Experience with the Hunter-Sessions inferior vena cava balloon occluder. During a two-year period, 12 patients with indication for inferior vena cava interruption underwent vena cava occlusion with the transvenous Hunter-Sessions balloon. The device permitted simultaneous anticoagulation (when not contraindicated), was tolerated by sick patients, did not cause mortality or significant morbidity, and prevented pulmonary emboli.


Biliary clonorchiasis.

Biliary clonorchiasis. Parasitic infection of the biliary tree may be seen more frequently because of changing patterns in travel, and may come to the attention of the surgeon when obstruction or secondary bacterial infection occurs. In this case, intraoperative cholangiography indicated common duct abnormalities, and choledochotomy led to the diagnosis of Clonorchis sinensis. A recommendation is made to follow up patients with bilary parasite infections to determine the long-term sequelae.


A safe and secure technique of cystic duct catheterization. An easily fabricated, small-caliber, flare-tipped polyethylene catheter was used for transcystic duct cholangiography in 385 patients. A modified cystic duct clamp and a Potts-Smith scissors have expedited the intubation. The catheter has proved to be a versatile tool during biliary surgery, being used in different technical maneuvers. Its value as a transcystic duct drain has been demonstrated in a selected group of patients.


Avoiding renal vein entry when implanting the Mobin-Uddin vena cava umbrella filter. Transvenous placement of a Mobin-Uddin vena cava umbrella filter is a safe and effective method of vena cava interruption in high-risk patients who cannot undergo laparotomy. When the renal veins enter the vena cava acutely, there may be preferential passage of the filter insertion device into the aberrant renal veins. If the usual maneuvers of changing the patient's position do not correct this aberrant passage, then a venous thrombectomy catheter may be used to temporarily occlude the vein orifice. This technique avoids the problems of incorrect placement and abandonment of the transvenous approach to vena cava interruption.


Microbiologic environment of the conventional operating room. Areas of potential contamination of the surgical wound in the conventional operating rooms include the back table, the unsterile suction receptacle, and the lack of a positive pressure relationship between the operating room and adjacent areas. Use of an impermeable hood with a large mask diminished contamination of the instrument table and the the wound from fallout of bacteria from the surgical team. The level of airborne bacterial comtamination in the operating room can be reduced by limiting the traffic and controlling the activity and the number of operating room personnel. Higher rates of postoperatively wound sepsis were noted in older operating rooms, particularly with difficult procedures and those performed later in the day. Conventional operating rooms should be categorized by the level of room air exchange per hour and the level of airborne bacterial contamination.


Environmental bacteriology in the unidirectional (horizontal) operating room. The continuing attempts to reduce bacterial contamination through clean air systems have been of special interest to surgeons dealing in joint replacement surgery. Although the definitive relationship between airborne contamination and surgical infections is not universally agreed on, there is little question that clean air systems reduce bacterial contamination of the surgical wound at the time of operation. This report reviews the history of surgical infections, presents statistical data that show the reduction of bacterial contamination by a clear air system, and suggests a pragmatic attitude regarding airborne bacterial contamination of surgical wounds.


Environmental bacteriology in the unidirectional (vertical) operating room. An integrated body exhaust/clean air operating room system was evaluated in terms of the microbiologic and particulate contamination control it afforded. The clean air unit was of a vertical unidirectional airflow design and employed high-efficiency particulate air filters to provide air low in both microbes and particulates. The body exhaust portion of the system was composed of an exhaust tube the surgeon's mask, a transparent plastic faceplate, and a microbe-retentive surgical gown and hood. Measurements were made of airborne and surface contamination at the wound site and of microbial burden levels associated with the surgical team. Sampling techniques were designed to parallel those used in a previous study of a horizontal flow/body exhaust system so as to provide comparative data on the effect of airflow configuration on wound site contamination. The data showed the vertical flow room to exhibit significantly lower (P less than .05) contamination levels than the horizontal flow enclosure. Surgical lights, draping techniques, and personnel and material positoning unobstructive to the airstream were judged to the prime factors in reducing wound site contamination.


Bacteriology of the operating room with the use of helmet aspiration systems. The bacteriology of the operating room with the use of the helmet-aspirator system has been discussed. The surgical team predictably contaminates the operating room. Current cotton gowns worn loosely about the neck do not serve as effective barriers to bacterial penetration. Barrier draping of the surgical team is possible with impervious materials, but requires the use of a helmet-aspirator system to dissipate the heat and particulate debris. These are commercially available and their use has been shown to decrease colony-forming particles, decrease wound contamination, and decrease wound infection. Barrier draping of the surgical team through the helmet-aspirator system is effective and is to be recommended for infection-prone cases.


Clean air bench. Use for sterile maintenance of unwrapped surgical instruments. Microbiologic sterility of unwrapped surgical instruments has been maintained for long periods by the use of an operating room instrument cabinet that continuously circulates high-flow, "particle-free" air. Use of this clean air bench has had excellent acceptance by operating room nurses and by surgeons because fewer instrument storage procedures are needed and setup time, takedown time, and case turnover time in the operating room are diminished. It has been found to be effective in operating rooms having busy schedules for both elective and emergency procedures.


Reduction of deep sepsis after total hip arthroplasty. The role of the operating room environment in the development of deep sepsis after total hip arthroplasty was studied at four centers. The incidence of deep sepsis after 5,865 total hip arthroplasties performed in the four centers varied from 0.5% to 2.3%. Procedures performed in a conventional operating room were associated with the highest incidence of deep sepsis (1.3%). The use of a vertical, unidrectional airflow system with a helmet aspirator suite was associated with the lowest incidence of deep sepsis (0.6%). Although patients with previous hip surgery had an increased incidence of deep sepsis regardless of the operating room environment, those procedures performed in a vertical, unidrectional facility had a lower incidence of deep sepsis. Newer techniques designed for the reduction of airborne contamination of the operative wound seem to reduce the incidence of deep-wound sepsis after total hip arthroplasty, especially in patients with previous hip surgery.


Use of antimicrobials in the management of open fractures. The role of antibiotic therapy in open fractures is secondary to adequate debridement, irrigation, and definitive wound care. Experimental and clinical studies indicate that parenteral administration of appropriate antibiotics within three hours after injury helps to prevent wound sepsis. Intial wound cultures of 158 open fracture wounds revealed bacterial growth in 70.3%. Eighty-six were Gram-positive, 57 were Gram-negative, and 32 yielded mixed bacterial growth. Sensitivity studies of these organisms suggest that cephalothin sodium is the most effective antibiotic for prophylaxis. In a prospective study from 1969 to 1975, treatment of 520 patients was as follows: debridement, copious irrigation, and primary closure for types 1 and 2 fractures and secondary closure for type 3 fractures. No primary internal fixation was done except in vascular injuries. Cultures were taken of all wounds and antibiotics were given before surgery and for three days postoperatively. In type 3 open fractures, severe soft tissue injury, and segmental or traumatic amputation, the infection rate was 9%, compared to a 44% infection rate in the retrospective study from 1955 to 1968.


Wound infections in patients undergoing total hip arthroplasty. Ultraviolet light for the control of airborne bacteria. Ultraviolet (UV) irradiation (1,537 A) during total hip arthroplasty will effectively reduce risk of airborne bacterial contamination of the operative field. An air sampling study at the operative site compared 28 total hip arthroplasties with UV lights on and 19 operations with UV lights off. The use of UV irradiation significantly reduced the average number of airborne bacteria over the operative site, although the results indicate that the number of airborne bacteria collected at the operative site in each conventional operating room without UV irradiation was quite low. Data confirmed the fact that airborne bacteria are a reflection of operating room personnel and their activities. With UV light, the rate of infection from possible airborne sources was 0.15% for 1,322 total hip patients. Thus, emphasis is now placed on those causes of infection that are not airborne.


Airflow effects in surgery.

Airflow effects in surgery. Accumulated evidence of the last decade has emphasized the multifaceted nature of wound infection control. Clean air is definitely one of the facets in the complex, but its place in the hierachy of precautions against wound infection has not been established, nor has the method of achieving acceptably clean air been universally agreed on. The surgical team and the patient are the prime sources of contamination during an operation, as evidenced by the good matches between bacteria of infected wounds and those of the team or the patient and by the poor matches between bacteria of infected wounds and airborne bacteria. Therefore, special air-handling systems, despite their ability to lower ambient bioparticulate counts, cannot be credited with being a highly relevant factor in the reduction of wound infection rates.


Diagnostic errors with peritoneal lavage in patients with pelvic fractures. Diagnostic peritoneal lavage, considered to be a highly accurate, technique for detecting intraperitoneal blood in the trauma patient, may be less reliable in the presence of a pelvic fracture. In a retrospective review of 222 patients with pelvic fractures, 61 patients were found who had had a diagnostic peritoneal lavage performed as part of the initial evaluation of their condition. Twenty-six of these patients had had a negative lavage result negative lavage result. There had been no false-negative results in this group, although six patients required operations for extraperitoneal injuries. Of the 35 patients with a positive lavage results, 10 (29%) were found to have false-positive lavage results with no intraperitoneal source of bleeding. The only deaths in this series occurred in the group requiring operations, eight of 41 (20%). Four of the eight detahs were due to uncontrollable bleeding that resulted from exploration of the retroperitoneal hematoma. These data suggest that a negative lavage result is highly reliable in the patient with a pelvic fracture and should allow management with confidence that there is no severe intraperitoneal injury. Positive lavage results, however, must be interpreted with caution.


Cardiopulmonary bypass in anesthetic management of resection. Its use for severe tracheal stenosis. On initial evaluation, two patients were found to be in severe respiratory distress from tracheal obstruction. One patient had late obstruction after a crushing injury to the chest, whereas the other had subtotal tracheal obstruction from a carcinoid adenoma. In each case, the state of the patient seemed to preclude safe anesthetic induction with an endotracheal tube as the sole means of oxygenating the patient. Partial cardiopulmonary bypass provided an adjunct to ensure adequate oxygenation for tracheal resection. Consideration for the use of this technique is recommended in similar circumstances.


