[Lymphographic alterations in carcinoma of the prostate (author's transl)]. Lymphography in carcinoma of the prostate has a characteristic pattern demonstrable in a rather early stage of the disease. This is due to a high rate of lymphogenous spread. In the present analysis the lymphographic data are recorded by computer system correlating the different types of alterations during the angiographic and retention phase. The alterations are evaluated separately in their significance for the prostate carcinoma.


[The diagnostic value of radiological, nuclear medicine and biochemical methods for detection of bone metastases in carcinoma of the prostate (author's transl)]. 785 combined diagnostic procedures are reported which were carried out on 353 patients with microscopically proven carcinoma of the prostate in order to detect metastases. X-ray films of the thorax, spine and pelvis were taken. Also bone-scintigraphy was done with 87MSr or 99MTc-polyphosphate. Additionally the alcaline, acid and prostate phosphatases were determined. A diagnostic coincidence between radiological results and bone-scan was found in 95.1% of cases. The bone-scan was false negative in 3.7%. Only in 1.2% metastases were detected earlier by the bone-scan than by x-ray examinations. Referring to the number of studies identical results were found. In roentgenologically detected metastases an increased serum level of the alcaline phosphatase was found in 61%, of the acid phosphatase in 31% and of the prostate-phosphatase in 25%.


[Curative radiotherapy of prostate carcinoma in localized stages (author's transl)]. The reported results of curative radiotherapy in carcinoma of the prostate are equal to radical surgical techniques. In stage C or T3 where radical surgical procedures are not possible, radiation therapy alone may achieve remarkable survival rates. The side effects and complication rates of radiation therapy are acceptable considering the potential cure. Hormone therapy should be reserved primarily for palliative treatment.


[Computer tomography of the pelvis. Basics for radiation-therapy, localization and treatment-planning in carcinoma of the prostate (author's transl)]. Computer tomography demonstrates topographic anatomy of the prostate which si important for localization and planning of radiation therapy in carcinoma of the prostate. Additionally, computer tomography detects enlarged regional lymph nodes which allows staging of the disease and individual radiation therapy-planning.


Effects of contrast media on the conducting system of the heart. Mechanism of action and identification of toxic component. Infusion of progressive volumes of meglumine sodium diatrizoate (Renografin 76) into the arteries to the sinoatrial and atrioventricular nodes in anesthetized dogs produced a dose rate-dependent decrease in heart rate and an increase in "PR interval." At high dose rates, Renografin 76 caused sinus arrest and complete heart block in 50% and 70% of the animals, respectively. Saline and meglumine solutions (0.939 M) equiosmolar with Renografin 76 produced similar effects. Infusions of metrizamide (equal in iodine content with Renografin 76), dextrose solution (0.939 M), and autologous blood each had substantially less effects. Contrast media have a direct inhibitory action on sinoatrial automaticity and atrioventricular conductivity which is dependent on ionic strength, not iodine content.


Bacterial or nonbacterial pneumonia: accuracy of radiographic diagnosis. The initial chest radiographs of 31 patients with laboratory-proved pneumonia were evaluated by a panel of 6 radiologists who had no prior knowledge of the clinical data. No statistical reliability was found for distinguishing bacterial from nonbacterial pneumonia. Radiographic diagnoses were 67% accurate for the 16 cases of bacterial pneumonia, and 65% accurate for the 9 viral cases. Six cases of Mycoplasma pneumonia were diagnosed as nonbacterial 19% of the time, and as "bacterial pneumonia" 81% of the time.


Duodenal varices in extrahepatic portal obstruction. Duodenal varices were angiographically demonstrated in 18 cases of extrahepatic obstruction of the portal vein or obstruction of the splenic vein. In 11 cases, barium examination of the upper gastrointestinal tract revealed prominent filling defects in the duodenal bulb and the duodenal sweep. These abnormalities share common characteristics and differ in their appearance from more commonly diagnosed duodenal lesions; their demonstration should raise the suspicion of extrahepatic  portal or splenic vein obstruction, which may be verified by angiography.


Superior mesenteric artery embolization: an angiographic emergency. Eleven cases of superior mesenteric artery embolization are presented. The extent of bowel necrosis was found to be related to two major factors: the site of occlusion and the elapsed time between the onset of symptoms and definitive therapy. Angiography, available on an emergency basis, provides a definitive diagnosis which can only be suspected by other means. Therapy instituted within 24 hours of the onset of symptoms in all cases resulted in a mortality of only 9% attributable to intestinal infarction.


Comparison of barium enema nad colonoscopy in the detection of small colonic polyps. A total of 210 patients was examined by barium enema and colonoscopy. The authors found 219 polyps in 112 patients. Single-contrast barium enema missed 33 (45.2%) and double-contrast barium enema missed 17 (11.7%) polyps. Colonoscopy failed to detect 6 polyps (2.7%) and another 21 (10%) were not seen because the area could not be reached by the colonoscope. Malignancy was present in 5 small polyps. The authors conclude that the double-contrast barium enema offers a definite advantage in the right colon. In general, the two methods are complementary.


The effect of vasopressin on hepatic arterial blood flow. Vasopressin was successively infused into the hepatic and superior mesenteric arteries and a systemic vein, and its levels monitored by blood samples drawn from the portal and hepatic veins and a systemic vein. Blood flow was monitored in the hepatic and superior mesenteric arteries and in the ascending aorta. Hepatic blood flow was inversely correlated with mesenteric blood flow, rising about 50% above baseline levels during hepatic and systemic artery infusions and 96% during superior mesenteric artery infusion. Hepatic artery and systemic vein infusions caused a reduction in mesenteric flow about 20% less than that caused by direct superior mesenteric artery infusion.


Influence of Cholografin and Renografin 76 on platelet function. Cholografin and Renografin 76 were studied to determine their effects on platelet function. In vitro platelet aggregation was significantly inhibited by at least 3.4 micron/ml Cholografin and 19.5 micron/ml Renografin 76. Patients who received Cholografin for intravenous cholangiography, and Renografin 76 for non-cardiac angiography, had low levels of plasma contrast agent, and hemostasis was clinically unimpaired. Patients who received Renografin 76 for cardiac angiography had inhibition of platelet aggregation at high levels of plasma contrast agent; there was no correlation with prolonged bleeding times, or with bleeding complications. High levels of plasma contrast agent may inhibit platelet aggregation in vitro and in vivo, although this may not be associated with clinically significant bleeding.


Evaluation of the physiological function of the ureter by fluoroscopy in bilharziasis. Of 40 cases of bilharziasis of the urinary tract examined by excretory urography, 26 (65%) showed evidence of abnormal ureteral motility. Although the severe ureteral dilatation of bilharziasis is generally believed to be caused by fibrotic strictures, only 2 strictures were seen. Abnormal peristalsis was also found in ureters which were not dilated. Upper urinary tract changes in S. haematobium infestation are shown to be more often due to disturbances of ureteral peristalsis rather than ureteral stricture.


A nontraumatic para-aortic lymphocele complicating nephrolithiasis. Many cases of traumatic para-aortic lymphocele have been reported. Recently, a case of nontraumatic para-aortic lymphocele was investigated. The etiologic consideration for this lymphocele formation is either a localized inflammatory process, or fibrosis induced by prior passage of calculi.


Superselective angiography of the hip. Technique, normal features, and early results in idiopathic necrosis of the femoral head. The vessels of the hip were studied by superselective injection of the various branches supplying it. The medial and lateral circumflex, obturator, and superior and inferior gluteal arteries were catheterized using a left axillary or brachial approach. The femoral head is supplied primarily by the capsular arteries arising from the medial circumflex artery. Good visualization of the superior capsular arteries is obtained by superselective injection with subtraction. Occlusion of these arteries is shown in the early phase of idiopathic necrosis of the femoral head. The capsular arteries may or may not be revascularized in later phases of this condition, whose evolution is discussed and correlated with the degree of revascularization.


Subtle transchondral fractures of the talar dome: a radiological perspective. Radiographic findings associated with small talar dome fractures were analyzed in 21 patients. Representative cases are presented. The classification of talar dome fractures, and the role of the radiologist in their evaluation, are discussed.


The accuracy of radiologic identification of humans using skeletal landmarks: a contribution of forensic pathology. The radiologic identification of humans, using skeletal landmarks in the thorax, is a potentially reliable method and its applicability to problems in forensic pathology is emphasized. This method was used in a case of homicide in which the identity of the victim required confirmation.


Intra-articular calcification in scleroderma. Two patients with scleroderma demonstrated intra-articular calcification, which is rarely observed in this disease. The authors suggest that intra-articular calcification and erosion of adjacent cartilage and bone are related.


Negative-mode soft-tissue xeroradiography. Positive-mode xeroradiography is an excellent method of visualizing soft-tissue structures in mammography and other procedures; however, toner deletions over a large area may preclude adequate delineation of the soft tissues near high-density structures such as bone. Use of the negative mode in the development cycle provides excellent demonstration of the soft tissues without toner deletions and requires only about 70% of the exposure needed in the positive mode. Negative-mode images also exhibit greater changes in radiographic contrast than those observed with the positive mode. The extent of achilles tendon lacerations was shown particularly well by this technique.


Autonomic dysreflexia: an unusual radiologic complication. Two cases of autonomic dysreflexia are reported in which patients with high spinal cord lesions developed untoward effects during a diagnostic radiologic procedure. One patient had a retrograde cystogram and the other had a femoral angiogram. Radiologists should be aware of this potentially hazardous complication which could occur in any patient with a spinal cord lesion at or above T6. It can precipitate severe acute hypertension, acute myocardial failure or intracranial hemorrhage. We reviewed clinical features, etiologies, pathophysiology, treatment and prophylaxis.


An automated radiology information system. An automated radiology department information system, serving the diagnostic radiology and nuclear medicine divisions, has been developed. Radiology applications are part of a centralized data processing operation which incorporates clinical, administrative, research, and teaching subsets. The radiology subset includes remote on-line ordering/reporting, automated examination census and statistics, an on-line audit trail/workload control program, and financial reports. The software is linked to other hospital applications. This system improved report turn-around times, decreased clerical loads, and provided better financial management.


Coronal computed tomography of the skull and brain in infants and children. Part I: Technique and results. The advent of scanners with an air gap and a tilting gantry have made possible the use of the coronal view in computed tomography of the skull and brain in infants and children. Of 400 axial scans performed over a four-month period, 50 were supplemented by the coronal projection. Although the artifacts, uncomfortable position, and prolonged scanning time associated with coronal scanning make it impractical as the only modality, when used as an adjunct to the axial view it can provide valuable additional diagnostic information.


