Surgical treatment of partial Achilles tendon rupture. Fifty-four patients with a total of 58 partial ruptures of the Achilles tendon were treated surgically. The postoperative observation time ranged from 8 months to 7 years. Forty-six patients indicated that they were pleased with the results, 8 were satisfied, and 3 were unsatisfied (one died during the interim). Thirty-seven of the 44 patients who had been engaged in competitive sports preoperatively were able to return successfully to the activity. We recommend surgical treatment if conservative treatment for presumed tendinitis is not successful. The operative procedure may encourage revascularization to the Achilles tendon and innervation after surgical excision of the pathologic and degenerated tissue.


Conditioning program for competitive figure skating. To test the feasibility that traditional interval training methods could be adapted to the needs of competitive figure skaters, an interval skating program was conducted during a 3-month period for a group of skaters at diverse levels of proficiency. The program required only a small portion of the total ice time utilized by the skaters on a daily basis, i.e., 1/2 hr, three times a week. On alternate days, the skaters used the same amount of time in a strength training program. A flexibility-stretching facet was to be done by the skaters on a daily basis. Progress was evaluated by treadmill oxygen consumption determinations and ability to perform a 1/2-mile skate effort. Over the course of the 3-month period, the skaters in the program showed an average increase in oxygen consumption of 9% from 44.73 cc per kg per min to 55.51 cc per kg per min. This was accompanied by an average 10-sec reduction in the timed effort at the 1/2-mile skate. Subjectively, the skaters were less fatigued during their freestyle skating programs and were able to improve consistency at skilled maneuvers in the last minute of their performances. This initial effort to evaluate the efficacy of this type of a training program for competitive figure skating seems to have proven to be beneficial to the skaters. Currently, we are continuing our efforts to expand the program.


Anterior cruciate ligament: functional anatomy of its bundles in rotatory instabilities. The functional anatomy of tha anterior cruciate ligament was studied in 18 freshly amputated specimens. The cruciates were observed in the extremes of flexion and extension, and in midposition in simulated weight-bearing and nonweight-bearing conditions. Five femoral shafts were split longitudinally so that the femoral and tibial attachments of the ligament could be inspected. The findings indicated that (1) the anterior cruciate ligament is a secondary static stabilizer against rotatory instabilities of the knee; (2) the anteromedial bundle contributes to anterolateral stability; (3) the intermediate bundle adds to straight and anteromedial stability; and (4) the posterolateral bundle assists in posterolateral stability. Specific bundles and functions of bundles must be considered in reconstruction, substitution, or replacement of the anterior cruciate ligament.


Cylinder or mobile cast brace after knee ligament surgery. A clinical analysis and morphologic and enzymatic studies of changes in the quadriceps muscle. Sixteen patients participated in a prospective randomized trial in which a standard cylinder cast was compared with a mobile cast brace. Both were worn for 4 weeks, beginning at 1 week after reconstruction of the anterior cruciate ligament. The athletes that had used a cast brace could return to sports activities in about one-half the time it took for the athletes with a standard cast. The patients with a standard cast showed a significant atrophy of Type I (slow twitch) muscle fibers in the vastus lateralis. The cast brace patients did not show any significant changes in cross-sectional areas of Type I or Type II (fast twitch) muscle fibers. The standard cast patients had a significant reduction of succinate dehydrogenase (SDH) activity in the vastus lateralis whereas the patients with the cast brace did not show any significant changes. No difference in surgical end result was found. A cast brace with a limited range of motion between 20 and 60 degrees of flexion is recommended as the standard postoperative treatment after knee ligament surgery.


Extra-articular reconstructive surgery for combined anterolateral-anteromedial rotatory instability. The knees of 14 patients (12 male and 2 female) were treated surgically by extra-articular reconstruction for combined anterolateral-anteromedial rotatory instability. Healing and rehabilitation required approximately 8 months after the operations. Only after adequate rehabilitation, including return of full confidence, were the patients released to full activity (although contact sports are not recommended). Of the group, 12 patients returned for follow-up evaluations and one returned a questionnaire. One patient was lost to follow-up. One patient did not return to full activity because in the 3rd month postoperatively, he stepped in a hole while jogging, reinjured his knee, and refused further surgery. The functional improvement in this series by our extra-articular procedure (a combination of an anteromedial capsulorrhaphy and pes transfer medially with Ellison's modification of an iliotibial band rerouting and partial biceps advancement laterally) compares favorably with the reported anterior cruciate ligament reconstructions. Further comparisons with longer periods of time after surgical procedures are needed to determine whether extra-articular repair with interarticular reconstruction of the anterior cruciate ligament is significantly better than this technically easier extra-articular repair alone.


Chondromalacia patellae in athletes. Clinical presentation and conservative management. A comprehensive conservative management program for chondromalacia patella in athletes has been presented. The clinical manifestations and the efficacy of conservative treatment have been documented in the prospective study of 100 consecutive athletes. The over-all success rate was 82%, and 18% were considered to be failures of conservative treatment. Only 8 of these 100 athletes have required surgical treatment. It was concluded that this type of conservative management is effective in the majority of athletes with symptomatic patellofemoral syndromes, and that surgical treatment should be necessary for only the relative few who fail to respond to an adequate trial of conservative treatment.


Blockade by vitamin A of the occurrence of permanent vaginal changes in mice treated neonatally with 5alpha-dihydrotestosterone. Estrogen-independent, persistent proliferation and cornification of the vaginal epithelium occurred in ovariectomized adult mice which had received neonatal injections of 50 microgram 5alpha-dihydrotestosterone (DHT). The occurrence of the permanent vaginal changes was prevented by injections of 200 IU vitamin A acetate (VA) given simultaneously with DHT. In 45% of the DHT plus VA-treated, ovariectomized mice, clear cells with pale cytoplasm appeared in the basal layer of the degenerating epithelium, while they came out in the epithelium of 13% of the ovariectomized mice receiving neonatal injections of DHT alone. For suppressing the permanent vaginal changes, including high mitotic rate, more than 1 month was required after the combined treatment. However, the occurrence of the permanent changes was not blocked by VA given after the DHT treatment. Permanent proliferation and squamous metaplasia took place in the uterine epithelium of the DHT-treated mice. Neonatal injections of VA also prevented the occurrence of the permanent uterine changes when given simultaneously with DHT but not when given after the androgen treatment.


Developmental interactions between the adjacent parts of combined heterologous skeletogenous territories. The right limb buds of chick embryos (H.-H.stages 22 to 26) were transversely divided at approximately the presumptive zeugopod mid-length, and (1) the distal parts exchanged between wing and hind-limb bud in apdv-reversed orientation (operation A), or (2) the severed distal part of the leg bud was reoriented in situ (operation B). Both the proximal and distal segments of the zeugopodal bones developing from the recombined portions of presumptive heterologous territories showed characteristic differences of size and shape in comparison to the corresponding parts of the skeletal pieces of the zeugopod of the intact, control limbs. These developmental changes are interpreted as being the consequence of reciprocal influences exerted by the adjacent parts of mesenchymal territories (or blastemata) that, under normal developmental conditions, are destined to give rise to different bones. Such influences may enhance or depress the growth potential of the skeletogenous populations affected, and, within each cell population, modify the geometry of the growth processes by which the various parts of each skeletal piece attain their typical shape.


Cortical desmoid-like lesion of the proximal humerus and its occurrence in gymnasts (ringman's shoulder lesion). Eighteen gymnasts were interviewed and examined radiographically for a cortical irregularity of the proximal humerus simulating malignancy. Fifty percent of the gymnasts had the lesion which is considered to be a benign reactive lesion secondary to excessive forces at the pectoralis major insertion to the proximal humerus. All patients were asymptomatic. The lesion is probably unique to gymnasts, particularly those involved with strength moves.


Acute acromioclavicular separations. A 20-year study. One hundred and twenty-two acromioclavicular separations treated surgically at the Campbell Clinic from 1956 to 1976 have been studied. On group of 44 patients who had primary excision of the distal clavicle with repair of ligaments was compared with another group of 78 patients who had primary repair of the ligaments only. Of the original 122 patients (average age, 27 years; range, 12 to 64 years), 112 were male and 10 were female. Eighty-six of the 122 patients were reevaluated (average follow-up, 4.4 years; range, 1 to 16 years). No difference in the two groups was apparent in range of motion or in muscle power/weakness, as tested by resistive examination. There was no correlation between presence or amount of degenerative changes in the acromioclavicular joint and the patient's symptomatology. Of the group who had excision of the distal end of the clavicle, only 4.5% had degenerative joint disease as compared with 24.3% of the other group. Repair of the coracoclavicular and acromioclavicular ligaments, with a beveled excision of the distal 1 cm of clavicle, has been a successful and reliable method for treating Type III (complete disruption of acromioclavicular and coracoclavicular ligaments and tears of deltoid and trapezius muscle attachments from the clavicle) and some Type II (complete disruption of capsule and acromioclavicular ligaments) injuries.


Correctable elbow lesions in professional baseball players: a review of 25 cases. In a retrospective study, 20 of 25 professional baseball pitchers (mean age, 24 years; range, 19 to 28 years) who had had a reconstructive surgical procedure on the dominant elbow had satisfactory results (able to return to competitive throwing for one full season or more after surgery). Gentle motion wasinitiated 1 week after the operation on each patient. Exercises for mobilization and muscle strengthening of grip, arm, and shoulder were increased until throwing was initiated 10 to 12 weeks postoperatively. Throwing was gradually increased over several weeks from 30 feet at no more than half speed for 15 min to 60 feet at three-quarter speed. Pitchers were instructed to warm up before throwing and warm down and to continue this practice after they began competitive throwing. The longest period of follow-up had been 4 years (mean, 2.8 years). Four of the 25 pitchers had unsatisfactory results (released from their team in less than one full season because of ineffective pitching and were not picked up by another team). The cause of the release of the other patient-player is controversial. This 25-patient group is too small and the follow-up period is too short for definite conclusions. Our evidence does suggest that surgical procedures directed at medial soft tissue and posterior intra-articular changes carry better prognosis for competitive throwers than other procedures. The radiohumeral articular condition should be evaluated at surgery.