Abdominal aortic aneurysm and horseshoe kidney. A different perspective. We report a case of abdominal aortic aneurysm with horseshoe kidney. The anatomic distribution of the renal vessels, the position of the thin portion of the isthmus of the kidney, and concern for the preservation of the sexual potency of the patient made standard aneurysm repair untenable. We describe a method of repair by exclusion of the aneurysm.


Nonoperative internal drainage of obstructive common bile ducts. A new nonoperative method for internal drainage of common bile duct obstructions by endoscopic retrograde cannulation of the papilla of Vater is described. After introduction of a tube in the common bile duct, a substantial decrease in serum activity of bilirubin, alkaline phosphatase, and gamma-glutamyl transferase was found. In addition, a rapid improvement of the clinical condition could be observed. No serious complications occurred. It is concluded that internal drainage of common bile duct obstructions might be of great value in the preoperative treatment of patients with common bile duct obstructions.


Studies on the toxicology of hexachlorobenzene. IV. Sulphur-containing metabolites. After administration of hexachlorobenzene rats excrete sulphur-containing conjugates from which pentachlorothiophenol can be split off. In the present study we describe the identification of pentachlorothiophenol and pentachlorothioanisol in the livers of animals treated with hexachlorobenzene. In order to clarify the further fate of these two substances, we administered them to rats, and isolated the conversion products excreted in the urine and feces. The metabolites of pentachlorothiophenol and pentachlorothioanisol are excreted in both conjugated and free form. From extracts of the excreta, we isolated tetra- and trichlorobenzene with two or three sulphur-containing substituents on the ring, analogous compounds in which thiol groups were converted into sulphoxide and sulphone groups, as well as analogous compounds with a phenolic oxygen in addition to sulphur, and sulphur-containing compounds in which clorine was replaced by hydrogen. Following administration of the sulphoxide and of the sulphone of pentachlorothioanisol under analogous conditions, pentachlorothiophenol and pentachlorothioanisol and their metabolites were detected in the excreta of the animals. No evidence was obtained that the parent compounds are excreted in the unchanged form.


Distribution of Fe59 in benzene and iomex treated rats. The distribution of Fe59 in plasma and blood at various time intervals has been studied in control, benzene and iomex administered, and anemic rats. A significant difference between control and benzene, and iomex treated animals was observed in the rate of reappearance of Fe59 in blood circulation. The accumulation of Fe59 in various organs was noted at the end of 48 h. A significant increase in the radio-iron content was observed in bone marrow, spleen and liver of benzene and iomex treated rats as compared to those of control rats.


The short term fate of dischargeable glass beads implanted surgically in the mouse urinary bladder. Although both male and female mice of different ages expelled surgically implanted glass beads with diameters of 1 mm and 0.5 mm within 5 weeks in comparable numbers, urinary stones formed in relation to these implanted beads more frequently in male mice than in females. This stone formation in male mice may be a consequence of the relatively high mucoprotein content in the urine of the male mouse.


Nephrotoxicity of aminophenols: effects of 4-dimethylaminophenol on isolated rat kidney tubules. In isolated rat kidney tubules DMAP was found to inhibit the gluconeogenesis from lactate, pyruvate, or dihydroxyacetone. The ratio DMAP/protein rather than the calculated concentration of DMAP determined the strength of the effect, 20--25 nmoles DMAP/mg protein inhibiting  the rate of gluconeogenesis by about 50%. The inhibition was not reversible. Phenacetin, 4-aminophenol and 4-acetamidophenol were much less effective than DMAP in inhibiting gluconeogenesis in isolated rat kidney tubules. DMAP 14C-labeled in the ring was quickly bound to proteins in kidney tubules. A portion of DMAP which did not exceed about 4 nmoles/mg protein, was bound in compounds soluble in perchloric acid. From this portion tris-GS-DMAP was isolated. DMAP diminished the glutathione content of isolated rat kidney tubules. Reduced glutathione added before DMAP prevented the inhibition of gluconeogenesis and diminished the binding of DMAP to proteins. The binding of DMAP required oxygen and was inhibited by carbon monoxide or cyanide. Several enzymes from isolated kidney tubules were found to be inhibited by DMAP doses which inhibited gluconeogenesis. Large DMAP doses also diminished the sums of ATP + ADP + AMP as well as NAD + NADH and NADP + NADPH. This effect corresponded to an increase in nucleotide degradation products and to increased activity of extracellular LDH. The results indicate that the inhibition of gluconeogenesis by DMAP is not due to a specific effect on one enzyme or on membranes but to unspecific reactions with many substances.


[Acetylcholinesterase in the cells of the neural germ of the chick embryo]. Activity of AChE in separate cells of the neural tube and ganglionic plate (neural crest) is detected histochemically in chick embryos after 36, 48, 60 and 74 h of incubation, before any specific morphological signs characteristic for the neuroblast appear in them. It is stated that biochemical determination, formation of acetylcholine system coinsides with the proneuroblast phase. The product of the reaction for AChE is a marker which helps to observe migration of proneuroblasts in embryos at early stages of development.


[Taxonomy of the microangiological changes in the ocular conjunctiva]. By means of biomicroscopical investigations of bulbar conjunctiva in healthy persons of different age certain characteristics on normal microcirculatory bed have been obtained. Morphometric analysis of the vital microscopical observations has revealed some age peculiarities in microcirculation of the conjunctiva. As a result of clinical examination of the persons, it has been stated that the phenomena noticed at biomicroscopy which characterize certain anomalies of microcirculatory parameters correlate with latent pathology, closely related diseases or developmental anomalies. Therefore, it is possible to consider the method of biomicroscopical investigation of the conjunctiva with a subsequent morphometric analysis of the data obtained as suitable for application not only for clinical but also for prophylactic examination of healthy persons.


[Morphofunctional characteristics of the microcirculatory bed of the human spinal dura mater]. Some morphofunctional peculiarities in microcirculatory pathways of the dura mater of the human spinal cord are described. They are concerned with the structure of arteriolo-venular anastomoses through which a rather large amount of arterial blood is transported into the venous bed. Around the vessels of arterial type running at an angle to the longitudinal axis of the vessel connective tissue fibres of the dura mater, there is a tissue layer intensively impregnated with silver salts and stained PAS-positively. The venous part of the dura mater microcirculatory pathways has a large number of accessory reservoirs in the form of venous "lakes". Functional importance of the peculiarities mentioned above for the dura mater and the perimedullar apparatus is clarified.


[Microcirculatory bed and the structure of the compact substance of the cat tibial diaphysis normally and after multiple exposure to G loads]. Blood bed and structure of the compact substance of the cat tibial diaphysis have been studied at normal conditions and after repeated effect of gravitational overloadings. Hypergravitation produced a noticeable rearrangement in the microcirculatory bed and in histoarchitectonics of the bone compact substance. The date obtained demonstrate that the changes produced depend on the number of parameters participating in the gravitational effect and on the position of the animal in the container, as well as on the time when the animal falls ill after the experiment.


[Morphology of the microcirculatory bed of the vascular coat of the human eye]. Recently ophthalmologists got interested in microcirculatory bed of the choroid (the main collector of blood in the eye) because of the vascular layer was studied in 25 eyes of persons who had died suddenly and had no eye pathology during their lives. The age was from 11 to 70 years. V. V. Kuprianov's method of impregnation was used. Structural peculiarities of the choroid microcirculatory bed were presented; its changes were stated to depend on functional importance of the given segment of the eyeground and on the age of the patient. The data obtained could facilitate in studying different pathologic conditions in the eye in order to clarify the role of the choroid microcirculatory bed in genesis of ophthalmic diseases.


[Valvular apparatus of the cardiac veins in the pig]. The valvular apparatus of the subepicardial venous network has been studied in reflected light of the diaphragmated source. Structure, form and variations of the valvular apparatus have been determined in different parts of the coronary sinus, in the large cardiac vein, in the median cardiac and in the posterior veins of the left ventricle and their main branches.


[Structural characteristics of the mucosa of the small intestine in gnotobiote rats]. Histological and electron microscopic investigations of mucosal strucutre of the small intestine in gnotobiotic and conventional rats have demonstrated that mucosal index (lenear dimentions of villi/crypt dimentions ratio) is equal to 3--4 and 1.4--2.5, respectively. In gnotobiotic rats the number of mitotic figures in crypts is less, migratory-desquamative parameters of enterocytes are 5--6 days, cranio-caudal gradient of linear dimentions of villi, crypts and the number of goblet-shaped cells is not expressed. The goblet-shaped cells and cells with acidophilic granules have secretion of moderate intensity. The number of cells infiltrating epithelium of villi and crypts is greater when microbes are present in the gut lumen. A considerable difference in the structure of the connective tissue basis of the gnotobiotic and conventional rats mucosa are also connected with presence or absence of microflora in the gut lumen.


[Utrastructural interrelationships of collagen fibrillar components in human connective tissue]. The data on structural interconnections between collagenous fibres in the human dermis and periosteum were obtained by means of raster electron microscopy. Collagenous fibres were demonstrated to be connected with each other by means of fine connective fibres situating mainly transversaly towards the main collagenous fibres. Comparing the data obtained with those from the literature, a suggestion was made on the existence, in the connective tissue, of a special connective system composing of peculiar fibrillar structures which maintains dynamic equilibrium in arrangement of collagenous fibres, muscles, vessels, etc. The system of the connective fibres demonstrates a common compositional principle for all the structures mentioned above, but in every case having its peculiarities.


[Estrous cycle of the Arctic lemming (Dicrostonyx torquatus Pall.) maintained and breeding under laboratory conditions]. Reproductive functions and life at laboratory conditions were studied in the lemming. Standard cage-terrariums with a wheel for motion and a plate for drinking are quite convenient. The main ration includes: hay, oats with some carrot added, some apples two--three times a week, sunflower seeds. The animals feel well and reproduce at +8 degrees and +20 degrees in well ventilated rooms. The estrous cycle in lemming females studied by microscopy of vaginal smears is not regular. Only two stages are definitely seen: diestrus and estrus. Intermediate stages--proestrus and metaestrus--can be identified by a successive studies of vaginal smears of the same animal.


