Metabolic profiles of thermal trauma.

Metabolic profiles of thermal trauma. The study was designed to establish where significant correlations exist in a variety of metabolic substrates and hormone mediators in patients sustaining thermal injury. The factors studied were insulin, human growth hormone, cortisol, glucagon, free fatty acid, triglyceride and glucose. Incorporated into this design was an evaluation of the impact of quantitated severity of injury upon these correlations. In patients sustaining a low severity of injury (Probability of death (p = 2.2 to 33.9) there appeared a loss of glucose regulation in conjunction with insulin resistance without significant interplay of other factors studied. In contrast, patients sustaining high severity injury (p = 46.9 to 100) evidenced correlations between glucagon and glucose (negative), cortisol and free fatty acid indicating a significant role of hyperglucagonemia in these patients. A discriminant function analysis was employed to incorporate all significant variables into a probability model. Only insulin, glucose and glucagon appeared in the optimal classification equation.


Perforated stress ulcer in infants: a silent threat. Stress ulcer has become an important clinical entity and its two major complications--bleeding and perforation--are among the most baffling problems, in terms of management, in clinical practice. Perforation, though the less common of the two, is perhaps the most formidable particularly when this occurs in a very sick infant. Four such infants (cyanotic heart disease, gastroenteritis and two severe pneumonias) all developed this severe complication of their illness and after surgery two survived. Two of these infants presented with bleeding prior to perforation of their stress ulcer. The perforation diagnosis was initially not apparent and was first made after radiological examination. Clinical signs of peritonitis were absent as these infants were too sick for such signs to be elicited. All four ulcers were situated in the posterior wall of the duodenum. Two of these infants developed cardiac complications on the operating table, the cause of which was not very clear. It may have been due to the debilitation of these babies with the additional effect of anesthesia perhaps leading to myocardial toxicity. It is therefore recommended that: all sick infants on steroid therapy be placed on prophylactic antacids; abdominal girth measurements be taken frequently in sick infants to appreciate any unexplained increase in girth; such increase in abdominal girth must be evaluated with an upright abdominal x-ray; operative closure of the perforation must be simple and expedient.


Glucagon or insulin suppressed biliary lipid excretion in dog and man. The possibility that gastrointestinal hormones influence biliary lipid secretion was studied further in chronic bile fistula dogs and subsequently in a patient with a balloon-occludable t-tube. After stabilization of bile flow in the dog by infusing 500 mg/hr sodium taurocholate, glucagon and insulin increased bile flow, decreased cholesterol output, and had no effect on phospholipid or bile salt output. Similarly, during reinfusion of bile in the human subject, glucagon increased bile flow, decreased cholesterol output and had no effect on bile salt output. Phospholipid secretion decreased, as had occurred at a lower bile salt infusion rate in the chronic bile fistula dog. These findings suggest that glucagon or insulin may play a role in regulating cholesterol secretion in dog and man, and that mechanisms other than simple dilution of micelles are operative.


Pseudocyst of the head of the pancreas: relationship to the duct of Santorini. A series of 14 patients with chronic alcoholic pancreatitis is presented which illustrates that cysts originating in the superior segment of the head of the pancreas communicate with the duct of Santorini which normally drains this area of the gland. Cysts in this location do not communicate with the major pancreatic duct (Wirsung) in most instances, and therefore may be overlooked in the standard retrograde drainage procedures employed to relieve pancreatic exocrine obstruction.


Experimental acute pancreatitis: the changes in pancreatic oxygen consumption and the effect of Dextran 40. A canine model was devised to measure the oxygen consumption of the pancreas in experimentally induced pancreatitis. Over the 120 minute investigation period the oxygen consumption fell by 63% in the presence of a diminishing pancreatic blood flow and constant arteriovenous percentage saturation across the pancreas. Dextran 40 has been previously shown to maintain the pancreatic circulation. Accordingly a second group of dogs was treated with Dextran 40 (1.5 ml/kg) 60 minutes after induction of the pancreatitis. This produced a significant increase in the pancreatic oxygen consumption and widening of the arteriovenous difference. Dextran 40 appears to reverse the hypoxia of the pancreas noted in acute experimental pancreatitis.


Intraoperative fine needle aspiration cytology in pancreatic lesions. The notes of 129 patients investigated by intraoperative fine needle aspiration biopsy between 1973 and 1977 have been reviewed. Eighty-four of the patients were operated on and punctured at the Department of Surgery, Lund, and 45 at different county hospitals belonging to the region. All aspirates were stained and evaluated at the Department of Cytodiagnostics, Lund. Sixty-four of the 75 patients with pancreatic cancer were correctly diagnosed and in another three patients the cytological diagnosis was "suspicion of cancer." Including these latter cases the sensitivity of the method was 91% in pancreatic cancer. In four out of five patients with endocrine tumors the cytological report was correct i.e., "endocrine tumor." In none of 22 patients with chronic pancreatitis or pancreatic cysts the diagnosis was falsely positive. Twenty-seven patients who during the operation were suspected of having a pancreatic lesion were at follow-up (mean 2.8 years) found not to have any significant pancreatic disease. Among these patients no falsely positive reports were given. In nine of the 129 patients (7%) the aspirates even at re-checking were found to be nonrepresentative or the aspiration unsuccessful. Six of these were performed at county hospitals. In 24 patients with pancreatic cancer total pancreatectomy was performed. In the remaining 105 patients no complications which could be related to the puncture were detected.


The use of arm veins in femoral-popliteal bypass grafts. In view of the increasing debate as to the best alternative to saphenous vein for femoral popliteal bypass grafts, we present our experience with the use of arm vein grafts. Though there are many anecdotal reports, only one series has been previously published. Arm veins were used when saphenous vein was unavailable in 18 femoral popliteal or femoral tibial bypass grafts. Eighty-three per cent of the patients were diabetic. Ninety-four per cent of the patients were operated on for limb salvage, and in 67% the arteriograms showed only fair to poor run-off. Despite this, the one year patency rate was 82%, which is significantly better than the sixty-nine per cent one year patency rate reported by the senior author in an earlier series using cloth grafts. In view of these good results, we believe that autogenous vein remains the material of choice in femoral popliteal bypass grafts. We do not feel that expanded polytetrafluoroethylene grafts or umbilical vein grafts have yet been shown to be superior. We emphasize also the special techniques that are required when using arm veins.


Aggressive approach to late thrombosis of bovine heterografts. Between January, 1977 and December, 1978, 26 patients presented with delayed thrombosis of bovine heterografts inserted for chronic hemodialysis. Time of presentation ranged from 2-29 months (mean 8.8 months) after insertion. At the time of presentation eight patients were not considered candidates for thrombectomy due to associated infection or physician preference. The remaining eighteen patients underwent thrombectomy, 13 of whom required concomitant revision of the graft (patch angioplasty at the venous anastomosis (6), dilatation (1), resection of intimal hyperplasia (2), resection of stenotic segment with interposition graft (2), resection of false aneurysm (1) and patch graft to mid graft stenosis (1)). Six grafts failed from eight days to seven months after thrombectomy and could not be salvaged. Two grafts functioned until death at three and four months after thrombectomy and the remaining ten grafts remain patent from 4-24 months (mean 13.1 months) after thrombectomy. Critical to success of thrombectomy is an incision over the venous limb with calibration of the venous anastomosis and patch angioplasty when indicated. At completion of thrombectomy arteriograms are mandatory to defect residual thrombosis, defects in the graft and adequacy of venous runoff. This standardized approach has resulted in a significant prolongation of bovine heterograft survival.


Superior vena caval obstruction associated with long-term peritoneovenous shunting. The first described case of superior vena caval obstruction associated with a chronically implanted peritoneovenous shunt occurred in a patient with Budd-Chiari syndrome eight months after placement, and necessitated operative portal decompression and shunt removal.


Influence of age on the endocrine-metabolic response to surgery. The pathogenesis of the increased operative risk in elderly patients is unknown. From a theoretical point of view, a change in endocrine-metabolic response might be involved. In the present study, a battery of hormonal and metabolic variables were measured in eight young and eight elderly healthy males undergoing elective inguinal hernial repair under general anesthesia. Blood was drawn before induction of anesthesia, at skin incision, and one, two, and six hours after skin incision. The findings were: 1) Plasma cortisol increase was significantly higher in elderly than in young controls. 2) Plasma renin level was lower in old age, but renin-aldosterone and electrolyte response patterns were alike in the two groups. 3) Thyroid parameters, in terms of serum T4, serum T3, serum rT3, and T3-resin uptake, responded normally to surgery and showed no age-related differences. 4) The hyperglycemic response was not significantly influenced by age indicating unchanged glycoregulatory mechanisms also verified by determinations of plasma catecholamines, cAMP, and insulin. 5) Blood lymphocyte count was constantly lower in elderly than in young and decreased with time, but the age-related difference was not significant. 6) Blood polymorphonuclear leukocytes showed an increase of the same magnitude in both age groups, although at a significantly slower rate in the elderly. It is concluded that age affects some aspects of the initial endocrine-metabolic response to surgery.


Hyperparathyroid crisis: clinical and pathologic studies of 14 patients. A study is presented of 14 patients with hyperparathyroid crisis treated at the Massachusetts General Hospital between 1964 and 1978. These patients showed diverse clinical manifestations that were indistinguishable from those in patients with pseudohyperparathyroidism. Their symptoms varied from progressive fatigue, malaise, and weakness to those related to the gastrointestinal and urinary tracts. The one biochemical alteration commonly found among these patients was the rapid increase in the serum calcium. There was a concomitant rise in the BUN in 50% of the patients and in the creatinine in 80%. The diagnosis was established by an elevated immunoreactive parathyroid hormone (PTH) level in all eight patients (100%) who had the radioimmunoassay; by the presence of subperiosteal resorption of the phalanges in six of the eight patients (75%); and in three of four patients (75%) by the loss of the lamina dura of the teeth. The 12 patients who had surgery all survived; the two who did not died. Thirteen patients (93%) had a neoplasm--an adenoma in 12 and a carcinoma in one. One patient had hyperplasia (7%). Nine patients (64%) received hypocalcemic drug therapy. The serum calcium temporarily fell to 12 mg/100 ml in five patients (56%) but failed to budge in four (44%). Simultaneous treatment with saline infusion, furosemide and with hypocalcemic drugs over a prolonged period compounded the difficulty at operation by increasing interstitial edema. Our findings from this study show prompt surgical intervention as the ideal treatment for hyperparathyroid crisis, preferably, within 72 hours of the acute onset of symptoms.