The role of the epididymis in descensus testis and the topographical relationship between the testis and epididymis from the sixth month of pregnancy until immediately after birth. The position of the testis, the relationship between the epididymis and the testis, as well as the development and regression of the gubernaculum were investigated in 18 testicles of children from the 26th week of pregnancy until a few weeks after birth. The most important role in descensus testiculorum is ascribed to the differentiation of the epididymis and the ductus deferens. It is androgen dependent. The testis descends in the processus vaginalis, being attached to its dorsal wall.


Morphological and functional studies on the odontoid process of the human axis. Studies on the morphology of the odontoid process by various methods strongly suggest a functional adaption of this bony element. With regard to the inclination of the dens axis and the varying position of its articular facets, a modified trabecular system can be observed. Photoelastic experiments confirm that these modifications are correlated with two specific kinds of mechanical stress. The straight odontoid process is only subjected to stress due to compression, but the dorsally inclined dens to bending stress. Based on the morphological and experimental findings, flexion and extension between the first and second vertebrae (in addition to rotation as the principle movement) are discussed.


Investigations on the influence of prolactin suppression on reproductive function in bulls. In 3 mature bulls 2 injections (i.m.) of 150 mg 2-Br-alpha-ergocryptine (CB-154, Sandoz) within 48 hrs. decreased the plasma prolactin concentrations significantly for about 14 days (first experiment). In a second experiment, where treatment was repeated after 2 weeks, the period of maximal prolaction deficiency could be extended to a length of about 4 weeks. However, intensity of prolactin inhibition was less pronounced. This is attributed to seasonal factors. Neither during the shorter nor during the longer period of prolactin suppression were apparent changes of the LH and testosterone levels observed. Apart from a minor increase in the rate of morphologically abnormal sperm cells, reproductive function as libido, mating behaviour, semen quality, secretory activity of the accessory glands (concentration of fructose, GPC and chloride in seminal plasma and pre-sperm fraction resp.) were not significantly affected. It seems questionable, therefore, whether under physiological conditions prolactin is essential for the regulation of sexual functions in mature bulls.


Men with a distinct testicular hypoplasia: sexual development and activity. In 101 married men examined for sterility a distinct testicular hypoplasia was found. The long axis of both sexual glands was shorter than 30 mm. Their heterosexual development and activity in sex life were studied by means of HTDM and SAM Questionnaires. A comparison with a group of 325 normozoospermic men of the same age has shown that the heterosexual development was in the pathological group only slightly retarded but that the activity in sex life was distinctly lower in a number of items.


Plasma cholesterol, triglycerides, FSH and testosterone levels of normolipemic male patients with decreased fertility treated with mesterolone. There were no changes in plasma cholesterol, triglycerides, FSH and testosterone levels of 24 healthy men treated with mesterolone for infertility during period of 6 months. The patients were normolipemic and the daily doses were 75 mg. No side-effects were noticed. Mesterolone seems to have too selective or too low androgenic effect with the doses used in order to have an influence on the lipid metabolism of men.


[Importance of arginine content and arginase activity in fertility]. Experimental studies have shown that in men with pathospermia the arginine content of sperm plasma is lower than in normal men. In order to find out the reason of this divergency the authors analysed the content of arginine, urea, citrulline, GAA and arginase activity in serum and in sperm plasma of 40 patients with normo-, oligo- or azoospermia. For the first time our results show that the low arginine content in pathological sperm is not due to disorder of the precursor metabolism, but to the increased arginase activity and to the increased conversion of arginine to GAA. In order to find out the mechanism of action and to develop an adequate andrological therapy detailed studies on molecular level have to be done.


Biochemical changes of the human semen produced by chlorambucil, testosterone propionate and human chorionic gonadotropin administration. Biochemical analysis and morphological studies were carried out in six patients with lymphomas during and after withdrawal treatment with chlorambucil, testosterone propionate (TP) and human chorionic gonadotropins (HCG). In the course of the treatment with chlorambucil patients developed severe oligozoospermia or azoospermia. The spermatogenesis recovered after a variable period of time following suspension of treatment. During the drug administration seminal fructose and citric acid concentrations increase but the recovery after withdrawal takes a longer period of time. Simultaneous treatment with HCG or TP normalized the biochemical parameters without restoring spermatogenesis.


Histochemical studies of testicular delta5-3beta-hydroxysteroid dehydrogenase and 17beta-hydroxysteroid dehydrogenase after chronic indomethacin administration in rats pretreated with clomiphene-citrate. Histochemical studies of testicular delta5-3beta-Hydroxysteroid Dehydrogenase and 17beta-Hydroxysteroid Dehydrogenase in sexually immature rats treated chronically with simultaneous Indomethacin and Clomiphene revealed greater inhibition in the enzyme activities when compared to Clomiphene treated animals alone. This suggests prostaglandin-inhibitors may be directly inhibitory to NAD-requiring enzymes involved in testicular steroid biosynthesis.


Morphologic evaluation of spermatozoa in different laboratories. The principles of morphologic evaluation of human spermatozoa may vary from time to time and between different laboratories. These principles are reflected in the mean and standard deviation of the results obtained from analysis of samples delivered by all new patients. These figures and distribution diagrams based on the same data were collected from eight different scandinavian fertility laboratories. It is suggested that such data should be used to define the investigational profile of the laboratory in question and to check that inadvertent changes in the principles of evaluation do not develop. The data may also be used to calculate correction factors in order to facilitate the comparison of results when the patient has delivered samples to more than one laboratory.


The spermiogram in urogenital tuberculosis. In 50 patients, all under 40 years old, with a diagnosis of urinary tuberculosis, a spermiogram, in order to see if there was any cytomorphological or biochemical alteration, was performed. They were divided into two groups: the first one including patients showing clinical alteration of the genital tract, and the second one including patients without any clinical symptomatology, eg. at the external genitalia. The modification of the spermiogram in accordance with the evolution of the urinary tuberculous lesion and the specific treatment employed, have also been evaluated. All patients with clinical alterations in the genital tract, showed also alterations in the cytomorphological and/or in the biochemical studies. 75% of the patients without genital lesions showed oligoasthenozoospermia. In spite of the treatment established, no improvements were observed in the spermiogram.


The effect of a combination of prostatic massage and antibiotic plus anticongestive drugs on human semen quality and fertility. A total of 123 patients suffering from chronic prostatitis and infertility were included in this study. No significant improvement in sperm quality was found following prostatic massage with (90 patients) or without (33) antiobiotic plus anticongestive therapy. There was no apparent change in the relative contribution on the prostate and seminal vesicle of the ejaculate, as judged by the concentration of calcium and fructose. Nor was the pregnancy rate increased. It is concluded that prostatic massage is of little or no therapeutic value in treatment of infertility.


Flunisolide in chronic bronchial asthma. Sixteen steroid dependent and 13 steroid independent patients with bronchial asthma were treated for three months with flunisolide by aerosol. Asthma improved in these patients, other medication usage decreased and adverse side effects were minimal. A significant increase in morning plasma cortisol levels occurred in steroid dependent patients, whereas cortisol levels in steroid independent patients remained normal. An unexpected decline in response to metyrapone occurred in both groups of patients and suggests that this test is affected by flunisolide usage.


Urticaria and giardia lamblia infection. A case of Giardia lamblia infestation with concomitent urticaria is presented. No mechanisms of association are suggested. With treatment of the Giardia, the urticaria cleared. The urticaria could also be suprressed with Atarax.


Asthma: some basic methods of prevention. Present traditional measures employed in the prevention of asthma are reviewed. It is recommended that in view of the extensive and possibly increasing prevalence of the disease together with continuing high death rates more attention in our treatment programs should be devoted to basic prevention in possibly susceptible people. High risk groups such as among small children, in certain industries and in developing counties make this approach especially desirable. An outline of suggested measures is presented.


Basal pathomechanism of asthmatic attacks (a review). Clinical examinations, including provocation, bronchography, electromyography of respiratory muscles, administration of anesthetics and autopsy reject the bronchospasm theory in the production of asthma attacks. Stimulation of sensory nerves, primarily in the upper airway, is the primary basal factor which promotes reflex respiratory activity.


Development of tight junctions in rat tracheal epithelium during the early hours after mechanical injury. Mild abrasion of rat tracheal epithelium results in the death of superficial cells and flattening of basal cells to cover the exposed areas of basal lamina. Six hours after injury, colloidal tracers were shown in previous studies to be excluded from the spaces between cells and from the underlying lamina propria. The structural basis for this restoration of barrier function was investigated in the present experiments using transmission electron microscopy of thin sections and freeze fracture replicas. For each of 4 elapsed times after injury, 12 healing lesions in the epithelium were studied extensively. In specimens obtaine 2 and 4 hours after wounding, apical junctions between epithelium cells could not be identified in either thin sections or freeze fracture replicas. Six hours after injury, point contact could be recognized between epithelial cells in thin sections, whereas freeze fracture replicas revealed rudimentary tight junctions consisting of fragmented strands and linearly organized particles. Twelve hours after injury, highly developed tight junctions similar in complexity to those in normal uninjured tracheal epithelium were observed between the relatively undifferentiated basal cells comprising the regenerating epithelium. The focal membrane modification that appears 6 hours after injury is thus an early step in the process of regeneration and restoration of cytologic specialization.


Tuberculosis in immigrants to Canada. A study of present-day patterns in relation to immigration trends and birthplace. The influences of immigration on tuberculosis morbidity in Canada were examined. The pattern of immigration has changed markedly in recent years, increasing proportions of immigrants being from areas other than Europe. Morbidity rates varied widely according to country of birth and were highest among persons born in Asia and lowest among those born in northwestern Europe and the United States. These rates were generally parallel to those reported in the countries of birth, although somewhat lower. Differences in patterns of disease by birthplace were noted, particularly the preponderance of lymphadenitis in Asians and genitourinary tuberculosis in Italians. Although the frequency of drug-resistant bacilli was higher in Asians than in other groups, the vast majority of bacilli in all groups were drug-sensitive. For purposes of tuberculosis control, immigrants from high-incidence countries constitute a high-risk group, and physicians should be aware of this when dealing with patients from these countries.


