Graduated internal dilatation in the treatment of fibromuscular dysplasia of the internal carotid artery. A patient with transient ischaemic attacks due to fibromuscular dysplasia of the internal carotid artery is presented. Standard methods of vascular reconstruction may not be possible as the disease often involves the distal half or two-thirds of the extracranial internal carotid artery. For this reason the technique of graduated internal dilatation first described by Morris et al. was employed and showed satisfactory results on short-term follow-up.


The use of phenothiazines and tricyclic antidepressants in the treatment of intractable pain. The use of trifluoperazine and amitriptyline in the treatment of pain is described. Of 12 patients who were suffering chronic pain from various causes, 8 obtained a major degree of relief from the use of this combination of drugs.


Tuberculosis of the skull vault: a case report. We describe a 3-year-old boy who had fluctuating swellings of the head and an infra-orbital sinus which were due to tuberculous osteitis. On radiological examination, the lesions may be found to be multifocal, and usually appear to be circumscribed and lytic. Definitive diagnosis depends, however, on bone biopsy.


Pneumoconiosis in non-mining industries on the Witwatersrand. Two hundred and eighty-seven patients referred to the National Research Institute for Occupational Diseases with suspected pneumoconiosis are recorded. The patients are classified according to the type of dust to which they were exposed, and by occupation or industry. Radiological evidence of pneumoconiosis according to ILO/UICC classification is the only acceptable basis for compensation at present, and the number of patients so diagnosed is also given. None of these figures show the true distribution and incidence of pneumoconiosis as a form of occupational disease on the Witwatersrand. They only indicate the presence of pneumoconiosis not associated with mining and reflect a wide range of occupations.


Tests for completeness of vagotomy.

Tests for completeness of vagotomy. A battery of tests was applied to 60 patients at periods varying from 2 to 24 months after they had undergone truncal vagotomy (42 with pyloroplasty, 18 with gastro-enterostomy). The major comparison was between those with endoscopic evidence of recurrent duodenal ulcers, and those in whom endoscopy showed no abnormality. Tests which differentiated between the two groups to a statistically significant extent were those for increased acid concentration in the first hour after insulin and serum gastrin, which was lower in this group. Useful, but statistically not significant tests, in patients with no endoscopic evidence of recurrent ulcers, were a postoperative decrease in basal acid output and maximal acid output after pentagastrin or insulin. Symptoms, the combined pentagastrin-insulin test, the volume of acid secreted after insulin, and the acid concentration in the second hour after insulin stimulation were poor indicators for differentiating between patients with recurrent ulcers and those without ulcers. Almost as much information was obtained by the postoperative basal acid output alone as by the pentagastrin and insulin stimulatory tests.


Amniotic membranes as a biological dressing. Amniotic membrane dressings were tested in the treatment of 30 patients. Fifteen of them had burns, 5 had chronic varicose ulcers, and 10 had decubitus ulcers or other open infected wounds. No effort was made to separate the chorion from the amnion. Dressings were changed every 48 hours, and treatment was, in some cases, partially ambulatory. Good results were obtained in the treatment of 2nd- and 3rd-degree burns and of other open, infected wounds, both in the preparation of the patients for autografting and in consequent treatment.


Bone cement and antibiotics.

Bone cement and antibiotics. Antibiotics of various kinds were added to the powdered polymer of methylmethacrylate in a concentration of 1 g antibiotic/40 g cement, prior to the addition of the liquid monomer. Specimens were subjected to mechanical testing by loading them in direct compression on a 20-ton Instron Universal Testing Machine, and load deflection curves were recorded. It was found that the addition of antibiotics does have an effect on the mechanical strength of the cement--the loss was small, less than 10% for both the compressive strength and the elastic modulus, provided the antibiotic was in powder form. Liquid antibiotics resulted in a greater loss of the compressive strength of the mixtures, but specimens tended to be less porous. In vitro studies of the antibiotic properties of the mixtures demonstrated potent antibacterial activity in all the antibiotics tested, except chloramphenicol. Possible clinical applications are discussed. Further in vivo studies are needed before widespread clinical use can be advocated.


Rhinosporidiosis: case reports.

Rhinosporidiosis: case reports. Two cases of rhinosporidiosis are reported from Natal. Rhinosporidiosis is a benign fungal disease, usually of the nose and upper respiratory tract and closely resembles the common angiomatous nasal polyp.


Medicine at McMaster; an innovative programme for undergraduates. An innovative programme in undergraduate medical education, developed at the McMaster Medical School in Hamilton, Canada, is described. A number of features distinguish the McMaster approach from the more traditional system. Among these is a firm commitment to well-defined goals which stress the need for comprehensive patient care and an awareness of changing patterns of health delivery. Emphasis is placed on the student as the focal point in the educational process and a flexible curriculum provides the medium through which all facets of this novel system can best find expression.


OASDI (Old-Age and Survivors Insurance): fiscal basis and long-range cost projections. A thorough understanding of the financing structure of social security is a prerequisite to serious discussion of the financial condition of the program. In examining this structure, it becomes clear that the most important test of the program's financial soundness is whether expected future income to the funds equals expected future expenditures. Short-range and long-range cost estimates indicate that this condition does not exist and that an actual deficit of 7.96 percent of taxable payroll, equivalent to $4.3 trillion, needs to be eliminated--half of it perhaps by stabilizing benefits at current levels in relation to preretirement earnings. In addition, an unfunded accrued liability of $3.1 trillion exists, although there is no indication that this liability needs to be funded.


Thirteenth valuation of the railroad retirement system. The most recent valuation of the financial condition of the railroad retirement system reveals that an existing actuarial deficiency will become more pronounced over time unless corrective action is taken. After projecting the progress of the fund under present law and certain assumptions about the future, the Railroad Retirement Board has concluded that the present value of benefits can be maintained only if the tax rate--already considerably higher for employers than under the social security program--is raised. An immediate increase of 4.1 percent of taxable payroll is required to effect an actuarial balance. Alternatively, a rise of 2.6 percent would be sufficient to prolong the fund until the year 2001. If the present tax rate is not changed, the fund is projected to run out in 1986.


State supplementation under SSI, 1975.

State supplementation under SSI, 1975. This article summarizes State supplementation activities under SSI for 1975. It discusses changes in the State programs that occurred during 1975 and presents some comparisons with data for 1974--the initial year of the SSI program. A slight shift occurred in the distribution of recipients by eligibility category for Federal and State supplementation from 1974 to 1975. During 1975 a few States changed from Federal administration to State administration of their mandatory supplementation programs while a few others initiated or expanded their optional supplementation programs. Several States also increased their supplements during the year.


Private industry health insurance plans: type of administration and insurer in 1974. This report examines the major forms of administration of private health insurance plans. Plans are classified according to whether they are employer-only or joint worker-employer-operated and according to whether they are negotiated or not. A further focus of examination that often reflects industry patterns is whether the plans cover workers of a single employer or involve multi-employer arrangements. These classifications of administration and the method of insuring benefits are examined in terms of proportions of workers with specified plan characteristics and health benefits.


Private industry health insurance plans: employment requirements for coverage in 1974. In 1974, approximately 28.4 million active workers participating in almost 52,000 health plans on their jobs were covered by in-hospital health insurance benefits. A survey of these plans, conducted for the Social Security Administration by the Bureau of Labor Statistics, revealed that not all workers are automatically entitled to benefits on the first day they report for work. More than three-fifths had to fulfill at least one job-related requirement before their hospital coverage was effective. The extent and variety of employment requirements in private industry are discussed here along with data that show how plans that have such requirements differ from those that do not.


Aged women OASDI beneficiaries: income and characteristics, 1971. This article examines selected benefit characteristics--primary insurance amount, entitlement status, and actuarial reduction--of women aged 62 and over and the relationship between these characteristics and the receipt of income from other sources and the size of total income in 1971. Special attention is given to age variations in beneficiary and income factors and to the comparatively disadvantageous economic situation of the oldest cohorts of aged beneficiary women. A major conclusion is that the lower incomes of the oldest cohorts were largely due to the fact that OASDI cash benefits are not adjusted to reflect rising wage levels after retirement or to steady increases in the taxable maximum.


Immediate changes in blood flow and oxygen metabolism of the cirrhotic liver following portacaval shunt operations. In 15 patients with cirrhosis of the liver, the pressures in a systemic artery, in the inferior vena cava and the portal vein, flows in the portal vein and the hepatic artery, and oxygen content and acid-base balance in the arterial, portal and hepatic venous blood were studied during operation before and after the construction of an end-to-side portacaval shunt. Portal pressure decreased from 23 to 13 millimeters of mercury. Portal flow increased from 660 mililiters per minute to the liver to 1,300 milliliters per minute through the shunt. Hepatic arterial flow increased from 230 to 480 milliliters per minute, but this did not fully compensate for the loss of portal blood flow to the liver. Accordingly, total hepatic blood flow was reduced. There was also a decrease in the oxygen transport to the liver, but in spite of this, there was no change in the oxygen content in the hepatic vein nor any production of acid metabolites. Possible implications of these findings on the preoperative investigation of patients with portal hypertension are discussed.


Carcinoma of the cecum.

Carcinoma of the cecum. During the ten year period of this retrospective study, 66 of 1,451 patients with carcinoma of the colon and rectum had carcinoma of the cecum. The most frequent symptoms were nonspecific and caused by anemia which, in some instances, were treated without adequate investigation. The standard and most appropriate treatment for carcinoma of the cecum is a right hemicolectomy with ileotranversostomy and, when necessary and feasible, en bloc resection of involved parts of the abdominal wall. In the absence of nodal disease or distant metastases, extension to the abdominal wall does not adversely influence the prognosis. The surgeon must remain aware of the possibility of coexisting carcinoma of the cecum and appendicitis. Any patient with a mass or a persistent draining sinus after an appendectomy or drainage of an appendical abscess should be suspected of having carcinoma of the cecum. The over-all five year survival rate in this series is 33%, and if curative resections alone are considered, it is 44%, with an operative mortality of 3%. More recent evidence indicates that there has been a shortening of the delay in treatment, and we believe future studies will show an improvement in these figures.


