cells.


Cytochalasin B partially inhibits the oxalate-induced radial segmentation of mononucleated blood cells. Cytochalasin B (CB), 5 microgram/ml (= 1.0 x 10(-5) M), inhibited the oxalate-induced radial segmentation of the nuclei of lymphocytes and monocytes from peripheral blood. The median inhibition was 60%. The oxalate-induced radial segmentation (RS) is thought to be due to a microtubule-dependent contraction of the intermitotic residue of the mitotic apparatus around the nucleus. CB is thought to inhibit cell locomotion and cytokinesis by a centripetal contraction of the membrane-associated contractile cell layer without subsequent relaxation. It is thus suggested that the CB inhibition of the oxalate-induced RS was due to a spatial interference of the CB-induced contraction with the formation of RS nuclei.


Cell culture studies in 19 cases of refractory aneamia: comparison of clinical data with in vivo erythrokinetic studies. A total of 19 cases of chronic refractory anaemia underwent simultaneous in vivo erythrokinetic study and in vitro bone marrow culture. They were followed up clinically for at least 2 years. Good correlation has been found between erythrokinetic data (simultaneous quantitative and qualitative disorders of erythroblastic proliferation in preleukaemic states; pure qualitative disorders in primary sideroblastic anaemia) and the results of culture of granulocyte precursors in the bone marrow (small number of colonies, reduced size of colonies in preleukaemic states; normal number and growth in non malignant refractory anaemia). It would seem thus that both examinations are of practical interest in clinical haematology, making it possible to foresee the malignant evolution of some refractory anaemias.


Acquired stomatocytosis: its prevalence of significance in routine haematology. 100 patients showing a significant number of stomatocytes were identified from the microscopic examination of 4291 peripheral blood films. The distinctive red cell appearance was most commonly found in patients with neoplastic, cardiovascular or hepatobiliary disease including acute alcoholism and during therapy with certain drugs some of which are known to be stomatocytogenic in vitro.


Autoimmune haemolytic anaemias in Thailand. 100 cases of autoimmune haemolytic anaemias (AIHA) in Thailand were analyzed. Clinical and immunological aspects of the disease were compared with those described in other parts of the world. Racial differences, especially between Thais and Caucasian, were emphasized. Thai patients show the following distinctions: (1) AIHA tends to occur in people of a younger age group, predominantly in females, (2) a rare occurrence of AIHA of cold-antibody type, an incidence which significantly differs from that in Caucasians, and (3) the autoantibodies consist of more than one immunoglobulin class in more than 50% of cases. Possible factors that might contribute to these differences were discussed.


Effects of acute myocardial ischaemia on platelet aggregation in the coronary sinus and aorta in dogs. The effect of an acute myocardial ischaemia on circulating platelet aggregates (CPA) in the coronary sinus and aorta was studied in open chest dogs. Even before induction of myocardial ischaemia significantly more CPA were found in the coronary sinus than in the aorta. Acute myocardial ischaemia produced by a non-thrombotic coronary artery occlusion increased CPA in coronary sinus, but not in aorta. Administration of acetylsalicylic acid (ASA) reduced the extent of the myocardial ischaemia as evidenced by reduced ST-segment elevations in epicardial ECG. Before induction of myocardial ischaemia, ASA significantly reduced CPA in coronary sinus, but no significant effect was observed during myocardial ischaemia. In the aorta no effect of ASA on CPA was found.


Polycythaemia and erythropoietin producing uterine fibromyoma. A case of polycythaemia secondary to uterine fibromyoma is reported. Polycythaemia disappeared after hysterectomy. Erythropoietic activity was detected in the cyst fluid of the tumour. Plasma and urine contained no erythropoietic factor. Polycythaemia was related to erythropoietinlike material produced by the tumour.


