Wheelchair user's shoulder? Shoulder pain in patients with spinal cord lesions. A questionnaire was circulated to the 708 members of the Spinal Cord Injuries Association in 1976. The response rate was 79.5%. Over one half (51.4%) of the respondents suffered from shoulder pain, an incidence in excess of any age group in a control population derived from a general practitioner's register. The pain, which was related particularly to wheelchair usage and other attendant factors such as transfers, was in some instances clearly in the shoulder, whereas in others it was more likely to be cervical root pain. The implication of these findings are discussed.


Increase of muscle strength from isometric quadriceps exercises at different knee angles. Isometric quadriceps exercises were performed at two different knee angles, 15 and 60 degrees respectively. The maximal torque was measured in both positions before and after training in 10 healthy females. Both legs were exercised, one at each position. The purpose was to develop practical recommendations for choice of training position. The strength increase was mainly specific according to the angle at which the knee was exercised. It was suggested that isometric exercise would preferably be performed at different knee angles to secure an optimal total strength increase. Isometric exercises improved dynamic strength at a low velocity but not at a high velocity.


Achilles tendon injury. 5. A model of isokinetic strength training using biofeedback. Plantar flexion strength was isokinetically trained under visual biofeedback control in subjects with long standing unilateral soleus muscle myopathy and plantar flexion weakness after Achilles tendon rupture. The rupture had been surgically treated at least one year before training commenced. In the subjects both static and dynamic plantar flexion strengths were normalized as compared to the uninjured leg pre-training. This was accomplished by a) normalization of muscle fibre cross-sectional profile and area within the myopathic muscles, and b) faster achievement of the peak torque during the angular motion. The successful results imply that this training model can be applied when hypotrophy and possibly calf weakness prevail in the aftermath of Achilles tendon rupture.


An appraisal of relative airborne sub-urban concentrations of polycyclic aromatic hydrocarbons monitored indoors and outdoors. Particle-size distribution studies of polycyclic aromatic hydrocarbons in city and sub-urban atmospheres indicate that these compounds are associated with particles having MMD values of about 0.5 micrometer. Ambient airborne concentrations of pyrene, chrysene, benzo[a]pyrene, benzo[e]pyrene and coronene at suburban sites between 11 and 17 km from a city centre are shown to be approximately similar inside and outside detached residential houses. At all sites, monitored chrysene appears in highest concentration in the range 4-7 ng m-3, followed by benzo[a]pyrene and benzo[e]pyrene between 2-4 ng m-3, with coronene generally less than 1 ng m-3. By taking benzo[a]pyrene as a typical example of this class of compounds, these results indicate that the lungs of sub-urban populations will be exposed to about 34 ng of benzo[a]pyrene per day. This background amount is roughly equivalent to the exposure to this chemical experienced by the lung when one cigarette is smoked per day.


Total mercury levels in whole blood, hair and fingernails for a population group from Rome and its surroundings. Whole blood, hair and fingernails of 80 representative subjects from the Province of Rome were analysed for total mercury. The mean value for whole blood was 0.020 mg/kg, for hair 0.51 mg/kg and for nails 1.08 mg/kg. Correlations were found (except for hair) between mercury levels and the number of fish meals, mercury amalgam dental fillings and residence (urban or rural) of the subjects examined. The levels found in hair appear to be influenced by external and individual pollution factors and thus unsuitable for any direct determination of the distribution in other organs of the human body.


Cadmium and lead pollution from secondary metal refinery operations. A study was made of cadmium and lead levels around a small secondary metal recovery factory as part of an environmental monitoring programme in a London borough. Lead levels were essentially typical for an urban environment whereas the levels of cadmium-in-air and in household dust gave rise to very considerable concern. Some of the problems associated with assessing the potential hazard and the steps taken to control the emission are considered. It is suggested that clearly-defined standards and procedures are necessary in order to deal efficiently with similar cases as they are discovered.


Toxic metals in street and household dusts. Street and household dusts have been sampled within the Lancaster area (U.K.), and analysed for Pb, Cd, Cr, Co, Cu, Ni and Zn. The concentration of each metal has been determined both as total and extractable metal, the latter referring to metal soluble in a 0.07N hydrochloric acid solution. The results are discussed in relation to the sources of the metals, and possible health hazards to children exposed to the dusts.


Endemic goitre, the factors controlling iodine deficiency in soils. Iodine concentrations in soils derived from a selection of very different parent rocks but within a small well-defined area of uniform environmental conditions have been studied. The results indicate that iodine in soils is independent of parent rock type, and that the maturing of young soils such as those found in areas of endemic goitre is the most important influence on iodine deficiency. The iodine is retained and enriched during vegetative recycling processes.


Risk with energy from conventional and nonconventional sources. Risk to human health was compared for five conventional and six nonconventional energy systems. The entire cycle for producing energy was considered, not just part. The most important conclusion drawn is that the risk to human health from nonconventional sources can be as high as, or even higher than, that of conventional sources. This result is produced only when the risk per unit energy is considered, rather than the risk per solar panel or windmill. The risk from nonconventional energy sources derives from the large amount of material and labor needed, along with their backup and storage requirements. Risk evaluation is a relatively new discipline, and therefore the results presented here can be considered only a beginning. However, society should keep relative risk in mind when evaluating present and future energy sources.


Timers in developing systems.

Timers in developing systems. Conditional methods are proposed for investigating the number and relationships of processes that are rate-limiting for the genesis of consecutive stages in a developmental sequence. These methods depend on the differential sensitivity of "timer" pathways to small changes in temperature and can be applied to any developmental sequence in which discrete stages can be reproducibly monitored with time. We have applied the methods to multicellular morphogenesis in the slime mold Dictyostelium discoideum and have obtained an unexpected tentative scheme for timer relationships. A minimum of six timers has been delineated, each specific for at least one morphological stage. The majority of these timers appear to be in parallel.


Classification of renal injuries as a guide to therapy. Renal injuries require immediate or early surgical intervention for threatened exsanguination, damage to the pedicle vessels and disruption of the renal pelvis. Elective delayed operation prevents late complications in those patients in whom there is transparenchymal connection between the pelvocaliceal system and the perirenal space following trauma. There appears to be an increased incidence of nephrectomy if the latter are explored early. Expectant treatment is appropriate for renal lacerations without extravasation, if there is no threat of exsanguination and if the pedicle is intact.


Obstructive, pseudo-obstructive and enteropathic syndromes after jejunoileal bypass. We have encountered two patients with volvulus of the small intestine at the ileocolic anastomosis, occurring after jejunoileal bypass. This uncommon complication is generally seen many months after bypass and may be difficult to diagnose. Barium enema examination was helpful in one patient. If there are acute, severe abdominal symptoms, mechanical obstruction and early operation should be considered. Attention has been called to other intestinal syndromes with obstructive features developing after jejunoileal bypass, and these have been compared.


Endoscopic retrograde cholangiopancreatography in carcinoma of the pancreas. The value of gastroduodenal endoscopy and retrograde cholangiopancreatography has been assessed in 55 patients subsequently confirmed to have pancreatic carcinoma. The technique provided a precise and accurate diagnosis in 45 patients. In nine of these patients, the diagnosis was obtained by duodenoscopy and biopsy alone. Cannulation of the duct was attempted in 47 of the 55 patients; roentgenograms of the pancreatic or biliary tree, or both, were obtained in 40 studies, 36 of which were diagnostic. Tumors were most common in the head of the pancreas, and virtually all roentgenograms showed duct obstruction or a major stricture with upstream dilatation. One pancreatogram of poor quality was reported as normal. Endoscopic cholangiograms were often diagnostic when pancreatography failed in patients with tumors of the head of the pancreas. Endoscopic retrograde cholangiopancreatography is a precise technique for the diagnosis of patients with tumors of the papilla of Vater which may present relatively early and prove resectable. Patients with tumors of the pancreas itself usually present with advanced disease, and in this series, endoscopic retrograde cholangiopancreatography provided no clear benefit in terms of operability or patient survival. However, the efficient documentation of inoperable tumors is important, and endoscopic retrograde cholangiopancreatography sets a standard against which other techniques can be evaluated.


Value of endoscopic retrograde pancreatography in pancreatic ascites. Endoscopic retrograde pancreatography was easily performed preoperatively in six patients with pancreatic ascites, and no complications resulted from this procedure. The abnormalities observed during the procedure were unpredictable and varied. Endoscopic pancreatograms provided delineation of the pancreatic ductal system, showing one or more sites of ductal leaks into pseudocysts or segmental narrowing of the main pancreatic duct. This preoperative information was invaluable in selecting appropriate surgical procedures.


Deaths among female patients with carcinoma of the breast treated by a surgical procedure only. The postoperative mortality from carcinoma of the breast is low, and it appears to be getting lower. Mortality is highest for the women in the older age group and for those with the most advanced stage of disease. Surgeons who generally consider these factors in deciding whether or not to perform an operation may wish to review their own experience in light of these data. In general, while surgical mortality for carcinoma of the breast is not zero, it certainly is low. The historical data collected in the Surveillance, Epidemiology and End Results Program do not contain details on the extent of the operations actually performed, and this should influence the mortality. With proper safeguards for protecting the confidentiality of the medical records, it may be possible for qualified persons interested in surgical research to review a sample of the detailed records that contributed to the series reported herein to determine the exact extent of the operation and the curative or palliative purpose, and to help elucidate the actual causes and patterns of early deaths.


A prospective evaluation of oculoplethysmography and carotid phonoangiography. With oculoplethysmography, conclusions are drawn regarding the state of internal carotid artery disease by measurements based upon pressure and flow in the eye, a location far removed from the site of the disease. Thus, many potential variables including ocular disease, vessel wall properties, intracranial atherosclerosis and collateral flow may affect the results. Although oculoplethysmography was quite accurate in detecting occlusion of the internal carotid artery, the identification of a high grade stenosis was much less precise. Furthermore, it could not distinguish between stenosis and occlusion, making angiography necessary for accurate diagnosis. In this study, oculoplethysmography, either alone or in combination with carotid phonoangiography, was not of sufficient accuracy to recommend its use as part of a noninvasive evaluation of carotid artery occlusive disease.