Tuberculosis chemoprophylaxis practices in metropolitan clinics. A survey of tuberculosis chemoprophylaxis policies was conducted from September 1977 through January 1978 of all metropolitan programs in the United States that reported more than 100 cases of tuberculosis during 1976. Twenty-eight programs were surveyed, and all responded. Uniform practice was found with regard to the dosage of isoniazid administered, duration of treatment, and most other indications for preventive therapy recommended by the American Thoracic Society and the U.S. Public Health Service Center for Disease Control. One third of the programs surveyed administered chemoprophylaxis to pregnant women, and one third regularly dispensed more than a one-month supply of isoniazid to patients. Three programs (11%) routinely monitored hepatic function by serum laboratory tests during chemoprophylaxis. Four programs (14%) regularly or occasionally used bacillus Calmette-Guérin vaccine for prevention of tuberculosis. Although large metropolitan programs generally followed the guidelines of the American Thoracic Society and the Center for Disease Control for tuberculosis chemoprophylaxis, some major variances in practice were reported.


Anaerobic bacterial pneumonitis.

Anaerobic bacterial pneumonitis. Clinical features of 46 patients with anaerobic bacterial pneumonitis were compared with those of patients with pneumococcal pneumonia. The presenting features in these 2 groups were comparable in terms of fever, leukocyte count, and radiographic abnormalities. In only 2 patients with anaerobic bacterial pneumonitis was putrid sputum noted on initial evaluation. None of the patients with anaerobic bacterial pneumonitis had shaking chills, although this was reported by nearly one half of those with pneumococcal pneumonia. The response to treatment with antimicrobial drugs was comparable in the 2 groups, except that 20% of patients with anaerobic bacterial pneumonitis subsequently developed pulmonary abscesses, despite the use of antimicrobial agents presumed to be active against the infecting flora. There was also a high incidence of bronchogenic neoplasms among patients who had anaerobic bacterial pneumonitis in the absence of an associated condition that would predispose to aspiration. The findings of this review suggest that anaerobic bacterial pneumonitis may be difficult to distinguish from pneumococcal pneumonia on the basis of clinical presentation.


Ventilation-perfusion imbalance after head trauma. To investigate the role of ventilation-perfusion (VA/Q) imbalance in the hypoxemia observed after head injury, 5 male subjects (17 to 26 years of age) with isolated head trauma and subsequent hypoxemia were studied. Disturbances of ventilation and perfusion were assessed using the steady-state elimination of six inert gases of different solubilities. Paired studies were conducted during mechanical ventilation with a volume-cycled ventilator and during spontaneous ventilation. Distributions recovered from studies of spontaneous ventilation show a mode of ventilation and perfusion near a VA/Q of 1.0. In addition, 41% of the cardiac output was distributed to a second population of lung units with low VA/Q (less than 0.1) and shunt. During mechanical ventilation, perfusion to these regions of low VA/Q decreased to 21% of the cardiac output, whereas shunt fraction was unchanged. This was associated with a marked broadening of the VA/Q mode near 1.0, relative to the studies during spontaneous ventilation. Mean functional residual capacity during mechanical ventilation was not different from that during spontaneous ventilation. These results suggest that head injury can lead to hypoxemia through a failure of VA/Q regulatory mechanisms.


Standardized respiratory questionnaires: comparison of the old with the new. Two standardized respiratory questionnaires were administered to 946 white male participants in a long-term study of respiratory symptoms in Washington County, Md. One half of the men were given the 1960 respiratory questionnaire developed by the British Medical Research Council (MRC) at the start of the interview and a new questionnaire developed by the American Thoracic Society and the Division of Lung Diseases (ATS-DLD) at the end. The order was reversed for the other half of the subjects. No important differences were found in the responses. To obtain a minimal basic history for evaluation of chronic obstructive pulmonary disease, either the MRC questionnaire or the corresponding questions from the ATS-DLD questionnaire may be used. More detailed information on a wider variety of historical items may be obtained by using the ATS-DLD questionnaire.


A national self-assessment program in internal medicine. The Medical Knowledge Self-Assessment Program of the American College of Physicians is one of the largest continuing medical education programs in the United States. The scope and educational rationale for each of the components of the program are described. More than 32,000 physicians used one or more components during 1977 and 1978. Performance on the self-assessment examinations showed that, on the average, participants who submitted answer sheets scored in the range of 65% to 75% correct responses. Participants performed better in areas reflecting their special interests and, in general, performance appeared to improve for groups that were closer to the completion of formal training in internal medicine. Specific suggestions have been made as to how the program might be improved in future years.


Left ventricular thrombi identified by cross-sectional echocardiography. We studied 25 patients with anterior myocardial infarction and two with congestive cardiomyopathy to evaluate two-dimensional echocardiography in the diagnosis of left ventricular thrombi. Five coronary patients had systemic emboli. Four of these patients manifested apical filling defects on cineangiogram, while a levophase cine was equivocal for clot in the fifth patient. Neither echocardiography nor cineangiography visualized ventricular thrombi in the nonembolus coronary patients. Echoes from a distinct apical mass, however, were visualized in all five patients in the embolus group by two-dimensional echocardiography at the cardiac apex. Apical thrombi were confirmed in all four patients in the embolus group undergoing surgery. The irregular configuration of recent thrombi in the coronary patients differed from the circumscribed appearance of chronic thrombi in the cardiomyopathy patients on two-dimensional echocardiogram. Thus, two-dimensional echocardiography can be used to detect and characterize left ventricular thrombi.


Electrophysiologic evaluation of elderly patients with sinus bradycardia: a long-term follow-up study. One hundred three patients with persistent sinus bradycardia were evaluated electrophysiologically and followed prospectively for a mean of 4.6 years. The 5-year survival rate was 74.8%, not significantly different from the 72% rate in the general population with similar age and sex distribution. Forty-one patients had abnormal corrected sinus-node recovery time. Overall accuracy of abnormal corrected sinus-node recovery time in predicting serious sinus node disease in symptomatic and asymptomatic patients was 90% (37 of 41 patients) and 100% in patients with syncope (18 of 18 patients). The sensitivity of the test was 66%. Abnormal corrected sinus-node recovery time in patients with sinus bradycardia appears to be a valuable specific, predictive index of serious sinus node disease and therefore a useful test in selecting patients for pacemaker therapy, especially if symptoms such as dizziness or syncope are present.


Converting enzyme inhibition in hypertensive emergencies. The diagnostic and therapeutic value of the angiotensin converting enzyme inhibitor teprotide (SQ 20881) was assessed in 18 patients with hypertensive emergencies. Mean blood pressure fell 31 +/- 18 mm Hg in the 10 subjects who responded to 1 mg/kg body weight administered intravenously, whereas it fell 5 +/- 3 mm Hg in the eight nonresponders. In patients who had received no previous drug treatment, log baseline plasma renin activity and change in mean blood pressure after SQ 20881 correlated significantly (r = 0.651, P less than 0.05). After acute therapy with SQ 20881, the patients who had a satisfactory response to the drug were treated with propranolol and a relatively normal sodium intake (88 meq/day). Nonresponders were treated with diuretics and sodium restriction (10 meq/day), and intermediate responders were given combination therapy. Mean blood pressure responded favorably within 24 h to the chosen regimen for each group from 152 +/- 47 to 102 +/- 31 mm Hg. SQ 20881 allows prompt evaluation of the role of renin in hypertensive emergencies and permits early choice of appropriate therapy based on the prevailing mechanism.


Long-term treatment of the syndrome of inappropriate antidiuretic hormone secretion with phenytoin. A 68-year-old patient with the syndrome of inappropriate antidiuretic hormone secretion secondary to basilary skull fracture was treated successfully with demeclocycline and phenytoin. Phenytoin, which was considered in the past only as a useful diagnostic tool, was given to the patient on a long-term basis. The drug reversed the patient's symptoms and abnormal laboratory values to normal limits without adverse reactions during a treatment period of 8 months.


NIH conference. Primary biliary cirrhosis and the complement system. Primary biliary cirrhosis is a disease characterized by slowly progressive intrahepatic cholestasis, destructive lesions of the septal and larger interlobular bile ducts, and granulomas. It is associated with defects of both humoral and cellular immune function. As part of the detailed evaluation of these defects, the status of the complement system has been evaluated. Striking abnormalities of serum complement levels are found but are difficult to interpret. However, the demonstration of marked hypercatabolism of C3, but not albumin, suggests that the complement system may be in a chronically activated state. Furthermore, an unequivocal defect in the clearance of sensitized erythrocytes by receptors for C3b on Kupffer cells has been found. One possible explanation for this finding would be that a large proportion of these receptors are occupied either by immune complexes containing C3b or excess free C3b that is generated by complement activation. Major defects of C3 catabolism and C3b-receptor-mediated clearance are not found in patients with HBsAg-negative chronic active hepatitis. These findings suggest a role for the complement system in the pathophysiology of primary biliary cirrhosis.


Anticoagulants and myocardial infarction. The problems of pooling, drowning, and floating. The time and expense required for adequate-sized, randomized control trials may often tempt investigators to try to answer long-standing clinical questions by retrospective analysis of data combined from old studies. In a recent example of such "pooling," the authors concluded not only that anticoagulation is beneficial in acute myocardial infarction but also that further experimental trials would be unethical. This conclusion can be disputed because of scientific, statistical, and clinical standards that were not fulfilled in the "pooled" analysis. Scientifically, the pooling of data from different sources can be valid only if the component studies contain patients who are sufficiently similar in diagnosis, clinical severity, principal treatment, and outcome events. Mathematically, exact numbers rather than percentages should be pooled. Clinically, even when the pooling process is appropriate, recent changes in ancillary therapy may negate the applicability of the old data to current medical practice.


