Psychomotor epilepsy and psychosis. III. Social and psychological correlates. In a controlled investigation of paranoid hallucinatory chronic or episodic epileptic psychoses, the social data, psychopathological symptoms and the psychological test findings (WAIS, Rorschach, object-sorting, proverb-interpretation and the Stroop test) were analyzed in order to delineate the characteristics of the psychotic syndrome and to evaluate the significance of organic etiological factors. The study comprised 45 patients with complex partial epilepsy followed by psychosis after median 23 years, and 34 control patients with the same type of epilepsy of median 30 years' duration. Among the psychotic symptoms, simple, mostly empathizable persecutory delusions and auditory hallucinations predominated. The affect tended to remain appropiate, and autistic traits were uncommon. In accordance with this finding of a relatively circumscribed psychotic personality disturbance, psychotic test indicators were infrequent in the psychological tests, the Rorschach test 28%, and the object-sorting test 18% of the cases. The poorer test performances in the WAIS and the Stroop tests, and the preponderance of organic Rorschach test signs in the psychotic group indicate that organic cerebral damage is of etiological significance in paranoid epileptic psychosis.


Effects of early neurological problems following head trauma on subsequent neuropsychological performance. Early neurological indicants based on information from the hospital admission clinical examination were studied in a group of patients who had sustained accident-incurred traumatic head injuries. Patients who had been hospitalized during the 3-year period just preceding the study were recalled and a battery of neuropsychological tests was administered. Early neurological problems were found to have a detrimental effect on subsequent test performance. The results supported the use of these early indicants to make prognostic decisions.


Diabetic polyneuropathy. Corneal sensitivity, vibratory perception and Achilles tendon reflex in diabetics. In a controlled study, corneal sensitivity, vibratory perception of the left index finger and great toe and achilles tendon reflex were examined in 100 diabetes patients and 100 controls. The result showed significantly reduced corneal sensitivity, vibratory perception and increased number of areflexi in the diabetic group. Furthermore, the decrease of corneal sensitivity, vibratory perception and presence of areflexi correlated well to one another and to age, duration of D. M. above 15 years and diabetic retinopathy. Significant intercorrelations suggest that a reduced corneal touch threshold forms part of a polyneuropathy in diabetes. A corneal hypesthesia cannot be considered a valuable index in screening a population for diabetes as previously has been suggested.


Decremental conduction in a mammalian peripheral nerve. Conduction velocities of the A-beta, A-delta and C-fibers in isolated vagal nerves were measured before, during, and after the nerve was exposed to sodium-deficient hypotonic solutions. The solution was kept at 23 degrees C. Recorded at a conduction distance of 18 mm and with the nerve in a 0.25% NaCl solution, the conduction velocity of the A-beta component in the response was found to decrease at an average rate of 1.07 m/s per min; of the A-delta, 0.35 m/s per min and of the C-fibers, 0.020 m/s per min. Thus, the A-delta component in the response would disappear in about 29 min; the C-component, in 49 min; and the A-beta component, in 54 min. Recorded at a distance of 36 mm, the decrease in conduction velocity of the A-beta was 1.40 m/s per min, of the A-delta, 0.43 m/s per min, and of the C-fibers, 0.023 m/s per min. Thus, recorded at this conduction distance, the A-delta would disappear in 20 min; the C-component, in 36 min; and the A-beta component, in 42 min. These findings indicate that when decremental conduction occurs in a mammalian peripheral nerve exposed to these solutions, the decrement is most apparent in the A-delta component, then the C-fiber component, and finally the A-beta component in the nerve. Similar observations were obtained in nerves exposed to 0.5% NaCl solution except that the rate of decrement was slower.


Non-linear properties of diaphyseal bone. An experimental study on dogs. The deformation of entire long bones from dogs has been studied in torsion. The load-deformation relationship is non-linear prior to ultimate failure and repeated successively increased loading and unloading in the non-linear range is found to reduce the stiffness of the bone. The non-linearity of the curve is assumed to be due to a change in the geometry of the bone originating from formation of small cracks in the cortex. The bone material of entire long bones from dogs seems to be linearly elastic for all torques.


Effect of chlorpromazine on skeletogenesis. The result of maternal administration of the drug in experimental rats. Chlorpromazine hydrochloride (CPZ) is known to induce intrauterine and extrauterine growth retardation. A single dose of CPZ (100 mg/kg) was administered to pregnant CF rats on the 14th day of gestation (sperm positive=day 0). Fetuses were collected from the 16th to the 20th day of gestation and processed for alizarin red-S stain. Ossification was delayed by 1 to 3 days in the long bones of the extremities, by 1 day in the scapulae and by 2 to 3 days in the ilium. Ischium and pubis remained unossified until the 20th day of gestation. Ossification of the skull bones was also delayed as manifested by the presence of wide sutures in the treated cases. The number and range of ossified vertebral bodies and arches in the treated group were always less than those in the control group. The sternebrae were most affected. The ribs also showed a significant delay in maturity.


Mortality after hip fractures.

Mortality after hip fractures. A survey was made of 1592 patients, over the age of 50 years, who had sustained a fracture of the hip. The mean age was found to be 77 years, and 76.9 per cent (1224/1592) of the patients were women. Trochanteric fractures accounted for 52.5 per cent (836/1592) of the cases and these patients had a higher mean age than those with femoral neck fractures. The average hospitalization time was 24 days and the mortality during the hospital stay was 8.6 per cent (137/1592). Statistical analysis revealed that the hospital mortality rate was related exclusively to the age and the sex. The mortality after 3 months was 17 per cent and that after 6 months 21.5 per cent. The survival rates paralleled the expected rate after 1.6 years but were found to be higher than expected after 2.8 years. The mortality after 1 year was 27 per cent, after 3 years 43 per cent and after 5 years 56 per cent.


Indomethacin treatment in osteoarthritis of the hip joint. Does the treatment interfere with the natural course of the disease? The course of osteoarthritis in 294 hips of 186 patients was evaluated by examining their radiographs. The development of the disease in patients treated with indomethacin was compared with that in a control material. In the indomethacin group the disease progressed more frequently and in one parameter the progress was more severe. The results support previous reports indicating that indomethacin might have a deleterious effect on osteoarthritic hip joints. Some possible explanations for this adverse effect of indomethacin treatment are discussed.


Thromboembolic complications following scoliosis surgery in Scandinavia. Out of 1229 patients operated on according to Harrington there were eight with clinical deep venous thrombosis (DVT) confirmed by phlebography or at autopsy. One patient died from massive pulmonary embolism. All eight DVT were located proximally on the left side. In two cases the first symptom was abdominal pain. At follow-up two patients had slight complaints. One had edema in hot weather and one swelling of the left leg. Another patient had no complaints but venography showed pathological collateral veins. There may be a considerable risk of development of a postthrombotic syndrome.


Bone mass in primary coxarthrosis.

Bone mass in primary coxarthrosis. The bone mineral content was measured by gamma absorptiometry at two levels on the forearms, proximally on the shafts and distally close to the wrist, in 53 cases of primary coxarthrosis. The bone mineral content at the distal measuring site, representing trabecular bone, was increased in coxarthrosis cases as compared with normal controls; the difference was significant only in women. At the proximal measuring site, representing cortical bone, there was no significant difference. The findings support the concept of impairment of the resilience of the juxta-articular trabecular bone as one factor contributing to the pathogenesis of arthrosis.


Containment of the femoral head in Legg-Calvé-Perthes' disease and its prognostic significance. The treatment of LCPD employs to an increasing degree the containment principle, in the form of femoral osteotomy, based on the hypothesis that the factor decisive for the prognosis is centralization of the femoral head, and not relief of weight-bearing by the hip. A follow-up of 48 unilateral LCPD hips treated by strict bed-rest showed a poor correlation (best value r=-0.385) between the degree of lateralization of the femoral head (the migration percentage) during the course of the disease and the spherical quotient at follow-up 12.6 years after the onset of the disease. The results reported, such as shortening of the fragmentation phase and a not unequivocally good outcome of intertrochanteric femoral osteotomy in hips "at risk", may therefore not be due to the containment principle, but perhaps to an improved venous drainage from the femoral head.


Total hip replacement in juvenile rheumatoid arthritis. Analysis of 59 hips. The results of 59 Charnley low friction arthroplasties in 41 patients with juvenile rheumatoid arthritis are presented. Mean follow-up was 30 months and mean age at operation 30.5 years. At review 90 per cent had an excellent result and 10 per cent a good result as regards pain relief. Mobility was significantly improved in all but two patients. These two patients developed severe ectopic bone formation. With few exceptions, the results remained constant after 6 months. Intraoperative complications were the most common. Careful selection of patients, advance planning of surgery and appreciation of the developmental abnormalities in these hips are essential features in avoiding complications and achieving a good result.


Total hip replacement with a trunnion bearing prosthesis. Biomechanical principles and preliminary clinical results. The biomechanics are presented of a bushing principle forming the basis for a trunnion bearing prosthesis in total hip replacement. The femoral stem is equipped with a trunnion on to which a cylindrical plastic sleeve is applied. On top of this a metal casing is placed which forms the femoral head. On flexion-extension this remains stationary in the acetabular cup and motion occurs between the trunnion and the cylindrical sleeve. Friction between head and cup is reduced to a minimum, decreasing the risk of loosening. A follow-up study of 61 hips replaced by the trunnion bearing prosthesis was performed 2.5 years postoperatively. Eighty-eight per cent were considerably improved. There was one deep infection and two femoral stem loosenings.


Fracture-suspending effect of the patellar-tendon-bearing cast. In order to evaluate the fracture-suspending effect of the patellar-tendon-bearing cast, experiments using a load cell under the heel were carried out on four subjects. Measurements were made using a conventional below-knee cast, the PTB cast, and an above-knee cast. There were no differences between the forces transmitted by the same subject wearing the three types of casts in turn and consequently the choice of cast must be based on other factors.