Cold blood as the vehicle for potassium cardioplegia. Cold blood with potassium, 34 mEq/L, was compared with cold blood and with a cardioplegic solution. Three groups of 6 dogs had 2 hours of aortic cross-clamp while on total bypass at 28 degrees C with the left ventricle vented. An initial 5-minute coronary perfusion was followed by 2 minutes of perfusion every 15 minutes for the cardioplegic solution (8 degrees C) and every 30 minutes for 3 minutes with cold blood or cold blood with potassium (8 degrees C). Hearts receiving cold blood or cold blood with potassium had topical cardiac hypothermia with crushed ice. Peak systolic pressure, rate of rise of left ventricular pressure, maximum velocity of the contractile element, pressure volume curves, coronary flow, coronary flow distribution, and myocardial uptake of oxygen, lactate, and pyruvate were measured prior to ischemia and 30 minutes after restoration of coronary flow. Myocardial creatine phosphate (CP), adenosine triphosphate (ATP), and adenosine diphosphate (ADP) were determined at the end of ischemia and after recovery. Changes in coronary flow, coronary flow distribution, and myocardial uptake of oxygen and pyruvate were not significant. Peak systolic pressure and lactate uptake declined significantly for hearts perfused with cold blood but not those with cold blood with potassium. ATP and ADP were lowest in hearts perfused with cardioplegic solution, and CP and ATP did not return to control in any group. Heart water increased with the use of cold blood and cardioplegic solution. Myocardial protection with cold blood with potassium and topical hypothermia has some advantages over cold blood and cardioplegic solution.


Surgical management of traumatic intracardiac injuries. Today, surgeons are able to manage both blunt and penetrating wounds of the heart with increasing success, including those with associated intracardiac injuries. After diagnosis by cardiac catheterization, substantial intracardiac lesions are repaired using cardiopulmonary bypass. Among more than 300 patients treated for cardiac wounds in our city-county hospital in recent years, 15 were found to have marded intracardiac defects. These defects included ventricular septal defects, aorta--right ventricle fistulas, aortic valve injuries, a mitral valve injury, and a coronary artery--right ventricle fistula. Thirteen of the 15 patients required repair of the intracardiac defects. One was repaired acutely and 12 were repaired electively. All 15 patients were alive and asymptomatic at the time of writing.


The Angell-Shiley porcine xenograft.

The Angell-Shiley porcine xenograft. A 4-year clinical experience with fresh allograft tissue valves prompted a trial of 0.5% buffered glutaraldehyde as a valve fixative and sterilant. Tanned allograft and porcine xenograft valves were inserted into experimental animals, and, beginning in 1970, similar valves were implanted in a series of patients now totaling 312. The clinical results are excellent. The 5-year valve-related mortality is 6% for patients who had mitral valve replacement and 16% for those with aortic valve replacement. To date, the incidence of thromboembolism is 1.3% per patient-year, and valve-related morbidity and mortality for the combined groups is 27.4%. Valve stent design has evolved from symmetrically configured metal to anatomically molded plastic. The maintenance of natural valve configuration has optimized leaflet coaptation and support, decreased tissue stress, and eliminated valve-stent dehiscence and tissue rupture seen in valves deformed to fit symmetrical stents. Stent design, controlled glutaraldehyde solutions, and fixation techniques have improved leaflet flexibility and reduced valve orifice to annulus diameter ratios, thus producing transvalvular gradients comparable to both mechanical and modified orifice tissue valves. To date, tissue failure, observed in only 1.0% (3 of 287) of patients, is the result of calcification (2 patients) and cusp rupture due to incomplete fixation (1 patient).


Successful repair of straddling atrioventricular valve by technique used for septation of univentricular heart. Straddling atrioventricular valve (SAVV) is a rare anomaly. Only recently have the premortem diagnostic features been elucidated. Repair of the associated ventricular septal defect poses a considerable technical problem. Corrective operations, infrequently reported, have usually involved replacement of the SAVV. This report describes the successful management of a patient with a straddling left atrioventricular valve in whom the valve was preserved by a technique previously used for septation of the univentricular heart. This technique offers a useful alternative to valve replacement in the management of patients with SAVV.


Results of epicardial pacing by the left subcostal approach. We have determined the clinical course of 200 consecutive patients (mean age, 67.5 years) in whom epicardial pacing was established by the left subcostal route by insertion of 2 sutureless myocardial electrodes and a demand bipolar generator. There was 1 intraoperative death (0.5%). The overall 30-day perioperative mortality was 4 of 200 patients (2.0%). The principal postoperative complications included postpericardiotomy syndrome in 8 patients (4.0%), pneumonia or marked atelectasis in 2 patients (1.0%), and pulmonary embolus in 1 patient. Hemiplegia developed in 2 patients at 9 and 10 days, respectively, after operation, and transient monoparesis developed in another patient (1.5%). There were no wound infections, but the one wound dehiscence required resuturing. Follow-up has been completed in all patients from 1 to 39 months postoperatively (mean, 14.9 months). There have been 21 late deaths. Late lead thresholds were recorded for 45 individual leads from 26 patients up to 35 months after operation. The results obtained indicate that for patients undergoing primary implantation, the sutureless myocardial electrode provides reliable lead function. However, patients who required reoperation because of previous pacemaker failure due to threshold rise have done poorly as a group and may be better managed with lithium high-output pacemaker generators.


The prosthetic (Teflon) central aortopulmonary shunt for cyanotic infants less than three weeks old: results and long-term follow-up. The expanded microporous polytetrafluoroethylene (PTFE) 4 mm vascular prosthesis has been used to create a central aortopulmonary shunt in 20 critically ill infants less than 3 weeks old. The infants ranged from 1 to 18 days old (5.25 days), and from 1.5 to 4.0 kg (2.9 kg). Conduit length ranged from 2 to 6 cm (4 cm). Sixteen patients had atresia of the tricuspid or pulmonary valve. There were 6 early deaths (30%), only 1 of which was shunt related. The mean preoperative arterial oxygen saturation was 62% (range, 33 to 80%), and mean postoperative saturation was 87% (range, 78 to 90%). There were 5 late deaths, 1 probably caused by shunt failure. Nine long-term survivors have done well. Follow-up ranges from 1 to 36 months (18 months). Factors influencing conduit function are length, technical considerations, and pulmonary vascular resistance. Late restudy in 5 of 9 survivors confirms patency and demonstrates bidirectional pulmonary blood flow. Since PTFE shunt flow capability is fixed, the infant may require repair or a second shunt within 24 months of the initial procedure.


Pancoast's tumor: irradiation or surgery? Seventy-three patients with Pancoast's tumor treated at the University of Maryland Hospital between 1955 and 1978 were reviewed. Three were 34 squamous cell carcinomas, 13 undifferentiated, 10 adenocarcinomas, 4 mixed adenosquamous, 1 alveolar cell, and 11 undetermined. Twenty-nine patients received irradiation, with 7% survival at 3 years; 19 patients underwent preoperative irradiation followed by en bloc resection of chest wall, with 23% survival at 3 years; 5 patients underwent extended resection, with 60% survival at 3 years; and 18 patients underwent operation followed by irradiation, with 7% survival at 3 years. Retrospective staging of 42 patients undergoing operation indicated that 22 (52%) were inoperable. Prognosis was related to staging of the disease, the extent of local invasion, nodal involvement, cell type, and adequacy of operation.


Nissen hiatal hernia repair: problems of recurrence and continued symptoms. The standard Nissen operation is the most effective method of reflux control. However, the procedure can result in continuance of symptoms, particularly dysphagia, which presents considerable diagnostic difficulty. Experience gained in the management of 17 patients with continued recurrent symptoms following standard Nissen repair has allowed more specific definition of the nature of these problems. The anatomical defect has been categorized as follows: (1) tight repair (tight fundoplication or tight diaphragmatic repair); (2) anatomical recurrence with and without reflux; and (3) intussusception recurrence. Each patient has been evaluated by history, manometry, pH reflux, acid perfusion, radiology, and endoscopy. At the time of corrective operation, the previous repair was carefully dissected to allow confirmation of the type of defect. Correlation is made between symptoms, investigative findings, and the anatomical problem at operation.


A technique of myocardial preservation perfusion. We present a technique for administering cold cardioplegia that permits the pump technician to conveniently give the fluid. The method is comparable to that used in providing coronary perfusion for aortic valve procedures because it allows controlled volume flow and perfusion pressure. In addition, the technique is inherently safe from infusion of air bubbles.


Left ventricular venting during cardioplegic arrest. A technique is described for venting the left ventricle during ischemic arrest without cannulation of the ventricle. This approach is ideally suited for coronary revascularization.


A special rongeur for removal of extensively calcified mitral valves. A rare complication of advanced mitral valve disease occurs when calcium extends from the valve downward along the wall of the left ventricle into the ventricular cavity. This unusual condition can be recognized on fluoroscopy because the calcium is visible at right angles to the calcium in the valve. The surgeon faces a very difficult technical problem because it is hard to obtain adequate exposure and to remove the calcium without injury to adjacent tissues or loss of calcific fragments, with resulting embolization. Such difficulties were encountered a year ago in a patient undergoing mitral and aortic valve replacement and ultimately resulted in the patient's death. After this event, the special rongeurs described here were designed.


A suction instrument for coronary artery and pediatric cardiac surgery. A suction instrument that is useful in the small heart and for maintaining clear visibility during direct coronary artery revascularization is described. The instrument permits a variable degree of suction intensity which allows it to be used atraumatically.


Effect of cyproterone acetate on adrenal cortex of castrated mice. Castrated adult male C57BL/6J mice displayed a wide perimedullary zone (secondary X-zone) whose cells were characterized by proliferated rough and smooth endoplasmic reticulum and elongated mitochondria with lamellar cristae. Castrated mice which received 0.08 mg/g of cyproterone acetate showed a much inhibited secondary X-zone at the light microscopic level, while at the ultrastructural level the perimedullary cells lacked the proliferated rough and smooth endoplasmic reticulum as well as the elongated mitochondria. Cyproterone acetate may inhibit the steroidogenic parameters of the androgen-producing cell population of the adrenal cortex without testicular mediation.