Prognosis in well differentiated noninvasive carcinoma of the bladder based on chromosomal analysis. In this series of 27 consecutive patients with well differentiated noninvasive carcinoma of the bladder, cytogenetic analysis repeatedly performed showed marker chromosomes in curative cytoscopic resections of 15 of the patients. In 14 of the 15 patients, recurrent carcinoma developed. Of the 12 patients without markers, one patient had a recurrence; the remaining 11 have been free of recurrence up to eight years after diagnosis. In this long term, although limited, experience with early carcinoma of the bladder, marker chromosomes have been a highly accurate prognostic aid.


Disseminated intravascular coagulation and refractory shock induced by splanchnic metabolic acidosis. In eight dogs, acidosis was induced by the infusion of lactic acid into the superior mesenteric artery in a dose of 5.0 to 12.5 millimoles per kilogram during a 30 minute period. Four dogs out of five in which the lowest pH of arterial blood was lower than 7 developed a typical acute disseminated intravascular coagulation, accompanied by a sudden elevation of arterial and portal venous pressure. In these four dogs, refractory shock developed between 0.5 and five hours after lactic acid infusion. The other four without disseminated intravascular coagulation maintained a normal blood pressure and survived until sacrifice six hours after infusion. In two dogs, systemic infusion of 10 millimoles per kilogram was performed in the same interval as the former. Both died from cardiac failure without occurrence of disseminated intravascular coagulation before the infusion was completed. The dogs with disseminated intravascular coagulation revealed a marked deterioration of coagulative system  and generalized thrombi in the intestine, liver, lung and kidney. Minimal changes in these parameters were observed in the dogs without disseminated intravascular coagulation. The results suggest that the infusion of lactic acid into the superior mesenteric artery is a convenient model for the production of disseminated intravascular coagulation and resultant shock.


The role of biliary scanning in the investigation of the surgically jaundiced patient. The diagnostic accuracy of biliary scanning using 99mTc-pyridoxylideneglutamate has been determined in a series of 51 surgically jaundiced patients. This noninvasive technique was found to be safe, reliable and universally applicable in all instances of jaundice, regardless of the serum bilirubin value or prothrombin time. The results were found to compare favorably with those of other investigative procedures. It is suggested that the 99mTc-pyridoxylideneglutamate biliary scan is most advantageously carried out after clinical assessment and full biochemical evaluation of the patient. The scan result will indicate the next logical step in the management of the patient whether it be endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, biopsy of the liver or laparotomy.


Local blood flow characteristics of arteriovenous fistulas in the forearm for dialysis. Local flow characteristics were studied in 21 patients with end-to-side cephalic vein to radial artery fistulas, constructed in the wrist for chronic hemodialysis. Intraoperative electromagnetic flow studies indicated a mean fistula flow of 242+/-72 milliliters per minute. Approximately two-thirds of the total fistula flow was derived from antegrade flow in the proximal part of the radial artery and one-third from retrograde flow in the distal part of the radial artery. Temporary occlusion of the distal part of the radial artery caused a 36% decrease in total fistula flow. Ten patients had an initial spasm of the radial artery which abated after 20 minutes. Calculations of a cross sectional area indicate that the size of the radial artery is more important than the size of the cephalic vein or the anastomosis in limiting total fistula flow. End of vein to side of artery anastomoses are preferred to end-to-end anastomoses because immediate retrograde flow in the distal part of the radial artery contributes significantly to total fistula flow.


Submucosal vagotomy of the canine gastric fundus. Ethyl alcohol infiltration of the submucosa of canine denervated gastric pouches markedly reduced the gastric secretory responses to histamine and food without changing the histologic appearance. It is postulated that the ethyl alcohol destroyed the submucosal nerve plexus which regulates the parietal cells.


Ths significance of metastases to the adrenal glands in adenocarcinoma of the colon and rectum. A study to determine the frequency of metastases to the adrenal glands following carcinoma of the colon and rectum was undertaken. Patients with, or without, adrenal spread were compared regarding age, sex, race and survival time. The over-all metastatic pattern was analyzed to determine its usefulness for predicting the presence of metastases to the adrenal glands. Autopsy reports and clinical records of patients with adrenal spread were reviewed regarding the extent of tumor involvement in the glands and possible adrenal insufficiency. Of 457 patients with adenocarcinoma of the colon and rectum who underwent autopsy, 63 or 14% had metastasis to the adrenal glands. Of these, 29 had bilateral involvement. Patients with bilateral metastases had a lower median age than did those without adrenal spread. No correlation was found between adrenal metastatic status and sex or race. Although survival time was found to be shorter for patients with bilateral metastases of the adrenal glands, adrenal insufficiency did not seem to be the reason for this shorter survival time. In retrospect, however, the presence of adrenal insufficiency could not be ruled out in several of these patients. Eight sites were studied with regard to whether or not metastatic involvement in a specific site might indicate a higher risk for simultaneous metastases to the adrenal glands. It was found for all sites that, when involved, there was a higher frequency of metastases to the adrenals than if free of tumor. Metastases especially above the diaphragm indicated a considerable risk for adrenal involvement. Different sites were combined in groups and studied in the same way. It was found that the more sites involved, the higher the relative chance of metastases to the adrenals. It was suggested that the results presented may be useful in predicting the relative chance of adrenal metastases in patients with advanced carcinoma of the colon and rectum.


Surgical considerations in the treatment of renovascular hypertension. The most frequent causes of postoperative failure in operations for stenosis of the renal artery are technical errors, that is, incomplete correction of renal inflow or outflow, or both, and incorrect selection of patients with additional damage to the parenchyma of the kidney. Several new principles ensure a high degree of security in the correction of impaired renal blood flow: one field correction; partial ex situ repair; improvement of the renal run-off by mechanical dilatation of the arterial branches, and one session repair of contralateral renal artery or other intraabdominal vascular lesions. Total segmental occlusions of the main artery, with or without impending uremia, should no longer be considered as a routine indication for nephrectomy, particularly when residual renal function and contralateral blood supply to the post-occlusive kidney can be demonstrated. Surgical revascularization may offer remarkably good results and achieve normalization of renovascular hypertension and kidney function.


Total hip replacement in disseminated neoplastic disease. Between 1972 and 1975, 11 total hip replacements were performed on ten patients with advanced neoplastic disease. Eight of ten patients survived more than one year after total hip replacement. Eight of 11 hips were rated as having excellent or good functional results six months postoperatively. We suggest that total hip arthroplasty be considered an appropriate procedure in the operative management of patients with advanced neoplastic disease involving the hip.


Assessment and resection of carcinoma at the gastroesophageal junction. In a five year retrospective study of 70 patients, the roentgenologic and surgical assessments of carcinoma at the gastroesophageal junction have been compared to the histologic findings of the resected specimens. Although the lesion was demonstrated roentgenologically in all patients, no reliable indication of its limits could be obtained, and spread was seriously underestimated by both preoperative barium studies and direct examination at operation. It is suggested that the lack of roentgenologic evidence may have encouraged an inadequate surgical approach and, thus, contributed to incomplete resection and the high immediate mortality. There is, at present, no satisfactory method by which spread can be defined, either before or at operation, and neither the preoperative barium studies nor his operative assessment should influence the surgeon to limit the resection.


Recurrent laryngeal nerve injury following thyroid operations. Preoperative and postoperative laryngoscopy should be performed with thyroid operations. A prospective study of 121 thyroid operations from June 1970 to December 1974 was analyzed. There was a 4.2 per cent recurrent laryngeal nerve injury incidence in 217 nerves at risk, four of nine injuries being permanent. Of 217 superior laryngeal nerves at risk, 1.4% were injured, one of three permanently. Previous thyroid operations may place the laryngeal nerves at a greater risk. Transient edema of the laryngeal nerve in 13.4% of the patients was believed due to endotracheal intubation. There seemed to be no difference in the incidence of injury whether the nerves were seen or palpated. It is recommended that indirect laryngoscopy be performed in the course of evaluating thyroid disorders.


A technique for isolation of ileostomy drainage during abdominal operations. An abdominal operation performed upon a patient with an existing ileostomy carries an increased risk of postoperative infection due to the escape of ileal effluent from the stoma during the course of the operation. The bacteriologic sample of this effluent has been shown to contain high cocentrations of both aerobic and anaerobic bacteria qualitatively similar to that of the microflora of the colon. A nontraumatic technique for effective isolation of the effluent using Foley catheter occlusion between the balloon and the fascial ring has been devised.


External carotid-vertebral artery anastomosis for vertebrobasilar insufficiency. Two patients with previous brain stem infarction and current symptoms of vascular insufficiency in the basilar circulation had evidence of vertebral artery occlusive disease. Angiography demonstrated ostial stenosis of the dominant right vertebral artery and retrograde flow down the left vertebral artery to the level of the transverse process of C2 in the first case and to the level of a severely stenosed origin in the second case. Carotid circulation was patent in both cases. The blood flow in the posterior circulation was patent in both cases. The blood flow in the posterior circulation was augumented by extracranial anastomosis of the external carotid artery to the vertebral artery in the foramen transversarium at the level of C1-2 by a lateral approach in Case 1 and at the level of C4-5 by an anterior approach in Case 2. Postoperative improvement in neurologic status occurred in both cases.


Bovine hydrocephalus in North Dakota: a survey and morphologic study. A survey of hydrocephalus in cattle in North Dakota in 1975 and 1976 included 26 proven cases falling into categories comparable to that seen in the human situation. The largest group was hydrocephalus secondary to aqueductal stenosis with the second largest group being hydranencephaly. Other groups included the Dandy-Walker malformation, porencephaly and a miscellaneous group having a variety of central nervous system malformations. All cases were sporadic with no evidence to suggest a genetic basis. The similarity suggests that calves could serve as a useful model for the human situation.