Morphological studies of the spleen in idiopathic portal hypertension (so-called Banti's syndrome without liver cirrhosis) using light microscopy, scanning electron microscopy and histometry. Morphological changes in the spleens of patients with idiopathic portal hypertension (IPH) were studied and compared with the normal spleen. The study used (1) light microscopy with histometry, (2) scanning electron microscopy (SEM) of the splenic tissue with histometry and (3) SEM of the spleen vascular replica. Histometrical studies by light microscopy showed that the volume of red pulp of IPH was increased in a unit area and to a total of 12 times the normal in the whole spleen. The white pulp was scanty of lymphocytes and decreased in a unit area but it was increased in the whole spleen. SEM of the white pulp of IPH demonstrated many channels formed by reticulum cells and running parallel with each other along the central artery. This finding presumably corresponds to periarterial fibrosis in light microscopy. SEM histometry demonstrated that the venous sinuses of IPH were small but increased in number and occupied the same percentage area in a unit red pulp area as in the normal spleen. The Billroth cord of IPH was narrowed and occupied by thickened reticulum cells, which may cause increased pooling and destruction of blood cells in the enlarged spleen (hypersplenism). SEM of the tissue and vascular replica demonstrated open arterial termination in the Billroth cord in the spleen of IPH as well as in the normal spleen. Venous sinuses in the replica of IPH ran parallel with each other forming bundles with fewer intercommunications than normal.


Malignant teratoma of the thyroid gland in an adolescent female. Malignant teratoma of the thyroid gland was found in a 19-year-old female. She was given a combined surgical and irradiation treatment. The tumor was 5.0X4.0X3.6 cm and located in the lower right lobe of the thyroid gland. Light and electron microscopical examination revealed mature or immature derivatives of the three primordial germ layers. The dominant portion of the tumor was composed of numerous masses of cancerous epithelial cells, which were distributed randomly in the mesenchymal tissue. Tumor cells invaded and replaced the surrounding thyroid tissue with occasional tumor thrombi in the lumens of blood vessels. No metastatic tumor was found in the lymph nodes. The patient was given a course of external irradiation, a total dose of 4000 rads, to the right thyroid area. Eight months after surgery, she is well and without any evidence of recurrence or metastasis.


Anaplastic carcinoma of the thyroid gland. An ultrastructural study on four cases. Four cases of anaplastic carcinoma of the thyroid, composed of one small cell carcinoma and three giant cell carcinomas, were studied with electron microscope. In the case of small cell carcinoma, fine cytoplasmic interdigitations and junctional complex between apposing cytoplasmic membranes of neighbouring tumor cells and a few microlumina within tumor cell clusters surrounded by well-defined basal lamina were seen. In the cases of giant cell carcinoma, occasional cytoplasmic interdigitations as well as desmosomal structures were detected even in tumor cells markedly pleomorphic and anaplastic. Abundant cytoplasmic organelles including profiles of Golgi apparatus, rough endoplasmic reticulum and a few mitochondria were seen in the cytoplasm of tumor cell of all four cases. Of interest to note was that all giant cell carcinomas demonstrated evidences of fairly well differentiated tumor within anaplastic carcinoma, indicating probable pre-existing either benign or malignant epithelial neoplasm more differentiated, with its subsequent anaplastic transformation. Findings in the present study support an assumption that these anaplastic tumors are derived from the follicular epithelium of the thyroid gland. In addition, it can be said that tumor cells of the small cell carcinoma provide evidences suggesting functional differentiation of carcinoma cells to a certain extent, yet unable to produce thyroglobulin.


Primary systemic amyloidosis. A case permitting pathological and biochemical investigations. In this 72-year-old male patient, large amounts of amyloid substances were deposited in the mesenchymal organs, but not in the parenchymal organs. Histochemical and electron microscopic studies revealed large amounts of amyloid substances and amyloid fibrils in the skeletal and smooth muscle tissues. In the skeletal muscle tissues, where large amounts of amyloid substances were deposited, glycosaminoglycan was also markedly deposited, especially chondroitin-4-sulfuric acid. The concentrations of silicon were also markedly increased in the amyloid fibrils. The concentrations of nickel and cobalt were increased but those of zinc were decreased in all organs measured, although both nickel and cobalt in another case of amyloidosis experienced were within normal values.


Establishment of a new human chondrosarcomatous cell line. A new cultured cell line (HuOS) was established from tumor cells obtained from the pulmonary metastatic foci of a patient diagnosed as chondroblastic osteosarcoma. The tumor cell line was maintained for over 19 months, and morphological and biological characteristics were studied. These cells retained their malignant properties and produced nodules when transferred intramuscularly to nude mice. Morphologically, these nodules revealed a chondromatous pattern.


Quantitative evaluation of hypertensive pulmonary arterial change. A new method to quantitatively evaluate pulmonary arterial change in pulmonary hypertension is presented in this paper. Hypertensive pulmonary arterial changes are classified into four grades according to severity and a score from 1 to 4 is given to each arterial change according to the grading. An index of pulmonary vascular disease is then defined as a relative mean value of all scores. It is concluded that this index accurately expresses the grade of pulmonary arterial change in the whole pulmonary arterial system in any given case and makes possible a detailed statistical analysis of large numbers of cases.


Beckwith-Wiedemann's syndrome--a report of an autopsied case--. The case presented here is a three-month-old male infant with the Beckwith-Wiedemann's syndrome. Clinically, the patient was characterized by macroglossia, visceromegaly, umbilical hernia, microcephalus and other multiple malformations such as facial flame nevus or ear lobe grooves. The patient died of bronchopneumonia at the age of three months, and an autopsy was performed. Morphological examination revealed adrenal cytomegaly, hyperplasia and hypertrophy of the pancreatic islets, adrenal rest tissue in the right testis or hypertrophy of muscle fibers of the tongue associated with fibrous degenerative change, in addition to bronchopneumonia of the lung, causing his death. On electron microscopical examination, the cytomegalic cell of the adrenal was characteristic of large pleomorphic nucleus and granular substances with high density in the cytoplasm. In this case, thorough histologic search revealed no evidence of tumorous growth in the organs, though the exomphalos-macroglossia-gigantism syndrome has been of interest in its relationship to the occasional occurrence of Wilms tumor, adrenal carcinoma or other tumors.


The ultrastructure of liposarcoma. A study of 10 cases. An ultrastructural study of 10 liposarcomas is reported. Four of the liposarcomas were wholly or predominantly of well-differentiated, lipoma-like or fibrosing type, 3 of myxoid type, 2 of round cell type and 1 pleomorphic type. The well-differentiated, lipoma-like liposarcomas showed cells with a few, large lipid droplets, few organelles and a peripherally located, fairly large nucleus, The well-differentiated liposarcomas of fibrosing type revealed mostly spindle-shaped, fibroblast-like cells, with abundant rough endoplasmic reticulum and inconspicuous lipid inclusions, surrounded by collagen. One well-differentiated liposarcoma contained an area which was similar to brown adipose tissue and hibernoma. The spindle and stellate shaped cells of the myxoid liposarcomas showed abundant rough endoplasmic reticulum and large smooth-membraned vacuoles filled with moderately dense amorphous material, which appeared to be extruded extracellularly by rupture of the vacuoles. Cytoplasmic lipid droplets were seen in most cells but were much less prominent than in the well-differentiated lipoma-like liposarcomas. Ultrastructurally there were many similarities between the myxoid and round cell liposarcoma, indicating a close relationship between the two types. The pleomorphic liposarcoma revealed cells with one or more large, irregular nuclei, numerous large vacuoles after dissolved lipids, abundant dilated cisternae of rough endoplasmic reticulum and rounded, electron-dense bodies corresponding to PAS-positive hyalin globules seen in the light microscope. The ultrastructural study suggests that the variegated cellular appearance of the different subtypes of liposarcoma reflects the wide cellular spectrum seen during the differentiation of adipose tissue and supports the view that all liposarcomas histogenetically represent a single entity.


Focal endothelial cell injury in rabbit aorta, aggravation of injury by 2 days of cholesterol feeding. A randomized morphometric study of "spontaneous" endothelial cell injury in rabbit aorta was performed blindly. Four different areas of the aorta were sampled in a standardized fashion and examined by scanning electron microscopy. The finding of protruding endothelial cells was taken as sign of injury. The endothelial cell injury was focal and, in the sampled areas, particularly prevalent in the distal part of the lesser curvature of the aortic arch and the distal lip of intercostal artery orifices. In the area between two intercostal artery orifices on the same side of the midline injured cells were only exceptionally found. Rabbits fed a 2% cholesterol diet for 2 days showed an increase in protruding cells, particularly at the intercostal artery orifices. It is concluded that the endothelial cell injury in rabbit aorta may be caused by local factors, determining the focal nature, and by systemic factors, such as acute hypercholesterolemia.


A retrospective histological study of 669 cases of primary cutaneous malignant melanoma in clinical stage I. 4. The relation of cross-sectional profile, level of invasion, ulceration and vascular invasion to tumour type and prognosis. A selected series of 669 primary cutaneous malignant melanomas, stage I, was studied. The series includes 86 lentigo maligna melanomas, 259 superficial spreading malignant melanomas, 194 nodular malignant melanomas and 130 unclassifiable malignant melanomas. The cross-sectional profile, level of invasion, ulceration and vascular invasion were graded. The relation of these features to each other and to tumour type was studied by X2 tests. The prognostic value was also studied. The most common finding was a slightly elevated surface, level III of invasion, no ulceration and no vascular invasion. Most of these tumours were superficial spreading malignant melanomas. A good prognosis was associated with a flat cross-sectional profile, level II of invasion, no ulceration and no vascular invasion. A poor prognosis was associated with marked protrusion of the surface, level IV--V of invasion, ulceration and vascular invasion. Lentigo maligna melanomas tended to be more benign while nodular malignant melanomas tended to be more malignant than the average. A superficial spreading malignant melanoma could vary in either direction. The prognostic value of level of invasion and ulceration was found to be greater than that of tumour type. The prognostic importance of invasion no further than level III is stressed. Level of invasion ought to be reported to the clinician as well as the tumour type.


Histological changes in testicular biopsies from chronic alcoholics with and without liver disease. Testicular and liver biopsies were obtained from thirty consecutive patients at the age of 30 and 64 years with chronic alcoholism (daily consumption of 72 g of alcohol or more for at least five years). The spermatogenesis was normal in 12 patients (40 per cent), moderately reduced in 15 patients (50 per cent) and severely reduced in 3 patients (10 per cent). No relation between the presence of liver disease as assessed by histological examination of the liver biopsy and the impairment in the spermatogenesis could be demonstrated.


