Dermoid cysts of the floor of the mouth and lateral neck. Dermoid cysts of the floor of the mouth and submandibular area represent an unusual clinical entity. We present three such cases and review their clinical presentation and pathologic classification. This study stresses the importance of recognizing and excising any tract leading from such cysts to the midline mandible or hyoid, in order to avoid a recurrence, since these tracts may be epithelialized.


The effect of static tympanic pressure gradients on hearing sensitivity in normal subjects. The effects of static tympanic air pressure gradients on hearing sensitivity was studied by introducing overpressures of 100 mm H2O to 400 mm H2O into the ear canals of 22 normal subjects. Sweep frequency threshold measures were obtained using a pressure-tight probe transducer driven by a Bekesy automatic audiometer. These gradients of tympanic pressure disequilibrium produced threshold losses through 4000 Hz, most prominently for the region of 500 to 1000 Hz, that increased systematically with the degree of overpressure. The data may be useful in estimating the degree of conductive loss associated with middle ears presenting retraction without effusion and normally compliant though negatively skewed tympanograms.


The screening value of monothermal caloric tests. A valid screening caloric test should decrease examination time, increase patient comfort and maintain a high degree of sensitivity in predicting bithermal (BT) caloric results. This prospective study of 362 consecutive electronystagmograms (ENG) compared right/left (R/L) difference results obtained using monothermal (MT) warm and cold irrigations alone with that of the (combined) BT tests. Comparing MT warm and cold irrigations, false negative (normal MT but abnormal BT test) results were obtained in 14% and 25% of irrigations, while false positive (abnormal MT but normal BT test) information was obtained in 22% and 15% of irrigations, respectively. False negative MT tests preclude detection of the abnormal BT test, while false positive tests require unnecessary completion of the BT caloric irrigations. This lack of diagnostic sensitivity limits the usefulness of the MT irrigation as a screening test.


Lipogenesis in the developing brain: utilization of radioactive leucine, isoleucine, octanoic acid and beta-hydroxybutyric acid. Incorporation of radioactivity from intracranially injected radioactive leucine, isoleucine (ketogenic amino acids), octanoic acid and beta-hydroxybutyric acid into the brain lipids of 15 to 16 day-old rats was examined. The results showed that radioactivity from all the above precursors was incorporated into brain lipids. Radioactivity from injected isoleucine was incorporated into odd numbered fatty acids indicating an alternate pathway to alpha-oxidation for the biosynthesis of these fatty acids in the brain. For some as yet unclear reasons, a substantial portion of the radioactivity from injected octanoic acid was incorporated into free fatty acids. Utilization of these compounds for providing carbon for lipogenesis during development under unstressed normal conditions is discussed.


Occurrence of plant sterols in aquatic vertebrates. Plant sterols were found by gas liquid chromatography in the sterols of five species of aquatic vertebrates; mackerel (Scomber japonicus), rainbow trout (Salmo gairdnerii), smelt (Osmerus dentex), sardine (Sardinops melanosticta) and chimera (Chimera phantasma). The sterols of chimera liver, sardine flesh and sardine viscera contained 9.0, 2.4 and 3.1% of C28 and C29 sterols in addition to 86.7, 96.6 and 95.2% of cholesterol. The occurrence of norcholestandienol, campesterol, beta-sitosterol and C28 stanol was shown by combined gas chromatography-mass spectrometry. Sperm whale (Physeter catodon) sterols consisted of more than 99% cholesterol with only traces of 22-dehydrocholesterol.


A comparison of the ganglioside distributions of fat tissues in various animals by two-dimensional thin layer chromatography. The ganglioside distributions of various fat tissues from human, rabbit, rat, mouse, chicken and frog were compared with pig adipose gangliosides by two-dimensional thin layer chromatography. It was found that there is a remarkable species variation in ganglioside distribution, especially in the composition and relative concentration of complex gangliosides. Differing from pig adipose tissues, those of human, rabbit, rat, mouse, chicken, but not frog, contained GM3 as a most abundant ganglioside. The data for human, rabbit and chicken indicated a simple distribution of only NeuAc-type gangliosides, while those for rat and mouse indicated a rather complicated pattern containing both NeuAc- and NeuGc-type gangliosides. The ganglioside pattern of the frog fat body differed markedly from those of mammalian fat tissues because of the presence of three different, unusual monosialosylgangliosides as major components. In other respects, a substantial amount of disialosylgangliosides was commonly found in all animal fat tissues.


Effect of marine oil and rapeseed oil on composition of fatty acids in lipoprotein triacylglycerols from rat blood plasma and liver perfusate. The fatty acid patterns of triacylglycerols (TG) from very low density lipoprotein (VLDL) in blood plasma and liver-perfusate from rats fed partially hydrogenated marine oil or rapeseed oil were determined. In the plasma from rats fed rapeseed oil for three days and three weeks, there was a small but significant decrease in the percentage of 22:1 fatty acid from 17.2 to 11.2% with length of feeding. In liver-perfusate, the comparable decrease with dietary rapeseed oil was from 18.5 to 5.2%, and with dietary marine oil from 13.4 to 8.0%. In contrast to the liver-perfusate, the remaining liver had only a very low 22:1 composition (ca 2%) independent of feeding period or diet. The results indicated that the liver exported the very long chain fatty acids and that an adaptation took place after three days feeding with rapeseed oil or marine oil. This adaptation in the liver could possibly explain why TG accumulation in hearts, which appears after three days' feeding with rapeseed oil or marine oil, disappears after an extended feeding period.


Isolated brain capillary endothelia: influence of various levels of essential fatty acids on the acyl group composition of glycerophospholipids. On day seven of gestation. Wistar rats were assigned to a high essential fatty acid (EFA), low EFA, or a fat free diet. The same diets were continued during lactation. On weaning, the offspring were fed the same diets as their mother. Rats were killed at 222 days, brain capillary endothelia isolated, and total lipids extracted from the purified capillaries. The composition of the constituent fatty acids of ethanolamine glycerophospholipid (EGP), choline glycerophospholipid (CGP), and the alk-1-enyl EGP composition from each diet is reported. A decrease in dietary EFA led to reduced proportions of total saturated acyl groups in EGP with no change observed in the total saturated acyl groups from CGP, and an increase in monoenoic fatty acids, particularly 18:1n-9 for each phospholipid class. The proportions of 20:4n-6 in alk-1-enyl EGP were reduced in fat-free fed animals. In addition, the relationship between 20:3n-9 and 20:4n-6 fatty acids in brain capillary endothelia were markedly increased with a reduction in dietary fat. Low EFA and fat deficient animals showed a tendency to sequester 22:6n-3.


1,25-Dihydroxyvitamin D3 increases the activity of the intestinal phosphatidylcholine deacylation-reacylation cycle. The activity of the intestinal phosphatidylcholine deacylation-reacylation cycle has been found to be stimulated by 1,25-dihydroxy-vitamin D3. The stimulation of this cycle thus provides a possible mechanism for the reported retailoring of the fatty acid composition of phosphatidylcholine in intestinal cell membranes by 1,25-dihydroxy-vitamin D3 and its analogue, 1alpha-hydroxyvitamin D3.


The importance of the steric configuration of lysophosphatidylcholine in the lymphatic transport of fat. The importance of the steric configuration of lysophosphatidylcholine in the lymphatic transport of fat was investigated in bile fistula rats. It was found that the feeding of 1-palmitoyl-sn-glycero-3-phosphocholine increased the lymphatic output of phosphatidyl choline and triacylglycerol, while the feeding of 3-palmitoyl-sn-glycero-1-phosphocholine had no effect. In intestinal microsomes of the bile fistula rats, it was found that the lysophosphatidylcholine acyltransferase was stereospecific in acylating the 1-acyl-sn-glycero-3-phosphocholine enantiomer. The significance of these findings is briefly discussed.


Isolation and partial characterization of the neutral glycosphingolipids and gangliosides of the human heart. The glycosphingolipids (GSL) of the human heart muscle have been isolated from total lipids by column and thin layer chromatography and their sugars and fatty acids analyzed by gas liquid chromatography. Hearts from traffic victims were obtained at autopsy between 12 and 16 hr after death and dissected into parts (left and right ventricular walls, intraventricular septum and papillary muscle). The neutral GSL content for those parts of the hearts of two males aged 22 and one female aged 14 ranged from about 90 to 160 nmoles/g wet weight. Trihexosyl ceramide and globoside were the most abundant neutral GSL. Total ganglioside content was about 50 nmoles/g wet weight, and the most abundant gangliosides were partially characterized as GM3 and GM1; other mono-, di- and trisialogangliosides were also present. Differences in the content and composition of neutral GSL and gangliosides between the heart and other human tissues are discussed. It is concluded that the patterns of these two GSL fractions of the heart are more complex than those of the extraneural human tissues.


Leucine as an in vitro precursor to lipids in rat sciatic nerve. The in vitro incorporation of lucine, isoleucine and pyruvate into lipids was compared and the possibility that leucine might serve as an in situ precursor to the corresponding iso fatty acids in the rat sciatic nerve was studied. The relative incorporation of 14C from leucine into lipids vs. nonlipids was 20%, and the incorporation of label into total lipids from leucine was one-halp that from pyruvate. The incorporation of label from leucine and pyruvate into sterols was nearly equivalent, but the incorporation of label into all other lipid classes from leucine was less than that from pyruvate, and the incorporation of label from isoleucine into lipids was much less in all cases. No detectable label from leucine was incorporated into brached chain fatty acids. It is concluded that leucine may be a substantial in vitro precursor to all major lipids in peripheral nerve, espeically sterols. The possibility and significance of a leucine catabolic pathway in the cytosol in relation to availability of 3-hydroxy-3-methylglutaryl CoA for sterol biosynthesis is discussed.


Fatty acid positional specificity in phospholipids of L1210 leukemia and normal mouse lymphocytes. The positional distribution of fatty acids in the choline and ethanolamine phosphoglycerides of the L1210 murine leukemia cells was determined and compared to that of normal mouse lymphocytes. The major phospholipids of both cell types had appreciable degrees of positional specificity as evident from the higher percentage of saturated fatty acids in position 1 and of polyunsaturated fatty acids in position 2. The L1210 cells had less arachidonate and more linoleate in position 2 of choline and ethanolamine phosphoglycerides as compared to the normal lymphocytes. However, there were similar proportions of saturated, monoenoic and polyenoic fatty acids in positions 1 and 2 of the phospholipids of the L1210 leukemia cells and the lymphocytes, These data demonstrate that fatty acid positional specificity is retained in the major phospholipids of this rapidly growing tumor.