Evaluation of atropine in acute pancreatitis. A prospective randomized clinical trial was carried out to evaluate the efficacy of atropine in the treatment of acute pancreatitis. Fifty-one patients with elevated amylase levels, and with the clinical signs and symptoms of acute pancreatitis, were included in the study. All were treated with fluids intravenously and analgesics, and a nasogastric tube if needed. In addition, on a random basis, 19 were given atropine intramuscularly and 32 were not. The clinical courses of the two groups of patients did not differ significantly.


Drifting hematomas.

Drifting hematomas. When blood is released into the tissues of the lower extremities, it may drift downward under the influence of the force of gravity to produce the influence of the force of gravity to produce pain, edema, redness and heat. A crescent shaped ecchymosis may appear around the malleoli. The relationship between cause and effect may be obscured by a time interval of up to four weeks before conclusive signs are seen. Early differentiation of this condition from that of phlebitis and deep venous thrombosis is necessary. Such differentiation prevents inappropriate and potentially dangerous anticoagulation as well as the disastrous consequences of untreated edema of the legs. With prompt, appropriate treatment, complete recovery can be expected. If treatment is delayed, permanent damage to the leg can result.


Clinical applications of nonoperative T-tube replacement. T tubes were successfully reintroduced through previously created drainage tracts in 17 consecutive attempts. The new tubes can re-establish bile flow in a variety of circumstances in avoiding reoperation.


Multiple transverse taeniamyotomy for diverticular disease. The indications for transverse taeniamyotomy, and the results obtained on a group of 11 patients, were analyzed. Intraluminal pressure recordings carried out before and one year after operation showed a significant decrease of the mean motility index after both natural and pharmacologic stimuli. The use of such a procedure, even in an early stage of the disease, should be considered.


Irrigation of subcutaneous tissue with povidone-iodine solution for prevention of surgical wound infections. Five hundred patients undergoing a variety of general surgical operative procedures were prospectively randomly allocated into a treatment group, in which the incisions were irrigated with povidone-iodine solution prior to skin closure or into a control group in which wounds were irrigated with saline solution. Wounds were classified according to the degree of bacterial contamination as clean, potentially contaminated, contaminated or dirty. For all categories of surgical incisions, povidone-iodine irrigation resulted in a significant decrease in wound infections over that for saline solution irrigation. Over-all incidence of wound sepsis in the treatment group was seven of 242 patients, 2.9 per cent, compared with the control rate of 39 wound infections of 258 patients, 15.1 per cent--p less than 0.001.


Assessment of the healing potentials of ulcers of the skin by photoplethysmography. An objective method of assessing the healing potentials of skin ulcers would eliminate the long waiting period necessary for visual evidence of healing or nonhealing to appear. This would permit the continued conservative treatment for healing ulcers and prompt surgical interventions for those ulcers which are nonhealing. In this preliminary study, the cutaneous blood flow immediately around the ulcer site was studied using the photoplethysmograph. Vigorous cutaneous blood flow shown by good pulsatile wave forms on the photoplethysmograph is shown to be indicative of an ongoing healing process in which spontaneous healing of the ulcer can be predicted. Ulcers with nonpulsatile wave forms fail to heal with conservative management. One patient with nonpulsatile wave forms at the ulcer site showed improvement and eventual healing of the ulcer after undergoing a lumbar sympathectomy. Thus, nonpulsatile blood flow shown by poor wave forms on the photoplethysmograph would suggest early surgical intervention. This method may also aid in determining the extent of surgical excision of the ischemic scar tissue surrounding the chronic skin ulcer.


The significance of urine phosphate measurements in the early diagnosis of intestinal infarction. This study has confirmed previous experiments which indicated that inorganic phosphate concentrations rise in body fluids after intestinal infarction. The phosphate clearance ratio is elevated in dogs after occlusion of the superior mesenteric artery, but is not as sensitive as indicator of the presence of a necrotic intestine as the serum or peritoneal fluid phosphate levels. The rise and fall of phosphate levels occur within the first 24 hours after infarction, similar to amylase levels in acute pancreatitis. The renal failure observed in dogs after ligation of the superior mesenteric vein is likely on the basis of hypovolemia and does not seem to result from hyperphosphatemia. Intestinal infarction should be suspected with laboratory evidence of hemo-concentration, marked leukocytosis, an inappropriate metabolic acidosis and elevated serum and peritoneal fluid phosphate levels. In dogs with normal renal function, an elevated urinary phosphate clearance ratio of greater than 0.20, as measured on a spot sample of urine and serum, is also highly suggestive of the presence of this condition, but its absence, by no means, excludes the diagnosis. With these simple laboratory tests, possibly an earlier diagnosis can be made, and timely operation can be an entirely intestine-saving procedure.


Monitoring of the patient in a state of shock. Patients in a state of shock require careful monitoring to carry out intelligently appropriate treatment. Many methods of monitoring are available. Some are required for all patients in a state of shock, some are only required in severe or refractory shock, some are of little value, some are valuable but difficult or expensive and some are confusing and may mean the opposite of what they seem to indicate.


Ultrasonography in the diagnosis of tumors of the ovary. Ultrasonography was performed prior to operation upon 60 patients with tumors of the ovary. This procedure was accurate in differentiating tumors of the ovary from other types of tumors of the pelvis in more than 90 per cent of the patients. Likewise, a determination between benign and malignant lesions of the ovary could be reliably made on the basis of ultrasonic patterns. These findings suggest that ultrasonography should be performed on all patients suspected of having a tumor of the ovary.


Limb salvage and selectivity.

Limb salvage and selectivity. In a group of properly prepared poor risk patients with advanced atherosclerosis of both the aortoiliac and femoropopliteal segments, a combined procedure, extra-anatomic bypass with an extended profundoplasty, was used for successful salvage of their ischemic--mean calf pressure=27 millimeters of mercury--limbs. Prediction of success versus failure could be determined on neither clinical nor angiographic-anatomic grounds but was possible using two simple measurements: a large aortoiliac differential pressure--deltaP--between inflow pressure obtained from a standard arm cuff and outflow pressure measured directly from the femoral artery, 89.3 millimeters of mercury versus 33.2 millimeters of mercury, p less than 0.001, and a potentially adequate outflow bed as determined by the percentage drop in outflow [(deltaPo/Po) per cent] upon papaverine injection, 36.3 versus 11.3 per cent, p less than 0.001. These values became an important part of the selection scheme developed in the approach to 24 ischemic limbs.


Ureteral obstruction secondary to metastatic tumors. Carcinoma metastatic to the ureter is uncommon, only 160 patients having been reported upon to date. During a ten year period, 82 patients with ureteral obstruction, secondary to metastatic disease, were seen at the UCLA Hospital. A critical analysis of the records of these patients revealed important clinical and diagnostic criteria to aid in the evaluation and treatment of extrinsic ureteral obstruction. Tumors of the cervix, prostate, breast and colon-rectum were the most common primary lesions to metastasize to the ureter. Subtle changes in urinary symptoms or in laboratory values should alert the physician to the possibility of ureteral involvement. Early detection of metastatic ureteral obstruction prior to the ravages of uremia may allow time for more aggressive use of adjuvant therapeutic modalities that would, at a later stage of the disease, be ineffectual or contraindicated.


Poor prognosis of patients with intra-abdominal sepsis and hypouricemia. With uric acid levels of 0.4 to 3.0 milligrams per cent, hypouricemia was noted in 17 patients with intra-abdominal sepsis. This was associated with a fivefold to sixteenfold increase in the urate clearance and uric acid to creatinine clearance ratios. The number of deaths in the 17 patients with hypouricemia is 14 versus 20 for the overall group of 111 patients studied. Two patients had a reversal of the serum uric acid, 24 hour urine uric acid output and uric acid to creatinine clearance ratio, with drainage of the intra-abdominal sepsis. Hypouricemia seems to indicate a poor prognosis in patients with intra-abdominal sepsis.


Prediction of total body water from the early arterial disappearance curve of isotopic water. With the use of tritiated water, total body water was measured by isotope dilution in 17 normal dogs. Analysis of the plasma arterial disappearance curve up to 20 minutes by a computer program using a weighted least-squares technique makes it possible to predict the final volume of dilution, with acceptable precision from the early curve.


Glucose tolerance in the obese surgical patient. Intraoperative glucose metabolism was studied in seven grossly obese patients during an intestinal bypass surgical procedure. Preoperative fasting plasma glucose levels were in the low normal range. Results of intravenous glucose tolerance studies during the preoperative period suggested that three patients demonstrated a diabetic utilization of glucose. Fasting awake plasma glucose levels were increased after premedication for anesthesia and surgical treatment. Following induction of anesthesia, laryngoscopy and intubation, there was a further increase in glucose concentrations. In five patients, a 25 gram glucose load was given intravenously during the anesthetic period and prior to operation; glucose utilization was severely impaired in all patients. When the glucose load was not administered to two patients, a slow uptake of glucose was suggested. Surgical trauma did not further decrease glucose utilization after anesthesia. In patients with no glucose load, surgical treatment resulted in a gradual rise in glucose levels. These results suggested that intraoperative glucose utilization is impaired in the obese. Although a marked osmotic diuresis leading to hypovolemia is not apparent in the present study, decreased intraoperative glucose utilization demonstrates that cautious intraoperative administration of glucose should be considered in the obese patient.


Observations during treatment of acute necrotizing pancreatitis with surgical ablation. Seven patients with acute necrotizing pancreatitis were treated by surgical ablation. Immediate improvement was seen in six patients. Two patients died during the course of postoperative complications requiring reoperations. At operation, strikingly conforming lesions were found in the shape of a sharply limited necrotic portion of the gland. The body and tail of the pancreas constituted this necrotic portion in all patients. In a certain group of patients, the vascular anatomy infers a total infarction of the body and tail of the pancreas if a thrombosis of the transverse pancreatic artery occurs. In view of these observations, more interest should be directed toward the possibility of a vascular occlusion as a cause of pancreatic necrosis.