Mechanical properties of the mammalian vas deferens. I. In the passive state. Knowledge of the mechanical properties of the vas deferens is important in order to understand the mechanical interaction between an intravasal device (IVD) and the vas deferens--a necessary step for successful long-term implantation. It is equally important in order to understand the mechanism of sperm transport through the vas, with or without an IVD implant, by means of quantitative mechanical models. Experiments were performed, in vitro, on vas deferens from rat, bull, and rabbit, to determine its mechanical properties in the passive state. The data consist of (1) load response to simple extension and cyclic extension, (2) extensional response to cyclic loading, and (3) stress relaxation response at constant extensions. The load-elongation behavior is characterized by Fung's exponential model T = (T* + beta)e alpha(lambda-lambda*) - beta quantitatively, where T is the Lagrangian or engineering stress (current force in the specimen divided by the original area of cross section) (dyn/cm2), T* is a convenient stress value (dyn/cm2), alpha is a parameter characterizing material elasticity (dimensionless), beta is a second material parameter (dyn/cm2), lambda is a stretch ratio (dimensionless) equal to l/l0, where l is the instantaneous length of the specimen (cm) and l0 is its reference length measured at 2-gram-force (1 gram force = 981 dyn) applied load (cm), and lambda* is the stretch level corresponding to T* (dimensionless). The vas appears to behave as a viscoelastic material and its reduced relaxation function may be dependent on the initial level of stretch. The cyclic-loading and cyclic-extension data give evidence of internal damping mechanisms, which make the loading curves different from the unloading curves (hysteresis). Also, the mechanical behavior of the vas is found to be altered by repeated loadings in quick succession. It is likely that cyclic loadings, in vivo, occur at much lower levels of stress and thus cause negligible damage, or that there are natural mechanisms which repair the damage. The behavior of tissue from different species of animals are qualitatively similar, although the tissue from the larger-size animal is likely to be stronger and stiffer. Due to very little interweaving between the muscle fibers of the longitudinal and circumferential layers, the data reported reflect the properties of the longitudinal layers only. Because the muscular structure of the three layers is very similar, the properties of the circumferential layer may be extrapolated.


Mechanical properties of the mammalian vas deferens. II. In the active state. The mechanical response of the vas induced by field stimulation is described in this paper. The experiments were performed, in vitro, on vasa from Sprague-Dawley albino rats. In the maintained ac tetanic stimulation, the active force achieves the peak magnitude in about 1 to 1.2 sec; thereafter, it relaxes gradually. For a given stimulus voltage (amplitude), a maximal response is elicited at 60 Hz. At 6000 Hz, and greater, no response is elicited. The ability to respond to stimulus dies out in 2 hr at 5 degrees C above the normal temperature of 37 degrees C; the ability to respond to stimulus remains unaffected at 5 degrees C below the normal temperature. The active force is always larger than the passive force when the vas is subjected to titanic stimulation near its in situ length.


Properties of spermatozoa in relation to their elimination after vasectomy. Sperm disposal and the formation of sperm granulomas are two related critical aspects of vasectomy which have been studied in man and several animal models. Since mammalian spermatozoa present a keratinoid quality, a comparison was made of the resistance of human and rat spermatozoa. When exposed to dithiothreitol and sodium dodecyl sulfate, human sperm decondense readily while rat sperm resist decondensation for long periods of time. A cooperative effect in the rate of decondensation was observed for human sperm but not for rat sperm. Oxidation of sulfhydryl groups renders human spermatozoa as resistant as rat spermatozoa, indicating that disulfide crosslinks are involved in this resistance. Human spermatozoa constitute a heterogeneous population with respect to sulfhydryl group content, suggesting variations in the state of maturation and/or elimination. The sulfhydryl group content of rat epididymal spermatozoa was similar from one cell to another, suggesting little sperm reabsorption in the epididymis. Human and rat spermatozoa differ in size, resistance to decondensing agents, cooperative effect during decondensation, and content and localization of sulfhydryl groups; these differences can explain why vasectomized rats invariably develop huge granulomas while this side effect is not severe in vasectomized men.


Estimation of daily sperm production rate (DSPR) by quantitative testicular histology in Buffalo-bulls (Bubalus bubalis). Testes and epididymides from six sexually rested buffalo-bulls were removed during breeding season. The average weight of the testicular parenchyma was 138.62 g, of which the tunica albuginea accounted for 8.45 g. Relative distribution of spermatozoa in caput, corpus, and cauda epididymides averaged 5.42, 0.75, and 11.45 billion, respectively. Total epididymal sperm reserve per bull was 36.2 billion. The efficiency of sperm production was quite uniform and averaged 14.5 x 10(6) sperm per gram of testicular parenchyma per day with a mean of 2.02 x 10(9) sperm per testis. Thus a typical buffalo-bull produces about 4 x 10(9) sperm daily during breeding season.


Endocrine studies of azoospermia. II. Serum steroid levels in obstructive azoospermia. Serum estrone, estradiol, estriol, progesterone, 17 alpha-hydroxyprogesterone, and testosterone were determined in the sera of 25 normal males and 25 patients with obstructive azoospermia. An increase in testosterone and estriol levels, and a decrease in other hormones were demonstrated in patients with obstructive azoospermia. These long-term effects of obstruction of the vas apparently also occur in comparable situations, for example, after vasectomy.


The leprous testis.

The leprous testis. A clinical investigative study of 148 male leprous patients demonstrated the presence of testicular lesions in 35 cases. Semen analysis revealed marked oligo-athenozoospermia in 10 cases and azoospermia in 25 cases. Testicular biopsies from leprous testes showed different histologic patterns ranging from spermatogenic arrest to complete hyalinization of both seminiferous tubules and interstitial tissue. Histochemical staining for neurovascular supply revealed degenerative nerve change in addition to altered permeability of the testicular capillaries. There was good correlation between the results of semen analysis and histological and histochemical examination of testicular biopsies.


Methotrexate and fertility in men.

Methotrexate and fertility in men. The possible deleterious effects of folic acid antagonist methotrexate on the fertility potential have been investigated in 26 male psoriatic patients. Examination for semen, testicular histology, and spermatogenic function using radioactive phosphorus revealed that methotrexate had no unfavorable effect on male fertility. A long follow up of the patients and their offspring is needed to exclude the possible teratogenic effect of the drug.


Local male hormonal therapy in male infertility: a preliminary report. The therapeutic effect of local infiltration of the testis by testosterone crystalline suspension was studied in 18 cases of severe oligozoospermia. Evaluation was done by semen analysis follow-up, and results were correlated with preoperative testicular biopsies. About 40% of the cases showed improvement of sperm count and/or motility. Testicular biopsies of responding cases showed mild inhibitory changes, such as sloughing or partial spermatogenic arrest at late stages, while cases with tubular hyalinization or spermatogenic arrest at the stage of spermatogonia showed no response. The method proved to be simple, safe, and promising.


Ultrastructure of spermiogenesis in men with congenital absence of the vasa deferentia. Spermiogenesis has been investigated in four cases of agenesia of vasa deferentia. During acrosome formation various anomalies gave rise to late spermatids with deformed heads. Chromatin condensation proceeded normally, but completion of this process appeared to be delayed. Redundant nuclear membranes frequently persisted at the basal region of the nuclei in mature spermatozoa, which occupied niches within Sertoli cells, as the tubules had no lumen. Flagellar structure was normal. These findings support the view that the altered local milieu and variations in acrosome formation may induce the observed anomalies.


High sperm densities and the quality of semen. Thirty semens with sperm densities above 200 million per milliliter from patients with fertility disorders were examined for volume, motility, vitality, and morphology of spermatozoa, and for fructose content as well as for percentile decreases with time of activity and viability. In addition, blood levels of follicle stimulating hormone, luteinizing hormone, testosterone, and prolactin were estimated. Percentages of motility, vitality, and morphological normality, motility grades, and percentile decreases in both activity and viability were found to be comparable with those of oligospermic specimens. On the average, volume of semens were lower by about 30% than in normo- and oligospermia. 42% of the investigated semens had low fructose values (below 1 mg/ml). In about 60% of patients the prolactin levels were low (2-5 ng/ml). Follicle stimulating hormone, luteinizing hormone, and testosterone were either within normal range or slightly decreased. Despite the above abnormalities, the overall numbers of "normal" spermatozoa per ejaculate were not inferior to those usually present in normospermic specimens, suggesting that factors of presently unknown nature, involved in regulation of both proliferation and spermatogenesis, might be responsible for fertility disorders in these conditions.


Elimination of errors induced during a routine human sperm motility analysis. Influence of some variables on the accuracy of sperm motility evaluation was studied by analyzing normal seminal specimens with the aid of themultiple exposure photography (MEP) method. Results of this study demonstrated the existence of variations in sperm motility between view areas of the same sample or between different samples of the same specimen. Variations were found even when the same view area was analyzed intermittently during a short period of time. Motility was practically unaffected when a regular sized drop was kept within the preparation for about 20 min. The light from the microscope neither stimulated nor depressed sperm motility when they were illuminated continuously for that period of time. Percent of motility and sperm velocity was directly related to the thickness of the examined drop when the latter ranged between zero and ten micrometers. According to these findings it is suggested that several view areas from various drops of the same specimen should be analyzed with each view area being inspected several times before motility of that field is assessed. Motility should be evaluated from drops of standard and constant thickness; otherwise major errors in sperm motility assessment are to be expected.


Macromolecular secretion into various segments of the guinea pig epididymis. The secretion of proteins of different segments of the guinea pig epididymis was studied using micropuncture and radiochemical techniques. Tissue and fluid samples were taken 24-48 hr after intraperitoneal injections of 2 mCi of tritiated lysine. Macromolecular secretion was higher in the caput than in the corpus and cauda. Labelled spermatozoa were detected in smears taken from the caput epididymis 24 hr after injection. Few labelled spermatozoa were found in the corpus and none in the cauda. Since the capacity of epididymal sperm for fertilization is apparently achieved before spermatozoa reach the cauda, the protein synthesized in the epididymal caput and corpus would account for trigering sperm maturation.