Ascites tumors in CBA mice. 2. Ultrastructural aspects on ascites conversion. We have studied four syngeneic murine tumors, a fibrosarcoma, a squamous cell carcinoma and their two ascites-converted counterparts, by transmission electron microscopy. The ascites tumors were investigated both as cell suspensions (AA-tumor) and as solid tumor (AS-tumor). We have also studied the ascites tumors, enzymatically produced cell suspensions of the AS-tumors and solid original tumors by scanning electron microscopy. The two ascites tumors are totally de-differentiated and lack intercellular junctions. This, we think, is a prerequisite for ascites growth. But the ascites tumors show no peculiar ultrastructural features in comparison with other undifferentiated malignant tumors. We found no morphological cell alternations by the enzymatical dissociation procedure used to bring the solid tumors into suspension. Differences between the AS and AA tumors can be ascribed to differences in proliferation rates.


The influence of specific antisera and unheated guinea pig serum on the pathogenicity of "Runde" virus for mice. Antisera from various animal species containing antibodies to "Runde" virus were not able to neutralize virus infection in newborn mice, the outcome of which is an acute, fatal CNS disease. There was, however, one noticeable exception. Mixtures of virus and hyperimmune mouse serum or ascitic fluid inoculated intracerebrally into newborn mice resulted in a persistent infection and a chronic disease which had previously only been recognized in 2 to 3-week-old mice inoculated with "Runde" virus. A serum pool from persistently infected mice had the same effect, though this was less pronounced. The addition of unheated guinea pig serum to the virus-hyperimmune serum mixtures reinforced the tendency to persistence and chronic disease, and unheated guinea pig serum alone modified the infection in the same way. The results suggest an immunological basis for the virus persistence and chronic disease in suckling mice.


Electron microscopical study of antibody binding to Mycoplasma gallisepticum: indirect immunoferritin labelling. The ultrastructural aspects of the interaction of Mycoplasma gallisepticum with specific rabbit antibody have been studied. In particular, fixation conditions which allow the simultaneous preservation of cellular fine structure and membrane antigenicity have been established and applied in a procedure of indirect immunological labelling of the antibody-coated organisms with ferritin conjugated sheep anti-rabbit IgG. The advantages of working with agar embedded organisms in a multistep labelling procedure are discussed. In membrane fractions of M. gallisepticum, prepared by osmolysis and freeze-thawing, only sealed membranes retained their antibody-binding capacity. Electron microscopical examination of "break-through" colonies from immune growth inhibition zones revealed that the majority of cells in these colonies were destroyed, sometimes limited only by a single-layered membrane and without extracellular antibody coat. An exception from this was the presumedly young cells in the periphery of colonies and in microcolonies which appeared to be intact and had a heavy antibody layer surrounding the cells. Based on these characteristics, a possible sequence of events is suggested eventually leading to destruction of mycoplasma organisms in immune growth inhibition zones.


Trisodium phosphonoformate inhibits hepatitis B Dane particle DNA polymerase. Evidence available indicates that the so-called Dane particles are the hepatitis virus. A DNA polymerase is associated with the core of these particles. The probability that this is the viral DNA polymerase offers the possibility of preventing hepatitis B multiplication by selective inhibition of this enzyme. This investigation reports that trisodium phosphonoformate (PFA) at low concentrations but not phosphonoacetate acid (PAA) inhitits Dane particle associated DNA polymerase.


Activated complement in the sputum from patients with cystic fibrosis. 14 cystic fibrosis (CF) patients chronically infected with mucoid P. aeruginosa and presenting multiple precipitins in serum against this bacterium (CF + P) and 13 CF patients without P. aeruginosa infection (CF-P) had their plasma and sputum sol phase examined for albumin, Clq. C3/C3c, C4 and C5 by means of electroimmunoassays. Their sputum sol phase was examined also for factor B by rocketimmunoelectrophoresis. C3c was demonstrated in the sputum sol phase but significantly more frequent (p less than 0.01) among the CF + P patients than among the CF-P patients. Factor B was also demonstrated in the sputum sol phase, but no significant difference in frequency could be demonstrated between the CF + P and the CF-P patients. None of the results indicated that a local pulmonary production of complement factors took place. Complement activation was significantly (p less than 0.01) associated with inflammation expressed as increased (formula: see text). The results show the importance of complement mediated inflammation in the pathogenesis of pulmonary tissue damage in patients with CF and support the concept of chronic P. aeruginosa lung infection as an immune complex disease in CF patients.


Modulation by macrophages of lymphocyte responses to phytohaemagglutinin, concanavalin A and semiallogeneic cells. To investigate the effect of macrophages on rat lymphocyte activation by phytohaemagglutinin (PHA), concanavalin A (Con A) and semiallogeneic cells (uniderectional MLR), increasing concentrations of peritoneal cells (PC) were added to cultures of lymph node lymphocytes. Lymph node cell preparations contained 2-4% esterase positive cells (macrophages/monocytes). Any additional PC seemed only to inhibit MLR, whereas optimal responses of PHA and Con A stimulated cultures occurred when 1-2% abd 3-7% PC respectively were added. Ten percent PC markedly inhibited the response of both PHA and Con A stimulated cultures when added for the last 24 h of incubation. Inhibitory cells were shown to belong to the glass-wool adherent population of PC.


Precipitating antibodies in dermatophytosis demonstrated by crossed immunoelectrophoresis. A total of 289 serum specimens from 262 patients with dermatophytosis were studied, using crossed immunoelectrophoresis with an intermediate gel. Rabbit antidermatophyte antisera were used as reference, and the antigens were water soluble extracts of Trichophyton (T) rubrum, T. mentagrophytes, Microsporum (M.) canis or Epidermophyton (E.) floccosum. Each serum was tested against the dermatophyte antigen corresponding to the infectious agent of the patient in question. Antidermatophyte antibodies could be demonstrated in 25 (9.5%) of the patients, and these were particularly frequent in patients with highly inflammatory lesions and those with chronic dermatophytosis caused by T. rubrum. Antibodies were detected in all four patients with kerion Celsi. Nine patients, five with acute dermatophytosis and four with chronic disease, who had precipitating antibodies at the initial examination were studied several times during the course of the disease. While the antibodies disappeared in all the patients with acute disease, they persisted in those with chronic dermatophytosis. The human antibodies showed marked cross reactivity with T. rubrum, T. mentagrophytes, M. canis and E. floccosum.


Salmonella typhi--induced stimulation of blood lymphocytes from persons with previous typhoid fever. In 21 persons with previous typhoid fever and in 15 controls thymidine incorporation of blood lymphocytes stimulated in vitro by killed Salmonella typhi was studied. The optimal culture conditions were established to be a cell density of 10(5) cells per vial, stimulated with 10(8) S. typhi and incubated for 5 days. The lymphocytes response to S. typhi was significantly higher in the typhoid group than in the controls. The lymphocyte responsiveness was not correlated to the time elapsed since the attack, and was not found different in patients who had had typhoid relapse. No difference was found in lymphocyte response to the mitogens PHA, PWM and Con-A between the typhoid group and the controls.


The timing of the immune response in relation to virus growth determines the outcome of the LCM infection. In the present study earlier observations of a dual role of the immune response against lymphocytic choriomeningitis (LCM) virus were confirmed and extended. At different times after intracerebral (i.c.) inoculation of the virus, groups of immunosuppressed recipients were transplanted with primary effector cells or memory cells, and the mortality was recorded. The brains and blood of untransplanted immunosuppressed recipients were titrated at intervals after the i.c. challenge, and so were the brains of mice receiving peak primary effector cells at various times relative to the i.c. challenge. The results showed a definite correlation between the brain virus titre at the time of the immune attack and the clinical outcome of the LCM infection. Furthermore, the results indicated that the extent of the extraneural infection is not unimportant but may affect the outcome of the infection through competition for the effector cells. The possible implications of these findings are discussed.


The effect of selenium on the biliary excretion and organ distribution of mercury in the rat after exposure to methyl mercuric chloride. The influence of selenium compounds on the biliary excretion and the organ distribution of mercury after injection of methyl mercuric chloride (4 mumol/kg) have been tested. Selenite, seleno-di-N-acetylglycine and seleno-methionine strongly inhibited the biliary excretion of mercury. Selenite even in a molar dose of 1/40 of the methyl mercury dose inhibited the biliary excretion of mercury. The less toxic seleno-di-N-acetylglycine was needed in larger molar doses and did not act as rapidly as selenite. Biliary excreted methyl mercury is known to be partly reabsorbed in the gut. Subsequently a part of it is deposited in the kidneys since drainage of the bile lowered the kidney content of mercury. Rats given selenium compounds in combination with bile drainage showed further reduction of the kidney mercury content than bile duct drainage alone. Thus the demonstrated lowering effect of selenium compounds on the kidney mercury content cannot be completely explained by an inhibition of biliary excretion of mercury. The mercury concentration in the brain was increased by the selenium compounds; the effect being dependent of the selenium dose reaching a maximum at an equimolar selenite--to methyl mercury dose ratio. The mechanisms by which selenium influences the methyl mercury kinetics are discussed.


The effect of nifedipine on the monophasic action potential and refractoriness of the right ventricle of the dog heart in situ after beta-adrenergic receptor blockade. The effect of nifedipine, a calcium-antagonistic drug, was studied on the electrophysiology of the right ventricle in the dog heart in situ. Monophasic action potential recordings were obtained by the suction electrode technique and refractoriness was measured by means of programmed electrical stimulation. Pentobarbital anaesthesia was used. As the basic cardiac effects of nifedipine can be altered by the release of catecholamines from sympathetic nerves of the heart and vessels, the dogs were pretreated with the beta-adrenergic receptor blocking agent acebutolol which increased the action potential duration and the refractoriness. Intravenous injection of nifedipine 30 microgram/kg body weight decreased the times for 50 and 90 per cent repolarization of the monophasic action potential and to a smaller extent the effective and functional refractory period. It is suggested that nifedipine decreases the action potential duration and the refractoriness of the right ventricle of the dog heart in situ due to a direct effect of the drug on the myocardium.


Effects of the GABA receptor agonist muscimol on the turnover of brain dopamine and on the motor activity of rats. Muscimol (3-hydroxy-5-aminomethylisoxazole) at a high dose (10 mg/kg intraperitoneally) elevated the concentration of brain dopamine in rats, decreased the utilization of dopamine and increased the synthesis of dopamine. The utilization of noradrenaline was acclerated rather than retarded by muscimol. Local application of muscimol to the nucleus accumbens of rats inhibited the motor activity in a dose-dependent manner with only a slight subsequent hyperactivity. The effects are similar to those produced by GABA and they support the view that muscimol is a GABA receptor agonist.