Composition of lipids bound to pure cytochrome P-450 of cholesterol side-chain cleavage enzyme from bovine adrenocortical mitochondria. Phospholipids bound to highly purified cytochrome P-450 from bovine adrenocortical mitochondria, part of the enzyme complex responsible for catalyzing the conversion of cholesterol to pregnenolone, have been examined for comparison with the bulk phospholipids of the mitochondria from the same tissue. In both cases, the major phospholipids are phosphatidylcholine (PC) (37%) and phosphatidylethanolamine (PE) (56%), as well as smaller amounts of sphingomyelin and diphosphatidylglycerol. The fatty acid compositions of the four classes of phospholipids and of the neutral lipids bound to the pure enzyme are indistinguishable from those of the respective mitochondrial lipids. They are also similar to those of mitochondria from other organs except for high levels of arachidonate and low levels of diphosphatidylglycerol.


The metabolism of dihomo-gamma-linolenic acid in man. Orally administered dihomo-gamma-linolenic acid (DHLA) is well absorbed in man; it appears in blood after ca. 4 hr first as triglyceride ester and later as phospholipid. After sustained-dosing, DHLA penetrated membrane pools and all phospholipid components but, depending on the dosage, reached a metabolic equilibrium in 4-16 days. Intact platelets do not accumulate arachidonate following DHLA administration, and species differences occur in the capacity of animals to metabolize DHLA to arachidonic acid (AA). The rat appears to be unusual in having a very active hepatic delta5-desaturase enzyme system. Potentially antithrombotic changes in platelet function which followed the administration of DHLA to man were accompanied by a significant increase in the capacity of platelets to synthesize PGE1. Concomitant increases in PGE2 synthesis do not apparently result from an  increased production of AA and suggest that DHLA, or a DHLA metabolite, interferes with the metabolism of AA. Effects on thromboxane and prostacyclin synthesis are being studied.


The relationship of dietary fats to prostaglandin biosynthesis. The direct and indirect evidence that the fatty acid composition of dietary fat is involved in the regulation of prostaglandin biosynthesis was reviewed. Direct evidence included effects of essential fatty acid deficiencies and excesses on endogenous tissue levels and production rates of prostaglandins by several tissues. Indirect evidence included lipolytic, platelet aggregatory, hypertensive, inflammatory and immune responses. In general, composition of dietary fat did not affect prostaglandin biosynthesis unless a biochemical essential fatty acid deficiency was induced or the linoleate to saturated fatty acids ratio of the dietary fat was greater than 5. Most results were interpreted in light of changing fatty acid composition; however, very few direct measurements have been made.


[Microflora and the potential capacity for gas formation of the bottom deposits of the Ivan and Arakhleĭ lakes (the Baikal region)]. The number of microorganisms and bacterial biomass in ooze deposits of the Ivano-Arakhleyskiye Lakes (Zabaikalye) decrease unevenly downward the ground column. This decrease is more sharp near the shores. The total number and bacterial biomass of the ground microflora directly depend on the extent of trophicity of the lakes. Gas production in the lakes Irgen, Ivan and Arakhley is accomplished by bacteria and involves exocellular enzymes. The rate of gas production differs among the lakes, along their horizontal layers, and in the vertical cross-section of sediments. The technique for determining the rate of gas production proposed by M. A. Messineva has been successive when applied to the ground of the Ivano-Arakhleyskiye Lakes.


[Fixation of molecular nitrogen by sulfate-reducing bacteria from petroleum strata]. The activity of nitrogen fixation by the museum strains of sulfate reducing bacteria isolated from oil deposits was studied using the acetylene technique. The mesophilic sulpfate reducing bacteria belonging to the species Desulfovibrio africanus 2372 and D. baculatus X were found to have a high nitrogenase activity. D desulfuricans subsp. aestuarii 2198 reduced acetylene at a low rate. The thermophilic sulfate reducing cultures of D. thermophilus 7, Desulfotomaculum nigrificans 781 and Dm. nigrificans subsp. salinus 435 produced only small quantities of ethylene. Apparently, nitrogen fixation by sulfate reducing bacteria can be considerable in oil strata whose temperature does not exceed 35--40 degrees C.


[Ultrastructural characteristics of Bdellovibrio chlorellavorus]. Intracellular and extracellular polar lamellar systems were detected in Bdellovibrio chlorellavorus, the obligate parasite of Chlorella. They were observed in negatively contrasted preparations and thin sections. These systems are considered as an essential character of the bacterium, being connected with its parasitic behaviour.


[Characteristics of the tricarboxylic acid cycle in Nocardia erythropolis]. The activity of enzymes involved in the tricarboxylic acid cycle was studied in Nocardia erythropolis IBFM B-293. It was found to be low and hardly change, with some exceptions, in the course of growth in the presence of various carbon sources. Acetate induced enzymes of the glyoxylate cycle which was here an important mechanism of oxalacetate synthesis. The absence of alpha-ketoglutarate dehydrogenase in the case of all studied substrates and the absence of 4-aminobutyrate aminotransferase, the key enzyme of the compensating 4-aminobutyrate shunt, suggest that the tricarboxylic acid cycle is decoupled. Therefore, this cycle does not operate as a mechanism generating energy in N. erythropolis, but fulfills mainly biosynthetic functions.


[n-Alkane oxidation by propionic acid bacteria]. Propionic acid bacteria were found for the first time to be capable of oxidizing n-alkanes. The value of QO2 is higher on a mixture of n-alkanes (C12--C20) than on individual hydrocarbons whose availability is determined by the length of a hydrocarbon chain: C15 and C16-alkanes are oxidized best of all; C14, C13 and C12-alkanes are oxidized at a lower rate; and alkanes whose chain comprises less than ten carbon atoms are not oxidized at all. Hexadecane is oxidized to CO2, cetyl alcohol and palmitic acid being intermediates; this suggests the existence of the monoterminal pathway for oxidation of n-alkanes in propionic acid bacteria.


[DNA content in Streptoverticillium mucoheptinicum spores in the period of their germination]. Changes in the DNA content were studied in the spores of Streptoverticillium mycoheptinicum. The content of DNA increased in the spores when they were incubated in a liquid nutrient medium at 28 degrees C for 5 hours. Changes in the DNA content during germination of spores corresponded to individual stages: at the stage of activation, the replication of DNA only commenced; at the stage of initiation, the content of DNA doubled in the majority of spores in the population. The rate of DNA synthesis varied among different spores of the actinomycete.


[Functional characteristics of the electron transport chain in Candida mycoderma yeasts exposed to benzhydroxamic acid]. The effect of antimycin A and benzhydroxamic acid (BHA) on functioning of the electron transport system was studied with the resting cells of Candida mycoderma grown in a medium containing glucose and collected at the beginning of the deceleration phase. In the original ("control") cells, the processes of oxygen consumption were shown to be mediated mainly by the phosphorylating electron transport chain. When the cells were incubated withe glucose, the cyanide resistant electron transport chain (CRETC) started to operate in these processes. Antimycin A stimulated the operation of CRETC. BHA blocked CRETC and, at the same time, prevented the participation of pyridine nucleotides (PN) in the processes of oxygen utilization. Apparently, electron donors (or reduced equivalents) in the electron transport chain were flavin enzymes operating in the cytochrome b region of the chain instead of PN. Similar changes in the electron transport system (when PN were not involved in the processes of oxygen utilization) were observed if resting cells were incubated in the presence of ethanol.


[Variant of Bacillus anthracoides].

[Variant of Bacillus anthracoides]. A comparative study of the Bacillus anthracoides culture and its variant has shown that the latter differs drastically from the parent culture in the shape and consistence of colonies, the size of spores and vegetative cells, the rate of spore germination in MPB, and the resistence to steam treatment and chloroactive disinfectants.


[New elementary structures of actinomycete spores of the genera Actinomadura and Streptomyces]. The structure of spore surfaces was studied by electron microscopy in five species of actinomycetes, and two new types of elementary surface structures were discovered. The surface of spores in Streptomyces regensis consists of long flexible, closely interwoven, band-like structures 25 A wide. Ring-like structures 140--150 A in diameter can be observed on spores of Actinomadura verrucosospora; their clusters resemble grapes and the spore silhouette looks like a cone. Rod-like structures of spores in Streptomyces cavourensis and Str. streptomycini which form an ornament resembling the surface of a basket and tubular strucutres in Str. acrimycini of which hair-shaped spore protrusions are made are similar to the elementary structures of spore surfaces in other actinomycetes.


The diffusion of medical technology.

The diffusion of medical technology. The diffusion of medical technology is a complex process dependent upon the character of the industry, cost of investment and adoption, sophistication of users and their environments, general-use standards, user prestige, patient distribution, government regulations, and scale of operation. The one positive influence with the greatest impact on the rate of adoption of a new technology is the third-party-payer system. The more we understand those parameters affecting the diffusion of technology in medicine, the more we will be able to provide society with good care in a reasonable cost.


[Action of isoniazid on the growth of saprophytic mycobacteria]. The effect of isoniazide on the ability to assimilate hydrophilic (sugars) and hydrophobic (hydrocarbon) substrates was studied with saprophytic mycobacteria. The minimal concentration of isoniazide inhibiting the growth of saprophytic mycobacteria in a medium containing hexadecane was 150 mcg/ml. If isoniazide was added at a concentration of 900 mcg/ml at the beginning of the logarithmic growth phase, the growth was sharply inhibited and assimilation of the hydrocarbon decelerated 4 times. The same concentration of isoniazide hardly affected the growth of the saprophytic mycobacteria in a medium containing a carbohydrate.


[Effects of the nitrogen nutrition conditions on the growth and protein synthesis of carboxydobacteria]. The rate of growth of bacterial strains oxidizing carbon monoxide (Pseudomonas gazotropha Z-1156, Comamonas compransoris Z-1155, and Seliberia carboxydohydrogena Z--1062) was studied as a function of the concentration of NH4Cl in the medium. The bacteria could grow on media containing various nitrogen sources (NH4Cl, KNO3, CO(NH2)2). Changes in the amino acid content and biochemical composition of the biomass were studied during growth of the bacteria on these media. The biological value of proteins of the bacteria was estimated.


Strategy for health technology.

Strategy for health technology. This paper presents a conceptual framework for improved management to support a pilot demonstration for the U.S. Department of Health, Education, and Welfare's new Office of Health Technology, and reports findings and implications of a recent intramural study of HEW's management of diverse technology-based activities such as development, assessment, synthesis, policymaking, and intervention.