Coronal computed tomography of the skull and brain in infants and children. Part II. Clinical value. Coronal computed tomography is an important adjunct to the routine axial view in the evaluation of lesions of the skull and brain in infants and children. Of 400 axial scans performed over a four-mounth period, 50 were supplemented by coronal scans. Intracranial or cranial abnormalities were present in 39 (78%). Although the disadvantages of the coronal projection make it impractical as the only modality, when used as an adjunct to the axial view certain lesions of the skull and brain are diagnosed and delineated better.


Computed tomographic evaluation of the pancreas. Computed tomography (CT) was used to assess possible pancreatic disease in 352 patients. It was found to be a reliable, often specific, and noninvasive method for detecting pancreatic neoplasms and pseudocysts. The use of CT has resulted in the diminished use of pancreatic angiography; effects of CT on patterns of utilization of other diagnostic methods are described.


Definitive role of CT scanning of the pancreas. The second year's experience. In a group of 188 patients, 192 computed tomographic (CT) scans of the pancreas were done, and the diagnostic accuracy of CT determined relative to other modalities. CT was the most effective method of detecting neoplastic and inflammatory diseases. The full extent of the disease process, including involvement of the retroperitoneum and metastasis to the liver, was visualized with one examination. Calcification and cystic collections associated with pancreatitis were also clearly seen.


Computed tomography in the evaluation of patients with suspected carcinoma of the pancreas. The authors assess the efficacy of CT of the pancreas in a series of 151 patients with suspected pancreatic carcinoma. CT diagnoses were divided into four categories based on the original interpretation: "mass" or carcinoma (53 scans); normal pancreas (68 scans); normal pancreas, but another pathologic process was discovered on the CT scan (20 scans); and unsatisfactory or indeterminate examinations (10 scans). In more than 50% of the erroneous diagnoses of pancreatic carcinoma, the mass lesion seen on CT was found at surgery or angiography to be adjacent to, not arising from, the pancreas. False-positive interpretation can be avoided by improved equipment and technique and the accumulation of interpreter experience.


Efficacy of simple sedation of pediatric computed tomography. A mixture of meperidine, chlorpromazine, and promethazine was used for sedation prior to computed tomography in pediatric patients. Diagnostic-quality scans were obtained in 88% of cases, and there were no important complications. Advantages of routine use of sedation over general anesthesia include random scheduling of adults and children, independence from the other demands placed on the anesthesia service, less need to admit these children to the hospital, and low cost.


Complications of cerebral angiography and pneumography. There were incidences of 0.7% severe and 5.5% mild complications in 1,971 direct puncture carotid angiograms done over a 5-year period. In 1,035 retrograde branchial angiograms, there was a 0.6% incidence of severe, and a 4.7% incidence of mild, complications. Complications tended to increase with increasing age of the patient. Brachial angiography is virtually free of life-threatening complications, and the incidence of neurological sequelae was markedly less than that shown by a comparable analysis of catheter angiography. Of patients undergoing 1,542 fractional pneumoencephalograms, 2 had severe complications.


A modular computer system for the nuclear medicine/ultrasound laboratory. Computer-controlled graphic displays are a necessity in many nuclear medicine studies. The authors propose using a set-up consisting of three modules: (a) a display system based on television technology; (b) an instrument interface employing list mode and having a low information loss rate; and (c) flexible modular software which can easily be tailored to the needs of both radiologists and technicians. The authors consider a mini-computer system with broad, flexible applications to be a valuable tool, particularly for those function studies which can only be done by means of nuclear medicine techniques.


Roentgenographic features of American Burkitt's lymphoma. Studies of American Burkitt's lymphoma in 12 children showed a high incidence of abdominal involvement, including ileocecal masses with intussusception, retroperitoneal extension, and diffuse bowel involvement. Pleural effusions were common, and 2 patients had pulmonary nodules. Three patients had diffuse renal involvement. The mandibles and other bones were not affected in any of the 9 patients tested. The first 2 patients survived 0.5 to 8.5 months; the last 2 were treated much more aggressively and were still free of disease at the time this paper was written, 14 and 16 months after treatment, respectively. Hopefully, early recognition of the clinical and roentgenographic features of American Burkitt's lymphoma will contribute to improved survival.


The radiographic features of early onset Group B streptococcal neonatal sepsis. The clinical and radiographic features of 27 newborn infants with early onset Group B streptococcal infection as documented by blood culture have been reviewed. Initial chest radiographs revealed a wide spectrum of patterns. These included changes usually associated with the respiratory distress syndrome, extensive pneumonia, and small infiltrates as well as a normal appearance. Premature birth and a fatal outcome were associated with extensive radiographic changes. At autopsy some of the infants with a radiographic appearance of respiratory distress syndrome had pathologic features of Group B streptococcal infection with no apparent evidence of coexisting respiratory distress syndrome.


Simple bone cysts: factors of age dependency. Patient age plays a significant role in the presentation and clinical behavior of bone cysts. In children, cysts behave more aggressively than in adults and the recurrence rate for patients in the first decade of life is four times that in the adolescent. Simple bone cysts are less frequent after 17 years of age and 80% of cysts in the young are located in the proximal end of the shaft of the humerus and femur. Pathological fractures will call attention to the cyst and the highest incidence of fractures is in childhood (0--10 years).


Ultrasonography in ascites.

Ultrasonography in ascites. Ascites is usually not difficult to detect with ultrasonography because of its characteristic lack of echoes. However, minimal or lobulated collections of fluid or unusual distributions due to anatomical variations or associated pathological processes may create problems in diagnosis. Differentiation from an intraperitoneal abscess, hematoma, lymphocele, or cystic mass is of considerable clinical importance.


Ultrasonographic appearance of adult intussusception. A gray scale ultrasound evaluation of a case of adult intussusception is presented. The observed "target-like" abdominal mass, with central dense echoes and peripheral sonolucency, may be characteristic of this entity. A primary bowel or intestinal loop process should be considered when a lesion with this appearance is encountered.


Ultrasound diagnosis of common bile duct dilatation. The use of ultrasound in the differential diagnosis of obstructive jaundice has been previously reported. Although common bile duct dilatation has been demonstrated, criteria for its accurate identification have not been stressed. This report describes findings and relationships helpful in recognition of a dilated common bile duct. It is important to identify this structure, since it could otherwise be confused with surrounding vessels.


Ultrasonic diagnosis of hydatidiform mole with a coexistent fetus. The sonogram of a patient with an intrauterine gestation revealed a partial posterior placenta praevia and a hydatidiform mole within the praevia portion of the placenta.


Ultrasonography of renal sinus lipomatosis. Gray scale B-scans in renal sinus lipomatosis show a variety of features which must be differentiated from clinically significant pathological processes. Normal kidneys show dense homogeneous central echoes. In renal sinus lipomatosis, however, the central echoes are divided and become more sparse (Type I), interspersed with small relatively echo-free areas (Type II), or outline a single relatively echo-free area resembling a mass (Type III). In contrast to similar features in hydronephrosis or multiple cysts, the relatively echo-free areas in lipomatosis are ill-defined and do present several weak internal echoes.


Intracranial ependymomas.

Intracranial ependymomas. Clinically significant spinal implants develop in intracranial ependymomas. Spinal subarachnoid implants developed in 11 of 32 patients who received local irradiation at the University of Michigan between 1955 and 1972 for intracranial ependymoma. Seven of these patients received spinal axis irradiation for neurological disturbances resulting from the implants, and implants were found in the other 4 patients postmortem. Ten patients had infratentorial tumors, and one had a supratentorial tumor; nine tumors were poorly differentiated, two were well differentiated. The authors conclude that spinal irradiation is required if the tumor is poorly differentiated, or located in the infratentorial fossa.


Elective irradiation of the lower cervical region in patients at high risk for recurrent cancer at the tracheal stoma. The results of treatment for recurrent cancer at the tracheal stoma have been poor. From 1971 to 1976, elective postoperative irradiation of the neck was given to 26 high-risk patients with carcinoma of the larynx and hypopharynx. None of the 22 patients whose stomas were irradiated developed stomal or peristomal recurrence, while 2 of the 4 patients whose stomas were shielded had stomal recurrence. Elective irradiation of the tracheal stoma was effective in preventing stomal recurrence; we recommend inclusion of the stomal area in preoperative or postoperative irradiation to the lower cervical region for high-risk patients.


Radiation necrosis of the scalp: a complication of cranial irradiation and methotrexate. A case of childhood leukemia with a severe skin reaction following a course of medium-dose cranial irradiation and intrathecal methotrexate is presented. Necrosis of the scalp of partial to full thickness resulted. The authors believe potentiation of the radiation reaction by methotrexate was the probable cause.


Comparison of intravenous and intra-arterial pyrimidine infusion as a means of radiosensitizing tumors in vivo. The halogenated pyrimidine analogue 5-bromo-2-deoxycytidine (BCdR) was infused into BALB/C mice bearing EMT-6 tumors via either the intravenous or intra-arterial route. Hepatic dehalogenation of the drug was blocked by 5-diazouracil (DAZU) in order to ascertain its relative importance in the degradation of intravenously administered analogues. Increased radiosensitization was noted with higher intravenous pyrimidine concentrations, but DAZU blockage of dehalogenation had little effect. These studies show that following intravenous infusion, enough BCdR apparently bypasses the hepatic vessels to permit tumor radiosensitization despite dilution of the drug by the systemic circulation.


Effect of radiation and contrast media on chromosomes. Preliminary report. Measurements of chromosome aberrations or micronuclei in lymphocytes obtained from 7 patients indicate that angiocardiography produced chromosome damage corresponding to an average absorbed dose of about 50 rads. This is an order of magnitude larger than was estimated from the exposure rate. Experiments on lymphocytes suspended in solutions of methylglucamine and sodium diatrizoate (Renografin) or sodium diatrizoate alone (Hypaque) indicate that the chromosome damage observed in the patients is due in larger part to two effects: (a) an increased absorption of x rays as compared to blood and (b) a breakage of chromosomes even in the absence of x rays.