Management of severe ischemia of the foot secondary to occlusive vascular disease. One hundred patients, 111 limbs, with gangrene of the lower extremity were initially treated with lumbar sympathectomy. Lumbar sympathectomy appears to be most beneficial in the management of gangrene of the toe with a limb salvage rate of 75 per cent. The best results were seen when only one toe, not the big toe, was involved. Limb salvage dropped to 38 per cent for gangrene of the foot, and with gangrene of the leg, lumbar sympathectomy had no affect. The presence of diabetes had no affect on limb salvage for gangrene of the toe but did have an apparent affect on limb salvage for gangrene of the foot. Sympathectomy appeared to aid in stump healing, with 77 per cent of the amputations done not requiring revision to a higher level. Results of our experience appear to indicate that, for patients presenting with gangrene of the toes or forefoot who are not candidates for reconstructive arterial procedures, lumbar sympathectomy as an initial operative procedure should be given serious consideration.


The role of cimetidine in the prevention of stress induced gastric mucosal injury. The results of these studies assessed the value of pretreatment with cimetidine in the prevention of gastric mucosal erosions secondary to stress. Ninety-four female C-D rats were divided into two trials using cold restraint stress. In trial 1, intraperitoneal cimetidine, administered prior to stress, significantly reduced the number of glandular mucosal lesions per animal, X +/- S.E.M., compared with saline solution controls, 1.2 +/- 0.5 versus 8.4 +/- 1.7. In trial 2, addition of hydrochloric acid given intragastrically to rats pretreated with cimetidine resulted in the same lesion rate per stomach as in the saline solution control group, 5.9 +/- 0.7 versus 6.1 +/- 0.6. Rats receiving cimetidine alone exhibited a reduced lesion rate, 1.2 +/- 0.4. The results demonstrate the ability of cimetidine to reduce gastric injury produced by cold induced stress. Furthermore, this action appears to be related to the pharmacologic effects which decrease gastric acid production.


The debate over immediate lymph node dissection in melanoma. The World Health Organization report has not dissuaded me from still believing that it is not in the best interest of the patient to allow regional lymph nodes draining an advanced primary melanoma, such as a thick level 5 nodular lesion, to go untreated and to be exposed to a wait and see philosophy. Whether the nodes are treated by excision or regional perfusion is probably unimportant. What is of importance is that clinicians in their own respective areas of the world continue to look critically at the concept of biologic determinism of regional lymph nodes in patients with advanced Clark-Breslow melanoma.


The importance of histologic grade in stage II endometrial carcinoma. Twenty-six patients with stage II endometrial carcinoma were reviewed. Survival time was found to be influenced most by histology. Fifteen of 19 patients with a favorable histologic grade survived. The combination of stage II disease and unfavorable histologic condition proved to be ominous, as there were no disease-free survivors in this group. Adequate combinations of pelvic irradiation and operation, as well as radiation therapy alone, provided satisfactory local control. Preoperative external irradiation and intracavitary insertion, followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy, are the preferred treatment sequence.


Splenomegaly with carcinoma of the colon and rectum. Scans of the liver and spleen were reviewed for patients with carcinoma of the large intestine. The patients were divided into groups, depending upon the size of the liver and spleen. Those with enlarged spleens tended to have an increased survival time compared with those without splenomegaly. It is postulated that splenomegaly is a good predictor of survival when used with the Dukes' classification and that the increased size of the spleen is on an immunologic basis.


Fibrinolytic activity of the peritoneum during experimental peritonitis. The effect of laparotomy, intestinal resection, heparin and bacterial peritonitis on fibrinolysis of the peritoneum was evaluated in dogs. Heparin had no effect. Sterile laparotomy and intestinal resection severely, but incompletely, reduced fibrinolytic activity measured 24 hours after operation. Fibrinopurulent peritonitis induced by creation of a 10 centimeter long ischemic loop of the terminal part of the ileum abolished the fibrinolytic activity of the peritoneum almost completely. The data are consistent with findings that adhesion formation is inversely correlated with the fibrinolytic activity of the peritoneum. Untreated peritonitis abolished that activity by mechanisms as yet not elucidated. Heparin, which has been shown to reduce both adhesion-formation and the lethality of peritonitis, apparently does so by mechanisms independent of the intrinsic fibrinolytic system of the peritoneum.


Deviation of the prostatic urethra in pelvic masses. A cystourethrogram in the anteroposterior view can be useful for the diagnosis of a mass in the true pelvis in males, particularly when rectal examination is not possible. The technique is simple and rapid and has the same morbidity as simple urethral catheterization. This maneuver should be used whenever a pelvic mass is suspected in a male and physical findings fail to confirm its presence.


Lateral approach for exploration of the parathyroid gland. The common use of automated metabolic screening has led to the early discovery of many patients with hyperparathyroidism and an increase in the number of operations performed upon the parathyroid glands. Approaching the parathyroid glands and the posterior aspect of the thyroid lateral to the sternohyoid and sternothyroid muscles has facilitated surgical exploration of these structures and has increased the rate of success of these operations. This approach has been used with 100 per cent success in 67 of 117 operations performed for hyperparathyroidism since 1973.


Preliminary experience with expanded polytetrafluoroethylene grafts. This early clinical experience of members of the New England Society for Vascular Surgery with expanded polytetrafluoroethylene (PTFE) grafts was evaluated. Questionnaires were distributed to 52 active members of the Society and 32 answers were received. A total of 186 graft insertions were evaluated, of which 112 were positioned in the lower limb; 106 grafts were inserted for libm salvage. Patency rates for femoral-popliteal bypass grafts were determined by life-table analysis. Our results show a 6 to 9 month cumulative patency rate of 91% for PTFE grafts with a popliteal anastomosis above the knee, and a 52% patency rate for below-knee anastomosis. Two complications, aneurysmal dilatation and graft sepsis, were noted in this series. The new graft material exhibits an early patency rate higher than bovine or Dacron grafts which warrants long-term use and evaluation.


Crystalloid vs. colloid resuscitation: is one better? A randomized clinical study. The effects of hemodynamic resuscitation with protein-containing or balanced salt solution were studied prospectively in 29 patients undergoing abdominal aortic surgery. Blood loss was replaced with packed red cells and extracellular volume with either Ringer's Lactate (RL) or 5% albumin in Ringer's lactate (ALB). Fluids were given to maintain the pulmonary capillary wedge pressure (PCWP) equal to or within 5 torr above preoperative (PO) levels, the cardiac output (CO) equal to or greater than preoperative values, and the urine output at least 50 ml/hr. Serum colloid osmotic pressure (COP), CO, PCWP, the gradient between COP and PCWP (COP-PCWP), and intrapulmonary shunt (Qs/Qt) were measured PO, intraoperatively (IO), and daily for 3 days. The measured variables were similar PO in both groups. Operation time, estimated blood loss, and transfusions were similar. Total fluids received for resuscitation (day of operation) was 11.3 +/- 0.8 liters (RL) and 6.2 +/- 0.4 liters (ALB). Fluid balance at the end of resuscitation was 8.4 +/- 0.8 liters (RL) and 3.4 +/- 0.5 liters (ALB). Maximum decrease in COP was 40% (P less than 0.001) in the RL group and was insignificant in the ALB group. The COP-PCWP decreased from 11 +/- 1 to 2 +/- 1 in RL (P less than 0.001) and insignificantly in ALB. Qs/Qt increased slightly in both groups following operation but was not different between groups. Fluid balance, total fluid infused, sodium balance, total sodium infused, COP, or COP-PCWP did not significantly correlate with Qs/Qt. Two patients in the ALB group experienced pulmonary edema associated with normal COPs and elevated PCWPs. There were no cases of pulmonary edema associated with low COPs and normal PCWPs in the crystalloid group. These data seriously question the necessity to maintain COP by using protein-containing solutions during acute hemodynamic resuscitation. When titrated to physiological end points, even large volumes of balanced salt solutions are tolerated well.


Cold sensitivity of the hand in arterial occlusive disease. Digital blood pressure was measured using photoplethysmography in patients with cold sensitivity of the hand. In 19 patients with Buerger's disease, or arteriosclerosis obliterans (arterial occlusion group), 90 of 91 fingers with cold sensitivity showed significantly low pressures. In 17 patients with typical Raynaud's phenomena due either to primary Raynaud's disease or secondary to collagen disease (Raynaud's group), decreased digital pressure was noted in only five of 123 fingers with cold sensitivity. Blood pressure measurements in the fingers after local cooling of the hand showed a more severe response to cold in the Raynaud group than in the arterial occlusion group. These results indicate that the pathophysiologic mechanism for cold sensitivity in arterial occlusive disease is different from that in Raynaud's disease. In the arterial occlusion group impaired circulation due to occlusions in the digital arteries or more proximal arteries is a necessary precondition for cold sensitivity, and an increased sympathetic response to cold is of less importance as an etiologic factor. Thus a patient with cold sensitivity of the hand and normal digital blood pressure should not be considered to have arterial occlusive disease as the underlying cause of cold sensitivity.


Early gastric cancer: report of twenty-five cases. Among 267 surgical specimens of histologically proved cancer of the stomach during the last 20 years (1957 to 1976), 25 were classified as early gastric cancer. Of these early gastric cancers, 16 were found during the last 5 year period. The increasing number of early gastric cancers found in the recent years may be attributed to the more aggressive diagnostic approaches in patients who have symptoms suggestive of peptic ulcer disease. Another factor which may contribute to the increased incidence of early detection of gastric cancer is a more aggressive surgical treatment in patients with a gastric ulcer. Some patients with early gastric cancer will remain undetected if the surgical treatment was vagotomy and pyloroplasty. Lymph node metastases were present in six patients in this series. Of these 25 patients who had gastric resection for early cancer, follow-up was available in 20. Two patients were noted to have local recurrence at 3 and 8 years, respectively, after the initial operation. One of these two patients died after reoperation and the other still is living. One other patient died of cerebral hemorrhage 12 years following the initial operation of gastric resection. The remaining 17 patients all are living, with no evidence of recurrence. From these results it is concluded that (1) routine gastroscopy should be done in patients with radiological gastric abnormalities and in patients with symptoms suggestive of peptic ulcer disease, even though the upper gastrointestinal series is normal; (2) multiple biopsies should be taken from gastric lesions seen on gastroscopy; and (3) gastrectomy is the treatment of choice, since some of the early gastric cancers in this series would have remained undetected if vagotomy and pyloroplasty had been performed.