A proposed method for quantitative performance evaluation of electrosurgical dispersive electrodes. The measurement of thermal performance of electrosurgical dispersive electrodes presents special problems since it is necessary to determine the spatial distribution of transient temperature fields in the presence of high-energy, high-frequency, electric fields. Contact sensors are contraindicated. high-speed video-scanning thermographic systems solve the problem and, additionally, provide a permanent record of the temperature-time history of experiments on videotape. The overall uncertainty in temperature rise determination using this method is on the order of 0.4 degrees C. This measurement approach, which has been used in experiments on human subjects, yields repeatable, quantitative determinations of the thermal performance of dispersive electrodes.


Medical manpower in Victoria, 1977.

Medical manpower in Victoria, 1977. A medical manpower survey in Victoria in 1977 revealed that there were 7823 registered medical practitioners, giving an apparent ratio of doctors to population of 1:483. However, only 81% of respondents were working in Victoria, and therefore the ratio of doctors in active practice in the State to population was estimated to be 1:597. Data from the survey revealed that the median age was 40 years. Female doctors comprised 17%, but the proportion of women was much higher amongst younger graduates. Private practitioners accounted for 60% of respondents (general practitioners, 36%; specialists, 24%), full-time hospital staff members for 28%, and practitioners in other salaried appointments for 12%. The ratio of general practitioners to population was estimated to be 1:1560 in the Melbourne statistical division, 1:1780 in the country, and 1:1617 in Victoria as a whole. Long hours of work were reported by the great majority of doctors. The impact of changing numbers and distribution of various categories of medical manpower on future work and postgraduate training is discussed. Early consideration of regulating the number of doctors by reducing the number of undergraduates entering Australian medical schools and by restricting the immigration of doctors from overseas is advocated.


Murderers: a personal series.

Murderers: a personal series. One hundred people who were accused either of murder (70 persons) or of attempted murder (30 persons) in Queensland were personally examined by the writer. The methods, motives, and ways of prevention of homicide are discussed. A considerable preportion of murderers in this series were either mentally ill or severely emotionally disturbed at the time the crime was committed, and at least one in 10 of these murders could have been prevented. It is recommended that the treatment and assessment of potentially violent psychotic patients should be undertaken more carefully, and that the antipsychiatrist campaigns for the freedom of the individual should be tempered with a consideration for public safety.


Mitral valve prolapse.

Mitral valve prolapse. Mitral valve prolapse is a relatively common condition in the general population. The syndrome appears more common in females, and is often associated with a family history. Patients may be asymptomatic or may present with a variety of symptoms ranging from mild chest aches and anxiety to severe angina-like chest pain, palpitations and dizziness. The common auscultatory features include mid-systolic clicks and a late systolic murmur, either alone or in combination. The wide spectrum of symptoms and signs may be explained by ventriculovalvular disproportion, where either the ventricle is too small for the valve, or the valve is too large for the ventricle. The long-term prognosis is very good; severe mitral regurgitation can occasionally develop, but both sudden death and bacterial endocarditis are rare. No treatment is required for asymptomatic patients, beyond antibiotic cover for dental procedures and surgery.


Stuttering as a manifestation of stroke. Two cases are described of stuttering as a manifestation of cerebral ischaemia in previously stutter-free individuals. In the first case, stuttering suddenly ceased after carotid endarterectomy; the second patient developed stuttering after a period of three days of complete aphasia after which the stutter gradually improved. Aetiological possibilities are discussed in the light of current theories.


Automated differential cell counting of viable cells. A rapid, automated method of differentially counting viable cells by ethidium bromide-acridine orange cytofluorography is described (Takasugi 1971). The method is shown to have comparability, equal precision, and sensitivity to the standard trypan blue, visual method. The method is applicable to microcytotoxicity testing.


Quality assurance of drug therapy in hospitals: patient serum creatinine values used by ward pharmacists in checking dosage regimens. A programme for the systematic adjustment of drug dosage in hospital patients with impairment of renal function is described. This programme involves the efficient identification of patients with elevated serum levels of creatinine, the checking of dosage regimens for these patients in terms of known pharmacokinetic data, and advising of medical officers when dosage regimens are in excess of those recommended, or where contraindicated drugs have been prescribed. The procedure, which has been shown to be both workable and effective in a large teaching hospital over a period of more than two years, serves as a model for quality assurance of an aspect of drug treatment with existing staff and with no additional capital costs.


Purgatives and periodic paralysis.

Purgatives and periodic paralysis. A married woman, aged 42, had suffered attacks of muscular weakness. She was found to have profound hypokalaemia. This was due to chronic purgative abuse. There was a prompt response to treatment. The case raises issues of theoretical and practical importance.


Saltwater drowning and near-drowning accidents involving children. A five-year total population study in south-east Queensland. A large total population study of childhood saltwater immersion accidents is reported. A total of 49 cases (16 fatalities, 33 survivors) occurred in the five year period from 1971 to 1975 in southeastern Queensland. As a group, more children survive a potentially fatal saltwater immersion (67%) than do those who lose consciousness in freshwater (50%). The serious saltwater accident rate (loss of consciousness or death) in childhood (from 0 to 15 years inclusive, is 3.37/100,000 children per year at risk (fatality rate 1.12). This is low; comparison with freshwater data shows that although the surf presents special hazards to children, it is very much safer than other types of water. Age-specific and site-specific accident and survival rates for saltwater immersions are presented for the first time. Toddlers are disproportionately represented (33% of all children) and their survival rates are lowest. Boating and the use of surfboards, in current practice, are negligible threats to children. The saltwater immersion rate is increasing (although the absolute risk is small) and reasons for this are discussed. Childhood saltwater immersions were unaffected by tidal state. All but one case of immersion occurred during daylight hours, and in younger children immersion occurred often on weekends.


[Barrett's syndrome (author's transl)].

[Barrett's syndrome (author's transl)]. Barrett's syndrome is a rare serious ulcerative inflammation of the middle or distal parts of esophagus, characterized by heterotopic gastric mucosa within the esophagus. In 4 cases, diagnosis of Barrett's syndrome suspected by means of x-ray examination was confirmed endoscopically and by taking biopsies under vision. The etiology of the disease is not clear. Alcoholism is common. In our patients, conservative treatment has been used without a great deal of benefit. Only by resection of the parts of esophagus lined by columnar epithelium a beneficial result can be expected, this surgical procedure certainly being a high risk.


[Clinical-histological correlation and significance of duodenitis (author's transl)]. In 200 patients with upper abdominal complaints biopsy material was taken by fiberoptic endoscopy for histologic evaluation. Histology was normal in both the gastric fractions from fundus and antrum and from the duodenal mucosa in 53 cases. 36 Patients showed the histologic picture of duodenitis with leucocytic infiltrates of the villous stroma in the vicinity of erosions or ulcerations. In 28 cases duodenitis was found without such mucosal lesions, accompanying coexistent gastritis. This is, however, not a constant finding in patients with gastritis of either histologic type in either gastric region: 82 cases from all age groups had gastritis without accompanying duodenitis. In contrast to a good deal of the literature reports about duodenitis being a disease entity, we could not find but one case of isolated duodenitis without gastritis and/or duodenal mucosal lesions. Furthermore, there is no specific clinical symptomatology.


[Ileus with endometriosis of the large intestine (author's transl)]. Dispersed endometrium tissue can be observed in 10% of all laparotomies. In some rare instances the endometriosis also appears within the region of the intestinal canal. It is reported on a 48 year old woman observing diarrhoea tinged with blood at four weekly intervals. With the clinical picture of a mechanical ileus she was admitted to hospital. In the laparotomy a big stenosing sigmoidotumor showing histological endometriosis seats was found.


[Results of rectoscopical investigations in unselected patients: contribution to the problems of prophylactical investigations (author's transl)]. A report and analysis is given about the results of totally 1665 rectoscopical investigations, which were done in unselected patients suffering from common internal diseases. In 7 cases (that means 0.4% of the whole collective) a carcinoma could be detected. An evidently great number of 304 patients were carriers of polyps (that means 17.6% of the whole collective), of whom 77% were male and 23% were female carriers of polyps. The differentiation of the polyps moreover was done according to the histological criteria: There were 126 prospectively precancerous polyps (that means 7.4% of the whole collective of 1665 patients). These results are compared with data in the literature. The number of prospectively important findings is found higher than commonly is expected. The security of the diagnostic significance of the rectoscopical investigations cannot be obtained by other methods of prophylactical investigations. Therefore this method should be practiced in internal, but among all in clinical conditions in first stage. Only more consequent medical procedures in future are able to help to gain more successful results in treating colorectal cancer.


[Plasma aldosterone after rest and exercise: normal values, type of distribution, dependence upon age and sex (author's transl)]. We determined plasma aldosterone levels of patients with healthy adrenals after rest (n = 80) and exercise (n = 30) using a radioimmune assay with highly specific antibodies. The obtained normal values had a log-normal distribution. The normal values did not show any differences regarding sex and age. At rest they ranged between 50 pg/ml and 190 pg/ml, after exercise between 110 pg/ml and 310 pg/ml.


[Glucose tolerance and muscular efficiency (author's transl)]. Glucose tolerance and insulin secretion were studied in 15 male patients suffering from muscular dystrophies. Creatinine excretion was used as a measure of functioning muscle mass. The decrease in glucose tolerance correlated significantly with the injury of muscular efficiency. Despite impaired glucose tolerance, very high levels of circulating insulin were reached, as in obese diabetics. The observations do not simply reflect the decrease in distribution volume of glucose. They can be explained by an altered proportion of muscle mass to adipose and connective tissue. Decreased glucose tolerance may signalize the myopathic reaction following an endocrine disorder or a malignant disease.


[Serum concentration of lactate in diabetic patients treated with biguanides in relationship to renal function (author's transl)]. Lactate, pyruvate, creatinine, urea, blood sugar and the serum concentration of phenformin or buformin were analyzed in the venous blood of a total of 90 diabetics who received biguanides regularly for at least one month. The creatinine clearance as well as the lactate-pyruvate quotient were computed. Age, body weight and size as well as duration of medication were recorded. Twenty-three diabetics who did not receive biguanides were used for control. Almost all patients revealed a mostly minor hyperlactatemia which was also observed in the control group. There was no significant difference between the two groups. There was no relationship between renal function, the serum lactate level and the biguanide concentration.


Ceramide metabolism in brain.