[Organization of the connections of the putamen with the cerebral cortex and hypothalamus]. Connection between the putamen, the brain cortex and the hypothalamus, as well as the role of the former in different aspects of purposive behaviour have been studied in a complex morpho-physiological investigation. In 12 cats, after developing a symmetrical active-defensive conditioned reflex, unilateral electrolysis of the putamen has been performed and the number of conditioned-reflexive reactions have been counted before and after coagulation. The brains have been treated after Nauta--Gygax, Fink--Heimer with additional staining after Kawamura--Niimi. Monosynaptic connections of the putamen with frontal, precentral, postcentral, orbital, parietal cortical areas have been revealed; direct pathways from the putamen to the infundibulum of the grey tuber, to the posterior and lateral hypothalamic nucleus have been demonstrated; participation of the putamen in the formation of active-defensive conditioned reflexes has been stated, as well as in emotional behaviour with a preferable use either the right or the left foreleg.


[Characteristics of the structure of the cornea of the reptilian eye]. Submicroscopic structural peculiarities in the cornea are described in some reptiles (grass-snake, lizard, turtle). Certain stages in histogenesis of the grass-snake cornea are presented. Poor differentiation of epithelium and its resemblance to endothelium is demonstrated in the grass-snake cornea. In cytoplasm of cornea cells of lizard and turtle a high content of mitochondria is noted. Great majority of mitochondria compactly arranged in the middle part of cytoplasm provide the appearance of zones. There is a middle zone of mitochondrial arrangement, there are also two zones in cytoplasm (internal-perinuclear and peripheral) without mitochondria but with supporting structures.


[Formation of a system of exogenous tangential fibers in layer I of the cerebral cortex in the ontogeny of the dog]. During pre- and postnatal periods, development of nuclear projections of the diencephalon into the cortical layer I has been studied in dogs by means of silver nitrate impregnation after Cajal. It has been stated that after the 5th week of the intrauterine development a great number of fibres from the diencephalon, through the germ of the cortical lamina, begin penetrating into the layer 1 within the areas of the paleocortex, the island, the subicular field of the archicotex, the presubicular and entorhinal cortex. A little less fibres have been revealed in the sensomotor and temporoentorhinal areas on the convex surface of the frontal lobe and on the medial surface of the occipital lobe. At the places of their penetrating into the cortical layer 1, by the time of birth, the fibres have sprouted up thickness of the whole area of the hemisphere.


[Causes of death in lymphogranulomatosis]. The results of 97 autopsy cases of lymphogranulomatosis showed the causes of death to be either progression of the disease (78 cases), complications of treatment (12) or other diseases (7). The immediate causes of death in the progression of the disease were toxicity (29%), pulmonary insufficiency (22%), pulmonary-cardial insufficiency (12%), hepatic insufficiency (21%), peritonitis (3.4%), sepsis (5.8%), uremia (3.4%), posthemorrhagic anemia (1.7%), cerebral edema (1.7%). The immediate causes of death in complications of therapy were secondary infection (5 cases), posthemorrhagic anemia (3), pulmonary insufficiency (3), cerebral edema (1). In 7 observations death was not due to lymphogranulomatosis: in 2 cases it was caused by disseminated hematogenic tuberculosis, in 2 pneumonia (with cured lymphogranulomatosis, in 1 myocardial infarction, in 1 uremia (aterosclerotic nephrosclerosis) and 1 patient died accidentally.


[Characteristics of the development of experimental allergic contact dermatitis]. Histological and electron microscopic examination of changes in the skin and blood revealed three different stages in the development of experimental allergic contact dermatitis (ACD). The primary contact reaction (24 hours) had features of nonspecific inflammation with some morphological signs of initial sensitization. Inflammation in the flare-up reaction (5-7 days) is the result of the immune process, and basophilic infiltration  of the skin is the obligatory component of this reaction. ACD (patch test at 15 days) was shown to have morphological manifestations typical of the delayed type hypersensitivity and some signs of the immediate type reactions.


[Morphological characteristics of secondary pulmonary hypertension in liver cirrhosis]. Morphological examinations of 24 autopsy cases of liver cirrhosis demonstrated the development of secondary postcapillary pulmonary hypertension with an increase of the muscular mass of the right ventricle and rearrangement of the blood vessels of pulmonary circulation. Most important morphological changes were observed in intraorgan veins and microcirculatory bed of the visceral pleura (particularly in the venular knee) indicating early reaction of the veins to hemodynamic disorders. It is suggested that hypervolemia in the pulmonary circulation system developing at the expence of blood discharge from the portal system into direct portopulmonary anastomoses plays an important role in the genesis of pulmonary hypertension in patients with hepatic cirrhosis.


[Correlation of wall thickness and the luminal diameter of the arterial vessels of the kidneys in hypertension]. The autopsy material was used to study the ratio of the wall thickness and the lumen diameter in arch and interlobular arteries and arterioles of the kidneys in patients with hypertension and in the control group. A statistical analysis revealed in interlobular arteries and arterioles of the age group of 30-49 years a slight but a significant shift of the parameter under study towards more severe degrees of involvement. This was confirmed by the frequency of different degrees of damage. No significant differences in changes observed in interlobular arteries and arterioles were found. This method is recommended for the study of the structural changes of intrarenal arteries.


[Healing characteristics of wounds produced by various surgical instruments]. Healing of liver wounds after marginal resection of the liver by CO2 laser of permanent action, scalpel and electric knife were studied. Considerable differences in the course of wound healing were observed. Wounds produced by laser heal without inflammatory infiltration of the abjacent tissues and within a shorter period of time.


[Electron microscopic study of the characteristics of skeletogenic tissue differentiation during distraction osteosynthesis]. Electron microscopic examination of the regenerating tissue was performed after distractional osteosynthesis carried out by the method of G. A. Ilizarov. The results showed osteogenesis to occur on the basis of the fibrous tissue formed in diastasis. The observed zones of the regeneration typical of distractional osteosynthesis are due to functional stimulation (tension) resulting in the arrangement of collagen fiber bundles and bone trabeculae in the direction of the extension forces. Cells of the skeletogenic tissue, between the bone fragments are also arranged with their longitudinal axis along the collagen fibril bundles. The ultrastructural pattern of the osteogenesis after distractional osteosynthesis reflects the intensification of the synthesis of glycosaminoglycan-protein complexes forming the main substance of the bone tissue.


[Epithelial permeability study of the bronchi in chronic bronchitis using an electron-dense tag]. An electron dense tracer, horseradish peroxidase (HRP), treated with DAB-H2O2 for electron histochemical demonstration of peroxidase was used in an effort to find out whether or not the human bronchial epithelium was permeable to some macromolecules in chronic bronchitis. The biopsy specimens obtained from 5 patients at bronchoscopy and cultured in a medium with 2% HRP for 1-6 hours showed the reaction product to be distributed within intracellular spaces of the epithelium as well as in some vesicles and vacuoles of the apical portion of the ciliated cells. When 2% HRP solution was topically applied on the bronchial epithelium surface of a narcotized patient for 10 min followed by biopsy of this part of the epithelium fixation and treatment for HRP demonstration, electron dense precipitates were identified only within some intercellular spaces. It is suggested that some intercellular contacts of the bronchial epithelium in chronic bronchitis are permeable to macromolecules, and that the ciliated cells of the bronchial epithelium are capable of endocytosing some macromolecules from the surface of the mucosa.


Regional cerebral blood flow in patients with Parkinson's disease. Regional cerebral blood flow (rCBF) was measured by the xenon 133 inhalation method in 60 patients with Parkinson's disease and compared with flow data obtained in 51 age-matched normal control subjects. Mean brain rCBF was significantly reduced in patients with parkinsonism (9.5%, P less than .001). The most marked and significant rCBF decreases were observed in the older patients (18.8%, P less than .001). There was no correlation between degree of rCBF reduction and duration of parkinsonism. Decreases in hemispheric mean rCBF values were similar in both hemispheres even in patients with unilateral signs. The present study provides additional evidence for involvement of the cerebral cortex in Parkinson's disease. The rCBF decline may be associated in part with high prevalence of mental impairment and cortical atrophy and with diminished cerebral metabolic rate due to brain dopamine deficiency in patients with parkinsonism.


Lipid composition of erythrocytes. Findings in Duchenne's muscular dystrophy and myotonic atrophy. The distribution of major erythrocyte phospholipids and fatty aldehydes and the total fatty acid composition of erythrocytes and plasma were compared from patients with Duchenne's muscular dystrophy, from definite carriers of the disease, from patients with myotonic atrophy, and from a number of normal controls. The data for normal controls closely agreed with the accepted values for these lipid components. Contrary to the published reports of others, no abnormalities in lipids were found in either disease or carrier groups.


Some factors determining prognosis in young people with severe head injuries. Eighty-four patients under the age of 40 were rehabilitated after severe head injuries. All had been unconscious for at least 24 hours, and 35 were unconscious for more than four weeks. The mean length of treatment was 30.2 weeks. Seventy were discharged home, 13 remained in hospital, and one died. Seventy-two of the patients were followed up nine months to 15 years after the injury. Twenty-eight were working, 27 were at home but not working, 13 were in hospital, and four were dead. Prolonged unconsciousness, extensive neurological damage, and severe mental changes were found to be the main factors adversely affecting the prognosis; an inadequate family background and cerebral hypoxia were also considered to have an influence.


Oculomotor abnormalities in Parkinson's disease. Ocular movement was studied in 19 patients with Parkinson's disease and in ten normal controls. Common abnormalities included "hypometric saccade" on the eye-tracking test and on command, "saccadic pursuit," and convergence paresis. Reaction time was longer in patients with Parkinson's disease than in controls for horizontal saccadic gaze, finger movements, and body movements. Maximal saccadic velocity of horizontal gaze was slower in patients with Parkinson's disease than in controls. Slowing of the horizontal saccadic movement correlated significantly with an increased reaction time of finger and body movements. Correlation of decreased saccadic velocity with increased reaction time of finger movement was found for the finger ipsilateral to the direction of horizontal gaze, but not for the contralateral finger. It is postulated from these facts that bradykinesia also exists in eye movements in Parkinson's disease.


