[Intrahepatic pregnancy cholestasis. A contribution to the casuistics of the disease (author's transl)]. Jaundice, or icterus, during pregnancy is frequently a symptom of an intrahepatic cholestasis. It is evident from the literature that intrahepatic pregancy cholestasis represents a risk pregnancy with moderate risk to the mother and high risk to the foetus. Although diagnostic clarification is necessary, the authors sound a warning against liver biopsy during pregnancy.


[Fetal and infantile development of weight, height and constitution and the influence exercised by the placenta and the duration of pregnancy (author's transl)]. Fetal and infantile development of weight and height are studied in relation to period of gestation and weight of placenta. The body weight at birth was selected as a measure of fetal development, whereas the development attained at the age of 6 years served as a measure of intantile growth. Weight and height at birth increase only slightly with increasing duration of pregnancy, whereas there is no cchange in the weight at birth/placental weight ratio. The weight at birth increases with increasing weight of placenta. The quotient weight at birth/weight of placenta increases with a deviation of the weight from the average constitution (represented in this study by the relation between height and weight). Deviations from the mean weight, the mean body height and the mean constitution at birth are still noticeable even when the child has reached the age of six, although on the whole there is evidence of a tendency towards levelling-out. The weight at birth correlates more closely with the placental weight than with the body weight at the age of 6 years. The shorter the period of gestation, the higher the body weight at the age of six. This connection is explained by the action of the feeding centre which participates in both inducing parturition and in developing the body weight. There is no connection between placental weight and body weight at the age of six.


[Significance of Ureaplasma urealyticum in the sperm of fertility patients]. U. urealyticum was found in the semen of 12.9% of the patients, who attended a fertility clinic. Ureaplasma counts of more than 1,000 CFU/ml were demonstrated in 8.6% of cases. Non-specific genital infection caused by U. urealyticum was rarely diagnosed, and there was no correlation of the ureaplasma counts and the spermatological findings in cases without inflammation.


[The "rubtest" and RAST].

[The "rubtest" and RAST]. The "rubtest" to induce an immediate reaction with various inhalative and ingestive allergens has proved to be a very reliable, easily demonstrable and extremely simple method for detection of allergy-type I, especially of the "highest-sensitivity-type". Recent examinations confirmed the clinical importance and the high correlation between the "rub-test", the IgE-titre (RAST) and the endpoint-skin test-titration.


C-reactive protein (CRP), 9.5 salpha1-glycoprotein and C1q: serum proteins with lectin properties? The human serum proteins C-reactive protein (CRP), the 9.5 Salpha1-glycoprotein and C1q show, when tested in the agar gel diffusion under certain buffer conditions, strong precipitin reactions with polysaccharides of the galactan type, indicating that they may have lectin-like recognition sites.


[Recommendations regarding the standardization in m-mode- and two-dimensional echocargiography in the U.S.A. (author's transl)]. After a long discussion a standardization of quantitative measurements is m-mode echocardiography as well as standardization for displays of two-dimensional echocardiograms in the long and short axis views of the left ventricle was agreed upon in the U.S.A. in 1978. It seems to be reasonable to follow the recommendations in Germany also in order to have more uniformity in echocardiographic diagnosis. Standardization would help for the overall understanding of data between laboratories.


[Cutaneous thermography in changes of the peripheral vessels in traumatological practice (author's transl)]. The article reports on the method of cutaneous thermography in the diagnosis of superficial thrombophlebitis, acute and chronic thrombosis of the veins and arterial occlusion, in a case material of 80 patients. Cholesterol ester foils were used. Results indicate that this method supplies valuable information on local temperature increases thanks to its rapid, simple and non-hazardous application.


[Comments on the lateral load capacity of the phalangeal joints (author's transl)]. The article compares the load capacity of the collateral ligaments of the metacarpo-phalangeal and interphalangeal joints exposed to a laterally applied force. The tests were performed in vivo with 50 each female and male volunteers. It was found that the average load capacity of the metacarpo-phalangeal and interphalangeal joints in women was 5.8 kp and in men 12.3 kp. Furthermore, the bones of the long fingers with the preserved joint capsules and collateral ligaments of ten corpses were also examined, and the collateral ligaments exposed to a load which was increased to the point of their destruction. The average values found in this manner were 26.5 kp for the metacarpo-phalangeal collateral ligaments and 15.4 kp for the interphalangeal collateral ligaments. This means that the pain threshold is usually below the destruction limit, so that generally there will be no spontaneous overloading. It is important for the construction of endoprostheses that their stability level should always be above that of the pain threshold and should attain at least the values of the tear tests, since otherwise these endoprotheses will not function properly. These basic prerequisites enable a comparative study of endoprostheses, the results of which will be presented at a later date.


[Long-term results following synovectomy of the knee joint in rheumatoid arthritis (author's transl)]. Late synovectomy of the knee joint in rheumatoid arthritis is considered by many authors as a positive influencing factor with regard to the local development of the disease at that particular site. Since this assumption is based on evaluation criteria which are by no means uniform, it has so far not been possible to compare the individual results achieved by different authors. For this reason, we conducted follow-up examinations of 57 knee joints in 44 patients with rheumatoid arthritis in whom the synovectomy had occurred at least five years ago, using the standardised follow-up scheme devised by Gschwent et al. Most of these cases represented a late synovectomy, as was evident from the duration of the disease and from Steinbrocker's stages. An analysis of the results showed that in our patients, pain and swelling were most impressively improved, in accordance with the reports made by other authors. Less impressive was the improvement of mobility following synovectomy. Despite increasing instability, it was usually possible to improve the ability of the patients to walk, especially in cases where this ability had been severely restricted. X-ray films showed in almost one-half of the cases that the objective finding had deteriorated, whereas in the other half of the patients the status was largely unchanged or even improved. We can sum up these results by stating that, taking into consideration the comparable results published in the literature regarding late synovectomy of the knee joint in rheumatoid arthritis, a positive influence exercised by late synovectomy on the local pathology can be assumed.


[A contribution to the recording and study of the disease pattern of osteogenesis imperfecta tarda (author's transl)]. This study aims at investigating in a group of thirty-five patients whether osteogenesis imperfecta tarda presents a uniform disease pattern in respect of clinical and roentgenological criteria, or whether it can be subdivided into clinical groups. Depending on the severity of the disease, it was possible to subdivide this into two groups: a severe form of osteogenesis imperfecta tarda, and a bland form. This subdivision was effected according to the most conspicuous symptom of frequency of the fracture. The other symptoms do not allow any subdivision into groups since their occurrence is independent of the severity of the disease pattern.


[The isolated loss of extension of the great toe following osteotomy of the fibula (author's transl)]. A peroneal nerve palsy can be observed following operative procedures or traumatic lesions of the lower leg. Primary damage of the nerve must be differentiated from the tibialis-anterior syndrome and the pseudo-paralysis. Following corrective osteotomies of the tibia with dissection of the fibula in the upper or medial third isolated lesions of the extensor hallucis longus muscle can be seen. Electromyographic and anatomical studies reveal that they may be caused by an isolated damage of the motor nerve fibres connecting the deep branch of the peroneal nerve with the extensor hallucis longus muscle lying very close to the fibula. Suggestions how to avoid this damage are made in the paper.


[Spasm of the adductor muscles, pre-dislocations and dislocations of the hip joints in children and adolescents with cerebral palsy. Clinical observations on aetiology, pathogenesis, therapy and rehabilitation. Part II. The importance of the iliopsoas tendon, its tenotomy, of the coxa valga antetorta, and correction through osteotomy turning the hip into varus (author's transl)]. The following factors besides spasm and contraction of the adductor muscles contribute to the occurrence of dislocations of the hip in spastic paralysis: Spasm and contraction of the iliopsoas muscle and enhanced valgus position and antetorsion. The author holds the opinion that in case of malformation of the proximal end of the femur, it is not only the indirect action of the spastic musculature via the proximal femur-epiphyseal cartilage which is responsible for this phenomen in accordance with the law on functional adaption through longitudinal growth (Pauwels), but also the direct traction of the iliopsoas tendon. A clue in this direction is the often very pronounced elongation or enlargement of the trochanter minor. The author demonstrates the pathogenetic importance of iliopsoas contracture and malpositioning of the neck of the femur by means of analyses of the course in two patients. The following principles of treatment are postulated for spastic dislocation of the hip: Elimination of the pathogenetic factors through myotenotomy of the adductor muscles and complete resection of the obturator nerve, with observation of strict aftertreatment criteria, tenotomy of the iliopsoas, repositioning and osteotomy with turning into varus. Osteotomy without previous elimination of the pathogenetically acting muscular forces does not appear useful. Likewise, permanent re-positioning by means of muscle-relaxing operation cannot be sufficiently safe-guarded without additional osteotomy once the dislocation has taken place. In twelve patients with spastic dislocation of the hip, treated in accordance with these guidelines (two without osteotomy) aged 6 6/12 and 19 5/12 years, a roentgenologically good result was obtained in half of the cases, whereas the functional result was satisfactory not only with these patients but also with part of the other patients. If surgical treatment is instituted early enough, and if the experiences described here are taken into consideration, it is to be expected that the results will be even more satisfactory. The corset supporting the seated patient, developed by us, has been found very useful during the aftertreatment stage. A definite stand is taken against the therapeutic nihilism which leaves treatment of spastic dislocations to physiotherapy. It is also pointed out that indication for treatment is not represented only by the target of learning how to walk, but also by providing an overall improvement of the life situation of the patient, by either enabling him, or improving his ability, to sit or by "merely" improving the care of the perineum.


[A technique for reproducible roentgenograms of the intercondylar sulcus for the study of the femoropatellar (author's transl)]. Roentgenographic documentation of certain features of FP-joint geometry and orientation may serve as guideline in deciding on the form of treatment for chondromalacia or recurrent patellar dislocation. Reproducible conditions for taking roentgen films are equally important for this purpose as well as for quantitative measurements and possible statistical work. A new positioning device for the patient's legs has been designed utilizing a parallellogram frame. The roentgenographic technique for skyline views at 30 degree, 60 degree and 90 degree inclination of the central beam relative to the femoral axis is described. The advantages over previous techniques are the ease of handling the positioning frame, the need for only vertical and horizontal adjustment of the roentgen tube, independence of the type of tube or table, reproducibility of cassette and patient positioning.