Ceramide metabolism in brain. Ceramide is the fundamental structure and key intermediate of all sphingolipids. Biosynthesis and catabolism of brain ceramide, especially their relationship to the metabolism of more complex sphingolipids in brain, are reviewed. Human genetic diseases which involve altered ceramide metabolism are also discussed.


Current concepts of the structure and nature of mammalian salivary mucous glycoproteins. The visco-elastic properties of salivary secretions are due to high molecular-weight glycoproteins, known as mucins. Mucins are composed of numerous oligosaccharide side-chains O-glycosidically linked through 2-acetamido-2-deoxy-alpha-D-galactose to the hydroxyl groups of seryl and threonyl residues of the protein core; on the average, every fourth amino acid residue is involved in such a bond. This work conveys their isolation and purification, compiles the compositional analysis of several mammalian submaxillary and sublingual mucins; defines the conditions of the alkaline beta-elimination reaction, its mechanism, and importance in structural studies of glycoprotens, and briefly discusses the influence of stimuli on mucous secretions, as well as biosynthesis, structural diversity, and physiological role of salivary mucous glycoproteins.


Staphylococcal nuclease reviewed: a prototypic study in contemporary enzymology. II. Solution studies of the nucleotide binding site and the effects of nucleotide binding. This is the second of a series of four articles in which the chemical, enzymological and crystallographic work on Ribonucleate (deoxyribonucleate)-3'-nucleotidohydrolase, EC 3.1.4.4. (staphylococcal nuclease, micrococcal nuclease) will be reviewed and correlated. This article discusses studies in solution delineating the extent of the binding site of the enzyme and identifying some of the particular amino acid residues that form this site. In addition, the effects of the very potent inhibitory combination of thymidine-3',5'-diphosphate and Ca2+ on the conformation of the enzyme and its physical, chemical and enzymological properties will be reviewed.


Purification and partial characterisation of a bovine kidney aminotripeptidase (capable of cleaving prolyl-glycylglycine). An enzyme was purified 163-fold in an 8.2% yield from bovine kidney. The specific activities of the pure preparation against L-prolyl glycylglycine and L-alanyl glycylglycine were found to be 244.5 and 578 micron Moles substrate hydrolyzed per min per mg protein respectively. The molecular weight of the enzyme was estimated on gel filtration to be 55,000. The isoelectric point was recorded to be pH 5.2. A preliminary study of substrate specificity showed that the enzyme preferentially hydrolyzed tripeptides of the type X-glycylglycine. The enzyme was tentatively identified as a tripeptide aminopeptidase (alpha aminoacyldipeptide hydrolase, EC 3.4.11.4).


Comparative characterization of mitochondrial nucleoids and of nuclear chromatin of sea urchin embryos. Chromatin and mitochondrial nucleoids of sea urchin embryos were found to have different isopycnic densities in metrizamide gradients. The banding density of nucleoids was constant during development, while there appeared to be alterations in the density profiles of chromatin banded at low ionic strength.


[Radiologic findings in abdominal pain in children (author's transl)]. The results of the radiological examination of 330 children following oral administration of barium are reported. It is pointed out that if one just takes into account the undoubted organic diseases, only a few children would benefit from the examination; in our case only 9 of them (a gastric and a duodenal ulcer, a pancreas pseudocyst, 5 hiatal hernias, and a celiac disease), i.e. 3%. This is not very satisfactory from a practical point of view. This situation improves radically when one looks for diseases usually rated as questionable: small hiatal hernia (cardiotuberositary malposition), functional disturbances of the small intestine, reactive hyperplasia of the lymphoid tissue, and chronic appendicitis. Thus we were able to offer 177 children, i.e. 53% of them, an efficacious therapy. The importance of chronic appendicitis and of functional disturbances of the small intestine as a cause of abdominal pain in children is pointed out, and their radiological symptoms are discussed. Finally the not uncommon, but not very well known disease of incomplete sigmoid volvulus is described.


[Correlation between clinical status and psychological variables in juvenile diabetics (author's transl)]. Correlations between clinical status and psychological variables in 56 juvenile diabetics were studied. Intelligence was only partly associated with clinical status. Among personality variables extraversion proved to be correlated with insufficient clinical control. This result is significant, both from a theoretical and from a practical point of view. There were no correlations of parental personality and clinical control.


[Studies on noise stress caused by infant incubators (author's transl)]. The following acoustic effects of incubators were investigated: Noise level and vibration measurements inside incubators. Noise emanation into the vicinity of incubators. Deadening of incubator noise by the hood. The noise intensity inside the incubators was also registered under conditions of intensive care using sound emitting therapeutic and monitoring equipment. The results show that the noise level of incubator motors can be tolerated. This applies to well-serviced incubators only, however. The hood muffles outside noise, particularly in the range of greatest hearing acuity. But there is no protection against noisy intensive-care systems within the incubator. The infants own noise production is considered to contribute substantially to the noise within an incubator.


[Results and consequences using Prechtl's concept of optimal conditions. Obstetrical and Postnatal complications (author's transl)]. An extended list of Prechtl's list of optimal obstetric conditions was used to describe the history of 200 newborns, randomly chosen from a defined population born in 1972. Differences between the population from Groningen (Prechtl's) and Tübingen, and different definitions of the items used in the list are discussed. Reduced optimal conditions in the history of the mother effectively reduced the optimal conditions in the newborn aswell. This was particularly so in case of: Preterm deliveries and miscarriages, bleedings in the first trimester, preterm onset of labour, operative deliveries, less than 38 weeks of gestational age, and an Apgar score below 7.


[Intoxication with anticoagulant rodenticides (author's transl)]. Generally the ingestion of rodenticides containing anticoagulant substances is not dangerous. Following accidental ingestion, 9 out of 77 children, and 7 out of 13 adults who had taken such substances in attempted suicide had slight or moderate increases of thromboplastin time, but no serious alteration of plasmatic blood coagulation. Vitamin K1 should be given as an antidote in all cases; gastric lavage or induced emesis are often unnecessary.


Mutagenicity of polycyclic hydrocarbons. V. Induction of sister-chromatid exchanges in vivo. The potency of polycyclic hydrocarbons to induce SCEs in vivo was analysed. The most potent SCE-inducing compound was benzo[a]pyrene. Benzanthracene, benzo[b]fluoranthene, benzo[e]pyrene, phenanthrene, chrysene and dibenzanthracene enhanced the SCE frequency to a smaller extent. The number of anthracene-induced SCEs per metaphase was not increased as compared with the controls.


Clastogenic effects of frusemide on human leukocytes in culture. The clastogenic effects of frusemide were investigated in vitro for 24 and 72 h. A mitodepressive activity was observed at both times. Chromosomal anomalies showed a dose response. There was a propensity for chromatid abnormalities. The chromosome mutational property of the drug is discussed in the light of earlier studies in vivo by the authors.


Elevated platelet-associated IgG in the thrombocytopenia of septicemia. The mechanism of thrombocytopenia, a frequent complication of septicemia, is obscure, but indirect evidence suggests that the immune system may be involved. To investigate this possibility, we quantitated platelet-associated IgG on platelets obtained from 44 patients during 46 episodes of septicemia. Thrombocytopenia occurred in 21 of 46 episodes (46 per cent). Platelet-associated IgG was elevated in eight of 11 episodes of gram-negative septicemia and thrombocytopenia (47.3 +/- 11.7 fg of IgG per platelet [mean +/- S.E.]) and in one of 20 patients with gram-negative septicemia and normal platelet counts (5.9 +/- 1.1) (P less than 0.001). Elevated levels occurred in eight of 10 patients with gram-positive septicemia and thrombocytopenia (55.3 +/- 14.7 fg of IgG per platelet) and in none of 11 patients with gram-positive septicemia and normal platelet counts (5.6 +/- 1.7) (P less than 0.001). Serial testing during the thrombocytopenia and recovery showed an inverse relation between the platelet count and platelet-associated IgG. Thrombocytopenia in some patients with septicemia may be related to the binding of IgG to platelets.


Risk of cutaneous carcinoma in patients treated with oral methoxsalen photochemotherapy for psoriasis. A 2.1-year prospective study of 1373 patients given oral 8-methoxypsoralen photochemotherapy for psoriasis revealed 30 patients with a total of 48 basal-cell and squamous-cell carcinomas. The observed incidence of cutaneous carcinoma was 2.63 (95 per cent confidence limits = 1.91 to 3.90) times that expected for an age, sex and geographically matched population. Relative risk to patients with history of ionizing radiation was 3.68 (99 per cent confidence limits, 2.42 to 8.69). Patients with a previous cutaneous carcinoma had a relative risk of 10.22 (99 per cent confidence limits, 4.78 to 37.08). A higher than expected proportion of squamous-cell carcinomas and an excess of squamous-cell carcinomas in areas not exposed to sun were seen. New patients with known histories of ionizing-radiation exposure or of skin tumors should be given 8-methyoxypsoralen photochemotherapy only if they understand the risks and have disabling psoriasis untreatable by other means.


Development of lithogenic bile during puberty in Pima indians. To determine whether highly saturated bile is a congenital or acquired characteristic of Pima Indians and to elucidate the basis of the rapid postpubertal increase in gallstones in Pimas, we studied the bile of 66 Pimas nine to 21 years of age. Highly saturated bile is not prevalent among Pimas under the age of 13, but bile saturation increases significantly (P less than 0.05) in both sexes during pubertal growth and development. Bile saturation was 15 per cent higher in females than males. Bile acid pools increased with age in the young men, but not in women. Bile cholesterol saturation correlated with obesity (r = 0.41; P less than 0.001) and urinary estrogen excretion (r = 0.44; P less than 0.001). Highly saturated bile may be present for several years before the onset of cholesterol cholelithiasis.


Increased insulin binding to erythrocytes in anorexia nervosa: restoration to normal with refeeding. We studied [125I] insulin binding to circulating cells in patients with anorexia nervosa (eight females), in the basal cachectic state (seven patients) and after weight gain (eight patients) and compared the values to those obtained in 17 normal volunteers (eight females and nine males). Untreated patients showed increased insulin binding to receptors on erythrocytes (mean +/- S.E.M., 12.2 +/- 0.99 per cent of total); after weight gain, these increased levels returned to normal (6.8 +/- 0.42 vs 6.7 +/- 0.63 per cent of total). Increased binding was due to an increased number of receptors per cell, with little or no change in receptor affinity. In five patients (one untreated, four treated), results of [125I] insulin binding to erythrocytes correlated closely (r = 0.982) with results obtained with monocytes. We conclude that in patients with anorexia nervosa, insulin binding to receptors is altered and that the abnormality is corrected by restoration of normal food intake and body weight.