The value of computerized tomography in the management of 1000 consecutive head injuries. One thousand consecutive head injuries were evaluated in a 14-month period. Computerized tomography (CT) was performed in 316 patients and 200 (63%) were scanned within 72 hours of injury. Fifty-one percent of patients had abnormal scans. The yield of abnormal scans varied with the neurological state at the time of the scan: alert and normal neurologically, 13%; alert and focal deficit, 50%; impaired consciousness and no lateralizing findings, 35%; impaired consciousness and lateralizing findings, 85%; deep coma or posturing, 56%. Thirty-eight percent of patients had multiple lesions. Repeat scans were done in 103 patients, 52% developed new lesions or deterioration in known lesions, and 31% required subsequent surgery. Ten patients developed delayed onset subdural hygromas noted six to 46 days after injury. Two of eight operated patients improved markedly. The CT scan appearance of subdural lesions may be independent of the time from injury depending upon initial composition and rebleeding episodes.  Thus, subdural lesions should not be labeled "acute," "subacute," or "chronic" on the basis of CT morphology alone. Seven patients had subdural lesions with the same density as brain (isodense). Arteriography aided diagnosis in six patients. The CT scan readily shows what proportion of a parenchymal lesion is intracerebral hematoma, contusion, or edema, rather than nonspecific arteriographic mass effect, and allows precise surgical decisions. Eighteen of 40 patients (45%) with "brain stem contusion" harbored surgical lesions, including five cases of delayed subdural hygroma.


Epidural hematoma with complete third nerve paralysis in an awake patient. A young adolescent with a large epidural hematoma presented with a complete paralysis of the ipsilateral oculomotor nerve. Prior to evacuation of the clot, the patient was awake and alert, without radiological evidence of skull fracture. Atypical features of pediatric extradural hematoma are reviewed to aid in the recognition of the clinically complex and varied aspects of the treatable disease.


Cerebral Ischemia during carotid endarterectomy with severe but reversible changes. Electroencephalographic monitoring of a patient during carotid endarterectomy demonstrated severe ipsilateral voltage suppression with preservation of rhythms when the common carotid artery was clamped. Because the atheromatous plaque extended almost to the base of the skull, it was impossible to insert a shunt. Occlusion time was 19 minutes. After carotid flow was re-established, there was a rapid recovery of voltage. The patient awoke with a profound hemiparesis, but this cleared almost completely within a week. The EEG changes indicated severe ischemia, but, though function was transiently impaired, there was no apparent cerebral necrosis. This case represents the most severe yet reversible episode of ischemia during carotid clamping reported to date. Preservation of EEG rhythms, even in the face of voltage suppression, may have been a favorable sign.


Surgical treatment of intracranial hematoma and hydrocephalus in an infant with hemophilia A. A seven-month0old hemophiliac infant developed intracerebral, subdural and intraventricular hematomas and hydrocephalus. Removal of hematomas and placement of ventriculoperitoneal shunt could be performed quite safely even in an infant under the cover of highly potent human antihemophilic factor concentrate. Computerized tomography is very useful for neurosurgical care of the hemophiliac patients as a noninvasive and atraumatic method of examination. Intracranial bleeding is listed as the most common cause of death among hemophiliacs. The literature of intracranial operations on the patients with hemophilia A is reviewed.


Balloon occlusion of carotid-cavernous fistula: introduction of a new catheter. The most widely used technique for treatment of a carotid-cavernous fistula involves embolization of the fistula with segmental occlusion of the internal carotid artery. An inflatable balloon capping a small flexible catheter becomes a controlled embolus when positioned within the internal carotid artery at the stoma of the fistula. A new double lumen catheter has been designed. Through one lumen the carotid circulation may be displayed, The second lumen allows inflation of the balloon through a self-sealing valve. In twelve patients, results were excellent in eight, fair in two, and poor in two patients intolerant of carotid occlusion.


Microsurgical removal of intramedullary spinal cord tumors. Eleven cases of microsurgical removal of intramedullary spinal cord tumors are reported. Difficulties previously recorded with removal of astrocytomas were not encountered in five such tumors of this series. None of these patients was significantly worse and seven out of the eleven patients were improved following surgery. The effects of prior surgery and radiotherapy on the tumor and normal spinal cord are discussed in detail.


The craniotubular bone modeling disorders: a neurosurgical introduction to rare skeletal dysplasias with cranial nerve compression. The craniotubular bone modeling disorders are a group of skeletal dysplasias which involve predominantly the skull and long bones. The cranial involvement includes both external facial deformities and internal bony overgrowth about the cranial foramina and fissures. The latter commonly leads to cranial nerve compression, particularly of the optic nerve. Craniotomy and cranial nerve decompression can give substantial benefit to selected patients with these diseases but the severe bony abnormalities create technical problems which prevent surgery in some extreme cases. These disorders are genetically determined but the basic pathophysiologic mechanism has been delineated for only a few types and non-surgical treatment remains supportive.


Regional cerebral blood flow with intracranial mass lesions. Part I: Local alterations in cerebral blood flow. Focal changes in the cat cerebral blood flow were studied by the technique of H2 polarography. Areas studied included the caudate nuclei, thalami and midbrain. A unilateral mass effect was created by inflation of an epidural balloon. A rapid decrease in regional cerebral blood flow was noted ipsilateral to the mass at very small balloon volumes. This was followed closely by contralateral supratentorial decrease in regional cerebral blood flow. The normal midbrain blood flow was found to be preserved until total decompensation (herniation) occurred.


Regional cerebral blood flow with intracranial mass lesions. Part II: Autoregulation in localized mass lesion. Autoregulation of regional cerebral blood flow was evaluated in cats. In normal baseline situations autoregulation was invariably present. Concomitant to an enlarging mass, supratentorial loss of this protective mechanism was seen both ipsilateral and contralateral to the mass. There was relative preservation of midbrain autoregulation until very high balloon volumes were reached. There was no acute regulation upon balloon deflation.


Experimental intracranial aneurysms.

Experimental intracranial aneurysms. Methods and results of creation of an experimental intracranial aneurysm on the canine basilar artery using an autogenous vein graft are presented. Aneurysms were produced either on the wall of the basilar artery or at a lingual-basilar artery anastomosis site. Postoperative angiography revealed no success in the first group and 55% success in the second group, with better results occurring later in the series. Mortality was higher in the first group. Hemodynamic and technical factors are discussed and compared with earlier work on experimental aneurysms in the rat. Construction of an aneurysm at the site of a lingual-basilar artery anastomosis seems to provide a satisfactory model for biophysical and catheter embolization experimentation, although at present it is unsuitable for studies of acute subarachnoid hemorrhage.


Human cadaver femoral head homografts for anterior cervical spine fusions. Cylindrical, dowel shaped human cadaver bone homografts from the heads of femurs were excised under sterile conditions. Forty-one of these grafts were stored at -80 degrees C and, on thawing, were used in performing anterior cervical spine fusions. Nineteen grafts were freeze-dried, stored at room temperature, reconstituted in saline and used in identical fashion. The use of these grafts, rather than those obtained from the ileum, offered several advantages. The grafts could be cut to a desired length of up to 2.5 cm and were composed of a very dense cancellous bone. Graft collapse and graft extrusion were not encountered.


Artery embolism of the upper limbs.

Artery embolism of the upper limbs. This report consists of an analysis of 256 consecutive patients with a total of 260 arterial emboli to the upper limbs treated in the Spasokukotsky Surgical Department of the Second Moscow Pirogov Medical Institute during the 35 year period from 1939 through 1974. Cardiac diseases were the causes of embolism in 92.58 percent of these patients. Mild ischemia of the limbs was revealed only in 33.82 percent of the patients. Severe ischemia accompanied by significant restriction or full absence of active movements in the joints of affected extremities was observed in 55.94 percent of the patients. Acute ischemia with a muscular edema and partial or total contracture was observed in 9.88 percent of the patients. Forty-seven patients were treated conservatively. Arteriectomy was performed in three patients. Embolectomy was carried out on 206 patients, 101 of whom were operated on by means of the approach outside the cubital fossa and 105 by means of the antecubital approach. The best results were obtained when embolectomy was performed with the use of the Fogarty catheter by means of the antecubital approach. This method achieved full restoration of circulation in 91.59 percent of our patients. The mortality rate was approximately equal in all groups of patients. The over-all hospital mortality rate was 21.1 percent. Recurrent embolism of cerebral and mesenteric arteries was the main cause of death. Fatal postischemic complications led to the death of two patients who were operated on with a total ischemic contracture of a limb. Autopsy revealed a pulmonary microembolism in one case and a myoglobinuric nephrosis in the other.


The pulse-reappearance time: an index of over-all blood flow impairment in the ischemic extremity. A simple test is described to evaluate limb blood supply. The technique utilizes the delayed reappearance of the volume pulse after transient arterial occlusion. As monitored from the toe by a mercury-in rubber gauge, pulse reappearance (PRT) was instantaneous (less than one second) and the 50 percent of control amplitude reappearance time (PRT/2) was 3.4 +/- 0.8 seconds in 22 control subjects. A significant delay of the PRT and especially of PRT/2 was found in 60 patients with angiographically documented ischemic disease of the lower extremities. The delay was correlated closely with the severity of the disease: the mean PRT/2 for single level arterial disease (aortoiliac, femoropopliteal, posterior tibial, or anterior tibial artery obstruction) was approximately 25 seconds, and the mean PRT/2 associated with multilevel occlusion was 71 seconds. Since the technique is very simple, it may be used as a quick  screening and follow-up procedure to detect the presence and over-all severity of peripheral arterial occlusive disease.


Bile-fat relationships in gastric secretory inhibition and bile flow stimulation. The effect of intraduodenal infusion of olive oil, bile, or a mixture of olive oil and bile on pentagastrin-stimulated gastric secretion, bile flow, and serum immunoreactive secretin levels was studied in dogs. Bile alone had no effect on gastric secretion, but the mixture of bile and olive oil induced prompt, statistically significant gastric secretory inhibition. Bile had the early choleretic effect that would be expected to result from the absorption of bile salts, whereas the bile--olive oil mixture brought about a delayed amd much greater increase in bile flow rates. None of the agents given intraduodenally produced a significant change in the serum secretin level. Intravenous pentagastrin infusion caused a significant increase in rate of bile flow.


Massive weight loss following jejunoileal bypass. I. Effects on pulmonary function. Twelve morbidly obese patients had jejunoileal bypass surgery and serial detailed pulmonary function studies done over a one year period. Before operation they showed evidence of a decreased ventilation: perfusion ratio producing a "shuntlike effect" (Pao2 = 73, Paco2 = 37, pH = 7.44) while breathing room air (FIo2 = 0.209). They also had measurements consistent with pure restrictive lung disease. There was a highly significant improvement in the arterial oxygenation over the entire one year period and a significant loss of chest wall mass over the first 6 month period. The improved oxygenation most likely was due to a return of lung volumes toward normal and an improvement in the efficiency of the respiratory muscles.