Haematological anomalies in a fresh water teleost, Colisa fasciatus, on acute exposure to cobalt. Colisa fasciatus, a fresh water teleost, when exposed for 90 hrs to a sublethal concentration of 195 p.p.m. (0.87 of the 96 hrs LC50 value) cobalt elicited leucopenia due to reduction in the number of circulating small lymphocytes. The treatment also caused decline in blood clotting time with a concomitant increase in the abundance of circulating thrombocytes. No differences in total erythrocyte count, haematocrit, erythrocyte sedimentation rate, and haemoglobin values were found between the control and treated fish. The hepatosomatic index of fish increased significantly after exposure to cobalt. Results are discussed in terms of fish's reaction to acute stress.


Interactions of surface-active alkyltrimethylammonium salts with the plasma membrane of Acanthamoeba castellanii. The interactions of three surface-active alkyltrimethylammonium salts (C12-C16) with the plasma membrane of Acanthamoeba castellanii were studied. The surfactants caused a release of K+ from the cells at premicellar concentrations. The lytic effectiveness of the surfactants increased with an increase in the length of the alkyl chain with about an order of magnitude for every two carbon atoms added to the alkyl chain. Binding studies with the C16 homologue revealed that at a concentration corresponding to 50% release of K+ there were about 1.9 x10(10) molecules bound per cell. At prelytic concentrations the surfactants stimulated phagocytosis and pinocytosis. The mode of action of the surfactants on the plasma membrane of Acanthamoeba castellanii is discussed and it is hypothesized that the stimulation of endocytosis is due to a "fluidizing" effect of the surfactants on the lipid bilayer of the plasma membrane.


Vascular anti-permeability effects of beta-receptor agonists and theophylline in the lung. In conscious guinea-pigs the effect of theophylline, terbutaline and isoprenaline on histamine-induced increase in lung weight was examined. Animals exposed to a saline aerosol had a lung weight to body weight ratio of about 0.8%. Exposure to a histamine aerosol raised this value to about 1.1 (P less than 0.001). Theophylline 55 mg/kg and 110 mg/kg was given orally, terbutaline 0.1 mg/kg and isoprenaline 0.01 mg/kg and 0.03 mg/kg subcutaneously before exposure to histamine. The three drugs prevented the lung weight effect produced by histamine aerosol (P less than 0.01, P less than 0.001, P less than 0.001, P less than 0.1, P less than 0.001 respectively). Changes in lung blood content did not contribute to the weight-reducing effects. The potency ratio found between terbutaline and isoprenaline suggests that beta-2-receptors might be involved in the anti-permeability effect. Propranolol-treated animals did not survive in the histamine-aerosol unless they received theophylline; neither bronchodilator nor antipermeability effects of theophylline were antagonized by propranolol. It is concluded that in guinea-pigs theophylline and beta-agonists, in bronchodilating doses have the additional effect of preventing permeability oedema in the lung.


Inhibition of ATP-induced contraction in the guinea-pig urinary bladder in vitro and in vivo. Contractions were elicted by adenosine 5'-triphosphate (ATP) in the guinea-pig urinary bladder in vitro and in vivo. In isolated detrusor strips, tetrodotoxin (3.1 x 10(-6)--4.4 x 10(-5) M) did not affect contractions induced by a submaximum concentration (10(-3) M) of ATP, nor did atropine (1.7 X 10(-6)--2.1 x 10(-4) M), or the anticholinergic agent PR 197 within the concentration range 2.6 x 10(-8)--2.6 x (0(-5) M. In higher concentractions (5.2 x 10(-5)--2.6 x 10(-4) M), PR 197 inhibited the ATP-response by 60-70% in a way that was not clearly concentration-related. Isoprenaline (10(-7)--2.0 x 10(-5) M) and noradrenaline (2.5 x 10(-6)--10(-4) M) reduced the ATP-induced contractions by up to 79%. The effects of the amines were abolished by propranolol (5.2 x 10(-6)--3.8 x 10(-5) M). Adenosine, 1.0--2.0 x 10(-2) M, reduced the ATP-response by about 50%; in lower concentrations, it had no effect. Nifedipine, 7.8 x 10(-7)--1.2 x 10(-5) M, reduced the responses by 15-79%. Indomethacin (less than 2.0 x 10(-4) M), and theophylline (2.0 x 10(-4) M) had no consistent effects on ATP-induced concentrations. Exposure of the preparations to a calcium-free medium reduced and abolished the ATP-response within 60 min. Intravenous injection of ATP (1-20 MG/KG) caused a rapid and transient increase in intravesical pressure in the anaesthetized guinea-pig. The effect of ATP (3 mg/kg) was reduced by atropine (5-10 mg/kg) by approximately 35%. PR 197 (2.5-5 mg/kg) abolished the ATP-response. Isoprenaline (5-100 microgram/kg) caused a 53-95% inhibition that could be blocked by propranolol (1 mg/kg). The inhibiting effect of noradrenaline (10-100 microgram/kg) could not be blocked by propranolol (1 mg/kg). Adenosine (1.5-3.0 mg/kg) given immedicately before ATP completely inhibited the ATP-response. Nifedipine, 0.1-0.2 mg/kg, reduced the ATP-induced contraction by 34 to 100%. It is concluded that the ATP-induced contraction is elicted by a direct effect on the smooth muscle cell. It can be inhibited non-specifically by drugs with different modes of action.


Effects of cholinoceptor blocking drugs, adrenoceptor stimulants, and calcium antagonists on the transmurally stimulated guinea-pig urinary bladder in vitro and in vivo. The effects of different drugs on the response to transmural electrical stimulation of the guinea-pig urinary bladder were studied in vitro and in vivo. In vitro, atropine (3.0 x 10(-8)-5.9 x 10(-4) M) did not influence the contractions. When used in high concentrations (greater than 5.2 x 10(-5) M), PR 197, another anticholinergic compound, reduced the responses by 25-40%, probably by a non-specific action. Noradrenaline (2.0 x 10(-6)--2.0 x 10(-4) M) and isoprenaline (2.0 x 10(-8)-2.0 x 10(-4) M) had concentration-related inhibitory effects that could be blocked by propranolol (5.2 x 10(-6) M). Adenosine (2.0 x 10(-2) M) inhibited the response by 27 +/- 3% (mean +/- S.E.M., n = 9). Theophylline (2.0 x 10(-5)-6.0 x 10(-4) M) had no consistent effects. The calcium antagonist nifedipone (1.2 x 10(-6)-1.7 x 10(-5) M) reduced the contractions by 25-50%; verapamil (2.2 x 10(-5)-4.4 x 10(-4) M) was little effective. In vivo, atropine (10 mg/kg) reduced the contractions by 55 +/- 5% (n = 10), whereas PR 197 (5 mg/kg) almost completely suppressed the responses. Noradrenaline (20-100 microgram/kg) and isoprenaline (20-300 microgram/kg) also caused a marked inhibition that could be blocked by propranolol (0.25-2.0 mg/kg). Theophylline (5 and 10 mg/kg) had a weak (10-20%) inhibitory effect. Adenosine (3.0 mg/kg) reduced the contractions by 47 +/- 4% (n = 14); in guinea-pigs pretreated with atropine (10 mg/kg), adenosine produced a further 10 to 20% decrease of the responses. Verapamil (0.5-2.0 mg/kg) had no consistent effect, whereas nifedipine (0.1-0.2 mg/kg) caused an inhibition of 20-50%. The results suggest that beta-adrenoceptor stimulants, and drugs with a combined anticholinergic and non-specific action, can effectively suppress the electrically evoked contractions in the guinea-pig urinary bladder.


Studies on the handling of retinotoxic doses of iodate in rabbits. Accumulation of iodate in eye tissues and fluids as a possible explanation of the retinotoxic effect of iodate has been studied by intravenous injection of NaIO3(30 mg/kg), 125IO-3 and 131I- in rabbits. 125IO-3 was determined in fluids and tissue extracts by precipitation with BaCl2 after addition of KIO3. 125IO-3 was rapidly broken down in blood (T 1/2 = 14 min.). 125IO-3 was not present in aqueous humour, vitreous or extracts from retina, choroid + pigmentary epithelium or liver. Concentrations of 125I were comparable in blood, choroid + pigmentary epithelium and liver tissue while in vitreous and aqueous humour low concentrations of 125I were found which, however, increased gradually during 5 hrs after injection to reach levels comparable with blood levels of 125I. Retina had a low concentration of 125I. The ratio 125I/131I (R) in blood decreases during the first 60 min. after injection followed by a slow rise. R in retina, choroid + pigmentary epithelium and liver was the same as in blood at the same time after injection. During the first 80 min. after injection R was higher in vitreous than in blood while it was lower in aqueous humour than in blood. At longer times after injection R was identical in the three fluids. The investigation has been supplemented with whole body scintigraphy of rabbits injected with NaIO3(30 mg/kg) and 131IO-3 or 131I-. The reduction kinetics of IO-3 to I- by some body fluids, tissues, cystein and glutathione was also studied. It is concluded that the retinotoxic effect of iodate is not due to accumulation of IO-3 in eye tissues, but more likely to damage to biochemical mechanisms involved in the reduction of IO-3 to I-.


Determination of thiopental by high pressure liquid chromatography. A specific and rapid reverse phase HPLC-method for the determination of thiopental in serum and in protein free solutions is described. No extraction is used. The detection limit is about 0.090 microgram/ml for serum and about 0.030 microgram/ml for buffer solutions. The retention time is 3.80 min. No interference is found with drugs commonly used in patients with heart diseases. The method was used to follow the serum concentrations in 7 patients who were given thiopental as an introduction to general anaesthesia.


The effect of prolonged pentobarbital anaesthesia on cardiac electrophysiology and inotropy of the dog heart in situ. The effect of prolonged pentobarbital anaesthesia was tested on the dog heart in situ by means of His bundle electrography and programmed electrical stimulation, monophasic action potential recordings from the right ventricle and measurements of peak dp/dt obtained by Millar tip transducer in the left ventricle. Sixteen dogs were used. Immediately after catheterization during anaesthesia, a slight decreased heart rate, a reduction in the conduction velocity and an increase in the functional refractory period of the atrioventricular node occurred. From 15 to 30 min. after catheterization we observed no change in cardiac electrophysiology during the 8 hrs observation period. A slight decrease in contractility, however, appeared towards the end of the period. We conclude that dogs anaesthetized with pentobarbital could serve as a suitable model for testing drug effect on cardiac electrophysiology and contractility. The limitations of the model area are discussed.