DNA sequences and structural homologies of the replication origins of lambdoid bacteriophages. The DNA sequences for the origins of replication of the lambdoid bacteriophages phi80, 434, phi21, and lambdaimm21 (identical to phi21) have been determined and compared to the lambda structure. Two presumptive elaborate binding sites for two initiator proteins have been identified in their outer sections, while a replicational primer start site seems to be located in their centres.


Structure of the human fetal globin gene locus. We have derived a 'map' of restriction enzyme sites in and around the human gamma-globin genes. This has enabled us to show that there are two gamma-globin genes per haploid set, that the genes contain 'introns' within the same regions of DNA as the human beta and delta-globin genes, and that the genes are 3,500 base pairs apart. We conclude that the correct gene organisation of the human beta-like globin locus is GgammaAgammadeltabeta.


The chick ovomucoid gene contains at least six intervening sequences. A 15-kilobase pair EcoRI chick DNA fragment, containing both the termination codon UGA and the 5'-portion of the structural ovomucoid gene, has been cloned in lambda phage Charon 4A by in vitro packaging. Restriction mapping and electron microscopic analyses of this cloned DNA have revealed that the structural ovomucoid gene sequences are separated by at least six intervening sequences.


Identification of potential ovomucoid mRNA precursors in chick oviduct nuclei. Denaturing gel electrophoresis of chick oviduct nuclear RNA reveals multiple species of RNA that are 1.5-5 times larger than ovomucoid mRNA. By analogy with ovalbumin RNA processing, these data suggest that ovomucoid mRNA is derived from a primary transcript that contains intervening sequences.


Biosynthesis of cyanogenic glycosides.

Biosynthesis of cyanogenic glycosides. Cyanogenic glycosides are secondary plant compounds that occur widely in the plant kingdom. They are the source of HCN which can render the plant toxic if it is taken as food. The enzymes responsible for production of the HCN have long been known. More recent biosynthetic studies have established certain protein amino acids as precursors of the aglycones, and indicate N-hydroxyamino acids, aldoximes, nitriles and alpha-hydroxynitriles as intermediates. In sorghum the several biosynthetic enzymes catalyzing the flow of carbon atoms from L-tyrosine through such nitrogenous intermediates are located in a membrane fraction and may be capable of metabolic channeling.


[Causes, shape and chemistry of gallstones]. Gallstones are precipitations of oversaturated bile fluid. They can develop in the gallbladder and in the efferent bile ducts; they are very often correlated with diseases of the gallbladder, bile ducts and neighboring organs. The gallstone disease (cholelithiasis) is increasing continually, especially in developed countries with overcaloric nourished population. Surgical interventions on the biliary tract are the most frequent abdominal operations at present.


Bradykinin as an algesic (pain producing) substance in the pulp. A rat uterine smooth muscle contracting substance was released into the superfusate of the dog's exposed canine pulp after noxious stimulation of the pulp by pricking, heat and electrical stimulation. This active substance was acid- and heat-resistant and was decomposed by carboxypeptidase B and alpha-chymotrypsin, but not by carboxypeptidase A and trypsin. This substance was also tested on several types of smooth muscle. Electrical activity of nerve cells in the reticular formation, which were sensitive to stimulation of the instep of the foot by pinching, was activated by the intrafemoral administration of the active substance. The algesic activity of this substance was examined in cantharidin blister base in man. This study conclusively demonstrated that the active substance of the pulp released by noxious stimulation produced pain and it was identified as bradykinin.


Increased pressor responses to physostigmine in spontaneously hypertensive rats. Intravenous injection of physostigmine evoked a pressor response in unanaesthetized rats. Spontaneously hypertensive rats (SHR) showed increased pressor responses, but the responses were within normal limits in renal hypertensive and DOCA-saline hypertensive rats. The pressor effect in SHR was abolished by the i.v. injection of atropine sulphate but not by the i.v. injection of atropine methylbromide. After inhibition of the peripheral muscarinic receptors by atropine methyl bromide, oxotremorine also produced a pressor response in unanaesthetized rats. In contrast to the pressor effect of physostigmine, there was no difference between the oxotremorine-induced pressor response of SHR and that of normotensive Wistar-Kyoto rats. The pressor effect of oxotremorine in SHR was blocked by the i.v. injection of atropine sulphate.


Supersensitivity to opioids following the chronic blockade of endorphin action by naloxone. Chronic treatment of guinea pigs with the narcotic antagonist naloxone (pellet implantation technique) caused an increased sensitivity to opioids of the electrically stimulated longitudinal muscle-myenteric plexus preparation of the ileum. This supersensitivity is associated with an elevation of the total number of opiate receptor binding sites in both the peripheral and the central nervous system.


The anti-nociceptive effect of reserpine and haloperidol mediated by the nigro-striatal system: antagonism by naloxone. Reserpine (10 mg/kg) and haloperidol (2 mg/kg) injected intraperitoneally increased the reaction time of the tail-flick response in intact but not in pre-nigrally decerebrate or spinal rats. The antinociceptive effect of both drugs was antagonized by intraperitoneal injections of dopa (100 mg/kg), apomorphine (2 mg/kg) or naloxone (1 mg/kg) as well as by bilateral micro-injections into the caudate nuclei of apomorphine (100 microgram and 20 microgram) and naloxone (10 microgram). It is concluded that the nigrostriatal feedback system is involved in the anti-nociceptive effect of reserpine and haloperidol.


[Responses of cat suprasylvian gyrus neurons to light flashes of different wave lengths]. Unit responses in the cat's suprasylvian gyrus to the light flashes of different wavelength were studied. 80% of colour-coding units were found in the suprasylvian gyrus, especially in the Clare-Bishop area. Four groups of neurons differently responding to different spectral regions are distinguished. The possible principle of stimulus wavelength information coding in the suprasylvian units is discussed.


[Response of pericruciate cortex neurons to stimulation of the medial geniculate body]. Electrical responses of 239 pericruciate neurons were studied in anaesthetized and curarized cats after stimulation of the medial geniculate body and medullary pyramids. The medial geniculate body stimulation evoked in the pericruciate neurons predominantly excitatory effects in the form of increase in the mean frequency of spike activity, generation of EPSPs and EPSPs-spike sequences. The latency analysis has shown that medial geniculate neurons have mono- and polysynaptic connections with pericruciate neurons not belonging to the pyramidal tract units.


[Characteristics of the neuronal responses of the auditory zone of the cortex of awake cats in the resting state and during an elaborated defensive conditioned reflex]. The responses of 288 neurons with background activity in the first auditory cortex were investigated using glass microelectrodes in chronic experiments on cats at rest (123 neurons) and during elaboration of a defensive conditioned reflex to sound stimulation (165 neurons). At rest 43% of recorded neurons did not respond to the sound stimulus. Pronounced inhibition of background activity prevailed among responding neurons (about 60%). The conditioning caused an increase (to 72%) in proportion of neurons responsive to the sound stimulus, appearance of tonic reactions, as well as an increase in frequency of bursts and in proportion of activation type responses. It is suggested that these changes indicate the enhancement of neurons excitability in the zone under study during conditioning.


[Structure of the receptive fields of cat pulvinar neurons sensitive to photic stimulation]. The structure of receptive fields of 262 neurons was studied in pulvinar. Of 262 neurons 142 were investigated in detail for receptive fields using stationary and dynamic visual stimuli. The receptive fields were classified into 6 groups according to the responses to the stationary light stimuli. The first group contained on-off receptive fields (44 of 142), all the investigated parts of which produced on-off responses to the flashing light spot. The second group (42 of 142) included neurons with the off-reactions from the whole surface of the receptive field. The third group comprised the on-receptive fields (19 of 142). Eight receptive fields (the fourth group) were similar to the "simple fields" of primary visual cortex. The fifth group (10 of 142 neurons) was characterized as concentric having on-off centre and on or off surrounding. The sixth group (19 of 142) included receptive fields with multiple discharge centres, the receptive field surface having silent zones for both on- and off-responses. The neurons having such receptive fields responded by multimodaly distributed discharges during the stimulation by moving and stationary visual stimuli. The average latency of responses of most neurons in pulvinar was 40-70 ms, some neurons displaying shorter (20 ms) and some longer (130-160 ms) latencies.


[Neuronal composition and interneuronal connections of field 5 of the parietal association cortex of cats]. Field 5 of the cat neocortex was studied by the Golgi method. Characteristic features here are as follows: predominance of pyramidal cells in layers II-III and existence of large forms (40X26 micron) among them; single and clustered giant pyramidal neurons (70X23 micron) in layer V; large (25-30 micron in diameter) and giant (40-45 micron in diameter) stellate cells with radial dendrites, single or gathered in groups, in layers V--VI; few efferent spindle-like neurons (40X20 micron) in layers V-VI. Stellate cells found in layers II-VI probably unite the pyramidal cells localized within one or several layers. Some of the stellate cells in layers II-III establish long horizontal connections within the field. Interneuronal connections are formed by axo-somatic and axo-dendritic terminals with the prevalence of the latter; dendro-dendritic and axo-axonic contacts were rarely observed.


[Electrophysiologic and chemoreceptive characteristics of pontomedullary and thalamic neurons during the process of ontogenetic development]. The background and evoked activity of reticular units in the medulla, pons and ventrobasal complex of the thalamus was studied on cat's fetuses and kittens 54-65 and 1-60 days old, respectively. 63% (pons) and 92% (medulla) of spontaneously active cells were recorded in the fetuses. The highest percentage of evoked responses (60% in the fetuses) was observed upon stimulation of the tongue. Repeated application of stimuli facilitated the firing during the interstimulus intervals, especially during the early developmental stages. Sensitivity to transmitters in the fetuses was maximal to noradrenalin (87%) and glutamate (70%) and minimal to acetylcholine (43%). With development of the animal the number of adrenosensitive units decreased, that of the cholinosensitive increased, and the sensitivity to glutamate remained at the same level. A conclusion is made that the synaptic processes at early developmental stages are mainly of adrenergic and glutamate nature.