Choroidal hemangioma: Response to cryotherapy. Choroidal hemangioma, a benign vascular tumor of the choroid, can frequently develop an effusive secondary retinal detachment. When such retinal detachment involves the macula, reduction in central vision occurs. Fluorescein angiography and radioactive prosphorus tests are helpful in accurately diagnosing choroidal hemangioma. Transscleral cryopexy, freeze-thaw-refreeze method, results in complete destruction and scarring of the choroidal hemangioma. Following treatment, subretinal fluid disappears, the macula becomes reattached, and central vision is restored.


Optic atrophy after irrigation of the lacrimal ducts with chloramphenicol. A case is presented of permanent visual loss and optic atrophy following irrigation of the lower canaliculus after probing, with a 20% solution of chloramphenicol. A false passage had apparently been created allowing the solution to gain access to the orbital tissues. The ensuing orbital edema probably caused a central retinal artery occlusion. This is a previously unreported complication of a common ophthalmologic procedure.


Intraocular gas tamponades used in retinal surgery. Intraocular gas tamponades have proven useful in the treatment of selected retinal detachments. The critical parameter determining the effectiveness of a gas tamponade is its ability to cover an area of retina. A technique for estimating intraocular bubble size in terms of the area of bubble-retina contact is described.


Expulsive choroidal effusion during cataract surgery (in a case with Fuchs' heterochromic cyclitis). A case of massive choroidal detachment during cataract extraction is described. Some thoughts about the pathophysiology of expulsive detachment in this case are discussed (Fuchs' heterochromy cyclitis and high blood pressure). The prognosis is good without need of posterior sclerotomy but with steroid treatment for a longer period.


Dominantly inherited cystoid macular edema. Four patients of Greek ancestry had dominantly inherited cystoid macular edema. Characteristics of this syndrome include the following: an early onset and prolonged course of cystoid changes in the macula, followed by atrophy of the macula in later stages. Some patients also show leakage of fluorescein from the optic disc capillaries, subnormal EOG Lp/Dt ratios, elevated rod dark adaptation thresholds, red-green and blue-yellow color deficiencies, normal ERG findings, hyperopia, peripheral pigmentary retinopathy, and vitreous opacities. Dominantly inherited cystoid macular edema is a distinct genetic trait among the dominantly inherited macular dystrophies.


Myasthenic "oculomotor" palsy.

Myasthenic "oculomotor" palsy. A patient is described who presented with an abrupt onset of diplopia in association with a drooping lid. The motility pattern was consistent with a pupil sparing oculomotor nerve palsy. In addition, the behavior of the palpebral fissure was characteristic of aberrant regeneration. Intravenous Tensilon resulted in a prompt elevation of the lid and improvement in eye movements. The differential diagnosis of a pupil sparing third nerve palsy should include myasthenia gravis.


Demodex folliculorum in hair follicles of eyelid skin. Although Demodex folliculorum is a common inhabitant of eyelid hair follicles, it has received scant attention by ophthalmologists in recent years. I examined 100 biopsies of eyelid skin for the presence of these mites. The incidence of infestation increased with age; 84% of all cases and 100% of cases over age 70 years were involved. No organisms were seen in sebaceous or meibomian glands. I found no pathologic changes except for follicular distention and hyperkeratosis and occasional mild chronic perifolliculitis. Circumstantial evidence for incriminating Demodex in human disease is good, although scientific proof is lacking.


Impending central retinal vein occlusion associated with increased platelet aggregability. A case is presented of an impending central retinal vein occlusion, venous stasis retinopathy, seen in an otherwise healthy 57-year-old woman. The patient demonstrated hyperactive platelets when tested for primary and secondary aggregation. Coagulation tests and platelet count were normal. It is proposed that such an abnormality in platelet function, when present, can be an important factor in the pathogenesis of impending central retinal venous occlusion. Antiplatelet therapy may be used in the management of this hemodynamic alteration.


Bilateral spontaneous hyphema arising from iridic microhemangiomas. Microhemangiomas of the iris are recently recognized lesions, the cause and pathogenesis of which are unknown. Almost all patients whose cases have been reported were more than 45 years old. Complications seem to be uncommon although some patients have developed spontaneous hyphema and transitory elevations of intraocular pressure. The patient whose case we are reporting is the first in whom bilateral spontaneous hyphema originating from microhemangiomas of the pupillary border is described.


Ocular involvement in recurrent cyst of Rathke's cleft: Case report. Cysts of Rathke's cleft are considered as benign lesions, a practically permanent cure of which can be achieved by aspiration of the fluid content and ample opening of the capsule. The case of a patient who suffered from a recurrence of the cyst, 13 years after a first operation carried out according to such surgical criteria, is reported in order to signal the actual possibility of recurrence of such lesions.


Microsurgical repair of peripheral nerve injuries in the upper extremity. Microsurgical techniques have been used for peripheral nerve repair at the University of Colorado since 1975. The authors prefer a modified fascicular repair. The rationale is discussed, surgical technique described, and a preliminary review of functional results presented.


Forehead and brow lifts and their relationship to blepharoplasty. The brows and forehead are important considerations in planning a blepharoplasty. Forehead wrinkles, ptotic brows, and frown lines can be corrected effectively and safely with minimal complications at the time of, and prior to, the blepharoplasty. Various approaches that we use are presented here. The surgical procedure selected should reflect the defect present and the surgeon's preference.


Non-Hodgkin lymphoma of the parotid gland: diagnosis, evaluation, and treatment. Malignant lymphoma of the parotid gland not infrequently presents as a solitary mass indistinguishable from other commonly occurring lesions. Two new cases are presented here with a comprehensive literature review. When encountered, the lesion should be excised with the superficial lobe of the gland. If it is within the deep lobe, the tumor should also be excised with preservation of the facial nerve. Recommendations for further evaluation and treatment are given.


Capsular contraction around silicone mammary prostheses. Contraction of fibrous capsules is the most common complication of augmentation mammaplasty using silicone implants. This contraction occurs unpredictably with all kinds of implants, and despite various surgical maneuvers to prevent it. Current clinical practices are reviewed. Wound healing around silicone breast implants is similar to that elsewhere in the body. Acute inflammation is followed by collagen synthesis. Breast capsules contain contractile fibroblasts like those found in other contracting scars. Silicones implanted into tissue undergo some detectable changes that at present cannot be related to capsular contraction. The possible roles of physical and chemical characteristics of the silicone implants are discussed. Steroids are widely used to prevent contraction, but much debate exists over whether or not they actually work. Other possible drug treatments are discussed, based on current research.


Total prosthetic replacement of the temporomandibular joint. Twenty-seven patients have been operated on for total replacement of the temporomandibular joint because of ankylosis due to trauma, arthritis, neoplasm, infection, or pain. One prosthesis had to be taken out because of gross infection due to Staphylococcus albus, 2 more were removed for pain and dislocation of the prosthesis, and 1 was removed because of erosion through the skin. The remaining 23 had no complications.


The surgical management of the arthritic hand. The surgical management of the arthritic hand is very largely concerned with rheumatoid arthritis and Still's disease and less frequently with psoriatic and degenerative arthritis. In the rheumatoid hand the surgeon may be called upon to intervene at any point in the chain reaction leading to total deformity, performing synovectomies of joints or tendons to relieve pain or prevent further deformity, repairing ruptured tendons, restoring the mechanism of injured joints, and correcting deformities when they have been allowed to occur. The great variety of operations that may be necessary to achieve these ends, with varying degrees of success, are discussed with reference to a personal series of 970 cases and 2002 operations.


Non-invasive investigation of the upper gastrointestinal tract using technetium-99m. The use of technetium-99m in the noninvasive investigation of the upper gastrointestinal tract is discussed with particular reference to the evolution of a method of assessing gastric function or gastric acid secretion non-invasively and to the applications of this method in the investigation of surgical patients with disease of the upper gastrointestinal tract. The assessment of maximal acid output and the insulin response is described and the use of the test in the diagnosis of pernicious anaemia, hypo- and hyperchlorhydric states, gastric cancer, hiatus hernia and Barrett's oesophagus, coeliac disease, Meckel's diverticulum, and abdominal aortic aneursym outlined. The use of chemicals labelled with this tracer in hepatobiliary scanning is briefly described.


The plain abdominal radiograph in acute appendicitis. Although the radiological features of acute appendicitis have been well documented, the value of the plain abdominal radiograph has not been fully appreciated. This article summarises the role of radiology in acute appendicitis, especially in atypical cases and extremes of age, where there is often delay in diagnosis.


A new approach to the surgical treatment of reflux oesophagitis. The rationale of combining proximal gastric vagotomy with Nissen fundoplication in the treatment of reflux oesophagitis due to hiatus hernia is discussed. The application of this procedure in 12 cases over a period of 4 years is described and the results, with a follow-up of 13--48 months, are reported. Ten of the 12 patients have been completely relieved of their symptoms and one has been significantly improved.


Haemorrhoidectomy without tears.

Haemorrhoidectomy without tears. A study of 50 patients undergoing haemorrhoidectomy under general anaesthesia in Reading was undertaken. Half the patients received, in addition, a caudal anaesthetic given by the surgeon at the beginning of the operation with the patient in the lithotomy position. The rest of the patients had no form of local anaesthetic. The amount of analgesia needed, general comfort after the operation, and the number of days after surgery of the first bowel movement were recorded. The use of caudal anaesthesia resulted in a 79% reduction in the number of doses of papaveretum needed by the patients after the operation and a reduction by half in the period of postoperative constipation. Possible reasons for the latter finding are discussed. The possible risks of caudal anaesthesia are considered, but it is concluded that they are far outweighed by the benefits obtained.


Surgery in children with homozygous sickle cell anaemia. During the 25 years 1952--77 31 surgical procedures were performed on children aged up to 16 years with sickle cell anaemia (SCA). Six emergency operations were carried out, all for complications of SCA indistinguishable from the acute surgical conditions they mimicked. Seventeen minor operations were well tolerated and major surgery was undertaken 8 times, including 5 splenectomies for hypersplenism and increased transfusion requirements. The preparation for surgery by planned multiple transfusions and the indications for splenectomy are discussed. Recommendations are made for the preparation of patients for acute and routine surgery.