The determination of naproxen by spectrofluorometry and its binding to serum proteins. A fluorometric method for the determination of naproxen in serum, albumin solutions and protein free buffer solutions is described. The detection limit is about 10 ng/ml. Furosemide, thiopental and salicylic acid did not show any disturbing fluorescence while phenprocoumon did. The in vitro binding of naproxen in albumin solutions and serum was studied by equilibrium dialysis. A small but significant increase was found in the percentual binding in albumin solutions as compared to serum. The percentual binding was not affected by changes in the pH from 5--8. By fitting the binding data to a model assuming two classes of binding sites, association constants and binding capacities were determined. A very high affinity and a high capacity were found. The association constant for the first class of binding sites was higher for human serum albumin than for serum (8.5 versus 5.3 . 10(6) M-1). The difference in the protein binding to the first class of binding sites in human serum albumin and serum can be explained by the existence of a competitive inhibitor in serum.


Cytotoxic effects of tris(2,3-dibromopropyl)phosphate and 2,4-diaminoanisole. The flame retardant tris(2,3-dibromopropyl)phosphate (Tris-BP) and the hair-dye component 2,4-diaminoanisole (2,4-DAA) were studied by possible cytotoxic effects in rat hepatoma cells grown in culture and in suspensions of isolated rat hepatocytes. Cell growth of Reuber cells was inhibited by 50% at 50 microgram/ml Tris-BP and 20 microgram/ml 2,4-DAA, respectively. At 200 microgram/ml Tris-BP protein synthesis in Reuber cells was reduced by 40%, whereas 50% inhibition of protein synthesis in isolated hepatocytes was seen at 100 microgram/ml. IC50 of 2,4-DAA with respect to protein synthesis was found at 400 microgram/ml in Reuber cells and at 3600 microgram/ml in MH1C1 cells, whereas in the isolated hepatocytes IC50 was 650 microgram/ml. DNA synthesis was inhibited by 50% at 225 microgram/ml Tris-BP in Reuber cells. At 500 microgram/ml 2,4-DAA DNA synthesis in Reuber and MH1C1 cells was inhibited by more than 80%.


Paroxetine: pharmacokinetics, tolerance and depletion of blood 5-HT in man. The tolerance of paroxetine (FG 7051), as well as its pharmacokinetics and reduction of 5-HT in blood, has been investigated in man. Three normal, healthy volunteers were administered the single doses 10, 25, 50, and 75 mg orally, and three volunteers received 10, 25, and 50 mg per day for seven or fourteen days. No toxic effect on blood, kidney, liver, heart or general condition was found by chemical and physical examinations. The pharmacokinetic studies revealed a dose dependent systemic availability, a rather slow elimination (t1-z2 = approximately 16 hrs), a good fit to one compartment open model, and an almost complete metabolism of the substance. 25 mg paroxetine per day gave a maximal reduction of 5-HT in the blood within 2--3 weeks (to approximately 0.03 microgram/ml). The 5-HT levels returned to the basic levels during a three to four weeks drug-free period.


Methotrexate concentrations in biological fluids: comparison of results obtained by radioimmunoassay and direct ligand binding radioassay. A sensitive (sensitivity 2.2 X 10(-9) mol/l) and specific (practically no cross-reaction with circulating folates) radioimmunoassay for the determination of methotrexate concentrations in biological fluids in described and compared with a commercial competitive protein binding assay. Antiserum with high titer was produced in rabbits immunized with MTX-human serum albumin conjugate. Fitness for use in pharmacokinetic drug level determinations was shown in three patients, who received both low doses and high dose therapy combined with citrovorum factor rescue. An excellent correlation was found between plasma and urine MTX concentrations obtained by RIA and competitive protein binding assay. A two-compartment pharmacokinetic model was found adequately describing the serum decay curves, but there was a great interindividual variability in the calculated pharmacokinetic parameters.


The distribution of 14C-ethoxyquin in rat. Adult male rats were given the antioxidant 14C-ethoxyquin by oral intubation and were sacrificed at various time intervals from 0.5 hr to 6 days following administration of the drug. The distribution pattern was studied by whole-body autoradiography and liquid scintillation counting. The isotopelabelled antioxidant was distributed throoughout most tissues and the blood at 0.5 hr after administration. The highest radioactivity throughout the experimental period was observed in the liver, the kidney, the gastrointestinal tract and the adipose tissue. No activity was observed in the brain and the central nervous system. Of the dose ingested 2.2 and 0.2% were found in the liver at 0.5 hr and 6 days respectively following dosing. The hepatic peak in radioactivity was measured at 8 hrs and after 6 days 7.5% of this level was still present in the liver. Six days after administration residues of ethoxyquin and metabolites were also present in the kidney cortex, the intestines, the lung, various adipose tissue and blood.


Effects of m-xylene on human equilibrium measured with a quantitative method. Swaying during normal upright posture in 17 young males and the effects of m-xylene exposure on the body sway of six of the 17 has been studied by a quantitative Romberg test, conducted with an equipment consisting of a strain gauge transducer platform and of an electronic unit. The exposures were conducted in a dynamic exposure chamber. The sway of the 17 subjects was larger when their eyes were closed than when they were open (P less than 0.001) indicating the importance of vision in the control of body balance. Exposure to a time-weighted average (TWA) concentration of 100 p.p.m. (4.1 mumol/l) of xylene with 200 p.p.m. (8.2 mumol/l) peaks had no observable effect on the body balance of the six subjects. Exposure to a TWA concentration of 200 p.p.m. of xylene with 400 p.p.m. (16.4 mumol/l) peaks--the corresponding mean concentration of xylene in venous blood being 29.1 +/- 3.2 mumol/l--clearly impaired the body balance of the six subjects. The impairment was most pronounced with the eyes closed (P = 0.016). The results suggest that human equilibrium is rather sensitive to effects of exposure to xylene.


Socio-economic status and prevalence of mental disorders in certain rural communities in India. A psychiatric field-survey was conducted in three villages in West Bengal, India in order to correlate the prevalence of mental morbidity with the socio-economic status of the families. The sample was divided into four groups on the basis of religion or caste. Total morbidity had no statistically significant relationship with socio-economic status in any of the four groups. In the total sample it was directly related. Higher classes had significantly higher rates. Psychoses were not correlated with socio-economic status in any of the groups. Neuroses showed a significantly higher rate in the upper strata of two groups; in the other two groups the trend of prevalence was in the same direction. The four groups had significant differences in their rates of total morbidity. In all the groups females had a higher rate of mental morbidity. Psychoses, Neuroses and Depression were commoner in females and Schizophrenia was commoner in males.


Mental health in the middle-aged population. In the general health screening carried out 9 September 1973--11 January 1974 in the municipality of Säkylä in Southwest Finland as part of the Säkylä-Köyliö project, the current self-perceived psychological symptomatology of the population between the ages of 40 and 64 years (a total of 2,431 persons) was measured by the questionnaire developed by Goldberg. With a participation rate of 93.3%, the study revealed that 21% of those who took part suffered from psychological symptoms. In the subjects 50 years old or over these symptoms were nearly twice as common as in those under 50 years. Mental symptoms occurred most frequently in widowed and divorced persons as well as in pensioners and the unemployed. An increase in income and/or education appeared to be related to a decline in psychosymptomatology. In the municipality of Köyliö, with a less developed social organization, the frequency of psychological symptoms was 1.5 times that obtained for the more highly developed Säkylä.


Lithium treatment and glucose tolerance in manic-melancholic patients. Intravenous glucose tolerance was measured in manic-melancholic patients given one daily lithium-dose for relapse prevention. It was found that glucose tolerance was increased for some hours after each lithium administration. In the first week of treatment glucose disposal rate was increased up to 12 h after lithium ingestion. In long-term treated patients glucose tolerance was increased 2 h after administration but not 12 h after. Fasting glucose was increased 2 h after lithium administration in long-term treated patients. Concomitant changes in lactate triglycerides, free-glycerol and electrolytes were measured in serum.


Discriminators between neurotics who die and neurotics who live. An increased death rate has been found in patients treated in hospital for neurosis but the reasons for this are not known. A case note study is described in which 37 patients who were treated in hospital for neurosis and subsequently died are compared with a cross-matched sample of treated neurotics who were alive at follow-up. Measures believed to indicate greater severity of neurosis were found to be significantly higher in the experimental (dead) group than in the control (living) group.


Termination of the drug career. An interview study of 58 ex-addicts. Fifty-eight ex-addicts, representing 87% of a group found to be drug-free at an earlier 3-year follow-up, have been the target group of an interview study, which aimed at elucidating various phases of the drug career. It was found that drug abusers tend to break their drug-taking habits either early (before 2 years of abuse) or late (after 6 years or more). Those who abandoned the drug career early regarded giving up drugs as easy and had often been supported by relatives and drug-free friends. Their dominating reason for giving up drugs was adverse drug reactions, or infectious complications. Those who abandoned the career late reported that it had been a difficult process and that they had received little or no support from friends and relatives. To a large extent they had resorted to the aid of outpatient clinics. This group of ex-addicts gave as their most common reason for giving up drugs: they had grown tired of the life of a street addict. The considerable number of critics of psychiatric inpatient treatment (74% rated inpatient clinics as moderately important or unimportant) casts doubt on present treatment approaches. A simplified clinical description of the drug carrer is given, where attention is focussed on three stages within the process of de-addiction.


Psychotic symptoms in normal-pressure hydrocephalus. Two patients with a psychiatric history of about 20 years, and clinical and neuroradiological signs of normal-pressure hydrocephalus (NPH) are reported. One had a periodic psychosis subsequent to a tuberculous meningitis, and this overshadowed the slight classical symptoms of NPH. She had received at least 120 treatments with electro-convulsive therapy. The second patient suffered from a paranoid psychosis; other signs of NPH were moderate though progressive. Both patients showed definite improvement of their NPH symptoms after ventriculo-atrial shunting, and psychotic symptoms ceased totally. Follow-up was 5 years for the patient with periodic psychosis. The other patient died from septicaemia 2.5 years after shunting. A large-scale screening of patients with psychiatric symptoms or dementia, particularly when combined with gait disturbance, should be done by using computerized tomography. Patients suspected of having NPH should then be referred for further examination with the aim of selecting patients suitable for shunting. These measures seem well motivated from humanitarian as well as economic points of view.