Rate of disappearance of circulating endogenous gastrin in dogs. In five awake mongrel dogs, endogenous gastrin was released by continuous irrigation of the antrum with acetylcholine. After 60 minutes of antral perfusion, the entire vascular supply of the antrum was suddenly and totally occluded, and serial samples of peripheral blood were taken for measurement of gastrin. The rate of disappearance of endogenous gastrin was caluclated by standard linear regression analysis; the calculated half-life of endogenous gastrin was 8.62 minutes. Analysis of the data suggests that the disappearance rate of endogenous gastrin could be explained by two distinct half-lives: one of 2.8 minutes (which is similar to the half-time in dogs of both 14- and 17 -amino acid gastrin), and another of 15.4 minutes (which is similar to the half-time of 34 -amino acid gastrin). Physiologically released gastrin is a mixture of three or more molecular forms of gastrin and the half-life of 8.62 minutes probably represents the disappearance half-time of this mixture.


Angiographic demonstration and transcatheter embolic control of post-traumatic intercostal arterial hemorrhage. A new method for arresting uncontrollable intercostal hemorrhage is presented. It consists of selective transcatheter embolization of the bleeding artery, either by pieces of gel foam or autologous blood clots. In the patient presented in this paper, the hemorrhage was identified and successfully controlled by embolizing the bleeding artery. Thoracotomy was unnecessary, and there were no complications related to the procedure.


Pulmonary sequestration in children: a twenty-five year experience. Pulmonary sequestration occurs when some disturbance produces a cystic mass of nonfunctioning lung tissue which lacks normal communication with the tracheobronchial tree. In most cases the sequestered pulmonary tissue receives its blood supply from anomalous systemic vessels. This paper considers 15 children, 11 boys and four girls, ranging in age from one day to 14 years, with ten extralobar sequestrations and five intralobar pulmonary sequestrations. Although roentgenographic examination of the chest may suggest the diagnosis, conclusive diagnosis can only be obtained by arteriography and/or surgical exploration. Arteriography is strongly advocated in all cases, not only for its diagnostic value, but for its preoperative localization of the aberrant blood vessels that are the major technical concern to the surgeon.


The influence of biliary disease on the excretion of cefazolin in human bile. Forty-five patients with varying biliary pathology were injected with one gram of intramuscular cefazolin sodium prior to surgery. Serum, gallbladder bile, and common duct bile levels were measured. The type of biliary disease did not influence serum levels (mean, 29 mug per milliliter) which reached a peak one hour after injection. Mean common duct bile levels were reduced from 52 mug per milliliter in nonjaundiced patients to 4 mug per milliliter in those with jaundice (p less than 0.001). Patients with radiologically functioning gallbladders had significantly higher mean gallbladder bile levels (21 mug per milliliter; p less than 0.005). Surprisingly, the mean gallbladder bile level in acute cholecystitis was 25 mug per milliliter. As the minimum inhibitory concentration of cefazolin for organisms commonly found in the bile is 0.5 to 6 mug per milliliter, we suggest that cefazolin sodium may be of value in the treatment of biliary disease, particularly acute cholecystitis.


Morphologic aspects of experimental esophageal lye strictures. II. Effect of steroid hormones, bougienage, and induced lathyrism on acute lye burns. Among 77 dogs surviving standardized transmural esophageal lye injury for at least 2 weeks and as long as 12 weeks, 24 were untreated, 26 received corticosteroids and bougienage (S&B), and 27 received only the lathyrogen beta-aminoproprionitrile (BAPN). Stricture frequency was reduced markedly and significantly in the S&B and BAPN groups when compared to the controls (p less than 0,01). Strictures resulted from inward circumferential remodeling of all mural layers, not proliferating bulky scar tissue, and persistent ulceration was apparently not an influential factor in any group. The S&B dogs invariably showed reduction of the internal or mucosal length of the injured segment as compared to the outer length; these relations were quite variable in the other two groups so that mean internal shortening was significantly greater (p less than 0.01) in the S&B group. Marked mural thinning in the injured zone was present in all three groups but was most frequent in the BAPN-treated animals. The major conclusion is that BAPN-induced changes in the physical properties of reparative tissue can increase the ultimate caliber of an injured hollow viscus without resort to mechanical bougienage. In addition, the data suggest that wound contraction may play a role in stricture formation in this model.


B-scan ultrasound in the diagnosis of popliteal aneurysms. Sonography gives a characteristic picture of popliteal aneurysms, with an easily demonstrable connection of the sonolucent aneurysmal sac with the popliteal artery. It is a good screening procedure for suspected aneurysms and for patients with popliteal pain, mass, or sudden distal ischemia. Three case reports of five popliteal aneurysms diagnosed by ultrasound are presented. A case of neurofibrosarcoma occurring in the popliteal fossa is shown for comparison.


Changes of upper gastrointestinal blood flow after hemorrhage in rabbits. The effect of hemorrhage and blood transfusion on the regional blood flow of the upper gastrointestinal tract was measured with radioactive microspheres in a rabbit shock model. Fifteen minutes after hemorrhage, mucosal blood flow in the esophagus, corpus, and antrum and total blood flow in the duodenum decreased drastically. The persistent reduction of mucosal blood flow continued until 60 minutes after hemorrhage. In spite of these distribution patterns of mucosal blood flow during hemorrhage, no macroscopic change was seen in any part of the gastrointestinal mucosa. One hour after blood reinfusion, the mucosal blood flow in the corpus was increased markedly, and innumerable hemorrhagic erosions appeared in this region. It may be that the striking increase of mucosal blood flow due to blood transfusion caused bleeding from the disrupted mucosa of the corpus. At this time the impaired flow in the esophagus, antrum, and duodenum tended to be improved already. Six hours after blood reinfusion, the bleeding from the mucosal foci in the corpus ceased and the mucosal blood flow returned to almost normal. Thus the higher susceptibility of the corpus to hemorrhagic shock may be due to the greater degree of rapid increase of mucosal blood flow occurring in this portion alone after blood transfusion as well as to its higher vulnerability to ischemia in the hemorrhagic period. The flow patterns in the muscular layer almost paralleled those in the mucosal layer during hemorrhage and blood transfusion.


Femoropopliteal bypass for limb salvage. A total of 148 femoropopliteal bypass procedures followed for a minimum of 2 years yielded a patency rate of 61.9 percent among survivors. Diabetes mellitus, cigarette smoking, quality of the outflow, or prior inflow procedures did not influence patency rate. Results were less satisfactory in women and when cloth grafts were used. The indications for femoropopliteal bypass require continuing careful assessment.


Blood flow measurements in arteriovenous dialysis fistulas. Blood flows were measured in 75 arteriovenous dialysis fistulas (AVF) at the time of fistula construction. End cephalic vein to side of radial artery AVF had a mean flow of 242 +/- 89 ml. per minute which was similar to bovine heterograft AVF that also originated from the radial artery (291 +/- 67 ml. per minute). AVF originating from the brachial artery had flow rates twice those originating from the radial artery (599 +/- 163 vs. 251 +/- 89 ml. per minute), respectively). Flow rates were similar for straight arm (641 +/- 111 ml. per minute), curved forearm (561 +/- 187 ml. per minute), and curved thigh (592 +/- 134 ml. per minute) bovine AVF. Initial blood flow through arteriovenous dialysis fistulas is too low to cause heart failure, except in patients with previously compromised cardiac function. In such patients AVF from the radial artery theoretically would be preferred over brachial or femoral artery AVF.


Physiologic observations of the heart six months after ischemic normothermic cardioplegia. The late effects of normothermic ischemic cardioplegia were studied in four experimental groups of dogs subjected to intervals of aortic cross-clamping during cardiopulmonary bypass. Groups which had zero, 20, 30, or 40 minutes of aortic cross-clamping, respectively, were studied 6 months later for cardiac performance and morphology. The immediate operative mortality rate of animals subjected to 40 minutes of ischemia was 65 percent, compared to 22 percent in controls. There were no late deaths in any group Compliance, histology, biochemical determination of deoxyribonucleic acid: ribonucleic acid, and Vmax determinations after cross-clamping revealed no differences between the experimental groups. Open chest isovolumetric contraction curves showed decreased experimental groups. Open chest isovolumetric contraction curves showed decreased function in the 40 minute ischemia group at the extreme levels of cardiac stress. These results suggest that under the conditions of this study normothermic cardiac ischemia of greater than 30 minutes in duration results in a high initial mortality rate (65 percent) and leads to compromise of cardiac function under stress in the late postoperative period.


Traumatic aortorenal vein fistula: repair using total circulatory arrest. Fistulas between the abdominal aorta and renal vein are exceedingly rare. Diagnostic delays are not unusual. Correction can be extremely difficult because of anatomical distortion and size of the arterialized veins. A young woman with such a fistula following a gunshot wound is presented. Four years following injury, the fistula was repaired successfully during intentional arrest of the circulation for 7 minutes. This was accomplished with deep hypothermia and cardiopulmonary bypass. No serious problems occurred during the operation. The patient tolerated the procedure well and has been relieved of her symptoms completely. Most patients with traumatic or spontaneous arteriovenous fistulas can be managed safely and effectively by conventional operative techniques. In selected situations, the risk of total circulatory arrest and deep hypothermia may be less than the risk of uncontrollable bleeding inherent in conventional techniques. Suggested indications for use of total circulatory arrest in vascular surgery are (1) inability to achieve vascular control by more conventional means, (2) massive distention of regional veins as occurrs in well established fistulas of the trunk, (3) one or more prior corrective attempts with use of conventional techniques, and (4) anticipated anatomical distortion and/or multiple abnormal vascular communications. This technique is a valuable approach to the correction of otherwise inoperable cardiovascular lesions.


Arterial microemboli and fibromuscular dysplasia of the external iliac arteries. A patient who developed acute focal ischemic lesions confined to several toes on the feet is described. The ischemic lesion were typical to those seen in digital arterial microemboli. The source of the microemboli was apparently external iliac artery fibromuscular dysplasia. These lesions were subsequently resected and no subsequent lower extremity embolic events have appeared.