The application and interviewing process for surgical house officership. The application and interviewing procedure for surgical house officership is an important process to both the medical student and the clinical department. Up-to-date, informative, and honest appraisals of the training programs under evaluation must be obtained. A survey was undertaken to compare and contrast students' and surgical department members' perceptions of nationwide surgical residency application procedures. It is concluded from this sampling that the majority of medical students applying to university-sponsored surgical training programs and the training institutions themselves generally are satisfied with the present application and interviewing experience. Certain areas in need of reform were elucidated, and the following recommendations are offered to aid in the development of a more effective process: (1) if possible, the descriptive information brochure should be updated on a yearly basis and must be comprehensive in scope; (2) when "en masse" interviewing is conducted, it should be held on a number of dates during the year, not just one, and a limited time for "walk-in" interviews should be allowed; (3) an opportunity should be available for the spouse or fiance'(e) to accompany the applicant; (4) an interviewer should prepare for an interview by having read the applicant's file beforehand; and (5) the interviewing schedule should be arranged so that the applicant is able to meet either the department chairperson and/or program director.


Effect of parenteral L-amino acids on gastric secretion and serum gastrin in normal dogs and dogs with portacaval transposition. The effect of intravenous infusion of L-amino acids (FreAmine II) on gastric secretion and on circulating levels of gastrin was studied in five gastric fistula dogs and three dogs with portacaval transposition. Significant increases in gastric acid secretion were found after infusions which delivered 2.0, 4.0, and 8.0 gm/hr of L-amino acids in five gastric fistula dogs. After portacaval transposition, administration of amino acid solutions via the hindleg (through the liver) resulted in a great fall in the acid secretory response. Gastrin levels were significantly elevated after 8.0 gm/hr of amino acids. After 2.0 and 4.0 gm/hr, there was a slight but insignificant increase in serum gastrin levels. Gastrin levels were unchanged after infusion of 8.0 gm/hr of L-amino acids through the liver. We conclude that L-amino acids given intravenously stimulate gastric acid secretion in a dose-dependent manner by a mechanism which does not involve gastrin. At the highest dosage of amino acids, some gastrin was released which might have stimulated acid output further.


Chlorpropamide-induced changes in patients with hyperparathyroidism. Ten patients with primary hyperparathyroidism were placed on a constant 30 mEq of calcium and 120 meq of sodium diet, and alterations in their calcium balance in response to standard oral doses of chlorpropamide were studied over a 4 day control period and a 4 day treatment period. The 10 patients treated with chlorpropamide significantly increased the urinary excretion of calcium and sodium and decreased the excretion of cyclic adenosine monophosphate (AMP). The serum calcium was lowered in six of the patients treated with chlorpropamide, and three of these patients, who had diabetes mellitus and either refused or were too ill for parathyroidectomy, continued to receive chlorpropamide for periods of 9 to 36 months. These three patients experienced prolonged lowering of the serum calcium level and became less confused, lethargic, and fatigued. The interrelationships between the chlorpropamide-induced changes in excretion of calcium, sodium, and cyclic AMP still must be clarified.


A preliminary report of the efficacy of Debrisan (dextranomer) in the debridement of cutaneous ulcers. A randomized trial involving 50 patients has demonstrated that a new type of debriding agent, cross-linked dextran beads with the trade name Debrisan (dextranomer, Pharmacia, Inc.), will produce rapid healing of cutaneous ulcers which have been resistant to conventional therapy over the long-term. Evaluation in terms of a number of therapeutic parameters, including rate of healing, dehydration, sterilization, loss of symptoms, and improvement in physiology, is included in this preliminary study.


Effect of sepsis on tissue adenine nucleotide levels. Tissue adenine nucleotides were measured in rats to determine if there is depletion of energy stores associated with sepsis. Peritonitis was produced by cecal ligation and cecal puncture. At 16 to 24 hours after ligation, rats which were lethargic but still normotensive (late sepsis) and showed clinical and laboratory confirmation of peritonitis-sepsis were stunned by a blow on the head, and small pieces of tissue were removed and frozen. Adenine nucleotides were measured enzymatically. In late sepsis adenosine triphosphate (ATP) levels in liver and kidney decreased significantly; however, no significant decreases were observed in the diaphragm or gastrocnemius muscle. Hydrogen polarograph measurements of hepatic blood flow indicated that flow was decreased markedly at this stage of peritonitis. A second group of rats was prepared in the same manner, except they were studied 10 hours after ligation (early sepsis). Most rats at this stage of sepsis appeared to be only mildly ill; however, blood cultures obtained from six rats so prepared all were positive. These rats did not show any decrease in either hepatic blood flow or tissue adenine nucleotides. Thus the changes in adenine nucleotides observed in late sepsis (lpw-flow septic rats) are similar to those seen during early hemorrhagic shock and suggest inadequate perfusion associated with peritonitis as the cause.


Aortorenal bypass with a branched saphenous vein graft for renal artery disease extending into the branches. Improved vascular reconstructive techniques now enable  renal revascularization in patients with extensive renovascular disease. Two patients are reported who underwent aortorenal bypass with a branched saphenous vein graft for disease involving the main renal artry and its major segmental branches. This technique represents an excellent means of achieving successful renal revascularization in some patients with branch renal artery disease.


Vertebral arteriovenous fistula associated with an anomalous arterial vessel. The widespread use of angiography in patients sustaining vascular trauma has demonstrated an increased incidence in vertebral artery injuries. With the improvement in peripheral vascular techniques and the utilization of extended exposure of the vertebral artery, aggressive therapy now is generally advocated. While new concepts continue to evolve, it becomes important to report anatomical variants that are not commonly recognized. An anomalous vessel originating from the proximal subclavian artery is reported. Initial ligation of a semmingly normal vertebral artery failed to control the fistula which was fed by the anomalous vessel. The importance of complete arteriographic studies is stressed. In particular, it is important to visualize the vascular anatomy both proximally and distally to the injury in order that anomalous vessels are recognized. Arteriography will improve diagnosis, help plan operative or nonoperative therapy, and decrease the incidence of missed injuries and complications.


[The veterinarian in research (author's transl)]. The veterinary research curriculum which is very similar to the medical curriculum in several respects, requires that the qualified veterinarian should be conversant with many subjects, including the extensive field of research. The title of the present paper is so comprehensive that deliberate qualification is required. The responsibility of the speaker invited implies that the first limitation he has to impose upon himself is that of approaching the subject on the basis of the present-day need for socially relevant research. To begin with, two main lines stand out clearly: (a) identifying, detecting, treating and preventing the causes of conditions which menace and impair the health of animals. (b) identifying, detecting, treating and preventing the causes of conditions which menace and impair the health of man. The present paper centres on the field of research which the two departments of science have in common and the management of which is highly relevant both to public health care and to protection of health from the point of view of hygiene. Reconnoitering this field leads to the conclusion that the preliminary training of the veterinarian predisposes him to the ability to develop into a research worker and specialist in one of the many departments making up this field of investigation.


[The veterinarian in the agricultural and food-supplying industries (author's transl)]. The major importance of the livestock industry in the Netherlands is apparent from the following facts. Over 250,000 jobs, roughly 9,600 million guilders' worth of exports in 1977 and roughly 11,000 million guilders' worth of annual sales to home consumers. A healthy livestock population is essential. Approximately 2,000 veterinarians have considerably assisted in achieving these aims. This made possible economics of scale and strengthening the international competitive position. Curing animals has been robbed of much of its importance, whereas prevention of diseases has become essential. To maintain the quality of products, improvement of legislation concerning the supply of drugs, antibiotics, etc., is imperative. This includes a well-defined Veterinary Surgeons Act. The major importance of disease prevention requires more extensive knowledge of the veterinarian. Specialization has also become increasingly necessary. Especially in employment, the future offers many possibilities for veterinarians, national as well as international. In particular fields such as the Veterinary Service and the Meat Inspection Service, the monopolistic position of the veterinarian may be impaired. In the light of these facts, it should be considered whether adjustment and widening of the training in Utrecht is not desirable.


[Collective responsibility of the veterinarian (author's transl)]. It is attempted to show that there are three characteristic turning-points in the history of veterinary medicine, which have directed attention from within outwards. The responsibility of veterinary medicine in regard to public health, the development of diagnosis and treatment and the welfare of animals make it clear that veterinary medicine is an independent science having its own views on the problems concerned, resulting from its origins and purpose. The fact that these views admittedly could not be developed without co-operating with other disciplines is evidence in itself that veterinary medicine has grown up.


Blood parasites of sheep in the Netherlands. I. Anaplasma mesaeterum sp.n. (Rickettsiales, Anaplasmataceae). On two occasions an anaplasm was isolated from sheep on the Dutch island of Ameland. The organism proved to be highly pathogenic for splenectomised sheep; a non-splenectomised animal recovered spontaneously after the packed cell volume had decreased by 40%. Treatment with oxytetracycline was effective. Its pathogenicity for goats appeared to be low, and the organism was apparently not infective to splenectomised cattle. This anaplasm differs from Anaplasma ovis in that less than 30% of the organisms are marginally situated in the red cell, as against over 70% in A. ovis; cross-immunity with A. ovis was incomplete and the latter appeared to be far more pathogenic to goats than the Dutch anaplasm, for which the name Anaplasma mesaeterum sp.n. is proposed. Its ultrastructure is similar to that of A. marginale and A. ovis. The vector is either Ixodes ricinus or Haemaphysalis punctata. Its practical importance remains to be ascertained.