[Spatial organization of inhibitory control of the activity of the vestibulospinal neurons of Deiter's nucleus by the Purkinje cells in the anterior lobe of the cerebellar cortex]. Peculiarities of topographical distribution of the Deiters nucleus vestibulospinal neurons were studied by means of microelectrode technique. It is shown, in contrast to morphological data, that the localization of antidromically identified vestibulocervical (C-neurons) and vestibulolumbal (L-neurons) cells is not restricted to the ventral mid- and rostral third part (forelimb region) and caudosorsal part (hindlimb region) of the nucleus, but extends correspondingly to the whole ventral and dorsal halves of the nucleus. There is a great overlapping in zones of these two groups of neurons: C-neurons are found in the dorsal portion also, whereas L-neurons--in its ventrocaudal part. Analysis of distribution of monosynaptic IPSPs in the vestibulospinal neurons, evoked in response to the stimulation of the Purkinje cells, has shown that the C-neurons are controlled mainly from the forelimb region of the cerebellar cortex, whereas L-neurons are inhibited from the forelimb as well as from the hindlimb regions of the vermal cortex anterior lobe.


[Central program for interaction between the hindlimbs of cats during locomotion]. Central program of interaction of hindlimbs during fictitious locomotion expressed in the time structure of motor discharges in nerves to different muscles was investigated in decerebrated and spinal immobilized cats. It was shown that in the decerebrated animals the program of interaction of hindlimbs (alternative or synphase) is determined by interaction of the flexor half-centres. The latter work either in-phase or out-of-phase. The character of activity of extensor half-centres is determined secondarily by alternating interaction of each of them with homolateral flexor half-centre. After injection of DOPA the central program of interaction of hindlimbs can be determined by synchronous work of extensor half-centres.


[Submicroscopic localization acetylcholinesterase in synapses of the caudal mesenteric ganglion in cats]. The existence of two types of synapses in the cat caudal mesenteric ganglion was studied using Karnovsky's electron microscopic method. Synapses of the first type contain light agranular synaptic vesicles and show acetylcholinesterase-positive response, which implies their cholinergic nature. Synapses of the second type show weak positive or negative AChE-responses. These synapses most of which contain also granular vesicles are considered to be noncholinergic. AChE-positive and AChE-negative synapses were found also in predecentralized ganglia. The origin of the two types of synapses is discussed.


[Reconstruction of tetrodotoxin-dependent passive transport structures in liposomes]. Proteoliposomes were obtained from cholate solubilized components of membrane fraction and crude phospholipid fraction from the calf brain. Permeability of the proteoliposomes was studied using Na22 and Rb86 tracers. Veratrine was shown to activate and tetrodotoxin to inhibit Na22 efflux from proteoliposomes, while Rb86 efflux was not affected by the drugs used. These results demonstrate reconstitution of tetrodotoxin-dependent structure inducing selective sodium passive transport in artificial membranes.


[Tryptophan and tyrosine in blood and cerebrospinal fluid in patients with recent cerebral infarct]. The determinations were carried out in the blood and cerebrospinal fluid of 40 patients with recent cerebral infarction and 30 controls. Tryptophan concentration was determined by the fluorimetric method of Denckla and Dewey, and tyrosine concentration by the method of Waalkes and Udenfried. A statistically significant rise of free tryptophan concentration in the plasma and tryptophan concentration in the cerebrospinal fluid was found which seemed to depend on the stress reaction following brain infarction. No statistically significant changes were observed in the concentration of tyrosine in the cerebrospinal fluid and plasma in patients with brain infarction.


[Case of spinal cord hemangioma simulating the clinical course of multiple sclerosis]. The authors report a case of haemangioma of the thoracic spine in a man aged 50 years in whom the clinical course of the disease resembled that of multiple sclerosis. The monofocal character of the clinical symptoms and signs, the course of the disease with steady progression without intermittent improvement suggested a slowly developing expanding lesion in the lower thoracic part of the spinal canal. The correct diagnosis was reached after myelography and spinal arteriography. Three months after surgical closure of the afferent vessels the patient died died from septicaemia originating from extensive refractory decubitus ulcers.


[Hereditary optic atrophy of the Kjer's type]. Kjer's disease is a benign form of hereditary optic nerve atrophy observed mainly in women. It starts in childhood and progresses slowly without leading to complete blindness. The inheritance is dominant. These features differentiate it from other known forms of hereditary optic nerve atrophy, that is Leber's and Behr's syndromes. The reported case was observed in a 21-year-old man whose mother, grandmother and great-grandmother had optic nerve atrophy. Since the age of 10 years the patient had visual acuity impairment progressing slowly. Examination demonstrated central scotoma, pallor of both optic discs particularly on the temporal side. After 10 years of the disease the visual acuity was 0.5 on the right and 0.3 on the left side. There was bilateral hearing impairment of high tones. The patient had no knee and ankle jerks. Differential diagnosis of Kjer's syndrome against other hereditary-degenerative diseases is discussed.


[Oscillopsia in multiple sclerosis].

[Oscillopsia in multiple sclerosis]. In a 20-year-old woman one of the presenting signs of multiple sclerosis was recurrent oscillopsia. Fixation of eyes while reading released during upward and downward gaze oscillopsia with variable amplitude and frequency. Electronystagmographic investigation failed to reveal signs of damage to the vestibular organ or vestibulo-oculomotor pathways. The most likely explantation of oscillopsie was, in this case, lesion of the pathway connecting the cerebellum with oculumotor nerve nuclei.


[Visual evoked potentials in cases of damage to visual pathways at different levels]. Visual potentials induced with a checker pattern were studied in a group of patients with damage to the visual pathways at different levels, and were compared with similar potentials in 10 adult subjects without diseases. A statistically significant prolongation of latency of the main deflections (N1, P max and N2) was observed in the group of 14 patients with optic nerve damage, while in 10 patients with lesions above the chiasma different, often normal responses were obtained. High-grade deformity of visual potentials was observed in 2 cases of visual agnosia. The study of visual evoked potentials may be in the opinion of the authors, useful in cases of damage to the optic nerve, retina and cortical visual centres.


[Developmental anomalies of the metencephalon in the craniofacial and vertebral malformation syndrome]. The authors describe a case of a girl aged 9 years with a syndrome of malformations--cleft of the upper lip, maxilla and palate, lack of C2 arch fusion, polycystic lesions of the vermis and cerebellar hemisphere with obliteration of the aqueduct. The syndrome of intracranial hypertension with prevailing cerebellar symptoms was the cause of diagnostic and surgical management. Suboccipital craniotomy was done with insertion of ventriculoatrial valve which restored the normal intracranial pressure. The girl recovered and resumed education.


[Visual somatosensory and auditory evoked potentials in multiple sclerosis]. In a group of 15 patients with multiple sclerosis and in a control group of 20 healthy subjects visual evoked potentials produced with flashes or checkerboard pattern, auditory evoked potentials after stimulation with three different tones, and somatosensory evoked potentials after stimulation of the left, right or both median nerves, and reactions to stroboscopic stimulation at seven different frequencies were investigated. Recording was done with unipolar leads from frontal, central, occipital and temporal regions on the left and right side. In patients with multiple sclerosis the cortical responses to all these stimuli had lower amplitude than in healthy subjects, and the reponses to stroboscopic stimulation were also abnormal in the group of patients. Different clinical signs related to various defects of sensory functions showed a high correlation with electrophysiological anomalies. Non-linear discrimination analysis was carried out using 13 variants (the amplitudes were calculated from peak to peak and correlation coefficients were calculated between identical regions on the left and right side) comparing the group of patients with the control group. Using this method it was possible to establish the correct diagnosis in all cases of multiple sclerosis and 85% of healthy subjects could have been included into the asymptomatic group. Since the methods used in these investigations are easy and can be easily automated the authors think that they could be very useful in the clinical diagnosis of multiple sclerosis.


[Estimation of hypoalgesia by the cerebral evoked potentials method]. The authors used the method of somatosensory evoked potentials for estimating hypoalgesia obtained by stimulation of exteroceptors (by electrostimulation and acupuncture) and telereceptors (by phonostimulation and photostimulation). Estimation of hypoalgesia was performed at a remote site from the stimulated receptors and owing to this it was possible to confirm a general analgesic effect of all these methods. The method of evoked cortical potentials may be useful for estimation of hypoalgesia which manifests itself as a slight prolongation of latency (by several msec.) in most tested individuals in 6 successive potential waves. For estimation of the hypoalgesia the environmental conditions must be kept unchanged and the apparatus must be of highest quality.


[Fronto-temporo-sphenoidal craniotomy using the Yasargil method in operations of aneurysms and expanding lesions of basal areas of the brain]. The authors describe in detail the technique of fronto-temporo-sphenoidal craniotomy of Yasargil and stress its advantages in surgical treatment of aneurysms of the circle of Willis. This method was used in surgical treatment of 82 patients with intracranial aneurysms, expanding lesions situated in the vicinity of the sella and ala parva of the sphenoid bone, and with other intracranial processes, and very good conditions for operation were obtained. The authors believe that fronto-temporo-sphenoidal craniotomy is the most favourable approach for the management of aneurysms of the circulus arteriosus.


[Stroke in the records of the Department of Neurology, Silesian Medical Academy in Katowice and Zabre as well as the Neurology Department of the 8th Municipal Hospital in Katowice in the years 1970-1974]. The authors analysed the clinical material of acute vascular diseases of the central nervous system treated at the Department of Neurology, Silesian Medical Academy and Neurological Department of the 8th Municipal Hospital providing in the years 1970-1974 medical care for the population of two greatest cities of the Upper Silesian Industrial Region in cases of sudden neurological diseases. Cerebrovascular strokes accounted for 14.7% of all hospitalized cases. The mean annual index of admissions for these departments was 52.5 per 100 000 population. Cerebral haemorrhages were diagnosed in 28% strokes, they were somewhat more frequent in women, especially in oldest age. Subarachnoideal haemorrhages were observed in 9.3% of strokes, more frequently in the age range from 41 to 60 years, and more frequently in middle aged men. Thrombotic brain softening accounted for 37.1% of cases, more frequently in men aged 51-70 years. Similarly, transient cerebral ischemia recognized in 13.9% of cases was more frequent in men. On the other hand, cerebral arterial embolism diagnosed in 11.7% of cases occurred usually in women aged over 60 years. In March and April the number of patients admitted with cerebral haemorrhages was slightly higher, while in April, May and June cases of thrombotic encephalomalacia were more frequent.


[Radical and conservative methods in the surgical treatment of brain abscesses]. In the light of own experience with 50 patients with brain abscesses and a survey of the literature the authors discuss the values of the surgical methods of treatment in this disease. When the radical methods are used the mortality is lowest and the incidence of recurrent abscesses is lowest, but of this treatment is likely to produce considerable neurological deficit it is better to apply conservative methods, such as puncture and drainage of the abscess. The sparing operation as a method of choice may be the first stage of treatment before radical operation in acute abscess and in patients in serious clinical condition.