Intrathoracic lipoma in a dog.

Intrathoracic lipoma in a dog. A seven year-old German Shepherd bitch had severe dyspnoea caused by a lipoma. The weight of this lipoma was approximately 4 kg, the total weight of the dog without this tumour being 20 kg. The lipoma was not attached to the body wall but to the mediastinum, so it must be concluded that it had its origin there. The dog expired because the lungs could not expand after the operation.


[Studies for the presence of Yersinia enterocolitica and Yersinia pseudotuberculosis in clinically normal pigs (author's transl)]. 163 clinically normal slaughtered pigs were examined for the presence of Yersinia enterocolitica and Yersinia pseudotuberculosis. The following results were obtained: Yersinia enterocolitica was isolated from the tonsils in twenty-two cases, Yersinia pseudotuberculosis being found to be present in the tonsils in seven cases, Yersinia enterolitica was isolated from the liver in one case and from the caecal contents in eight cases, and Yersinia pseudotuberculosis was isolated from the caecal contents in three cases. These bacteria were not isolated from the mesenteric lymph nodes and muscle tissues. All sixty samples of minced raw pork which were examined, were also negative for these micro-organisms. Almost all strains isolated were of the same serotypes as those isolated from man in the Netherlands. The findings did not suggest that ingestion of raw pork might involve a risk of human yersiniasis. It is doubted, however, whether the methods of isolation were sufficiently selective.


[Field experinence of the molluscicide "Frescon" in the control of fascioliasis (author's transl)]. The effectiveness of the molluscicide N-tritylmorpholine (Frescon, Shell) in the control of fascioliasis was tested in various field conditions. The effect was not only measured by the study of populations of L. truncatula but its use in prevention was also determined by turning tracer lambs out to grass in treated and control field. The studies showed that Frescon applied at the recommended dose rate is a reliable agent, even in the prevention of acute outbreaks of fascioliasis. The preventive effect was found to be most marked on treatment in the spring (preferable to single treatment during the summer), which is  of  particular importance in view of the fact that infections may occur in the southern Netherlands during the early grazing season.


[Studies on hepatitis vaccines in geese (author's transl)]. Three passages of goose hepatitis virus of muscoy duck embryo cell cultures were used as a vaccine in geese. The offspring of birds inoculated with the thirty-second of fifty-fifth passage were found to be immune to experimental infection with virulent goose hepatitis virus. The fifty-fifth passage, inoculated intramuscularly, did not result in transmission of the virus, neither through the hatching egg nor by direct contact. The eight-seventh passage was non-pathogenic for susceptible day-old goslings and produced active and adequate immunity in these young birds.


[Radical surgery (amputation) or conservative treatment (drainage) in cases of septic pedal arthritis and navicular bursitis in cattle (author's transl)]. An observation was carried out with regard to forty-nine cows, which had been treated for a  purulent necrotizing arthritis as a complication of a rear leg. In seventeen cases the pedal joint was drained by means of track made by an electric fraise. In sixteen cases the claw was amputated under the coronet and in the remaining sixteen cases the claw was sawn off above the coronet, through the second phalanx. It emerged that from the seventeen drainage-cases nine patients were retained for several laction-periods. Thirty out of the thiry-two cows where a claw-amputation had been performed, were slaughtered within one year. If a cow is not to be retained for several years after treatment, a simple amputation above the coronet is to be recommended.


[Botulism in cattle in a loose housing following the use of litter from a broiler farm (author's transl)]. An outbreak of type C botulism in cattle is reported, which was caused by the fact that litter from a broiler farm, in which a large number of toxic carcases had been present, had been used as a bedding in the cubicles. There is evidence to suggest that there is a relationship with the large number of cases of type C botulism in waterfowl in the Netherlands in recent years.


[Disease and causes of death in birds (authors transl)]. In 1975, post-mortem studies were done on 745 birds. The findings are tabulated. The most important problems are evaluated. The most striking finding is the very large proportion (46.0 per cent) of birds which died from infectious disease caused either by bacteria, viruses, protozoa or parasites. Hygiene is stressed as a valuable preventive measure.


[Measures to be adopted in the prevention and treatment of atrophic rhinitis in piglets under field conditions (author's transl)]. The following measures designed for the prevention of Atrophic rhinitis (AR) were compared. (1) Adopting the all in - all out system in separate farrowing quarters. The variation in age between piglets in a single farrowing house was confined to one to two weeks. (2) Treating the piglets with a combined preparation of penicillin, chloramphenicol, oxytetracycline hydrochloride or sulphonamides on the third, sixth and twelfth days of life. (3) Administering immune sera to piglets. (4) Vaccinating sows and piglets with Bordetella bronchiseptica vaccine and piggery--specific Pasteurella multocida vaccine. The various forms of treatment had a beneficial effect  on the clinical picture in every case of Atrophic rhinitis. Moreover, the dosage of the antibiotic oxytetracycline hydrochloride as well as the titre of the immune serum were found to be factors in the prevention of AR. The pressure of infection with Bordetella bronchiseptica and/or Pasteurella multocida is a factor of major importance in the pathogenesis of clinically apparent AR in piglets under eight weeks. Maintaining infection at a low level is the main object in the control of AR. The more so as the knowledge available today does not make it possible to free piggeries from Bordetella bronchiseptica and Pasteurella multocida.


Influence of salivary glands extirpation on procreation in rats. The influence of extirpation of the submandibular and sublingual, parotid and all major salivary glands on pregnancy of rats was studied. The statistic analysis of the results indicated that there are statistically significant differences in the number of offsprings between before and after extirpation of the salivary glands. The parotidectomized female rats presented the smallest number of offsprings as compared with other groups and presented some progressive sterility after the gland extirpation.


Effect of spironolactone on urinary kallikrein excretion in patients with essential hypertension and in primary aldosteronism. Urinary kallikrein excretion was measured before and after administration of spironolactone in 12 patients with essential hypertension (including 7 patients with low renin and 5 patients with normal renin) and 6 patients with primary aldosteronism. In low renin essential hypertension, two types of urinary kallikrein excretion were observed. In one type, urinary kallikrein decreased from 6.2+/-2.1 (S.E.) EU/day to 2.7+/-0.3 EU/day after the treatment. In another type, urinary kallikrein increased from 3.1+/-0.5 EU/day to 6.4+/-1.0 EU/day. In the former, plasma aldosteron showed high levels (12.3+/-2.1 ng/100 ml), while in the latter, it was normal (3.2+/-0.5 ng/100 ml). In normal renin essential hypertension, urinary kallikrein excretion did not alter after the treatment. In primary aldosteronism, urinary kallikrein showed moderate decrease after the spironolactone treatment from 8.5+/-1.6 EU/day to 4.2+/-1.6 EU/day. Spironolactone is said to compete directly with the effect of aldosterone at renal distal tubules. The present investigation suggests that urinary kalikrein excretion is related to the effective levels of aldosterone at renal distal tubules, and alteration of aldosterone levels mediates the release of kallikrein, and that there are different mechanisms in the renal handling of sodium and kallikrein in low renin essential hypertension, in normal renin essential hypertension, and in primary aldosteronism.


A constant electrical activity of the renal pelvis correlated to ureteral peristalsis. Using a bipolar macroelectrode, simultaneous recordings of both pelvic and ureteral electromyograms (EMG) were carried out in dogs. The recordings were performed at 3 stages of urine flow; oliguric, increasing and diuretic stages. The results showed that the interval of the pelvic discharge was constant while its speed of propagation was slower than that of the ureter (1.32 cm/sec and 2.12 cm/sec, respectively). At oliguric stage the interperstaltic interval in the ureter constituted a multiple of the pelvic discharge interval. Ureteral peristaltic rate reached that of the renal pelvis with increasing urine flow. These results are discussed in relation to a hypothesis of a renal pacemaker.


Altered growth behavior and phenotypic expression of cells of mouse and hamster cell lines after treatment with polyanions. Effect of polyanions on saturation density and production of viscous substance of cells of mouse and hamster cell lines was studied. Cell lines used were 3T6, HA-2 and HA-8 cells. Polyanions were dextran sulfate, (3,6-anhydro-4-o-beta-galactopyranosyl-2-D-galactopyranose-2,4'-bis (potassium/sodium sulfate) (1 leads to 3) polysaccharide (polygeenan) and dextran phosphate. Dextran sulfate reduced the saturation densities of cell lines. Growth of 3T6 cells was not significantly affected by dextran sulfate. Polygeenan and dextran phosphate could not decrease the saturation densities of all the cell lines tested. The production of viscous substance into medium from the treated cells increased after treatment with all polyanions with the exception of dextran phosphate of molecular weight 40,000. It was suggested that specific structure of polyanion might be necessary for the decrease of saturation density of cell lines. Furthermore, it appears that dextran sulfate decreases saturation density of cell line along with change of phenotypic expression of cells.


Effects of pacing location on coronary circulation in dogs. In 13 open chest dogs, the right atrium and various ventricular sites (i.e. the inflow and outflow tracts and apex of the right ventricle, apex and lateral wall of the left ventricle) were stimulated electrically at a given rate, ranging from 140 to 210 per min. Coronary circulation and cardiodynamics in response to ventricular pacing were compared with those to right atrial pacing at equivalent heart rate. Stimulation of the ventricle except lateral wall of the left ventricle produced no significant changes in coronary sinus blood flow and myocardial oxygen consumption despite decreased blood pressure and cardiac output. The minor change of coronary sinus blood flow was related to the decrease in coronary vascular resistance. Oxygen content of coronary sinus blood decreased during ventricular pacing, while arterial oxygen saturation remained constant. The response of coronary circulation to ventricular pacing did not differ essentially at faster and slower heart rates. It was considered that when stimuli were applied to the ventricular surface, the relatively constant myocardial oxygen consumption in the presence of lowered cardiac performance was attributed to the asynchrony of fractionate contractions of the ventricular muscle.