Influence of ante- and peri-mortem factors on biochemical and physical characteristics of turkey breast muscle. The course of post-mortem breakdown of glycogen and ATP in turkey pectoralis major muscle was markedly influenced by several ante- and peri-mortem variables. Application of a proper stunning procedure was highly effective in preventing peri- and post-mortem muscle stress reactions. The physiological level of glycogen and ATP was not significantly affected by road transportation covering 260 km. Birds which rested for 24 hrs following transportation had lower glycogen and ATP levels at the moment of slaughter than non-rested birds. According to the changes in the rate and extent of post-mortem biochemical reactions, several meat characteristics such as water-holding capacity, colour, and tenderness were significantly changed. Furthermore, the results also indicate that turkey breast muscle is susceptible to a PSE-like condition as described in pork.


Differences in mastitis susceptibility between Holstein Friesian, Dutch Friesian and Dutch Red and White cows. Correlation between parameters for mastitis and for production. On an experimental farm 3 dairy breeds were compared with regard to mastitis by various parameters. Higher cell counts and more udder infections were present in the Dutch Red and White (DRW) in comparison with the Holstein Friesian (HF) and the Dutch Friesian (DF). Within the HF breed a negative correlation between cell count and production was established and also in this breed, a negative correlation between maximum rate of milk flow and cell count. There is no evidence that higher production and easier milking are connected with more mastitis. On the contrary, within the breeds an opposite trend appeared. Selection against mastitis does not conflict with selection for production and ease of milking. An addition trial revealed that sampling after too quick preparation of the cows before milking resulted in much higher cell counts in quarter samples. Cows which were selected for drying off with antibiotics recovered from their infection but these more susceptible animals maintained a higher cell count to a certain extent.


[Passive and active immunization against feline enteritis and rhinotracheitis in experimental cats (author's transl)]. The results of passive and active immunization against feline rhinotracheitis with regard to mortality and morbidity were studied in 335 cats. Passive immunization reduced mortality from pneumonia from 5 per cent to 1 per cent. Vaccination against rhinotracheitis also reduced mortality from pneumonia from 5.3 per cent to 0 per cent and markedly reduced morbidity of these conditions.


[The use of drugs in animal breeding, viewed in the light of the quality of the finished animal product (author's transl)]. In view of the export of foods of animal origin by the Netherlands, it is essential: --to provide guarantees that these finished products shall be free from veterinary drug residues or that any residues shall not be in excess of fixed tolerance levels; --also to adjust legislation concerning the permissibility and use of veterinary drugs and feed additives to factors stimulating the transfer to finished animal products. Adequate methods of investigation will have to be developed; --to perform adequate tests for residues of groups of veterinary drugs on inspecting finished products of animal origin. When these residues are in excess of permissible levels, stock farmers should be prosecuted for possible improper use and the product in question should be condemned; --closely to follow developments in countries to which these products are being exported and to base policies on these developments; --to achieve a high degree of harmonization between legislation concerning veterinary drugs and criteria of investigation.


[Stability of a number of antibiotics, coccidiostats and growth-stimulating substances during manufacture and storage of (medicated) feed pellets (author's transl)]. The effect of processing and storage on the stability of a number of antibiotics, coccidiostats and growth-stimulating substances, viz. lasalocid, monensin-Na, avoparcin, olaquindox, carbadox, sulfadimidine-Na and lincomycin in (medicated) feeds was studied. Mixtures containing the additives were conditioned by steam at a temperature of 80 degrees C, and pelleted. After each stage in processing and following storage of the pellets for a month, the concentrations of antibiotics, etc., were determined and compared with the concentrations as calculated in the original feed mixtures. The results suggested that none of these substances were very susceptible to the conditions of processing applied. All samples of stored pellets were found to contain at least 90 per cent of the concentrations present in the original feed mixtures, the combined negative effects of processing and storage hardly being beyond the margin of accuracy of the analyses.


[Effect of various preparations of iron on the growth and haemoglobin levels of newborn piglets (author's transl)]. Four preparations of iron dextran, which differed markedly in price, were compared in an experimental study. 100 or 200 mg. of iron were injected intramuscularly on the first, second or third day of life of the piglets. Differences in weight or concentration of haemoglobin were not detectable during the first eight weeks of life, neither at a dosage of 100 mg. nor at a dosage of 200 mg. of iron.


[Veterinary supervision of pig farms (author's transl)]. The structure of pig-farming has undergone considerable alterations since organized pig health care started in 1958. Despite education and improvement in a variety of fields, results have been showing a slight decrease in recent years. Veterinary supervision of pig farms should therefore be adjusted. This process of adjustment which started in the Province of North Brabant in 1965, consists of four sections, each of which is discussed. These are the system of integration, examination in the slaughter-house, supervision by the practitioner and field studies.


[Epidemiological studies on Salmonella in a particular area ('Walcheren Project'). IV. The incidence of Salmonella in the sewage system, in faeces of man and pets as well as in shops, kitchens and lavatories in the village of Aagtekerke (author's transl)]. As part of the epidemiological investigations on Salmonella on the island of Walcheren, the contamination of sewage water in the village of Aagtekerke was studied over a prolonged period. These studies showed that this sewage water was frequently contaminated by large numbers of Salmonella. In the present study, efforts were made to find an answer to the question of the origins of this contamination. For this purpose, the incidence of Salmonella in the sewage system, in faeces of man and pets as well as in shops, kitchens and lavatories in the village of Aagtekerke was studied for a period of three weeks in June 1977. In addition to the findings in the sewage system (including the inlet water and effluents of the sewage works) which were positive for Salmonella, this organism was only isolated from a few faecal samples of human and animal origin. Serotyping showed that the strains isolated from human faeces were similar to those found to be present in the sewage system. This fact, in conjunction with the results of the bacterial counts. suggests that the sewage system was only contaminated by the small number of carriers. The reduction of contamination observed in the sewage system during the period of investigation could be evidence of the fact that Salmonella organisms cannot survive by themselves in an environment of this type, at least not at the temperatures recorded on collecting samples from the sewage water. Growth of organisms under more favourable conditions cannot be ruled out. An inquiry on dietary habits and kitchen hygiene of the local population showed that contamination within households. Origination with the food, is a real possibility.


[Rickets-like changes in broiler chickens (author's transl)]. A disease in broiler chickens associated with rickets-like symptoms observed on post-mortem examination is described. The disease is not caused by deficiencies in the feed. Treatment with vitamin D3, calcium and phosphorus has little if any effect. There is evidence to suggest a relationship with the origin of the broilers. It also is an established fact that the disease is related to the farm. Particularly those broilers will develop rickets-like symptoms, which were housed on litter previously used for chickens with the same disease. It probably is an infectious disease. Non-purulent inflammation of the glandular stomach is constantly observed in chickens showing rickets-like symptoms. This disease is transmissible to SPF chickens. It is not clear whether this is an accidental finding or typical of this clinical picture.


[A survey of mastitis control, based on the number of drug containers made commercially available in the Netherlands during the period from 1971 to 1977 (author's transl)]. The figures on the number of marketed short-acting and long-acting antibiotics for the control of mastitis reported by the industry convey an impression of the mastitis situation in the Netherlands. The numbers and proportions of quarters and animals treated with short-acting antibiotics as well as the number and proportions of dry cows are reviewed. The figures suggest that the number of animals treated for acute mastitis are gradually decreasing, whereas the number of cattle treated with long-acting antibiotics in the early part of the dry period continues to be fairly constant.


[Chemistry as the guide (author's transl)]. In the present paper a comprehensive review of the duties of a food chemist is presented. Three subjects in the field of food chemistry, i.e., the role of unsaturated fatty acids in human nutrition, the presence of harmful elements in foods of animal origin, and the analysis of residues and other hazardous agents, are briefly discussed to convey an impression of the problems in modern food chemistry. The reasons are stated, for which university education in food chemistry is required, and why it is useful to have a chair of food chemistry within a faculty of veterinary medicine.


Reconstruction of a chromosome model from its projections. As a pilot experiment towards the reconstruction of human chromosomes from their electron microscopic projections, a chromosome model was photographed and several cross-sectional planes successfully reconstructed. Some practical constraints and conditions for this type of work are defined.


[Total body computer tomography or the urogenital system (author's transl)]. Computer tomography cannot only produce transversal sections of the body, but also evaluate the x-ray absorption values of various organs and tissues. It was first used in the investigation of the brain and has influenced the use of traditional neuroradiological techniques. Computer tomography can be used in special cases of diseases of the urogenital system. It is especially helpful in the diagnosis of primary or secondary retroperitoneal processes and also for tumors of the kidney. It allows effective frequent follow up of various therapies and has no side effects. Also in the follow up of various tumors, this noninvasive technique can demonstrate possible recurrences. It appears however that the total body computer tomography will not replace traditional radiological technique. During treatment and follow up of malignant tumors of the urogenital system however it appears very helpful.


[Indications for surgical treatment of urotuberculosis (author's transl)]. The importance of the finding of specific antibodies in urotuberculosis and its importance for surgical indications are emphasized. The various antibodies and their evaluation in the followup of urotuberculosis are described. Case reports are given to show the value of the immunology in tuberculosis for the surgical selection of patients.


[Complications following ureteroneocystostomy without antireflux technique in the adult (author's transl)]. 65 adult patients subjected to direct uretero-vesical implantation without the use of a recognized antirefluxing technique were followed up to 9 years. Good results could be achieved in 90.8%, whereas failures were mainly due to radiation damage and malignant tumors. A postoperative stenosis was observed five times. Reflux was demonstrable in 7 cases, of which, however, only one was of pathologic significance.


[Endometriosis of the kidney (author's transl)]. Endometriosis of the left kidney complicated by urolithiasis is described. This represents the tenth case in the world literature of kidney endometriosis. The most common symptom is low back pain. Macroscopic hematuria was only present in half the cases. The preoperative radiological findings have been interpreted as tumor in four cases, contracted, pyelonephritic kidney in two cases and congenital abnormalities in two cases.