[Surgical treatment of the internal carotid-posterior communicating artery aneurysm--from the experience of 213 cases (author's transl)]. 213 cases of so-called posterior communicating artery aneurysm submitted to surgical operation without using microscope were reviewed from the technical point of view. Aneurysm project boradly to two directions, i.e. postero-inferior and lateral directions. We have treated these anuerysms with two very distinct operative approaches in order to reach the aneurysmal neck from the right angle. Frontal approach is used for the aneurysms projecting laterally. In contrast, the aneurysms projecting postero-inferior are reached laterally by mobilizing the tip of the temporal lobe. Of 213 patients, 15 died (mortality rate 7.0%) and 19 were poor (8.9%). The operative result of the cases in which the aneurysm ruptured during the exposure of the aneurysmal neck was poor. Therefore, intensive care is emphasized to avoid the aneurysm rupture during surgery. Other important technical points which affect the operative results were discussed.


[Surgical treatment of aneurysms of the anterior communicating artery using Yasargil's approach]. The results of surgical treatment in 19 cases of aneurysms of the anterior communicating artery from the approach described by Yasargil are described. In 16 patients the pedicle of the aneurysm was closed with a clip, in 2 cases the anterior communicating artery was excluded from the circulation by trapping, and in only 1 patient the aneurysm was enclosed in muscle and gazue. Control angiography demonstrated in 16 cases exclusion of the aneurysm from the circulation with maintenance of the patency of the main vessels, and in one case the sac of the aneurysm was partly shadowed. Good results were obtained in 80% of cases. One patient died (5%). Complications with development of Korsakoff's syndrome were observed in 3 patients (15%). The advantages of the approach described by Yasargil for the exposure and safe management of anterior communicating artery aneurysms are stressed.


[Arterial occlusion following cerebral vasospasm (author's transl)]. 1. The present study analysed the clinical course, the serial angiograms and the CT scans of the patients with angiographic arterial occlusion following vasospasm after subarachnoid hemorrhage. The occlusion was observed in 6 out of 84 patients with vasospasm. 2. The angiograms which showed this phenomenon were obtained between the 11th and the 30th day of the illness. The affected vessels were the branches of middle cerebral artery. 3. Thrombus formed on the intima which had been injured by vasospasm is suspected to be a genesis of this arterial occlusion. The pathological findings of a case in this series support this concept. 4. The surgical procedure during the direct aneurysmal operation performed in the period of "smooth narrowing" seems to be a contributing factor to the arterial occlusion. There was no correlation between antifibrinolytic therapy and this phenomenon except in one case. 5. Fibrinolytic therapy after clipping of aneurysm may be a treatment of choice for this arterial occlusion following vasospasm.


[Spontaneously cured carotid-cavernous fistula verified by angiography--report of a case (author's transl)]. A case of spontaneously cured carotid-cavernous fistula has been reported in details with a review of literatures. Seven cases verified by angiography have been described so far in the literature. Spontaneous cure has been revealed within 6 months after the initial examination in 5 out of 7 cases by follow up angiography, and has occurred in five women of middle age. The presented case was a 45 year-old female who has suffered from the exophthalmos associated with disturbed eye movements of two months duration. On January 2, 1977, the carotid angiography demonstrated a c--c fistula and an oval aneurysm of the middle cerebral artery on the right side. The exopthalmos was slowly decreased with the conservative treatment after two months. The c--c fistula was not demonstrated by the angiography carried out on March 10, 1977, and was not revealed thereafter by follow up studies.


Priming action of estrogen: minimum duration of exposure for feedback and behavioral effects. The minimum duration of the centrally-mediated "priming" effects of estrogen on "positive feedback" release of LH and sexual receptivity (lordosis) was studied. Spayed rats were given Silastic implants of estradiol followed 3 days later by an s.c. injection of progesterone and testing. 30-min implantation of preincubated estradiol capsules sufficed for behavioral responses, but did not stimulate the LH surge. When the capsules were not preincubated, however, LH surges did occur, presumably because of the greater release of estrogen. It is concluded that the minimum duration of the estrogen priming effects is considerably less than the period of natural preovulatory surge of estrogen at proestrus.


Daily rhythmic changes in synaptic vesicle contents of nerve endings on adrenomedullary adrenaline cells, and their modification by pinealectomy and sham operations. Nerve endings on adrenaline cells in male rat adrenal medullas were investigated by quantitative electron microscopy, with sampling at 8 times during a standard light: dark (12:12) photoperiod. Number (N) per unit area of 2 vesicle types (small clear vesicle, SCV; large granular vesicle, LGV) and % of LGV per total vesicle N were determined. Normal (non-operated) animals showed a circadian rhythm (p less than 0.005) in mean SCVN and one with nearly opposite phase relations in % LGVN. Doubly sham-operated animals had a similar rhythm in %LGVN but diminished circadian change in SCVN. Pinealectomized animals had a circadian pattern in SCVN, but this differed from that of normals in having a 2nd peak, a delay or phase shift of the primary peak, and an increased amplitude of the rhythmic changes.


Glycemic responses induced by hypothalamic stimulation. Serum Glucose concentrations were measured before and after electrical stimulation in the ventromedial and supramamillary nuclei of the hypothalamus. 27 fed rats of both sexes were anesthetized with Sodium Pentobarbital. A 36 gauge nichrome electrode was positioned stereotaxically within the rat brain. Stimulus parameters were 0.1 mA using a 1.0 ms biphasic square wave applied at a rate of 50 Hz for 3 min. Blood samples were removed from the left carotid artery at -20 and 0 min pre-stimulation and also at 5, 10 and 15 min post stimulation. Serum glucose concentrations were determined by enzymatic estimation with hexokinase. Electrical stimulation of either the ventromedial or supramamillary nuclei produced statistically significant elevations in serum glucose concentrations, whereas stimulation in areas immediately surrounding both nuclei did not produce any significant changes in serum glucose concentrations. These results suggest that both nuclei may be involved in the regulation of serum glucose concentrations.


Metabolism of L-sorbose in the rat and the effect of the intestinal microflora on its utilization both in the rat and in the human. L-[U-14C]-sorbose was administered orally as single doses to 5 normal rats. The recovery of radioactivity was 5.3% in the urine, 46% in the faeces exclusively as L-sorbose 16% as carbon dioxide. Caloric utilization was approximately 25%. A second group of 3 rats that had previously received L-sorbose in their diet showed 14C recoveries of 8.9% in the urine, 6.6% in the faeces and 59% as carbon dioxide. The time course of expired carbon dioxide suggests that a portion of L-sorbose was rapidly absorbed and partially metabolized while the principal pathway involved fermentation by the intestinal microflora to volatile fatty acids which were subsequently absorbed and metabolized. The total caloric utilization of L-sorbose was estimated to be 70%. It was observed that a human intestinal microflora also required an adaptation period in order to ferment this sugar. The efficiency of the fermentation was estimated to be 70%.


Occult anticonvulsant osteomalacia in North India. Serum calcium, inorganic phosphate and alkaline phosphatase, tubular reabsorption of phosphate (TRP) estimation and radiological examination of the skeleton were conducted in 40 cases (18-50 years of age) on anticonvulsant therapy and 20 controls. The epileptic group showed a statistically significant rise in serum alkaline phosphatase and a fall in TRP. In none of the cases, however, was there clinical or radiological evidence of osteomalacia. Biochemical abnormalities were seen mainly in the youngest individuals. It seems that the critical factor for the development of anticonvulsant osteomalacia is the lack of dietary vitamin D/solar exposure or increased body requirement of the vitamin.


Biochemical parameters of vitamin D nutriture in old people in Jerusalem. Serum 25-hydroxycholecalciferol (25[OH]D3) levels and other parameters of vitamin D nutriture were examined in 58 subjects aged 70 or more, living in Jerusalem. They were compared with those of 54 young adults living in the same neighbourhood. No evidence was obtained of a lower level of vitamin D nutriture in the elderly compared to younger adults. Serum 25 (OH)D3 of the elderly adults was 18.4 (SEM: 1.4) ng/ml and in the younger adults, 17.8 (1.0) ng/ml. There was no seasonal variation in serum 25(OH)D3, nor could a strong association be found between reported vitamin D intake nor with exposure to sunshine. There was a negative correlation between serum alkaline phosphatase and the calcium-phosphorus product in serum. High values of alkaline phosphatase were associated with reported low exposure to sunlight and, in elderly persons, with a reported low consumption of vitamin D.


Effect of raw field bean (Vicia faba) on amino-acid-degrading enzymes in rats and chicks. The effects of Vicia faba diet on urinary nitrogenous compounds and on enzyme activities of pathways directly associated with amino acid metabolism were studied in rats and chicks. The urea and creatinine excretion of rats fed on V. faba was approximately 90% more than that of control rats. The V.-faba-fed rats had increased activities of liver arginase (EC 3.5.3.1), argininosuccinate synthetase (EC 6.3.4.5) and alanine aminotransferase (EC 2.6.1.2). The chicks fed on V. faba also showed increased activity of xanthine dehydrogenase (EC 1.2.3.2). The possible nature of these altered amino-acid-degrading enzyme activities is discussed.


[Activity of different dehydrogenases and alkaline phosphatase in manganese deficiency]. The enzyme activities of the isocitrate, glucose-6-phosphate and malate dehydrogenases and of malic enzyme in liver, of lactate dehydrogenase in serum, and of alkaline phosphatase in bone and serum were determined in early-weaned rats given different Mn supplies. The activities of malate dehydrogenase were reduced by 16 and 18% during suboptimum and deficient Mn supply, respectively, the values of alkaline phosphatase in serum and bone were elevated by 29 and 35%, respectively. The enzyme values of the glucose-6-phosphate and lactate dehydrogenases were elevated only during Mn deficiency (by 40 and 65%, respectively), while a suboptimum Mn supply had no noticeable influence on these enzymes. The activities of isocitrate dehydrogenase and of malic enzyme, which were described to be activated by Mn++ in vitro, did not respond in vivo to Mn deficiency.


Tissue levels and optimum dosage of vitamin C in guinea pigs. Ascorbic acid mixed with the diet of guinea pigs achieved substantially higher maximum tissue concentrations of ascorbate than when ascorbic acid was administered orally once a day. A 0.5% w/w of ascorbic acid in the diet ensured a state close to maximal tissue steady-state levels of ascorbate. In guinea pigs fed a diet with a high content of saturated fatty acids or with 0.2% w/w of cholesterol, the highest rate of cholesterol transformation into bile acids and the lowest concentration of total lipids, cholesterol and triglycerides in blood serum and liver were found in the group fed a diet with 0.5% w/w of ascorbic acid as compared to the marginal-deficiency group and the group receiving 0.05% w/w of ascorbic acid in the diet. Maximal tissue steady-state levels of vitamin C are probably optimal for the guinea pigs' health.