Cell cycles in two cell lines of human bladder carcinoma. Cell cycle analysis was performed on two established cell lines of human bladder transitional carcinoma, MGH-U1 and T24 cells. The cells were cultured on round cover slips for three days, autoradiograms were prepared after pulse-labeling with 3H-TdR and the fractions of labeled mitoses (FLM) were calculated every 2 hours through 36 hours. The FLM curves were analyzed by the empirical half-height level method as well as Mendelsohn-Takahashi's asymmetry method which is a global type of FLM analysis based on Takahashi's generalized model. The results did not show any distinct differences in the cell cycle parameters between MGH-U1 and T24 cell lines. A remarkable discrepancy, however, was observed between the cell cycle times analyzed by the asymmetry method and by the half-height level method. Although there is no evidence that the asymmetry method is biologically correct up to now, Mendelsohn and Takahashi tested this method repeatedly and mathematically proved that it had much less error than that of the traditional boundary method.


Autoregulation of renal blood flow during ether, halothane and methoxyflurane anesthesia in dogs. The effects of ether, halothane and methoxyflurane (0.5-1.5 MAC) on renal blood flow and its autoregulation were studied in 24 dogs. The left renal artery was perfused with the animals' own blood by a constant pressure perfusion system. The perfusion pressure ranged from 60 to 200 mmHg. Renal blood flow at the perfusion pressure of 100 mmHg was changed neither by ether nor by halothane, while it was decreased dose-dependently by methoxyflurane. At equipotent anesthetic concentrations the autoregulation of renal blood flow was only slightly impaired by ether, but significantly by halothane and methoxyflurane. Adenosine (100 mug/min) or calcium chloride (10 mg/min) which was infused directly into the renal artery resulted in a restoration of autoregulation impaired by MAC-1 of each anesthetic when perfusion pressure was raised stepwise from 100 to 200 mmHg, but no restoration was observed at low perfusion pressure below 100 mmHg. The results indicate that methoxyflurane exerts a direct constrictive effect on the renal vasculature. Adenosine and calcium may play a significant role on the response of the renal vasculature to raised perfusion pressure.


Inherited chromosomal translocation in two families (t(4q-;13q+) and t(5q-; 13q+)). Two families with reciprocal translocations, t(4q-; 13q+) and t(5q-; 13q+), are reported. Each proband carried multiple malformations resulting from the unbalanced segregation in two mothers of balanced carriers. The karyotype-phenotype relationship is discussed with reference to other previously reported cases of B/D translocation.


Infantile type of homocystinuria with N5,10-methylenetetrahydrofolate reductase defect. Two infants of homocystinuria with a defective activity of the N5,10-methylenetetrahydrofolate reductase in the liver, kidney, brain and/or leukocytes were reported. Contrary to four cases with similar biochemical defects reported up to date, the two cases of ours demonstrated peculiar clinical features characterized by an early onset in infancy, fits of apnea and seizures, downhill course with coma, and death within one year of life. Thus "an infantile type" of this disorder was advanced as a new clinical entity. Assay for the N5,10-methylenetetrahydrofolate reductase activity using peripheral leukocytes was established and might be useful for a diagnosis of this disorder and also for detection of heterozygotes.


Plasma C-peptide response to oral glucose in low insulin responders, subdiabetic, and diabetic subjects. It is one of the characteristic features in diabetes mellitus that insulin response to glucose is low. Nine low insulin responders with normal glucose tolerance in whom prediabetes mellitus should be suspected were found to be included in 104 apparently healthy subjects (9%). A 100 g glucose tolerance test (GTT) was performed in nine apparently healthy subjects with a low insulin response and 11 healthy subjects with a normal insulin response. A 50 g GTT was performed in 15 normal subjects, 20 subdiabetics, 38 chemical diabetics and 17 mild diabetics. In all subjects C-peptide during GTT was estimated by the double antibody systems using a synthetic human C-peptide. Though C-peptide secretion from the beta cell of the pancreas seems to keep pace with insulin secretion, the peak of C-peptide was delayed in its appearance in the circulating blood, as compared with that of insulin. The pattern of plasma C-peptide during GTT in diabetics was identical with that of insulin. In the low insulin responders C-peptide response to glucose was observed to be lower like that of insulin than in the normal insulin responders. However, a molar ratio of C-peptide to insulin at 30 min during GTT in the former was higher than that in the latter.


Trigeminal artery and occlusive cerebrovascular disease. Two patients with persistent trigeminal artery who had an ipsilateral cerebral stroke are presented. The relevant literature is reviewed. The significance of the trigeminal artery in occlusive cerebrovascular disease is discussed and it is concluded that the presence of a trigeminal artery in patients with occlusive cerebrovascular disease may not be of major protective value.


Cerebral circulation after cardiac arrest. Microangiographic and protein tracer studies. The effects of ventricular fibrillation and subsequent resuscitation on the microcirculation of the verebral cortex were studied with microangiographic and fluorescent protein tracer techniques. Immediately after revival, a transient period of impaired cerebral perfusion occurred before complete recovery from circulatory arrest was obtained. A circulatory arrest of longer than ten minutes, followed by four to six hours of resuscitation, caused defects of cortical capillary filling in both microangiography and Trypan blue fluorescence. This was considered to represent impairment of cortical perfusion, most likely due to edema. Cardiac arrest up to 12 minutes and subsequent resuscitation per se caused no blood-brain barrier damage. Minimal blood-brain barrier damage occurred in one dog following uncomplicated revival from a 14-minute arrest and in animals with prolonged hypertension post-resuscitation. Up to three consecutive carotid angiographies did not cause blood-brain barrier damage in the postischemic brain.


Cerebral blood flow regulation. II. Vasodilator mechanisms. Rapid vasicular resistance adjustments in the brain and in the circle of Willis have been continuously measured and enhanced by signal averaging methods. Naftidrofuryl, a drug chemically similar to local anesthetics and to beta adrenergic blocking agents, increases local CBF by reducing resistance in brain and in extracerebral supply arteries. It has also been reported to affect brain metabolism. Other similar drugs merit study for potential effects on CBF and brain metabolism which may be useful in treatment.


Intracranial aneurysms and subarachnoid hemorrhage - report on a randomized treatment study. IV-A. regulated bed rest. Three weeks of regulated bed rest was one of four treatments evaluated in the Cooperative Aneurysm Study. A total of 187 patients with a recently ruptured intracranial aneurysm had subarachnoid hemorrhage confirmed by lumbar puncture. A group of 124 patients were assigned to treatment within 7 days after the bleed, 49 between 8 and 21 days, and 14 between 22 days and 92 days. During the mean follow-up interval of 6.5 years, mortality was 55.1%. A proved rebleed was the cause of death in 34.2%, progressive deterioration from aneurysm rupture in 8.0%, and a suspected rebleed in 4.8%. A total of 47.1% died of causes related directly to the cerebral effects of the ruptured aneurysm.


Carotid ligation in gerbils. Influence of age, sex, and gonads. The ill effects of carotid artery occlusion or ligation vary in man and experimental animals according to surgical techniques, environmental conditions, diet, stress, sex, age, strain of the animal, blood pressure, the state of cardiopulmonary system, and other diverse factors. Unilateral carotid artery ligation in most small laboratory animals is an innocuous procedure. The gerbil, a desert rat, has been found to be quite sensitive to unilateral carotid artery ligation. The present experiments were designed to study the influence of age, sex, and castration on end results of the unilateral carotid artery ligation in gerbils. It appears that the young animals prior to sexual maturity and the sexually mature female are more resistant than the sexually mature male. This difference is assumed to be due to the influence of the gonads on the blood flow of the brain.


Pleocytosis and elevation of prostaglandins F2a and E2 in cerebrospinal fluid following intracisternal injection of thrombin. A marked pleocytosis and increase in the levels of prostaglandin F2a (PGF2a) and prostaglandin E2 (PGE2) were noted in cerebrospinal fluid of dogs within two hours following the intracisternal injection of thrombin. Quantitation of the prostaglandins (PG's) was done by gas chromatography-mass spectroscopy using deuterated PGF2a and PGE2 as internal standards. Whereas the levels of these prostaglandins were below the sensitivity of the method in control animals, a marked increase was noted following thrombin. PGF2a levels were 15-21 ng/ml and the PGE2 levels were 55-72 ng/ml. This concentration of the PG's is adequate to cause spasm of the cerebral vessels and could explain the spasm which occurs following the intracisternal injection of thrombin. These two effects, a pleocytosis and elevation of PG levels, may be specific to thrombin.


Experimental model for systematic study of impaired microvascular reperfusion. A technique is described for reliably producing quantifiable impairment of microvascular reperfusion of the brain after ischemia in dogs. The technique is derived from an analysis of the cerebrospinal fluid compression ischemia model as a Starling resistor. It is proposed that this model would be useful in systematic study of post-ischemic impairment of reperfusion.


Respiratory influence on the total and regional cerebral blood flow responses to intracranial hypertension. The effect of respiration on the cerebrovascular response to elevated intracranial pressure (ICP) was studied in anesthetized dogs. Total and regional cerebral blood flows were measured using labelled microspheres. In spontaneously breathing dogs total and regional cerebral blood flows increased when cerebral perfusion pressure was reduced to 20 mm Hg. The increase in regional flows was greater in the infratentorial areas than in the supratentorial areas. The increase in cerebral flow in spontaneously breathing dogs was associated with the development of hypoxemia and respiratory acidosis secondary to depression of ventilation. Elevation in ICP while regulating PO2, PCO2, and pH by controlled ventilation resulted in decrease in the total and regional cerebral blood flows. The decrease in regional flows was greater in the supratentorial areas. Induction of respiratory acidosis during elevated ICP in the controlled ventilated dogs with a 5% CO2 in air gas mixture, reversed the decrease in cerebral flows. The results suggest that the increase in cerebral blood flow during elevated ICP in spontaneously breathing dogs is secondary to the development of hypoxemia and respiratory acidosis since cerebral vessels retain responsiveness to increased PaCO2 when the vessels are dilated due to elevated ICP. The results also indicate that the regional cerebrovascular response to elevated ICP is non-uniform.


Coagulopathy following experimental cerebral ischemia. In adult normothermic cats cerebral blood flow was interrupted for 1 hour by clamping the innominate and subclavian arteries. Following ischemia the brains were recirculated with blood, and the coagulation system was investigated by measuring coagulation times and blood content of fibrinogen and platelets. Ischemia induced progressive consumption coagulopathy with an increase in coagulation times and a decrease of platelets and fibrinogen by more than 40%. Coagulopathy was accompanied by a respiratory distress syndrome with a significant increase in the alveolar-arterial carbon dioxide gradient from --3.3 to --13.5 mm Hg. A correlation was found between plasma fibrinogen concentration, cerebral blood flow and electrophysiological function, indicating that a relationship exists between the severity of postischemic coagulopathy and functional recovery following prolonged cerebral ischemia.