[Fistulas between bowel and urinary tract (author's transl)]. From 1968 to 1977, 21 patients were observed who had fistulas between the bowel and the urinary tract. Except in five patients, fistulas were located vesicointestinally. The main etiologic factors were inflammatory lesions of the bowel, especially diverticulitis and appendicitis. All patients had symptoms relating to the urinary tract, mainly recurrent urinary infection with dysuria. On the average, nine months passed until the fistula was diagnosed. Urethrocystoscopy proved to be the most valuable aid in diagnosing intestinovesical fistulas, the fistulous opening was thus seen in 11 patients. Thirteen patients were treated by operation and eight by conservative treatment only. In the conservatively treated group, two fistulas healed spontaneously. Fistulas based on diverticulitis from the sigma were treated using a multiple stage procedure. No complications were observed.


[Differential diagnosis of postoperative fistulas of the urinary tract (author's transl)]. A case is demonstrated in which an indwelling intravenous catheter was pushed by mistake via V. subclavia and the right heart into the V. cava inf. There the catheter perforated the wall of the V. cava. The continued infusion induced a cystic retroperitoneal tumor. The puncture of this tumor was followed by a fistula that was misinterpreted as a fistula of the urinary tract.


[(Semi-)open renal biopsy: a new instrument (author's transl)]. A new instrument for (semi-)open renal biopsies is presented. The advantages of this instrument are proved in animal experiments. Histopathological studies in animal and human renal tissues have shown the efficiency of the biopsies.


[Carbon polymer stomata in vesicostomy and other urinary diversion procedures (author's transl)]. Implants of pure carbon are ideal for prosteses because of their tissue acceptability and lack of incrustation. Animal experiments with biocarbon implants were tested as subfascial implantations, coeco-, ileo-, and vesicostomies, (n = 37). The results showed lack of reaction and good healing of the stomata, lack of incrustation, and water tight urinary diversion. Based on these animal experiments biocarbon vesicostomies were carried out successfully in six patients. The follow up period was 3--16 months.


[Renal hypothermia in situ. Comparison between surface and perfusion cooling concerning renal function in pigs (author's transl)]. There are 2 competing methods for cooling the kidney in situ during surgical ischemia: from without by applying ice to the renal surface and from within by perfusing the renal artery. The latter procedure is said to be superior in protecting renal function. Herein the protective effect on renal function of both methods are compared. Pigs of 15--25 kg weight underwent nephrectomy on one side. The remaining kidney was subjected to cold ischemia during 90 minutes while perfusion- or surface cooling was performed. For perfusion cooling the aorta was punctured and the catheter introduced into the renal artery. The perfusing liquid consisted of a physiologic electrolyt solution (Ringer-Lactate) with heparin kept at a temperature of 3--5 degrees C. The initial perfusion lasted 10 minutes and resulted in a median renal core temperature of 23 degrees C. Then the kidney was put on a cooling pad and every 15 minutes again perfused for one minute. For surface cooling sterile melting ice made of glucose solution 5% was applied directly to the kidney. The renal core temperature could be kept at 15--20 degrees C. The two methods of hypothermia were judged by comparing the serum creatinine levels and the I131-hippuran clearances one month after surgery. There was no difference whatever as analysed by the t-test. Hypothermia by applying ice to the renal surface therefore proved to be equivalent to hypothermia by perfusion. Moreover it is much simpler.


[Aspects of the biological activity of thiochrome]. The influence of thiochrome on the lipids metabolism in animals fed on a usual vivarium ration or synthetic thiamine-free diet carrying as a fat component 18 per cent of oleic acid was investigated. Under conditions of an ordinary vivarium ration thiochrome acted as a weak antivitamin and changed the lipids metabolism rates, like this is done by oxythiamine. When superimposed on an oleate-containing, thiochrome displayed a slightly pronounced vitaminic properties, while its influence on the individual study lipids metabolism rates was somewhat similar to that exerted by thiamine. It is suggested that the effect of thiochrome on the lipids metabolism is not related to the coenzymatic function of thiamine.


[Effect of component 5 of the proteose-peptone fraction of milk on blood circulation indices]. Under study was the influence exerted by peroral administration of component 5 of the proteosoic-peptone milk fraction on the pulse rate, arterial pressure and cerebral circulation in dogs with the subcutaneously exteriorized carotid and under a functional load on the central nervous system (with photostimulation used as a load). The resulting data on the slowing down of the cardiac contractions rhythm and diminished reaction on the level of the minimum pressure and the stroke volume of the cerebral blood flow in response to the functional load testify to a certain regulating effect exerted by component 5 on the circulation, when the central nervous system is subjected to a functional load.


[Effect of rations with qualitatively varying carbohydrates on lipid metabolic indices in the liver, blood and bile]. In tests conducted on rats the process of eliminating the endogenous formed lipids with bile was studied and the discovered changes were contrasted against the lipids metabolism disorders in the liver and blood of the animals receiving rations with differing quantitative and qualitative content of carbohydrates. A balanced ration with saccharose led to a higher quantity and radioactivity of the total lipids and triglycerides in the liver and blood. In the bile a fall in the level of the cholic acid, cholesterol and the lipid complex and an increased radioactivity in the composition of the lipids complex, cholesterol and phospholipids were observed. A ration with an elevated level of starch did not upset the lipids metabolism in the liver and blood. In the bile the lipids complex decreased, the quantity of cholic acid increased, while the radioactivity in the lipids complex and phospholipids was rising. A carbohydrate-rich ration with saccharose raised the content of total lipids, triglycerides and of the ether-bound blood cholesterol and their radioactivity. The described diet resulted in an increased amount of the bile and in a drop therein of the level of the lipids complex, cholesterol and phospholipids and in an accrued radioactivity in them.


[Effect on the body of rats of rations varying in protein content in acrylomitrile poisoning]. The effect of protein of isocaloric rations (10, 18 and 30 per cent of the total calorific value) differing in its proportion on the course of a subacute poisoning provoked by the acrylic acid nitrile (AAN) in a concentration of 9.7 +/- 2.8 mg/m3 was studied. A comparative study of the results obtained showed that a protein-rich ration produced a more pronounced protective effect. Against its background the AAN metabolites were eliminated from the organism more intensively. This effect could have been occasioned by an excessive supply to the organism together with the additional protein of free sulphur and of SH-group necessary for rendering the cyanides harmless. Considering the results obtained and with the view of a more effective prevention of the AAN poisoning it is advisable to recommend providing workers with a protein-rich medico-prophylactic ration containing an assortment of food products rich in sulphur-containing elements.


[Change in the exocrine function of the liver after cholecystectomy under the influence of diet therapy]. In patients with sustained cholecystectomy the content of the basic bile components (cholesterol, cholic acid, total phosphorus) was measured. The cholate-cholesterol coefficient, enabling it to a certain degree to evaluate the lithogeneity of the bile, was calculated. The cholesterol concentration in the serum and bile was contrasted. A total of 104 patients were examined at different post-operative periodss and it was found that in 70 per cent of them the bile was not oversaturated with cholesterol. Two variants of the No. 5 diet were used--the sparing and fatty, differing in the amount of fat and carbohydrates. Under the effect of the No. 5 sparing diet a reduced serum cholesterol concentration was noted along with a noticeable rise of the cholic acid content in the bile with a not too brusque rise of the cholesterol level therein, which led to an increase of the cholate-cholesterol coefficient. Against the background of the treatment with a No. 5 fat diet in evidence was a diminution of the serum cholesterol content, a clearcut fall in the cholesteroland cholic acid concentration in the bile with a continuing fairly high cholate-chole sterol coefficient.


[Determination of the vitamin E in fish and fish products]. To measure the tocopherols content in fish and fishery products conditions of analysis permitting the utilization of the Emmiry-Engel method were selected. Subsequent to a comparative investigation, a system of solvents was sorted out with which in column chromatography using aluminium oxide the most complete separation of tocopherols from compounds hindering colourimetric determination could be achieved. The procedures used in determinations and data on the tocopherols content in 27 species of fish, fishery products and others are given.


[Isolation of the core of Dane particles from donor blood]. Ultracentrifugation in a flow rotor was used for partial purification and concentration of Dane particles from the plasma of donors, carriers of HBsAg. Subsequent purification was achieved by centrifugation in sucrose and cesium chloride density gradients. The iodinized inner component of Dane particles formed a peak in the zone of density typical of HBsAg localization. The specificity of the antigen was confirmed by the radioimmunologic method.


[Action of biotin-pyridoxine complex on the development of experimental atherosclerosis]. Investigations were conducted in two series of tests on 40 rabbits. In the first series a selection of the optimal dose of the vitamins was made and in the II series the action of the optimal dose of the biotin-pyridoxine complex was studied. Each test series included 2 control groups of the animals. The biotin-pyridoxine complex (in doses of 80 gamma and 3.2 mg per 1 kg of the body mass) was shown to exert an inhibitory action on the development of experimental atherosclerosis.


[Effect of the casein content in the feed on the growth and state of the nitrogen balance of white rats]. Investigations conducted on albino rats of the Wistar line established a marked relation between the growth rate, consumption of food and the nitrogen balance, on the one hand, and the proteins content in the feeding stuff, on the other. Then the maximum consumption and the gain of body mass was observed with 22--25 per cent of the casein protein content.


[Change in the sterol and phospholipid makeup during the hydrothermal processing of buckwheat grain]. The effect of different modes of the hydrothermal treatment of buckwheat and of the grit cooking on a change in the composition of sterols and phospholipids was investigated. While not changing the qualitative composition of sterols and phospholipids, the hydrothermal and culinary treatment was found to produce some changes in the correlation of their individual fractions.


[Experience with computer utilization in organizing rational nutrition]. A number of algorhythms and programmes in the language "Algol-60" are proposed. On the ground of a balanced assortment of products and a "library of courses" corresponding to it is possible to formulate optimal nutrition rations for a definite designed period of time (1, 2, 3 weeks, etc). From the given rations one may compile a menu for any pre-set number of meals per day, to obtain information on the chemical composition of the ration, its cost, calorific value in weight units, as well as on the amount and kinds of products entering the ration.


[Experience in creating a card file of reference publications on foreign institutions working in the field of the science of nutrition]. Work on detecting reference publications on foreign scientific institutions active in the domain of nutritional science is summed up. Information on reference books and guides embracing scientific and research establishments of the whole world, individual countries and also on the guides containing information on international bodies and prominent figures in nutritional science is offered.