Distribution of pyrimidine synthetic enzymes in the rat testis. The distribution of the de novo and the salvage pathway enzymes for pyrimidine synthesis in the rat testis was investigated in separated seminiferous tubules and interstitial tissue. Aspartate carbamyltransferase (de novo synthesis) was localized primarily in the seminiferous tubules while the uridine and thymidine kinase activities were associated mainly with the interstitial tissue. To further delineate this distribution these enzymes were studied in testes from rats treated with Busulfan (the methane sulfonic acid diester of 1,4-butanediol), which causes degeneration of spermatogonia but not Sertoli cells. The results indicate that a part of the low tubular thymidine kinase activity resides in the germinal elements while the tubular uridine kinase activity is localized in the Sertoli cells.


The penetration of antibody-covered spermatozoa into cervical mucus and egg white. Autoantibodies to sperm membrane antigens may cause infertility in men. The antibodies can often be revealed in seminal plasma and the antifertility effect seems mainly to be due to hampered penetration into cervical mucus of antibody-covered spermatozoa. Recently, egg white has been used instead of cervical mucus in penetration tests. We have, therefore, compared the concentration of sperm autoantibodies in serum and seminal plasma to the ability of spermatozoa to penetrate into cervical mucus and egg white, respectively. With sperm from ten normospermic men with antibodies to sperm there was a correlation between the maximal penetration in the two different media and the cases with poor penetration were equally well revealed in cervical mucus and egg white. Penetration experiments with normal spermatozoa, treated with selected antibody-containing sera confirmed that the penetration-inhibiting effect of autoantibodies is revealed in egg white. Thus, the use of egg white in penetration tests can be of value in evaluation of cases with immunological infertility.


Enzyme comparative study of spermatozoa and seminal plasma in normal and subfertile man. A semiquantitative colorimetric micromethod (APIZYM) was used to study the enzyme profiles of seminal plasma and of spermatozoa. Reactions with 65 different substrates are simultaneously tested in a single specimen. These substrates (principally naphtolic) allow the detection of hydrolytic enzymes (esterases, phosphatases, and peptidases) and of dehydrogenases potentially involved in sperm metabolism and in the process of fertilization. The usual sperm enzymes were regularly observed: C3-C4 esterases, amino acid arylamidases, acrosine, phosphatases, glutamyl transpeptidase, and various osidases. Among the dehydrogenases we observed a striking predominance of the enzymes of the hexose monophosphate shunt and of LDH. Seminal plasma has an enzyme pattern very similar to that of spermatozoa except for the absence of acrosine and of some dehydrogenases. This unexpected similarity is discussed. The gametes from subfertile donors do not at first sight differ in their enzyme pattern from those from fertile donors. Moreover, we found no marked differences between zymograms of seminal plasma from normal, subfertile, or even azoospermic patients. Deep freezing does not modify the hydrolytic enzymes of human sperm either quantitatively of qualitatively, but the dehydrogenases of the hexose monophosphate shunt are adversely affected (60% loss of activity for G 6 PDH, and 30% for 6 PGDH); LDH is not affected. The consequences on fertilizing capacity of frozen semen are discussed.


Histological characteristics of the human testis after long-term treatment with cyproterone acetate. Cyproterone acetate, an antiandrogen drug, is used to reduce mammalian fertility. Effects on the human testis are controversial. Findings in this study reveal that long-term treatment-7 months with 200 mg/day-leads to disappearance of the germinal cells and to Sertoli cells with either a normal or undifferentiated aspect as well as involution of the Leydig cell. Some pathogenetic hypotheses on the action of cyproterone acetate upon human spermatogenesis are discussed.


Agonistic properties of low doses of antifertility compounds in male rats. Male Wistar Strain rats of known fertility were given subcutaneous dosage of three drugs, alpha-chlorohydrin, amino-alpha-chlorohydrin, and busulphan alone or in combination for a period of thirty days. Males were housed overnight with females at various times during the treatment and ninety days after cessation of treatment. There were significant differences in levels of glycerylphosphorylcholine in the epididymides of two treatment groups as well as differences in numbers of spermatozoa recovered from the reproductive tracts of female rats mated with males from four treatment groups. Treatment had no effect on the weights of the testes or sex accessory organs or sialic acid levels in the epididymis, fructose levels in dorso-lateral prostate and coagulating gland, or citric acid levels in seminal vesicle and ventral prostate of the treated males when compared to controls. The antifertility activity was probably mediated by an effect on epididymal spermatozoa and thereby subsequent change in sperm transport within the female genital tract.


Endocarditis associated with porcine valve xenografts. Review of porcine valve xenografts in 68 patients over a 32-month period disclosed seven episodes of endocarditis in six patients, an attack rate of 10%. Four patients died as a result of the infections. The presence of Staphylococcus epidermidis in every case was most striking as was the preponderance of methicillin sodium resistance. The clustering of cases within a restricted time period, and the absence of subsequent cases, suggests the strong possibility of a nosocomial occurrence.


Bacterial variants in urinary casts and renal epithelial cells. Casts with numerous and unusually large granules were seen in the urine of a child with renal Fanconi's syndrome. When the urine sediment was sealed under a coverslip for several days, many granules changed to filamentous bacterial variants that segmented and, finally, appeared as streptococcal-like forms. When the patient's blood was cultured by a special method, bacterial variants grew consistently, and frequently reverted to parent coccal forms, although conventional cultures were negative. Variants from blood cultures had the same morphology and staining properties as granules in casts and in cystic structures found within hypertrophied renal pelvic epithelial cells. Cryptic parasitization with bacterial variants probably occurs in many nephropathies. Variants are known to produce toxins and immunogens, which could lead to mesangial and basement membrane deposits as well as to occlusive reactions in the renal microcirculation.


Role of renin classification for diuretic treatment of black hypertensive patients. Previous studies in white and mixed-race hypertensive patient populations have generally found patients with low renin activity more responsive to diuretic therapy than patients with normal renin activity. Twenty-nine black patients (26 women and three men) with placebo diastolic blood pressure of 90 to 115 mm Hg were treated with spironolactone (100 to 400 mg/day) and hydrochlorothiazide (100/mg/day). Renin status was categorized by (1) the intravenous furosemide test, (2) ambulation during placebo, and (3) ambulation during spironolactone and hydrochlorothiazide treatment. Only seven patients were categorized identically with all methods. No method identified a low renin subgroup that was more responsive to either spironolactone or hydrochlorothiazide. Diastolic blood pressure fall with hydrochlorothiazide (18 mm Hg) and 400 mg/day of spironolactone (15 mm Hg) was similar. Thus, since black women with both low and normal renin activity are quite responsive to diuretics, renin classification to guide initial antihypertensive selection is not warranted.


The pathogenesis of pulmonary and miliary tuberculosis. Tuberculosis is spread from human to human by airborne transmission; it is not a highly infectious disease. Primary infection remits in 90% of cases and is progressive in the remainder; it is accompanied by lymphohematogenous seeding of many organs, and reactivation may occur as early as three months or many years after initial infection. Primary infection generally confers immunity from subsequent reinfection. The risk of reactivation of tuberculosis is greatest in the year after infection, declining sharply thereafter for most patients. Acute miliary tuberculosis has a distinctive pathogenesis that is different from localized postprimary disease. Miliary tuberculosis may appear in a patient with a normal chest roentgenogram; even in patients with abnormal chest roentgenograms, sputum cultures for acid-fast organisms may be negative. Transbronchial biopsy is the preferred method of diagnosis and prompt initiation of treatment is essential.


The treatment of pulmonary tuberculosis. Current options. Appropriate chemotherapy must be received by the patient if the treatment of pulmonary tuberculosis is to be successful. The choice of the antituberculous regimen depends on the susceptibility and number of organisms infecting the patient and the side effects and cost of the drugs. The patient's life-style and the resources available in the community need to be considered to ensure compliance with the prescribed chemotherapy. If treatment is to be unsupervised, meaning that each dose is not actually witnessed by a health provider, a daily isoniazid and ethambutol hydrochloride treatment for 18 months or daily isoniazid and rifampin treatment for nine months is suggested. If each dose of chemotherapy is to be directly supervised, necessary for the noncompliant patient, then the following regimens are recommended: intermittent isoniazid and ethambutol, isoniazid and streptomycin, or intermittent isoniazid and rifampin following an initial period of daily therapy.


Public health and preventive aspects of pulmonary tuberculosis. Infectiousness, epidemiology, risk factors, classification, and preventive therapy. Tuberculosis is usually of a low order of infectivity. Once treatment has begun, patients are no longer infectious to close contacts, and there is no benefit to isolating them. Among the risk factors associated with tuberculosis that reactivates after many years of dormant infection, the coexistence of silicosis, diabetes mellitus, and the postgastrectomy state with tuberculosis are reasonably well demonstrated. Preventive treatment begins with prompt institution of chemotherapy in  the index case. Isoniazid is extremely effective in preventing tuberculosis infection from becoming tuberculosis disease. The benefits of BCG vaccine are controversial, and it is little used in the United States. Hepatotoxicity is a potential serious side effect of isoniazid chemoprophylaxis. Clinical monitoring for prodromal symptoms makes the drug safe and effective for patients under 35 years of  age.


Hyperprolactinemia--a review of recent clinical advances. Since the radioimmunoassay for serum prolactin became available eight years ago, prolactin has become a hormone of considerable clinical interest. An elevated serum prolactin concentration is the most frequent hormone marker for pituitary tumors. Secreted in excess, prolactin causes dysfunction of the hypothalamic-pituitary axis, the gonads, and the adrenal cortex. In women, menstrual disturbances, galactorrhea, infertility, and hirsutism result. Impotence, oligospermia, and decreased libido are common in men. These metabolic abnormalities attributed to prolactin excess are corrected when prolactin concentrations are lowered by either medical or surgical therapy. The availability of effective therapy mandates early recognition and proper management of the patient with hyperprolactinemia.