[The anatomical GT sledge endoprosthesis Lübeck (author's transl)]. In case of complete or partial destruction of articular surfaces of the knee joint where the ligamentous apparatus is present but probably insufficient, alloplastic substitution of the articular surfaces is indicated. To achieve mobility as ideally as possible, it will be necessary to shape the endoprosthetic parts in such a manner that the healthy knee joint is imitated as closely as ever possible. The anatomical GT sledge endoprosthesis Lübeck (Grundei--Thomas) was conceived with this view in mind. To preserve the knee-joint as a functional unit, all of its compartments were taken into consideration, in particular also the articulatio plana, or arthrodial joint. To perform implantation of these endoprosthetic parts without improvisation, the implantates must be prepared in accordance with surgical patterns. The high functional demands made on the knee joint can only be met by completely abandoning the simplified schematic shapes and by producing articular surface substitutes imitating the normal anatomic joints.


[Urinary excretion of hydroxyproline during the healing period of bone fractures (author's transl)]. This article refers to the total hydroxyproline excretion during the healing period of bone fractures. The hydroxyprolyne excretion is twice as high in patients with fractures than in persons in good health. Its amount depends on the localisation of the fracture and the therapy chosen as well as the age of the patient. However, no significant therapeutic conclusions can be drawn from the quantitative analysis of hydroxyproline during the healing period of the bone fracture as far as the course of stabilization of the fracture is concerned.


[Lysosomal enzymatic changes due to intra-articular treatment with polyvalent proteinase inhibitors (author's transl)]. In 30 cases of disease of the knee joint (9 cases of rheumatoid arthritis, 14 arthroses and 7 cases of posttraumatic postoperative synovitis), the quantitative changes of the four lysosomal enzymes (acid phosphatase, lactic acid dehydrogenase, cathepsin and proteins) was observed in the course of intra-articular treatment with Gordox. It was evident from the analysis of the enzyme determinations conducted within 5--30 days at various times, and from the clinical results of the treatment, that in the cured or improved cases, all four enzymes were reduced (6 patients), whereas, in 16 cases, three of the enzyme levels had decreased. The enzyme titer remained unchanged in those patients who had been treated without success. Although these results do not as yet allow any final conclusions with regard to the mechanisms of action of Gordox administered intraarticularly, they do indicate that further and even more thorough studies in this direction should be conducted.


[A rare case of so-called idiopathic osteolysis associated with a lymphangioma of the fibula (author's transl)]. In a 70-year old female patient, a so-called idiopathic massive osteolysis with destruction of the proximal right femur within six months, was observed. Histologically, the following conditions were found at the time of resection: a stroma rich in fibres, with the inclusion of blood vessels, as well as an osteoclastic absorption which was still clearly active at the margins, besides marginally defined processes of bone formation. A good functional result without progressing osteolysis at the femur was achieved via a total endoprosthetic replacement of the right hip joint. Within the following three years, polycystic intramedullar osteolysis developed from a slight loosening of the spongiosa in the right head of the fibula. In contrast to the changes which had occurred at the femur, this was a clear case of a rare intraosseous lymphangioma.


[Surgical treatment of chondromalacia patellae according to Maquet/Bandi--indication, technique, results (author's transl)]. Degenerative changes of the femoropatellar joint are being observed increasingly more often. These may be due to various disturbances of the gliding movement and gliding plane. The article describes the clinical and x-ray symptoms and the therapy; in most cases, additional surgery will be necessary besides antepositioning according to the technique described by Bandi.--Follow-up examinations of 32 patients showed that in 28 of 35 surgically treated knee joints, a positive influence had been exercised on the complaints, load capacity and walking distance.


Current status of hormone receptors in human breast cancer. In an effort to improve the response rate to endocrine manipulation in patients with metastatic breast cancer, there has been vigorous inquiry into the mechanism of action of steroid hormones. The author discusses the value of receptor assays, specifically recommending the measurement of the estrogen receptor status of every breast cancer.


[Determination of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) in 2,4,5-trichlorophenoxyacetic acid, 2,4,5-trichlorophenoxyacetic acid-alkylesters and in the corresponding herbicide formulations (author's transl)]. A method is described for the determination of 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) in 2,4,5-Trichlorophenoxyacetic Acid (2,4,5-T), 2,4,5-T-Akylesters and commercial herbicide formulations containing these substances. TCDD is extracted from alkaline solution with n-hexane and purified by column chromatography on silica gel and Florisil. TCDD is determined by gas-liquid chromatography with EC-detection. For TCDD-additions of 20 micron/kg to herbicide formulations recoveries of dioxin are 96--104%. The detection limit is about 5 microgram/kg 2,4,5-T.


[Vitamin A in irradiated foodstuffs (author's transl)]. Vitamin A losses induced by 10 MeV electrons in cream cheese, calf liver sausage, pig liver, whole egg powder and margarine continued to increase during storage for 4--8 weeks in presence of air. Thus vitamin A loss in sausage irradiated with 5 Mrad was 22% on the day after irradiation, 61% after 4 weeks. Irradiation and storage at 0 degrees C instead of at ambient temperature reduced these losses considerably. Exclusion of air (vacuum, nitrogen) or irradiation on dry ice (approx. -80 degrees C) were even more effective in preventing destruction of vitamin A. After 4 weeks of storage, cream cheese irradiated at 5 Mrad had lost 60% when irradiated and stored in air at ambient temperature, 20% in nitrogen atmosphere, 5% in vacuum package, and 5% when irradiated on dry ice and stored at ambient temperature.


[Simultaneous determination of lysine, lysinoalanine, furosine, and pyridosine in food and feed (author's transl)]. A method for the simultaneous separation and determination of lysinoalanine (LAL), lysine, furosine and pyridosine with an automatic amino acid analyzer using a single Column 4 buffer- and 3 temperature-programme is described. The procedure needs 160 Minutes analysis time and allows a separation and quantitative determination of LAL, when present in amounts of more than 100 ppm (semiquantitative above 10 ppm). All amino acids found in food proteins and all other ninhydrinpositive compounds tested until now do not interfere with the determination.


[Assay of vitamin B1 in food and biological material (author's transl]. A fluorometric method for the estimation of the vitamin B1 content in food and biological materials is described. Acid hydrolysis is followed by enzymatic treatment to liberate the vitamin B1 of the sample. Interfering substances in the extract are removed to a great extent by chromatography on Amberlite CG 50, a weakly acidic cation exchanger. After oxidation and extraction into an organic medium, the fluorescence of thiochrome is measured. The procedure is simple, reproducible and not susceptible to interference. The recoveries are good.


[Analytical characterization of palatinit (author's transl)]. The reaction product of the catalytic hydrogenation of isomaltulose (palatinose) is a mixture of alpha-D-glucopyranosido-1,6-sorbitol and alpha-D-glucopyranosido-1,6-mannitol designated palatinit. Because of its high potential as a sugar substitute methods for the identification and characterization of hydrogenation products and for the determination of palatinit as an ingredient in food preparations and biological samples are required. Several working procedures are described in full detail including thin layer and gas chromatography as well as enzymatic and chemical determinations.


[Suicide in Switzerland 1876-1977].

[Suicide in Switzerland 1876-1977]. To make statements about the evolution of suicide frequency, one has to analyse long periods. The Federal Bureau of Statistics disposes of data since 1876. When treating the statistics material of such as long period, changes in the "dark-numbers" have to be considered for they can simulate (false) tendencies. There are various reasons to assume that the dark-numbers today are smaller than at the end of the last and at the beginning of this century. A separated analysis according to age-groups brings more specific results for the size of the dark-number as well as its changes varies from age-group to age-group. In Switzerland the suicide rate of males above 30 years of age is low presently than at the begining of this century, whereas the suicide rate of males below 30 years (without regard to fluctuations) is practically the same. Since the Second World War, the suicide rate of females oscillates within a range of near-constancy. Prospective statements cannot be made. The calculated suicide rates since 1971 are only provisonal, for the basic population sizes are estimated.


[Suicide prevention: role and efficacy of telephone assistance services]. This paper deals with the effectiveness of emergency telephonic help services in suicide prevention; it gives an historical account, describes the activity of Geneva's "Main Tendue" and proposes some practical principles on emergency telephonic help. 41 calls of 35 callers of Geneva's telephonic help service are briefly analyzed. A review of the literature available on this subject leaves a pessimistic impression about effectiveness of such services.


[The increase in suicide in psychiatric hospitals. Facts, causes and prevention]. In the psychiatric clinics of five countries and in ours as well, suicides have significantly increased since the twenties, and many times more than in the general population. This trend is probably not due to change in the sociographic and diagnostic composition of admitted patients but to more liberal hospital treatment and more active rehabilitation. In order to prevent suicide in the clinic, it has to be kept in mind that what proves to be an asset for the great majority of patients may be detrimental for a minority.


[Suicide and endogenous psychosis].

[Suicide and endogenous psychosis]. The frequency of suicide among a population of 675 patients with functional psychoses, within a period of observation between 9 and 24 years, was 5.5%. Suicide was the cause of death in 25.6% of all lethal outcomes. The suicide frequency of schizophrenics was 1.4%, of the bipolar cases 2.4% of the monopolar depressives 10.4%. The frequency of suicide of the parents and sibs of schizophrenics was 1.3%, of schizoaffectives 3.8%, monopolar depressives 4.2%, bipolar affective psychotics 4.3%. There was no sex difference in regard to suicide frequency but in regard to the choice of suicide means (strangulation in male, poisoning and submersion in female relatives).


[Suicidal thoughts, personality structure and social problems in 19-year-old Zuricher adolescents]. A sample of 586 19-year old male adolescents from the canton of Zurich was examined 446 of the adolescents surveyed, i.e. 76.1%, indicated that they had never entertained thoughts of suicide, while 140, i.e. 23.9%, had already thought of commiting suicide. These two groups are compared with regard to various personal und sociographic data, as well as to their personality structure. The significance of important conflicts leading to thought of suicide is discussed.