Computed tomography of the breast. A preliminary report. Initial studies indicate that computed tomography can detect both benign and malignant breast disease in both fatty and dense, thick breasts. CT may also be capable of diagnosing early cancer or a precancerous lesion in women with dysplastic breasts or patients who have had radiation therapy or surgery, whereas some of these lesions cannot be diagnosed by mammography because the breast is too dense.


The effect of drug-induced thrombocytopenia on direct-current transcatheter electrocoagulation. Direct-current transcatheter electrocoagulation in vitro produced substantial clots in thrombocytopenic blood in dogs. The splenic artery was occluded in 3 dogs following ristocetin-induced thrombocytopenia. This procedure may produce effective vessel occlusion in patients with platelet-poor blood.


Comparison of computed tomography and conventional transverse axial tomography in radiotherapy treatment planning. Treatment plans can differ widely depending on whether they were developed from anatomical information generated by computed tomography or conventional transverse axial tomography. In the present study, deviations between tumor doses calculated using the two methods were as great as 10%, increasing to 20% for the spinal cord.


Distribution of 99mTc-1-thioglucose in rats: effect of administration route on pancreatic specificity. Tissue distribution of 99mTc-1-thioglucose was studied in inbred albino Fisher rats. High levels of radioactivity were observed in the kidney with concurrent low pancreatic levels and pancreas/liver ratios of 0.4 following intravenous administration of the agent. High pancreatic concentration were observed with pancreas/liver ratios of 4.0 after intraperitoneal administrations. Future studies on pancreatic radiopharmaceuticals should avoid production of artificially high pancreatic values by intraperitoneal injection.


Eye lens protection for radiological personnel. Various radiodiagnostic procedures expose the eye lens of the diagnostic technician to radiations. With the aid of lead glasses with an attenuation of radiation equivalent to 0.25 mm of lead, the dose can be reduced by 90%.


An improved computer model for 60cobalt dose distributions. A previously developed model for the calculation of 60Co isodose contours exhibits poor fit to experimental data at certain points. Methods for improving the fit at these points are described. The model contains few parameters, and may be useful for treatment planning in cases for which data are not available.


A simple approach to the diagnosis of bronchopleural fistula. The authors describe a simple, yet reliable technique for confirmation of a bronchopleural fistula. It is based on detection of radioactivity in the pleural space after the washout phase of the 133Xe ventilation study. This method demonstrated the pathological communication while bronchoscopy, bronchography, and methylene blue testing did not.


Errors in radiographic measurements caused by variations in the table top/Bucky tray distance. The distance between the table top and the Bucky tray varies between radiographic rooms in most x-ray departments. A potential difference of 8% or more in the degree of magnification of radiographic images was found in five Memphis hospitals. Articles on measurement of kidneys, intracranial volume, sella turcica, etc, should specify the distance used to establish the charts.


Some applications of the law of evidence to the specialty of radiology. Certain rules or laws of evidence are particularly applicable to diagnostic images in whatever form they are used in court as evidence. The legal principles and precedents of this subject, including opinion evidence, hearsay evidence rule, best evidence rule, and the role of the radiologist as a medical expert witness, are discussed.


The identification of two novel prostaglandins and a thromboxane. 6,15-Dioxo-PGF1alpha, 6,15-dioxo-13,14-dihydro-PGF1alpha and 15-oxo-thromboxane B2 have been identified in incubates of ram seminal vesicle homogenates with added arachidonic acid or in the perfusate from sensitised challenged guinea pig lungs. These compounds are probably related to 6-oxo-PGF1alpha and thromboxane B2. The structures have been determined by gas chromatography mass spectrometry, following suitable chemical derivatisation.


Prostaglandins H1 and H2. Convenient biochemical synthesis and isolation. Further biological and spectroscopic characterization. An easy biochemical preparation of the prostaglandin endoperoxides, PGH1 and PGH2, is described. Both of the endoperoxides are potent contractors of isolated gerbil colon smooth muscle. Contracture with PGH2 is about equal to that caused by the standard, PGE1, while contracture with PGH1 is about half of that caused by PGE1. PGH1 was found to inhibit platelet aggregation induced by PGH2 and is about 1/10 as potent a stimulator of cAMP accumulation as is PGE1. The mass spectra of the methyl esters of both PGH1 and PGH2 were obtained, as were the infrared spectra of the two compounds. The nuclear magnetic resonance spectrum of PGH2 is characterized by signals at 4.58 delta and 4.47 delta for the C-9 and C-11 protons, respectively.


Enzymatic preparation of prostaglandin endoperoxides. A simple and reliable method is described for the preparation of the endoperoxide intermediates (PGG2 and PGH2) in the biosynthesis of prostaglandins. The endoperoxides are thermolabile and easily decomposed by water (t 1/2 congruent to 5 min at 37 degrees C). Because of this, special precautions must be taken to work at low temperature and to minimize contact with moisture. Milligram quantities of PGG2 and PGH2 were obtained by running several reactions successively and pooling the extracts before chromatographic fractionation. The method is now being developed further to scale up the procedure.


Hormone selective lipase activation in the isolated rabbit heart. The synthesis and release of PGs by the isolated perfused rabbit heart upon bradykinin stimulation results from lipase stimulation which liberates arachidonic acid for PG biosynthesis. The [14C]-labelled fatty acids, arachidonate, linoleate, and oleate, when infused into the heart preparation, were efficiently incorporated into the phospholipid pool in the heart mostly in the 2-position of phosphatidylcholine. On the other hand, [14C]-palmitate was esterified into both the 1- and the 2-position. Bradykinin released bioassayable PG when injected into the rabbit hearts, regardless of which fatty acid label was incorporated into the phospholipid pool. However, only [14C]-arachidonic acid (but not [14C]-linoleate, oleate or palmitate) was liberated from the variously labelled hearts upon hormone stimulation. This selective bradykinin effect on fatty acid release suggests that hormone stimulation either activates a specific lipase that distinguishes different fatty acids in the 2-position or activates lipase which is selectively compartmented with arachidonate-containing phospholipids. Ischemia, on the other hand, appeared to non-specifically stimulate tissue lipases, resulting in a non-selective release of oleic as well as arachidonic acid. A disproportionally large release of arachidonic acid was observed accompanying a relatively small PG (10:1 arachidonate: PG ratio) production during ischemia, as compared to bradykinin (3:1 ratio), suggesting distinct mechanisms for PG biosynthesis induced by bradykinin and ischemia.


The effect of prostaglandin inhibition on the natriuresis of drug-induced renal vasodilatation. It has been suggested that increased prostaglandin release may mediate the natriuresis seen during the administration of renal vasodilators. To further investigate this possibility, either acetylcholine (40 microgram/min) or bradykinin (5 microgram/min) was infused into the left renal artery of anesthetized dogs previously given an inhibitor of prostaglandin synthesis. During the infusion of either vasodilator drug in the prostaglandin-inhibited dogs, urinary sodium excretion increased to a similar degree as in a group of normal dogs with intact prostaglandin synthesis. These studies therefore do not confirm that prostaglandins play a significant role in the natriuresis of drug-induced vasodilatation.


Dual effects of bradykinin on prostaglandin metabolism: relationship to the dissimilar vascular actions of kinins. Generation of a prostaglandin of the F series by bovine mesenteric veins in response to bradykinin may depend on increased synthesis of PGE and conversion of the latter to PGF after activation of PGE 9-ketoreductase by the kinin. The prostaglandin then mediates the constrictor action of bradykinin on the bovine mesenteric vein. A high speed supernatant (HSS) fraction of bovine mesenteric blood vessels contains the highest activity of PGE 9-ketoreductase. Incubation of PGE2 with HSS at 37 degrees C in the presence of a NADPH generating system resulted in time-dependent conversion of PGE2 to PGF2alpha. Bradykin (0.01mM) more than doubled conversion of PGE2 to PGF2alpha by the PGE 9-ketoreductase obtained from mesenteric veins whereas the kinin had little effect on enzymic activity of the HSS fraction of mesenteric arteries. However, after inhibition of kininase catabolism, bradykinin increased PGE 9-ketoreductase activity of arteries and veins to the same degree. Prostaglandin release from veins by bradykinin appears essential to contraction of mesenteric venous strips evoked by the polypeptide as indomethacin treatment abolished this effect. PGE 9-ketoreductase may be an important prostaglandin regulatory mechanism of the vascular wall whereby the functional consequences of changes in rates of prostaglandin synthesis are governed by determining the ratio of PGE to PGF within vascular tissue. Constriction of bovine mesenteric veins evoked by bradykinin may, therefore, depend on increased prostaglandin synthesis and conversion of newly formed PGE to PGF, both steps being affected by the kinin.


Radioimmunological and biological measurement of prostaglandins in rabbit urine: decrease of PGE2 excretion at high NaCl intake. The estimation of prostaglandin (PG) E2 and of PGF2alpha by radioimmunoassay is described in detail. PGE2 was measured after conversion to either PGB2 or PGF2alpha and the results compared to bioassay. The methods were used to follow the excretion of PGE2 and PGF2alpha after salt loading in rabbits. A marked reduction of PGE2 levels was observed at high NaC1 intake, while PGF2alpha excretion remained unchanged.


Hypercalcemia induced by prostaglandin E2 in thyroparathyroidectomized but not intact rats. Prostaglandin E2 was infused into thoracic aorta of thyroparathyroidectomized (TPTX) and intact rats. Circulating calcium increased significantly in the TPTX group by 30 minutes and reached an increment of 1.5 +/- 0.21 mg/dl (x +/- SE, p less than .001) by 90 minutes. No calcium increments were observed in the intact rats. It is postulated that prior failures to demonstrate hypercalcemia during PGE2 infusion may have been due to calcitonin counterregulation.


Uterine trauma associated with midtrimester abortion induced by intra-amniotic prostaglandin F2alpha with and without concomitant use of oxytocin. Five of 80 (6.2%) nulliparous women sustained uterine trauma in association with midtrimester abortion induced by intra-amniotic prostaglandin F2alpha and intravenous oxytocin. All five women suffered cervical lacerations, one extending to the lower uterine segment of the corpus and another associated with myometrial necrosis caused by cornual sacculation and ischemia. No uterine trauma was observed among 95 parous women aborted in the same fashion during this study. The different mechanisms of cervical dilation in the parous woman and the nullipara are offered as an explanation for this difference. Thirty-nine other cases of uterine injury associated with the use of intraamniotic prostaglandin F2alpha from the literature were reviewed, and found to indicate that midtrimester abortion induced by intra-amniotic prostaglandin F2alpha is associated with a significant risk of uterine trauma in the nullipara. The risk seems to increase with the use of oxytocin and with increasing gestational age.