The Bech-Rafaelsen Mania Scale and the Hamilton Depression Scale. In a study of 18 patients with manic symptomatology and 31 patients with melancholic symptomatology the Bech-Rafaelsen Mania Scale (BRMS) and the Hamilton Depression Scale (HDS) have been compared. The results showed that the inter-observer reliability of the BRMS was adequate compared with the HDS. Both scales are constructed for assessing the severity of manic or melancholic states, and no difference was found in the total BRMS or HDS score between the various diagnostic groups, when the patients were classified by an index of the course and symptomatology otive disorder, using the Multi-axial Classificetion System for Affective Disorders (MULTI-CLAD). The homogeneity of the BRMS seemed more adequate than that of the HDS, when each item was correlated to the corresponding total score. Although the homogeneity of the BRMS needs to be evaluated by other statistical models than correlation analysis, our results seem to indicate that the improvement in assessing manic-melancholic states quantitatively is a matter of redefining items or incorporating new items in the melancholic rather than the manic part of these rating scales.


Mortality in psychiatric hospitals in Norway 1950--74. The present investigation comprises all deaths in Norwegian psychiatric hospitals 1950--74: 10,413 deaths. Mortality in men declined from 361 per 10,000 before 1950 to 252 per 10,000 in 1969--74 and in women from 324 per 10,000 to 215 per 10,000 during the same periods. In the organic and symptomatic psychoses (mainly senile and arteriosclerotic) mortality ranged from six to ten times that of the general population, whereas in the non-organic (functional) psychoses mortality was only twice as high as in the general population. This discrepancy in mortality between organic and non-organic psychoses, which is caused by the somatic disorders with high lethality underlying the organic psychoses, suggests that mortality should be calculated separately for organic and non-organic psychoses, which is sometimes neglected. An increasing number of hospital admissions with organic, mainly senile, psychoses is to be expected in the future, as well as an increasing proportion of non-organic patients with slight psychotic symptoms and a low and possibly decreasing mortality. between 1950 and 1974 radical changes took place in the psychiatric hospitals which could have influenced mortality. Age-adjusted death rates from cardio-vascular diseases were actually higher in 1963--68 than in 1950--62, possibly indicating that an adverse effect of drug therapy on physical activity and somatic fitness had outweighed the stress-relieving effect. A significant rise in unnatural deaths (suicides and accidents) has been observed particularly since 1963. As in previous investigations from Norway 1926--41, cancer as cause of death was equal to or below the general population in the non-organic psychoses and somewhat higher in the organic psychoses.


Effect of ionic and non-ionic contrast media on red cell deformability in vitro. The effect on red cell deformability from solutions of the ionic contrast media diatrizoate, iocarmate and metrizoate and the non-ionic metrizamide and hypertonic saline (1.5 osm) was investigated by measuring the flow rate of 10% red cell suspension (VRBC) and of plasma (Vplasma) through Nucleopore sieves of 5 micrometer in diameter. By calculating the relative flow rate Vrel (VRBC/Vplasma) the deformability of the red cell was quantified. Both the contrast media solutions and the hypertonic saline solution decreased the Vrel, indicating an increased rigidity of the red cell. The increased rigidity was due mainly to the osmotic effect. The higher the osmolality, the more the deformability was reduced. The low osmotic metrizamide induced a smaller reduction in red cell deformability compared to ionic media of high osmolality in iodine-equivalent concentration.


Occlusion of the carotid artery using catheter with detachable balloon in pigs. A new catheter with detachable balloon for vascular occlusion was successfully used for permanent occlusion of the internal carotid artery as well as branches of the external carotid artery in 5 pigs. The technique is intended for clinical use in man.


Placenta scintigraphy using markers of the uterine cervix and pelvic skeleton. A method of placenta scintigraphy is described which provides a differential diagnosis between total and marginal placenta praevia. The uterine cervix, symphysis and 5th lumbar vertebra are included on the scintigram by means of atraumatic markers. Of 101 examined patients 6 had total placenta praevia and 12 marginal placenta praevia. No incorrect evaluation of the scans or complications occurred. The examination supplements ultrasound scanning in late pregnancy.


Quantity of tomographic blurring.

Quantity of tomographic blurring. A spiral tomographic movement gives rise to a lower quantity of blurring than does a circular movement with the same tomographic angle since in the former the focus comes nearer to the central point. It has been demonstrated that the transfer function may be used to express the quantity of blurring for different tomographic movements. For the sake of convenience the blurring quantity for every type of spiral movement may be expressed in terms of the tomographic angle of a circular movement giving rise to the same transfer function.


Energy imparted in roentgen diagnostic procedures. Results of two surveys during the periods 1958-1960 and 1974-1976 related to technical modifications. A comparison of the energy imparted during diagnostic radiographic procedures at the University Hospital in Lund during 1958 to 1960 and during 1974 revealed an unexpected, low decrease during the intermediate period. The influence of various technical factors on the irradiation of the patient was estimated and attempts made to explain the discrepancy between expected and measured energy imparted during 1974 to 1976. Considering the growth in frequency of examinations from 1960 to 1975 an increase in the population irradiation from diagnostic radiology is deduced for that period. The consequences of an optimum use of the technical modifications could have led to a decrease.


Proteinuria following nephroangiography. IV. Comparison in dogs between ionic and non-ionic contrast media. The degree of albuminuria following hephroangiography with the ionic contrast medium Urografin, the non-ionic Amipaque and a recently synthesized non-ionic contrast medium with the code name C 29 was compared. Significantly less albuminuria was caused by C 29 than by the other two contrast media.


Image enhancement by digital-analog filtration. I. Technical description of device. A device for general (10 x 10 pixels) image filtration of 24 cm x 30 cm roentgenograms in the image domain (10(6) pixels) is described. It combines analog and digital techniques and records the processed image on film in the same scale as the original. Results from preliminary tests of the equipment are reported and it is concluded that it yields images with increased perceptibility of large-scale objects of low photographic contrast in the presence of disturbing structures of high spatial frequency and comparably high photographic contrast.


Excretion of sodium and methylglucamine diatrizoate after longtime unilateral ureteric stasis in the rabbit. The excretion of sodium and meglumine diatrizoate was examined following one or two weeks of unilateral ureteric occlusion. No difference between the two diatrizoate salts was found. A slow compensatory increase of the function of the intact kidney occurred, but after two weeks it was still insufficient at high blood concentration levels.


Volume of distribution of contrast media in blood. The volume of distribution of diatrizoate and iodipamide in blood in relation to hematocrit and contrast concentration was measured using 125I-labeled compounds. In concentration obtained after intravenous injection, the percentage volume of distribution of both contrast media is 100 minus hematocrit, except for high hematocrit values, which may cause uneven distribution of contrast media in smaller concentrations. No evidence of intracellular penetration was obtained.


Metrizamide in high-dose urography.

Metrizamide in high-dose urography. The non-ionic water-soluble contrast medium metrizamide (Amipaque) was used for high-dose urography in 11 patients with apparently normal renal function. Films of good quality were obtained. Adverse reactions and the effect on pulse and blood pressure as well as a large number of blood and urine laboratory parameters were recorded. Only clinically insignificant effects occurred, and the medium is recommended for further use in urography.


Thrombosis following phlebography with ionic and non-ionic contrast media. The side-effects at phlebography of the lower limb were evaluated using an ionic contrast medium, meglumine-metrizoate, and a non-ionic contrast medium, metrizamide. A post-phlebographic accumulation of 125I-fibrinogen was found in 6 patients examined with meglumine-metrizoate indicating a post-phlebographic thrombosis. Ten patients were examined with metrizamide with no post-phlebographic increase in 125I-fibrinogen uptake. Though the groups are small the difference is statistically significant at the 0.2 per cent level.


Radiologic heart volume and subsequent mortality. In the London Civil Service Health Survey, both p.a. and lateral 100 mm chest films were taken on 12,630 men aged 40 and above. Radiologic heart volume was calculated on a 10 per cent sample and to the sample were added the films of all other subjects from the cohort who had died within 5 years of the survey, or more than 5 years afterwards. Radiologic heart volume could be calculated on 1,390 subjects of whom 233 had died within 5 years, and 47 after 5 years had elapsed. For deaths within the first 5 years there was a stepwise increase in mortality with increasing quintile of heart volume. Radiologic heart volume predicts death from cardiovascular disease both within 5 years of estimation and for deaths occurring more than 5 years after examination.


Facial bone scintigraphy. III. Effects of radiation therapy. The uptake of 99Tcm-DP in normal facial bones was not changed by irradiation of malignant tumors. The intensity of the pathologic uptake into regions with active parodontitis in a few patients increased during irradiation. The uptake of 99Tcm-DP in bone with neoplastic growth varied during the period of treatment, probably depending on the tumor reaction to irradiation.


Arthrography in dislocation of the acromioclavicular joint. Arthrography was performed in 10 patients with dislocation of the acromioclavicular joint. The examination was unsuccessful in one case. In the remaining 9 patients, leakage of the contrast medium was observed around the joint and in the direction of the coracoid process. The arthrographic abnormalities were compared with the findings at operation. The distribution of the medium that had leaked out provided information on the severity of the injury to the ligaments.


Arthrosis of the ankle evaluated on films in weight-bearing position. About 7 years after a malleolar fracture 113 patients were examined for development of arthrosis. The addition of films exposed in weight-bearing position with a.p. beam direction to views of the ankle joint exposed in supine position did not contribute to the diagnosis of arthrosis.


Equivalence of quantitative models for tumour response to ionizing radiation in treatment field optimisation procedures. Three cell kinetic models of tumour response to ionising radiation were compared with regard to their prediction of variation in curability when the dose to the tumour varied between 54 and 66 Gy given in 30 fractions. It was found that a simple model emulated the results of the more complex ones when the parameters of the simple model were properly adjusted. A comparison of the simple model and the CRE formula gave a similar result.