Time-related increase in leucocyte yields by continuous-flow centrifugation (CFC) leukopheresis. Continuous flow centrifugation leukopheresis lasting 3 to 4 h was performed 18 times on 16 normal donors. The total yield of leucocytes collected was 1.59 +/- 0.14 x 10(10) (mean +/- SE). Comparison of leucocyte yields on the first, second, third and fourth hour of leukopheresis indicated a progressive increase with time in 15 out of 18 procedures, with 3.6 times more leucocytes collected within the last hour of leukophoresis as compared to the first hour. This increase was independent of the volume of leucocytes collected per unit time, since an equally significant increase was found when calculated per 100 ml of leucocyte concentrate. Although the mechanism of this improvement in yield with time is unknown, the present data indicate, that moderate prolongation of the duration of leukopheresis may result in an increase in efficiency which is comparable to that produced by the use of hydroxyethyl starch, etiocholanolone or corticosteroids.


Sickle-cell anaemia in Turkey. Evaluation of 97 cases (with parents' findings). The haematological and clinical data in 97 sickle-cell anaemia cases and haematological findings of their parents are reported. In spite of the low Hb values of the patients, they tolerated their anaemia and very rarely required blood transfusions. The Hb F levels of the patients were in general higher than African origin SS anaemia patients but lower than the Shiite Saudi Arabians. However, in most of the cases the concentration of Hb F did not seem to influence the Hb concentration of the patients. Serum iron was found unexpectedly decreased in 22% of the patients. Osmotic fragility was found decreased in 100% of the patients and in 83.5% of the parents. The prevalence of G-6-PD deficiency was 21.2% in male patients and 15.6% in the parents.


Enhancing effect of levamisole on the phagocytic activity of human neutrophil polymorphonuclear leucocytes in vitro. The effect of levamisole on the phagocytic activity of normal human polymorphonuclear neutrophil leucocytes has been studied in vitro. In concentrations comparable with the serum levels obtained in treatment with levamisole perorally, the engulfment of  heat-killed yeast cells is moderately but significantly increased. It is shown that levamisole can only stimulate phagocytosis of adequately opsonized particles. The action of the drug is still unknown but appears to be directly linked to the phagocytic cell.


Flaming promyelocytes in acute hypergranular promyelocytic leukaemia. Light and electron microscopic study. Flaming in the peripheral parts of promyelocytes was seen in 3 out of 4 patients with acute hypergranular promyelocytic leukaemia. In one of these patients (ER) the flaming was quite marked, and electron microscopy showed the flaming to correspond to greatly dilated cisternae of the RER.


Map order of the linkage group GLO-Bf-HLA-A-PGM3 on human chromosome 6. Linkage analysis of 52 families with 181 children confirms close linkage for GLO-Bf, GLO-HLA-A, and Bf-HLA-A and proves linkage between HLA-A and PGM3. Linkage for Bf-PGM3 and GLO-PGM3, respectively, seems to be likely; close linkage can be excluded. From the relative map distances, but above all from the segregation of defined linkage phases in crossover families, we can hypothesize that the sequence order of the loci should be GLO-Bf-HLA-A-PGM3.


Three-point association of HLA-A,B,Bf haplotypes deduced in 200 parents of 100 families. The association of HLA-A and -B antigens with Bf alleles was investigated in 200 parents from 100 unrelated families. There were significant associations between HLA-A3 and Bf-F, B7 and Bf-S, B8 and Bf-S, B12 and Bf-F, and BW 35 and Bf-F. Three-point HLA-A,B,Bf haplotype frequencies, linkage disequilibrium parameters, and chi-square values were determined both from the genotype and from the phenotype data. Although the HLA-B,Bf associations involve antigens that are also present in the highly associated A,B and B,D haplotypes of the Caucasian population, there was--with the possible exception of HLA-A3,B7,Bf-S--no significant three-point association for HLA-A,B,Bf.