Selenium requirement for active xanthine dehydrogenase from Clostridium acidiurici and Clostridium cylindrosporum. The xanthine dehydrogenase of Clostridium acidiurici and C. cylindrosporum was assayed with methyl viologen as acceptor. In C. acidiurici the basal activity level was about 0.3 mumol/min x mg of protein. Cells grown on uric acid in the presence of 10(-7) M selenite showed a 14-fold increase in xanthine dehydrogenase activity, which decreased with higher selenite concentrations (10(-5) M). The supplementation with 10(-7) M molybdate or tungstate was without effect. High concentrations of tungstate decreased the xanthine dehydrogenase if selenite was also present. In comparison, high concentrations of molybdate affected only a small decrease in activity level at the optimal concentration for selenite and relieved to some degree the inhibitory effect of 10(-5) M selenite. With hypoxanthine and xanthine as substrates for growth again only the addition of selenite was necessary to show a similar increase in xanthine dehydrogenase activity. C. acidiurici could be grown in a mineral medium. Both xanthine dehydrogenase and formate dehydrogenase exhibited the highest level of activity if selenite and tungstate were present in that medium. In C. cyclindrosporum the basal activity level of xanthine dehydrogenase was about 0.95 mumol/min x mg of protein. The addition of 10(-7) M selenite to the growth medium increased the activity level about 3-fold, but the highest level (3.7 U/mg) was reached if 10(-7) M molybdate was also added. The presence of tungstate resulted in a decreased enzyme activity.


The amino acid sequence of the peptide moiety of the pseudomurein from Methanobacterium thermoautotrophicum. The amino acid sequence of the peptide  subunits of the peptide moiety of the sacculus polymer (pseudomurein) of Methanobacterium thermoautotrophicum was elucidated by analysing overlapping peptides obtained from partial acid hydrolsates of isolated sacculi. It is suggested that the peptide subunits are attached to glycan strands via one of their glutamyl residues. Another glutamyl residue may crosslink two adjacent peptide subunits to form a dimer. The calculated molar ratios of the amino acids and the percentages of the N- or C-terminal amino acid residues of the supposed dimers are compatible with those actually found in the sacculus polymer.


Capnocytophaga: new genus of gram-negative gliding bacteria. II. Morphology and ultrastructure. Gram-negative, anaerobic gliding bacteria were isolated from normal supragingival plaque and from periodontal lesions. Isolates could be divided into two size classes: small 2.4-4.2 micrograms x 0.38-0.5 microgram and large 4.8-5.8 micrograms x 0.42-0.6 microgram cells. The outer membrane was either loose-fitting and wavy, or taut, and of variable thickness. An electron-dense fuzz was discernible on several of the isolates. The periplasmic region was of variable electron-density. The genus Capnocytophaga has been proposed for these organisms based on morphological and cultural characteristics.


Capnocytophaga: new genus of gram-negative gliding bacteria. III. Physiological characterization. Sixty-eight strains of capnophilic fusiform Gram-negative rods from the human oral cavity were subjected to extensive physiologic characterization, tested for susceptibility to various antibiotics, and the mol-percent guanine plus cytosine of each isolate determined. The characteristics of the isolates were compared with 10 fresh and 2 stock isolates of Fusobacterium nucleatum. The isolates clearly differed from the Fusobacterium species on the basis of mol-percent guanine plus cytosine, end products, growth in a capnophilic environment and fermentation of carbohydrates. All of the gliding isolates required CO2 and formed acetate and succinate, but not H2S, indole or acetylmethylcarbinol. All fermented glucose, sucrose, maltose and mannose. The organisms may be differentiated on the basis of fermentation of additional carbohydrates, hydrolysis of polymers and reduction nitrate. Three species are proposed: Capnocytophaga ochracea, Capnocytophaga sputigena and Capnocytophaga gingivalis. Ten isolates did not fit into the proposed species.


Adenosine triphosphate pool levels and endogenous metabolism in Arthrobacter crystallopoietes during growth and starvation. The adenosine triphosphate (ATP) content of Arthrobacter crystallopoietes was measured during growth, starvation and recovery from starvation. During exponential growth of the cells as spheres in a glucose slats medium, the level of ATP per cell remained constant at 8.0 x 10(-10) micrograms/cell. Morphogenesis to rodshaped cells and an increased growth rate following addition of casein hydrolysate was accompanied by an almost two-fold increase in the ATP level. As division of the rod-shaped cells proceeded, the level of ATP declined. After growing as rods for 12-14 h the cells underwent fragmentation to spheres during which time the ATP level again increased to the original value of 8.0 x 10(-10) micrograms/cell. As the spherical cells resumed growth on the residual glucose, their ATP content declined for a short period and then remained relatively constant. During starvation of sphere or rod-shaped cells for one week, the ATP level declined by approximately 70% during the first 40-50 h and then remained constant. The endogenous metabolism rate of spherical cells declined during the first 10-20 h of starvation and then remained constant at approximately 0.02% of the cell carbon being utilized per h. Addition of glucose to spherical cells which had been starved for one week increased both the ATP content per cell and their rate of endogenous metabolism. The ATP content fluctuated and then remained at a level higher than maintained during starvation while endogenous metabolism quickly declined.


Adenylate nucleotide levels and energy charge in Arthrobacter crystallopoietes during growth and starvation. The adenylate nucleotide concentrations, based on internal water space, were determined in cells of Arthrobacter crystallopoietes during growth and starvation and the energy charge of the cells was calculated. The energy charge of spherical cells rose during the first 10 h of growth, then remained nearly constant for as long as 20 h into the stationary phase. The energy charge of rod-shaped cells rose during the first 4 h of growth, then remained constant during subsequent growth and decreased in the stationary growth phase. Both spherical and rod-shaped cells excreted adenosine monophosphate but not adenosine triphosphate or adenosine diphosphate during starvation. The intracellular energy charge of spherical cells declined during the initial 10 h and then remained constant for 1 week of starvation at a value of 0.78. The intracellular energy charge of rod-shaped cells declined during the first 24 h of starvation, remained constant for the next 80 h, then decreased to a value of 0.73 after a total of 168 h starvation. Both cell forms remained more than 90% viable during this time. Addition of a carbon and energy source to starving cells resulted in an increase in the ATP concentration and as a result the energy charge increased to the smae levels as found during growth.


Capnocytophaga: new genus of gram-negative gliding bacteria. I. General characteristics, taxonomic considerations and significance. The characteristics of gliding bacteria isolated from both healthy and diseased sites in the oral cavity are, summarized and the taxonomic position of the bacteria discussed. Uniform attirubtes of the fusiform isolates include gliding motility, strictly fermentative metabolism dependent on the presence of CO2 (or HCO3-), under either anaerobic or aerobic conditions, presence of benzidine-reactive components, and the production of acetic and succinic acids as the major or sole, acidic, metabolic and products. Given the guanine and cytosine content of DNA, their gliding motility, and the ability of many strains to attack polysaccharide a relationship to the cytophagus is suggested. This relationship, along with the CO2-dependent growth is recognized by the generic name Capnocytophaga given them. Many of the isolates are grouped into three species C. ochracea, C. Sputigena, and C. gingivalis, separated on the basis of morphological and physiological traits.


Genetic control of lysine permeases in Saccharomycopsis lipolytica. In order to obtain strains of Saccharomycopsis lipolytica impaired in the active transport of L-lysine, mutants resistant to a mixture of L-canavanine, L-4-5-transdehydrolysine and L-S-amino ethylcysteine, taken either all three or two by two, were isolated. These compounds were shown previously to be competitive inhibitors of L-lysine uptake. The resistance patterns and excretion capacity of the mutants were established. All mutants behaved as monogenic. Recombination tests indicated that four genes at least were involved. All mutants were impaired in both high and low affinity L-lysine transport systems. Several hypotheses on the functions of these genes are put forward and discussed.


Psychiatric manpower ratios. A beguiling numbers game? Many characteristics of California's counties that correlate with physician-population ratios also correlate with psychiatrist-population ratios, with their changes through time and with rural counties' ability to attract psychiatrists. These same county characteristics seem to influence the uneven distribution of lawyers throughout the state, a fact that should help physicians help legislators understand problems in attempting to equalize manpower distribution. California's relatively high psychiatrist-population ratio and the presence of counties that are statistically anomalous should preclude the application of these findings to other states. Despite government interest in psychiatrist-population ratios as a device to estimate manpower needs, these ratios are a poor measure of access to services. Barriers to care such as lack of private insurance coverage and Medicaid and Medicare restrictions appear more powerful than uneven manpower distribution. Proposals for influencing psychiatrists' distribution should be compared with other methods of decreasing mental illness morbidity, such as mandating insurance coverage and increasing funds for preventive services and research.


The psychiatrist shortage. What's the right number? This report examines the assertion that there is a shortage of psychiatrists in the light of available methodologies for projecting the supply and demand for psychiatrists. We conclude that such projections are of little value and divert attention from other approaches to solving problems in mental health service delivery. Training institutions also have legitimate concerns that need to be addressed. Given the current state of ignorance and current fiscal constraints, government administrators should be modest about their ability to design perfect solutions and should hesitate to impose sweeping changes on the existing service delivery and training system.


New data do not suggest linkage between the Xg blood group and bipolar illness. The Xg blood group antigen (a genetic marker of a region of the X chromosome at a considerable distance from protan/deutan color blindness) was studied for linkage to bipolar manic-depressive illness. A multigenerational analytic method, taking variable penetrance into account, was used. In our series of six informative pedigrees, very close linkage could be definitively ruled out, and the likelihood of less tight linkage was consistently less than the likelihood of nonlinkage.


Differential symptom reduction by drugs and psychotherapy in acute depression. A randomized, controlled trial compared the combination of amitriptyline hydrochloride and short-term interpersonal psychotherapy, either treatment alone, and a nonscheduled treatment control group in ambulatory acute, nonbipolar, nonpsychotic depressives. Results show the efficacy of both psychotherapy and amitriptyline in overall symptom reduction. Amitriptyline and psychotherapy were about equal, and the effects of both treatments in combination were additive. The additive effect of combined treatment was largely due to the differential effects of the two treatments. Amitriptyline had its effect mainly on the vegetative symptoms of depression such as sleep and appetite disturbance, these occurred early in treatment, often within the first week. Psychotherapy had its effect mainly on mood, suicidal ideation, work, and interests; these effects occurred slightly later, at four to eight weeks.