Hormone changes in relation to the time of fetal death after prostaglandin-induced abortion. The changes in unconjugated estradiol-17beta and estriol, progesterone and chorionic somatomammotropin (HCS) in peripheral plasma have been studied in 18 women at 30-minute intervals following intra-uterine prostaglandin E2 administration for therapeutic termination of second trimester pregnancy. The hormonal changes were related to the time of fetal death detected by the disappearance of fetal heart pulsations. Prostaglandin E2 was given by the intra-amniotic route with urea (5 patients) or with intravenous oxytocin (5 patients), or by the extra-amniotic route with intravenous oxytocin (8 patients). Fetal death occurred rapidly with intra-amniotic PGE2, but usually at a late stage with extra-amniotic PGE2. Three fetuses in the extra-amniotic group died at or just before abortion. A variety of fetal heart changes were noted and the time of fetal death did not appear to influence the time of abortion within each treatment subgroup. Estradiol and estriol showed a sligh but persistent fall over 24 hours prior to induction of abortion. A more rapid fall usually occurred after induction, with a consistent fall around the time of fetal death. Progesterone and HCS usually fell much less before and immediately after fetal death. A marked rise in estradiol sometimes occurred before fetal death, particularly in the intraamniotic PGE2 and urea subgroup. Estriol levels declined more rapidly before than after fetal death, whereas fetal death had less consistent effects on the other hormones. All hormones had usually fallen considerably at the time of abortion, and in some individuals marked fluctuations in hormone levels were seen.


The effect of orciprenaline sulphate on the in vitro production of postaglandins E and F by the guinea pig uterus. The effect of orciprenaline sulphate on the in vitro production of PGs E and F by guinea pig uterine tissue homogenates has been investigated. Estmations of PGs were carried out using sensitive radioimmunoassay techniques. The results indicated that orciprenaline can effectively reduce the in vitro yield of PGs E and F from guinea pig uterine tissue. This could in turn be due to an inhibitory effect of orciprenalline on PG formation or due to stimulation of PG breadkdown by the drug. The implications of these results in relation to premature labour are discussed.


Effect of prostaglandins F2alpha and E2 on milk ejection, blood pressure and blood flow through the mammary artery in the cow. The influence of prostaglandins (PG) F2alpha and E2 on milk ejection, mammary artery blood flow and arterial blood pressure was studied in lactating cows. Injections of both PG in the jugular vein or the carotid artery induced milk ejection after a relatively long latency period. The minimal effective dose amounted to 1 to 5 microng and to 100 to 300 microng for PGF2alpha and PGE2 respectively. In several cases with PGF2alpha and once with PGE2 milk ejection was accompanied with a simultaneous increase in blood flow through the mammary artery whereas arterial blood pressure remained unchanged. Both routes of administration showed the same response. It was suggested that the effect of the PG on the bovine myoepithelium is indirect, possibly secondary to a release of oxytocin from the neurohypophysis.


Failure of LH and/or prolactin to prevent PGF 2alpha-induced luteolysis of ovine corpora lutea. Infusions of phosphate buffered saline, LH (4 microgram/min or 14 microgram/min), prolactin (42 microgram/min) or LH (4 microgram/min) plus prolactin (42 microgram/min) for 12 hr did not prevent luteolysis following intramuscular injections of prostaglandin F2alpha-tham salt two and six hr after beginning the infusion. Likewise, these treatments did not delay luteolysis since a similar rate of decline in peripheral plasma progesterone occurred in all groups. It was concluded that elevation of serum concentrations of LH and prolactin to high levels had no effect on PGF2alpha-induced luteolysis on day 8 following induced ovulation.


The effect of electrical stimulation upon the activity of brain glutamate decarboxilase "in vitro". Using the cytoplasmic soluble fraction from rat brain as a source of glutamate decarboxilase, its enzymatic activity was induced by electrical stimulation and determined by gas release. Modified Warburg's flasks were used for such determination. The limits of frequency and the use of sinusoidal waves were based on normal cerebral rhythms. At low frequencies, GAD activity is markedly enhanced (1-10 Hz, 2v, 500 muA). Activation of the enzyme may be due to distortion of the tertiary structure promoting thus an increased coupling between the substrate and the enzyme complex.


Ellis-van Creveld syndrome. An inbred kindred with five cases. Five additional cases of a kindred with inbred Ellis-van Creveld syndrome are reported. Ectodermal dysplasia polydactyly, chondroectodermal dysplasia and possibly congenital heart diseases were present in all our cases. Cephalometric radiographs from one patient showed an enlargement of the mentum-groove-labial distance. The diagnosis of two individuals was performed by clinical and radiological examinations. An autosomal recessive mode of inheritance is strongly suggested by their pedigree.


Surgical anatomy of hepatic veins: morphologic and angiographic study in the dog. Post-mortem angiography with Schlesinger mass was performed on 30 mongrel dogs to study the hepatic veins and its confluence into the caudal vena cava. The study was complemented by anatomic dissection of the specimens with the purpose of confronting angiographic and morphologic patterns. After sacrificing the animals by section of the cervical vessels, a right thoraco-abdominal incision was made with exposition of the vena cava followed by retrograde catheterization and injection of radiopaque mass through a polyethylene catheter. Two radiographies were performed, one with the dog in a supine position and another of the specimen after its withdraw "en bloc", from the abdominal cavity. The left hepatic division alone or the central and left divisions "en bloc" are the ones that should be used for studies of hepatic ressection, segmentar portal hypertension and lobar liver transplant.


[A comparison between radiologic and endoscopic examinations of early cancer of the stomach (author's transl)]. Comparison between radiologic and endoscopic-bioptic examinations shows that, in early cancer, great demands are made on the radiologic technique and experience of the examiner. An integrated technique using relief- and double-contrast with additional induced hypotony can achieve demonstration of circumscribed shallow changes of less than 2 cm diameter in all segments of the stomach. With this technique over 80% of early cancers can be detected radiologically.


[Cancer and advanced pancreatitis of the head of pancreas in the ERCP (endoscopic retrograde cholangio-pancreaticography) (author's transl)]. 3 cases each of carcinoma and chronic pancreatitis of the head of pancreas show tha difficulties of differential diagnosis in retrograde cholangio-pancreaticography. When both duct-systems are shown, diagnosis is facilitated when changes are typical. In favor of cancer--apart from well-known criteria--is the more frequent occurrence in the choledochus and, possibly, the higher age of the patients. All other possible techniques have to be utilized side by side with ERCP.


Post-operative medical problems of the stomach (author's transl). Short survey of late or long-term consequences of gastric operations (recurrent ulceration, postprandial discomfort, disturbances of motility, syndrome of malassimilation). The possible importance of the recently discovered gastro-intestinal hormones Motilin, Gastric Inhibitory Polypeptide (GIP) and Vaso-active Intestinal Peptide (VIP) is discussed.


[Radiologic signs in the colon in disease of the gallbladder (author's transl)]. Acute and chronic inflammation of the gallbladder may simulate pseudotumors of the right half of the colon; this may at times be obvious on straight films of the abdomen. Analysis of the changes of relief in contrast-examinations of the colon will lead to the correct diagnosis. Inflammatory reactions of the colon mostly appear near the mesocolic tenia. Cholecystocolic fistulae are mostly due to perforation of stones, only exceptionally to tumors. Adhesions appear to be the precondition for malignant infiltration and stoneperforation.


[Benign disease of the throat in xerotomograms (Part I) (author's transl)]. The advantages of xeroradiography in radiology of the soft parts are emphasized. The technique in tomography of the throat is described. Typical benign diseases of the throat like acute or chronic inflammation, edema, pareses of the vocal cords and injuries are demonstrated on xerotomograms and discussed. Detail of the structures of the throat is better seen in xeroradiographic tomograms than in Röntgentomograms.


[The value of xerotomography in the radiologic diagnosis of chronic cervical myelopathy (author's transl)]. Report on experience with radiologic diagnosis of 13 patients with chronic cervical myelopathy, who were examined at our clinic within 6 months. The various neuroradiologic findings are described and evaluated as to their causal importance. If plain radiograms show a spinal canal of normal diameter and where there are no multiple osteochondrotic changes, examinations with positive contrast media are most suitable. Air myelograms should be used when the advantages of xerotomography can be made use of.


[Hydroxyapatite rheumatism (multiple tendon calcification disease). II. - Microscopic study - HL-A antigen - Experimental arthritis - Pathogeny]. Optical and electron microscopic studies of the articular fluid in multiple calcification disease reveals the existence of rounded intra- and extracellular crystalline formations. These crystalline formations of calcium and phosphorus are made up of accumulations of tiny crystals shaped like fine needles 200 nm X 15-20 nm and are highly suggestive of hydroxyapatite. Crystals injected into the plantar pads of rats or the knees of rabbits induce an acute inflammatory reaction maximal at 5 hours and recovering in 24 72 hours. Hydroxyapatite crystals are swiftly dissolved in serum and more rapidly still when cells are present. Their dissolution releases calcium into the surrounding area. HLA typing of patients with multiple tendinous calcification (28 cases) or single tendinous calcification (10 cases) shows an increased frequency of HLA A2 and BW 35 in comparison with controls.


Body infestations.

Body infestations. The common body infestations, their incidence, diagnosis and treatment are discussed. Pediculosis capitis still has a high incidence in Britain. The louse could probably be effectively eradicated provided a national campaign of treatment and education were undertaken. Intensive therapy with a malathion containing preparation should be used before the louse develops resistance to this new organophosphorus insecticide. Similarly, scabies can be effectively treated. All doctors should be aware of the signs and symptoms of this common dermatosis and its treatment.


Enzymic activities of commercial preparations of pancreatic enzymes. The enzymic activities of 20 commercial pancreatic extracts have been measured by standard (F.I.P.) methods of assay and the activities have been compared with a standard preparation of pancreatin supplied by the British Pharmacopoeia Commission. A wide range of enzymic activities was found. The tabulated cost per unit of enzymic activities provides a guide to one aspect of the potential therapeutic efficacy of pancreatic extracts in the treatment of pancreatic exocrine insufficiency.