Optimum fractionation for irradiation of carcinoma of the bladder. Experiments based on one case. A patient with multiple metastases of transitional cell carcinoma of the bladder to the skin and subcutaneous tissues proved a model where most of the biologic and host-related factors were constant. The effects of varying the physical factors of radiation dose and time were observed. The results indicate that fractionated irradiation at intervals of 48 h was more effective than at intervals of 24 h and that superfractionation (intervals of 5 h) was not an effective method for the treatment of this tumor. The possible reasons for this effect and the implication for the treatment of bladder carcinoma are discussed.


New primary malignant tumors in patients treated for carcinoma of the uterine cervix or corpus. Subsequent primary malignancy was revealed in 1.8 per cent of 2, 689 cases with cervical and in 1.7 per cent of 773 cases with corpus carcinoma. In the cervical carcinoma series the most frequent new primary sites were the skin, breast and recto-sigmoid. Of the cases with cervical and corpus carcinoma 18.8 and 30.7 per cent, respectively, had a family history of malignant disease.


Pharmacologic effects of radiation protective compounds related to their protective effect in mice. Effects of presumptive radiation protective substances on physiologic criteria such as oxygen consumption, rectal temperature, respiratory and acoustic response are described. The rate of oxygen consumption and rectal temperature cannot entirely be considered a reliable measure of radiation protection. Some substances cause a decrease in the investigated parameters, strong enough to incapacitate the treated individuals severely. This limits the use of such substances. It is suggested that not only the effect on the survival but also the metabolic effects on the organism caused by the substance have to be investigated.


Cell survival description of the cumulative radiation effect. An equation is proposed to link the Cumulative Radiation Effect (CRE) scale of radiation damage with the fraction of basal cells surviving after irradiation of skin epithelium. The model assumes an expression for the basal cell survival curve which fits the various hit-target models over the range of doses found in clinical practice. The model is consistent with CRE in the dependence on total treatment dose and fractionation number. A 'first order' analysis using a Gompertzian re-growth of cells also yields reasonable agreement with the CRE equation in time dependence during treatment and during a gap. This model is suitable for acute skin reactions but not necessarily for late effects in connective tissue.


Protective effect of hypoxia against radiation induced fibrosis in the rat gut. The protective effect of hypoxia, induced by degradable microspheres, against the development of fibrosis was investigated after single-dose irradiation of exteriorized rat ileum. Evaluation, based upon microscopy and analysis of hydroxyproline in protected and nonprotected gut segments, demonstrated an evident protective effect at doses of 15 to 25 Gy.


Cytologic diagnosis of thyrotoxicosis.

Cytologic diagnosis of thyrotoxicosis. In specimens obtained by fine needle thyroid puncture it is possible to define cytologic criteria of toxic goiter. This cytologic picture is compound but the authors describe marginal vacuolization and nuclear ring patterns in follicular wall fragments as fairly specific signs of thyroid hyperfunction. Thyroid puncture is hardly a measure of choice in the routine clinical evaluation of hyperthyrosis but some case histories demonstrate that due attention to the cytologic picture of toxic goiter is profitable also when the puncture was made with quite other indications.


The influence of endogenous cortisol on the peripheral conversion of thyroxine in patients with acute myocardial infarction. A study was performed to elucidate whether endogenous cortisol, as previously suggested, could be responsible for the decreased T3 levels seen in euthyroid patients with acute myocardial infarction. Levels of these hormones as well as levels of T4 and reverse-T3 were monitored in 31 consecutive patients admitted to the Coronary Care Unit with symptoms of precordial pain or with acute arrhythmias. Sixteen of the patients had proven myocardial infarction, the remaining 15 were used as a control group. The results demonstrated that a reduction of T3 levels was seen in the infarction group without evidence of a statistically significant difference between the daily mean cortisol levels. No significant difference could be observed in T4 or reverse-T3 levels in the two groups or in T3 levels in the control group. It is concluded that the decrease in T3 levels is not a consequence of the increased levels of endogenous cortisol.


Occurrence of acute myocardial infarction in Stockholm studied by two different methods. Two studies on the occurrence of acute myocardial infarction (AMI) in Stockholm have been made. In one, the study population consisted of patients who attended a health-control station; cases of AMI were detected retrospectively by a mail questionnaire and by the official cause-of-death register. In the other study, the population comprised the total population of Stockholm county; cases of AMI were detected from routine information on hospital care, and from the official cause-of-death register. The aims of the present study were to compare the two methods for detection of AMI cases and to compare the AMI morbidity of the two populations. The mail questionnaire method missed a small number of cases but, on the other hand, the register method included some cases in which the diagnostic criteria were not fulfilled. The AMI morbidity in the two populations did not differ significantly.


Angina pectoris in aortic valvular disease and its relation to coronary pathology. Angina pectoris is a common symptom in aortic valvular disease. In our study of 100 consecutive patients it was found more commonly in patients with aortic stenosis than in those with aortic insufficiency. Only 21 of 80 patients with angina pectoris had significant narrowing (more that 75%) of one or several coronary arteries. Angina pectoris in aortic valvular disease thus seems to be most often functional due to disproportion between myocardial oxygen supply and demand. On the other hand, 5 of 20 patients without angina pectoris had significant coronary artery stenosis. As coronary artery involvement may jeopardize the results of aortic valve replacement in these patients, coronary angiography should always be carried out in patients evaluated for surgery of aortic vavlular disease. Coronary bypass surgery should be carried out during the same operation if the stenosis is severe and bypass is technically feasible.


Oesophageal dysfunction in non-infarction coronary care unit patients. Oesophageal dysfunction (OD) is a common finding in patients discharged from a coronary care unit without definite diagnosis. Of 55 patients investigated with oesophageal manometry, acid perfusion test and exercise ECG, 32 had signs of OD and 19 signs of ischaemic heart disease (IHD). Symptoms such as heart burn, acid regurgitations, feeling of a lump in the throat, surfeitness after meals, chest pain at night, and relief of chest pain when lying with the head raised were significantly more common in patients with OD than in patients with normal oesophageal function. Chest pain was significantly more often provoked by effort, emotions or cold and more often relieved by nitroglycerine in patients with signs of IHD than in those without. These pain-provoking factors were, however, also common in patients with OD. A careful case history with specific inquiry directed at not only cardiac but also oesophageal symptoms is important in the differential diagnosis of chest pain.


Micromethods for analysis of lipids in endomyocardial biopsy specimens. Triglycerides and phospholipids extracted from endomyocardial biopsy specimens were quantitated with sensitive photometric methods and the fatty acid composition of phospholipids was determined after separation of the methyl esters by gas chromatography. The degree of triglyceride accumulation was expressed as the molar ratio triglyceride/phospholipid since in most cases the phospholipid concentration is relatively constant. The representativity of the analysis of endomyocardial biopsy was investigated by comparing lipid analyses of large and small myocardial specimens obtained at necropsy. The methods described may be valuable tools in studies on metabolic disturbances in different cardiomyophaties.


Circumstances around the onset of a myocardial infarction. A study of factors relevant to the perception of symptoms and to the delay in arriving at a coronary care unit. Psychosocial factors, experienced pain and anxiety in relation to patient delay were studied in 100 patients admitted for suspected acute myocardial infarction (AMI). More severe pain was reported by women, by those who had recently consulted a physician, who experienced severe anxiety, who fell ill away from their place of work, or who possessed little medical knowledge. These patients tried to get relief from pain by resting. Patients experiencing more severe anxiety were younger, had not consulted a physician recently, had poor medical knowledge, belonged to lower socio-economic groups or were impatient. These patients also sought relief from pain by resting. Pain, but not anxiety, was related to delay. Long delay was seen more often in patients who did not believe they had suffered an AMI and who were psychologically inactive prior to the onset of pain. Recent physician consultation, failure to call for help and belonging to lower socio-economic groups were also related to long delay. Medical knowledge was unrelated to patient delay. Patients with a low degree of pain rarely reported considerable anxiety, whereas several patients with severe pain had little or no anxiety.


Rapid thrombolysis and preservation of valvular venous function in high deep vein thrombosis. A comparative study between streptokinase and heparin therapy. The results of streptokinase and heparin treatment are compared in a 4-year prospective study with special reference to preservation of high valvular venous function. An objective assessment was based upon phlebographic examinations before, during and 1-2 months after therapy. Complete lysis was demonstrated in 44% of high thromboses treated with streptokinase and in 6% treated with heparin. Retrograde phlebography revealed normal function of the proximal femoral valves in 92% of streptokinase-treated high thromboses, compared with 13% of those treated with heparin. These phlebographic results were considered to be a valid prognostic indicator of the eventual development of the postthrombotic syndrome. Allergic reactions were seen in 39% and minor haemorrhagic complications in 18% of the streptokinase-treated cases. The therapeutic benefit of streptokinase therapy in this study was found to outweigh any disadvantages incurred by observed complications.


Influence of high plasma concentrations of free-fatty acids on heart rhythm in healthy fasting men. Ten healthy male student in regular sinus rhythm fasted for 66 hours. Their overnight fasting plasma concentration of free fatty acids (FFA) was 455 +/- 104 micro mol/1 (mean +/- S.E.M., n=7), the reference value of our laboratory, measured in another normal population of young men, being 344 +/- 28 micro mol/1 (n=10). After 42 and 66 hours of fasting, the plasma concentration of FFA rose to 1198 +/- 181 (p less than 0.01, n=10) and 1471 +/- 89 micro mol/1 (p less than 0.001, n=10), respectively. During the last 24 hours of fasting, the heart rate rhythm was monitored continuously by means of a Holter recorder and computer. No arrhythmias were observed, indicating that elevated plasma concentrations of FFA, exceeding those reported in patients with acute myocardial infarction, are well tolerated by the healthy human myocardium.


Citrate in plasma and urine during total fasting. Plasma citrate was determined in 12 obese subjects who underwent total fasting for 10 days. Mean plasma citrate concentration rose significantly from 128 before to 205 micro mol/1 on the 10th day of fasting. Plasma citrate rose continuously during fasting in seven subjects in whom daily determinations were carried out. The 24-hour urinary citrate excretion was followed in six subjects. A significant decrease was found from 2.91 mmol/24 h in the prefasting state to 0.25 mmol/24 h at the end of the fast. Intravenous glucose tolerance test were performed before and on the 10th day of fasting. Kivgtt decreased significantly and was inversely related to plasma citrate concentration on the 10th day of fasting. The results agree well with the concept that an increased citrate level of tissues is of regulatory importance for the decreased glucose utilization during fasting in man.