[Attempted suicide and care channels: towards a comprehension of therapeutic measures]. The authors study the various aspects of the 484 attempts of suicide examined over the year 1974 at the Psychiatric Policlinic of the Geneva Cantonal Hospital. After having established the specific data inherent to this population, the main object of this paper consists in studying the different kinds of previous treatments given and their reconduction or modification following the suicide attempt. The influence of both the "suicidal story" and further parameters is approached. Some learnings as to the therapy to be applied are drawn from the results achieved.


[Suicide attempts in the Fribourg Canton. II. Suicide attempts in patients of the Marsens psychiatric hospital in the period from August 1st 1977 till July 31st 1978]. Subject of these two papers are the suicidal attempts in the Canton of Fribourg: - The first considers their admissions to the Cantonal Hospital at Fribourg. - The second, to the Psychiatric Clinic at Marsens This is a relatively restricted choice because may patients do not come to these hospitals. They are examined by a general practitioner or admitted to a private or a district hospital. The first paper analyzes the personaltiy types and emphasizes the rapidity of medical intervention and the cooperation between psychiatrists and other physicians and health personnel. The second paper is a statistical attempts, their numbers and their repetition, according also to the sex of the patients. Some considerations are made on preventive measures.


[The future of suicidal patients admitted to a general hospital. Comparative study of 2 methods of prevention recurrence and of suicides]. This is a comparative study of two groups of suicide attempters admitted in a general hospital, who were treated in different ways. The 143 attempters of the "systematically treated group (STG)" were proposed the classical therapeutic measures (supportive psychotherapy, psychiatric hospitalization, crisis interventions within couples or families, mixed interventions with the above treatments, psychoanalytically oriented psychotherapy, etc.), plus ambulatory controls (a few days after discharge from the general hospital, after one month, three months, six months, a year, and two years). The 145 attempters of the "reference group (RG)" were proposed the classical measures only. All the attempters of both groups had a follow-up after two years. The results suggest the controls to be probably responsible for the difference of relapses and committed suicides between the two groups. More indirectly, this study facilitated a further analysis of the relational problems between suicide attempters and staff, and among staff members themselves. The consequences were a modification of some attitudes of the staff toward the attempters and their significant others, and a new collaboration for an interdisciplinary clinical research.


[The Psychiatric and Social-Communication Record, an instrument for the standardized inventory of neurotic findings]. The comparable documentation of neurotic conditions is a supposition for the scientific access to neuroses, especially concerning psychotherapy research and epidemiology. Efforts on this field have rarely brought satisfying results. This paper shows the construction and the application of a documentary scheme, which describes neurotic conditions under a psychoanalytic point of view and accentuates the aspect of interpersonal relationships: The psychic and socialcommunicative report (PSB). In contrast to other charts, PSB avoids the use of psychoanalytic theory and of psychopathological terms and describes neurotic traits in everyday-language, which makes the system easy to use. After the psychoanalytic interview the investigator or therapist does a rating of the 82 PSB-items. This gives both a quantitative and qualitative description of the neurotic disease. In several projects including follow-up studies of psychotherapy-patients PSB-instrument was useful for important questions of psychotherapy research. The combination of PSB with documentation of patient's life-data allows correlation of "soft" personality-data and "hard" social data. In medical student's training PSB helps to teach systematic examination of neurotic patients.


[Money in psychoanalytic treatment].

[Money in psychoanalytic treatment]. The appreciation of money as a medium of exchange strongly depends on the experienced type of reciprocal action between individual and environment. Money claims during treatment activate problems in particular with primary reference persons, but also with the enlarged cultural milieu and cause a structural specific experience and elaboration both with the patient and the therapeutist. The chances and dangers of treatment paid by the insurance have already been pointed out.


[Psychoanalytic setting and technic as forms of interpersonal relations]. Psychoanalytic attitude, technique and setting are considered forms of real human interaction which the patient will internalize during the course of analysis. Using case material, some of the aspects of "classic" technique are compared to different forms of pathogenic interaction in the patients' families. It can be demonstrated that the same behavior on the part of the analyst can have quite different effects, depending on the interaction pattern internalized. Some aspects of technique may effect a new interactional experience or may be re-traumatizing or may be a joint acting out of a defense pattern. As the effect will mostly be due to the previous experience of the patient, not a general change, but flexibility in the use of technique is warranted. Such flexibility would also be apt to prevent "professional deformation" (Déformation professionelle) in the analyst.


[Psychodynamics of psychogenic somnolence (secondary narcolepsy). Case report]. The therapy of a patient suffering from secondary narcolepsy is described. The illness and the function of the symptom as a defense-mechanism are analysed. Sleep appears to be an ontogenetically archaic reaction to extreme--real and neurotic--dangers, which there is not possibility to escape from. The defense against extreme dangers is the withdrawal of all object-cathexis; following Freuds explanations this means: Sleep. In the patient the danger consisted of a regression to a narcisstic position: The symptom helped to avoid a separation of instincts in form of on the one hand narcisstic rage, on the other hand symbiosis. Taking into account the ideas of Spitz, the concept of fusion and separation of instincts is discussed.20


[An undisguised case history in an example of contemporary literature. Psychoanalytic reflections on K. Struck's "The Mother"]. The novel "The Mother" by K. Struck describes the protagonist's intensive experiences between her great desires, disappointment and hatred. In this connection her own disturbed child-mother relation and its negative effects on her relation towards other persons and her mother role is revealed. Thy are explained by psychoanalytic principles.


[Selected aspects of percutaneous renal bipsy]. In connection with the complications after percutaneous renal biopsy is reported on a collecting statistics in which 16,644 renal biopsies are analysed which are performed in 51 nephrological centres of the GDR. On the basis of the same material the question was examined to what extent the frequency of biopsy has influence on the complication rate. With the help of an own investigation material of 3,122 renal biopsies the importance of the puncture of neighbour organs of the kidney is examined which with 3.3% is indeed relatively often, but is apparantly of only insignificant clinical relevance. Summarizing the contraindications of the renal biopsy are described, and the indications, issuing from the practical necessity and the importance for the patient are explained. The problem of the repeated biopsies is discussed under the aspect of the statement ability and the influence on decisive changes of therapeutic measures.


[Removal of substances with low and medium molecular weight by repeated application of C-DAK-capillary  dialysers]. The capillary dialysator type C-DAK (Cordis Dow Mod. 4) can according to the regeneration method described be used three times as valid membrane for the elimination of the small as well as of the medium-sized molecules from the serum in the same patient.


[Hemodynamic changes during ultrafiltration and hemodialysis in uremia]. 1. The ultrafiltration causes a reduction of blood pressure and minute output of the heart which is compensated by vasoconstriction and thus a decrease of blood pressure is prevented. 2. Changes in the salt concentrations with reduction of the osmolarity during the dialysis without simultaneous ultrafiltration lead to vasodilation and hypotension despite increase of the minute output of the heart. 3. During a usual haemodialysis (i.e. dialysis with simultaneous ultrafiltration) the vasodilating effect of the dialysis may abolish the vasoconstrictive effect of the ultrafiltration and thus may be the cause of the hypotension.


[Dialysis costs. 2. Ward-integrated dialysis]. It is described how with a small personnel and material expenditure in a nephrologic ward since several years haemodialytic therapies are performed successfully and effectively. The expenses for this form of dialysis integrated into the ward were compared with those in the dialysis centre. Demands of cost and personnel are essentially lower. In this paper the suggestion shall be given to test the organization of similar dialysis units in other places. The fund at disposal would then used more rationally and the degree of care for patients who need this therapy improved.


[Automatic regeneration of capillary dialysers]. First results of an automatically working regeneration apparatus for capillary dialysators in 200 dialyses allow the on an average tenfold use of the dialysator CDAK 4. In this case a reduction of the effective surface to 70% of the initial value must be taken into bargain. Pyrogenic reactions or bacterial contamination of the regenerated dialysators were not taken into consideration. This method is recommended as transitional solution up to the industrial production of cheap dialysators for a single use.


[Treatment of glomerulonephritis].

[Treatment of glomerulonephritis]. The therapeutic effect of the prednisone therapy, of the short-time (duration of treatment 2-4 months) and of the long-term (duration of treatment 1.5 to 2 years) imuran and prednisone therapy was investigated on 218 patients with chronic, functionally compensated glomerulonephritis. The importance of the urine symptomatology for the control of the therapeutic success and for the prognosis of the disease was elaborated. Corresponding to the clinical picture the experiment of a clinical classification of the chronic glomerulonephritis was performed.


[Lactation inhibition by the early postpartum administration of Methylergobrevin]. Lactation was found to be significantly inhibited by greater than or equal to 2.0 mg methylergometrin-bimaleinate administered during the early postpartal period, particularly when the treatment was started as early as on the first or second day of puerperium. Therefore, such ergometrin treatment should be avoided as far as possible in order to improve breast-feeding, which was shown to be of great importance for the mental, psychic and physical development of the newborn.


[Normal values of fetal heart rate in the 5th to 18th weeks of pregnancy (in vivo and in vitro studies)]. The normal values of the foetal heart rate (FHR) in early pregnancy were determined in utero by Doppler ultrasound technique and in vitro on isolated, in nutrient solution surviving, foetal hearts obtained from termination of pregnancy. The early heart rate was found to be surprisingly high in 354 successful ultrasonic examinations. In the eighth week the average FHR was 178 min-1. In the course of pregnancy there was a gradual decrease in FHR and in the 17th-18th week it reached 140 min-1 characteristic of the human foetus. Similar data were obtained under in vitro conditions.


[Relation between the biparietal diameter, thoracic transverse diameter, birth weight and the sex of the infant]. We have found in ultrasonic measurements, that the birth weight from newborn males and females is equal, if the biparietal diameter of the fetuses had been the same. Opposite we found by measuring the equal thoracic transversal diameter, that the birthweight of the males was about 200 bis 300 g higher than that of the females.


[Detection of the RDS risk from postnatally sampled stomach contents]. The results of foam tests carried out on postnatal stomach contents from 267 neonates were analyzed to see whether a correlation can be found between the incidence of RDS and the foam-test values. The test proved to be a good indicator in the recognition of RDS. If ++, + positive, on negative foam-tests are obtained development of RDS can be expected in about 60% of the cases. By this quick and simple test neonates with the risk of RDS can be screened off and transported in time to centres of intensive care.