[The influence of 2-acetylaminofluorene on the dietary induction of pentose phosphate pathway enzymes (author's transl)]. The influence of feeding 2-acetylaminofluorene on the dietary induction of the enzymes glucose-6-phosphate dehydrogenase, and 6-phosphogluconate dehydrogenase by a fasting-refeeding regime was investigated in the liver of hooded rats. After feeding a diet containing 0,03% acetylaminofluorene for two weeks, the induced activity of glucose-6-phosphate dehydrogenase was diminished significantly; after feeding this carcinogen either for 4 weeks or for 4 weeks followed by feeding carcinogen-free diet for 2 weeks, the diminution of the induction was hardly perceptible. In case of 6-phosphogluconate dehydrogenase the diminution of the induction was only slightly expressed, without statistical significance.


[Antineoplastic activity of the anthracycline antibiotic violamycin BI in mice and rats using experimental metastases models (author's transl)]. The report describes the antineoplastic activity of violamycin BI on three rodent tumour systems. The test systems are two syngeneic mouse tumours: a benzo(a)pyrene induced sarcoma and a spontaneously originated mammary carcinoma of the inbred strain XVII/Berlin. Both tumours grow in ascitic form and were weekly passaged by i.p. administrations. A third system is a dimethylhydrazine induced rectum carcinoma of the Wistar rat. This rat tumour represents a slowly growing system transplanted by s.c. administrations of tumour fragments. The principle of the screening consists of the evaluation of metastatic parameters, e.g. weight, number and growth rate of metastases, experimentally induced by i.v. administrations of tumour cell suspensions. Under the given experimental conditions violamycin BI represents an antineoplastic antibiotikum with a good effectivity which is superior to the effectivity of the reference antibiotic daunorubicin.


[Biological parameters of a standardized tumor model for chemotherapeutical and toxicological testing (author's transl)]. Biological parameters for standardization of the syngeneic i.m. transplanted ascitic sarcoma 276A in the mouse inbred strain XVII Berlin are described. As therapeutical criteria of cytostatic treatment are used the increase in lifespan of the experimental animals and the parameter E, which results from a growth kinetics obeying a Gompertz function. For estimation of the effect on other quickly proliferating tissues were determined: leukocytes, thrombocytes, reticulocytes, hemoglobin and differentiation of leukocytes. These parameters can serve for the evaluation of pharmacological effectiveness of a cytostatic agent, as shown by the example of a treatment with cyclophosphamide in two different dosages.


Long-term cultivation of human mammary carcionoma: proliferation and differential biochemical properties of the cultured cells. Human mammary carcinoma cell cultures proliferated from primary explants in Eagle's essential medium (MEM) supplemented with insulin, fetal calf serum (FCS) and/or human alpha-a1-antitrypsin. Human mammary carcinoma cells differed from normal mammary epithelial cells by the following catalytic activities: a. Thymidine uptake into the carcinoma cells was 6 to 10 fold greater, whereas thymidine conversion to CO2 was half to one fifth that of normal cells. b. The nucleolytic activity patterns of the mammary carcinoma cells preferred polycytydylic acid and double helical polynucleotides, whereas those of the normal mammary cells preferred polyuridylic acid and had no effect on double helical polynucleotides. c. The polymerase activity most evident in mammary carcinoma cells is a hybrid-dependent DNA polymerase which is guided by the ribo-strand of the template poly (rA) . poly(dT). In contrast the all-ribo template poly (rA) . poly(rU) showed little activity. d. There was slight or statistically non-significant difference between the amino acid composition of material cleaved from mammary carcinoma cells prepared from tumor tissues and from cells cultivated 10 months in vitro. e. There was no difference between the molar proportions of the carbohydrate components of the cell membrane from fresh tumor tissue and long term in vitro cultivated cells. f. The granules from long term in vitro cultured mammary carcinoma cells contained high collagenolytic, caseinolytic, fibrinolytic and esterolytic activities.


In vivo and in vitro investigations on a fast growing Brenner tumor. In vivo and in vitro investigations performed on a fast growing Brenner tumor show the following peculiarities of this tumor: 1. wide epithelial islands embedded in connective ovarian stroma, 2. rich proliferation of epithelial cells in organ cultures with the presence of mitotical figures, 3. numerical variations of chromosomes in certain metaphases. All these peculiarities reveal the tumor borderline stage.


The effect of hyperthermia 42.5 degrees C on the incorporation of 3H-thymidine into the DNA of solid tumours in childhood. Supranormal temperatures inhibit selectively the growth of malignant cells more than that of normal cells. The autoradiographic determination of the 3H-thymidine-labelling-index (LI) in vitro is a suitable method for the examination of thermosensitivity of individual human tumours. 44 solid tumours of children (Wilms' tumours, neuroblastomas, osteogenic sarcomas, non-Hodgkin-Lymphomas and other tumours) were studied by the temperatures 37.5 and 42.5 degrees C/120 min, with this method. 90% of the histologically undifferentiated tumours showed a highly significant inhibition of the 3H-thymidine incorporation between 28.6 and 79.9% with an average of 51.1%. In 4 histologically mature tumours (carcinoma of the adrenal cortex, malignant hepatoblastoma, fibrosarcoma, hamartoblastoma) no significant decrease of the LI was present. The inhibition of incorporation with hyperthermia cannot be correlated with the primary magnitude of the LI with normothermia. In 1 neuroblastoma a 75% rise of the LI was found possibly due to exogenic caused thermotolerance. The individuality of the reaction towards heat may contribute to the biological characterization of tumours.


Histological and cytological evidence of a condylomatous lesion in association with an invasive carcinoma of uterine cervix. A 38-year-old woman is presented in whom both cytological and histological evidence disclosed a flat type condylomatous lesion in the uterine cervix where an invasive squamous cell carcinoma had its origin. The significance of this association of condyloma and cervical carcinoma is discussed, and the conclusion is drawn that the cervical epithelium of the women showing condyloma-suggestive cells in the cytologic smears should be thoroughly examined and strictly followed-up because of the possibility that these virus-induced condylomatous lesions may represent the precursors of an invasive cervical carcinoma.


The Balkan endemic nephropathy and urinary tract tumors. Topographical distribution of the Balkan endemic nephropathy and tumors of urinary organs was investigated in the most affected region -- Central Serbia (Yugoslavia). The data expose that there is an association of endemic nephropathy and tumors of the pelvis and ureters, but not of the bladder. Disagreement related to the kind and degree of correlation of endemic nephropathy and tumors of the urinary organs is explained by insufficient knowledge of the problem rather than by influence of different ecological factors.


Malignant non-Hodgkin lymphomas of the epipharynx and the mesopharynx including tonsils, paranasal sinuses and neck. Histological reclassification using the "Kiel-classification". In the present study a re-classification of 96 lymphomas of the epipharynx and the mesopharynx including tonsils, paranasal sinuses and neck region was performed using the Kiel-classification. The histological criteria employed for this procedure were described briefly. 33 cases could be diagnosed as lymphomas of low grade malignancy, 50 cases belonged to the group of high grade malignancy and 13 cases remained unclassifiable. There was a light preponderance of male patients in the whole lymphoma group. The most frequent tumors were immunoblastic lymphomas, followed by immunocytomas, lymphoblastic lymphomas, centroblastic lymphomas, centroblastic/centrocytic and centrocytic lymphomas. Examples of transitions of one lymphoma type into another were demonstrated. The fact must be mentioned that lymphomas of the paranasal sinuses were nearly completely of the immunocytic or immunoblastic type.


Partial characterization of the E rosette restoring factor (RRF) from normal human serum. A factor that restores E rosette formation (RRF) was isolated and purified on AMICON membranes. After initial purification, the product showed minimal activity at a concentration of 2 microgram protein per sample. Chromatography on Sephadex G-150 of the partly purified factor caused a further rise in activity to 0.15 microgram per sample. RRF restores normal rosette formation not only by lymphocytes isolated from peripheral blood of patients with active pulmonary tuberculosis, but also stimulated E rosette formation by bone marrow cells. The factor is thermolabile, being completely inactivated at 56 degrees C and partly at 37 degrees C, and is sensitive to freezing and thawing. Its molecular weight is about 10 x 10(3) to 20 x 10(3).


Influence of classic immunosuppressants on spleen colony formation in mice. 3. Concentration of colony forming units in bone marrow and spleens of cyclophosphamide-treated mice. The concentration of colony forming units (CFU) increased nonsignificantly in bone marrow, and significantly in spleens of cyclophosphamide-treated mice, but there was no increase in the absolute number of CFU in these organs due to decreased celullarity. The serum of mice pretreated with cyclophosphamide seems to have colony-stimulating activity.


Method for studying immunologic cell-mediated response to transplanted syngeneic, allogeneic and xenogeneic fibroblasts in mice. A method is described for studying the types of host cells which react with transplanted xenogeneic, allogeneic and syngenetic fibroblasts. Fibroblasts were placed in an 0.15 mm glass fissure, thus limiting the wound reaction and making possible study of host cells infiltrating into the chamber. Under the conditions of the method, in early stages of the reaction to xenogeneic and allogeneic fibroblasts, mostly granulocytes migrated into the transplanted fissures, whereas syngeneic fibroblasts caused infiltration of only a small number of granulocytes.


Cellular and humoral response to Kunin antigen (CA) in ulcerative colitis and Crohn's disease. In 18 patients with ulcerative colitis and in 8 with Crohn's disease two tests were performed simultaneously: a) the leukocyte migration inhibition test using Kunin antigen, and b) titration of serum antibodies against this antigen. Leukocyte migration was studied by the agarose plate technique. At the concentration of 25 microgram/ml, Kunin antigen inhibited migration in five cases of ulcerative colitis and in one with Crohn's disease. This phenomenon was not observed in any of 33 control subjects. All patients in whom leukocyte migration was inhibited were in the active phase of the disease. Titers of antibodies against Kunin antigen were determined by the passive hemagglutination test in an expended group of patients comprising 61 with Crohn's disease. The antibody titer, expressed as the geometric mean of hemagglutinin titers, was nearly three times as high in patients as in 324 healthy controls. The titers were not correlated either with clinical activity of both diseases or with the results of the leukocyte migration inhibition test. The significance of these findings is discussed in the light of other data indicating that Kunin antigen plays a role in the pathogenesis of inflammatory bowel disease.