[HB antigen e in acute hepatitis B].

[HB antigen e in acute hepatitis B]. The presence of HBe-antigen and antibody to it was determined in 233 subjects, including patients with acute hepatitis B, chronic hepatitis, and asymptomatic carriers of HBs-antigen. Preliminary concentration of blood sera was shown to increase the frequency of the e antigen detection in patients with acute hepatitis B to 33.3%, and in carriers to 1.7%. In parallel studies, no antibody to the e antigen was found in the acute period of hepatitis B. A direct correlation was found to exist between e-antigenemia and the severity of hepatitis B, with the exception of fatal outcomes. No significant differences in the frequency of the e antigen detection by sex, age of the patients, and titers of HBs-antigen in acute hepatitis B were established.


[Method of isolating the surface antigen of hepatitis B]. Hepatitis B antigen was isolated from HBs-positive human blood. A method of precipitation with polyethylene glycol (PEG) was used for concentration of HBs-antigen. The regularities of HBs-antigen precipitation were studied, and the degree of HBs-antigen precipitation increased with an increase of the molecular mass and concentration of PEG. Optimal precipitation conditions were selected, and the precipitation was found to go selectively and with large yields in an acid medium at pH 4.5. As a result of employment of a set of physico-chemical methods, highly purified HBs-antigen was isolated.


[Biological value of new canned baby foods stabilized with various types of starch]. The nature of influence produced by native and modified starches on the biological value of new baby food homogenized canned meat of the "Kroshka" type was studied. Experiments on animals have found the stabilization of the structure of approbated canned goods modified with phosphate starches, such as maze, amylopectin and potato (TY 18 RSFSR 279-73) ones, causes lowering of the biological value of the product by comparison with analogous native starches.


[Physical characteristics of human adenovirus type 6]. The size, chemical composition and the buoyant density of the virion, sedimentation and diffusion constants of human adenovirus type 6 were determined. The molecular mass of the virion was calculated on the basis of the values of sedimentation and diffusion constants and electron microscopy data.


Allergic bronchopulmonary aspergillosis. Allergic bronchopulmonary aspergillosis, a syndrome associated with asthma, manifests with transient pulmonary infiltrates and eosinophilia and can progress to severe proximal bronchiectasis, bronchocentric granulomatosis and pulmonary fibrosis. Early recognition and treatment should favorably influence these complications. Use of the precipitins test with Aspergillus antigens as a screening procedure has identified 99 possible cases in California over a 50-month period. At least 44 cases have been confirmed; and demographic analysis shows that a preponderance of them involved patients less than 35 years old, occurred in farming and rural communities and were discovered in the months of September through February.


[Effect of the tick-borne encephalitis virus on the chromosomes and cell division in different cell cultures]. The mutagenic effect of tick-borne encephalitis virus (the Pan strain) was studied in chick embryo cells, Syrian hamster kidney cells and pig embryo kidney (SPEV) cell cultures showing different sensitivities to this virus. The dynamics of formation and types of chromosome damages were shown to be different in latent, subacute and acute forms of infection. Virus-induced chromosome aberrations appeared in the period of termination of the virus reproduction cycle. Differences in the effect of tick-borne encephalitis virus on the synthesis of nuclear DNA in chick embryo and SPEV cells were demonstrated. The experimental results suggest that a temporary increase of the mitotic activity observed in the inoculated cultures was due both to a delay of cells in one of the stages of the mitotic cycle (chick embryo and SPEV cells) and to a temporary stimulation of DNA synthesis (SPEV cells).


[One year experience in the public hospital in Linz/Austria (author's transl)]. 222 coronary angiographies were performed in a new established laboratory in the medical division of the public hospital in Linz (Austria) from May 1977 to May 1978. Indications, method, complications and results are presented.


[The effect of hexestrol on the breast in climacteric women (author's transl)]. In 176 women hexestrol was substituted during 12 month or longer after ovarectomy and hysterectomy. Changes of the breast were watched by mammography and plate-thermography during hexestrol treatment. Also blood cagulation was examined. No differencies were found between these women and 179 women of a control group. In the authors opinion the substitution of hexestrol is justified further on in climacteric periods.


[Age distribution of the incidence and immune structure of the pediatric population in epidemic parotitis]. An increase in the incidence of epidemic mumps among children is observed at 1 year, the highest incidence is found in the age group of 3--4 years which clearly correlates with the immunological status of the examined children. Antihemagglutinins to epidemic mumps virus have been found in 76.3% of infants at the age of 0 to 3 months, the minimal number of seropositives (36.2%) is observed at 7--9 months of age. Beginning at 10 months of age the percentage of seropositives increases reaching maximum (92.4--94.2%) in the age group of 6--7 years, after which the immune portion reaches stable 90.0%. The optimal age for vaccination is believed to be 1 year.


[Pathomorphological characteristics of the experimental infection in animals infected with viruses of the rabies antigenic group]. Comparison of pathomorphological lesions in the brains of white mice inoculated with viruses isolated in Africa from shrews, in America from bats, in Czechoslovakia from rodents (6 strains) and classified into the rabies group, with those observed in the same animal species infected with street rabies virus and virus of human acute encephalomyelitis (HAE) established the peculiar features of the reactive processes distinguishing these infections from each other. In contrast to the reactions after inoculation with street rabies virus and HAE, 24 hours after inoculation of white mice with Lagos bat, Ib An 27 377, 297 BF, 548 BF, 808 BF, 482 SG, 598 SG, and 638 SG strains hemorrhagic foci were observed; within 48 hours multiple perivascular cuffs were formed in the brain, and degeneration of the Ammon horn down to its disappearance and formation of multiple voids in the brain tissue were observed. Cytoplasmic inclusions in neurons of the cerebrum cortex and Ammon horn in the form of small paired formations with a pinpoint basophilic granule inside could be detected 24 hours postinfection. Later in the disease, the number of inclusions found diminished sharply.


[Laboratory studies of an epidemic outbreak caused by influenza A1 viruses]. Virological and serological studies of an epidemic influenza outbreak in December, 1977, carried out in the clinical department of D. I. Ivanovsky Institute of Virology of the USSR AMS established the disease to have been caused by influenza Al viruses. The marked incidence of the disease among younger age groups was due to a low humoral immunity level to the strains which had circulated before the young people's birth. The reduced effectiveness of protection by antibody against viruses which had caused influenza disease 20--30 years ago was conducive to the spread of influenza Al cases among middle-aged and senile population.


[Use of the immunoautoradiographic method for determining HBsAg in the blood of serum hepatitis patients]. The use of immunoautoradiography for HBsAg detection increased its primary detection rate in the blood of patients with acute serum hepatitis to 70% (by 12--15% more than in the gel precipitation test). Antigenemia in patients with acute serum hepatitis has been shown to last much longer than could be determined by gel precipitation. As a result of this, over 60% of the patients with HBs-antigenemia in the acute period are discharged from the hospital still containing the antigen. A correlation between the duration of antigenemia in the GP test and the speed of antigen disappearance from the blood according to the IAR test was established. The IAR method was found to be highly sensitive and specific; its application helps solving some theoretical and practical problems.


[Characteristics of the vitamin status and of the individual indices of mineral metabolism and catecholamines in the students of sports colleges]. Materials derived from a study on the allowances of the organism of the physical culture institutes students of different sporting specialties (wrestling, cycling, light athletics, heavy athletics) of individual vitamins (A, B1, B2, B6, PP, C) and also results of investigations of the diurnal excretion with urine in them of sodium, potassium, as well as the catecholamines metabolism rates (epinephrine, norepinephrine, DOPA and dopamine) are presented.


[Role of cellular organelles in the reproduction of the influenza virus]. Virus-cell interaction may result in changes of both cell population and the original properties of the persisting virus. The elucidation of infectious RNA localization is of undoubtful interest in the light of the investigation of the mechanism of chronic influenza infection. The studies were aimed at comparing chronic and acute infections on the model of influenza virus. Particularly important were the studies on comparative distribution of the virus infectious activity among cell organoids. The investigation of virus accumulation in subcellular fractions in chronic infection revealed infectivity in the lysosomal fraction. This fact led to an important hypothesis on possible lysosomal virus carrier state. It has also been shown that activation and redistribution of the acid phosphatase activity occurs in virus infection of cells. The activity of the enzyme in cell juice was absent in the chronic and present in the acute infection.


[Immunological markers of hepatitis-A and -B in blood donors from Vienna]. In 1076 sera of healthy volunteer blood donors from Vienna and surroundings HBSAg was positive in 1,7%, HBSAb in 9,5%, HBCAb in 5,7% by radioimmunoassays. HA-Ab was more frequently positive in the rural than in the urban population, its incidence was higher than it was observed by others in Switzerland and in the USA, but lower than in Belgium, Israel, Yugoslavia and Taiwan. 4% of the blood units were positive for HBCAb but negative for HBSAg. The possibility to decrease the incidence of posttransfusion hepatitis by screening for HBCAb is discussed.


[Benign chronic conjugated hyperbilirubinaemia: rotor syndrome or hepatic storage impairment?]. In a 52-year-old female who was jaundiced since early childhood, marked conjugated hyperbilirubinaemia and a delay of bromsulfophthalein and indocyanine green plasma disappearance rates were observed. Liver histology, plasma bile acids and plasma clearance of 14-C-cholic acid were normal. There was a pronounced impairment of the relative storage capacity of bromsulfophthalein (S = 2,4 mg/mg%) and a moderate decrease of BSP-transport maximum.


[Chronic persistent hepatitis. Histological and clinical study of different forms of the course of CPH]. Among 4903 liver biopsies were found 96 cases (241 biopsies) of non-active hepatitis persisting for longer than one year (up to 12 years). Three forms of the course of chronic persistent hepatitis could be delimited in morphological terms taking into account clinical laparoscopic and clinical chemical data. The type Ia presents the picture of a largely subsided, lobular accentuated acute virus hepatitis. The type Ib corresponds to a chronic inflammation with emphasis on the portal system without destruction of the limiting plate, without fibrosis and with only slight intralobular involvement. The type Ic is characterized by a portal and slight septal fibrosis with round-cell infiltrates and a slight facultative periportally active inflammation as well as a moderate intralobular mesenchyme reaction. The typing permits a clear subdivision and a differentiated prognosis: 10% of the cases of type Ic pass into an active chronic hepatitis of the type IIa.