The CSF pressure-volume relationship before and after cardiac arrest in the cat. The CSF pressure-volume (P-V) function was evaluated before and after cardiac arrest in 15 cats. The CSF volume change was produced by bolus loading (loading rate, greater than 0.1 mL/s) of the CSF space. Comparison of the CSF P-V function before and after cardiac arrest was made over a CSF pressure range of 5 to 46 mm Hg and for a CSF volume change of up to 9% of total CSF volume. After cardiac arrest, all CSF P-V curves were well described by the mathematical model konwn to be valid under normal physiological conditions. In eight animals, there was no significant difference between the prearrest and postarrest P-V functions. For the seven animals demonstrating a significant difference between prearrest and postarrest P-V data, all but one of the postarrest P-V curves were within the normal range. These results suggest that the shape of the CSF P-V curve is not substantially altered by cardiac arrest. We conclude that under normal circumstances material properties of brain tissue are the most important factors in determining the configuration of the CSF P-V curve and that under normal circumstances cerebral hemodynamic factors do not affect the shape of this curve.


Woodpecker drilling behavior. An endorsement of the rotational theory of impact brain injury. High-speed cinematograph films of a drilling woodpecker were examined by direct visual inspection and by a microdensitometer and computer-imaging technique. These showed (1) that the drilling trajectory is essentially linear, with very little, if any, rotation of the head; (2) that there is minimal movement after impact; (3) that the impact velocity is of the order of 600 to 700 cm/s; and (4) that the impact deceleration is of the order of 1,000 g. Dynamic and morphologic findings in the woodpecker may be highly relevant to the prevention of concussion and brain injury in man. Taken in the context of modern packaging technology and other animal and mathematical modelling research, they suggest that brain injury preventive systems could be greatly improved over those now in common use.


Radiology of a large cisterna magna cyst. A case report. A case of a large cisterna magna cyst presented a problem in differential diagnosis. Characteristic changes were shown on plain skull roentgenograms and on radionuclide brain scan. The diagnosis was established on the basis of pneumoencephalography and isotope cisternography. The lesion responded well to surgical management.


Fibrosarcoma after proton-beam pituitary ablation. In a case of malignant tumor after proton-beam radiotherapy, the course of the ophthalmoplegia was consistent with infiltration of the cavernous sinus. This was confirmed at autopsy.


Delayed cerebral radionecrosis following treatment of basal cell carcinoma. Delayed radiation necrosis of the brain was found around the right ear in a patient with basal cell carcinoma of the skin. Five months after excision, the tumor recurred. The patient received 5,575 rads in 24 doses during radiotherapy. Thirteen months later, the patient had cerebral radionecrosis, which was the cause of death. At autopsy, typical radionecrotic lesions of the temporal lobe were found. There were widespread metastases.


Somatosensory evoked potentials recorded directly from human thalamus and Sm I cortical area. Somatosensory evoked potentials (SEPs) to median nerve stimulation were recorded from the nucleus ventralis caudalis. They consisted of monophasic or diphasic potentials with mean onset latency of 13.8 ms. More complex SEPs to median nerve stimulation were obtained from the cortex. The SEPs consisted of two major positive waves, P1 and P2, and were recorded over both the precentral and postcentral gyri, suggesting that somatosensory information converges to the motor cortex, probably to be used for the integration of critical motor activity. In two patients, it was noted that the motor representation of facial movements was larger than the correspondent sensory representation on the postcentral gyrus. This larger motor representation of the face and more specifically of the lips and tongue may be related to human acquisition of mimicry and articulation of language.


Open-biopsy electromyography. Direct correlation of a pattern of excessively recruited, pathologically small motor unit potentials with histologic evidence of neuropathy. Open-biopsy electromyography (EMG) of two muscles of a 29-year-old man with slowly progressive proximal weakness demonstrated a striking pattern of excessively recruited, pathologically small motor unit potentials. This pattern is usually equated with myopathy. Histologic study of tissue enclosing the recording sites, however, yielded evidence of neurogenic disease alone. In muscle, this included isolated and small groups of atrophic type I, IIA, and IIB fibers, and in intramuscular nerve a loss of myelinated fibers with connective tissue and Schwann cell proliferation. The EMG pattern is considered to reflect a reduced number of activated muscle fibers within motor units due to random neurogenic involvement of terminal axons.


Effects of advancing age on regional cerebral blood flow. Studies in normal subjects and subjects with risk factors for atherothrombotic stroke. Regional cerebral blood flow (rCBF) was measured by 133Xe inhalation in 46 normal volunteers, aged 21 to 63 years, and 14 neurologically asymptomatic subjects above age 40 with risk factors for atherothrombotic stroke, including hypertension, diabetes mellitus, and hyperlipidemia. In normal volunteers, there was diffuse and progresive reduction of gray matter flow and weight as well as increases of cerebrovascular resistance (CVR) with advancing age. Reduction of gray matter flow with advancing age appears to be attributed in part to neuronal atrophy and in part to cerebral arteriosclerosis. Regional increases of CVR and reduction of gray matter flow with advancing age were most evident in the middle cerebral arterial (MCA) distribution and were enhanced by the association of risk factors. Development of cerebral arteriosclerosis with age and/or risk factors appears to be most evident in MCA distribution.


Effect of calcium and antacids on phenytoin bioavailability. The effects of bihourly administration of gluconate calcium and tow magnesium-aluminum-containing acids on the bioavailability of a single capsule dose of phenytoin sodium were determined in two normal volunteers. Neither the rate nor the extent of phenytoin absorption were altered by the treatments, in spite of indirect evidence from other studies that might suggest such an interaction. No interaction between calcium or magnesium and either unionized or anionic phenytoin could be demonstrated in vitro using solubility and spectral techniques.


Spinal cord ischemia and left atrial myxoma. A 62-year-old man had an acute, transient, flaccid paraplegia. Examination showed a primary cardiac tumor with emboli to major branches of the aorta. A myxoma was removed from the left atrium, and normal function returned. Left atrial myxoma should be suspected as a cause for embolism to the CNS.


Sudden monocular visual loss in pseudotumor cerebri. We describe a patient with papilledema due to benign intracranial hypertension who had sudden, painless monocular visual loss. Fear of further visual deterioration prompted vigorous therapeutic efforts to reduce intracranial pressure. Subsequent neuro-ophthalmologic evaluation disclosed that the visual loss was due to a subretinal neovascular membrane. Vision continued to improve after medical therapy was discontinued, and was accompanied by complete resolution of papilledema and headache. In any patient with minimal papilledema, sudden visual deterioration should initiate a search for other causes rather than zealous therapeutic efforts to reduce intracranial pressure.


Normal laboratory values of CSF during pregnancy. Cerebrospinal fluid samples from 44 pregnant women undergoing spinal anesthesia for delivery were studied to determine whether an abdomen distended with a full-term fetus could alter the dynamics of lumbar CSF. The mean CSF values for opening pressure, CSF cell count, and protein concentration were all normal.


Temporal orientation and education. A direct relationship in normal people. Neurologists usually do not take socioeconomic status into account when evaluating temporal orientation. Our data indicate that this is a mistake: temporal orientation related directly to education, one measure os socioeconomic level, in New Jersey residents. The neurologist should suspect an abnormality in temporal orientation for patients with (1) some college training and (2) no education beyond high school, if they misstate the day of the month by more than one or three days, respectively.


Hysterical seizures.

Hysterical seizures. Twenty-two inpatients with a discharge diagnosis of hysterical seizures were compared with 22 matched inpatients with a discharge diagnosis of epileptic seizures. There were significant differences between the groups in respect to family and personal history of psychiatric disorder, attempted suicide, sexual maladjustment, and a current affective syndrome.


Sciatic nerve compression during anticoagulation therapy. Computerized tomography aids in diagnosis. Severe hip pain developed in a patient who was receiving anticoagulation therapy of heparin sodium and warfarin sodium (Coumadin) for femoral vein phlebitis. The patient had exquisite tenderness but no ecchymoses along the sciatic nerve. A drop in the hemoglobin level showed a large volume loss of blood. Retroperitoneal hematoma with lumbar plexopathy was suspected, but a computerized tomographic scan revealed instead hemorrhage into the gluteal muscles. The anticoagulation therapy was corrected with the addition of protamine sulfate and vitamin K; the patient's pain lessened and the hemoglobin level stabilized. Computerized tomography allowed clear visualization of the hematomas in the buttock, and invasive studies were avoided. Hip pain and a falling hemoglobin level in a patient receiving anticoagulation therapy should alert one to the possibility of bleeding into the retroperitoneal space, thigh, or buttock.


The lens and pars plana vitrectomy for diabetic retinopathy complications. Major cataracts developed in 28 of 168 eyes during the six months after pars plana vitrectomy for complications of diabetic retinopathy. In only ten of these cases did the cataract influence the visual results. The visual acuities of the phakic and aphakic eyes six months after vitrectomy were almost identical. Rubeosis iridis occurred in 23% of the phakic eyes and 45% of the aphakic eyes, with the difference being related to the loss in the aphakic eyes of a protective barrier lens quality. However, this same barrier quality increased the incidence of postoperative opaque vitreous hemorrhage from 8% of the aphakic eyes to 21% of the phakic eyes. Corneal epithelial edema at surgery occurred in 55% of those eyes that had lens removal combined with vitrectomy, but in only 36% of those that retained their lenses, and the difference was caused by the increase in operative time and procedure.


Diabetic traction detachment.

Diabetic traction detachment. One hundred thirty-six of 124 patients with diabetic traction detachment (TD) were observed for an average of 4.6 years (range, 3.0 to 9.4 years) with no surgical intervention. Visual acuity was maintained or improved in 51 of these eyes; 71 continued to be 20/200 or better. Diabetic TDs remained stable for long periods, those of more severe grade being more stable. At final examination, 60% (81/136) were graded at the same anatomic level (36/136) or an improved level (45/136). Spontaneous reattachment occurred in 20% (27/136); 78% (21/27) of these eyes had small detachments (TD1). The status of the vitreous and the vitreoretinal adhesion determined both the degree of detachment and the incidence of spontaneous reattachment.