Differential cell-cycle-dependent inhibition of DNA synthesis by hydroxyurea and cytosine arabinoside in cultured L5178Y mouse lymphoma cells. The effect of various concentrations of hydroxyurea and cytosine arabinoside on DNA synthesis, measured as 3H-thymidine incorporation, in exponentially growing and synchronized L5178Y cells in culture was investigated. The experiments revealed that each compound causes differential inhibition of DNA synthesis at various times of the S-phase. Maximum sensitivity to hydroxyurea occurred in cells in the late S, and maximum sensitivity to cytosine arabinoside in the early S-phase. When they were given simultaneously in low concentrations an additive effect was observed.


Activity of the reticuloendothelial system in the course of experimental burn disease. The influence of extensive thermal on selected functions of the reticuloendothelial system (RES) was studied in 35 rabbits of both sexes. Phagocytic activity was evaluated by the method of Malpern et al. and by the isotope method. The results indicate marked prolongation of the depression of phagocytic function of the RES in the course of burn disease. In animals which died early in the course of burn disease, RES activity was depressed throughout the period of observation. In animals which survived burn disease, RES activity underwent periodic changes.


Production of interferon in human diploid cell cultures. II. Effect of various factors on interferon production in human diploid cell cultures. Interferon was induced in primary human embryonic fibroblast cultures, using the Newcastle disease virus and synthetic polynucleotide poly I : poly C. Kinetics of interferon production were studied in this system, and optimal doses of some chemical factors which enhance interferon production were determined.


Cardiac output and contractility indices: establishing a standard in response to low-to-moderate level exercise in healthy men. Measurement by impedance cardiography (ZCG) of cardiac output and contractility indices during exercise is a recent addition to exercise testing of the cardiac patient. To provide a needed standard of normal responses to exercise at integrals of resting oxygen consumption (METS), 10 healthy men were tested. Basal oxygen consumption (1MET) under standardized conditions was measured by mass spectrometry. Over several days the subjects were exercised on a treadmill at 2METS through 6METS with monitoring of heart rate, electrocardiogram, oxygen consumption per minute (VO2) and ZCG. The exercise routine was then repeated to look for test-retest effect. Values closely approximating presently accepted basal oxygen consumptions were achieved under these standardized but practical conditions. Cardiac output during sitting, fully supported rest was slightly higher than that at 2METS on treadmill owing to higher stroke volume. From 2METS through 6METS the curvilinear mean heart rate and stroke volume were mirror images, producing a linear increase in mean cardiac output which at 6METS was 145% of basal and 160% of the 2MET value, while the contractility index increased to 217% of basal. Comparison of the 2 trials revealed no significant test-retest effect.


Endurance training and cardiovascular function in 9-and 10-year-old boys. Thirty-two boys, 9 and 10 years old, were randomly divided into experimental and control groups in order to investigate cardiovascular responses to interval cycle training. The experimental group exercised on a cycle ergometer 5 days a week during their physical education periods. There were 4 work bouts of 4 minutes each, separated by 3-minute recovery intervals each day for 8 weeks. Loads were prescribed so that heart rates ranged from 170 to 195 for each bout (80--90% estimated maximum). The control group took part in a traditional sports-oriented physical education period during this time. Pretest steady-state values at HR130 were determined for oxygen consumption, heart rate, and cardiac output, after which the load was progressively increased to determine physical work capacity at heart rate 170. The tests were repeated after the 8-week training period, at work loads identical to pretest values. Analysis of covariance revealed that significant improvements in the experimental group occurred in stroke volume and oxygen pulse. The 6.5% increase in stroke volume was countered by a 6.8% decrease in heart rate, resulting in no differences in cardiac output. Increases in physical work capacity occurred in each group, but only that of the experimental group was significant. No differences were detected for either group in steady state oxygen consumption or calculated arteriovenous oxygen difference. It was concluded that children of this age level adapt readily to cardiovascular stress. It was suggested that if improvement in cardiovascular fitness is considered to be a valid goal of physical education, then the traditional sports and games should be supplemented by training procedures designed specifically for endurance.


Thermal response of skin to application of localized pressure. Pressure was applied to a small circular area of the skin over the trochanter of human subjects for variable time periods. The local skin temperature response was monitored during and after pressure application. Pressures of 100, 200, and 300mmHg were applied for time periods of between 11 and 67 minutes. Upon the release of pressure the local skin temperature rose quickly and then gradually decreased. Peak temperature responses occurred at between 3 and 5 minutes after pressure release. Larger pressure and longer application times produced larger peak temperature increases, with the largest individual increase being 1.9C. The data derived from the study tend to quantify what clinicians have long appreciated in a qualitative sense, especially in areas where decubitus ulcers most often occur.


Spinal cord injury: time out of bed during rehabilitation. Preliminary experience in applying unobtrusive instrumentation to monitor selected patient activities over extended periods of time has shown this procedure to be both feasible and useful. The target activity studied was time out of bed (TOB) for 36 spinal cord injury patients undergoing comprehensive rehabilitation. Measurements were made with a rest-time monitor (RTM), which provides an objective daily record of how often and for how long a patient is out of bed. During the initial week of mobilization, paraplegic patients (n = 14) were out of bed for an average of 1.7 hours and quadriplegic patients (n = 22) for an average of 1.5 hours. Maximum TOB in each group was 8.7 and 9.2 hours, respectively, which dropped to 7.2 and 7.8 hours at time of discharge. Based on this experience, a standard activity curve has been developed which is used as a reference in assessing the weekly progress of individual patients. Distinctive types of activity patterns are described in relation to clinical and functional outcomes during hospitalization and 12 months after discharge.


Energy cost of ambulation in paraplegic patients using Craig-Scott braces. Energy metabolism data were collected in a series of 8 male paraplegic patients with neurologically complete spinal cord lesions between T4 and T12 (1 patient had complete motor paralysis with incomplete sensory function). Energy costs were measured at the subject's seated basal rate (mean = 17.12cal/min/kg) and during 2 separate trials at ambulation using Craig-Scott braces. The rates of ambulation reflected the patient's perceived comfortable rate and ranged from 2.2 to 44.8m/min. (mean = 14m/min). The subjects ambulated in a straight line, with the data collection instrumentation (the Mobile Automatic Metabolic Analyzer) moving alongside. Mean O2 consumption was 0.1867ml/sec/kg and mean energy cost was 52.96 cal/min/kg, which when compared to a mean of 17.12 cal/min/kg at their resting state, represents a 3-fold increase in their energy cost. Three cases were further measured for O2 debt, which ranged from 1483 to 3112 ml and was repaid completely within 10 minutes post-walk.


Attitude changes following a sexual counseling program for spinal cord injured persons. The attitudes of a sample of spinal cord injured outpatients toward a range of sexual behaviors were measured before and after participation in a counseling program. In comparison to the sexual attitudes of an untreated control group those of the sample group were found to be more permissive after than before the program. In addition, the counseling program, which operated in a workshop format over a period of 6 weeks, was favorably evaluated by participants on a number of criteria.


Pain in patients with spinal cord injury. For this study of intractable pain after spinal cord injury (SCI), a questionnaire was developed, pilot-tested and mailed to 356 previously hospitalized SCI patients, 200 (56%) of whom returned the completed questionnaire. Of the respondents, 160 (80%) reported abnormal sensation and 96 (48%) called the discomfort painful. Abnormal sensations were first noted within 6 months of injury by 105 patients, from 7 months to 4 years after injury by 39, and longer than 4 years after injury or unknown by 16. Pain locations varied and were unrelated to the level of lesion. In 30% of those reporting abnormal sensation the location of pain remained stationary, whereas in 17% it changed over time. The intensity of pain was described as severe to extreme by 25%; 44% indicated that it interfered with daily activities. Increase of pain over time was noted by 41%. Activity, inactivity, weather change and overexertion were not frequently identified as aggravating circumstances. Rest and medication were cited as alleviating factors. Approximately 38% of those experiencing pain used medications but only 22% obtained consistent relief from their use. Patients with low level lesions were more willing to exchange a hypothetical chance of recovery and/or loss of reacquired physiologic functions for pain relief than were patients with higher lesions.


Reinterpretative cognitive strategies in chronic pain management. This preliminary study was conducted to test the effectiveness of cognitive treatment of clinical pain. Chronic pain patients were trained in a self-control cognitive strategy procedure. Specifically, they were provided with a conceptualization of their pain, instructed in an awareness of their thoughts prior to and during their experience of pain, and trained in the use of several cognitive strategies to replace these thoughts and relabel their pain experience. Training was provided in a group setting to further consolidate the use of the instructions by enabling patients to roleplay the instructions to one another. Patients were also encouraged to verbally reinforce themselves each time they used the procedure. The experience of pain was measured by the McGill pain questionnaire, a behavioral checklist and staff reports. Results suggest that cognitive strategies can effectively alter the experience of clinical pain. Moreover, pain as a cognitive label for a nonspecific state of arousal is suggested.


[Hormonal regulation of uterine contraction]. A personal method has been used to study spontaneous kinetic activity of the uterus in 50 women during puerperium following miscarriage between the VIIIth and XIIth weeks. Modifications induced were evaluated in several sessions (510 recordings) and at various periods of time, following administration of: 50 mg of 17B oestradiol, 200 mg natural progesterone, 500 mg of natural progesterone, 250 mg of 17 hydroxyprogesterone caproate and 500 mg of 17 hydroxyprogesterone caproate. In the case of some of the patients, hysterotonometry was evaluated following intravenous oxytocin loading. The results pointed to an activation of the uterine pacemaker after oestrogenic loading, and a clear-cut progestinic block of contractile activity.


[Epithelial neoplasms of the head and neck. Study of 72 cases treated with radiotherapy only or combined with chemotherapy]. A comparison between the effects of radiotherapy with and without supplementary chemotherapy in 72 cases of head and neck tumours treated Turin, Oncology Department is reported. The overall results were similar to those in the international literature (59.7% local remissions 2 yr after treatment). Personal experience is cited for the view that radiotherapy alone should always be employed on the satellite lymph node chains in N0 patients (clinically negative nodes), whereas chemotherapy should be added when node positivity (N1 or N2) is apparent at the outset.