[Incidence of ventricular arrhythmias after aneurysmectomy (author's transl)]. Incidence and type of premature ventricular contractions (PVC) were studied by ambulatory monitoring in 66 patients at the average 20 months after left ventricular aneurysmectomy. In 25 of these patients long-term-Ecg-monitoring was obtained before and after surgical intervention. After aneurysmectomy only 30% of all patients showed no PVCs; 35% had few PVCs and 35% demonstrated frequent PVCs. In 16 patients (24%) PVCs of Lown Classes III and IV were found. Only 7 out of 25 patients of the group analyzed before and after aneurysmectomy improved by one or more Lown Classes, 10 patients remained in the same Class, 8 patients worsened. In 11 patients ventricular arrhythmias refractory to medical treatment were the indication for aneurysmectomy. There were three in-hospital deaths. Of the remaining 8 patients only two became free from ventricular ectopic activity, 5 continued to have frequent multifocal PVCs, two of them required repeatedly DC-cardioversions. In two patients sudden cardiac death occurred two and three years after aneurysmectomy. It is concluded that only a small percentage of patients with left ventricular aneurysm gets free from ventricular ectopic activities after aneurysmectomy. Results of aneurysmectomy for intractable ventricular arrhythmias are disappointing and unpredictable. The application of new surgical techniques to localize and excise irritable foci seems advisable for the future.


[Echocardiographic observations in malfunctioning heart valves due to thrombosis (author's transl)]. The study includes two patients with obstruction of prosthetic heart valves by thrombosis. In the first patient, a thrombus attached to the ventricular side of the cage of a Smeloff-Cutter mitral prosthesis caused incomplete excursion of the ball in most cardiac cycles, which was detected by echocardiography. In the second patient a thrombosis of the atrial and ventricular side of a Lillehei-Kaster mitral prosthesis delayed opening of the disc. The initial part of the opening movement was "rounded", the excursion of the disk diminished. The cases presented indicate that in patients whose condition deteriorates after prosthetic valve replacement, echocardiography can help identify the cause. In particular, the technique makes it possible to differentiate between valvular dysfunction and muscular insufficiency of the left ventricle. Comparison with recordings obtained in the early postoperative period facilitate the detection of a malfunctioning prosthesis.


[Echocardiographic diagnosis of malfunction of the Björk-Shiley prosthetic heart valve in the mitral position (author's transl)]. In patients with mitral valve replacement an acute cardiac decompensation most often signalizes malfunction of the prosthesis. Echocardiography proves to be of great value in the noninvasive diagnostic to detecting valve dysfunction. The echocardiogram of two patients few weeks after cardiac surgery was strongly suggestive of perivalve leak with severe regurgitation: enlarged left atrium and left ventricle, hyperactive septal motion and hyperkinetic motion of the left ventricular posterior wall, unique "hump" in early diastole with normal excursion, opening and closing velocity of the disc. The echocardiogram of one patient exhibited the pattern of mitral stenosis: large left atrium, decreased amplitude of excursion of the opening of the disc with a slowing and "rounded" opening upstroke as well as a slowed and "rounded" downstroke with prolonged opening and closing rates of the disc. One patient with aortic and mitral valve replacement showed no echocardiographic signs of abnormal disc motion. The reason for the cardiac decompensation was an acute malfunction of the left ventricle. The echocardiographic findings were confirmed by cardiac catheterization, left ventricular cineangiography or direct inspection during open heart surgery.


[Prevention of delayed cardiogenic shock in 850 patients with myocardial infarction (author's transl)]. In 850 patients with acute myocardial infarction, cardiac output has been checked daily with acid-base-balance determinations, respiratory alcalosis being a sign of decreased cardiac output. In 84 patients without spontaneous increase of low cardiac output, treatment with cardiac glycosides has been started with the aim to prevent delayed cardiogenic shock: only 1 patient died in delayed cardiogenic shock and 3 patients in delayed heart failure. In the remaining 766 patients, only 1 patient died in delayed heart failure. With this successful prevention, the overall hospital lethality has dropped to 11.06% as compared with 21.70% in 3272 comparable patients in the literature.


[Exercise capacity and physical activity following prosthetic valve replacement in relation to cardiovascular function (author's transl)]. 31 patients (Pt) with Mitral Valve Repacement (MVR), 22 Pt with Aortic VR (AVR) and 10 Pt with Double VR (DVR) are investigated hemodynamically and by ergometry. Normal working capacity (100% WC) has been achieved in 59% of Pt with AVR, in 34% with MVR and in 22% with DVR. Pulmonary artery mean pressure (PAMP) in this group was 19.5 mmHg, in a second group with a WC of 80% PAMP was 22.2 mmHG. 77% OF Pt with AVR are working regularly, in MVR 58% and in DVR 50%. In the average of these Pt, 7 months after VR professional occupation is started again. PAMP and pulmonary vascular resistance (APR) is significantly lower in the working vs. the non working group: PAMP 19.8/23.7 mmHg; APR 115/145 dynes sec cm-5, respectively. In MVR, the transprosthetic pressure gradient at rest was 4.1 (working PPT) and 7.5 mmHg (other); in AVR statistically no significant difference in the gradient could be found. In general, 68% of the working Pt are employed in a preferably sedentary job. The mean duration of daily work was estimated to 6.7 hours. It is concluded that AVR yields more favourable results in terms of regaining normal working activity than MVR. Cardiovascular function and physical capability in Pt with DVR are approximately comparable to MVR.


[Estimation of myocardial damage after open-heart surgery by CK isoencymes (author's transl)]. After 12 cases of open-heart surgery serum activities of CK and CKMB have been registrated. To make a more exact statement about myocardial damage the portion of CKMB out of the CK-activity has been evaluated by the way of a mathematic programm. The results verify the statement that after aortic valve replacement the CKMB portion is higher than the average, and that after intraoperative complications the highest CKMB portions have been reached. No myocardial infarction occurred.


[Cardiac output and central-hemodynamic parameter under bencyclan (author's transl)]. In 17 patients with peripheral arterial occlusive disease the influence of intra-veinously applicated Bencyclane (Fludilat) on cardiac output and central-hemodynamic parameter has been investigated. While 100 mg (n = 8) of Bencyclane almost do not influence cardiac output, 200 mg (n = 9) cause a significant decrease of minute-volume of the heart by-17.22% and of heartfrequency by-8.85%. With either dose there is also a significant increase of aortic pressure, pulmonary arterial pressure and pulmonary vessel resistance to be seen. These results correlate with the animal-experimental proof of a negative inotropy under Bencyclane, and they have to be considered in therapeutical use.


Compliance revisited: further notes on the problem of nonadherence to medical regimens. A study of outpatients at a community hospital reveals that 46% consistently defaulted on some aspects of their medical regimens. The more complex the regimen, the more likely the patient was to default, with particular neglect of directives regulating personal habits, work, and diet. The authors recommend an educational intervention program to inform patients of the risks in noncompliance.


Nephrotic syndrome in childhood: diagnosis and management. The nephrotic syndrome is characterized by gross proteinuria, hypoproteinemia, hyperlipemia, and edema. The authors review the diagnostic features and management protocol of this syndrome in children.


Pre-hospital coronary care in the community setting. Technological advances have made pre-hospital coronary care programs possible for communities of all sizes. The author describes and illustrates with case reports a successful Newport News program in which physicians, hospitals, paramedics, and local government services work together.


Transsphenoidal microsurgery for tumors of the hypophysis. The microsurgical transsphenoidal approach is the authors' procedure of choice in the operative management of pituitary tumors. The literature supports their recommendation.


[Chondrocalcinosis of the intervertebral disks]. Intervertebral discs removed in cases of disc herniation were investigated by polarized light microscopy. In about 4% of all cases crystalline deposits were detected. The crystals were characterized by different staining methods, scanning electron microscopy and X-ray diffraction. From the results it is concluded that the crystalline deposits are usually composed of calcium pyrophosphate dihydrate. With regard to the age of the patients it became obvious that there was an increased frequency of crystalline deposits with increasing age. Therefore it is assumed that calcium pyrophosphate deposits in intervertebral discs are an agerelated phenomenon as is known from chondrocalcinosis of other joints.


[Arthrosis of the sternoclavicular joint]. A comprehensive study of the sternoclavicular joints (SCG) of 120 autopsy cases comprising both sexes and all age groups has proved that this non-weight-bearing joint turns arthritic with increasing age. The degenerative lesions set on already from the 3rd decade; between 40 and 50 years of age, 84% of the joints are arthrotic, and over 70, all patients show an osteoarthrosis. Statistically significant relationships could further be demonstrated between SCG-arthrosis, aging, obesity, fatty degeneration of the liver, and severe arteriosclerosis.


[The detection of rheumatic factors by means of a new hemagglutination drop test (Cellognost-RF)]. A comparative evaluation was made in 510 sera to study the specificity and sensitivity of 5 different methods for the determination of rheumatoid factors. Special attention was given to the hemagglutination drop tests which are commercially available (Cellognost-RF and Rheumaton). Both hemagglutination slide tests, which are easy to perform and easy to read, were shown to be practically equivalent, and in comparison to the other methods, also showed a good agreement. This is as well applicable to rheumatoid arthritis as to non-inflammatory processes and internal diseases. In practice, Cellognost-RF and analogous hemagglutination slide tests are certainly good screening tests for the rheumatic factors. In combination with the also simple latex-slidetest, the detection of rheumatoid factors in rheumatoid arthritis is somewhat better, although not much. When both reactions are negative, it is not necessary to do any additional tests for the demonstration of rheumatoid factors. Should one or both, however, be positive, the titre determination using the hemagglutination reaction of Waaler-Rose or latex fixation test should be made if possible. In our investigations it was also in principle possible to do these titre determinations with Cellognost-RF.