[Further study of the effectiveness of oral immunization against plague in experiments on animals]. It was shown in comparative experiments on guinea pigs that the oral method of immunization with plague vaccine was much less effective than the inhalation and subcutaneous. Guinea pigs were found to be a poor model for studying the efficacy of oral immunization with dry live plague vaccine rehydrated before use: with the use of this preparation the animals were 46 times less resistant to aerosol plague infection than in application of strain EB cultured in agar.


[Comparative study of different types of rosette-forming cells in human peripheral blood and tonsils]. E-, EA-, and EAC-reaction of rosette formation and detection of surface immunoglobulins were applied to the comparative study of the peripheral blood lymphocytes populations and tonsils in man. The relative lymphocyte content with different surface characteristics differed significantly in these populations. In detection of surface immunoglobulins on EAC-rosette forming cells it was revealed that not all the C3-lymphocytes of the tonsils bore surface Ig. A possibility of appearance of the C3-receptor on the activated T-lymphocytes is discussed.


[Cytomorphologic and other indices of immunogenesis in guinea pigs vaccinated with different doses of EB culture]. Experiments were conducted on guinea pigs. There was shown an association between the results of nonspecific immunity development, the character of cell differentiations, the specific immunity intensity, and the microbial dose at the immediate postvaccination periods; retention of immunological memory at the late postvaccination periods was demonstrated. With increase of the dose differentiation of the erythroid cell series was disturbed and the macrophage activity decreased. Transformation of lymphoid elements in the direction of immunologically active lymphocytes and plasma cells was more active at the initial periods; this accelerated the development of specific immunity, but had a negative effect on its efficacy at the late postvaccination periods.


[Etiology and pathogenesis of multiple sclerosis]. The features of the clinical picture and pathomorphology are analysed in 23 patients with disseminated sclerosis (in the acute, subacute and chronic phases). A clinico-anatomical observation of a subacute development of disseminated sclerosis is described in detail. Certain arguments distinguishing the subacute form of disseminated sclerosis of an infectious allergic nature are given (the traits of the clinical picture, morphological changes in the nervous system in the form of combined micronecrosis, pericellular oedema, different degrees of lymphocyte infiltration, extensive areas with accumulated oligodendroglia or fibrillar astrocytes with fresh and old foci of demyelinization).


[Functional activity of lymphocytes in multiple sclerosis]. The paper is concerned with the functional activity of blood lymphocytes in the reaction of blast-cell transformation encountered in 17 patients with disseminated sclerosis and in 17 normal donors. The synthesis of lymphocyte DNA was measured by the radioisotope method and its increase under the impact of PHA. The stage of exacerbation of the disease was characterized by a significant increase of the DNA synthesis under the impact of DNA compared to the remission stage. The same regularities were found in the same patients examined both in the stage of remission and exacerbation. A higher degree of increased DNA synthesis under the impact of PHA is assessed as an index of lymphocyte sensitation. The possible role of lymphocyte sensitation in the pathogenesis of exacerbations of disseminated sclerosis is discussed.


[Immune complexes in multiple sclerosis and experimental allergic encephalomyelitis]. Immune complexes in the blood serum were determined in patients with disseminated sclerosis and in dogs in the process of experimental allergic encephalomyelitis. In disseminated sclerosis the existence of immune complexes was found in the exacerbation period and their absence in remissions. In animals with clinical signs of experimental allergic encephalomyelitis the immune complexes began to be established in the period of sensitization and attained the maximum in the preparalytic and paralytic period. In animals without clinical signs, the immune complexes were determined later and in insignificant amounts. The role of immune complexes in the pathogenesis of exacerbations in disseminated sclerosis and development of experimental allergic encephalomyelitis as factors involved in the disturbances of permeability in the hematoencephalic barrier is discussed.


[Electroneuromyographic study of the spastic-ataxic syndrome in multiple sclerosis]. Electroneuromyographical studies were performed in 39 patients with atactic-spastic and mixed forms of disseminated sclerosis. The examinations detected a drop in the velocity of impulse conduction along the tibial nerve in spastic forms and an increase in the velocity of impulse conduction along the medium nerve in atactic forms. The most pronounced were changes in velocity of afferent conduction. The data obtained were compared with electroneuromyographical studies in atactic and spastic syndromes of different origin.


[Correlation between brain lesion lateralization and immunologic indices in a model of experimental allergic encephalomyelitis]. The report contains new data, concerning checking of concepts of interdependence in the reaction development of humoral and cellular immunity from the lateralization of the affected hemisphere (Chuprikov, 1974). A comparative analysis of immunological indices in a local affections of different cortical zones detected that the influence of regulating mechanisms on the cortical level is accompanied by less expressed effects than on the behalf of the hypothalamo-limbic structures. The dominating influence of the left hemisphere was expressed on the development of humoral antibrain reactions while the right hemisphere demonstrated a prevalent influence on the development of reactions of a retarded type to normal and encephalitogenic antigens from the brain.


[Late sequelae of tuberculous meningitis]. The paper contains a clinico-morphological description of a case with late sequelae of treated tubercular meningitis. The patient at 7 years of age had tuberculous meningitis which was treated by suboccipital and endolumbar administration of streptomycin. Following 12 years, epileptical seizures ensued with an eventual gradual weakness in the extremities leading to profound spastic tetraparesis. During the last years of life contractures and stem symptoms developed. The morphological picture was characterized by posttuberculous fibrous leptomeningitis with an extensive internal hydrocephalus, universal sclerosis of the cerebral and spinal vessels, disseminated demyelinization in the spinal cord and brain, a distinct improverishment of the grey matter by ganglionic cells. The result of liquorohemodynamical disorders was a syringolike cavity in the spinal cord. Under the ependima of the laral ventricle calcified cholesteatomas were found, which are considered as complications of suboccipital punctures in administering streptomycin.


[Cytotoxic effect of the serum of amyotrophic lateral sclerosis patients on spinal cord motoneurons in tissue culture]. Organotypical cultures of the spinal cord of the fetal mouse were used to study the neurocytotoxic effect of sera from patients with amyotrophic lateral sclerosis (ALS). Sera from 16 patients with ALS were used in two experiments: 1. short-term treatment (up to 6 days) of the mature cultures with nutrient medium containing 30% of ALS serum; 2. long-term cultivation from the explantation up to 4 weeks of spinal cord in the medium containing 5-25% of ALS serum. No specific neurotoxic effect of ALS sera on the motor neurons of the cultured spinal cord were observed in acute or chronic experiments.


[Toxoplasmosis hypothalamic syndromes in children]. Immunological studies of 1245 children with diseases of the nervous system and their mothers detected that in 9.0 +/- 0,7% they were due to toxoplasmosis. Clinico-physiological studies of 144 children with inborn neurotoxoplasmosis demonstrated that in pre- and pubertal periods the prevalent symptoms may be disorders of the hypothalamus. The clinical traits of toxoplasmotic syndromes in children are described.


[Electromyography in spastic torticollis]. The EMG characteristics of convulsive activity in the sternocleidomastoid muscle in spastic torticollis vary in different stages of the disease. At the onset of the disease, the bioelectric muscle activity which accomplishes an involuntary turn of the head is registered. Eventually, as the morbid areas of myopathosis are formed in the "active" muscles and muscles preventing an involuntary turn, the electrogenesis of the latter becomes dominating. It is assumed that at the basis of this phenomenon lies a lowering of the excitation threshold in the neuromotor apparatus in the respective group of muscles with an appearance of a peripheral subordinating factor.


[State of general and cerebral hemodynamics in patients with ischemic strokes]. In 64 patients with ischemic strokes that occurred on the background of atherosclerosis (33) and a combination of atherosclerosis with arterial hypertension (31) using the dilution method of Evans's blue the authors studied indices of general hemodynamics compared to rheoencephalographic data. Twenty similar patients without signs of brain circulation disturbances and 20 healthy persons were taken as control groups. In 69% of the patients with ischemic strokes deep disturbances of general hemodynamics were observed. An increase of tonus, a decrease of elasticity of cerebral vessels and deficit of pulse blood repletion were determined rheoencephalographically. Insufficiency of general hemodynamics in conditions of changed autoregulation of brain circulation promotes development of ischemic disorders of brain circulation and unfavourably influences the course and outcome of the stroke.


[Serum immunoglobulins of drug addicts and alcoholics]. In 34 patients with polyaddiction, 30 with hashishaddiction and 10 opiateaddiction and in 6 patients with chronic alcoholism the author studies the content of serum immunoglobulins of class A. M. G. The studies established that the content of IgA is increased in patients with polyaddiction, chronic alcoholism. An increase of IgA in the blood serum is marked in hashishaddiction, opiateaddiction and chronic alcoholism and its increase in opiateaddiction and polyaddiction. The character of changed serum IgM depends upon the type of addiction: it is increased in opiateaddiction, decreased in hashishaddiction and chronic alcoholism and not changed in polyaddiction.


[Effect of of alcohol on male sex glands]. The influence of alcohol on the sexual glands was studied in 708 males. The control group consisted of 138 individuals who denied alcohol consumption. The age of the individuals studied was 21-50. It was established that alcoholic beverages evoke degenerative changes in the sexual glands which are more pronounced in males who began to consume alcoholic beverages in the period of sexual function formation. Degenerative changes are more distinctly marked in males with a history of epidemic parotitis. Changes in the sexual glands due to the influence of alcohol intoxication lead to disorders of sexual function spermatogenesis and sterility.


[Effect of small doses of alcohol on emotional stress in patients with late sequelae of cranio-cerebral injuries]. An experimental study of individuals with late sequelae of closed cerebrocranial trauma, demonstrated that diverse signs of CNS activity to a different extent may be under the influence of small doses of alcohol. For instance, the sensorial process does not change significantly, which may indicate a relative independence of specific sensorial pathways (including the cortical area) from small doses of alcohol. Changes in cortical electro-activity and the threshold of the orientation reflex, the mechanisms of which are connected with the function of the brain stem reticular formation, points to an inhibitory action of alcohol on it. Against the background of alcoholic influence the socially significant emotionally negative stimula intensify emotional stress, the action of which is related to the activity of the limbic system structures and a weakening of the function of associative cortical fields. The results of this study permit to assume that different functional-structural mechanisms may lie at the basis of an emotional background (mood) and emotional stress.