Intraretinal macrocysts in retinal detachment. Seven cases of retinal detachment were associated with ophthalmoscopically visible macrocysts. These cysts were associated with long-standing retinal detachment, particularly of the traumatic type with retinal dialysis. They arose from the outer plexiform layer of the retina. In four cases, the macrocyst extended to the ora serrata. Most macrocysts require no specific attention during retinal detachment repair. If the cyst prevents closure of the primary retinal break, we advocate its surgical drainage. Four cases in the present series required surgical collapse of the macrocyst.


Cryopexy treatment of proliferative diabetic retinopathy. Retinal cryoablation in patients with severe vitreous hemorrhage. Severe diabetic retinopathy with neovascular proliferation may produce severe vitreous hemorrhage that prevents laser therapy. Retinal ablation, if indicated, can be partly accomplished by cryopexy. In a small series of cases, cryotherapy to the retina was not apparently harmful and sometimes seemed beneficial. Blood absorption seemed more rapid and recurrent bleeding less frequent; however, vitreous hemorrhages in proliferative diabetic retinopathy are too variable in their natural history of absorption and recurrence to permit any definite conclusion as to the value of this method of retinal ablation. A national collaborative study with lengthy follow-ups will be necessary to determine whether chorioretinal scars produced by laser therapy and those produced by cryotherapy will afford similar protection from the forward course of proliferative diabetic retinopathy, vitreous hemorrhage and blindness. In the meantime, this report is intended to alert ophthalmologists that retinal cryoablation is a conservation alternative to "early" vitrectomy for vitreous hemorrhages from diabetic retinopathy.


Stargardt's disease and fundus flavimaculatus. A study of 67 patients with a diagnosis of Stargardt's disease (juvenile macular degeneration) or fundus flavimaculatus showed that, apart from the ophthalmoscopic appearance, there is no clear distinction between these two disorders. The disease is an autosomal recessive macular degeneration that is bilateral and symmetrical in appearance, with diminished central vision as the hallmark symptom. The onset of symptoms usually occurred in the first or second decade, but a substantial number of patients were asymptomatic until the fourth or fifth decade. Psychophysical and electrophysiologic tests indicated that this is a localized and not a generalized retinal dystrophy. While the initial vision in the better eye was 6/12 (20/40) or better in one third of the patients, follow-up studies showed progression to levels between 6/30 (20/100) and 6/60 (20/400).


Dominant retinitis pigmentosa with reduced penetrance. Further studies of the electroretinogram. Full-field electroretinograms (ERGs) were recorded after a ten-year interval from four affected patients in a family with dominant retinitis pigmentosa with reduced penetrance; all patients showed decreases in amplitude. Cone ERGs from affected patients (aged 11 to 15 years) in this family as well as from affected patients of comparable ages from two other families with this genetic type, were normal or slightly reduced in amplitude and substantially delayed in b-wave implicit time. In one family, an asymptomatic older patient, representing an apparent skipped generation, showed abnormal full-field cone and rod ERGs that differed in implicit times from those of young affected patients. Evidence is presented to support the idea that the abnormal full-field cone ERGs recorded from young affected patients are due to an abnormal extrafoveal cone contribution to their full-field responses.


Fenestrated sheen macular dystrophy. A new autosomal dominant maculopathy. A new, slowly progressive, autosomal dominant macular dystrophy was found in five patients from three generations of a family, with follow-up for long as 27 years. The mild functional abnormalities of this dystrophy were roughly correlated with age; in the sixth decade of life, paracentral scotomatous areas were noted. The earliest ophthalmoscopic findings were present in a 4-year-old and consisted of a yellowish refractile sheen with red fenestrations within the sensory retina of the macula. By the third decade, an annular zone of hypopigmentation of the retinal pigment epithelium (RPE) appeared around the area of the sheen and progressively enlarged. Surrounding the annular zone of hypopigmentation and at its center was slightly hyperpigmented RPE (bull's-eye lesion). Fluorescein angiography showed no abnormalities in the sensory retina and intact perfusion of choriocapillaris.


Hypotony due to inadvertent cyclodialysis after intraocular lens implantation. Six patients had hypotony from inadvertent cyclodialysis after intraocular lens implantation. Factors that may have contributed to the formation or persistence of the cyclodialysis are scleral cataract incision, prolonged postoperative course of corticosteroid treatment, intraocular lens weight, iridectomy, and maneuvers related to insertion and fixation of the intraocular lens. Closure of these cyclodialysis clefts may be a lengthy process involving various treatment modalities. Fortunately, cyclodialysis with hypotony, although increased in incidence with intraocular lens surgery over routine extraction, occurs rarely.


The electroretinogram in retinitis pigmentosa. Examination of electroretinographic (ERG) reports from 70 consecutive patients with retinitis pigmentosa (RP) showed that photopic and scotopic B-wave amplitudes correlated with age and visual acuity, but not with dark adaptation threshold. No appreciable differences in ERG characteristics (including B-wave implicit time) were observed between recessive, dominant, and X-linked cases. However, the ERG findings from one group of patients stood out clearly from the rest, because of normal flicker B-wave implicit times (less than or equal to 32 ms) and large B-wave amplitudes (less than or equal to 100 muV under scotopic conditions). These patients constitute a recognizable subgroup of RP, independent of the mode of inheritance, which is characterized by delimited disease, mild functional symptoms, and a good visual prognosis.


Paradoxical intraocular pressure response to pilocarpine. A proposed mechanism and treatment. A patient with unilateral angle-recession glaucoma had an ipsilateral increased intraocular pressure (IOP) with miotics despite open angles, and decreased IOP with cycloplegics. The following mechanism is proposed to explain these findings: Pilocarpine hydrochloride has been demonstrated experimentally to increase trabecular outflow and decrease uveoscleral outflow. In this eye with a severely compromised and unresponsive trabecular outflow, miotics served to impair uveoscleral outflow and cause a net rise in IOP. Similarly, an increase in uveoscleral outflow with cycloplegics served to decrease IOP. The use of atrophine sulfate in these rate cases may be of therapeutic value in lieu of systemic or surgical therapy.


Blood reflux in Schlemm's canal. I. Normal findings. Blood may be refluxed into Schlemm's canal in the normal eye by occlusion of recipient veins in a sector of the conjunctiva and episclera. The blood makes the anterior margin of the canal distinct near the midportion of the trabecular mesh at the same place in which it is seen after hypotony. Circumferential flow in segments of the canal is possible when a pressure head exists to promote such flow. Evidence was found that the canal is not partially collapsed in the normal eye.


Fine-needle aspiration biopsy. Its use in orbital tumors. Fifteen orbital tumors have been evaluated with the fine-needle aspiration biopsy (FNAB) technique. The best indication for FNAB is supposed malignant orbital disease. The technique has not been helpful in tumors or inflammatory disease with a high fibrous content. Lesions that are suspected of being pseudotumors are not recommended for FNAB since, even in histologic sections, they are notoriously difficult to distinguish from well-differentiated lymphocytic malignant lymphoma. Benign encapsulated tumors should not be subjected to FNAB.


Silicone tube intubation of the lacrimal drainage system. We report 158 silicone tubes placed in the lacrimal drainage systems in 150 patients. Intubation is indicated in the following: congenital nasolacrimal duct obstruction, fresh canalicular lacerations, primary canalicular disease, complicated dacryocystorhinostomies, canaliculorhinostomies, and failed dacryocystorhinostomies. The procedure may be useful prophylactically before surgery or radiation of the medial canthal region.


Stimulation of corneal wound healing with mesodermal growth factor. Mesodermal growth factor (MGF) from mouse submaxillary glands was tested in vivo for stimulating effects on corneal wounds in rabbits. Intrastromal injection of 5 microgram of MGF induced widespread fibroblast activity and stromal cell division, and markedly stimulated stromal healing. At high doses (greater than 25 microgram), corneal destruction was indicated by extensive necrosis and perforation. When low doses (1 to 5 microgram) of MGF were applied to the lip of nonperforating knife wounds of the cornea, three major differences were noted between control and experimental wounds. In wounds treated with MGF, the depth of stromal healing was greater, as was the intensity of the fibroblast activity, and the width and depth of the epithelial plug were significantly decreased. These results establish that MGF is an effective growth-stimulating agent in vivo and that the initial stages of corneal wound healing may be accelerated in vivo.


Choroidal blood flow. IV. effect of vasodilating agents. The effect of vasodilators on choroidal blood flow (CBF) was studied by the krypton clathrate Kr 85 desaturation technique in anesthetized cats. Niacin, papaverine hydrochloride, phentolamine mesylate, and tolazoline hydrochloride were injected via the lateral long posterior ciliary artery (LLPCA) and the femoral artery. The systemic administration of these drugs via the femoral artery, in the doses used, had no significant effect on mean arterial pressure, choroidal vascular resistance (CVR), or CBF. Local administration of the same agents via the LLPCA caused a decrease in CVR with a corresponding increase in CBF.


Drainage of microspheres and RBCs from the vitreous of aphakic and phakic eyes. The movements of plastic microspheres (7 to 10 mu in diameter) and autologous RBCs labeled with sodium chromate Cr 51 from the vitreous to the anterior chamber were studied in 24 rabbit eyes. Rabbits were made aphakic in one eye by intracapsular lens extraction of lensectomy via the pars plana, the fellow eyes serving as phakic controls. In phakic eyes the intravitreally injected microspheres and RBCs were retained inside the vitreous space, not gaining access to the anterior chamber. In aphakic eyes microspheres and RBCs moved to the anterior chamber and were usually seen on the corneal endothelium and in the chamber angle within two to ten days, although most particles remained in the vitreous for long periods of time. Removal of the lens thus improved forward drainage of particles from the vitreous space, but the structure of the vitreous seemed to preclude rapid clearance.


Experimental model for scleritis.

Experimental model for scleritis. Rabbits were sensitized over a prolonged period to ovalbumin by intradermal injection. Ovalbumin was then injected into the limbus of the eye. A corneoscleral lesion, similar to necrotizing scleritis in humans, was produced. The clinical progression of the lesion is described and its histologic appearance discussed in relation to the human disease.