Methylmercury poisoning in the harp seal (Pagophilus groenlandicus). Hematological and blood chemistry values were examined in harp seals (Pagophilus groenlandicus) exposed to daily oral dosages of methylmercuric chloride (MMC). Two seals, exposed to 0.25 mg MMC/kg body weight/day for 60 and 90 days, respectively, did not show abnormal blood values. Two other seals exposed to 25.0 mg MMC/kg body weight/day died on day 20 and 26 of exposure. Blood parameters indicated toxic hepatitis, uremia and renal failure. Total mercury and methylmercury values in the tissues of the experimental animals indicated that harp seals can tolerate high levels of mercury in the brain and that the observed renal and hepatic dysfunction were related to the high accumulation of mercury in these tissues. Tests of renal function are useful in cases of severe methylmercury poisoning.


Multistranded helix in xanthan polysaccharide. The extracellular polysaccharide xanthan is shown by electron microscopy to be an unbranched, probably double-stranded fiber 4 nanometers wide and 2 to 10 micrometers long when native. Denaturation yields a single strand only 2 nanometers wide and 0.3 to 1.8 micrometers long. Renatured xanthan shows short unraveled regions with two or three strands arranged in a right-handed twist.


Phase control of neural pacemakers.

Phase control of neural pacemakers. An electrical stimulus resets the phase of a spontaneously rhythmic neuron. The "new phase" versus "old phase" curve shows either of two distinct topological characters, depending on the stimulus magnitude. These features, and a phase singularity implicit in them, are common to many stable oscillations deriving from continuous feedback between two or more biophysical quantities.


Polarity reversal in nerve-free hydra.

Polarity reversal in nerve-free hydra. Hydra experimentally depleted of all nerve cells and nerve stem cells (interstitial cells) demonstrate normal polarity reversal. Thus hydra epithelial cells are capable of controlling complex developmental patterning phenomena.


Ovarian hormone: lack of effect on reproductive structures of female Asian musk shrews. Uterine and vaginal weights and histologies are not altered by ovariectomy or estrogen treatment in the Asian musk shrew (Suncus murinus). In addition, ovariectomized shrews mate. Thus, the role of ovarian hormones in the control of the reproductive status of this species does not conform to the accepted mammalian pattern.


Loss of Y-cells in the lateral geniculate nucleus of monocularly deprived tree shrews. In tree shrews (Tupaia glis) reared with one eye closed, Y-cells were almost entirely absent in the binocular segment of the lateral geniculate laminae receiving input from the deprived eye. Y-cells were found in the monocular segment of these laminae, and in the binocular segment of the laminae with input from the normal eye. X-cells were present in both the deprived and normal laminae and appeared unaffected by the deprivation. A number of abnormal cells were also found, and these were located primarily in the binocular segment where Y-cells were absent.


Augmenting mental chronometry: the P300 as a measure of stimulus evaluation time. A technique for measuring the latency of the P300 component of event-related brain potentials on individual trials is described. Choice reaction times and the latency of the P300 were compared under speed-maximizing and under accuracy-mazimising instructions. The choice stimuli required different levels of semantic categorization. The data support the proposition that the latency of P300 corresponds to stimulus evaluation time and is independent of response selection.


Progressive brain damage accelerates axon sprouting in the adult rat. An entorhinal cortical lesion causes undamaged fibers in the deafferented hippocampus to sprout and form new connections within 4 to 7 days after the lesion was made. When a partial lesion of the entorhinal cortex precedes a second, more complete entorhinal lesion by a few days, the rate of axon sprouting is accelerated so that the response to the second lesion occurs within only 2 days. This priming effect is present within 4 days, lasts for a few weeks, and eventually subsides. This acceleration may explain, in part, the faster recovery and reduced deficits seen in behavioral studies that have followed serial lesion paradigms.


Animal parthenogenesis.

Animal parthenogenesis. The available evidence on the ecological factors favoring the existence and origin of natural parthenogenesis is evaluated. Analysis of the geographical distributions of the well-known cases of animal parthenogenesis in nature reveals (i) that most of these species exist in natural disclimax communities and (ii) that within these communities they exist in isolation from closely related congeneric species. Parthenogenesis can only evolve in areas devoid of the generating bisexual species, because such species would prevent newly formed unisexuals from establishing clones due either to hybridization or competition. Furthermore, the two unique features allowing parthenogenetic species to invade and occupy open habitats faster than bisexuals are (i) a double intrinsic rate of increase and (ii) the ability of one individual to establish a new colony.


Venous gas bubbles: production by transient, deep isobaric counterdiffusion of helium against nitrogen. When awake goats were subjected to isobaric gas switching from saturation (17 hours) on 4.7 atmospheres of nitrogen (0.3 atmosphere of oxygen) to 4.7 atmospheres of helium (0.3 atmosphere of oxygen), bubbles detected by 5-megahertz Doppler ultrasound in the posterior vena cava 20 to 60 minutes after the switch continued for 4 hours. Similar experiments carried out at 6.7 atmospheres of inert gas and 0.3 atmosphere of oxygen produced more bubbles for as long as 12 hours after the gas switch. This is believed to be the first objective demonstration of the phenomenon of deep isobaric supersaturation under transient operational diving conditions at relatively shallow diving depths. Detection of bubbles by Doppler ultrasound confirms the potential importance of the phenomenon to shallow saturation diving and holds promise for better quantitification of its effects as well as those of its counterpart, isobaric undersaturation, which can confer a decompression advantage.


Metastasis results from preexisting variant cells within a malignant tumor. Clones derived in vitro from a parent culture of murine malignant melanoma cells varied greatly in their ability to produce metastatic colonies in the lungs upon intravenous inoculation into syngeneic mice. This suggests that the parent tumor is heterogeneous and that highly metastatic tumor cell variants preexist in the parental population.


Liquid chromatographic analysis of endogenous catecholamine release from brain slices. A simple new liquid chromatographic technique has been applied to transmitter release studies in brain slice preparations. This method, which gives direct readings of picomoles of endogenous transmitter released, has been shown to yield reliable results with a variety of brain slice manipulations.


Psoralen-DNA photoreaction: controlled production of mono- and diadducts with nanosecond ultraviolet laser pulses. Samples of DNA which contain adducts of a new psoralen derivative, but no cross-links, have been prepared by irradiating mixtures of DNA and the derivative with single, 15-nanosecond pulses of laser light. Succeeding pulses introduce cross-links. The ability to rapidly and selectively create monoadducts and corss-links may allow the use of psoralens as probes of dynamic processes in living cells.


Reye's syndrome: patient serum alters mitochondrial function and morphology in vitro. A direct relationship between a putative Reye's syndrome "serum factor" and generalized mitochondrial damage has been demonstrated in vitro. The clinical features of Reye's syndrome may be secondary to disrupted mitochondrial structure and a consequent impairment of energy-linked functions involving many organs.


Alcohol tolerance in a cholinergic nerve terminal: relation to the membrane expansion-fluidization theory of ethanol action. Phrenic nerve terminals from rats subjected to long-term ethanol treatment were more resistant to ethanol (in vitro) than terminals from sucrose-fed rats, as measured by the effect of ethanol on the frequency of miniature end plate potentials. Long-term ethanol exposure may thus induce the synthesis of more rigid membrane lipids, reducing membrane "fluidizability". This may provide a neurocellular basis for ethanol tolerance and cross-tolerance with anesthetics and barbiturates.


Synaptic mechanism of pentylenetetrazole: selectivity for chloride conductance. In the neurons of Aplysia californica pentylenetetrazole (2 millimolar) greatly reduced chloride-dependent responses to the iontophoresis of putative transmitters. At the same concentration, pentylenetetrazole caused less attenuation of the other iontophoretic responses and had minimal membrane effects. Several convulsants have been observed to have a similar selectivity for the chloride conductance. A common mechanism of convulsant action--reduction of transmitter-induced chloride conductances--is hypothesized.


Relaxin: a disulfide homolog of insulin. Relaxin, a peptide hormone responsible for the widening of the birth canal in mammals, has been purified from the ovaries of pregnant hogs. The amino acid sequences of its constituent A and B chains were determined, and the positions of the disulfide cross-links were established. Relaxin was shown to be identical to insulin with respect to its disulfide bond distribution, but significant homology was lacking in other positions. These findings suggest that relaxin and insulin were derived from a common ancestral gene. Since the intrauterine mode of propagation is synonymous with the development of mammals, the genetic distance between insulin and relaxin should therefore permit an estimate of the earliest possible time of commitment of one evolutionary branch to the development of mammals. This event was estimated to have occurred about 5 X 10(8) years ago.


Quantitation of dimethylnitrosamine in the whole mouse after biosynthesis in vivo from trace levels of precursors. A simple and highly sensitive procedure is described for the recovery and quantitative identification of nanogram quantities of preformed N-nitroso compounds in the whole mouse. This procedure has also been applied to the quantitation of N-nitroso compounds after they have been biosynthesized from trace amounts of precursors. The whole animal is frozen in liquid nitrogen and homogenized to a frozen powder; the powder is then extracted and analyzed by a thermal energy analyzer interfaced to a gas-liquid and a high-pressure liquid chromatograph.


Age-related changes in the hepatic endoplasmic reticulum: a quantitative analysis. Morphometric analysis demonstrated a twofold increase in the surface area of the hepatic endoplasmic reticulum in Fischer 344 rats between 1 and 20 months of age, followed by a significant decrease in this parameter between 20 and 30 months. These changes are attributed to the smooth-surfaced endoplasmic reticulum, since neither the rough-surfaced variety nor the Golgi membranes underwent any significant change in surface area as a function of the age of the animal.


Phase separation of a protein-water mixture in cold cataract in the young rat lens. A remarkable resemblance between the appearance of opacity in lysozyme--salt water mixtures and the development of opacity in cold cataract in the young rat lens is strong evidence that cold cataract is fundamentally a phase separation of the "protein-water binary mixture" in the lens.


Diet and uptake of aldomet by the brain: competition with natural large neutral amino acids. The rise in levels of aldomet in the brains of rats after an injection of the alpha-methylated amino acid was depressed when large neutral amino acids, but not acidic amino acids, were coadministered with the drug. This result suggests that aldomet is transported into brain by the carrier for natural large neutral amino acids. The prior ingestion of a carbohydrate meal, which lowers levels of neural amino acids in the serum, enhanced the uptake of aldomet into brain; the consumption of a protein-containing meal inhibited the subsequent uptake of aldomet into the brain. Antecedent diet can thus affect the availability of aldomet to the central nervous system; the mechanism of this effect probably involves the blood-brain barrier uptake system for large neutral amino acids.