Identification of antimicrobial alpha-hydroxyacids in Lactobacillus plantarum-fermented animal protein. During the fermentation of animal protein by Lactobacillus plantarum, highly volatile and less volatile antimicrobial substances are formed. The antimicrobial effect of the latter fraction depends on the content of alpha-hydroxyacids in the fermentation product. These acids were isolated from the fermentation mixture and identified by chemical methods. The main components are racemic forms of lactic, alpha-hydroxyisovaleric and alpha-hydroxyisocaproic acids.


Prolactin and deficient luteal function. The possibility of prolactin-dependent subfertility was investigated in a group of 8 women, with luteal insufficiency exhibiting moderately elevated plasma prolactin (PRL) levels and/or galactorrhea. Another group of 10 normal women volunteers served as the control group. A "luteal index" was elaborated by integration of the area below the curve of plasma progesterone (P) values recorded throughout the postovulatory period. The calculated index for normal women was 177 +/- 35 (SD) expressed as [(ng/ml) x time], and the value of 107 (--2 SD) was adopted as the lower limit of normality (97.5% confidence limit). All 8 patients had luteal indexes (range 20--105) below the established limit. Therapy with bromocriptine (CB 154), 5 mg/day, suppressed PRL to normal levels and prolonged the postovulatory hyperthermic phase in 6 out of 8 women. This was accompanied by an improvement in the luteal index, and 5 women conceived. It is concluded that prolactin may interfere with normal progesterone synthesis by the corpus luteum, as demonstrated by the prompt restoration of fertility by bromocriptine treatment in women with regular cycles and inadequate luteal function.


Treatment of luteal phase inadequacy with bromocriptine. A group of 15 women diagnosed as having luteal phase inadequacy (LPI) and a history of 1--2 years of infertility were treated with bromocriptine continuously for 4 months. Plasma levels of prolactin, progesterone, 17 alpha-hydroxy-progesterone and estradiol were measured by radioimmunoassay in a control month and each of the treatment months. There was no significant improvement in the levels of the steroids over the 4-month period, although the prolactin levels were depressed, and 2 subjects became pregnant during the study.


Radical hysterectomy: influence of recent conization on morbidity and complications. From 1956 through 1975, 610 radical hysterectomies with pelvic lymphadenectomy were performed at the Mayo Clinic. Eighty-eight of these operations were done after conization of the cervix: 7, within 7 days; 74, between 8 and 28 days; and 7, on or after the 29th day. Operative febrile morbidity was not increased in the patients who had conization, and they also required fewer blood transfusions than the patients without previous conization. Incidences of all postoperative complications except pulmonary embolism were lower in the patients with cone biopsy than in those without. Of the 88 patients, 77% received antibiotics prophylactically during the operative period. There appeared to be no serious contraindications to performing radical hysterectomy and pelvic lymphadenectomy at any interval after diagnostic conization of the cervix.


Autonomy in practice.

Autonomy in practice. When the nurse practitioner (NP) role was first described in the early 1960s it was clear that important dimensions had been added to the role of the nurse. One of these dimensions was the increased professional autonomy. As the NP role continued to evolve, autonomy became a characterizing feature of the role. the purpose of this paper is to present basic assumptions concerning automony and its relationship to the definition of profession; to examine the implications of autonomy to the individual NP, to the nursing profession, and to the health care system; and to offer a model for considering professional autonomy in relation to the NP role.


Development of DES-associated clear-cell carcinoma: the importance of regular screening. Because the rate of malignancies in young women exposed in utero to diethylstilbesterol (DES) is low, appropriate population screening methods have not been established. A case is presented that is believed to represent the first reported instance of a DES-exposed daughter who developed clear cell adenocarcinoma of the vagina after initially negative examinations. The patient was followed with Papanicolaou smears, pelvic examinations, and colposcopy every 6 months for 2 years prior to the discovery of malignancy. Initially negative, Papanicolaou smears successfully predicted the presence of an early adenocarcinoma. Palpation aided by colposcopy allowed directed biopsy of the small asymptomatic lesion. This case underscores the necessity for frequent vaginal cytologic smears and pelvic examinations at intervals no greater than 6 months. Colposcopy is indicated to direct biopsies when an abnormal cytologic smears is reported or when abnormal bleeding or discharge occurs. Biopsy of any palpable lesion is mandatory.


Vaginal epithelial changes in young women enrolled in the National Cooperative Diethylstilbestrol Adenosis (DESAD) project. Initial clinical findings are reported for the 3339 young women enrolled in the Diethylstilbestrol Adenosis (DESAD) project. Changes in the vaginal mucosa (VEC--vaginal epithelial changes), which were detected by colposcopy or iodine staining, occurred in 34% of 1275 participants identified by review of prenatal records 59% of participants who themselves requested entry into the project, and 65% of participants referred by a physician. Analysis of data on the 298 women who were identified by record review and whose prenatal records contained complete information about drug exposure indicated that VEC is most closely associated with the timing of the onset of intrauterine exposure to diethylstilbestrol (DES), total dose, and length of exposure. Frequency of VEC was also found to decrease with age. No instances of severe dysplasia, carcinoma in situ, invasive squamous cell adenocarcinoma, or clear cell carcinoma were observed among the women identified by record review.


A histologic study of ovarian endometriosis with emphasis on hyperplastic and atypical changes. One hundred ninety-four cases of ovarian endometriosis, encountered during a 3-year period, were studied. In addition to endometrial-type epithelium and stroma that were present in each of these cases, oviduct-type epithelium was demonstrated in 26, papillary epithelial-lined projections in 7, and hobnail cells in 36 patients. Forty-three cases showed reactive epithelial changes, probably due to inflammation and regeneration. There were 4 cases of adenomatous hyperplasia. Severe epithelial atypism was seen in 7 patients (3.6%), 1 in conjunction with adenomatous hyperplasia. Although the areas of severe epithelial atypism in ovarian endometriosis may be of reactive origin, one must also consider the possibility that in some instances these atypical changes may constitute a neoplastic potential.


Dysgerminoma associated with pregnancy.

Dysgerminoma associated with pregnancy. From a review of 26 reported case (our case being the 27th) of dysgerminoma associated with pregnancy, several salient facts are evident. Torsion and incarceration are common among these rapidly enlarging tumors. Obstetrical complications occurred in nearly half and fetal demise in one quarter of the reviewed cases. Our case was typical of patients presenting with this vexed problems: The patient was under 25 (as were 70%); nulliparous (as were 67%); and the tumor appeared confined to one ovary (as in 89%). Authorities are in dispute as to the treatment of stage IA dysgerminomas, and the association of pregnancy complicates this debate even further. The results of conservative treatment in this series were jarring: There were recurrences in 30% of the 23 stage IA tumors, and the recurrences were all following unilateral oophorectomy. In our case, the grossly normal contralateral ovary was infiltrated with dysgerminoma cells. While treatment of a young woman with a dysgerminoma of 1 ovary is a matter of perplexity, we believe that a unilateral operation should be limited to those women who desire above all earthly things to retain their childbearing capacity.


Evaluation of a program of bed rest in the treatment of chronic hypertension in pregnancy. Sixty-six patients with chronic hypertension were cared for during a total of 72 pregnancies. Patients were treated at home primarily by greater than or equal to 4 hours of bed rest daily in the left recumbent position. Only patients whose diastolic blood pressures remained greater than 110 mmHg were treated with hydralazine (Apresoline, Ciba). With this plan of treatment there were only 3 perinatal deaths for an uncorrected perinatal mortality of 4.1% (1.4% corrected). Twenty-nine  percent of the patients had babies that were small for gestational age, 13.8% had positive oxytocin challenge tests, and 36.8% developed superimposed preeclampsia. When compared with the outcome of previous pregnancies, the program of bed rest lowered perinatal mortality from 16.8 to 8.8%. Thus, it is suggested that bed rest together with the avoidance of diuretics and the judicious use of hydralazine results in the most favorable fetal outcome.


Vaginal delivery of the term breech. A preliminary report. A total of 150 term uncomplicated breech deliveries were selected for a prospective study. Although 223 women were selected for analysis, subsequent complications required that 73 women be excluded. A predetermined  protocol was utilized for the management of 81 women, while 69 women qualified for the control group. Analysis of the results clearly demonstrated the value of a well-defined management program.


Epilepsy and pregnancy. Serum thyroxine levels during phenytoin therapy. Blood levels of phenytoin, total thyroxine, and free thyroxine were determined in 10 epileptic women during and following pregnancy. Although total thyroxine concentrations of phenytoin-treated subjects were significantly lower than control values, pregnancy did not appear to diminish the relative increase in total thyroxine seen in normal pregnancy. Free thyroxine concentrations, which were equally depressed at all test times, remained at low euthyroid levels during pregnancy. Following delivery, 3 patients developed free thyroxine levels below 1.0 ng/100 ml. Phenytoin dosage was increased to improve seizure control but produced relatively low blood levels during pregnancy. Following delivery, phenytoin dosage was slightly decreased but produced a significant increase in phenytoin blood levels. The potential effects of phenytoin-related changes in maternal and fetal thyroxine levels are discussed.


The effect of internal fetal monitoring on cesarean section morbidity. A retrospective review was made of 179 patients who underwent  primary cesarean section after laboring with ruptured membranes. Patients with internal fetal monitoring (IFM) were more likely to have endometritis. Of the patients who had ruptured membranes for more than 12 hours, those with IFM were more likely to have febrile morbidity than those without IFM.


The significance of temperature during the first 24 hours postpartum. One thousand gravidas were prospectively monitored for the development of a temperature greater than or equal to 38 C during the first 24 hours postpartum. Fever occurred in 6.5% of patients. Of the 858 gravidas who had vaginal deliveries, 33 had temperature elevations. Only 7 required antibiotics. Of the 142 patients undergoing cesarean section, 32 patients exhibited 1 or more temperature elevations of greater than or equal to C. Of these 32 patients, 23 required antibiotics. Thirteen of the 14 patients with a recorded temperature of greater than 38.4 C required antibiotics. Eighteen of the 22 patients who underwent cesarean section and had 2 consecutive temperatures of greater than or equal to 38 C (taken 4--6 hours apart) required antibiotics.