[Induced visual hallucinations and visual adaptation disorders in patients with delirium tremens]. In 91 cases of alcoholic delirium, acute alcoholic hallucinosis and alcoholic withdrawal conditions, a clinico-experimental study of the formation of evoked visual hallucinations was conducted with the aid of a dozed compression of the eye (a modification of Lippman's test). The following 3 stages in the development of pseudoperception are described: sensorial, hallucinoid, hallucinatory. A parallel study of visual dark adaptation (40 cases) and brain bioelectrical activity (37 patients) detected 7 pathological types of changed time of visual dark adaptation and disorders of brain bioelectrical activity. These factors are connected with conditions of sensorial disadaptation, having a clinico-diagnostic significance.


[Latent endogenous depressions in adolescents]. A clinico-catamnestical study of 200 adolescents with depressive conditions in endogenous psychoses revealed 28 patients who suffered from schizophrenia and manic-depressive psychosis with manifestations of larvate depressions. It was established that larvate depressions in adolescents in the majority of the cases proceed with disorders of behaviour and poor school progress. The clinical picture is characterized by diverse somatic complaints in the absence of actual somatical pathology. Larvate depressions in adolescents differ significantly from similar states in adults, inasmuch as poor progress in school is due to disorders of cognitive activity during the disease.


[Clinico-psychopathologic features of amentia in kidney diseases]. The paper contains some results of a clinico-psychopathological analysis of the amentive syndrome in patients with nephrogenic psychoses. Among 97 patients studied 25 showed amentive states. Pathogenetic possibilities of uremic toxicosis, depending upon the intensity and severity of which the amentive symptomatology may develop in different ways is discussed. The pathoplastic significance of renal hypertension is described in detail. Two variants of nephrogenic amentia are distinguished and described (hyperkinetic and hypokinetic) which differ by their intensity of psychotic symptoms, rate of development and the severity of the outcome. It is demonstrated that the amentive syndrome in such cases has certain nozological information, which facilitates significantly a differential diagnosis.


[Effect of dehydration therapy on intracranial pressure and local cerebral blood flow in hemorrhagic stroke and cranio-cerebral injuries]. The degree and duration of the effect of dehydration therapy on intracerebral pressure and local cerebral blood flow were studied. The record was taken by means of an original combined sensor implanted into the brain tissue during neurosurgical operations in patients with acute disorder of cerebral circulation of the hemorrhagic type and severe craniocerebral trauma. Urea, mannitol, and glucose were applied as the dehydration agents. They were infused intravenously with due account for the initial values of intracerebral and arterial pressure.


[Results of mass spectrometry studies of oxygen and carbon dioxide tension and blood flow in the brain tissue of neurosurgical patients]. The results of composite appraisal of the tissue tension of oxygen, carbon dioxide, and regional blood flow in the brain of 21 patients during the early period after neurosurgical operations are discussed. The dynamics of the efficacy indices of the cerebral circulation and gas exchange were studied during intensive therapy of postoperative pathological conditions. It was established that the use of some of the components of intensive therapy in severe intracranial pathological conditions is attended with changes in cerebral gas homeostasis.


[Dynamics of components of the kallikrein-kinin system in the arterial and venous blood and cerebrospinal fluid of patients with severe cranio-cerebral injuries]. Comparative study of the activity dynamics of the components of the kallikrein-kinin system in portions of blood flowing to the brain and draining from it and in the cerebrospinal fluid was carried out in 26 patients with a severe craniocerebral trauma. It was found that activation of the system is displayed by a considerable increase in spontaneous esterase activity, a fall in the activity of kallikrein inhibitors, and a decrease in the content of prekallikrein and kininogen. The degree of activation depends on the severity of the lesion, reaches the maximum level by the 3rd--4th day of the development of the pathological process, and is manifested most fully in blood draining from the brain.


[Selective catheterization and embolization of the branches of the external carotid artery in neurosurgical clinical practice]. A method for selective catheterization and angiography of the branches of the external carotid artery and their subsequent embolization is described. Selective catheterization of arteries for diagnostic and therapeutic purposes was carried out in 148 patients (183 vessels). Embolization of the branches was performed in 79 patients, a total of 111 arteries were occluded. The method was successfully used in the treatment of arteriosinusal anastomoses and arteriovenous aneurysms supplied with blood from the branches of the external carotid artery, severe nasal hemorrhages, and as a first stage before operation for richly vascularized meningiomas, angiomas of the maxillofacial region, and tumors in the region of the neck.


[Variants and developmental anomalies of the odontoid process of the axis]. Clinical and X-ray examination of 140 persons demonstrated a wide range of developmental disorders of the odontoid process, from neglible deviations from the average normal structure to total absence of the process. From the pathogenetic standpoints, some of the variants may be characterized as possessing normal structural features, others are developmental anomalies and defects which call for suboccipital decompression, laminectomy for freeing the compressed bulbarspinal parts of the brain or stabilization of the disturbed craniovertebral relationship.


[Surgical anatomy of the stellate ganglion]. Peculiarities in the shape, size, and skeletotopy of the stellate ganglion were revealed in examination of 56 specimens collected from cadavers of adult humans of both sexes differing in age. The topographo-anatomical interrelationship of the stellate ganglion and the structures surrounding it may be conducive to the development of the "sympathological cervico-ganglionic phenomenon" the clinical picture of which is due to circulatory disorders in the vertebrobasilar basin.


[Primary multiple brain neoplasms].

[Primary multiple brain neoplasms]. A rarely encountered case of primary multiple brain tumours is discussed: polymorphic cellular astrocytoma of the frontal and temporal lobes of both hemispheres of the brain and fibroblastic arachnoid endothelioma of the right temporal area. Intravital diagnosis of such tumours was extremely difficult due to the prevalence of general suprafocal symptoms in the brain.


[Pressure in intracranial saccular aneurysms in the presence of hypotension]. The pressure in saccular aneurysms of various localizations was studied in 6 patients during neurosurgical operations. The systolic, diastolic, mean, and pulse pressure in aneurysms with a wide neck corresponded to systemic pressure; in aneurysms with a narrow neck (3 patients) they were lower. In occlusion of the carotid artery on the neck, the pressure in the anurysms decreased. Pulsations disappeared in 3 patients. Fourteen patients with aneurysm of the internal carotid artery were followed-up for 2--17 years, after ligation of the carotid artery on the neck. There were no recurrent hemorrhages. Despite the clinical effect, however, due to possible complications this operation has limited indications (subclinoid aneurysms, refusal of patients to undergo intracranial operations).


Adrenergic inputs to the amygdala and the control of gonadotrophin release. Drugs able to mimic or to antagonize the action of catecholamines have been implanted bilaterally into the basomedial region of the amygdala of adult castrated female rats. The animals were killed at different intervals after the implantation of the different drugs, and serum levels of LH and FSH were measured by radioimmunoassay. The results have shown that the intra-amygdalar implantation of the alpha-adrenergic blocker phenoxybenzamine induces a significant increase of the release both of LH and FSH. The implantation of the beta-adrenergic blocker propranolol brings about a rise of LH only. The dopamine receptor blocker pimozide stimulates the release of LH and exerts a biphasic effect (stimulation followed by inhibition) of FSH secretion. The alpha-receptor stimulant clonidine and the dopaminergic drug 2-Br-alpha-ergocryptine were without significant effects. From these observations it is suggested that the adrenergic signals reaching the basomedial area of the amygdala (possibly from the brain stem) may be involved in the modulation of gonadotrophin secretion.


The influence of amino acids and somatostatin on prolactin and growth hormone release in man. The effect of an iv load of individual amino acids (alanine, arginine, histidine, leucine, phenylalanine, and valine) on serum prolactin (Prl) and growth hormone (GH) concentrations was studied in healthy adult males (n = 5). A rise in both, Prl and GH with a maximal increment of 15.9 +/- 6.7 (SE) ng/ml, and 12.4 +/- 4.9 ng/ml above basal levels, respectively, (P less than 0.05) was observed after iv arginine. Following iv phenylalanine the mean peak level of Prl rose from 9.9 +/- 3.5 to 29.9 +/- 7.3 ng/ml (P less than 0.01), whereas GH concentration remained unchanged. Iv leucine however induced an immediate rise in GH, but not in serum Prl. Serum concentrations of both, Prl and GH, failed to increase upon the infusion of either alanine or histidine or valine. Additional somatostatin administration starting prior to amino acid infusion diminished the amino acid induced increase of both Prl and GH release.


Effect of androgens on prolactin (PRL) release in humans. In order to evaluate whether androgens were able to affect PRL release, testosterone and dihydrotestosterone were injected intramuscularly in male and female subjects. PRL blood levels were not modified by testosterone either in healthy males or in amenorrhoeic women, and PRL release in males proved unaffected by dihydrotestosterone at the dose used.


Non-suppressible insulin-like activity in Laron's syndrome. Severe growth retardation is found in patients with high levels of growth hormone and low sulphation factor activity or somatomedin. Also non-suppressible insulin-like activity (NSILA-s) has been found to be very low in a patient with this condition as measured by bioassay, protein binding assay and radioimmunoassay and to be below activities found in hypopituitary patients. Partially purified NSILA-s restored the ability of serum to increase sulphation activity although full restitution may still depend on other factors. These findings support the hypothesis that NSILA-s belongs to the family of somatomedin and thus is involved in promoting growth, and that low activity of these growth factors is a primary cause of the growth retardation found in these patients.