Glucocorticoid in inflammatory proliferative skin disease reduces arachidonic and hydroxyeicosatetraenoic acids. Psoriasis is a prototype of several common, glucocorticoid responsive, inflammatory proliferative skin diseases. Within 28 hours, glucocorticoid reduced the increased concentration of free arachidonic acid in diseased tissue. This reduction was observed prior to visible improvement of disease and may be an important molecular mechanism for the therapeutic efficacy of glucocorticoids in psoriasis and similar inflammatory diseases.


A specific high-affinity binding macromolecule for 1,25-dihydroxyvitamin D3 in fetal bone. Cytosol fractions were prepared from fetal rat or embryonic chick calvaria and analyzed for binding of vitamin D3 metabolites on sucrose density gradients. Both cytosol fractions contain a 3.5S macromolecule which specifically binds 1,25-dihydroxy-[3H]vitamin D3 and in addition, a 5 to 6S macromolecule which binds 25-hydroxy-[3H]vitamin D3. In rat calvaria cytosol, 1,25-dihydroxy-[3H]vitamin D3 also binds to the 5 to 6S macromolecule but appears to have greater affinity for the 3.5S component.


Suprachiasmatic nucleus: use of 14C-labeled deoxyglucose uptake as a functional marker. Glucose consumption of the rat suprachiasmatic nuclei (SCN) was studied under various experimental conditions by means of the [14C]deoxyglucose (DG) technique. The results show that glucose consumption of the SCN, in contrast to other brain structures, is a function of both the time of day and environmental lighting conditions. These data are consistent with the hypothesis that the SCN have an essential role in circadian rhythm regulation and indicate that the DG technique may provide a novel approach for the study of the central neural mechanisms underlying circadian rhythm regulation.


Neurogenesis in the adult rat: electron microscopic analysis of light radioautographs. Three-month-old rats were injected intraperitoneally with [3H]thymidine (4.3 microcuries per gram of body weight) and allowed to survive for 30 days. Radioautography of 1-micrometer sections revealed labeled cells in the granular layers of dentate gyrus and olfactory bulb; these were confirmed as neurons by electron microscopy of reembedded 1-micrometer sections.


An adenylate cyclase of brain reflects propensity for breast cancer in mice. High propensity for breast cancer in mice was associated with low dopamine-stimulated adenylate cyclase activity in the brain, low spontaneous motorization, and low motor responses to injections of the catecholamine precursor, L-dopa.


Communication deviance in the families of schizophrenics: a comment on the misuse of analysis of covariance. Serious contradictions in recent research programs concerning communication anomalies in parents of schizophrenics have been generated by invalid statistical analyses. The method of analysis used, the analysis of covariance, can lead to erroneous conclusions in the context of these studies, and thus, other means must be sought for bringing these important research programs into common focus.


Mixtures of substances with similar tastes. A test of a psychophysical model of taste mixture interactions. When substances of similar taste are mixed, the mixture can show suppression or synergism. That is, the perceived intensity of the mixture can be less than or greater than the sum of the perceived intensities of the components. In the present study, these departures from simple additivity could be predicted from the psychophysical functions relating tast intensity to stimulus concentration of the unmixed components. Psychophysical functions are said to show compression when successive increments in concentration produce progessively smaller increments in perceived intensity and to show expansion when successive increments in concentration produce progressively larger increments in perceived intensity. Suppression resulted from mixtures of substances with compressed psychophysical functions, and synergism resulted from mixtures of substances with expanded functions.


Enhancement of vibrotactile sensation magnitude and predictions from the duplex model of mechanoreception. The degree to which the sensation magnitude of a vibrotactile stimulus is enhanced by a prior stimulus was studied for vibration of the thenar eminence of the right hand. Enhancement was measured by a psychophysical matching procedure in which two brief stimuli separated by a variable time interval were presented to the skin and the subject adjusted a third stimulus to match the sensation magnitude of the second stimulus. By this procedure, it is possible to determine functional relationships between enhancement and the time interval between stimuli, the intensity of the stimuli, and the frequency of the stimuli. The results were consistent with the duplex model of mechanoreception.


Mutual action of taste and olfaction.

Mutual action of taste and olfaction. Subjects estimated the intensity of various concentrations of an odorant (ethyl butyrate), a tastant (sodium saccharin), and mixtures of the two. The question of primary interest was whether the perceived intensity of the odor-tast mixtures would be equal to, greater than , or less than the intensities of the unmixed components. The outcome approximated simple additivity: The intensity of the mixtures was only slightly less than the sum of the perceived intensities of the unmixed components. An examination of how subjects apportioned their judgments into the categories odor and taste revealed the existence of taste-smell confusions. Subjects ascribed little odor magnitude to solutions containing only sodium saccharin, but ascribed considerable taste magnitude to solutions containing only ethyl butyrate. The taste ascribed to ethyl butyrate was not due exclusively to its action on gustation since, when the nostrils were closed, as much as 80% of the "taste" disappeared. Subjects seem to resolve ambiguity regarding the locus of mutual olfactory-taste stimulation in favor of taste.


Profiling of odor components and their mixtures. Observers evaluated five odors and their 26 mixtures (two, three, four, and five components) by magnitude estimation. Estimates revealed that in mixtures there is moderate suppression of perceived intensity; a vector model proposed by Berglund (Annals of the New York Academy of Sciences, 1974, 237, 35-51) provides a good prediction of the intensity of binary mixtures, but overpredicts the intensity of three, four, and five component mixtures. Hedonic tones of mixtures were difficult to predict from hedonic tones of components. Qualities of mixtures were difficult to predict from quality of components. Intermediacy, of quality and hedonic values, was often observed.


The pleasantness of mixtures in taste and olfaction. Human subjects rated the perceived intensity and pleasantness of taste mixtures (sucrose-quinine) and odor mixtures (lemon-heptanal or pyridine-lavender). The components of the mixture were judged as less intense when mixed than when judged alone. A multiple regression indicated that the pleasantness of a mixture can be predicted from a weighted additive function of the pleasantness values of the component sensations. Pleasantness values of the componetns had to be estimated from their pleasantness-intensity functions, because the perceived intensities of the components change when the components are combined. Weighting coefficients for the linear regressions were greater for the unpleasant components, especially in the odor mixtures.


Punctate pressure sensitivity: effects of skin temperature. The dependence on skin temperature of tactile sensitivity to punctiform (hair) stimulation of the finger tip came under study in five subjects. Their data show that punctate sensitivity is relatively stable over a wide range of thermal environments. On the average, some elevation of touch threshold occurred at a skin temperature of 20 degrees C (i.e., about 10 degree below normal), but severe loss of sensitivity first occurred at 10 degrees C. A small but possibly insignificant loss appeared at skin temperatures of 40 and 43 degrees C. The relatively stable behavior of the punctate threshold between about 20 and 40 degrees C contrasts with that of the vibrotactile threshold, which, at least for high frequencies, depends strongly on the skin temperature.


Silicone implant for Freiberg's disease. Freiberg's disease or osteochondrosis of the second metatarsal head may necessitate surgical intervention because of pain. Several surgical procedures have been recommended. A new surgical procedure similar to the present treatment of hallux rigidus with a silicone rubber implant is described. The procedure is simple and results were cosmetically appealing and functionally effective.


Fatal myocarditis associated with acute tonsillitis. A case of myocarditis, hepatic necrosis, and acute anuria associated with acute tonsillitis was described. The previously reported relation between myocarditis and tonsillitis not of diphtheritic or beta-hemolytic streptococcal origin was discussed, as well as the implications for management.


Cavernous hemangioma of the neck simulating thyroglossal cyst. A rare case of cavernous hemangioma simulating a thyroglossal duct cyst was reported. It is recommended that these be treated by total excision, including hyoid bone, to prevent recurrence.


Kaposi's sarcoma after long-term alkylating agent therapy for multiple myeloma. Described is a patient with multiple myeloma who, during long-term treatment with alkylating agents, developed cutaneous Kaposi's sarcoma. Patients with multiple myeloma, unlike those with malignant lymphoma, do not usually develop Kaposi's sarcoma during the natural course of the disease. It is suggested that the immunosuppression resulting from the long-term alkylating agent therapy for multiple myeloma may have prediposed this individual to the development of Kaposi's sarcoma.


Syphilitic meningitis with papilledema.

Syphilitic meningitis with papilledema. Reported is a patient with associated papilledema and syphilitic meningitis. The clinical picture initially suggested an intracranial mass lesion. The cause of the papilledema in this patient was not clear; it did not appear to be related to increased intracranial pressure. Patients with syphilitic meningitis should receive prompt penicillin therapy to avoid serious neurologic sequelae.


Angiographic findings in giant cell arteritis. A 65-year-old woman had intermittent episodes of blindness. Although severe atherosclerotic changes were documented angiographically, definite radiographic evidence of arteritis also was present. A temporal artery biopsy was diagnostic for giant cell arteritis. Despite high-dose corticosteroid treatment, the patient became blind. A Westergren sedimentation rate of greater than 40 mm/hr in a patient over age 50 with headache, constitutional complaints, or visual symptoms is presumptive evidence of giant cell arteritis and demands further investigation. Prompt treatment with prednisone in high doses may prevent visual loss. At times angiography may be helpful in diagnosis of this illness or in selection of a biopsy site.


Ethchlorvynol intoxication.

Ethchlorvynol intoxication. Ethchlorvynol intoxication can be confusing because of the lack of correlation between blood levels of the drug and clinical status. In this case, the patient was in a coma for approximately one week although he had a blood level of ethchlorvynol (0.8 mg/100 ml) generally considered to be subtoxic.


Importance of the external carotid artery in extracranial cerebrovascular occlusive disease. We have encountered 12 patients whose symptoms of transient ischemic attacks were due to total occlusion of the internal carotid artery with patency of the intracranial circulation being maintained by collateral circulation from the external carotid artery. In each case there was either tight stenosis or total occlusion at the origin of the external carotid artery. Eleven of the 12 patients were operated upon, receiving either thromboendarterectomy of the external carotid artery or a saphenous vein bypass to the patent distal portion of this artery. Ten of these 11 had complete or significant relief of symptoms. Although this condition represents only a small percentage of the total number of clinically significant extracranial occlusive lesions, studies suggest that the external carotid artery may be involved more commonly than previously suspected. Adequate radiographic visualization of the cerebral circulation is essential to evaluate the collateral pathways.