The removal of exogenous triglycerides in haemorrhagic hyperlipidaemia in rabbits. Bleedings (15 ml/day/kg b.wt.) on two consecutive days caused a threefold increase in plasma triglycerides (TG) in rabbits. Both in normal and in haemorrhagic rabbits the elimination of injected TGs (fat emulsion) was exponential, the fractional removal rate in the haemorrhagic group being slower than normal. In order to rule out the possible effect of the TG pool in haemorrhagic rabbits and the possible changes in endogenous TGs during the test, the TGs were fractionated by the polyvinylpyrolidone density gradient method. Again, both in normal and in haemorrhagic rabbits the elimination of exogenous TGs was exponential, the removal rate of haemorrhagic animals being retarded. Accordingly, the changes in endogenous TGs were negligible. The results are regarded as indicative of an elimination defect as one factor in the pathogenesis of haemorrhagic hyperlipidaemia.


Changes in amylase, hepatic enzymes and bilirubin in serum upon initiation of alcohol abstinence. The serum levels of bilirubin, aspartate aminotransferase (ASAT), gamma-glutamyltransferase (GT), and pancreatic isoamylase were determined in 156 alcohol addicts during the first 9 days upon initiation of alcohol abstinence. During this period decreasing activities were recorded for S-bilirubin and S-ASAT but patients possessing moderatly increased serum activity of GT showed no decrease. Increased activities of S-ASAT and S-GT were still frequently seen at the end of the observation period. For S-pancreatic isoamylase, both decreases and increases from initial activities were frequently found. In patients with low activities initially, the S-pancreatic isoamylase activity increased during the observation period and thus, pathologically increased activities were recorded more often 9 days after alcohol withdrawal than on arrival at the hospital.


Serum ethanol, hepatic enzymes and length of debauch in chronic alcoholics. The serum concentration of ethanol and the activities of aspartate aminotransferase, alanine aminotransferase and gamma-glutamyltransferase (GT) in 40 male chronic alcoholics were determined on admission to hospital. The serum activities of the enzymes were highest in patients with established alcoholism for less than 5 years. The serum concentration of ethanol, however, was lowest among these patients and gradually increased with the duration of alcoholism. No correlation was found between the serum ethanol level and the activity of any of the enzymes. The duration of the current debauch, which was shortest in cases of long-standing alcoholism, showed a positive correlation with the S-GT activity.


Mycoplasma pneumoniae infection associated with affection of the central nervous system. A total of 371 patients with acute, febrile, non-bacterial affection of the CNS hospitalized between Nov. 1, 1971, and June 1, 1976, were examined for Mycoplasma (M.) pneumoniae infection. Nineteen of the patients showed evidence of a current M. pneumoniae infection, 32 of a previous infection, and 320 no evidence. In patients with a current infection due to M. pneumoniae, suggestive evidence is presented that this agent might be involved in the pathogenesis of the neurological syndromes. Compared to cases without the infection, these cases and, to a lesser degree, those with a previous M. pneumoniae infection showed an increased frequency of pathological values, found by various laboratory and instrumental parameters, and a slightly higher frequency of neurological sequelae. Respiratory illness was present in only 11 of the 19 patients infected with M. pneumoniae, a classical respiratory tract pathogen. The overall incidence of current M. pneumoniae infections among patients with neurological syndromes was 5%, with a maximum of 10% during the 1972 epidemic. This is a much higher figure than expected from a mere coincidence of the two conditions.


A patient with Cronkhite-Canada syndrome, myxedema and muscle atrophy. A case of Cronkhite-Canada syndrome is presented. The patient had alopecia, onychodystrophy and gastrointestinal polyposis, mainly in the stomach and duodenum, with transient diarrhea and hypoproteinemia. Marked atrophy and weakness of the shoulder girdle muscles due to myopathy were also present. In addition she had primary hypothyroidism. The outcome of the disease is usually fatal within months, but so far our patient is alive four years after the onset of symptoms. The pathological changes, pathophysiology, symptoms, course and treatment of this rare disorder of unknown etiology are discussed.


Trauma and Hodgkin's disease.

Trauma and Hodgkin's disease. In two patients, Hodgkin's disease developed apparently after a trauma. The relationship between trauma and Hodgkin's disease is discussed. The trauma may be the initiating factor in the development of the pathological process, or it may be a localizing factor in a patient already suffering from Hodgkin's disease. As long as these questions remain unanswered and a causal relationship cannot be excluded, it will be reasonable, if accident insurance problems are involved, to give the patient the benefit of the doubt.


The transparent face mask.

The transparent face mask. Fabrication of an accurate transparent mask for total contact pressure to the healed burned face proved helpful in controlling scarring. Wearing the mask for 20 hours daily, secured by elastic straps giving 35-mmHG pressure to the scar, can prevent the original facial contours from being distorted by contracting scar tissue.


Verbal and nonverbal memory abilities of adult brain-damaged patients. Retention abilities of three groups of patients were investigated in this study; ten left hemisphere brain-damaged patients (aphasics), ten right hemisphere-damaged patients, and ten patients with no known neurological deficits who served as controls. The patients were asked to detect repetitions of a word within a list of words presented either auditorily or visually. They were also tested for their ability to detect repeated pictures and repeated shapes. It was discovered that the aphasics had greater difficulty than the other two groups in retaining stimuli on the verbal subtests presented auditorily or visually. On the other hand, the right-hemisphere-damaged patients performed poorly on the visual subtests (verbal and nonverbal), but performed well on the auditorily presented verbal test. Application of these findings is offered for the clinical treatment of both right and left brain-injured patients.


Volunteer program to assist the elderly to remain in home settings. A community-based volunteer program was organized to improve the quality of life for elderly individuals in the community. Each elderly client referred for the program from welfare and home health agencies, or from family and friends, was matched with a volunteer who visited regularly. The volunteers also assisted with transportation, sitting, home maintenance, and meal preparation when these services were not available. The goals of the program were to improve the quality of life of elderly in the community, to assist the clients to remain in their home setting despite physical limitations, to encourage positive attitudes toward the elderly by the volunteers, and to increase the community's awareness of the older person's needs. The program also included educational seminars on gerontology for volunteers and community members.


Pericardial effusion as an early complication of acute myocardial infarction. Two days after an acute myocardial infarction, a patient developed pleuropericarditis. A negative lung scan and echocardiographic evidence of pericardial effusion were instrumental in making the diagnosis. Steroid therapy led to a dramatic resolution of the signs and symptoms. Pericardial effusion is usually a late complication of myocardial infarction (Dressler's syndrome), but the increasing use of echocardiography may demonstrate that it occurs early in the course.


The 'sprained wrist'.

The 'sprained wrist'. "Sprain of the wrist" is a precarious diagnosis. Although true ligamentous injuries do occur, it is important for the physician who first sees the patient to make a more specific and accurate diagnosis. In most instances, this can be done by locating the precise area of maximum tenderness and obtaining appropriate radiographs. Understanding the basic anatomy and biomechanics of the carpal bones and knowing the most likely diagnostic possibilities will permit recognition of these frequently overlooked injuries.


Counseling after resection of the penis. Surgery is the most effective means of controlling or curing cancer of the penis, but management of a patient with penile cancer encompasses more than excising the lesion. Anticipatory guidance and counseling are required components of total patient care. An integral part of counseling is psychotherapy, including marital and sex therapy. This comprehensive management program is best provided by a team of health care professionals including the family physician.


Lithium therapy and toxicity.

Lithium therapy and toxicity. Lithium is a potent agent for the control of psychiatric disease. It is safe and effective when properly administered; however, its use requires a maximally informed physician and careful clinical monitoring of patients. The drug's side effects are usually dose related, and certain patients are at greater risk of experiencing toxicity than others. Management of acute intoxication involves gastric lavage, sodium replacement and the administration of other agents or dialysis to facilitate clearance.


Sputum cytology.

Sputum cytology. The primary purpose of sputum cytology is to detect preinvasive and invasive malignancy. Candidates for the screening procedure include long-time smokers with productive cough, patients chronically exposed to asbestos, patients with hemoptysis, persistent cough and/or weight loss, and asymptomatic patients with x-ray lesions or unexplained pleural effusions. The procedure is inexpensive and highly diagnostic. Five consecutive specimens produced by deep coughing are required for adequate evaluation.


Chronic diarrhea in infants and children. A useful clinical classification of chronic diarrhea is based on the character of the stool--watery, fatty or bloody. Pathophysiologic mechanisms include osmotic and secretory diarrheas, bacterial overgrowth leading to excess colonic bile acids and fatty acids, defective anion exchange systems, mucosal damage and abnormal motility and transit. Evaluation may require hospitalization. Antidiarrheal agents are not used. Antibiotics are generally not indicated. Parenteral hydration and feedings of special formulas are carefully monitored.


Methotrexate for psoriasis-revisited.

Methotrexate for psoriasis-revisited. If maximum medical management-hospitalization, tar and sunlight therapy, topical steroids with plastic-wrap occlusion--is not effective, and PUVA is not available, methotrexate therapy should be considered, especially in a patient with severe psoriatic arthritis. It should be used if systemic steroids are inadvisable and if the patient has a normal liver biopsy and no history of alcohol excess. The least toxic and most effective method of administration is three divided doses every 12 hours, once a week.


The reliability of coronary angiogram interpretation: an angiographic-pathologic correlation with a comparison of radiographic views. This prospective study correlates premortem coronary angiographic interpretation with pathologic findings including the use of postmortem coronary angiograms. The reliability of a single radiographic view, left anterior oblique or right anterior oblique, or combined views (left anterior oblique plus right anterior oblique) was examined. The most reliable interpretation, the combined view, has a specificity of 93 per cent, but sensitivity is less at 61 per cent. Using a single view enhances diagnosis (sensitivity), but it leads to overestimation more frequently (decreased specificity). Proximal segments of the coronary arteries are prone to a significant per cent of false positive readings. The most accurate assessment of the anterior descending coronary artery system occurs with the use of the right anterior oblique with multiple views. Less routine use of the left anterior oblique view with increased use of the hemiaxial view is suggested for the angiography of the left coronary artery. Initial cusp injections of the right coronary artery may avoid a high per cent of false positive readings in the proximal segment.