Responses of alloantigen-primed lymphocytes in vitro. The specificity of secondary responses assayed by titration of primed lymphocyte populations. Maximal proliferative responses were observed at lower responder cell densities in alloantigen-primed lymphocyte populations when restimulated with the specific priming cell than when restimulated with other allogeneic cells. This relationship was due to the larger number of lymphocytes within the primed population which responded to the specific sensitizing cell than to unrelated stimulator cells. As a result, at high responder cell densities, stimulator cells unrelated to the specific sensitizing cells elicited a disproportionately high response relative to the response stimulated by the specific cells. Restimulation of decreasing numpacity of different cells. Because primed populations contain a larger number of lymphocytes that responde to the specific stimulator than to other stimulators, responses of primed lymphocytes could be made operationally monospecific. Limiting dilution analysis demonstrated that low numbers of primed cells were stimulated by the specific sensitizing cells but not by unrelated stimulator cells.


Clinically occult lung cancer with positive sputum cytology and primarily negative radiological findings. Five  patients with early clinically occult squamous cell carcinoma of the bronchus were reviewed with respect to previous sputum cytological examinations and clinical investigations. In one patient, selective bronchial washings demonstrated the site of the tumour and the patient was successfully operated. In the remaining four patients the interval between cytological diagnosis and radiological, bronchoscopical and/or histological demonstration of the tumour varied between 2 months and 9 years. It seems possible that the duration of bronchogenic carcinoma in situ may be of similar magnitude as that of carcinoma in situ of the cervix (10-15 years). The considerably higher frequency of early stromal invasion after semi-serial sectioning of carcinoma in situ of the bronchus compared with carcinoma in situ of the cervix is emphasized. The results stress that a diagnostic delay of several years is not acceptable, as the possibility of successful treatment will be greatly diminished in such cases.


Haemodynamics and pulmonary wedge angiography findings in chronic bronchopulmonary disease. Pulmonary wedge angiograms were compared with haemodynamic measurements at rest and during light exercise in 47 patients with chronic bronchopulmonary disease. The patients were divided into two groups on the basis of the angiograms. In group I (26 patients) less than 50% of the angiograms were abnormal, whilst in group II (21 patients) more than 50% of angiograms were abnormal. Pulmonary artery pressure and pulmonary vascular resistance were lower in group I than in group II and these differences became more marked during exercise. The pulmonary wedge pressure increased significantly on exercise in group II. Similarly, driving pressure in relation to cardiac output increased more from rest to exercise in group II than in group I. We conclude that wedge angiograms are one way to estimate the reduction in the pulmonary vascular bed.


Chronic respiratory disease, smoking and prognosis for life. An epidemiological study. A population group, comprising 653 men and 823 women aged 40-64 years, was surveyed in 1961 to determine the prevalence of chronic respiratory disease. Questionnaire, simple spirometry and thoracic radiography were used. The 10-year mortality of the population has been related to the initial findings. After standardization for age and smoking, men in each of the disease or symptom groups had a higher risk of dying during the 10-year period than men without lung disease; for the total group of men with chronic non-specific lung disease (CNSLD) the standardized risk ratio was 1.3. After standardization for age and presence of CNSLD, men in all smoking groups had a higher risk of dying than male non-smokers. For the total before the age of 15 therisk was 4.1-fold. When men with and without CNSLD were analysed separtely in different smoking groups, the excess mortality of men with CNSLD varied from 10 to 110% (risk ratios from 1.1 to 2.1), being highest among the heaviest smokers. In men without lung disease, the smokers had a 1.8-fold mortality as compared with non-smokers. In women, the CNSLD did not increase mortality, but in female smokers the risk of dying was roughly twice that of female non-smokers although the difference was not significant. It appears from the findings that, as far as the prognosis for life is concerned in the male population surveyed, smoking is more important than CNSLD. The effect of CNSLD seemed to be stronger in men who smoked at least 25 g of tobacco daily, than in men who smoked less. The ex-smokers resembled non-smokers more than smokers in mortality experience which suggests that the deleterious effects of smoking may disappear after smoking has been discontinued.


NBT-test in asthmatic patients with regard to bacterial infections and steroid therapy. In this communication we report our negative experience in differentiating bacterially infected from non-infected adult asthmatic patients, using a simplified modification of the NBT-test. The outcome of the test was unrelated to the steroid dose of the patient.