Sex and age correlated reference values of serum thyroglobulin measured by a modified radioimmunoassay. The aim of the present investigation was to describe variations in serum thyroglobulin in relation to sex and age in a group of normal persons. The method used was a modified double antibody radioimmunoassay characterized by pre-incubation at 37 degrees C of standard or sample with antiserum, resulting in a reduced total incubation time. Both sensitivity and precision were comparable to other published methods. Of the 152 blood-donors initially investigated, 7 were excluded due to the presence of antithyroglobulin antibodies as evidenced by a radioassay. Both sexes were equally represented with an even distribution of ages from 20-65 years. Increased serum thyroglobulin with increasing age was demonstrated, the correlation being significant in women (Kendall's tau, P less than 0.001). Detectable concentrations of serum thyroglobulin (above 1.7 microgram/1) were found in 94%. Based on the logarithmic transformation, the upper reference limits were determined for men less than or equal to 40 years: 36 microgram/l, greater than 40 years: 44 microgram/l (difference between groups not significant, P greater than 0.05), and for women less than or equal to 40 years: 30 microgram/l, greater than 40 years: 60 microgram/l (significant difference, P less than 0.005).


Bone mineral loss in insulin-treated diabetes mellitus: studies on pathogenesis. To elucidate pathogenetic factors of bone mineral loss in diabetes mellitus, bone mineral content (BMC), glucose and calcium homeostasis were evaluated in a cross-sectionsl study of 215 insulin-treated diabetics. BMC declined 10% during the first 5 years of diabetes. This coincided with cessation of insulin secretion, deterioration of metabolic control and raising urinary calcium excretion rates of calcium and phosphorus. BMC was inversely correlated to fasting blood glucose (P less than 0.02), to glycosuria (P less than 0.02) and to insulin requirement (P less than 0.002), and positively to the glucagon-stimulated serum C-peptide levels (P less than 0.005). Urinary excretion rates of calcium and phosphorus correlated positively with the degree of hyperglycaemia (P less than 0.001) and glycosuria (P less than 0.001). The skeletal calcium loss corresponded to the excess of urinary excretion during the phase of BMC reduction. There was no evidence of secondary hyperparathyroidism. The relationship between bone loss and disturbed glucose homeostasis indicates that diabetic bone loss is secondary to the metabolic abnormalities, possibly acting directly on bone.


Circadian rhythm of free oestradiol in relation to plasma cortisol in late human pregnancy. The present study investigates the diurnal variations of free plasma oestradiol levels in late human pregnancy. The oestradiol levels are correlated to the maternal adrenal function as reflected by the plasma levels of cortisol. According to the half life time of oestradiol, blood samples were collected at short time intervals of 30 and 60 min, respectively. Three pregnant women volunteered in the study. Free oestradiol was measured by radioimmunoassay and cortisol was quantitated by a protein binding method. All patients exhibited a circadian rhythm for free oestradiol with significantly higher values in the early morning (28.3 +/- 7.2 ng/ml) than in the afternoon and early night (21.2 +/- 3.6 ng/ml, P less than 0.001). The course of oestradiol followed in a moderate but significant correlation plasma cortisol (r = 0.34, P less than 0.001). During the period of increasing cortisol the oestradiol levels demonstrated the phenomenon of episodic secretion. The results obtained suggest that the maternal adrenals predominantly regulate the diurnal rhythm of free oestradiol in late human pregnancy.


NSILA and foetal growth.

NSILA and foetal growth. Employing a sensitive competitive protein binding assay for NSILA (non-suppressible insulin-like activity), circulating levels of this somatomedin (SM) have been measured throughout pregnancy, at parturition, and in foetal and newborn sera. Acid-dissociable serum NSILA (mean +/- SEM) in 57 women was significantly higher during pregnancy (1106 +/- 46 microunits/ml), than in 11 adult non-pregnant control subjects (844 +/- 22 microunits/ml), but not correlated with week of gestation or with serum growth hormone (GH) or cortisol levels. At parturition, the NSILA concentration in 28 cord sera (598 +/- 38 microunits/ml) was significantly less than in the corresponding maternal sera (1039 +/- 63 microunits/ml). The NSILA levels in 23 premature newborns (370 +/- 20 microunits/ml) and 8 small-for-gestational-age newborns (310 +/- 46 microunits/ml) were significantly less than in 33 term newborns (494 +/- 18 microunits/ml). Serum NSILA in 56 term and premature newborns exhibited a significant positive correlation both with gestational age and birth weight but not with serum GH or cortisol levels. These data suggest that the maternal-foetal growth-promoting system is a highly complex one in which NSILA levels both in maternal and foetal circulations appear to be under multifactorial control.


Endocrine testicular function in vivo and in vitro in infertile men. In order to detect any possible Leydig cell dysfunction associated with male infertility, the endocrine capacity of the tests was investigated in vivo and in vitro in 21 infertile men. Plasma testosterone was determined before and after 3 days of hCG stimulation. Testicular tissue obtained by bilateral biopsies was subjected to (1) histological examination, (2) determination of basal testosterone concentration and (3) incubation with hCG. Patients were grouped according to histology. In vitro basal and stimulated testicular testosterone was similar in patients with normal histology, Sertoli-cell-only syndrome and spermatogenic arrest. Tissue from patients with Leydig cell hyperplasia showed 3-fold higher basal testosterone levels and a greater response to hCG. All patients had plasma testosterone levels and responses to hCG in the normal range. There was no significant correlation between the data obtained in vivo and in vitro, indicating that testosterone determinations in peripheral blood do not necessarily reflect the intratesticular situation. There was no evidence for gross abnormality in Leydig cell function accompanying disturbed spermatogenesis.


Work capacity, contractile protein and quantitative electromyogram (EMG) changes following exercise or nandrolone decanoate treatment in experimentally induced muscle disuse atrophy in rats. Anabolic steroid administration and planned exercise have been the two main methods applied to improve the function and morphology of atrophied muscle tissue. The effects of these two factors-specifically nandrolone decanoate administration and exercise by swimming on muscle weight, EMG activity, work capacity and on contractile protein content of rat gastrocnemius muscle, following experimentally induced atrophy by immobilization, were investigated. The results appear to support the conclusion that although both types of treatment obtain significant positive results exercise acts more effectively than the anabolic steroid in this respect.


Injury of liver in experimental salmonellosis of rabbits infected by salmonella agona. Liver injury was investigated in the course of salmonellosis evoked by Salmonella agona in experimental infection of rabbits. Histological and biochemical examination (proteinogram, the level of bilirubin, fibrinogen, cholesterol and its esters in blood, activity of asparine and alanine aminotransferases and alkaline phosphatase and guanase in blood) were carried out in 70 animals. Liver injury showing degeneration, steatosis and necrosis was found in the course of salmonellosis. Hepatitis gigantocellularis was sporadically observed. Biochemical parameters were not in correlation with the observed histological changes.


Further evidence for the superiority of a 3-compartmental model for distribution analyses of i.v. injected bile acids in men: studies in patients with liver diseases. In 15 patients (n = 6 without and n = 9 with liver diseases) we measured the plasma disappearance curves after single injections of C 14-glycocholate, calculated the distribution and excretion kinetics on the basis of a 2- and 3-compartmental model and compared the calculated values for the maximal C 14-accumulation within compartment 2 that should correspond to the liver in both compartmental models. The results demonstrate that only the 3-compartmental model reproduces the pathophysiological situation in the patients with liver injuries, namely a decrease of the maximal C 14-accumulation within the liver and an increased C 14-accumulation within the extrahepatoplasmatic compartment. The results therefore confirm our previous studies in healthy patients even for the patient with liver diseases.


Chronic active hepatitis and mesopic vision in aged and non aged patients. The time of macular functional-recuperation after dazzling has been evaluated in 46 patients of both sexes with ages between 26 and 65, with chronic active hepatitis (CAH). Knowing that the macular recuperation time, even under physiological conditions, increases after the age of 40, we divided these subjects in two groups: under 40 years old (20 cases) and over 40 years old (26 cases). Patients with CAH show a noticeably increased frequency of pathological times especially in those over 40 years old. In this group the pathological cases are 96,15% compared to 60% found among those under 40. The reason for this behavior is only hypothetic. However, the importance of the results must be underlined, as during biological and clinical remission of chronic liver disease patients of working age hold jobs where weakness of mesopic vision could cause serious accidents of legal-medical interest.


Effects of cholecystokinin-pancreozymin on amylase synthesis and secretion in the mouse pancreas. Perfusion of mouse pancreatic slices revealed that continuous exposition with cholecystokinin-pancreazymin (CCK-PZ) provokes an initially high peak of amylase secretion, which is followed by a slow decline in enzyme discharge. A return to the basal secretory level is noticed after about 45 min. Repeated pulse stimulations with CCK-PZ result in a more efficient stimulation of pancreatic amylase release, compared to a continuous stimulation. In the presence of CCK-PZ for 45 min, as well as during a post-stimulatory period of 45 min, a significant depression of L-(U-14C) leucine incorporation into amylase as well as total protein is recorded. In conclusion, in vitro incubated mouse pancreatic slices thus seem to be unable to increase their rate of protein synthesis during and after stimulation of secretion.


Rapid increase of fibrinolytic activity in pig and rat after exclusion of the liver from the circulation and its control by various organs. Liver-bypass in the pig and the rat instantly results in a marked increase of fibrinolytic activity. Within 1--2 hours this increase is followed in rats by a normalization. A new increase can be obtained by intravenous Carbachol injection. Removal of organs results to various degrees -- most pronounced after bilateral nephrectomy -- in reduction of control value of fibrinolytic activity before liver-bypass. In rats with adrenalectomy plus splenectomy there is no normalization of liver-bypass-induced increased fibrinolytic activity.


Leucocyte migration inhibition test with two gastric antigens in pernicious anaemia and in simple atrophic gastritis. Leucocyte migration inhibition test was used for evaluation of cell-mediated immunity in patients with pernicious anaemia (PA) and simple atrophic gastritis (SAG). As antigens microsomal antigen from gastric mucosa of swine foetus and relatively pure hog intrinsic factor (IF) were used. Significant differences were found between PA and SAG with microsomal antigen, but not with IF. It was concluded, that the microsomal antigen might be more active than IF. This observation could contribute to explane the higher incidence of parietal cell antibody than that of IF antibody in PA patients.


The effect of duodenal acidification on gastric circulation and function in the dog. The effect of acidification of duodenal contents on splanchnic bloodflow and gastric circulation was investigated in anaesthetized dogs by measuring electromagnetically portal venous and left gastric artery bloodflow and gastric mucosa bloodflow with pertechnetate clearance. Duodenal acidification increased portal venous bloodflow and reduced mesenteric inflow resistance. At the same time bloodflow in the gastric artery and (not significantly) in the mucosa were reduced in consequence of increased inflow resistances.