Prediction of postoperative respiratory complications by simple spirometry. Spirometry was carried out before and after operation in groups of patients undergoing three preselected surgical procedures. The patterns of impairment of pulmonary function in each group are discussed. Only in patients undergoing inguinal herniorrhaphy was spirometry of value in determining an 'at-risk' group for the development of respiratory complications. Discrimination was optimal on the 1st postoperative day, making it possible for 70% of patients to be discharged from hospital 48 h after this operation with little risk of subsequent respiratory complications.


Development and validation of a specific radioimmunoassay for somatostatin in human plasma. Little is known about the factors controlling somatostatin secretion in man, and data are not available on the changes in circulating levels in various human physiological or pathophysiological states. This is mainly a consequence of the technical difficulties involved in measuring somatostatin in plasma. In the presence of plasma, binding of somatostatin tracer to antibody was consistently decreased by about 20%, and this could not be abolished by the addition of EDTA and aprotinin or by the use of specially prepared somatostatin-free plasma. Furthermore, in the presence of plasma, endogenous somatostatin does not dilute in parallel with synthetic cyclic somatostatin standard. We have, therefore, developed and validated a radioimmunoassay for somatostatin using prior extraction of the peptide onto leached silica glass. Tyrosine-II somatostatin was iodinated using lactoperoxidase and purified on ODS silica. This method is superior to iodination using chloramine-T with CMC cellulose purification, and gives a highly purified preparation with a shelf-life of at least eight weeks. Using this tracer and a specific antiserum, the limit of sensitivity of the assay was 10 pg/ml, with an intra-assay coefficient of variation of 12% (n = 16) and inter-assay coefficient of variation of 15% (n - 10). Parallelism has been demonstrated between standard synthetic cyclic somatostatin and all extracted plasma samples. The mean recovery of exogenous somatostatin from plasma was 78%. The fasting level of immunoreactive somatostatin at 0,900 hours in 40 normal subjects ranged from 17 to 81 pg/ml. Care is needed, however, when comparing these values with those obtained from other laboratories since standard preparations of somatostatin vary considerably in their immunopotency.


Validation of the self-displacement technique for estimation of specific radioactivity of radioimmunoassay tracers. There has been controversy recently about the validity of the data-analysis of the self-displacement technique for estimation of specific radioactivity. This paper investigates the technique theoretically and provides practical corroboration of the results.


A data processing system for a group of three clinical chemistry laboratories. 1. Hardware and organisation. A real time data processing system for a group of three clinical chemistry laboratories (one base and two satellite) has been developed as a successor to one used previously. This paper describes both the inadequacies of the previous worksheet-based system and the advantages of the new system, including flexibility, fast response and comprehensiveness, incorporating urgent routine and long delay (that is, endocrine) requests, and the use of a parallel flow work scheme.


A data processing system for a group of three clinical chemistry laboratories. 2. File structure and operation. In the preceding article the hardware and organisation of a new data processing system were described. This paper deals with the file structure and operation, the use of management information, the economical use of disc-file space and hardware, and the transferability of the system.


Routine laboratory investigation of urinary catecholamine metabolites in sick children. Simple and rapid thin-layer chromatographic methods have been used to investigate the catecholamine metabolites present in the urine of sick children. A semi-quantitative method for 4-hydroxy-3-methoxy-mandelic acid (HMMA) has been devised and compared with the quantitative spectrophotometric procedure. The methods have been performed on both normal subjects and children with catecholamine-secreting tumours, without dietary restriction, and have led to a 50% reduction in the number of samples requiring laborious quantitative determination of HMMA excretion.


A rapid and simple method for the quantification in human plasma of tricyclic antidepressant drugs taken in overdose. A rapid and simple extraction procedure followed by gas chromatography using a nitrogen detector is described for the analysis of amitriptyline, nortriptyline, imipramine, and desipramine in 100 microliter plasma. No derivitisation of the drugs is required. Recoveries ranged from 93.7 to 104.6%. Within-batch precision and day-to-day variation showed coefficients of variation of less than 10% with the exception of desipramine, for which the day-to-day coefficient of variation was 15.2%. The method was developed to measure plasma concentrations in patients who had taken non-fatal and fatal overdoses of the drugs.


An evaluation of a simple polyacrylamide gel electrophoresis system for lipoproteins and its use for the characterisation of hyperlipoproteinaemia. The use of polyacrylamide gel electrophoresis as a screening procedure for the characterisation of hyperlipoproteinaemia is described. Sixty-one samples were investigated and classified by four different methods: (1) chemical profile derived from visual appearance and estimation of total cholesterol and triglyceride; (2) 'SML' profile by nephelometry; (3) electrophoresis on agarose gel; and (4) electrophoresis on polyacrylamide gel. Polyacrylamide gel electrophoresis showed the closest correlation with the chemical profile when compared with the other two methods. Polyacrylamide gel electrophoresis was found to be a rapid, reliable, and satisfactory procedure for plasma lipoprotein phenotyping.


Evaluation of 3,4-dinitrophenyl tetra-N-acetyl-beta-chitotetraoside as a substrate for the measurement of lysozyme in normal and pathological sera. Lysozyme was measured using the synthetic substrate 3',4-dinitrophenyl tetra-N-acetyl-beta-chitotetraoside and the LKB Reaction Rate Analyser. This method has been evaluated by comparing levels obtained with serum samples from healthy individuals and patients with either cancer or inflammatory bowel disease with those obtained from the same specimens using a turbidimetric method. In terms of standard egg-white lysozyme, the colorimetric method gave much higher levels for all samples than the turbidimetric method; however, similar group differences were maintained. For individual serum specimens significant correlation between the two methods was found to occur only in the healthy group. Assay precision for the two methods was similar but the turbidimetric method could detect levels of lysozyme activity which were 10 times lower than those detected by the colorimetric method.


The use of cytology to evaluate pericardial effusions. Pericardial effusions from 27 patients were examined cytologically during the five-year period of 1973-1977. Malignant cells were found in eight cases (30 percent). In three of these patients malignancy was unsuspected clinically, and this was the first time the cancer was diagnosed. In addition, cytology often suggested the specific histological types and possible primary sites to be determined. Special stains were also found helpful. There were no false positive reports. Although the pericardial effusions from the remaining 19 patients were negative for tumor cells, metastatic carcinoma to the pericardium was discovered at autopsy in two of these cases. Thus, cytologic examination of pericardial fluid is an important tool in the diagnosis of malignancy, but false negative results may occur.


Behavioural deviance in children with early treated phenylketonuria. A sample of 99 early treated phenylketonuric children showed higher levels of behavioural deviance than 197 matched controls. For boys this excess of behavioural deviance persisted when IQ was taken into account. For phenylketonuric girls however it was restricted to those with IQs less than 70. The type of behavioural deviance shown by the boys over the whole IQ range was predominantly neurotic. The levels of behavioural deviance found in phenylketonuric children were among the highest that have been reported for children with various handicapping conditions.


Intellectual performance in children after circulatory arrest with profound hypothermia in infancy. 38 children were assessed 22 months to 6 years after open heart surgery using circulatory arrest with deep hypothermia. The mean IQ of the group was 99.2 (SD 19.5). No correlation was found between IQ and the age or weight at operation or the duration of circulatory arrest. The results suggest that the technique gives effective protection to the brain during periods of circulatory arrest for up to 60 minutes.


Peroperative pancreatic aspirations.

Peroperative pancreatic aspirations. Peroperative fine needle pancreatic aspirations were performed on 16 patients with suspected pancreatic masses during 1976 and 1977. Seven of the 16 aspirates demonstrated benign cells. Nine of the 16 revealed malignant cells, eight of which could be classified as to tumor type. This procedure provided a definitive diagnosis resulting in the appropriate surgery. The aspiration technique is highly accurate, rapid, uncomplicated and eliminates the problems associated with biopsy of this organ.


Intestinal bile salts in cystic fibrosis: studies in the patient and experimental animal. The quantitative and qualitative distribution of bile salts in the duodenal juice of 13 patients with cystic fibrosis (CF) was studied after a test meal. The effects of triolein (TO), bovine serum albumin (BSA), and ricinoleic acid (RA) on the absorption of taurocholate (TCA) in the distal ileum of the rat in vivo was also studied. The mean (and ranges) of total bile salt concentrations, glycine: taurine conjugate ratios, and percentage of dihydroxy bile salts in the patients with CF and pancreatic insufficiency were 3.5 (1.3--6.6) mmol/l, 8.6 (greater than 10-3.1), and 37 (10--60) compared with control values of 7.4 (3.0--16.0) mmol/l, 3.0 (1.3--4.5), and 61 (52--70) respectively. The differences between the control and CF values were statistically significant (P less than 0.01--P less than 0.001). Three of the 13 CF patients had total bile salt concentrations less than 2 mmol/l, 8 had much higher glycine: taurine ratios, and 8 had a reduced percentage of dihydroxy bile salts. In 2 patients with normal pancreatic enzyme activities, duodenal bile salts were both quantitatively and qualitatively normal. TO (10 and 30 mmol/l), BSA (3%), and RA (5 mmol/l) had no inhibitory effect on the ileal absorption of TCA. These results show pronounced abnormalities of duodenal juice bile salts in CF with pancreatic insufficiency consistent with a broken enterohepatic circulation (EHC); such abnormalities may contribute to defective lipid absorption in CF. The data in the experimental animal do not support the suggestion that unhydrolysed dietary substrates play a role in the pathophysiology of the broken EHC.