Human urinary excretion of the herbicide 2-methyl-4-chloropheno xyacetic acid. To see if urinary 2-methyl-4-chlorophenoxyacetic acid (MCPA) excretion could be used to estimate MCPA exposure, four healthy males ingested 5 mg MCPA. The MCPA in the urine was extracted and anlyzed by high pressure liquid chromatography. About 50% of the ingested dose was detected in the urine within 48 h. On the fifth day after intake the MCPA concentration in the urine was below the level of detection, 0.2 microgram/ml. The MCPA did not increase those serum enzymes indicating liver cell damage (S-alanine-aminotransferase, S-alkaline-phosphate). Some creatine kinase (CK) and S-aspartate-aminotransferase (ASAT) values were pathological, but, as all CK values were normal in two persons and all ASAT values were normal in three persons, it not likely that MCPA had a toxic effect on muscle cells. MCPA in urine seems to be a useful indicator of MCPA intake in humans. All the urine passed within 48 h of MCPA exposure must be collected.


Brain and blood lead in acute intoxication. Administering lead acetate in drinking water to adult male rats resulted in an elevated lead content in blood and brain during 11 subsequent days. The brain and blood lead contents were proportional to each other although the interdependency changed according to the cumulative dose and equilibration period. The present data indicate that the permeability of the blood-brain barrier towards inorganic lead may be dose-dependent and saturable with high doses of the metal.


Proposed biological threshold limit values for industrial exposure to trichloroethylene vapor. A model was used for the simulation of the pharmacokinetics of inhaled trichloroethylene (TRI) vapor. Computed data of TRI in alveolar air and of trichloroacetic acid (TCA) and trichloroethanol (TCE) in blood and urine agreed satisfactorily with experimental results obtained by various authors. Biological threshold limit values were calculated for subjects exposed at rest to a steady concentration of 100 ppm of TRI in ambient air, between 0800 and 1200 and between 1300 and 1700, five days week during the whole year. The Monday to Friday range of values for urinary excretion (243--322 mg of TCA/24 h and 288--429 mg of TCE/24 h) roughly corresponded to the findings of several surveys among TRI workers in industry. The hypnotic effect of TCE and/or TRI during steady or fluctuating industrial TRI exposure was discussed with the aid of the model.


[Hairy-cell leukemia with osteolytic bone changes]. Spontaneous bone fractures and/or focal osteolytic lesions were observed in three patients with morphologically and cytochemically confirmed hairy-cell leukemia 1-3 years after diagnosis and splenectomy. In a bone biopsy obtained from the body of the 12th thoracic vertebra light microscopy revealed a medullary osteopathy, the marrow cavities being infiltrated by a uniform population of rounded or slightly elongated cells. In addition, focal osteolytic lesions were observed on the trabeculae. Ultrastructurally, the cellular infiltrates consisted of reticulum cells, few mature and immature plasmocytes and numerous typical hairy cells with or without ribosome-lamella complexes. These observations demonstrate that hairy-cell leukemia may be associated with severe bone lesions similar to those observed in plasmocytoma. Moreover, these findings support the hypothesis that the hairy cell is a leukemic cell with B-lymphocyte properties.


Experiences in the treatment of esophageal cancer of the upper and middle thoracic segment. Between 1946 and 1974 we carried out 1,174 resections of the esophagus for cancer in the upper and middle thoracic segment. Through early diagnosis and the combination of preoperative irradiation therapy and antethoracic anastomosis, divided into three stages when necessary, the operative mortality was decreased (6.0 percent), and the survival rate was increased. The 5-year survival rate was 10.8 percent for men and 29.3 percent for women.


The team approach in salvage of the diabetic foot. Various problems encountered in dealing with diabetic feet are discussed from the point of view of the orthopedist, the vascular surgeon, and the specialist  in infectious disease. In our hospital, each new diabetic patient with a compromised extremity is evaluated by the team, and joint decisions are made concerning therapy. Treatment may be tedious and time consuming, but under these optimum conditions, we feel our salvage rate has been much improved. When it is realized that 30 percent of all diabetics with an amputation of one extremity come to amputation of the other extremity within three years, the rationale for this additional attention and care becomes obvious.