Serum gastrin concentrations in healthy males and females of various ages. We measured, by the RIA method, the concentrations of serum gastrin in a fasting state in 80 healthy volunteers of both sexes (M = 43, F = 37) aged 15-81 years. We did not find significant differences in the mean values of gastrin among them and the correlation of gastrin with the ages was insignificant. Further study of various age groups (15-29, 30-59, greater than 60 years) in both sexes and of two more age groups (18-45, 46-71) in the females, did not disclose any significant differences either. People of ages greater than 60 years had the greatest concentration of gastrin. Furthermore, we studied the concentrations of gastrin in the sera of 39 of these 80 people (M = 23, F = 16), aged 15-47 years, 10 min. and 40 min. after a test meal. No differences were found between the two sexes. However, although the mean levels of gastrin were significantly increased 10 min and 40 min after the meal in comparison with the fasting levels in both sexes, only in the men was the increase after 40 min. significantly greater than that after 10 min.


Hyperplasia of Brunner's glands. Radiology, endoscopy and biopsy findings in 11 cases of diffuse, nodular and adenomatous form. Eleven cases of hyperplasia of Brunner's glands are reported including 10 cases of diffuse and nodular type and one case of Brunnerian polyadenomatosis. Histological changes were identified in aspiration biopsy specimens and termed "biopsy indication of hyperplasia of Brunner's glands". Polypoid pattern seen roentgenologically and endoscopically in the case of the adenomatous type was constant whereas in the case of the diffuse and nodular type it was not constant; it is suggested that this is due to irregular contraction of muscularis mucosae disrupted by protruding Brunner's glands. Most patients had epigastric distress; less than half had duodenitis.


Multiseptate gallbladder. Report of a case with a review of literature. Multiseptate gallbladder is an extremely rare anomaly, the number of reported cases not having exceeded ten. In this 37-year-old man with a complaint of occasional nausea, vomiting and abdominal pain, intravenous cholecystography combined with tomography demonstrated a normal size gallbladder with many thin septa. The removed gallbladder had multiple intercommunicating locules divided by thin septa, looking like a honeycomb on the cut surface. The bile contained was dark brown in the neck and much lighter in color in the fundus, suggesting a disturbed bladder function. Histologically, some of the septa lacked the muscularis. He has been free of the previous complaints after surgery. Eight similar cases already documented are reviewed with a discussion on the embryogenetic aspect of this anomaly.


The use of steroid suppositories in the treatment of chronic active hepatitis complicated by peptic ulceration. Because of intolerance to oral steroids, a patient with Chronic Active Hepatitis and an active gastric ulcer was treated with rectal steroids in addition to azathioprine and carbenoxolone sodium. The liver function tests showed a marked improvement with this therapy, and the gastric ulcer healed. The possible advantages of steroid administration by suppositories are discussed.


Effects of neurolept anaesthesia (NLA) on haemodynamics and oxygen consumption in the dog with special reference to the liver and preportal tissues. The effects of neurolept anaesthesia (NLA) on central circulation, total oxygen uptake and splanchnic circulation and oxygen uptake were studied in 12 artificially ventilated dogs, basally anaesthetized with thiopental and nitrous oxide. Hepatic arterial, superior mesenteric arterial and portal venous blood flows were measured with electromagnetic flowmetry. Cardiac output was measured by thermodilution. Determinations of oxygen contents were made in arterial, pulmonary arterial, portal venous and hepatic venous blood. NLA was induced with droperidol 0.5 mg . kg-1 b.w. and fentanyl 0.01 mg . kg-1 b.w. Arterial blood pressure decreased to 63% of control value due to reductions of cardiac output to 78% and of total peripheral vascular resistance to 81% of control values. Hepatic arterial, superior mesenteric arterial and portal venous blood flows all diminished to 75% of control values. Hepatic arterial, superior mesenteric arterial and preportal tissue vascular resistances all decreased. Total oxygen uptake declined to the same extent as cardiac output, leaving the arterio-venous oxygen difference unchanged. Oxygen uptake of the preportal tissues was unaffected and hepatic oxygen uptake was not significantly reduced, although there were decreases of hepatic oxygen uptake in some of the individual dogs. It is suggested that the cardiovascular depression following NLA was due to adaptation to a lowered total oxygen uptake. It is further concluded that splanchnic circulation was well preserved due to decreases in splanchnic vascular resistances, and that splanchnic oxygen consumption was maintained by means of increased oxygen extraction.


The potentiation of halothane anaesthesia by clonidine. The antihypertensive agent, clonidine, has a marked sedative effect. We studied whether clonidine also deepens halothane anaesthesia. Eight rabbits were anaesthetized with and without clonidine premedication in a cross-over study. Clonidine premedication (50 microgram/kg subcutaneously) was administered three times daily for 3 days. Tolerance to pain during halothane anaesthesia was tested by compressing the ear with a vessel clamp. Halothane concentrations were determined by gas chromatography. The rabbits premedicated with clonidine tolerated painful stimuli without reactions at lower halothane concentrations in arterial blood and inspired air than unpremedicated rabbits. MAC calculated from blood concentrations was 1.29% for unpremedicated and 1.09% for clonidine-premedicated rabbits. The results suggest that clonidine diminishes the anaesthetic requirement in halothane anaesthesia.


Effects of enflurane on haemodynamics and oxygen consumption in the dog with special reference to the liver and preportal tissues. The effects of enflurane anaesthesia on central circulation, total oxygen uptake, splanchnic circulation and splanchnic oxygen uptake were studied in 10 artifically ventilated dogs, basally anaesthetized with thiopental and nitrous oxide. Hepatic arterial, superior mesenteric arterial and portal venous blood flows were measured with electromagnetic flowmetry. Cardiac output was measured by thermodilution. Determinations of oxygen contents were made in arterial, pulmonary arterial, portal venous and hepatic venous blood. The end-tidal enflurane concentration was kept at about 1 MAC (= 2.2%). Arterial blood pressure diminished 54% of control value due to decreases of cardiac output to 65% and of total peripheral vascular resistance to 81% of control values. Hepatic arterial, superior mesenteric arterial and portal venous blood flows decreased to 65-70% of control levels and the corresponding vascular resistances all declined to about 80-85% of control values. Total oxygen uptake decreased, but less than cardiac output, leading to an increased arterio-venous oxygen content difference. Oxygen uptake of the preportal tissues was unchanged and hepatic oxygen uptake was not significantly altered, although there were decreases in hepatic oxygen uptake in some of the individual experiments. It is suggested that the cardiovascular depression following enflurane anaesthesia in the dog was due, to a great extent, to a primary myocardial depression. It is further concluded that the splanchnic blood flows were relatively well preserved, due to decreases in splanchnic vascular resistances, and that hepatic and preportal tissue oxygen consumptions were maintained by increased oxygen extraction.


Paresthesiae or no paresthesiae? Nerve lesions after axillary blocks. Seeking paresthesiae when performing a peripheral nerve block may increase the risk of post-anesthetic neurological sequelae. To test this hypothesis, we prospectively followed two groups of patients who underwent hand surgery with an axillary block. In one group, the axillary plexus was located by actively seeking paresthesiae; in the other, pulsations of the axillary artery indicated an adequate position of the injection needle. Mepivacaine 10 mg/ml, with or without adrenaline, was used. The study included 533 patients, 290 in the paresthesia group and 243 in the artery group. Although unintentional, paresthesiae were elicited in 40% of patients in the artery group. Postanesthetic nerve lesions were seen in ten patients, eight in the paresthesia group and two in the artery group, all of whom had been blocked by mepivacaine with adrenaline. Symptoms varied between light paresthesiae lasting a few weeks, and severe paresthesiae, ache and paresis lasting more than 1 year. The etiology suspected was needle and perhaps injection trauma to the nerves during blocking. We conclude that whenever possible nerve blocks should be performed without searching for paresthesiae.


The foam nose--a new disposable heat and moisture exchanger. A comparison with other similar devices. The Foam Nose (Kemi-Intressen AB), a heat- and moisture exchanger (HME), was compared with two other commercially available HME's with respect to its heat and moisture exchanging capacity. During steady state, 77% of the expired humidity is restored to the airways with the Foam Nose, 63% with HME Portex and 63% with HME Dameca.


In-line blood warming and microfiltration devices. I. Testing of flow and warming properties by pressure transfusion of aggregate-free blood. Homogeneous microaggregate-free whole blood at +5 degrees C was transfused at constant pressures of 20 and 40 kPa through two micro-filtration and blood warming devices, and the temperature of the blood was recorded before it reached the venous cannula. The flow rates with the Fenwal system were 58 and 139 g/min, whereas the micro-filter MF10B combined with the Portex Coil allowed flow rates of 143 and 224 g/min. The warming capacities of the two warmers were almost equal and this did not prove to be their weak point. The infusion temperature varied considerably during the transfusion. Increasing the priming volume of the coil would raise the mean infusion temperature. A pressure infusor (Fenwal) was tested, and the internal pressures of the blood bag and the infusor were determined separately. The bag pressure differed significantly from the infusor pressure as the blood bag emptied, making the usefulness of the infusor manometer questionable.


In-line blood warming and microfiltration devices. II. Influence of blood temperature on flow rate and hemolysis during pressure transfusion through microfilters and transfusion sets. The influence of blood temperature on flow rate and hemolysis was studied. Homogeneous aggregate-free blood was transfused through six different microfilters and transfusion sets, combined with a large-bore venous cannula (Venflon No. 2) at a constant pressure of 20 kPa. Flow rates and plasma hemoglobin for cold (+5 degrees C) and prewarmed (+37 degrees C) blood were determined separately. Warming the blood from +5 degrees C to +37 degrees C improved the flow from 49 to 86%. The best flow rates with +37 degrees C blood were obtained with surface filters (MF10B, 275 g/l), and the poorest with depth filters (Swank, 179 g/l). However, the transfusion set and venous cannula seemed to have more influence on the total flow resistance. The Fenwal "dry-heat" warmer was found to have a great flow resistance. The pressure transfusion caused only a slight increase in free plasma hemoglobin of cold blood and no increase in prewarmed blood. It seems more practical to warm the entire blood unit before transfusion than to use so-called in-line blood warmers, because prewarming results in a flow rate approximately twice as high as that obtained with coils.