Complete deficiency of adenine phosphoribosyltransferase: a third case presenting as renal stones in a young child. We report a third case of 2, 8-dihydroxyadenine stones in a child with a complete lack of the adenine salvage enzyme--adenine phosphoribosyltransferase (APRT). The propositus, a 20-month-old girl of consanguineous Arab parents, presented with multiple urinary tract infections and supposed 'uric acid' stones in the right renal pelvis and left ureter. Both parents and one brother were heterzygotes for the defect, in keeping with an autosomal recessive mode of inheritance. In contrast with the other purine salvage enzyme disorder of childhood with true uric acid stones (the Lesch-Nyhan syndrome), uric acid excretion was normal in all family members. As in our previous case, treatment with allopurinol, without alkali, has eliminated the urinary excretion of 2, 8-dihydroxyadenine: the stones were removed surgically. 2, 8-Dihydroxyadenine should be considered in any child thought to have uric acid stones and tests made to distinguish the two compounds.


Prognostic factors in acute meningococcaemia. During a meningococcal (group A) epidemic, 47 Nigerian children with acute meningococcaemia without meningitis were studied. Their mortality rate was 43% compared with 8% during the whole epidemic. Those presenting with coma and shock had a mortality of 93%, but without shock or coma mortality was only 6%. Coma or shock occurring alone carried an intermediate prognosis. The outcome correlated with initial serum antigen titre, but not with the serum levels of endotoxin, cortisol, or fibrin degradation products. Chloramphenicol was as effective as penicillin. A predictor of expected mortality, based on serum antigen titre and the presence of coma or shock, may allow new forms of treatment to be assessed.


Electron microscopy studies of papillary interstitial granules in normal human kidneys. The papillae of five kidneys from four heart-beating cadaver donors (one child and three young adults) were studied using electron microscopy (EM) technique. The kidneys were made available for EM study after they were found unsuitable for transplantation owing to low antigen match. All papillae had interstitial cells (IC), stellate processes, and intracellular and free granules. The three types of granules observed were (1) homogeneously dark, (2) gray and (3) layered; the free (outside the IC) granules were identical to the granules within the IC. The child kidney had more IC but fewer granules than the adult kidneys. The granules are ultrastructurally identical to those found in the rat renal papilla. Since rat renal papillary granules have been implicated as the source of renal vasodepressor substance(s), this ultrastructural resemblance suggests that human papillary interstitial granules likewise may be the source renal vasodepressor substance.


Aortic arch interruption presenting with absence of all limb pulses. Three patients with aortic arch anomalies presented with severe heart failure, acidaemia, and poor or absent upper and lower limb pulses. Prominent carotid arterial pulsations were detected which distinguished the condition clinically from aortic atresia. In 2 patients with a left aortic arch, interruption was distal to the left common carotid artery and there was an aberrant right subclavian. In the 3rd patient with a right aortic arch, interruption was distal to the right common carotid and there was an aberrant left subclavian artery. By dilating the narrowed ductus, prostaglandin E2 infusion corrected the acidosis. Successful surgical correction was achieved in one patient by direct anastomosis of descending aorta to ascending aorta and the base of the left common carotid artery.


Housing and mothering: their effects upon the developmental levels of 3-year-old children. The development of 200 3-year-old children was measured, using Gesell parameters of development. The levels of development were matched against the adequacy, or inadequacy, of maternal care and housing, the scales for which were derived from a questionnaire completed by the children's mothers. Housing was not found to affect the children's developmental levels, while the adequacy of maternal care was highly significantly related to satisfactory child development.


Serum ceruloplasmin concentrations in rats with primary and transplanted sarcomas induced by nickel subsulfide. Ceruloplasmin (CPN) concentrations were measured by p-phenylenediamine oxidase assay in serums from (a) 30 control Fischer rats; (b) 5 rats with primary sarcomas induced by i.m. injection of nickel subsulfide (alpha Ni3S2), and (c) 12 rats at intervals up to six weeks after s.c. transplantation of four alpha Ni3S2-induced sarcomas. Serum CPN concentrations were not significantly increased in rats with primary sarcomas (mean = 0.38 g per liter) (S.D. +/- 0.05), versus 0.35 g per liter (S.D. +/- 0.04) in controls. In contrast, serum CPN concentrations were increased within 11 to 21 days in all rats with transplanted sarcomas. Maximum concentrations of serum CPN occurred at 31 to 34 days after tumor transplantation, (mean = 0.56 +/- 0.05 g per liter), equivalent to 1.6 +/- 0.2 times the initial CPN concentrations in serums obtained prior to treatment (P less than 0.001). The development of hyperceruloplasminemia in rats with transplanted sarcomas and not in rats with primary sarcomas is attributed to greatly enhanced growth-rates of the transplanted neoplasms.


The detection of creatine kinase isoenzyme CK1 in serum. The brain isoenzyme of creatine kinase (CK) (EC 2.7.3.2) has been identified in the serum of 21 of 950 patients tested. Samples were received over a period of about 20 months. Analysis was performed by electrophoresis on agarose gel with isoenzyme bands visualized by fluorescence after enzyme coupled reactions producing NADH. Specialized substrate preparations were used to rule out the possibility that observed fluorescence was due to enzymatic activity other than that of CK isoenzymes. Patients who were hypothermic and/or had undergone cardiopulmonary resuscitation accounted for 19 of the 21 patients showing the brain isoenzyme. The inciting mechanism for the release of CK1, into the circulation is not clearly understood.


Measurement and diagnostic value of cerebrospinal fluid enzymes. The diagnostic value of cerebrospinal fluid (CSF) enzyme activities in neurological disorders has been evaluated most extensively with the enzymes aspartate aminotransferase (ASAT), lactate dehydrogenase (LDH), creatine kinase (CK) and lysozyme. Methods use for performing the assays have been similar to those employed for serum analysis. Reference intervals for these enzymes in the CSF are given from several sources and demonstrate much lower activities than in serum. Studies of these CSF enzymes in cerebral infarction, brain tumors, central nervous system (CNS) infections and acute brain injury and reviewed.


An autoradiographic study on the distribution of 63NiCl2 in mice. The distribution of 63NiCl2 in mice was studied by autoradiography. A localization of radioactivity was found in the kidneys, the lungs, and the brain and spinal cord. The cartilages, the connective tissues, the skin and the epithelium of the forestomach also showed an uptake of radioactivity. In the kidney, 63Ni(II) was present at all the survival intervals (five minutes to three weeks) in areas of the cortex, probably corresponding to the distal convoluted tubuli. In the lung, radioactivity occurred in the parenchyma shortly after the administration of 63Ni(II) and was retained throughout the observational period three weeks. In the brain and spinal cord, a retention of radioactivity was obvious 10 days and three weeks after administration of 63NiCl2. In cartilage, a high level of 63Ni(II) was present up to 24 hours, while in connective tissues there was a high initial radioactivity, followed by a constant decrease during the seven hours after the administration of 63NiCl2. An uptake of 63Ni(II) in cartilage and skin was also seen when tissue sections of non-treated mice were incubated in solutions containing 63NiCl2. The chondroitin sulphate of cartilage and the keratin of skin have cation-binding properties which may explain the binding of 63Ni(II) in these tissues.


Isoniazid liver injury during chemoprophylaxis in children. The incidence of INH-associated liver injury was evaluated in 239 children aged between 9 and 14 years, who were receiving 300 mg INH/day for tuberculosis prophylaxis. Serum SGOT and SGPT levels were determined before INH administration and at 4-weekly intervals thereafter. Levels of both enzymes were raised during the first 3 months of treatment in 18 (7.5%) children, while in 23 (9.6%) children either SGOT or SGPT exceeded normal levels (SGOT greater than 40 units, SGPT greater than 30 units). Only 2 (0.8%) children showed SGOT and SGPT values above 100 units and in them treatment with INH had to be discontinued. In all other children transaminases returned to normal during uninterrupted INH administration. It was noted also that transaminase values in children who did not exhibit a rise above normal, still had significantly higher levels during treatment compared with before. The findings of this study suggest that liver injury in children receiving INH for prophylaxis occurs more often than it had hitherto been believed but that it is usually mild and transient.


Light and electron microscopy of hepatocellular changes in griseofulvin fed mice. Particular reference to Mallory bodies. Male Swiss Webster mice were fed a diet containing 2.5 percent griseofulvin (GF). Serially progressive light and electron microscopic hepatic altertions were present from one day on and grossly visible hepatomegaly from two weeks until termination at 22 weeks. GF induced liver changes included hepatocyte nuclear and cytoplasmic hypertrophy, increased incidence of necrosis and mitosis, Kupffer cell activation, bile duct proliferation and portal fibrosis. Protoporphyrin crystals were present in hepatocyte cytoplasm as early as one day after GF feeding. Hepatocellular hyalin was initially noted at seven weeks. Thereafter, the hyalin increased in prominence and frequency of occurrence. Ultrastructurally, three types of hyalin have been presently demonstrated to correspond to Mallory bodies (MB) reported in human liver disease. Forms intermediate in appearance between various MB types suggested transition from one to another. Areas of organelle free cytosol with abundant, loosely scattered filamentous elements as well as vesicular, smooth surfaced endoplasmic reticulum and ribosomes appeared preceding and closely associated with MB formation. Similarities of hepatocellular MB observed in GF fed mice and reported earlier in human alcoholic liver disease suggest a common pathway in its formation as a response to divergent noxious insults.


Congenital complete heart block in the newborn associated with maternal systemic lupus erythematosus and other connective tissue disorders. Four babies with complete heart block associated with maternal systemic lupus erythematosus (SLE) are described, together with a 5th baby whose mother had serological abnormalities only. One baby had a rapidly fatal outcome, one has required digoxin for heart failure, and the remaining 3 are asymptomatic but remain in complete heart block. Additional manifestations were present in 2 of them. The spectrum of neonatal abnormalities that may occur in association with maternal SLE and related connective tissue disorders is discussed, together with the possible causes and the prognosis. We conclude that congenital heart block is more common than had previously been appreciated.


Reye's syndrome associated with respiratory syncytial virus infection. An upper respiratory tract infection in a 22-month-old boy was followed by rapid loss of consciousness, hypoglycaemia, uraemia, and death. Necropsy examination showed fatty change of liver and kidneys, severe cerebral oedema, bronchiolitis, and endocardial fibroelastosis affecting the left ventricle. Immunofluorescence staining showed infection with respiratory syncytial virus (RSV). The clinical and pathological findings were those of Reye's syndrome, not previously reported accompanying RSV infection.