Management of facial fractures.

Management of facial fractures. Maxillofacial fractures are usually diagnosed easily by history, clinical findings, and standard roentgenograms. Emergency treatment centers around airway management; the conscious patient should be allowed to clear his own airway whenever possible. Treatment of lower and upper jaw fractures focuses on reducing the fragments so that dental occlusion is normal. Other midface fracture reductions require additional exact orbital rim alignment. Immobilization of fractures can require various combinations of intermaxillary fixation, interosseous wiring, suspensory wires from intraoral arch bars, transfacial Kirschner wires, occasional maxillary antral packs, and rare external fixation with headframes or external pins. Patients who may be comatose or seriously ill for several weeks should have a simple and safe compromise reduction and K-wire fixation done at the bedside. Management of blow-out fractures of the orbit and frontal sinus fractures is somewhat controversial. Naso-orbital central factial fractures are especially difficult to maintain in proper reduction. Listed are possible late postoperative complications after treatment of facial fractures.


Condylar fractures of the distal humerus in adults. Condylar fractures of the distal humerus are serious and in many instances pose a difficult treatment problem for the orthopedist. From 1969 to 1974, 24 condylar fractures of the distal humerus were treated at the University of Alabama Hospitals. Twenty of the fractures were closed and four were open. Eighteen fractures were treated open and fixed with a variety of K-wires and screws, and six fractures were treated closed. One postoperative wound infection occurred. Based on the 18 cases in which follow-up was sufficient to assess end result, we concluded that in comminuted fractures of the distal end of the humerus in adults, it may be technically very difficult to restore anatomic continuity. When secure fixation cannot be obtained or when the injury is of such a nature that internal fixation is contraindicated, such as a gunshot wound, traction may provide a functional range of motion. In fractures where good continuity and firm fixation can be obtained, open reduction and internal fixation give a superior functional range of motion.


Geriatric mental function and serum folate: a review and survey. A review of the growing body of information regarding folic acid biochemistry indicates a relationship between folate metabolism and mental disturbance. Clinical correlations between altered mental functions associated with aging and lowered serum folate values are found to suggest that further studies are warranted. The fasting serum folate levels of two groups of subjects 65 years of age and older are compared after excluding the influence of drugs, alcohol, and gastrointestinal disease. The results show that those elderly persons with good dietary habits and mental acuity had no lowered serum folate levels. Thus, the suggestion that serum folate level normally falls with age is not confirmed. Additionally, it was found that 35% of similarly aged subjects with combined mental dysfunction and poor dietary habits had lowered serum folate values.


Fine needle aspiration cytology.

Fine needle aspiration cytology. Aspirations were done in 221 breasts and 32 extramammary sites with a 25 gauge needle attached to an ordinary 10 ml syringe. The aspirated material was expressed from the needle hub onto a slide, smeared by means of a second slide, air dried, and stained with a Wright-Giemsa solution. The cytologic interpretation closely correlated with the subsequent histological diagnoses. No false-positive readings were encountered. A falsely negative diagnosis was made in 11 breasts, mostly due to faulty aspiration. Widespread use of the fine needle aspiration cytology should drastically reduce the need for breast biopsies. This technic also may be used in the diagnosis of extramammary lesions.


Endoscopic electrosurgical polypectomies of the upper gastrointestinal tract. The electrosurgical removal of polypoid lesions from the upper gastrointestinal tract with the esophagogastro-duodenoscope has proven to be a safe, effective, and relatively inexpensive procedure. Twenty-six polypectomies performed on 24 different patients are presented. Polyps were removed from the distal esophagus, stomach, duodenum, and jejunum. There were no significant complications.


Recurrent subareolar abscess of the breast and squamous metaplasia of the lactiferous ducts: a clinical syndrome. When squamous metaplasia of the lactiferous ducts occurs, the normal cuboidal epithelium lining the lactiferous ducts is replaced by squamous epithelium, leading to intraluminal accumulation of epithelial debris. Recurrent subareolar abscess is a common co-feature of the disease. The chronicity of suppuration is related to a general unfamiliarity with this entity and its underlying pathogenesis and failure to recognize the inadequacy of simple incision and drainage. Recent experience with six patients with recurrent subareolar abscess suggests that cure requires excision of the disease duct(s) and abscess cavity in continuity with the nipple inversion, which also is seen with this problem. The clinical triad of recurrent subareolar abscess, intermittent periareolar drainage, and (possibly) nipple inversion should alert the practitioner to this entity. Appropriate initial operative management will minimize recurrence.


Fatal poisoning with propoxyphene: report from 100 consecutive cases. The first 100 deaths caused by propoxyphene and recorded by the Chief Medical Examiner of North Carolina were studied. Victims ranged evenly in age from the second to the seventh decade. Over 65% were suicides with a female to male ratio of 2:1. Blood propoxyphene concentrations of 0.2 mg/dl were fatal, representing rapid ingestion of approximately ten capsules. In North Carolina, deaths due to propoxyphene have increased from five in 1969 to 49 in 1975. Raising physician-awareness of propoxyphene's toxicity and placing the drug in Schedule II are two of the author's recommendations for reducing the number of propoxyphene deaths.


Reconstruction of the deep femoral artery. This article describes various surgical technics commonly used for reconstructing the deep femoral artery. The applicability, advantages, and disadvantages of various methods also are discussed.


Bacterial flora of patients with prematurely ruptured membranes. Twenty consecutive patients with premature rupture of the membranes were studied to determine the vaginal, endocervical, and neonatal bacteriologic flora. Patients who had membranes ruptured for more than 12 hours had more anaerobic species isolated from vaginal plus endocervical or endocervical cultures alone than did those patients with membranes ruptured for less than 12 hours. Overall, aerobic organisms were more frequently isolated than anaerobic organisms, but the majority of cultures were of a mixed flora. Streptococci, corynebacteria, and Bacteroides organisms were the most frequently isolated organisms from all sites cultured. Lactobacilli were isolated in only 45% of endocervical and vaginal cultures, and Enterobacteriaceae were infrequently encountered. This study indicates that there is a change toward a preponderance of anaerobic species in the birth canal when membranes are ruptured for more than 12 hours, and that this change is detectable before delivery.


Urinary estrogens during late pregnancy: observations on the validity of "24-hour" urine collections and the estrogen/creatinine ratio. The determination of estriol content of the maternal urine in late pregnancy has gained widespread use as a means of assessing the fetoplacental unit. Major drawbacks have included the time lag in obtaining a 24-hour urine collection and obtaining an accurate 24-hour collection. To overcome these problems, it has been suggested that the estrogen/creatinine (E/C) ratio of incomplete collections or even random urine specimens might provide adequate information. Our analysis of these E/C ratio technics, as compared to accurate 24-hour urine estrogen values and fetal outcome, shows the E/C ratio to be less reliable and occasionally misleading.


Radioimmunoassay of serum bile acid levels in biopsy-proved cirrhosis. Serum bile acid levels were determined by a radioimmunoassay for conjugates of cholic acid in 18 patients with biopsy-proved cirrhosis and compared to results of conventional liver function tests. Serum bile acid levels were abnormal in all 18 patients whereas results of the other tests were abnormal in only 50% to 72% of patients. In this group of patients with a well established diagnosis of cirrhosis, serum bile acid levels were a more sensitive indicator of liver dysfunction than standard liver function tests.


Psychiatric consultations for 112 pediatric inpatients. The investigator, a child psychiatry consultant for a pediatric service, studied 112 consecutive consultations, categorizing the presenting psychiatric problems, mental status, psychiatric diagnoses, final physical diagnoses, and psychiatric recommendations. The 112 patients represented 3.4% of all pediatric patients in the same age range admitted to the hospital. Girls comprised 59% of the sample studied. The most common presenting problems were unexplained physical symptoms, while the most frequent physical diagnoses were seizure disorder and diabetes. Psychiatric diagnoses were made for 82% of the patients seen; the most common diagnosis was "reactive" disorder. Specific recommendations for either inpatient or outpatient psychiatric care were made for 42 patients, of whom 23 were known to have followed through with the recommendations. However, most recommendations involved technics that could be applied by the primary care physician, eg, advice to parents, counseling the child, liaison with schools, direction of hospital staff.


Congenital atresia of the colon.

Congenital atresia of the colon. Atresia of the colon is a rare congenital anomaly. In 1673, Binninger reported the first case of colonic atresia and Gaub reported the first survival of a patient with this anomaly in 1922. Since that time there have been 97 successfully managed patients described in the literature.


Hyposplenism and disseminated intravascular coagulation (DIC) in fulminant pneumococcal sepsis. A case of pneumococcal sepsis with DIC is reported. The patient had hyposplenism from thorium dioxide administration 23 years previously. Evidences of consumptive coagulopathy were verified by clinical manifestations of shock, generalized petechiae, abnormal hemostatic studies, and autopsy findings. The possible pathogenetic mechanism(s) of DIC in hyposplenism and pneumococcemia are reviewed.


The association between thalassaemic diseases and traits and post-streptococcal acute glomerulonephritis. This prospective study showed that thalassaemic patients, though susceptible to streptococcal infection, as evident from their elevated A.S.O. titres, are not, as has been suggested, more likely to develop acute glomerulonephritis than the rest of the population. The incidence of thalassaemic trait found among typical cases of acute glomerulonephritis does not exceed that of the general Thai population. There were 5 out of 56 cases of thalassaemic patients having transient microscopic haematuria.


Study of intestinal immunity against V. cholerae: role of antibody to V. cholerae haemagglutinin in intestinal immunity. Cell-bound haemagglutinin as an adhesive factor of Vibrio cholerae has been partially purified from E1 Tor vibrios using 0.05 M cyclohexylaminopropane sulfonic acid buffer pH 9.5 and gel filtration column chromatography. Rabbits were immunized with the precipitin complexes of the haemagglutinin and its antibody. The antiserum is tested for the protective ability against the oral challenge with Vibrio cholerae strain of which the haemagglutinin has been prepared. The results indicate definite protection of the haemagglutinin antiserum.