Congenital pits of the optic nerve head. I. Experimental studies in collie dogs. In three collie dogs with a congenital pit of the optic nerve and associated serous macular detachment, no connection between the subarachnoid space and the pit or subretinal fluid could be demonstrated with subarachnoid injection of India ink or with serial sections of the eyes. A direct communication between the vitreous, the pit, and the subretinal space could be demonstrated, however, in all three dogs. Flow of India ink particles from the vitreous to the pit and into the subretinal space was demonstrated. Indirect evidence to support the above mechanism in humans includes the biomicroscopic observation of channels coursing from the pit toward the subretinal space and the presence of posterior vitreous detachment or liquefaction of the vitreous in patients with optic pits and macular detachment.


Coaxial bipolar probe.

Coaxial bipolar probe. A coaxial electrode probe that uses the principle of bipolar coagulation is introduced to ophthalmic microsurgery. The central, or axial, electrode is insulated with silicone from the surrounding outer, or coaxial, diameter electrode. The probe uses available bipolar electrode cautery power and control sources. The distance between the electrode is fixed. Therefore, uniform and repeatable coagulations are attained under controlled power settings. Unwanted microscopic scleral shrinkage is eliminated, while desired scleral shrinkage is controlled. Precise pinpoint coagulations of individual capillaries are routine, especially at corneoscleral incision sites. Higher power settings produce a desired scleral marker in retinal surgery.


Brainstem audiometry in neurotologic diagnosis. Brainstem electric response audiometry (BERA) has been found to be a valuable adjunct to the neurotologic diagnosis. Ninety-eight percent of patients with surgically confirmed acoustic neuromas has positive BERA findings. We report six cases that illustrate the value of this technique in examining patients with suspected retrocochlear lesions.


Rhabdomyosarcoma of the temporal bone. Is surgical resection necessary? Three patients had embryonal rhabdomyosarcoma of the temporal bone. Their clinical appearances demonstrated the following characteristics: (1) symptoms of an acute process in the middle ear cleft and mastoid, (2) a rapidly growing polypoid mass that was visible in the middle ear and external auditory canal, and (3) seventh nerve involvement and destruction of bone. Definitive treatment with the use of systemic chemotherapy and radiation therapy to the invaded structures was followed by maintenance chemotherapy for up to 24 months. Surgical treatment was sufficient to obtain adequate biopsy material. All patients recovered variable degrees of motor nerve functions. One patient experienced a meningococcal meningitis years after treatment; this condition resulted in total deafness. The results suggest that multiple-drug chemotherapy and radiation therapy for all involved areas are the mainstay of treatment for this disease entity.


A protocol for the air caloric test and a comparison with a standard water caloric test. This communication describes the development of a protocol for the air caloric stimulus for vestibular testing. The protocol is based on matching the peak responses of air and water caloric stimuli and minimizing subject discomfort. Air stimulus temperatures of 30 and 44 degrees C are used, and these appear to minimize subject complaints of pain with the test. Composite data are presented from 16 normal subjects who were tested with the protocol. A comparison is made with their responses to a standard water protocol. Test-retest data for both air and water protocols are also presented, and these data indicate similar day-to-day variation in the two methods. On the basis of the work presented, it is concluded that the air protocol produces responses equivalent to that of standard water calorics in a group of normal subjects. Neither test was found, in the present experiments, to be particularly sensitive.


Fractures of the zygoma. A geometric, biomechanical, and surgical analysis. We present a four-part study of the cosmetic results of common zygomatic fracture reduction techniques: (1) a geometric analysis of an idealized paper and clay model; (2) a topographic analysis of zygomatic fractures in the dry skull; (3) a biomechanical analysis of fixation techniques in the fresh cadaver; and (4) a retrospective and prospective review of our clinical experience. The following are concluded: Alignment of the fracture at three points and fixation at two stable points provide the most accurate and satisfactory postoperative results. Masseteric contraction may cause late displacement in poorly fixed fractures. Two-point interosseous fixation at the "buttress" fracture and the frontozygomatic fracture is suitable for routine surgery. The infraorbital rim may be aligned through the gingivobuccal sulcus incision. Transcutaneous incisions may be limited to the brow incision. The transconjunctival approach is suitable for orbital floor repair.


Usage of CROS hearing aids by unilaterally deaf patients. Fifty (58%) unilaterally deaf patients responded to a contralateral routing of signals (CROS) hearing aid usage questionnaire. Their actual usage in communicative environments was quite variable, with 50% to 60% of the time being the avarage in most of these situations. Mean communicative usage was essentially similar when the ambient nature of the environment could be described as quiet, speech competition, noise and/or speech babble, and reverberant/noisy. It is extremely difficult to determine who will be a successful CROS wearer on the basis of diagnostic results that are obtained with the use of earphones. Not every unilateral listener is a CROS candidate. The importance of a sound-field evaluation in a controlled environment, a trial period, and follow-up consultations cannot be overemphasized.


Angiography and embolization of the internal maxillary artery for posterior epistaxis. Epistaxis that originates from the posterior aspect of the nasal cavity is most often due to hemorrhage from one of the branches of the internal maxillary artery. There are multiple methods of treatment of this problem that vary in effectiveness, complexity, and stress on the patient. Most cases are controlled with either packing or surgical arterial ligation, but occasionally patients either cannot tolerate this therapy or continue to hemorrhage. We describe ten patients who were referred to the Neuroradiology Section of the Massachusetts General Hospital from the Massachusetts Eye and Ear Infirmary for angiography and embolization of the internal maxillary artery for epistaxis.


Cystic fibrosis and hearing loss.

Cystic fibrosis and hearing loss. The mucosal epithelium of the middle ear and Eustachian tube is in direct continuity with the upper respiratory tract. Since the otolaryngological aspects of cystic fibrosis (CF) are dominated by involvement of the paranasal sinuses, it might be assumed that children with CF would be expected to have a higher than usual incidence of middle ear disease. Eighty patients who were afflicted with CF had audiological evaluations, which consisted of hearing threshold levels (250 to 8,000 Hz) and speech and impedance audiometry. We found no greater incidence of a conductive or sensorineural hearing loss in patients with CF when compared with a normal age-adjusted population.


Intracranial abscesses with behavioral changes. Intracranial abscesses represent one of the most serious complications of ear and paranasal sinus infections. The infection may spread by bone erosion, preformed pathways, or septic thrombosis via the Haversian canals. This may result in subdural abscesses, meningitis, or intracerebral abscesses. These intracranial complications are associated with a high morbidity. The purpose of this communication is to emphasize that behavioral changes after ear or paranasal sinus infections may be a manifestation of an intracranial abscess.


Surgical management of the hypodynamic palate. The most successful surgical correction of velopharyngeal insufficiency (VPI) has been achieved in those patients in whom residual dynamic function of the soft palate/nasopharyngeal sphincter mechanism exists. In spite of the obvious need for rehabilitation, surgical reconstruction has often been advised against in those cases where the palate was hypodynamic or adynamic. We have developed a surgical procedure for these patients by utilizing a modification of Hogan's lateral port control pharyngeal flap method. We present the surgical considerations along with the initial application and results in four patients with hypodynamic palates of differing origins. We think that this technique extends surgical correction of VPI to the previously neglected group of patients in whom this condition is the result of a hypodynamic palate.


Heparin therapy for sudden sensorineural hearing loss. Twenty-three patients with sudden unilateral sensorineural hearing loss were treated with a course of intravenous heparin sodium within one week of the onset of the hearing loss. Complete or good recovery developed in a total of 69.6% of these patients, but this is very similar to previously reported criteria of 66% spontaneous recovery. There was one complication in the series, ie. priapism.


Usher's syndrome type III.

Usher's syndrome type III. We describe a rare example of Usher's syndrome type III in a 9-year-old boy. This type is characterized by retinitis pigmentosa and progressive sensorineural deafness.


A modified intraoral electrolarynx.

A modified intraoral electrolarynx. Most electrolarynx devices currently available are designed to be hand-held. The postlaryngectomy patient who cannot develop esophageal speech and requires the use of both hands is clearly handicapped by this design. We report a modification of the intraoral (Cooper-Rand) electrolarynx that is not hand-held.


Radiation-induced pharyngeal stenosis. A report of two cases after planned postoperative radiation therapy. Two cases of almost complete stenosis of the hypopharynx occurred after laryngectomy, radical neck dissection, and postoperative radiation therapy. Successful reconstruction that utilized a tubed, deltopectoral flap was accomplished in each case. In the absence of evidence indicating increased long-term survival with combined surgery and postoperative radiation therapy, one must question the utilization of these methods. Decreased local recurrence or cervical metastasis may not be an adequate justification if the rate of complications is notably increased, especially when complications can be as severe as these.


Tracheal carcinoma after tracheostomy.

Tracheal carcinoma after tracheostomy. The trachea is rarely the site of origin of a primary malignant tumor. Causal factors have not been determined, but cigarette smoking is one suspected cause. We report an unusual case of tracheal carcinoma that occurred many years after permanent tracheostomy for benign disease, and we review other cases of posttraumatic tracheal cancer. This study suggests that trauma can be a factor in the development of certain malignant tumors of the trachea.


Glucagon and esophageal meat impaction.

Glucagon and esophageal meat impaction. Glucagon is suggested as an alternate method of treatment in difficult cases of esophageal meat impaction. Glucagon has been used in diagnostic roentgenology to facilitate smooth muscle relaxation. We describe its characteristics and mode of action, and we report two cases that emphasize the advantages of glucagon therapy as a primary modality or as an alternative in problem cases.


The meatally based musculoperiosteal flap in cavity obliteration. A meatally based musculoperiosteal flap that was formed for radical mastoid cavity obliteration was deliberately excised during revision surgery in three cases of recurring tympanic cholesteatoma. The flaps, which contained subcutaneous connective tissue, were well vascularized and contained large, viable muscle bundles and many nerve trunks from the postauricular branch of the facial nerve. In two cases, the periosteum-attached bone chips that had been removed from the patient's mastoid tip region and implanted to form a new bony canal wall were viable and gave the intended support for the meatus after radical ear surgery.