Women's sexual arousal concurrently assessed by three genital measures. The relationship among three objective measures of genital vasocongestion in women was evaluated both during and after an erotic film using simultaneous recording of both vaginal pressure pulse and vaginal blood volume responses by means of photoplethysmography and of labial temperature change by means of a thermistor clip. During the film each of the genital measures increased for most subjects, resulting in highly significant positive correlations between measures. However, following the erotic film presentation there was considerably less direct correspondence among the three measures; although the genital reactions of most subjects subsided to some extent following the film, none of the three measures consistently returned to prestimulation levels. Periodic estimates of subjective levels of sexual arousal were significantly correlated with each of the genital measures during the erotic film but were not significantly correlated with any after the film.


[Personal experience with thermographic studies of skeletal metastasis of breast cancer]. Dynamic telethermography may be usefully employed, alone or in association with X-ray or scintigraphy investigations, for the evaluation of skeletal metastases both diagnostically (differential diagnosis, screening of pains in patients with tumours, study of the extent of metastatic bone localizations) and prognostico-therapeutically (assessment of the effectiveness of chemo-hormonal or radiant treatment).


[Cardiovascular and respiratory reflex responses due to stimulation of muscle nerve receptors and experimental physical exercise]. The cardiovascular and respiratory reflex effects brought on by the infection into the femoral artery of bradyquinine and of hypertonic sodium chloride solutions and by rhythmic muscular work and muscular work of tetanic type induced by low and high frequency electrostimulation in the muscles have been investigated in the rear extremity anaesthetized rabbits. Intra-arterial injection of bradyquinine and rhythmic muscular contractions trigger off cardiovascular reflux effects of inhibitory type represented by a reduction in arterial pressure, heart frequency and vascular resistances of the rear extremity controlateral to the one stimulated. Intra-arterial injection of hypertonic NaCl and tetanic contractions cause opposite effects, namely of decidedly excitatory type. Such responses are not substantially altered by complete removal of the skin layer of the stimulated extremity. The neuromuscular block obtained with curare-like substances does not affect chemical stimulation responses, whereas it eliminates similar effects caused by experimental muscular work. The experiments carried out show that injection into the muscular arteries of chemical agents of various type produces varying cardiovascular reflex effects as a result of activation of chemosensitive nervous receptors located in the muscular tissue, and also that during physical exercise similar reflex modifications are produced, very probably caused by stimulation of receptors present in the contracting muscles.


[Clinical and statistical study of 843 hospitalized diabetics]. A retrospective cross study of 843 hospitalized diabetics is reported. The heterogeneity of the sample was obviated to some extent by subdividing it into age, duration and diabetes mellitus treatment groups. The major part of the sample consisted of elderly patients presenting the characteristic correlations between hyperglycaemia, overweight and triglyceridaemia common to insulin-resistant diabetes. Impairment of the cardiovascular system and particularly the coronary circulation, was particularly serious. Stress is laid on the need to standardize study of the diabetic in the interests of a correct, epidemiological and clinical approach to the disease.


Effects of testosterone undecanoate on sexual potency and the hypothalamic-pituitary-gonadal axis of impotent males. A double-blind comparison was made of the effects of testosterone undecanoate (TU) and placebo on sexual potency of 29 impotent men ages 45--75. The main criteria for inclusion in the study were a reduced or nonexistent capacity to have an erection during intercourse and no clinical signs of endocrinological pathology. All patients received placebo for 2 weeks. Then TU was given at a daily dose of 120 mg to 13 patients selected at random while the other patients continued to receive placebo. After 8 weeks all patients received placebo again for 2 weeks. An improvement in sexual potency was reported by five patients given TU and eight patients given placebo, with no significant differences between the groups. Treatment with TU influenced neither the hypothalamic-pituitary-gonadal axis, as judged by levels of prolactin, LH, FSH, and the LHRH-induced LH/FSH response, nor depression, anxiety, and somatic scores or performance tests. The only specific effect of TU treatment was to decrease the total plasma testosterone level. The present findings show pharmacotherapy with androgens to be no more effective than placebo in restoring sexual potency to sexually impotent men without androgen deficiency. Further studies may be needed to elucidate fully the effects of androgen administration on psychological and endocrinological variables in such patients.


[Physiopathological and clinical features of hypernatremia]. The observation of hypernatriaemia in a large series under a variety of clinical conditions (gastrointestinal loss, increased "forced loss", and insufficiency parenteral feeding) is made the occasional for an overview of its main physiopathological and clinical features. From the physiopathological standpoint, the syndrome is rarely coupled with an absolute water deficiency. More commonly, sodium and water losses go together to bring about a fall in both intracellular and extracellular volume. The clinical significance of hypernatriaemia is essentially linked to increased osmolar content, not only of the extracellular liquid, but more particularly (due to water depletion) of the intracellular compartment, which underlies the establishment and progress of the anatomopathological lesions and the clinical symptoms.


[Treatment of Hodgkin's disease: review of 90 cases]. 90 patients suffering from Hodgkin's disease, 32 in stages I and II, 42 in stage III and 16 in stage IV have been studied retrospectively. The first were treated with supra and subdiaphragmatic extensive radiotherapy, the second with total nodal or polychemotherapy (MOPP), the third with polychemotherapy. Results were highly satisfactory in stages I and II with a complete remission rate of 100% (duration: 4/100 months) and with survival of 91.8% at 7 years. At the 3rd stage,  total nodal therapy led to complete remission in 73.3% of patients (9--46 months) with 5-year survival of 76.1%; at this stage, polychemotherapy induced complete remission in 65.2% of cases (6--34 months) with 4-year survival of 64%. Much worse were the results of polychemotherapy in the IVth stage. The same series has been reconsidered with allowance for explorative laparotomy by splenectomy carried out in 15 patients in I-II stage and treated with extensive radiotherapy, in 7 IIIrd stage patients subjected to total nodal therapy and in 10 in IIIrd stage treated with MOPP. In IIIrd stage splenectomized patients, the incidence of recurrences is lower than in the controls and independent of treatment. The lower incidence of recurrences also observed in I-II stage cannot be evaluated for the moment.


Female-to-male transsexuals compared to lesbians: behavioral patterns of childhood and adolescent development. We report detailed interview data on a clinical sample (N = 15) of female-to-male transsexuals (FTs) compared to a matched research sample (N = 15) of lesbians (Ls). Both groups were relatively young, with a mean age of 21 years 10 months (FTs) and 23 years 8 months (Ls), respectively, and were of middle or lower SES. Both groups did not differ from each other in respect to frequency of tomboyish behavior or interest in doll play and other aspects of materanl rehearsal. Male peer preference was more often remembered among the FTs, but the difference between the groups was only of borderline significance. The groups differed significantly regarding childhood cross-dressing (80% for FTs, 0% for Ls), gender identity confusion in adolescence (absent among Ls), and negative reaction to breast development and menarche (approximately 70% for FTs, 10% for Ls). The similarities and differences between the two groups in childhood and adolescent development are relevant for clinical management and the differential diagnosis of transsexualism vs. lesbianism.


Psychopathology in self-identified female-to-male transsexuals, homosexuals, and heterosexuals. The comparative self-esteem and psychological well-being of female-to-male transsexuals, homosexuals, and heterosexuals (patient and nonpatient) were studied. Results indicated that individual candidates for sex-change surgery varied appreciably in self-concept and adjustment, and as a group were indistinguishable from psychiatric controls. Nonpatient homosexuals and heterosexuals demonstrated the most positive self-esteem and level of adjustment.


[A case of perirenal myxoid liposarcoma]. Radical operation of a right perirenal myxoid liposarcoma is reported. Retroperitoneal sarcomas, in fact, show little response to antiblastic and radiation management. It is pointed out that angiographic diagnosis is an essential prelmiminary to correct surgical indication, particularly since the clinical picture may well be indistinct and poorly specific.


[Draize's test in assessment of eye tolerance to various cosmetic products]. The methods of Marzulli-Ruggles and Draize were used in an assessment of eye irritation on the part of three children's shampoos. Two products proved irritant with the Marzulli-Ruggles method. The most aggressive product was designated VAS-2-36/A. Better tolerance was observed in albino rabbits when the Draize method was used, though even here some ocular alterations were noted. Once again, VAS-2-36/A was the most irritant substance.


Flexibility, persistence, and success in sex therapy. The predictive utility of patient flexibility as a moderator of persistence and benefit from sex therapy was examined. In addition to a direct self-report flexibility scale, 21 couples completed psychometric measures of sexual and marital compatibility before undergoing a modified Masters and Johnson sexual retraining regimen. Following treatment the 15 continuing pairs filled out the same satisfaction inventories and, along with their male and female cotherapists, made posttherapy ratings of change on sex-specific personal and marital criteria. Flexibility proved to be a strikingly effective discriminator of remainers from early terminators and demonstrated promise as a predictor of favorable sex therapy outcome. Results are discussed in terms of the need to identify and prepare rigid individuals who cannot easily accommodate the relatively directive and value-laden features of sexual retraining.


Program evaluation in sex education: outcome assessment of sexual awareness weekend workshops. The results of an outcome assessment of a growth-oriented sex education program are reported. The evaluation project attempted to overcome flaws of existing sex education research by explicitly delineating goals and by incorporating both a rigorous experimental control group design and quasiexperimental cohort comparisons. A Sex Questionnaire (covering sexual knowledge, attitudes, and behavior) was administered to the participants of three weekend workshops at the tiem of registration and 1 month later. Overflow resistration for one workshop permitted the random selection of a no-program control group. Results supported inferences of workshop effectiveness in meeting program goals in the areas of attitude and behavior change, but not with regard to increasing sexual knowledge. Implications for development and evaluation of sex education programs are discussed.


Vitamin A (retinol) status in the rat after a single oral dose of 2,3,7,8-tetrachlorodibenzo-p-dioxin. The effect of a single oral dose of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), 10 microgram . kg-1, on the status of vitamin A (retinol) was studied in rats during an eight week period after administration. Retinol was determined spectrophotometrically after separation by means of high pressure liquid chromatography. In the liver of control animals the total storage and the concentration of retinol were found to increase linearly with time whilst in the TCDD-exposed animals both the concentration and total storage remained essentially unchanged. Differences in the storage levels were evident after 4 days, and after 8 weeks the treated animals had a total liver storage corresponding to about 30% of the controls. Retinol levels in serum were significantly higher in the treated animals after week 1 and 2.