Phagocytic activity of rabbit pulmonary macrophages at different temperatures. Phagocytic activity of pulmonary macrophages (PM) in contact with latex particles was studied in a group of twelve adult male rabbits, by means of in vitro phagocytosis tests at 35, 37, 39 and 41 degrees C. The phagocytic index at 35 degrees C was 14.70 (sigma = 4.5); at 37 degrees C, 19.61 (sigma = 4.7); at 39 degrees C, 22.45 (sigma = 5.1), and at 41 degrees C, 25.02 (sigma = 5.4). The value of the correlation coefficient between phagocytic index and temperature was r = 0.6022. The previous results allowed to conclude that there is lineal and direct relationship increase between phagocytic indexes and temperature.


Detection of antibodies to Salmonella "O" antigens in typhoid fever by counterimmunoelectrophoresis. I. Description of technique. In the serum of patients with typhoid fever counterimmunoelectrophoretic techniques were used for the detection of antibodies to Salmonella "O" antigen. Lipopolysacharides (LPS) obtained with phenol and water from Salmonella typhi (antigens 0, 9 and 12) were used. Positive results were obtained in those patients with typhoid fever (20). The lower and higher titration levels were 1:8 and 1:32 respectively; the geometric mean was 1:16. The variation coefficient during the intra assay tests was 0.19, and remained stable throughout the inter-assay tests. Reproducibility, as well as a rapid technique, make this test a valuable tool for the serologic diagnosis of typhoid fever.


Detection of antibodies to Salmonella "O" antigens in typhoid fever by counterimmunoelectrophoresis. II. Assessment in patients with typhoid fever and in a healthy population. Two different population groups were studied. In one, 50 patients with a confirmed diagnosis of typhoid fever. Serum determinations were made for the detection of antibodies to S. typhi somatic antigen using Widal technique, surface fixation test and counterimmunoelectrophoresis (CIE). In the other group, 350 healthy subjects were studied to determine the minimum diagnostic titer by means of CIE. It was possible to establish that a 1:16 titer was suggestive of typhoid fever when CIE techniques were used. Surface fixation test showed the highest sensitivity levels. CIE with sensitivity levels similar to those found in Widal's reaction exceeds the other test because of its standardization and greater reproducibility.


Influence of demographic characteristics on two measures of depressive symptoms: the relation of prevalence and persistence of symptoms with sex, age, education, and marital status. Respondents from community and inpatient populations were asked to recall for the preceding week the prevalence (presence of symptom at any time) and persistence (presence of symptom for five to seven days) of 16 symptoms associated with depression. The rates were adjusted for four-variable combinations of sex, age, education, marital status, and clinical status. For the majority of symptoms, statistically significant associations were found between prevalence and sex, age, and marital status and between persistence and education. These results suggest that white women, young adults, and those not currently married have a higher prevalence of transient depressed affect than those in the other categories of each variable, while the less well-educated are at greater risk than those in other education categories of having the depressive syndrome requiring therapeutic intervention.


The psychotherapeutic impact of women's consciousness-raising groups. The psychotherapeutic impact of women's consciousness-raising (CR) groups was assessed for 32 women entering groups formed in suburban, middle-class communities. Changes occurring over a six-month period were examined through pre-CR group and follow-up questionnaires and intensive interviews. Women increased in self-esteem and identification with the Women's Movement, but symptom distress was not alleviated, nor were marital relationships affected. While women expressed more positive self attitudes with greater feelings of autonomy and assertiveness, few participants manifested life-style or behavioral changes. The CR groups in this study thus served a limited psychotherapeutic function. In addition, CR and professional psychotherapy were seen as complementary and not as antagonistic help-giving systems.


Psychiatric disorders among professional women. A group of 111 women physicians and 103 women PhDs, selected from the general community, were studied for the presence of psychiatric illness. Fifty-one percent of the MDs and 32% of the PhDs were diagnosed as having primary affective disorder (P less than .01). Other psychiatric disorders were found in less than 10% of each group. Depression among the psychiatrists was significantly more common (73%) than among the other physicians (46%). More than 50% of all the women reported prejudice in training or employment, and depressed subjects reported prejudice more often than well subjects. The presence of children and depression were shown to disrupt a woman's professional career. The finding of a high prevalence of affective disorder among women physicians is consistent with the reported excessive suicide risk for this group.


Which short-term therapy? Matching patient and method. In recent years, numerous forms of short-term psychotherapy have been developed, without clear guidelines for choosing among them. There are three major approaches in terms of both their techniques and their criteria for patient selection. The "interpretive" method stresses the use of insight produced by a therapist's interpretations, the "existential," the maturational effect of a brief empathic encounter with the therapist, and the "corrective," the behavioral changes resulting from patient management by the therapist. The question facing a short-term therapist is how to choose a particular method for a particular patient. A framework is proposed based on developmental phases of adult life to help therapists match patient and method.


Psychotherapy in the goldfish bowl: the role of the indigenous therapist. The therapeutic advantages and liabilities that accrue to the indigenous therapist (be he professional or paraprofessional) because of the indigenous state were explored, utilizing the five-year experience of ten indigenous therapists in Boston's North End. The current and historical proximity of therapists who live in the same neighborhood as their patients do provides both with increased access to, longitudinal knowledge about, and a blurred role concept of the other that may help or hinder the therapeutic process. Similarities in culture and values can foster alliance formation, differentiation of psychopathology, and therapeutic interventions, but also may interfere when therapy abuts culturally shared blind spots. These data are relevant to the private general psychiatrist as an indigenous therapist in non-metropolitan America.


Egocentrism in children of parents with a history of psychotic disorders. It is known that children of schizophrenic parents have an increased risk for becoming schizophrenic, but it has been extremely difficult to determine what features may exist in such children before they become manifestly ill that might provide a key for identifying vulnerability to subsequent disorder. This study was carried out to determine whether certain types of egocentric perception exist in the children of psychotic parents that might represent a clue to vulnerability. Sixty parent-child pairs were investigated as part of the University of Rochester (NY) Child and Family Study, using standardized diagnostic assessment procedures in the parents and several methods for evaluating egocentric perception in their offspring. Results showed that severity of psychotic symptoms in a parent related significantly to the degree of persistent age-inappropriate spatial egocentrism in his or her child. All of several diagnostic approaches used for parent classification were about equally valid in this regard, except for hospital diagnosis of schizophrenia, which did not correlate significantly with offspring egocentricity.


Growth of hyperactive children treated with methylphenidate. This is a study of the growth of 72 hyperactive boys treated continuously with methylphenidate hydrochloride. Major findings were that methylphenidate produces an adverse effect on growth in height and in weight in the first year of treatment, but not in the second year; the first year height deficit is offset in the second year by a greater-than-expected growth rate. No clinical predictors of growth deficits were found; growth in height deficits are not related to total dosage or summer drug holidays, but weight deficits may be related to these factors. Side effects did not correlate with dosage. The temporary growth deficits of the first year are of such minor magnitude as to have little clinical significance.


Vasodilators in senile dementias: a review of the literature. The rationale for the use of vasodilators in the aged has changed from the attempt to increase cerebral blood flow to the attempt to improve cerebral metabolism. Review of 102 studies of eight vasodilators showed that significantly more controlled studies claimed practical clinical benefit from drugs supposed to improve neuronal intermediary metabolism with secondary vasodilatation than from drugs supposed to have only vasodilator action (P less than .005). Studies of both classes of drugs often suffered from poor study design, inappropriate and inconsistent application of outcome measurements, as well as negative bias due to selection of severely demented subjects. Future studies should be placebo-controlled investigations of drugs with primarily metabolic action, address questions of dose and time response, consistently use appropriate outcome measurement, and concentrate on the elderly in whom cognitive improvement is possible.


Alcohol and central serotonin metabolism in man. Animal studies and some of thephenomena associated with alcoholism in humans suggest that some central effects of alcohol may involve serotonergic systems. The CSF metabolites of serotonin and dopamine, 5-hydroxyindoleacetic acid (5HIAA), and homovanillic acid (HVA) were studied in hospitalized alcoholics. There were no significant differences in HVA levels between groups. The level of 5HIAA of alcoholics in the abstinence phase, 28 to 63 days after their last drink, was significantly lower (21.8 +/- 1.9 ng/mL) than both a nonalcoholic comparison group (31.7 +/- 2.0 ng/mL) and alcoholics in the immediate postintoxication phase, within one to two days after their last drink (32.3 +/- 2.9 ng/mL).


HLA antigens and schizophrenia.

HLA antigens and schizophrenia. We typed 45 schizophrenic patients for 35 HLA antigens and compared their frequencies with 1,263 population controls. No significant differences between schizophrenics and controls were found. When the schizophrenics were subtyped, a significant (P less than .05) excess of Aw26 was found among the hebephrenics, compared with the population controls. When the published literature on schizophrenia-HLA associations was surveyed, none of the reported associations were found to be consistent across studies. Some possible explanations for the heterogeneity among studies are discussed and it is concluded that an association between schizophrenia and any of the HLA antigens has not yet been demonstrated.


Cognitive concomitants of hemispheric dysfunction in schizophrenia. Forty-eight schizophrenics (24 paranoids, 24 nonparanoids) and 24 matched controls (12 men and 12 women in each group) were asked to detect the differences between 30 pairs of altered pictures presented successively (15 pairs) and simultaneously (15 pairs) in a counterbalanced order. Overall performance, as measured by reaction time and response quality, was better for controls than for schizophrenics. However, schizophrenics, like right hemisphere brain-damaged patients who presumably rely on their left hemisphere, reacted faster in the successive presentation procedure while the controls reacted equally fast in both conditions. These results support the hypothesis that schizophrenics tend to overactivate their left dysfunctional hemisphere. Twenty-four depressed patients, tested in the same procedure, showed a pattern of results similar to that of controls, suggesting that the results obtained for schizophrenics are not a general characteristic of psychosis.