Patterns of ear disease in the southwestern American Indian. Native Americans are predisposed to one of the highest incidences of otitis media in mankind. The origin of otitis media in Indians remains multifaceted. However, an unusually high prevalence of congenital anomalies of the ear and oral cavity, ie, oral clefts, facial paralysis in diabetics, and the absence of otosclerosis, suggest racial inheritance as a predominant factor for their pattern or ear disease. An analysis of outpatient and operative records at the Phoenix (Ariz) Indian Medical Center substantiates this hypothesis and shows contrasts in ear disease between American Indians and white persons.


Binaural interaction in brainstem-evoked responses. Binaural interaction (BI) in brainstem-auditory-evoked responses (BSERs) was defined as any deviation from the predictions of a model that assumes two independent monaural BSER generators whose outputs are additive. Brainstem-auditory-evoked responses were recorded in response to right (R) monaural, left (L) monaural, and binaural click stimuli. The monaural BSERs were added to give the model's prediction (P) of binaurally evoked BSER (P = L + R), and this trace was then subtracted from the actual binaurally evoked response (B). The resultant difference trace (d = b - p) represents the derived BI. In each of ten guinea pigs, a strong BI was present in the peak IV region (latency = 3.5 to 4.0 ms). This interaction is probably present with interaural intensity differences of up to 40 dB and interaural time differences of up to 3 ms. Preliminary studies suggest the presence of a similar phenomenon in human BSERs.


Surgical correction of maxillary hypoplasia. In this report the pathophysiology of maxillary hypoplasia is reviewed, and two patients who underwent surgical treatment described. Included in the analyses are illustrations and photographs of the face, cephalometric measurements, predictive tracings, and model surgery. Corrective surgical techniques, consisting primarily of LeForte III osteotomies, are presented in detail. Segmental osteotomy of the lower jaw, sliding genioplasty, and augmentation rhinoplasty are discussed and shown as various adjunctive procedures in the correction of associated deformities. Postoperative tracings and photographs are used to illustrate the predictive changes and improved cosmetic and functional results.


Nasal polypectomy in patients with asthma and sensitivity to aspirin. Nasal polypectomy is safe in patients with asthma and intolerance to aspirin. Asthma should be controlled before polypectomy. Patency of the nasal airway after the operation and the effect of polypectomy on asthma are independent of severity of the asthma, history of atopy, and administration of steroids. We reviewed retrospectively the courses of 101 patients with the asthma triad who had nasal polypectomies between 1970 and 1974. Before polypectomy, 39 patients were hospitalized to control active asthma: during the postoperative hospitalization, 19 had wheezing, mostly mild. Of the 62 patients with inactive asthma, three had wheezing postoperatively. Asthmatic condition at one year after polypectomy, compared with the condition at one year before, was improved in 30 patients, worse in 14, and unchanged in the rest. Nasal airways remained good for at least one year in 60% of the patients.


Facial nerve repair with tissue adhesive. The facial nerve in dogs was exposed, transected, and repaired by either of two methods. Suture and a Silastic sheath was the control method, since a review of the literature suggests it gives the highest rate of success. A tissue adhesive (Histoacryl) was used as the experimental method. In both techniques, the surgical microscope was used. Thirteen nerves were repaired: seven with the adhesive and six with suture and Silastic sheath. Success was judged on two criteria: (1) observation of motion in the muscles that were innervated after electrical stimulation of the nerve proximal to the repair site and (2) evaluation of microanatomical continuity after removal of the repair site and preparation of slides and tissues staining. The two repair methods produced statistically equal results. The "adhesive" method can be performed with greater ease and is less time-consuming. The number of studies required for statistical reliability was determined by means of sequential analysis.


Head and neck manifestations of Maffucci's syndrome. Maffucci's syndrome consists of multiple cutaneous hemangiomas, dyschondroplasia, and often enchondroma. Once considered as a rare disorder, the syndrome has been frequently recognized and reported in the last 20 years. We report a case of multiple neoplasms of the head and neck and review the literature with regard to those manifestations of Maffucci's syndrome in the head and neck area. We also discuss treatment and the potential for malignant change.


Pediatric otoscopy and photography of the tympanic membrane. A further miniaturization of the lens telescopes (Hopkins Rod) has resulted in a telescope (length, 6 cm; diameter, 2.7 mm) that is suitable for pediatric otoscopy. The adaptation of otoscopic specula, a lightweight motor-driven remote flash camera, and movie and video photography to this telescope has resulted in a system that represents a significant advance in the examination of the ear. In this study, we document ear diseases in children with the use of color photographs.


Macrocytic anaemia.

Macrocytic anaemia. Macrocytosis of red cells is now more easily and precisely detected in the laboratory by the adoption of electronic methods of cell volume measurement. This means the practitioner will be more frequently faced with the problem of what an elevated mean corpuscular volume (MCV) means. Macrocytic anaemia is not synonymous with folate or cobalamin deficiency, there being many causes of non-megaloblastic macrocytosis including excess alcohol, hypothyroidism, and liver disease. The commonest cause is blood regeneration as after a bleed, or in response to a haematinic or in haemolysis, as reticulocytes are large red cells and will raise the MCV. Megaloblastic anaemia, as in folate or cobalamin deficiency, has a normal or low reticulocyte count and a multiplicity of causes which must be identified as the cause may require treatment in its own right as well as the prescription of the required vitamin.


Visual-vestibular interactions: I. Influence of peripheral vision on suppression of the vestibulo-ocular reflex and visual acuity. Legibility of head-fixed displays in some motion environments is partially dependent upon visual suppression of the vestibuloocular reflex (VOR). This study investigates the effects of differing relationships between peripheral background movement and whole-body motion on the VOR and on visual performance. The purpose of the study is to explore factors in motion environments that influence performance limits and to develop procedures of potential usefulness in evaluating interacting visual and vestibular function. Visual performance and visual suppression of the VOR were markedly different, depending upon the relative direction of peripheral background movement. Visual suppression of the VOR, and visual performance, were disrupted far more when vestibular inputs and peripheral optokinetic inputs were discordant than when they were concordant. Results have potential implications for head-up displays and suggest a procedure for evaluating visual/vestibular function.


RBC-51Cr half-life and albumin turnover in growing beagle dogs during chronic radial acceleration. The effects of chronic centrifugation on growing Beagle dogs exposed to -2 or -2.6 Gx on albumin and RBC turnover rates, albumin concentration and space, and total blood volume were determined and compared with caged and run control animals. Albumin-125I and autologous RBC-51Cr preparations were injected into all dogs at day 82 of the centrifugation period and the disappearance curves were determined by successive bleedings of the animals over the next 35 d, during which the centrifugation was continued. There were no differences in albumin turnover rates or space. Two populations of RBCs were found in both centrifuged groups, one with a normal half-life of 27 +/- 1 S.E.M. d, and one with a significantly ( less than 0.01) shorter half-life of 15 +/- 2 S.E.M. d. An absolute polycythemia was also observed in both centrifuged groups. The results suggest that chronic centrifugation acts through some as yet unknown mechanism to affect RBC population kinetics.


Systolic time intervals during combined hand cooling and head-up tilt. Cardiac effects initiated by hand cooling and head-up tilt, separately and in combination, were studied in human subjects. Systolic and diastolic arterial pressures, heart rate, pre-ejection period (PEP), and left ventricular ejection time (LVET) were measured while subjects were resting supine, supine with hand immersed in 10 degrees C water, tilted 70 degrees head up, and hand immersed during head-up tilt. Hand immersion and head-up tilt individually increased diastolic blood pressure and concomitantly increased the duration of PEP. During the combined maneuver, the increase in diastolic pressure was greater than observed during either separate maneuver; however, the combined maneuver had no comparable summative effect on PEP prolongation. An interaction appears to occur during the combined maneuver which counteracts the Frank/Starling effect on PEP due to decreased venous return during head-up tilt.


Changes in serum ferritin and other factors associated with iron metabolism during chronic hyperbaric exposure. Factors related to iron metabolism were determined in 20 United States Navy divers during 8 d of air saturation-excursion hyperbaric exposures. During these simulated dives progressive and correlated increases in serum ferritin and iron occurred. No significant changes were observed in bilirubin, hemoglobin, ceruloplasmin, transferrin, copper, or total iron binding capacity. The significance of the increased serum ferritin is discussed in relation to bone marrow damage and early detection of aseptic bone necrosis.


Human facial temperatures in natural and laboratory cold. Asian, European, and American Indian men were subjected to craniofacial cooling to determine relative ranking and temperature curves for various facial skin sites. Moving and still air 0 degrees C to -35 degrees C in both laboratory and subarctic outdoor settings were used. The objective was to examine resistance to facial frostbite. Facial temperatures stabilize well above freezing even under quite cold conditions and this conclusion is congruent with low incidences of facial frostbite. Racial differences in face temperatures were clearly shown at only the malar eminence, and there was some evidence that exercise can be used to enhance facial circulation. These results and those of other studies reviewed demonstrate that facial sites cooled by convection are usually ranked from forehead (warmest) through malar, cheek, and chin, to nose (coldest). When cooled by still air, the sites tend to retain that same ranking, but there is more variation in ranking.


Swimming accuracy and consistency of scuba divers under conditions of low visibility. We had 55 blindfolded scuba divers repeatedly attempt to swim a straight line, make 90 degrees turns to the right and left, and make a 180 degrees turn. A given diver was reasonably consistent in the direction of his error from one trial to another and from one maneuver to another, although about half the divers tended to err to the right and half to the left. When attempted in a swimming pool, the median error over all maneuvers, irrespective of direction, was about 12 degrees. Further experiments showed that the direction of error was consistent, whether the divers were wearing scuba tanks or not, and whether they were swimming blindfolded in a swimming pool or sighted in a lake with water visibility limited to about 2 m. Direction of error did not correlate, however, with the preferred hand, with preferred foot for kicking a football, or with relative strength of the legs. Although hand- and foot-preference were highly correlated, foot-preference was not correlated with relative strength of legs.


Laser eye protection for flight personnel. Developments in laser technology have resulted in an expanding use of lasers in many field and laboratory situations. The implications of the use of lasers in military applications have been examined for flight personnel, and the requirement for eye protection determined. Recommendations for methods of providing that protection are made.