Studies on the migratory route of Paragonimus siamensis in the bandicoot (Bandicota indica). The migration route and the development of P. siamensis obtained from S. juliae and S. germaini were studied in B. indica. The infection rates of P. siamensis in these 2 species of crabs were 19.7% and 21.4% respectively. Worms were recovered in the abdominal cavity, pleural cavity and lungs on day 12, 16 and 30 respectively after oral infection. Worms became mature and laid eggs on day 47 after infection, but their size still increased considerably. The average egg output was found to be 144 eggs/gm faeces/worm or 443 eggs/day/worm. The average recovery rate of P. siamensis in the experimental B. indica was 15%.


An autocidal ovitrap for the control and possible eradication of Aedes aegypti. A revolutionary, autocidal ovitrap has been developed as a promising weapon for the control and possible eradication of Ae, aegypti, the principal vector of dengue haemorrhagic fever (DHF), in urban high DHF endemic areas. A study carried out with this trap in a highly endemic area for DHF in Singapore city, namely the Rochor area, has shown this trap to be superior to all other domestic habitats in attractiveness to ovipositing Ae. aegypti females.


Studies on the life history of Megaselia scalaris (Loew) in Thailand. The morphological, life-cycle, and experimental studies of Megaselia scalaris were reported. This fly is commonly found both in urban and rural areas in Thailand. It is easily identified and the humped thorax was the most distinct characteristic of the adult. The egg to the adult stage and the life span required 15 to 20 days for the male and 16 to 22 days for the female. Experimental attempts to induce myiasis infection in laboratory animals were unsuccessful.


Histamine content in 24-hour urine in patients with dengue haemorrhagic fever. Twenty-four hour urinary histamine in 12 patients with DHF compared to 12 normal subjects in the comparable age and sex were studied. The results revealed significantly increased urinary excretion in patients with DHF than in normal subjects in both free and total forms. This finding suggests that histamine may be one, if not all, of the mediators released during the course of the disease, especially in the severe cases. Histamine may play an important role for the leakage of intravascular fluid to the various serous spaces resulting in hypovolemia and shock.


The urinary sulfur/creatinine ratio in the assessment of protein nutritional status. The urinary sulfur/creatinine ratio and urea nitrogen/creatinine ratio of Thai soldiers and schoolchildren from Nakhon Nayok, 100 km northeast of Bangkok, the Lam-takong resettlement area and the Kohn Kaen resettlement and irrigation area northeast of Thailand were determined. As reference group healthy children from the University school in Khon Kaen were selected. The urinary urea N/creatinine ratio was significantly lower for the children from Nakhon Nayok, the Lam-takong resettlement and the Khon Kaen resettlement and irrigation area when compared with the reference group. The ratio values of the soldiers was significantly lower than the ratio of every group of children. The urinary sulfur/creatinine ratio for the children in Nakhon Nayok was lower and for the children in the Lam-takong and Khon Kaen resettlements were significantly lower than the ratio of the reference group. For the reference group the normal range for urea N/creatinine ratio was between 4.8 and 14.5 and for sulfur/creatinine ratio between 0.40 and 1.40.


The effect of topical retinoic acid (Airol) in the treatment of tinea versicolor. A clinical trial with retinoic acid (Airol) cream 0.05% applied topically was carried out on 50 patients suffering from tinea versicolor allocated to a random procedure. The results, judged in terms of cure rate, incidence of relapse and tolerance were very satisfactory. As regards the above mentioned criteria for a successful treatment, there was no significant difference between the lotion and cream groups. Repigmentation of the affected skin after retinoic acid occurred in a relatively shorter period compared with other anti-fungal preparations, especially when simultaneously exposed to sunlight. The therapeutic action on dermatophytes was discussed. It was pointed out that patients suffering from tinea versicolor are predisposed to dermatophyte infections and that cleanliness of the skin is a simple but essential way of preventing contamination with Malassezia furfur.


Cirrhosis of the liver in Rhodesian Blacks. Thirty-five Black patients with cirrhosis of the liver were admitted to the professorial unit over a 1-year period and were included in a carefully planned prospective study. Men predominated over women in a ratio of 3:1. Alcohol consumption in the form of African beer was significantly higher in cirrhotic patients than in a control population. The clinical picture was neither predominantly that of alcoholic nor of cryptogenic cirrhosis. Hepatomegaly, porphyria cutanea tarda, ascites, splenomegaly and oesophageal varices were common. There was a complete absence of gynaecomastia, spider naevi and liver palms. Histologically, the majority of patients had macronodular cirrhosis, and only 1 patient had micronodular cirrhosis and minimal fatty change. Hepatitis B surface antigen (HbsAg) was not detected in any patient, despite a positive HbAg rate of 4% in Black African blood donors, determined by means of the same laboratory technique.


The reconstruction of unequal or absent breasts. The different varieties and combinations of unequal breasts, as well as frequently associated defects such as pectus excavatum and absent or maldeveloped pectoral muscles, are discussed. The possible aetiological factors are considered, and the important role that a good history, clinical examination and detailed investigation play, is stressed. The reconstructive treatment of each variety is discussed in some depth. The management and treatment of absent breasts after mastectomy are also considered.


Hiatal hernia--manometric and symptomatic assessment of failed surgical management in 60 patients. The recurrent symptoms in 60 patients who had undergone surgical management of hiatal hernia with reflux were analysed with the help of manometry. Despite reduction of the hernia in 43 patients, the primary and important defect of sphincter incompetence was the commonest residual abnormality. Oesophageal spasm associated with reflux or occurring as a primary condition was another cause of recurrent symptoms. The addition of vagotomy and pyloroplasty to the hiatal hernia repair procedure in several patients did not prevent reflux. The use of valvuloplasty techniques such as the Hill posterior gastropexy, the Belsey Mark IV operation or the Nissen fundoplication should be encouraged when the primary defect is incompetence of the lower oesophageal sphincter.


Postpartum ruptured abdominal aortic aneurysm: a case report. The successful management of a postpartum ruptured abdominal aortic aneurysm is described. The rarity of the condition in the Black South African parturient is emphasized. Recent advances in surgery have improved the prognosis of this condition and early recognition and surgery are essential components of a successful result.


A review of 450 stabwounds of the spinal cord. Patients with spinal cord stabwounds accounted for over one-quarter of the more than 1 600 patients with spinal cord injury admitted to this unit during 13 years. Over half the lesions were of the Brown-Séquard type. Functional recovery was good in nearly two-thirds of patients. The principles of treatment are discussed.


Familial vesico-ureteral reflux.

Familial vesico-ureteral reflux. Four families of which 2 or more members were affected with primary vesico-ureteral reflux are reported. A multifactorial inheritance pattern subject to environmental factors is likely. Early examination and detection of the disorder in relatives at risk provide an opportunity to avoid the serious sequelae of vesico-ureteral reflux.


Rheumatic disorders in the South African Negro. Part IV. Gout and hyperuricaemia. The prevalence of gout and the frequency distribution of serum uric acid (SUA) concentrations have been studied in four South African populations. Approximately 450 respondents over the age of 15 years were investigated in each of the following: a tribal Xhosa community in Transkei; a rural Tswana community in the northwestern Transvaal; an urban Negro population in Johannesburg; and a Caucasian community in the same city. No case of gout was encountered in any of the Negro groups, while the prevalence among the urban Caucasians was 13/1 000 men and 3/1 000 women. The mean SUA concentrations showed two consistent trends: (i) the levels rose with age in all four populations and in both sexes; (ii) they were generally higher in men than in women throughout the age range. There was, moreover, an increase in SUA concentrations with increasing sophistication of lifestyle (P less than 0,01), the lowest levels occurring in the tribal Africans, and the highest in the urban communities. This latter finding could not be explained on a genetic basis, nor were there significant differences in physical configuration and nutritional status among the three Negro groups. It is suggested that hyperuricaemia, and possibly the clinical manifestations of gout, have a polygenic aetiology in which acculturation plays an important contributory role.


The monitoring of heparin activity during extracorporeal circulation. Heparin activity was assessed in 11 patients who underwent extracorporeal circulation for open-heart surgery. The activated partial thromboplastin time (A-PTT), thrombin time, protamine sulphate titration and factor Xa inhibition assay were used. The patients received heparin 3 mg/kg body weight, and 20 mg/450 ml blood was added to the pump. When the operative procedure was extended beyond 100 minutes patients received an additional 1,5 mg heparin/kg body weight. Protamine sulphate in a dose of 1,5 mg/1 mg heparin, was given to neutralize the heparin activity. The A-PTT was the easiest test which gave reliable results. The factor Xa inhibition assay measured heparin levels most precisely and mirrored the A-PTT results in all but one instance. These results indicate that the protocol employed produced adequate anticoagulation for the bypass procedure in all the patients. Protamine sulphate failed to neutralize heparin adequately after bypass in the 3 patients who received additional heparin during the surgical procedure. The monitoring of heparin activity during and after extracorporeal circulation is a desirable addition to open-heart surgical treatment.


Isovaleric acidaemia in two South African children. Two siblings who were repeatedly admitted to hospital with acute episodes of vomiting, dehydration and coma were found to be suffering from isovaleric acidaemia. This condition is a rare inherited abnormality of leucine metabolism, which is frequently fatal in the early weeks of life and leads to mental retardation in a high proportion of those who survive early attacts. However, both our patients were of normal intelligence. The clinical presentation, biochemical defect, diagnosis and suggested therapies are reviewed.


Benign gastric ulcer as a cause of gastrocolic fistula. A report of 3 cases. Three cases of gastrocolic fistula due to benign gastric ulcer seen during a 5-year period are presented. Although colonic or gastric malignancy is said to be the commonest cause of gastrocolic fistula, in the same period only 1 case due to colonic carcinoma was seen. The important role played by radiology in the diagnosis of gastrocolic fistula is emphasized and the clinical presentation is discussed, together with the possible role of analgesics in the aetiology.


Tuberculous mastitis. A review of 34 cases. During a review of 67 cases of mastitis, 34 were diagnosed as cases of tuberculous mastitis. The majority of the patients with tuberculous mastitis were Black women. The mean age of the patients was 34 years. One patient was lactating and several were of postmenopausal age. All presented with unilateral breast masses, thought to be inflammatory in 10 and neoplastic in 10. In none was tuberculosis suspected clinically. The diagnosis of tuberculosis was based on the histopathological demonstration of tubercles, caseation and a granulomatous inflammation, with acid-fast bacilli in 5 instances. The differential diagnoses included duct ectasia, a foreign-body giant-cell reaction with fat necrosis, foreign material or an abscess, granulomatous mastitis, fungal mastitis, sarcoidosis and a syphilitic gumma.