Central nervous system angioendothelosis. A treatable multiple infarct dementia. CNS neoplastic angioendothelosis is a treatable primary proliferative disorder of the endothelial cells of blood vessels characterized by a clinical neurological picture of multiple infarct dementia and an inordinate amount of local cerebral edema, so striking that it may simulate primary or metastatic central nervous system tumor. The malignant cells remain within the lumen of the vessels and rarely if ever metastasize or occur in peripheral blood. There is remarkable improvement in symptoms by treating with high dose steroids. Antimetabolites and irradiation are suggested means of additional treatment.


Effects of high static pressures on human cerebral arteries in vitro. Static elastic properties were obtained from pressure, volume, and length measurements of 34 isolated human cerebral arteries from 23 circles of Willis of patients aged 23-76 years. No significant difference in initial or final elastance was observed with age or branch in the circle of Willis. Twenty-four of the arteries from 18 circles of Willis were then subjected to transmural pressures of 200-300 mm Hg for periods of less than or equal to 5 minutes and the elastic properties restudied. In general, this had little effect on the arteries except for a significant increase in the initial radius for the less than or equal to 40 year age group. In the less than or equal to 40 year group, female arteries tended to show a greater increase in initial elastance than the males. Histological studies to look for elastin fragmentation in the intima were inconclusive.


Implanted device for middle cerebral artery occlusion in conscious cats. A simple implantable device was applied to the left middle cerebral artery of adult cats. One week later the artery was occluded acutely while the animals were conscious. Forced circling and tonic deviation of the head and neck toward the left were noted within seconds of occlusion. A right hemiparesis developed one to two minutes later. Cerebral angiography confirmed the presence of the middle cerebral artery occlusion when the occluding stylet was inserted. Removal of the stylet resulted in reopening of the artery. Light microscopic examination of the brains revealed severe acute ischemic changes in a large left cortical and subcortical area. Partial loss of endothelial lining and thinning of the media were demonstrated in the compressed segment of the middle cerebral artery.


Amaurosis fugax.

Amaurosis fugax. We reviewed 112 patients with amaurosis fugax to refine our indications for carotid angiography. Eighty patients had a carotid endarterectomy. Thiry-four patients with ipsilateral hemispheric transient ischemic attacks plus amaurosis fugax all had an operable carotid lesion. The presence or absence of a carotid bruit, a normal or abnormal ophthalmologic examination, or a normal or abnormal cerebrovascular Doppler examination did not predict which patients would or would not have an operable carotid lesion. All patients with amaurosis fugax being evaluated for an operable carotid stenosis require angiography.


Variations in mean cerebral blood flow under anesthesia at rest and during cortical activation. More than one cerebral blood flow (CBF) measurement was performed on the same occasion in three groups of patients using the intracarotid 133Xenon technique. In the anesthetized group there was a highly significant reduction in CBF (mean = 24.3%) from the first to the second measurement. In those at rest under local anesthesia there was also a significant fall (mean 9.8%). The third group, who were stimulated during the second estimation, showed no change. A second CBF determination some time after beginning a study is recommended, especially in pharmacological studies, to provide a more reliable resting control, rather than the first value which represents flow in an "activated" brain which has not yet adapted fully to its new environment.


The anterior communicating artery has significant branches. The anterior communicating artery was studied with the operating microscope in 10 autopsy cases. This vessel was present in all cases with reduplication in three. Arterial diameter ranged from 0.8 to 2.3 mm, with lengths of 5 to 10 mm. Branches of the anterior communicating artery were found in every case (range 3-13, average 5.4). Most branches were small (50-250 mu), but at least one large branch (250-1000 mu) was invariably present. Small ventral branches ramified on the optic chiasm. Small and large dorsal branches distributed themselves to lamina terminalis, hypothalamus, parolfactory areas, columns of fornix, and corpus callosum. Injury to these vessels caused by aneurysmal rupture or surgical manipulation may lead to serious clinical deficits.


How BRH, FCC, CPSC, FDA & OSHA regulations affect you. United States Government regulations cover industrial, medical and consumer ultrasound products for the protection of those using the equipment. There are currently five government agencies which regulate permissible power, intensity and radiation field patterns; permissible frequency and power bands; safety standards for the protection of consumers using ultrasound devices; safety and design standards for diagnosis and therapy by physicians; and standards for the protection of workers in factories using ultrasonic equipment.


Digital image focussing in the near field of a sampled acoustic aperture. A study has been carried out to investigate digital techniques which can be used to form fully focussed acoustic images. An algebraic approach was used rather than a Fourier technique. Pulse-echo data was digitized from a 2.4 cm long, 32 element, 3 MHz linear array. Water bath tests have demonstrated azimuthal resolution close to beig diffraction limited throughout the field of view. Good images of tissue samples in-vitro have been obtained. Consideration of image sampling requirements and symmetry properties have led to the development of an efficient processing algorithm.


Direct conversion of real-time two-dimensional echocardiographic images. This paper describes an instrument which performs a direct conversion of real-time, two-dimensional echocardiographic images into standard television format. The convertor has been designed to display images on a television monitor and to store images on a videorecorder in standard video format. Design considerations and a block diagram are discussed as well as a method for real-time processing of images by means of such a convertor.


[Transfemoral cannulation of the renal vessels. Diagnostic and therapeutic use in urology  (author's transl)]. Transfemoral cannulation of renal vessels with the Seldinger technique has been used as well as routine angiography in the following urologic indications. 1. Hypothermic in situ perfusion of the kidney in difficult surgical procedures on the renal parenchyma, e.g., multiple stones, stag-horn calculi, benign and malignant tumors in solitary, residual or functionally residual kidneys. The advantages of this method are sufficient time for surgery, no contamination of blood and therefore excellent view by means of complete ischemia and good long-term results of the renal function. 2. Embolization of inoperable renal tumors to reduce tumor growth and control bleeding. The material used for embolization was a modified preparation of homogenized autologous muscle tissue. 3.  Occlusion of the renal artery prior to tumor nephrectomy by a flow-guided balloon catheter in order to reduce the difficulty of the surgical produce, e.g., in massive carcinomatous infiltration of the hilus vessels. 4. Retrograde phlebography of the left internal spermatic vein in recurrent or persistent varicocele and in infertility with only insignificant or doubtful varicocele. The advantage compared with orthograde phlebography via plexus pampiniformis is the direct evidence that the venous reflux causes the varicocele. When the technique has been mastered transfemoral cannulation of the renal vessels can be used in routinely in the clinic Critical consideration of the indications, however, is necessary.


[Mobile kidney diagnosis by renography with a gamma camera (author's transl)]. There were 15 nephroptosis patients examined by renography with a gamma camera, which appears to be of value in demonstrating if the mobility of the kidney causes changes in urinary flow or in renal blood flow. By means of gamma camera renography, it seems possible to distinguish between cases where the nephroptosis is a casual finding and cases where it has pathogenic significance.


[On a modification of the otis urethrotome (author's transl)]. A modification of the Otis urethrotome is presented and the technique of internal urethrotomy with this instrument is described. The instrument opens parallel, and the incision blade makes a cut in two directions possible. Special additional parts at the top of the instrument make the introduction easier. The unintentional stretching of the urethra by the extraction of a conical instrument is therefore avoided.


[Capacitive effects during transurethral resections with high-frequency currents (author's transl)]. The cutting probe of transurethral resection devices has to be fed through a line inside of the shaft. The capacitive high-frequency currents between this feeder and the shaft flow through the urethra and may cause destructive heat within the urethra if a metallic shaft is used. This paper shows that no danger is caused from these capacitive currents as long as the capacity between feeder and shaft is less than 120 pF.


[Renal arterial aneurysms--diffuse renal arterial ectasia. (Review and case histories) (author's transl)]. Two cases of renal arterial aneurysm or diffuse renal arterial dilatation are presented. Frequency, pathogenesis, clinical appearance, and prognosis of this disorder are discussed. Major complications include rupture or thrombosis of the renal artery, and hypertension due to renal ischemia; the latter is best diagnosed by renin determination in renal venous blood collected by selective catheterization.


[The implantation of human kidney stones--a simple experimental model (author's transl)]. Human kidney stones of different chemical components were implanted into the renal pelvis of 15 mongrel dogs. In the first surgical intervention the ureter was ligated near the bladder. Eight days later a second laparotomy was performed. It was possible to implant concrements with a diameter of about 1 - 1.5 cm into the dilated pelvis. At the same time urinary stasis was removed by a neoureterostomy. This method offers a unique experimental model for the evaluation of problems involved in litholysis of human kidney stones by chemical and physical methods.


[The distribution of antibiotics in extravascular renal tissue during experimental pyelonephritis of dogs (author's transl)]. For the success of an antibiotic therapy in pyelonephritis the concentration of antibiotics attainable in the kidney tissue is of extreme importance. Therefore in dogs, besides serum level and urin level a tissue level was defined after a single dose of gentamycin and cefazolin. While gentamycin is highly concentrated in the kidney, which is indeed more in a state of shock than health, Cefalozin is being excreted, after initially high values, excreted in a course approximately parallel to the blood level curve, within 5 h down to concentrations between 1 mcg/ml and 4 mcg/ml. The level of the tissue in the cortex of healthy kidneys and infected kidneys without additional damage by a ureter ligature averaged about 40% less than the serum level. The tissue level of kidneys infected by the additional damage of a ureter ligature and with signs of a pyelonephritis was extremely lower and reached occasionally hardly 20% of the serum level. Attention is also called  to the consequence of these results for the therapy of the pyelonephritis.


[Bilateral complete renal vein thrombosis (author's transl)]. A short review of the causes, the course, symptomatology, diagnostics, and therapy of thrombosis of the renal vein is presented. The author's own observation of a bilateral complete thrombosis of the renal vein as the consequence of an ascending phlebothrombosis of the lower leg and pelvic veins with occlusion of the inferior vena cava is described.