Organ blood flow, cardiac output, arterial blood pressure, and vascular resistance in rats exposed to various oxygen pressures. Blood flow in different organs, cardiac output, and arterial blood pressure were measured in unanesthetized rats under 1, 2, 3.5, 5, and 7 ATA O2, during first electrical discharge developed at 7 ATA O2 and following decompression. Brain, spinal cord, and hypophysis blood flow were reduced after 10 min of exposure to 2, 3.5, and 5 ATA O2 and were normal before and during first electrical discharge. Liver and muscle blood flow were significantly reduced under all investigated pressures, while myocardium, lung, kidney, and adrenal blood flow remained unchanged except for a significant increase in myocardium and lung blood flow under 1 ATA O2. Cardiac output was significantly decreased while arterial blood pressure was significantly decreased under all investigated pressures. The total peripheral resistance increased 36 to 81% at various oxygen pressures. These results are discussed in relation to the possible involvement of hemodynamic changes in awake animals, in the development of the adverse effects of HOP.


Head acceleration and psychomotor performance. Concussion resulting from head acceleration could explain the poor survival rates in some types of accidents. Experiments have been conducted on a decelerator using a tracking task to determine whether high head acceleration could affect psychomotor performance. Human subjects were exposed to impact acceleration of O (sham), 5, 10 and 12 -Gx facing forwards. Measurements were made of the linear and angular accelerations experienced at the head and a step tracking task was used to examine psychomotor performance. Electroencephalographs were also recorded. Both the linear and angular accelerations at the head were increased at the higher levels of impact acceleration. At -5Gx there were no significant differences in psychomotor performance when compared with controls, but at -10Gx, and especially -12Gx, significant differences were found. The EEG activity did not vary significantly and no concussive effects were observed in any subject. These results suggest that impairment of psychomotor performance severe enough to jeopardise survival could be produced by high accelerations of the head, though neither linear nor angular acceleration appear to have special significance.


Age trends in the cardiovascular dynamics of aircrewmen. Age trends in the cardiovascular dynamics of 51 aircrewmen were investigated by means of noninvasive techniques. A statistically significant (p less than 0.01) decline in the ability of their hearts to accelerate blood was found to accompany advancing age. This trend was stronger than the rise in blood pressure found in the group, and known to occur in all aging populations. Assessment of cardiovascular aging in this way may provide new information necessary for the revision of the present mandatory retirement age for airline pilots.


Current role of alcohol as a factor in civil aircraft accidents. Ethyl alcohol continues as a serious adverse factor in general aviation flight safety. According to FAA figures, the level of alcohol-associated general aviation fatal accidents has remained relatively static at a 16% general level since 1969. A recent survey of the attitudes of pilots toward alcohol and flying reveals a lack of appreciation among one-third of the pilots concerning the adverse effects of alcohol on safe flight. A renewed pilot education program on alcohol and flight safety appears indicated.


Aeromedical aspects of otolaryngology.

Aeromedical aspects of otolaryngology. Abnormalities in the ENT area that are directly related to aerospace operations are largely secondary to man's persistence in operating outside his intended environment. These are spatial disorientation, motion sickness, barotrauma, noise-induced hearing loss, and certain clinical entities which have the capability of producing sudden incapacitation. Pertinent features of these primary problem areas are discussed.


Establishing an audit system for Air Evac. Because of JCAH requirements and nursing's progression toward self-evaluation, most fixed facilities have established audit systems to determine the effectiveness of nursing intervention. Due to the transient nature of the Aeromedical Evacuation System, there was no method of evaluating the patient's care inflight. Many obstacles had to be overcome in establishing a method of evaluation; and these problems are discussed by the researchers. A pilot project was formulated to determine the validity of our audit tool. Then, 99 patients' charts were audited over a four-month period. From this data, many deficiencies in the continuity of patient care and the patient's lack of understanding concerning our system became evident. The implications of this study are far reaching and will lead to further research in the future. By disseminating these results to various hospitals, we hope to see significant improvement in patient preparation in the near future.


Induction/catastrophe theory: a behavioral ecological approach to cognition in human individuals. Gibson's (1966) ecological formulation of perceptual processes as abstracted systems, the tenets and units of neobehaviorism as formulated within psychobiology and the experimental analysis of behavior, and the topological approaches of mathematical biology as formulated by Rashevsky (1951, 1960) and Thom (1975) are the elemental concepts that form the basis of the theory presented in this paper. A cognitive or decision process of individual human beings--living systems at the organism level--emerges as a one-step, match-contrast, serial pattern embedded as a triplet of Gibson frames in five-dimensional butterfly catastrophe. Some of the experimental, clinical and philosophical implications of a "catastrophic" formulation of induction are discussed.


Allozyme genotype--environment relationships in natural populations of Drosophila buzzatii. Allozyme frequency data from natural populations of Drosophila buzzatii were analyzed for genotype--environment relationships. Allele frequency and heterozygosity at six loci polymorphic throughout eastern Australia and a number of environmental factors (both means and variabilities) were examined by a variety of multivariate techniques. Significant genotype--environment associations were found for five of the six loci, and after correcting for geographic location significant associations remained for Est-2 and Adh-1 gene frequencies and heterozygosities and for Pgm gene frequencies. The results are discussed in relation to selection and gene flow and provide the basis for laboratory studies to disentangle confounded effects of (1) environmental means and environmental variabilities and (2) allele frequency and heterozygosity, and thus to further test for and determine the nature of any natural selection at particular allozyme loci.


Comparative sensitivities of electrophoretic assays for human enzymes. The sensitivities of 26 starch gel electrophoretic enzyme assays have been compared using HeLa human cells and A9 mouse cells grown in vitro.


Characterization of hybrids between bovine (MDBK) and mouse (L-cell) cell lines. Hypoxanthine-guanine phosphoribosyltransferase (HGPRT)-deficient mutants of a bovine kidney cell line (MDBK) were selected following mutagenesis with ethylmethane sulfonate or ICR-170G. MDBK mutants were hybridized to thymidine kinase-deficient L cells and selected in HAT medium. Parental and hybrid cells were characterized for isozyme patterns of lactic dehydrogenase malate dehydrogenase, glucose-6-phosphate dehydrogenase, and glutamate oxalate transaminase. Chromosomes of MDBK can be distinguished from mouse L cells by configuration and by fluorescent staining with Hoechst 33-258 stain. Hybrid cells contained both MDBK and L-cell chromosomes and had elevated DNA content. MDBK cells are normally restrictive for mengovirus replication. Both permissive and restrictive hybrids were found. Our data indicate that there was preferential loss of MDBK chromosomes in the hybrid cell lines.


Linkage of the locus for conversion of albumin (Acf-1) in the house mouse, Mus musculus. The linkage of the locus for conversion of albumin (Acf-1) has been established on chromosome 1 with the following gene order and recombination percentages: Id-1  19.3 +/- 5.2%  Acf-1  4.2 +/- 1.7%  Dip-1  18.4 +/- 4.2%  Lp.


Electrophoretic comparisons of liver chromatin proteins isolated from heterotic rats during postweaning development. Electrophoretic comparisons of histones and other acid-extractable chromatin proteins isolated from the livers of growing F344 inbred rats and a heterotic paternal hybrid derived by crossing F344 males with Holtzman females reveal significant heterogeneity among a class of nonhistone components soluble in acid. These variations appear to be age and line specific and show more variation in the inbred than the hybrid. Comparisons of the acid-insoluble nonhistone proteins by sodium dodecylsulfate gel electrophoresis reveal significant quantitative changes in a 28,600 dalton polypeptide present in large quantities at 30, 35, and 50 days of age in the hybrid and at 40 and 45 days only in the inbred. Other minor variations were noted in a class of proteins of 40,000--45,000 molecular weight and in those of very high molecular weight (100,000-200,000). Such variations could be a reflection of or prelude to changes in genetic activity and could ultimately be important in the control of growth patterns of developing heterotic animals.


Assignment of the gene governing cellular ouabain resistance to Mus musculus chromosome 3 using human/mouse microcell hybrids. Human/mouse microcell hybrids were used to establish the assignment of the gene governing resistance to the cardiac glycoside ouabain (Oua-1) to Mus musculus chromosome 3. Microcells were prepared from primary mouse embryo fibroblasts and fused with HeLa S3 cells, and microcell hybrids were isolated and maintained in medium containing 10(-6) M ouabain. Resistance to ouabain was not expressed concordantly with any of 26 murine isozyme markers. Karyotypic analysis of five primary clones showed that one to five murine chromosomes had been transferred from donor to recipient in these experiments. Only mouse chromosome 3 was common to all ouabain-resistant primary clones. Both ouabain-resistant and -sensitive subclones were isolated from hybrids grown in the absence of selective pressure, and karyotyping showed that loss of resistance to ouabain was concordant with the loss of murine chromosome 3.


Alcohol dehydrogenase activity in diploid and autotetraploid Phlox. The effect of polyploidy on the activity of alcohol dehydrogenase was examined in a series of diploid and synthetic autotetraploid Phlox drummondii. In most cases autotetraploids had about twice as much activity as the corresponding diploids, in two cases autotetraploids had about 1.5 times more activity, and in one wild seed pair the activity of the tetraploid was somewhat lower.


Genetic variability for regional brain gangliosides in five strains of young mice. The quantitative and qualitative distributions of gangliosides were determined in the cerebrum, cerebellum, and brain stem of five inbred strains (C57BL/6J, DBA/2J, LG/J, C3H/HeJ, BALB/cJ) of mice at 21 days of age. Genetic differences were found among the strains for wet weight, absolute amount of gangliosides per region, and concentration of ganglioside (expressed on bolth a wet and a dry weight basis) in all three regions of the brain. The water content of the various brain regions showed the least amount of genetic variability. Coefficients of genetic determination were used to estimate the magnitude of genetic influence on these traits in each brain region. Significant differences were also found among the five strains for the distribution of certain gangliosides. The DBA strain, which is susceptible to audiogenic seizure at this age, had the highest level of the myelin-enriched ganglioside GM1 in all brain regions. Most of the genetic variation that influences the content and distribution of gangliosides among neurologically normal mice can be considered polygenic. Several possible sources of this genetic variation that may contribute to the differences observed among the strains are discussed.