Recent advances in the management of trauma. Delivery of the most up-to-date trauma care requires a well-trained team of four physicians and four nurses to carry out the initial management of a single major injury patient (Border et al, 1975). Ventilatory insufficiency, circulatory insufficiency, and wounds must all be treated promptly and simultaneously.


Non-neoplastic stenosis of the aqueduct presenting in adolescence and adult life. Twenty-six cases of non-neoplastic stenosis of the aqueduct are reviewed. This condition may take a very chronic course and may not be revealed until decompensation of hydrocephalus takes place. Poor athletic record in the school or intellectual impairment in early life, commonly overlooked, can presage the more obvious symptoms. A prolonged follow-up of these cases is essential to exclude a slowly growing neoplasm near the aqueduct. Our management and the outcome of these cases is discussed.


Operative techniques for management of lesions involving the dural venous sinuses. The basic principles of vascular surgery, adequate exposure, proximal and distal control of hemorrhage, and meticulous approximation of endothelial surfaces should be adhered to in the management of lesions of the dural venous sinuses. Modification of conventional vascular techniques must be made since the major dural venous sinuses are essentially non collapsible and non mobilizable because of the entry of cortical veins at frequent intervals along their course. These problems can be solved by occlusion of the proximal and distal segments of the sinus from within the lumen and by use of a shunt consisting of a siliconized non-collapsible tube with an inflatable balloon cuff at each end. Saphenous vein autografts are used if primary repair is impossible because of loss of tissue. Using these techniques, a patency rate of 91% and a mortality rate of 9% were achieved in eleven cases involving the posterior sagittal and transverse sinuses.


Management of acute spinal cord injury.

Management of acute spinal cord injury. Based on the experience with 58 patients with acute spinal cord injuries, a system for rapidly evaluating such patients has been developed. With the knowledge that has been acquired clinically and experimentally of spinal cord injury and with the information provided by laminography and by either air or Pantopaque myelography, a reasonably certain diagnosis of the type of spinal cord injury may be made. Treatment designed to restore neurological function may then be instituted promptly.


Acute spinal subdural hematoma following lumbar puncture. A case of acute spinal subdural hematoma following lumbar puncture in a patient with a normal coagulation profile is reported. Lumbar myelography may be unsuccessful. Other methods of myelography (via cisternal or lateral cervical puncture) to corroborate a block may be made or a laminectomy at the proper clinical level without further studies may be indicated.


Surgical and embolic treatment of cerebral arteriovenous malformations. Twenty-eight cases of cerebral arteriovenous malformations in which the treatment consisted of embolization and/or surgical excision are reviewed. Embolization was considered an adjuvant procedure; carried out to reduce the size of the malformation or eliminate the deep arterial supply to it prior to excision. In sixteen of the cases the combined treatment was carried out with one death and one significant postoperative deficit. In the other twelve cases surgical operation or embolization alone was carried out. The anatomy of the lesion determined the applicability of embolization. Although embolization has a high degree of safety, certain pitfalls must be avoided. Changing patterns in the cerebral circulation following embolization and operation as well as the role of collateral circulation to cerebral arteriovenous malformations are discussed.


Computed tomography in extra-dural epidermoid and xanthoma. Two cases of extradural epidermoid cyst and one case of xanthoma are reported in order to describe the computed tomographic and other radiographic findings. Contrast enhancement of the margin was seen in all of the cases. Absorption values almost as low as those found with cerebrospinal fluid were present in the central region of the lesions.


Pineal epidermoid cyst: its surgical therapy. A pineal epidermoid cyst was initially diagnosed as a pinealoma. Seven years later combined computerized axial tomography and carotid-vertebral angiography accurately delineated the location and suggested the diagnosis of this histologically benign lesion. Microsurgical technique via a right occipital transtentorial approach allowed successful intracapsular resection of this tumor.