Restlessness and shivering after naloxone reversal of fentanyl-supplemented anaesthesia. To study the significance of normalization of ventilatory or thermal homeostasis during naloxone reversal, 95 patients were given naloxone after thiopental-N2O-O2-relaxant anaesthesia supplemented with fentanyl (6 microgram/kg/h). If naloxone 0.16 mg was given to combat postoperative apnoea during hypercapnia (end tidal carbon dioxide concentration (ETco2)8%), minute ventilation and respiratory rate were significantly higher during the first minutes as compared to the normocapnic patients. Shivering occurred in 44% in the hypercapnic group, as compared to about 30% if naloxone was given during normocapnia (ETco2 5%). Postoperative pain and restlessness were significantly increased in the hypercapnic group. During normocapnia, untoward reactions were less frequent (40%) if naloxone was given in smaller increments (0.08 + 0.08 mg) rather than in one dose (0.16 mg) (72%). This was mainly due to nausea (8% compared to 32%). The incidence and severity of shivering showed a positive correlation to the duration of anaesthesia (r = 0.42) and to the total amount of fentanyl (r = 0.32), but not to the actual postoperative oesophageal temperature (r = -0.13). The results indicate that though untoward reactions after naloxone reversal are aggravated by naloxone-induced normalization of deranged homeostatic mechanisms, their aetiology probably should be sought in an acute abstinence syndrome.


Post-mortem findings of tracheal injury after cuffed intubation and tracheostomy. A clinical and histopathological study. The tracheas of 37 tracheostomized patients (31 men and 6 women) were studied in connection with obduction. Twenty-six patients had been intubated before tracheostomy and 29 of the tracheostomized patients were treated with a respirator. At autopsy, the damage caused to the tracheal wall by the cuff was studied macroscopically; the finding was photographed for later investigation and samples were taken from the damaged area for microscopic examination. The purpose of the study was to determine the damage caused to the tracheal wall by the low-volume cuff we have used during the last 4 years. The cuff diameter was nearly the same as that of the trachea. The injuries were grouped according to their extent and depth as mild, moderate or severe, and the groups contained, respectively, 5, 12 and 20 patients. It seemed that cuff pressure played a greater part in causing damage than the duration of cuff strain. Factors in the clinical condition of patients, like hypotension, uraemia, respiratory infections, sepsis and use of steroids, may have had an effect on the development of damage. The injuries caused by the cuff used are so severe that there is every reason to use instead the low-pressure, high-volume cuff, which has been shown to cause less damage, whenever long-term treatment is involved.


Prognosis after cardiac arrest occurring outside intensive care and coronary units. Emergency calls to a total of 1686 patients with verified cardiac arrest in the University Hospital, Arhus, were made in the 8-year period 1969-1977. Among the patients, cardiac arrest occurred outside the hospital in 1347, in the general wards in 240, while it was present on arrival at the emergency room in 99. Resuscitation was attempted in 1172 patients; 181 survived for at least 24 hours, and 72 were discharged alive, including 13 with residual brain damage. The prognosis was best when cardiac arrest occurred in the general wards (13% discharged) and poorest when it occurred outside the hospital (4% discharged). However, in the latter group, the prognosis showed considerable improvement when resuscitation was initiated at once by a doctor or by laymen present at the accident site (16% discharged). As regards the mechanism of cardiac arrest, ventricular fibrillation was found to be a relatively favourable prognostic sign (10% discharged), whereas almost none of the patients with asystole or severe bradycardia survived. The possibility of improving the prognosis of cardiac arrest occurring outside hospital by the establishment of mobile coronary care units and by instructing lay people in the technique of cardiopulmonary resuscitation is discussed.


The effect of local anaesthetic agents on the contractility of human myometrium in late pregnancy. An in vitro study. Four local anaesthetic agents, lidocaine, prilocaine, bupivacaine and etidocaine with and without adrenaline, were tested regarding their influence on the contraction amplitude, tone and frequency of contractions of human myometrium in vitro. All four drugs had a dose-related inhibitory effect on the amplitude. This was enhanced by adrenaline. The two short-acting and the two long-acting agents were tested in equianalgesic doses in a crossover test. Lidocaine and etidocaine had a significantly greater inhibitory effect on the spontaneous myometrial contractions than prilocaine and bupivacaine. With all drugs, except etidocaine, the tone increased with increasing drug concentrations in the bath. The changes in frequency were inconsistent. Based on the concentrations required to produce 50% inhibition, lidocaine, bupivacaine and etidocaine were, respectively, 1.3, 6.5 and 8.3 times more potent than prilocaine; the corresponding figures for the anaesthetic effect on isolated nerves are reported to be 1.5, 5.3, and 5.3. The inhibitory effect of etidocaine declined with time, in contrast to the other local anaesthetic agents tested.


Additive effects of hypothermia and phenobarbitol upon cerebral oxygen consumption in the rat. The quantitative effects of a combination of hypothermia and phenobarbital on cerebral oxygen uptake (CMRo2) was studied in rats, curarized and artificially ventilated with 70% nitrous oxide in oxygen. Cerebral blood flow (CBF) was measured with a modification of the KETY & SCHMIDT (1948) technique, using 133xenon as a tracer. Arteriovenous difference in oxygen content over the brain was measured and CMRo2 was calculated. Four groups were studied. Group 1 was a control group. The three experimental groups were injected with phenobarbital intraperitoneally: Group 2 with 50 mg/kg body weight; Group 3 with 150 mg/kg; and Group 4 with 50 mg/kg of phenobarbital, and, in addition, body temperature was lowered to 32 degrees C in this group. CMRo2 in groups 2, 3 and 4 was reduced by 22, 37 and 43%, respectively, compared to Group 1. The changes in CBF were of the same magnitude. In a previous study we have found that CMRo2 decreases by 5% per 1 degree C decrease in body temperature. The value for CMRo2 in Group 4 is close to the value obtained if the effect of 50 mg/kg body weight of phenobarbital on CMRo2 is added to the effect of a temperature reduction of 5 degrees C. It is concluded that the effects of barbiturates and hypothermia on CMRo2 are additive.


A fine-structural analysis of mouse molar odontoblast maturation. The first mandibular molars of the Swiss albino mice, 1 through 4 days of age, were fixed in glutaraldehyde or Karnovsky's fixative. The tissues were postfixed in OSO4, dehydrated and embedded in Epon. The prepolarizing, polarizing and secretory odontoblasts were described. The prepolarizing cells, located in the vicinity of the cervical loop, were mesenchymal-like in morphology. The cells of the polarizing stage possessed organelles indicative of protein synthesis. The nucleus was located proximally. Aperiodic fibers were evident in the wide basement membrane. The secretory odontoblasts were long, slender, polarized cells closely adjoining one another. Each odontoblast possessed six morphologically discernible regions: (1) an infranuclear region, limited in size and containing few cellular organelles; (2) a nuclear region, housing the oval nucleus and a few associated lamellae of rough endoplasmic reticulum as well as a limited number of mitochondria; (3) a supranuclear rough endoplasmic reticulum region, possessing an abundance of these organelles as well as some mitochondria and secretory vesicles; (4) a Golgi region, occupying the middle third of the cell, housing the elements of an extensive Golgi apparatus which was surrounded by peripherally located profiles of rough endoplasmic reticulum; additionally, this region contained smooth endoplasmic reticulum, mitochondria, numerous secretory granules and vesicles and occasional intracellular collagen fibers; (5) an apical rough endoplasmic reticulum region, containing a rough endoplasmic reticulum component that was less extensive than its supranuclear counterpart; in addition, this region was the one richest in mitochondria and contained a plethora of secretory vesicles and granules; (6) the odontoblastic process, a region mostly void of organelles, containing various secretory products, some of which appeared to be in the process of being released extracellularly into the surrounding dentin matrix.


Topography of the dopamine neurons in the arcuate nucleus of the mouse hypothalamus. The distribution of the dopamine (DA) cell bodies was elucidated within the mouse arcuate nucleus by fluorescence histochemistry. The arcuate nucleus was divided into five regions; heterogeneity in distribution and different amounts of DA among the regional areas were demonstrated. The DA cell bodies containing a large amount of DA, observable even in the arcuate nucleus of the intact mice, distributed in the medial areas of the anterio-central and the middle-central regions and in the dorsal area of the posterior-central region. On the other hand, those containing probably as small amount of DA distributed in the medial area of the rostral region and in the ventral areas of the anterior-central and middle-central regions. They were not observed in the intact mice, but found in the mice treated with nialamide plus alpha-methyldopa. No DA cells were found in the caudal region.


Ultrastructural study of the embryonic development of the pineal gland of the chicken (Gallus gallus). The authors studied the embryonic development of the pineal gland of the chicken with the electron microscope. The denomination of 'pinealoblasts' was given to the undifferentiated cells which form the primitive pineal outline. In the wall of the pineal cavities, the follicular and parafollicular zones were distinguished; these are formed by type A and type B pinealocytes, the B type being much more abundant. The degenerated cells are constant in the pineal throughout its embryonic development, but much more abundant in the early phases.


Osteoarthritis of the knee in the rabbit produced by immobilization. Attempts to achieve a reproducible model for studies on pathogenesis and therapy. In order to obtain a reproducible experimental model of osteoarthritis a method of immobilizing the rabbit's knee in extension by means of plastic splint was developed. The right knees of the rabbits were immobilized for periods varying from 4 days to 24 weeks. With the left knees as controls the knees were studied in a variety of ways among these being radiography (126 rabbits), histological sections stained with Alcian Blue (88 rabbits), analysis of 35S-sulphate uptake (22 rabbits) and 35S-autoradiography (6 rabbits). In 27 rabbits the regaining of mobility after immobilization was studied. After 5-6 weeks of immobilization most of the knees showed moderate or severe changes including loss of articular cartlilage and osteophyte formation. Immobilization of the rabbit's knee by this method provokes a fairly easily reproducible type of degenerative joint disease showing similarities to advanced osteoarthritis as seen in humans.