[Urologic aspects of retroperitoneal hematoma (author's transl)]. Traumatic kidney injuries are the most frequent causes of retroperitoneal hematoma. The intensity of hematuria among other symptoms does not always correspond to the severity of the lesion. Apart from the i.v. urogram as the first screening test, angiography is the most important diagnostic criterion for the estimation of the degree of severity of the injury and in deciding whether or not surgery is necessary. Hemorrhage makes immediate surgery necessary in 10 - 20% of kidney ruptures. In contrast to the combined urohematoma, the simple hematoma is usually absorbed. Secondary complications make drainage or nephrectomy essential. The rupture of the venal vascular peduncle and ruptures of renal arterial aneurysms are seen seldom and are usually fatal. The mortality rate for urohematomas caused by rupture of the bladder/urethra increases, the longer corrective surgery is postponed. Clinically relevant retroperitoneal hematomas after kidney biopsies, operations on the renal parenchyma, and after vascular injuries resulting from angiography are relatively infrequent and require a specific therapy, according to the individual case.


The isolation of Haemophilus somnus following sudden deaths in suckler calves in Scotland. A blood or yeast dependent pleomorphic Gram-negative bacillus was isolated from the pneumonic lung of a suckled calf which died suddenly. The organism was biochemically similar to American strains of Haemophilus somnus and was shown to be serologically similar by rapid slide agglutination, tube agglutination and micro-complement fixation tests. The possible importance of this organism in disease syndromes in cattle in the United Kingdom is discussed.


Osteochondrosis of the equine stifle.

Osteochondrosis of the equine stifle. Two cases of osteochondrosis are presented. Lesions involving the lateral trochlear ridge of the femur are demonstrated on conventional radiographs and double-contrast arthrograms. A radiographic suggestion of osteochondrosis lesions in the patella is noted. Post mortem examination of one case confirmed the presence of partially free cartilaginous flaps. Reference is made to familial tendency to osteochondrosis in man, dog, pig and horse. The significance of rapid growth rate in the pathogenesis of the condition is also discussed.


Skull malformation and cerebellar herniation in captive African lions. Thickening of the cranial vault with a resulting cerebellar herniation is described in a series of litters of lion cubs, all with the same parents, one of whom was also very mildly affected. This animal, when mated to his daughter, also produced affected cubs. The aetiology of the condition is discussed and it is considered that vitamin A deficiency may have been less important than has been suggested by other authors.


Coccidial infection in a cat colony.

Coccidial infection in a cat colony. The significance of coccidiosis in the cat is discussed and the clinical signs of infection are described. The occurrence of subclinical infection with Isospora felis in 49 of 58 cats in a colony is reported. Treatment with a 20% solution of sulphadimethoxine at a dose rate of 50 mg per kg bodyweight, administered in the food daily for 14 days, was successful in eradicating the infection. Sulphadimidine appeared to have no effect on the number of oocysts in the faeces of one cat. Ancillary hygienic measures included the use of disposable feeding and drinking utensils, frequent removal and destruction of faeces and scrubbing of sanitary trays and cages with hot 5% sodium carbonate solution.


Echocardiographic findings in Marfan's syndrome. Echocardiographic studies of 11 patients with Marfan's syndrome showed that in all adult patients aortic root diameters were larger than 35 mm (normal range 24 to 35, mean 30+/-2 mm). Prolapse of the mitral valve was present in seven of 11 patients. There was no relationship between the degree of aortic root enlargement and the presence of prolapse. However, in five of seven patients with prolapse there were premature ventricular contractions recorded during the echocardiogram or on a separate electrocardiogram. In four patients without prolapse, no premature atrial or ventricular contractions were seen.


Maintenance hemodialysis in myeloma kidney disease. Maintenance hemodialysis and chemotherapeutic agents were used in the treatment of seven patients with end-stage myeloma kidney disease. Results indicate that with the use of such therapy life can be prolonged substantially. It appears that patients with myeloma-with or without serious extrarenal complications-are suitable candidates for maintenance hemodialysis and should not be denied the treatment even in the face of systemic neoplasm.


Adjuvant treatment of colorectal cancer. Surgical operation remains the most effective method of treatment for patients with cancer of the large bowel. However, innovative surgical techniques have not improved survival rates for colorectal cancer in 25 years. Attempts at increasing survival with chemotherapy as an adjunct to surgical procedures remain inconclusive and controversial. Many adjuvant chemotherapy trials have failed to recognize those prognostic factors-such as nodal involvement, serosal penetration, vascular or perineural invasion, and microscopic invasion at margins of resection-that characterize certain patients at high risk for recurrent cancer. Failure to include only high risk patients in adjuvant chemotherapy is, in part, responsible for the lackluster performance to date. For rectal cancer, preoperative irradiation increases the chances of cure with surgical operation by reduction of pathologic staging, but it has not increased survival in patients with persistent nodal involvement. Immunotherapy is a possibly valuable method of treatment; however, it is clinically untested. An adjuvant immunotherapy protocol for high risk patients is described.


[Leg ulcer and allergic eczematous contact dermatitis incidence of contact allergies induced by topical therapy (author's transl)]. In the IInd Department of Dermatology, Vienna University, 200 patients (143 female, 57 male) suffering from leg ulcers due to chronic venous insufficiency underwent patch testing with routine allergens, vehicles and their ingredients, as well as topical antibiotics. 114 patients (57%) had contact allergy. Balsam of Peru heads the list of allergens with postive reactions in 22%, closely followed by oil/water emulsions such as Drointin (21%), Ultrasicc (20%) and Ung. emulsificans aqu. (15,5%). The causative agents in these preparations were emulsifiers on the one hand (Lanette O, E, N) and preservatives (parabens) on the other hand. In comparison, allergic reactions to water/oil emulsions were less common. The low index of sensitivity to local antibiotics was also surprising. The results of the present study, in accordance with other reports in the literature, underline the need (1) for full label diclosure of cosmetics and topically-applied drugs and (2) for patch-testing every patient suffering from leg ulcers of long duration.


[Photoallergy: results of photo patch testing in dermatological patients (author's transl)]. 150 patients with light sensitivity of unknown aetiology were photo patch tested at the 2nd Department of Dermatology University of Vienna. 22 patients showed photoallergy. The identified photoallergens were mostly halogenated salicylanilides and other phenolic compounds. These substances are used as antimicrobials in soaps and cosmetics and as antimycotics in dermatological preparations. Four of the patients showed allergic contact photosensitivity to chlorpromazine. In two patients a new photoallergen has, perhaps, been discovered, namely a derivative of phthalic acid which is employed as fungicidal pesticide. The problems and consequences of photoallergy are discussed.


Epoxidation of the stilbene double bond, a major pathway in aminostilbene metabolism. 1. The vicinal diol 1-(4-acetylamino)-phenyl-2-phenyl-1,2-ethanediol is shown to be a major metabolite of cis- and trans-4-dimethylaminostilbene in the rat. 2. The threo-diastereomeric diols were identified in urine with both the cis- and trans-aminostilbene. This is consistent with enzymic trans-opening of an epoxide intermediate only for the cis-stilbene. For the hydrolysis of the trans-stilbene epoxide alternative mechanisms are discussed. 3. A mercapturic acid isolated from urine is identical with the reaction product of 4-acetylaminostilbene epoxide and N-acetylcysteine. This provides additional evidence for an epoxide intermediate. 4. Oxidation of the intercyclic linkage occurs also in 4-dimethylaminobibenzyl, leading to 1-phenyl-2-(4-acetylamino)-phenyl-1-ethanol as a major urinary metabolite. 5. The syntheses of several reference compounds, including the epoxides and dihydrodiols of cis- and trans-4-acetylaminostilbene are described.


Microbial models of mammalian metabolism O-demethylations of papaverine. 1. Papaverine is converted to its 4'-, 6- and 7-desmethyl metabolites when incubated with hepatic microsomal preparations from phenobarbital-induced rats. The 7-desmethyl compound was predominantly formed in these studes. When incubated with guinea-pig microsomal preparations, papaverine was converted to its 6- and 4'-desmethyl metabolites in approximately equal amounts. 2. The O-demethylation of papaverine was studied with sixty micro-organisms. Ten organisms (including Aspergillus Cunninghamella and Streptomyces species) were found to actively metabolize this drug in a manner similar to that of mammals. 3. A strain of Aspergillus alliaceus was used to produce gram quantitites of the mammalian metabolite, 6-desmethylpapaverine. Preparative amounts of 4'-desmethylpapaverine, a major mammalian metabolite of papaverine in vivo, was produced with a strain of Cunninghamella echinulata.


The absorption, excretion and plasma protein binding of lofepramine in the rat, dog and man. 1. Lofepramine labelled with 3H in the dihydrodibenzazepine moiety and 14C in the chlorobenzene moiety was given orally to rats (20 mg/kg), dogs (3 mg/kg) and man (2 mg/kg).2. In dogs and man blood isotope levels were determined by combustion. In both species the 14C-levels were higher than the 3H-levels during the first 6 h after dosing. Later more 3H was found. 3. In all three species most of the 14C activity was rapidly excreted in the urine as the glycine conjugate of p-chlorobenzoic acid. 4. No significant species difference in the urinary excretion of 3H-labelled metabolites was found and the major metabolites were 2-hydroxydesmethylimi pramine, 2-hydroxyiminodibenzyl and desmethylimipramine. 5. Considerable amounts of desmethylimipramine were found in faeces of dog and man but not rat. This differnece is discussed. 6. By the ultrafiltration technique, lofepramine was found to be bound to plasma proteins of the rat, dog and man to an extent of 99%.


Inhibition of 1,2-dimethylhydrazine metabolism by disulfiram. 1. The effects of disulfiram on the metabolism of 1,2-dimethylhydrazine were studied in CDF rats. 2. Treatment with disulfiram causes enhanced elimination of azomethane in the expired air, inhibition of CO2 production, and decreased levels of 1,2-dimethylhydrazine metabolites in the urine. 3. These results suggest that disulfiram inhibits the N-oxidation of azomethane to azoxymethane, thus preventing further metabolism to the ultimate carcinogenic species, and provide an explanation for the observations that disulfiram inhibits 1,2-dimethylhydrazine-induced neoplasia of the large intestine.