Commercial dietary influences on the frequency of cortisone-induced cleft palate in C57B1/6J mice. Changes in standard laboratory diet were found to affect appreciably the cortisone-induced CP frequencies in the offspring of C57B1/6J mice. Fetuses from females maintained on Purina Mouse Chow consistently showed much higher CP frequencies than fetuses from females maintained on Wayne Lab-Blox.


Palatomandibular and maxillo-mandibular fusion, partial aglossia and cleft palate in a human embryo. Report of a case. A 32-mm CRL male human embryo was examined for malformation. Histological observation showed fusion between the left vertical palatal shelf and mandible and the maxilla and mandible in the posterior part of the oronasal cavity. The right shelf was horizontal anteriorly, vertical posteriorly and changing its position from a vertical to a horizontal plane in the middle. The tongue was underdeveloped anteriorly and completely absent posteriorly. The mandibular tooth buds were not formed. Both clinical and experimental literature were analyzed to find the  mechanism of statu nascendi defect observed in the present case. It was deduced that the tongue may not play an active role during normal palatal development and that it may not have played any role during the fusion between different intraoral structures observed in the present case. It was concluded that, had the embryo developed further, then at the birth a cleft palate, partial aglossia and associated intraoral malformation would have been expected.


Asbestos and embryonic development.

Asbestos and embryonic development. Chrysotile asbestos was administered to pregnant CD-1 mice in their drinking water and to Day 4 blastocysts during culture. Administration to pregnant mice did not affect embryo survival. In vitro administration of asbestos did not interfere with embryo implantation upon transfer of blastocysts to recipient females but did result in a decrease in postimplantation survival. These studies did not demonstrate asbestos to be teratogenic whether administered to the dam or to the blastocyst in vitro.


Ultrastructure of the expected fusion zone in rat fetuses with diazo-oxo-norleucine (DON)-induced cleft palate. The aim of this study was to determine whether the glutamine analog, 6-diazo-5-oxo-L-norleucine (DON), which is known to inhibit cell degeneration in rat palatal processes in vitro, exerted a similar effect on cleft palatal processes in vivo. Sprague-Dawley rats were injected intraperitoneally with 5.0 mg/kg body wt of DON on Day 15 of gestation and fetuses were removed over Days 16, 17 and 18. A high frequency (80-90%) of cleft palate was obtained. Fetal heads were removed on each of the three days and transverse sections of the palatal processes were examined by light and electron microscopy. Results showed that treatment with DON failed to inhibit degenerative changes in the palatal epithelium. The same sequence and timing of ultrastructural changes occurred in the expected fusion zone (EFZ) as have been described previously in cleft palatal processes from Meclozine-treated and amniotic sac punctured rat fetuses; namely, autophagic cytoplasmic degeneration, loss of basal lamina and the subepithelial accumulation of macrophages all of which were most prominent in that part of the EFZ immediately next to the developing oral epithelium. The results therefore suggest that a teratogenic dose of DON does not interfere with the ultrastructurally observable changes in the EFZ.


Influence of cyclophosphamide and 4-ketocyclophosphamide on mouse limb development. Many studies have been performed on the in vivo teratogenicity of cyclophosphamide, and there is uncertainty whether the parent compound or P-450 generated alkylating metabolite(s) is the proximal teratogen(s). We have examined the influence of cyclophosphamide and a metabolite, 4-ketocyclophosphamide, on mouse limb development. Pregnant mice were injected with 10, 15 or 20 mg/kg of cyclophosphamide on days 9 to 11 of gestation. Hindlimb buds were maximally sensitive to 20 mg/kg of cyclophosphamide at 9 A.M. on day 11, and the predominant malformations formed were preaxial ectrodactyly and hemimelia. Hindlimb buds of the same gestational age exposed to cyclophosphamide in vitro responded identically to controls in morphology and uptake of 3H-thymidine and 35SO4. Exposure to 4-ketocyclophosphamide in culture, however, resulted in the formation of limbs with a "hemimelic" appearance and distal limb reduction, and with reduced uptake of 3H-thymidine and 35SO4. These findings support the position that the P-450 generated metabolite(s), and not the parent compound, is the proximal teratogen(s).