Intracranial self-stimulation thresholds: a model for the hedonic effects of drugs of abuse. We present the thesis that many drugs of abuse are used for their hedonic effects and that a relevant animal model for the study of these effects is the action of these drugs on the pathways that support rewarding intracranial self-stimulation. A relationship between abuse potential of a drug and its ability to lower the threshold for rewarding brain stimulation in the rat was found. Of all the compounds we have studied, morphine and cocaine were the drugs that caused the maximum lowering of the rewarding threshold. Phencyclidine hydrochloride and the mixed agonist-antagonist pentazocine also lowered the threshold to a lesser degree, while the mixed agonist-antagonists cyclazocine and nalorphine hydrochloride had inconsistent effects. Naloxone hydrochloride, at the doses tested, had no effect on the threshold. Further, there is no evidence that tolerance develops to the threshold-lowering effect of morphine, suggesting that continued use of narcotics by the physically dependent individual is not simply due to an effort to avoid the pain of withdrawal.


Methylation hypothesis.

Methylation hypothesis. L-Methionine had no behavioral effects in normal humans and failed to increase concentrations of S-adenosylmethionine (methyl donor) in human or rat blood, while increasing rat liver levels more than fivefold. Methionine or S-adenosylmethionine in very high doses had almost no effect on methylation of tritiated levodopa in rodent tissues; various "methyl acceptor" molecules, including nicotinamide, guanidineacetic acid, and estradiol similarly had little effect. In rabbit lung, methionine and S-adenosylmethionine not only failed to increase production of dimethyltryptamine, but actually decreased it, possibly due to end-product inhibition by S-adenosylhomocysteine, which also strongly inhibited methylation of dopa in rat. These results fail to support several predictions of the "methylation hypothesis" concerning the pathophysiology and potential treatment of idiopathic psychotic disorders and leave the consistent clinical worsening effects of methionine in schizophrenia unexplained.


The management of patients with undiagnosed psychiatric illness. The results of using formal diagnostic criteria on a series of newly admitted inpatients are presented. Several strategies were employed in the management of the undiagnosed patients. The percent of undiagnosed patients significantly decreased with time during the course of hospitalization.


The therapeutic community as a research ward: myths and facts. The clinical research ward run as a therapeutic community has been criticized as inefficient and scientifically unsound. This article discusses the therapeutic community as a research ward and identifies certain misconceptions which underlie many criticisms. The following myths are discussed and refuted: (1) There is an insurmountable community-research chasm. (2) The therapeutic community induces stress that interferes with research. (3) Patient passivity is engendered by research and this is destructive to the therapeutic community. (4) Symptoms are exacerbated by a research ward that is disruptive to the community. (5) Normal research subjects cannot live in a therapeutic community without pathologic psychic changes. These inaccurate myths are seen as a reflection of attempts to oversimplify very complex clinical and research issues. The use of mythology to simplify experiments, to artificially "clarify" complex issues, or to "protect" patients is seen as a disservice. The therapeutic community and research are syntonic when both receive appropriate support.


Lumbosacral fusion by standing h-graft technique. Fusion of the lumbosacral spine was carried out on 44 patients. A modification of the standing H-graft technique was used in 41 of the patients. The operative diagnosis was degeneration of the lumbosacral spine in nearly two-thirds of the cases and spondylolisthesis in about one-third. Operations for low back or sciatic pain had previously been performed on 17 patients. The duration of postoperative bed rest ranged from one to six weeks; a lumbosacral corset was used at least for six weeks postoperatively. The average stay in hospital was 52 days. Complications occurred in five cases. The operative results of 40 patients were evaluated on the basis of a follow-up examination performed on average 3.6 years after operation. Nearly half the patients with radiologically successful fusions had a good subjective improvement and about one-fourth had returned to their previous or corresponding occupations. The operative result was at least fair in about half the patients, assessed by a measure of the patients' subjective improvement and working capacity. In the non-fusion group (six cases) the operative results were exclusively poor. Age over 40 years, long-standing preoperative disability and previous back operations proved prognostic factors for poor results. Assessed from functional radiographs, 63% of two-segment fusions and 95% of one-segment fusions were successful. The operative technique appeared simple and suitable for fusions of one spinal segment, but the value of the lumbosacral fusion in the treatment of low back pain seemed doubtful because of the great proportion of poor clinical results even following technically successful fusions.


[Indication, technique, and results for high tibial osteotomies (author's transl)]. In degenerative and posttraumatic osteoarthritis of the knee joint pain is a major indication for correctional osteotomy. In additon, the degree of arthrosis, axis deviation, range of motion and derangement of ligaments must be considered. In the cases reviewed supracondylar femur osteotomy, extraligamentar and high interligamentar osteotomy of the tibial head were utilized for correction. High tibial osteotomies were performed without using stabilizing plates. Autologous as well as homologous bone implants were added as needed. From the results presented we conclude, that the different methods of correctional osteotomies are equivalent, as long as the axis deviation, which is present in most cases, is corrected into a physiological valgus position. About 3/4 of the patient operated upon were improved as far as pain, range of motion and weigthbearing are concerned. Regression of the arthrotic structural changes could be demonstrated in a few cases only.


[Benign solitary enchondroma (author's transl)]. Solitary enchondroma is a benign bone tumor with a doubtful prognosis changing by topical but not by clinical, roentgenological or histological characteristics. Therefore benign solitary enchondroma should be subdivided in such of peripheral and such of central localisation. Both forms of enchondroma normally show an asymptomatic development. Diagnostic problems occur in central enchondroma because of its radiological, angiographical and szintigraphical aspects. Peripheral enchondroma should be treated by local excision. Recurrences after local treatment are extremely rare. In treatment of central enchondroma bone resection should be performed following common principles of onkological radicality. Local excision is not sufficient; amputation should be reserved for treatment of chondroma close to the trunk or chondrosarcoma.


[Dyschondroplasia with glioma of the brain. Third histologically verified case (author's transl)]. Dyschondroplasia is a mesodermal dysplasia with typical skeletal malformations of varying extent and severity. The combination with other malformations has led to numerous disease entities (Maffucci's syndrome, M. Kast, M. Ollier) that should be regarded as different forms of the same syndrome. The importance of the rare disease lies in the high risk of sacomatous transformation of the skeletal lesions and furthermore in an increased risk of development of other tumours. Involvement of the central nervous system is possible through lesions of the bones of the skull or through primary intracranial tumours. The present report concerns a patient with dyschondroplasia complicated by the occurrence of a cerebral glioma and is the third reported case verifed by biopsy.


[Fibrosarcoma of the cervical spine. Case report (author's transl)]. Primary malignant tumours of the cervical spine are very rare. Perhaps only 30 reports of sarcoma of the cervical spine have appeared until today. We are recording another case of fibrosarcoma, which was diagnosed initially as hysteric pain in gravidity by a 19-year-old girl. The fibrosarcoma lateron metastasized into the third lumbar vertebra by a direct hematogenic pathway.


[The growth of the juvenile hip joint. A planimetric study of x-ray films (author's transl)]. A total of 1.779 X-ray films of the pelvis done with the same technic in children and adolescents was divided into 8 different age groups between 5 and 20 years. Several planimetric parameters for the evaluation of pelvic growth were measured and statistically analysed. A growth quotient was found showing periods of limited intensive growth efforts of the human hip joint. Such growth periods were found in both sexes between 5 and 8 years, and again for girls between 9 and 12 years, for boys between 11 and 14 years. In pathologic hip joints the triradiate cartilage closes sooner. The development of the pelvic roof and the closure of the triradiate cartilage show a close relationship. By evaluating 802 normal hip joints, an acetabular form index useful for all age groups was found.


[Alternatives for the operative treatment of the pseudarthrosis (author's transl)]. The stable osteosynthesis and bone grafting mostly cause the osseous healing of a false joint (pseudarthrosis). There are cases of pseudarthrosis in combination with other adverse failures. For them even an osseous healing would not achieve painlessness and usability of the limb, but the alternative operation might result in a satisfactory effect.


The epidemiology of primary osteoarthrosis of the knee in Greenland. Two hundred ninety-five Greenlanders, 5% of the population of Greenland, aged 40 years or more, were investigated regarding primary osteoarthrosis of the knee. The pathological changes were categorized as mild, intermediate, or severe. Eighty-six (29%) of the patients were found to have osteoarthrosis and the mild form accounted for 72% of these, while only one individual was found to have severe osteoarthrosis. Significantly more individuals from the West coast of Greenland (a mixed Eskimo-European population) than individuals from the East coast (genuine Eskimos) were found to have osteoarthrosis of the knee (38% and 18%, respectively). An investigation of the sex distribution revealed more soteoarthrosi among West coast women than among East coast women (P less than 0.05), whereas no such differences were found among the men. It was speculated that the difference between the rates of osteoarthrosis of the knee in the two population groups might reflect differences in occupation and possibly also a genetic predisposition.


Effects and side effects of radiosynovectomy with Yttrium 90 on rheumatic joint cartilage. 8 and 12 weeks after Synovectomy with Yttrium 90, cartilage specimens from the femoral condyle of 8 patients with R.A. were examined. Cellular and matrix damage could be detected. Intracellular particles containing Circonium, an Yttrium decay-product could be found using microprobe X-ray analysis. This was verified in experimentally induced arthritis in the rat.


Electrophysiologic analysis of the motor system after stroke: the "suppressive" effect of vibration. The "suppressive" effect of vibration on the H-reflex was studied in 18 patients with motor system deficits due to cerebrovascular lesions of less than 3 weeks duration. No meaningful difference was found in the degree of H-reflex suppression between clinically involved and uninvolved sides in the patients, several of whom had increased deep tendon reflexes at the time of examination. It is concluded that hyperreflexia of "spasticity" cannot be explained purely on the basis of lack of presynaptic inhibition, even if it were one of the underlying mechanisms responsible for the suppression of the H-reflex by vibration, as previously claimed. Not only specific lesions themselves but also changes with the passage of time after CNS damage are important for understanding and treatment of motor system abnormalities.